DECLARATION OF ALMA-ATA

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Under WHO director Mahler of Denmark (1973-88) the goal of "Health for All" was proposed and was formally put forth in the 1978 WHO-UNICEF Alma-Ata Declaration. The attendees of the conference realized that improving health called for a comprehensive approach whereby primary health care was seen as "the key to achieving an acceptable level of health throughout the world in the foreseeable future as a part of social development and in the spirit of social justice." WHO, Declaration of Alma Ata, as reported in "Report on the international conference on primary health care".

The Alma-Ata Declaration affirmed health as a fundamental human and right and called for a transformation of conventional health care systems and for broad intersectoral collaboration and community organizing.

ORIGINAL TEXT OF DECLARATION OF ALMA-ATA

The International Conference on Primary Health Care, meeting in Alma-Ata this twelfth day of September in the year Nineteen hundred and seventy-eight, expressing the need for urgent action by all governments, all health and development workers, and the world community to protect and promote the health of all the people of the world, hereby makes the following Declaration:

I

The Conference strongly reaffirms that health, which is a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity, is a fundamental human right and that the attainment of the highest possible level of health is a most important world-wide social goal whose realization requires the action of many other social and economic sectors in addition to the health sector.

II

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.

III

Economic and social development, based on a New International Economic Order, is of basic importance to the fullest attainment of health for all and to the reduction of the gap between the health status of the developing and developed 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.

IV

The people have the right and duty to participate individually and collectively in the planning and implementation of their health care.

V

Governments have a responsibility for the health of their people which can be fulfilled only by the provision of adequate health and social measures. A main social target of governments, international organizations and the whole world community in the coming decades should be the attainment by all peoples of the world by the year 2000 of a level of health that will permit them to lead a socially and economically productive life. Primary health care is the key to attaining this target as part of development in the spirit of social justice.

VI

Primary health care is essential health care based on practical, scientifically sound and socially 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 country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination. It forms an integral part both of the country's health system, of which it is the central function and main focus, and of the overall social and economic development of the community. It is the first level of contact of individuals, the family and community with the national health system bringing health care as close as possible to where people live and work, and constitutes the first element of a continuing health care process.

VII

Primary health care:

1.       reflects and evolves from the economic conditions and sociocultural and political characteristics of the country and its communities and is based on the application of the relevant results of social, biomedical and health services research and public health experience;

2.       addresses the main health problems in the community, providing promotive, preventive, curative and rehabilitative services accordingly;

3.       includes at least: education concerning prevailing health problems and the methods of preventing and controlling them; promotion of food supply and proper nutrition; an adequate supply of safe water and basic sanitation; maternal and child health care, including family planning; immunization against the major infectious diseases; prevention and control of locally endemic diseases; appropriate treatment of common diseases and injuries; and provision of essential drugs;

4.       involves, in addition to the health sector, all related sectors and aspects of national and community development, in particular agriculture, animal husbandry, food, industry, education, housing, public works, communications and other sectors; and demands the coordinated efforts of all those sectors;

5.       requires and promotes maximum community and individual self-reliance and participation in the planning, organization, operation and control of primary health care, making fullest use of local, national and other available resources; and to this end develops through appropriate education the ability of communities to participate;

6.       should be sustained by integrated, functional and mutually supportive referral systems, leading to the progressive improvement of comprehensive health care for all, and giving priority to those most in need;

7.       relies, at local and referral levels, on health workers, including physicians, nurses, midwives, auxiliaries and community workers as applicable, as well as traditional practitioners as needed, suitably trained socially and technically to work as a health team and to respond to the expressed health needs of the community.

VIII

All governments should formulate national policies, strategies and plans of action to launch and sustain primary health care as part of a comprehensive national health system and in coordination with other sectors. To this end, it will be necessary to exercise political will, to mobilize the country's resources and to use available external resources rationally.

IX

All countries should cooperate in a spirit of partnership and service to ensure primary health care for all people since the attainment of health by people in any one country directly concerns and benefits every other country. In this context the joint WHO/UNICEF report on primary health care constitutes a solid basis for the further development and operation of primary health care throughout the world.

X

An acceptable level of health for all the people of the world by the year 2000 can be attained through a fuller and better use of the world's resources, a considerable part of which is now spent on armaments and military conflicts. A genuine policy of independence, peace, détente and disarmament could and should release additional resources that could well be devoted to peaceful aims and in particular to the acceleration of social and economic development of which primary health care, as an essential part, should be allotted its proper share.

