Perspectives in health - Volume 8, Number 2, 2003

Perspectives in Health Magazine
The Magazine of the Pan American Health Organization
Volume 8, Number 2, 2003

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Alma-Ata Revisited
by David A. Tejada de Rivero
 
"Health for All by the Year 2000" was an ambitious and worthy goal. But even those who formulated it back in 1978 did not fully grasp its meaning. No wonder that 25 years later we have yet to realize all the dreams of the first International Conference on Primary Health Care.

 Glicério Shantytown
PAHO/WHO photo
This year marks the 25th anniversary of the first International Conference on Primary Health Care in Alma-Ata, Kazakhstan, an event of major historical significance. Convened by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF), Alma-Ata drew representatives from 134 countries, 67 international organizations and many nongovernmental organizations. China, unfortunately, was notably absent.

By the end of the three-day event, nearly all of the world's countries had signed on to an ambitious commitment. The meeting itself, the final Declaration of Alma-Ata and its Recommendations mobilized countries worldwide to embark on a process of slow but steady progress toward the social and political goal of "Health for All." Since then, Alma-Ata and primary health care have become inseparable terms.

A quarter century later, it is useful to look back on the event and its historical context -particularly on the theme of "Health for All" in its original sense. For one who was a direct witness to these events, it is clear that the concept has been repeatedly misinterpreted and distorted. It has fallen victim to oversimplification and voguishly facile interpretations, as well as to our mental and behavioral conditioning to an obsolete world model that continues to confuse the concepts of health and integral care with curative medical treatment focused almost entirely on disease.

Looking back
 
The 1970s saw the cresting of the scientific and technological revolution that began with the end of World War II, a revolution that produced, among other major changes, what is today known as globalization. But there was also a recognition of growing inequality among vast sectors of the world's population. This recognition provided the impetus during the 28th and 29th World Health Assemblies in 1975-76 for the commitment to "Health for All in the Year 2000."

Politically, the world was in a state of ideological and economic polarization, as well as a historically new form of confrontation. The Cold War was based on extraordinary technological development on the part of the competing parties, as part of an implacable economic war whose goal was the elimination of one of the two superpowers (this would eventually happen with the fall of the Berlin Wall). But within the socialist bloc, there was also a major rivalry between the Soviet Union and China. This competition would prove decisive for the conference at Alma-Ata.

At the same time, a number of developing countries had been trying, for a number of years and in various ways, to tackle health problems with limited financial, technological and human resources. Their experiences became the subject of scholarly studies in the 1960s and 1970s, with China, India and some countries of Africa and Latin America emerging as the most often cited examples. Following the publication of some of these studies, WHO- under the leadership of Director-General Halfdan Mahler (1973-88)-responded enthusiastically. Mahler saw clearly the worth of these experiences and began to promote them around the world as the responsibility of all countries, rich and poor.

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