When there are more primary turns than secondary, the voltage will be stepped down. If there are more secondary turns than primary, then the voltage will be stepped up.
Transformers are used to reduce the power lost over transmission lines, eg between a generator and a city. Once the electricity is generated, it will travel through a step up transformer, which will increase its voltage to a much larger voltage. This massive increase in voltage will reduce the current in the wire. As the current is lowered, the power loss is minimised, as Ploss=I^2R. This voltage can then be stepped down to 240 volts, so it can be used in homes (lighting etc). Basically, transformers are used, as they are cost efficient. The only other ways to reduce power loss, would be to increase the resistance of the cables, but this would be nearly impossible, as it would cost ZILLIONS of dollars. Or the length of the transmission lines could be decreased but then again, this is not practical. Thats why transformers are efficient, they do not cost as much, and effectively reduce power loss.