Alma-Ata: 25 years later. What happened to the goal of "Health for All"?
Washington, DC, August 28, 2003 (PAHO)—Twenty five years ago the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) convened in Alma-Ata, Kazakhstan, the world's first International Conference on Primary Health Care. It was driven by the dream that there should be "Health for All by the Year 2000." This worthy and ambitious goal is yet to be reached.
 Former Peruvian Health Minister David A. Tejada de Rivero, WHO's deputy director-general between 1974 and 1985, and the key organizer of the Alma-Ata conference, writes in the latest edition of Perspectives in Health why the goals of the Alma-Ata meeting were not only misunderstood, but also misinterpreted. And he explains why health and its integral care have been confused with curative medical treatment focused almost entirely on disease. Perspectives in Health is published by the Pan American Health Organization (PAHO).
The final Declaration of Alma-Ata was reached by consensus. The three-day event was attended by representatives from 134 countries, 67 international organizations and many non-governmental organizations. Halfdan Mahler, who was WHO's director-general at the time, proposed the slogan "Health for All."
"He made it clear he was referring to the need to provide a level of health that would enable all people without exception to live socially and economically productive lives," Tejada writes. "The reference to the year 2000 meant that, as of that date, all the world's countries would have developed the appropriate political strategies and be carrying out concrete measures toward achieving this social goal, albeit within different time frames."
However, Dr. Tejada argues that the three key words meant to summarize this goal - "primary health care"-have been misinterpreted. First, it was not understood that health care is a fundamental human right and a social reality whose reach cannot be easily and clearly separated from other social and economic issues. As for the word "care," the original English word was translated into Spanish as "atención" rather than ""cuidado." The latter has a much broader connotation and meaning than the former. As for the word "primary," it was translated, in Spanish texts, as "primario," which can also mean "primitive" and "uncivilized." That's why "primary health care" was taken to mean basic care in rural areas rather than the more complete care given at urban hospitals.
For these reasons, Dr. Tejada proposes the continued use of the slogan and goal of "Health for All." He writes that "integral health care for all and by all - perhaps the best way to phrase Alma-Ata's call for genuine primary health care - is a necessity not only for health but for the future of countries that aspire to remain sovereign nation states in an increasingly unjust world.
Dr. Tejada believes the time may be ripe for a follow-up Alma-Ata II conference to set forth again, and without distortions, the original concepts that led to that conference in 1978.
The full story can be read in the online edition of "Perspectives in Health".
PAHO was established in 1902 and is the world's oldest public health organization. PAHO works with all the countries of the Americas to improve the health and the quality of life of its people. It serves as the Regional Office for the Americas of the World Health Organization (WHO).
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