medicines and vaccines for all by 2030. They also agreed to support research and development of vaccines and medicines for the communicable diseases and NCDs that primarily affect low- and middle-income countries and provide access to medicines for all. Furthermore, they agreed to increase substantially health financing and the recruitment, development, training and retention of the health workforce in low-resource settings, especially in least developed countries and small island developing states. Meeting the global commitments to provide universal health coverage would have a significant impact on improving the lives of people, especially those with chronic conditions such as psoriasis. Having access to affordable basic health care, having their psoriasis diagnosed and receiving early and appropriate treatment as well as affordable long-term supply of medicines and treatments would significantly reduce the unnecessary burden of psoriasis. Strengthening the health workforce means more general practitioners who have appropriate training in the management of skin diseases. Patient needs and goals related to treatment Globally, there is a high need of psoriasis patients for remission of skin lesions and for relief from the psychosocial burden of disease (139). However, besides the disappearance of visible disease, a variety of other needs were observed, including healing of nonvisible lesions such as in the genital area, relief from itch and pain, more participation in social activities and improvement of functioning in professional and private life (Figure 8). Treatments also should be evaluated for their potential to improve associated conditions. These needs provide hints of the benefits that could be gained from treatment and could thus be used as evaluation criteria for optimizing therapy (173). It is evident that the results of clinical studies Global report on psoriasis 27 do not sufficiently reflect the therapeutic benefits from psoriasis treatment since they mostly focus on a few primary and secondary endpoints. Instead, extended outcomes research based on patient-relevant benefit endpoints of psoriasis would better reflect the patients’ perspective – that is, patient reported outcomes. Figure 8. Importance of patient needs related to treatment of psoriasis Patient needs in psoriasis treatment (% responses) ... GET BETTER SKIN QUICKLY ...RECOVER FROM ALL SKIN LESIONS ...HAVE CONFIDENCE IN THE THERAPY ...REGAIN CONTROL OF THE DISEASE ...FIND A CLEAR DIAGNOSIS AND THERAPY ...HAVE NO FEAR THAT THE DISEASE WILL BECOME WORSE ...BE LESS DEPENDENT ON DOCTOR AND CLINIC VISITS ...BE FREE OF ITCHING ...NEED LESS TIME FOR DAILY TREATMENT ...BE ABLE TO LEAD A NORMAL EVERYDAY LIFE ...BE COMFORTABLE SHOWING MORE IN PUBLIC ...EXPERIENCE A GREATER ENJOYMENT OF LIFE ...HAVE FEWER OUT-OF-POCKET TREATMENT EXPENSES ...BE ABLE TO ENGAGE IN NORMAL LEISURE ACTIVITIES ...HAVE FEWER SIDE EFFECTS FROM TREATMENT ...NO LONGER HAVE A BURNING SENSATION ON THE SKIN ...FEEL LESS DEPRESSED ...BE MORE PRODUCTIVE IN EVERYDAY LIFE ...BE LESS BURDENED IN YOUR PARTNERSHIP ...BE FREE OF PAIN ...BE LESS OF A BURDEN TO RELATIVES AND FRIENDS ...BE ABLE TO HAVE A NORMAL SEX LIFE ... BE ABLE TO HAVE MORE CONTACT WITH OTHER PEOPLE ...BE ABLE TO SLEEP BETTER ...BE ABLE TO LEAD A NORMAL WORKING LIFE Source: Blome et al. 2011 (139). From German national health-care studies 2007 and 2008 (n = 4458). A people-centred model of care People with chronic and complex conditions, including psoriasis, require a health-care system that responds to their needs as a complete person. This is more difficult to achieve in health systems that are designed for acute episodic care, often for very specific conditions such as maternal and child health, or acute infectious diseases. Health systems in all countries must undergo a fundamental paradigm shift in the model of health-care delivery to respond to the rising burden of chronic complex conditions, and multiple comorbidities, such as psoriasis and other major NCDs. The WHO global strategy on people-centred and integrated health services is a call for precisely