front |1 |2 |3 |4 |5 |6 |7 |8 |9 |10 |11 |12 |13 |14 |15 |16 |review

Much has changed since Last wrote his provocative letter. Health and health services have come to be seen in a much broader social, cultural and economic context, the interrelated parts of which are today considered as constituting the health system. It comprises three important elements: the community the health service delivery system and the environment in which both of them are located.

These three are highly interdependent. Health needs - objective and subjective - of the community are mostly determined by environmental ecology, i.e. its socio-cultural, demographic, economical and political surroundings. Health problems and health needs, in turn, should determine the orientation of the health care system. If the health care system is to serve the community within a given environment, there must be a close 'fit' between these three elements.

front |1 |2 |3 |4 |5 |6 |7 |8 |9 |10 |11 |12 |13 |14 |15 |16 |review