Address at the International Conference Dedicated to the 30th Anniversary of the Declaration of Alma-Ata

Dr Margaret Chan
Director-General of the World Health Organization

Almaty, Kazakhstan

Honourable ministers, Ms Veneman, Dr Danzon, distinguished delegates, ladies and gentlemen,

We are meeting here to commemorate an event that launched primary health care as the route to health for all. This was a deliberate effort to tackle the huge, and largely avoidable, differences in the health status of populations. The Declaration of Alma-Ata put health equity on the international political agenda for the first time.

All those miracles of modern medicine paled when viewed against the vast numbers of people who had no access to even a minimum standard of basic health care. Their health was further compromised by low rates of literacy, poor nutrition, substandard housing, and a lack of safe water and sanitation.

The Declaration of Alma-Ata tackled all of these problems. It revolutionized the way health was interpreted and radically altered prevailing models for organizing and delivering care.

We are meeting here to launch a renewed call for primary health care. The World Health Report makes the case that primary health care is more relevant today than ever before. I fully agree, and want to stress this relevance in rich and poor countries alike.

All around the world, health is being shaped by the same powerful forces. More and more, all countries are facing similar health problems. In our closely interconnected and interdependent world, the distinctions between poor and wealthy nations are blurred. More developing countries have pockets of wealth that attract the lion’s share of spending on health. More wealthy countries have urban slums and shantytowns that drain health resources and strain the social welfare system.

Health care now faces three major ills of life in the 21st century: the globalization of unhealthy lifestyles, rapid unplanned urbanization, and the ageing of populations. These trends affect every country.

One of the consequences is the rise, everywhere, of chronic diseases, like heart disease, cancer, diabetes, and mental disorders. Long considered the companions of affluent societies, chronic diseases now impose their greatest burden on low- and middle-income countries.

The need for long-term care strains health systems and budgets. The catastrophic costs of care drive households, in the millions, below the poverty line. A great need for prevention faces a situation in which most risk factors lie outside the direct control of the health sector.

In other words, the response to these challenges requires fairness, efficiency, and multisectoral action. In other words: it requires a primary health care approach.

The Millennium Declaration and its Goals breathed new life into the values of equity and social justice, this time with a view towards ensuring that the benefits of globalization are more evenly distributed.

The AIDS epidemic showed the relevance of equity and universal access in an especially vivid way. With the advent of antiretroviral therapy, an ability to access medicines and services became equivalent to an ability to survive for many millions of people.

Equity, social justice, universal access, and solidarity for health are the values that underpin primary health care.

At a time when the costs of health care are increasing, and the expectations of consumers are rising, primary health care looks more and more like a smart way to pursue better health. Decades of experience tell us that primary health care produces better outcomes, at lower costs, and with higher user satisfaction.

A primary health care approach is the most efficient, fair, and cost-effective way to organize a health system. It can prevent much of the disease burden, and it can also prevent people with minor complaints from flooding hospital emergency wards.

WHO estimates that better use of existing measures, as promoted by primary health care, could prevent as much as 70% of the global disease burden.

No one can question the relevance or the wisdom of an approach that can contribute so much to better, more effective, more equitable, and less costly health care.

Ladies and gentlemen,

At a time when we are calling for a renewal of values, principles, and approaches put forward 30 years ago, I cannot overemphasize the importance of foresighted policies.

We are meeting at a time of crisis. We face a fuel crisis, a food crisis, and a severe global financial crisis. The effects of climate change, another global crisis, are already being felt. All of these crises have profound consequences for health.

The health sector had no say when the policies that led to these crises were formulated. But health bears the brunt.

Some things need to be said. The policies governing the international systems that link us all so closely together need to be more foresighted. They need to look beyond financial gains, benefits for trade, and economic growth for its own sake.

They need to be put to the true test. What impact do they have on poverty, misery, and ill health? Do they contribute to greater fairness in the distribution of benefits? Or are they leaving this world more and more out of balance, especially in matters of health?

Ladies and gentlemen,

This world will not become a fair place for health all by itself. Economic developments within a country will not automatically protect the poor or guarantee universal access to health care. Globalization will not self-regulate in ways that favour fairness. International trade and economic agreements will not automatically consider the impact on health. All of these changes require deliberate policy decisions.

We received visionary policy guidance for better global health thirty years ago in this city. That guidance is now renewed by the World Health Report.

The visionary thinkers who gathered in this city in 1978 could not have foreseen an oil crisis, a global recession, or the emergence of a world-transforming disease like AIDS.

In the recession that followed the Declaration of Alma-Ata, major mistakes were made in restructuring national budgets, with reductions in health and other fundamental social sectors. Health care has still not recovered from these mistakes, and the bill has been extremely high. This is especially true in sub-Saharan Africa, but also in large parts of Latin America and Asia.

If history tends to repeat itself, can we not at least learn from the past and avoid repeating mistakes?

Health is the very foundation of productivity and prosperity. Balanced health within a population contributes to social cohesion and stability. These are assets for every country, and they must be preserved, no matter what the crisis.

The World Health Report sets out a way forward that is highly and universally relevant today, and all the more important given the crises the world now faces.

The subtitle of the report is “now more than ever.” I believe this pertains to the financial crisis as well. Efficiency and fairness in health care are now more important than ever. Protection of the poor is now more important than ever.

With so much at stake for the health of so many millions, let us all hope that the report’s recommendations and advice are widely heeded.

Thank you.