The International Conference on Primary Health Care calls for urgent and effective national and international action to develop and implement primary health care throughout the world and particularly in developing countries in a spirit of technical cooperation and in keeping with a New International Economic Order. It urges governments, WHO and UNICEF, and other international organizations, as well as multilateral and bilateral agencies, non-governmental organizations, funding agencies, all health workers and the whole world community to support national and international commitment to primary health care and to channel increased technical and financial support to it, particularly in developing countries. The Conference calls on all the aforementioned to collaborate in introducing, developing and maintaining primary health care in accordance with the spirit and content of this Declaration.

US Constitutional Amendment guaranteeing health care as a right for every American

Today, Rep. Pete Stark (D-CA) announced his introduction of a proposed amendment to the US Constitution to guarantee health care as a right for every American. The amendment, H.J. Res. 30, is cosponsored by Rep. Jesse Jackson, Jr. (D-CA) and 27 other House members.

"The health of every American is vital to their unalienable rights of 'life, liberty, and the pursuit of happiness,'" said Rep. Pete Stark. "To ensure these rights are fully enjoyed, we must be certain that every American can access quality health care - regardless of their income, race, education or job status. This Constitutional amendment is aimed at achieving this fundamental goal."

Today, there are [sic. 45 million] [editor's note: no, today there are at least 90 million, 45 million is the number of Americans uninsured for the whole fiscal year Jan 1 2004 to Dec 31 2004] uninsured Americans, including 8 million children. Millions more are underinsured, excluded from certain types of health coverage or being quickly priced out of the health insurance market altogether. Additional disparities in access, treatment, and outcomes exist for people of color.

Facing skyrocketing costs, many employers are cutting benefits or dropping coverage for their employees, chipping away at the very foundation of health care insurance in the United States. Proposed cuts in Medicaid now endanger coverage for the over 50 million Americans that currently rely on the program for medical care.

"We face a health care crisis where equal opportunity and basic fairness in our nation are at stake," said Rep. Stark. "I'm frustrated, as many Americans are, that the President and Congress continue to ignore the problems we face. A Constitutional guarantee of health care for all will force Congress to take action to ensure that health coverage is there for all Americans."

H.J. Res. 30 would amend the Constitution to say "all persons shall enjoy the right to health care of equal high quality." It would require ratification by three-fourths of the States and so-called implementing legislation must be passed by Congress to ensure compliance with the amendment.

"I firmly believe that until we can guarantee that all people have the right to equal, high-quality health care through the Constitution, the interests of the people will continue to play second fiddle to the corporate bottom-line," said Rep. Stark. "It's time we put the health care of the people first. Our Constitution should be amended to promote that common interest."

The United Nations
Commission on Human Rights
April 15, 2005

In a resolution on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, adopted by a roll-call vote of 52 in favour to one against, with no abstentions, the Commission urged States to take steps, individually and through international assistance and cooperation, especially economic and technical, to the maximum of their available resources, with a view to achieving progressively the full realization of the right of everyone to the enjoyment of the highest attainable standard of physical and mental health; and called upon the international community to continue to assist the developing countries in promoting the full realization of the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, including through financial and technical support as well as training of personnel, while recognizing that the primary responsibility for promoting and protecting all human rights rests with States.

The Commission encouraged States to recognize the particular needs of persons with disabilities related to mental disorders, as well as their families, including by reflecting their needs in national health and social policies, such as national poverty reduction strategies; and called upon them to place a gender perspective at the centre of all policies and programmes affecting women's health. They also called upon States to protect and promote sexual and reproductive health as integral elements of the right of everyone to the enjoyment of the highest attainable standard of physical and mental health and decided to extend, for a period of three years, the mandate of the Special Rapporteur on the right to everyone to the enjoyment of the highest attainable standard of physical and mental health.

The result of the vote was as follows:

In favour (52): Argentina, Armenia, Australia, Bhutan, Brazil, Burkina Faso, Canada, China, Congo, Costa Rica, Cuba, Dominican Republic, Ecuador, Egypt, Eritrea, Ethiopia, Finland, France, Gabon, Germany, Guatemala, Guinea, Honduras, Hungary, India, Indonesia, Ireland, Italy, Japan, Kenya, Malaysia, Mauritania, Mexico, Nepal, Netherlands, Nigeria, Pakistan, Paraguay, Peru, Qatar, Republic of Korea, Romania, Russian Federation, Saudi Arabia, South Africa, Sri Lanka, Sudan, Swaziland, Togo, Ukraine, United Kingdom and Zimbabwe.

Against (1): United States.

David Hohman (United States), speaking in explanation of the vote... said the United States believed that while the progressive realization of economic, social and cultural rights required government action, those rights were not an immediate entitlement to a citizen.