Mexico City, Mexico, 9-10 April 2019

Remarks Inaugural Session

Dr. Carissa F. Etienne, Director PAHO 

His excellency Andres Lopez Obrador, President of the United Mexican States;

Lic. Marcelo Ebrard Casaubón, Secretary of External Relations;

Dr. Jorge Alcocer Varela, Secretary of Health;

Dr. Michelle Bachelet, United Nations High-level Commissioner for Human Rights;

Ambassador Nestor Mendez, Assistant Secretary General of the OAS and Chair of the High-level Commission;

Other members of the head table,

Dear commissioners,



Ladies and gentlemen let me begin by thanking President Lopez Obrador for accepting to host this meeting and for his commitment to lead this Region’s efforts toward UNGA 2019. We are at a historical junction, and it is only with strong leadership and commitment that we will drive the necessary changes to ensure that all, everyone, everywhere have access to health.

Ladies and gentlemen, today, we are here to reaffirm, once again, that health is not a privilege, nor a commodity, it is a fundamental human right. We are here to reaffirm our commitment to the values and principles of Primary Health Care.

In the 21st Century, with all the advances in technology, knowledge and wealth, it is unacceptable that millions lack access to comprehensive health services. It is for this reason that I wish to congratulate and applaud his Excellency Lopez Obrador for his bold decision to bring about deep transformations of the health system and other social sector institutions in Mexico with a view to ensure that health for all, universal health will be a reality in this country. Your Excellency, pleased be assured of PAHO’s commitment and support in this endeavor. It is not an easy road, there will be many ups and downs, but I want to assure you that there is light at the end of the tunnel, Universal Health is not an impossible dream, universal health is achievable, is necessary, and is the right thing to do.

Ladies and gentlemen, today we are here in Mexico to observe World Health Day 2019.  As you may know, World Health Day was established more than 70 years ago to commemorate the foundation of the World Health Organization, and to urge governments, organizations and companies to invest in health to forge a safer future. 

The Region of the Americas has joined the global campaign for World Health Day this year under the theme “Universal Health”: everyone, everywhere”.

We have chosen the launch of the report “Universal Health in the 21st Century: 40 years of Alma-Ata” to be the central regional activity for World Health 2019, because the recommendations of the High-level Commission are about the changes required to make universal health a reality in this Region, and perhaps the World.  

In December 2017, I convened a Regional Forum in Quito, Ecuador, hosted by the Government of Ecuador en “la mitad del mundo”. The Regional Forum was a call to action, a call for a regional movement that will bring together governments, academia, civil society, and representatives of various social movements, to take stock after 40 years of the emblematic Alma-Ata Declaration, and to define the path for the health of generations to come.

That is where the idea of a High-level Commission was born and in February 2018, I established the High-level Commission “Universal Health in the 21st Century, under the able leadership of Her Excellency, Dr. Michelle Bachelet and Ambassador Nestor Mendez and with the commitment of 20 individuals from different backgrounds, expertise and collectively a wealth of knowledge. I want to express my deepest appreciation to the Commission for working tirelessly for a year to complete this report and I affirm my commitment to use the report and its recommendations to exercise leadership at the regional and global levels, to bring about the changes required to attain health for all, and by all.

Ladies and gentlemen, Primary Health Care (PHC) has a long history in the Region of the Americas, many of us, including myself, have been believers, implementers and activists for 40 years, since the Alma-Ata Declaration. In this Region, the Alma Ata Declaration of 1978, its core values of the right to health, equity, solidarity and social justice, and its principles, inspired many regional and country initiatives, and have guided many health system’s transformations. The Region of the Americas has built a clear concept and vision for PHC. In this Region, “Primary Health Care is a strategy for health and well-being, and also for human and social development, which focuses on people, their families and communities. It is not only the first level of care, nor a limited set of services for the poor.

Countries begun the implementation of the PHC approach in the 1980 but several factors, including the economic crisis, and the structural adjustment program imposed on countries led to the diminishing of the Alma-Ata vision and greatly affected the implementation of the PHC strategy. Some countries began to focus only on selective and minimum packages of services while others returned to hospital centric model of care, however, other countries persisted with the implementation of the vision of health for all. These countries achieved holistic national health development, with better health and empowerment of their people.

In 2005 there was a national and regional movement launched by PAHO for the renewal of PHC. Reiterating the same principles and values of the Alma Ata declaration.

In 2014, after one year of consultation and discussions, the Member States adopted the Strategy for Universal Health. Universal Health (UH) for the countries of this region goes beyond Universal Health Coverage (UHC), it means universal access to comprehensive quality health services and access to interventions to address the social determinants of health. It reiterates the right to health, solidarity and equity as fundamental values of the strategy. The strategy clearly defined that the achievement of UH was only possible through the strengthening of the health systems based on a PHC approach.

In 2018, Member States approved the Sustainable Health Agenda 2030, crafting the regional path towards the Sustainable Development Goals and fully engaged in the development of the new PHC Declaration (the Astana Declaration) to preserve the values, principles and the spirit of Alma-Ata, today more relevant than ever.  

Ladies and gentlemen, we have learnt many lessons during these 40 years. We have learnt that “access barriers have to be systematically identified and demolished, and that the fragmentation and segmentation of health systems and services is a recipe for failure”.

Ladies and gentlemen, unfortunately, one-third of the population of the Americas still faces barriers in accessing the health services they need. These barriers are varied in nature, and removing these barriers requires a whole-of-society movement, it requires peoples’ participation, it requires the voices of all, and it requires that those voices are heard, particularly the voices of those living in extremely difficult circumstances due to social inequalities: the indigenous, afro descendants and other ethnic groups; women, LGBT populations, migrants, just to mention a few.

Today, I am thinking of the many women who have died prematurely while giving birth, the many adolescent girls that have forgone an education due to teenage pregnancy, the many men and women that have died prematurely due to Noncommunicable Diseases, the many boys and men that have died prematurely due to violence, suicide or homicide. The many men, women and children that have been forced to leave their countries in the quest for a better future. Let us also remember those lost due to mass shooting and terrorist attacks.

Ladies and gentlemen, the biggest challenge in health and for the health systems in this Region is the unacceptable levels of inequities in health, with many being left behind.  Universal Health is simply not possible if we cannot tackle social inequalities and societal challenges. Gender, ethnic and other social inequalities, and the widespread violence in our societies, are persistent barriers that we need to overcome.

In closing, I would like to recognize again the hard and excellent work carried out by the Commission in just one year and for delivering this report on time to influence important upcoming events such as the World Health Assembly and the UNGA 2019. I would like to encourage all participants, in particular Heads of States, Ministers of Health and civil society, to use the report as a tool for national, regional and global activities in preparation for UNGA 2019 and beyond. I reassure you that I will continue to work tirelessly to make health for all and by all a reality for the Region of the Americas in the 21st Century.

The time is now!