The Alma-Ata Declaration — Updated and Re-affirmed
By The People’s Health Movement (PHM)
The People’s Health Movement (PHM) re-affirms its commitment to Primary Health Care (PHC) in pursuit of health and well-being for all, aiming to achieve equity in health outcomes. We envision:
· Societies and environments that prioritize, protect and promote people’s health;
· Health care that is accessible, affordable and acceptable for everyone, everywhere;
· Health care of good quality that treats people with respect and dignity;
· Health systems over which communities are able to exert control.
We are far from achieving these objectives, as the last public draft of the Astana Declaration on Primary Health Care cited:
‘Over half of the world’s population, especially marginalized communities, cannot access essential health care. Where communities do have access to services, care is too often inappropriate or unsafe. Around the world, 100 million people are driven into poverty each year because of out-of-pocket spending on health services.’
We have only made limited progress in achieving ‘health for all’ as articulated 40 years ago in the Alma-Ata declaration. Moreover, the improved health outcomes that have been achieved are unevenly distributed, and in some places are being reversed.
The fundamental reason for this inadequate progress towards ‘health for all’ is the rejection by governments — primarily, governments in the Global North — of the core tenets of the Alma-Ata declaration: the need to address the political, economic, social, and cultural determinants of health inequalities; to ensure that approaches to PHC are driven by the affected communities; to massively increase the resources available for PHC, rejecting neoliberal economic policies and pursuing policies of independence, peace, détente and disarmament; etc.
In recognition of the Astana Conference, we re-affirm the underlying analysis, principles and agenda presented in the Alma-Ata declaration — and update it to take account of today’s changed world. We need to:
· Stress the links between health and environmental degradation;
· Take full account both of the health benefits afforded by technological progress, and of the need for adequate regulation to ensure that technology contributes optimally to overall population health and equity.
· Recognise that health gains from PHC are being undermined by the commercial determinants of health, including promotion and trade of health harming commodities (such as food, alcohol and tobacco), and environmentally damaging extractive industries.
Secondly, we need to identify trends in global health policy, governance and practice that are eroding the Alma-Ata principles. Regrettably, some of these trends manifest in the official Astana Declaration, including:
· The widespread adoption of Universal Health Coverage (UHC) as the ultimate goal or criterion for realising the Right to Health — including, in the current context, presenting PHC as a means of achieving UHC. This both fails to recognise the more comprehensive nature of PHC — which, as noted above, includes actions to address social determinants of health as well as community participation (and is therefore broader than, and subsumes, UHC); and also ignores the fact that, in practice, UHC has come to mean financial protection for a limited package of care, with private insurance companies often involved.
· The unexamined assumption that the private sector shares the goals of civil society and is therefore a valued partner in the pursuit of ‘health for all’. This assumption fails to recognise that partnerships with the private sector generally lead to private extraction of profits at the expense of public health.
The original Alma-Ata declaration provided a rigorous and inspiring agenda for achieving ‘health for all’. The fact that we have made such poor progress towards that goal is not a reason for diluting the Alma-Ata principles, but rather for taking this opportunity to genuinely endorse and implement them.
To see an elaboration of the ideas expressed here go to http://phmovement.org/alternative-civil-society-astana-declaration-on-primary-health-care/
