A global overview of changes in the world health situation as determined through an analysis of data submitted by 151 countries for 1985-1990 is provided in this second evaluation. Focused on a number of well defined indicators of health status and socioeconomic and environmental determinants, the report looks for trends, measures progress, defines problems and suggests programmes for continuing to strengthen health systems and improve the accessibility and quality of care. Emphasis is placed on factors linked to the increased coverage of primary health care, equity in health and sustainability in the national approaches employed.