Health for all by the year 2000BMJ 1996; 313 doi: https://doi.org/10.1136/bmj.313.7068.1331 (Published 23 November 1996) Cite this as: BMJ 1996;313:1331
WHO is spearheading global consultation to update policy on health for all
EDITOR,—Staffan Bergstrom and Pascoal Mocumbi highlight several impediments to the attainment of health for all.1 In so doing they provide a too pessimistic view of past successes and future opportunities.
At the World Health Organisation/Unicef conference in Alma-Ata in 1978 the concept of health for all was accepted as a motivational vision for the world.2 The “revolutionary” ideas of the primary health care strategy included an emphasis on intersectoral action for health, reallocation of health resources from tertiary care to community based health promotion and disease control, participation by the community, and scientifically validated interventions. These are now mainstream concepts and are being increasingly applied in developed and developing countries.
In terms of increases in life expectancy, decreases in infant mortality and in the prevalence of many infectious diseases, and improved access to environmental health and basic maternal and childhood preventive and promotional services, there have been substantial global health gains since the conference in Alma-Ata.3 Nevertheless, along with these gains the WHO has documented numerous obstacles, such as increased inequality in health and wealth in many countries.
As the global health community prepares for the 21 st century the WHO is spearheading a global consultation aimed at renewing the concept of health for all. This broad based process aims to update the old policy and add components that address the present and future context of health development. The WHO believes that health for all remains a powerful vision for the 21st century. Yet we are not naive; we realise that certain serious challenges threaten future progress, and in this respect we welcome the authors' identification of macroeconomic factors that influence health. These same factors have been repeatedly emphasised by the WHO's task force on health and development,4 of which Mocumbi is a member.
The WHO is realistic, however, about its direct role in alleviating poverty. We will continue to document the root causes of ill health and poverty. We will continue to advocate development policies that reduce inequalities in wealth, build long term human and institutional capacity, use intersectoral approaches, and encourage sustainable development. Beyond advocacy, the WHO supports actions within the health sector that directly reduce the burden of disease and thereby help to improve the scholastic performance of children, increase the productivity of workers, and alleviate human suffering. These direct inputs, when combined with basic education, can accelerate populations' escape from poverty.