The World Health Organisation has strongly backed publicly funded healthcare systems, while arguing that rationing must be a feature of them.

In The World Health Report 1999, WHO says: 'The least organised and most inequitable way of paying for healthcare is on an out-of-pocket basis.'

In a message issued with the report, WHO director general Dr Gro Harlem Brundtland says: 'Our values cannot support market-oriented approaches that ration health services to those with the ability to pay.'

But she also argues that 'many governments have over-extended themselves' by trying to provide 'all services to all people'.

The report backs a 'new universalism' - with governments leading, regulating and financing healthcare, but recognising 'that if services are to be provided for all, then not all services can be provided'. It calls for health systems to be focused on interventions that have 'the greatest impact on reducing the excessive disease burden suffered by the poor' and 'counter the threats to health resulting from risky behaviour'.

WHO is 'rapidly building internal capacity to learn about health finance' so it can play a more prominent role in the debate about the development of healthcare services.

The World Health Report 1999 says policy makers will face 'a double burden of disease' over the next 20 years, with 'emerging epidemics' of non-communicable disease accompanying the 'unfinished agenda' of controlling infectious diseases and malnutrition.

It says depression will become a major problem, and also highlights tobacco control as a key issue 'to avert scores of millions of premature deaths'.

WHO has called for a worldwide ban on tobacco advertising, sustained increases in tax on tobacco and wider availability of nicotine replacement therapies.

The World Health Report 1999: making a difference.

Stationery Office.£9.50.