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This Article Extract Full Text (PDF) All Versions of this Article: AJPH.2006.102533v1 96/12/2089    most recent Submit a response View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Bassett, M. T. Search for Related Content PubMed Articles by Bassett, M. T.

Mary T. Bassett, MD, MPH, Deputy Commissioner

New York City, Department of Health and Mental Hygiene

In 1978, the Declaration of Alma-Ata, signed by nearly all member states of the World Health Organization and UNICEF, issued a bold call for "Health for All" (available at: http://www.who.int/hpr/NPH/docs/declaration_almaata.pdf). Its core strategy was primary health care, comprising essential elements ranging from safe water to basic health care services. "Health for All" was to occur by the year 2000. Its words signaled a transformative step for the World Health Organization. No longer would the premier international health agency treat health as a technical project, reliant mainly on experts. Instead, it linked health to community action, intersectoral cooperation, and the broader goal of social justice.

In the mid-1980s, I was a newly trained public health physician, beginning what would be a long stint in the small southern African country of Zimbabwe. Although well trained in epidemiology and health services research, I had never heard of the Declaration of Alma-Alta. I did not even know Alma-Ata was a place. It was obvious my knowledge was deficient. I sat in the library stacks and read the simple, eloquent language of the declaration. It is worth recalling some of its words:

The existing gross inequality in the health status of the people particularly between developed and developing countries as well as within countries is politically, socially and economically unacceptable and is, therefore, of common concern to all countries. . . . The promotion and protection of the health of the people is essential to sustained economic and social development and contributes to a better quality of life and to world peace.

Although the declaration would not achieve its ambitious target, this visionary document changed both the nature of public health services and the broad political context for health. For example, during its first decade of independence, Zimbabwe increased the budget share for health, despite a faltering economy. Mobilized communities, together with a new network of primary care services, achieved stunning public health results. Infant mortality was halved, childhood immunization rates tripled, and childhood diarrhea as a cause of death declined (Stone-man C, ed. Zimbabwe’s Prospects. London, England: Macmillan; 1989).

Today the gaps between rich and poor nations remain and, particularly in Africa, have greatly widened. Within wealthy nations, income inequality also has increased. The statistics on extreme poverty are grim. Worldwide, approximately 1 billion people live on less than $1 a day. In Africa, this level of poverty engulfs nearly half of the population. New York City is one of the world’s wealthiest cities, but its South Bronx neighborhood is one of the nation’s poorest communities.

Too often public health workers incorrectly use disparity as a synonym for poverty. But disparities link the poor to the rich, non-Whites to Whites, the native to the foreign born, and so on. Disparities occur because we all live in one world, together. Data abound to document the impact of disparities measured in excess mortality and lost years of healthy life. A key role of public health practitioners is to document this cost, set goals, and track progress. But progress comes from more than setting targets and aspiring to managerial efficiency. "Health for All" is not just about numbers. More crucially, now as in 1978, "Health for All" requires political will to reallocate resources to human development, not war and armaments, and to give priority to those most in need.

This Article Extract Full Text (PDF) All Versions of this Article: AJPH.2006.102533v1 96/12/2089    most recent Submit a response View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Bassett, M. T. Search for Related Content PubMed Articles by Bassett, M. T.