although public health care in principle offers free basic health care services to all most states health systems suffer from insufficient spending and shortfalls in management leaving many with insufficient care as a result most people turn to private health care providers which range dramatically in quality and of course charge for their services public health efforts over past decades have contributed to these improvements as most recently demonstrated through the recent eradication of polio after an ambitious immunisation campaign nevertheless life expectancy remains behind most large middle income countries and health outcomes are strongly influenced by socioeconomic factors gender education and geography balarajan et al