Primary health care can cover the majority of a person’s health needs throughout their life including prevention, treatment, rehabilitation and palliative care. At least half of the world’s people still lack full coverage of essential health services. A fit-for-purpose workforce is essential to deliver primary health care, yet the world has an estimated shortfall of 18 million health workers.Most health systems around the world remain heavily focused on illness and do relatively little to optimize health and thereby minimize the burden of illness, especially for vulnerable groups . Failure to improve the underlying conditions for health is compounded by insufficient allocation of resources to address priority needs with equity (universality, accessibility and affordability). Instead, when engaged in public debate on health care, jurisdictions tend to focus on high-cost items that preoccupy administrators. This short-sighted focus overlooks ‘upstream factors’: health-promoting environments and workplaces, primary prevention, e.g., nutrition education, immunization, antenatal care, physical activity, smoking prevention, and social policies that influence literacy, employment, crime, housing quality, and community well-being. In particular, there is a global need to improve the response to the surging chronic disease burden. Research indicates that much of this burden is preventable by acting on modifiable behaviors, e.g., smoking, fitness, weight control; and about half of those who do develop these conditions can be prevented from progressing to complicated forms through attention to secondary prevention by identifying and engaging in early intervention for persons at risk, e.g., blood pressure screening and glucose monitoring. However, many decision makers remain preoccupied with acute-care issues, crisis-prone yet glamorized, even overlooking important ‘downstream considerations’, e.g., long-term care, home care, whose availability determines the speed with which acute-care patients may move to more appropriate levels of care.