30 years ago, 134 WHO member states gathered as a conference on international primary health care. On Sept 12, 1978, the Alma-Ata Declaration was signed, with the ambitious target of achieving “Health for All by 2000”.
In 1978, 2000 million people were estimated to have no access to adequate health care. There were large inequalities between rich and poor countries, and between rich and poor populations within countries. The Alma-Ata Declaration revolutionised the world’s interpretation of health. Its message was that inadequate and unequal health care was unacceptable: economically, socially, : and politically. Unfortunately, the goal of “health for all”, while a rallying call to action, was not met.
30 years on, primary health care is still offering global health a lifeline. Weak health systems have restricted the success of efforts to improve maternal, newborn, and child health, and to reduce the disease burden from malaria and tuberculosis. New epidemics of chronic disease threaten to reverse what small gains have been achieved. Countries need to strengthen their health systems through the implementation of effective primary health care.
Many of the challenges faced in 1978 remain, such as infectious diseases (eg, the ongoing threat of H5N1 avian influenza and HIV/AIDS), political instability and conflict (most recently seen in Iraq and Zimbabwe), and worsening poverty (the World Bank last month estimated that 1-4 billion people now live in poverty).
The Lancet of September 13th 2008 page 863 revisits, updates, and relaunches the key messages from Alma-Ata. A series of eight papers outlines the picture. A magnificent overview of a vital subject and one which is central to Nutrition.
- Martin Eastwood