The global Health for All movement
The 1946 Constitution of the World Health Organization states that
“the health of all peoples is fundamental to the attainment of peace and security” (10). The Constitution also recognizes “the enjoyment of the highest attainable standard of health” as a fundamental human right.
By the late 1970s, the widespread enjoyment of this right was still far from being achieved, with about one thousand million people in the world living in such poverty that acceptable standards of health were impossible. Recognizing the challenge, WHO and its Member States set about creating a framework to help translate the vision of universal health into a strategy and policy. The process began in 1977 with a call for national governments and WHO to work towards one goal: to enable all of the world’s citizens to enjoy by 2000 a level of health that would allow them to lead a socially active and economically productive life (11). This vision and movement have come to be known as Health for All.
The Health for All concept was subsequently introduced at the 1978 International Conference on Primary Health Care in Alma-Ata (in the former USSR). The Declaration of Alma-Ata states that attaining health for all as part of overall development starts with primary health care based on “acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and the country can afford” (12).
Since then, Member States have been urged to consider the Health for All concept when formulating policies and action plans. It was believed
that, by interpreting Health for All in a national social, political and developmental context, each country would be able to contribute to the global aim of health for all by the year 2000.
The call for health for all was, and fundamentally remains, a call for social justice, equity and solidarity, and a societal response that strives for unity in diversity. Rather than enshrining a single finite goal, Health for All is instead a process of bringing countries to progressive improvement in the health of all their citizens. Globally, WHO has continued to pursue its own commitment to health for all, by:
• adopting in 1981 the Global Strategy for Health for All by the Year 2000 (13) and approving, one year later, a global action plan for implementing the Strategy (14);
• renewing the Health for All strategy in 1995 (15) by developing a holistic health policy – still based on equity and solidarity but with further emphasis on individual, family and community responsibility for health – and by placing health within an overall development framework;
• linking the renewed strategy to programme budgets and evaluation (16); and
• launching in 1999, after consultation with and within the Member States, a global Health for All policy for the 21st century (17).
Health for All in the European Region
In 1980, the Regional Committee for Europe approved a European strategy for attaining health for all by the year 2000 (18). It decided to monitor the strategy’s implementation every two years (beginning in 1983), and to evaluate its effectiveness every six years (beginning in 1985).
Following the initial launch of a European Health for All policy, the Regional Committee asked for the formulation of specific regional targets to assist in implementation of the regional strategy. Such targets were thought necessary in order to motivate and actively involve Member States in committing to Health for All. The first Health for All policy and targets in support of the regional strategy were adopted
in 1984 (19). They provided a broad but precisely drawn vision of health development in the Region. They also outlined a clear ethical framework for policy development – instead of focusing solely on inputs to health services (characteristic of an inward-looking, hospital-oriented health sector), they also emphasized outcomes, encouraging a shift to a health sector that reaches out and is oriented towards primary care. In addition, a list of 65 indicators, linked to the 38 regional targets, was devised to measure progress.
In the same year, the Regional Committee also adopted an action plan for implementing the regional strategy. This described the roles and actions to be taken by Member States, the Regional Committee and the Regional Office, respectively. While the plan was again directly linked to the regional targets, it also left room for each country to define its own priorities and strategies.
With the adoption of these three documents in 1984, the Regional Committee created a framework for health policies in the Region. At the same time, it also established a mechanism to regularly monitor and evaluate progress towards achieving health for all in the Region by 2000. As a consequence of this commitment, an update of the regional policy, strategy and targets was made in 1991 (20). Meanwhile, the Regional Committee also assessed progress towards the regional targets every three years, in 1985, 1988, 1991, 1994 and 1997.
In 1998, a revised European Health for All policy framework, entitled Health21, was adopted (1). It reflected the extraordinary changes that had occurred in the Region since the previous regional policy, including the addition of 20 new pluralistic societies and their emerging voices, as well as, despite many positive developments, severe economic downturns that had led to major crises in the health sector. Health21 articulates two primary aims, three basic values and four main strategies. Its 21 targets also provide benchmarks to measure progress in improving and protecting health and in reducing health risks.
13