44th PAHO Directing Council
Ministers Urge New Push Toward 'Health for All' in the Americas

Health ministers from throughout the Americas called for a renewed commitment to the goal of "health for all" and endorsed primary health care as a strategy for reducing the region's persisting inequities in health.

Health leaders at this year's meeting noted that although "health for all" had not been fully achieved by the turn of the millennium, many of the region's impressive health achievements over the past quarter-century could be attributed to the primary health care strategy. PAHO Director Mirta Roses Periago said the Directing Council's endorsement showed "a recommitment to the transformational nature of primary health care and to health as a basic human right."

Alma-Ata recalled
The 1978 Alma-Ata conference brought international attention to the concept of health as a human right and proposed primary health care as the best strategy for bringing it within reach of all members of society. A central focus of the strategy is a reorientation of resources toward basic care and disease prevention and less toward hospitals and advanced medical technologies. Social participation and multisectoral involvement in health are also key elements of the strategy.

In an official resolution, members of the Directing Council called on PAHO to "take the principles of primary health care into account in the activities of all technical cooperation programs, especially those related to the attainment of the Millennium Development Goals." They also called on the organization to spearhead a yearlong series of events to observe the Alma-Ata anniversary and reexamine the value of primary health care.

Setting priorities
As it does annually, PAHO's Directing Council gathered this year to analyze health problems and challenges in the Americas and to set policies and priorities for the organization's technical cooperation programs in its 35 member countries. This year's council president was Bahamas Minister of Health Marcus Bethel.

In addition to calling for renewed emphasis on primary health care, the health ministers also called on PAHO member countries to:

• Step up efforts to eliminate rubella and congenital rubella syndrome (CRS) from the Americas, with a target elimination date of 2010.
• Expand influenza vaccination for high-risk groups, reaching 75 percent of the elderly by the year 2006.
• Mount new efforts to prevent and control dengue, which sickened more than 1 million of the region's citizens during 2002.
• Develop plans and programs to fight violence, particularly that related to gender, ethnicity and social class.

During the meeting, delegates heard briefings from PAHO experts on critical communicable diseases including SARS, West Nile virus, jungle yellow fever, cholera and bovine spongiform encephalopathy (BSE).

Jong-Wook Lee, director-general of the World Health Organization (WHO), addressed the council on its third day about growing health inequities at the global level.

"Everyone equally needs health," he said, "and when society fails massively through negligence to meet that need, it is in very serious trouble." Conditions in some of the world's poorest countries have reduced life expectancy to 40 years, he said, "while in others, wealth and health technology are enabling it to rise towards 80. Inequalities of this magnitude are not just a danger but an injustice which itself undermines human well-being."

In observance of the 25th anniversary of Alma-Ata, this year's meeting featured panel and roundtable discussions on "Primary Health Care in the Americas: Lessons Learned Over 25 Years and Future Challenges."

Javier Tórres Goitia, former minister of health of Bolivia, told health leaders that the chief lesson to be drawn from the region's efforts to implement primary health care was that "health cannot be considered in isolation or as the simple absence of disease. Rather it is intimately related with socioeconomic development, justice, education, solidarity and peace."

Costa Rica's minister of health, María del Rocío Sáenz Madrigal, said in a summary of the roundtable talks that "primary health care has emerged as the frame of reference for the reorientation of health services, emphasizing the promotion of collective health, the definition of intersectoral policies, and citizen participation, which during the last 25 years have made clear the symbiotic relationship between health and development."

The Directing Council called on PAHO to organize a year-long celebration of the anniversary of Alma-Ata to refocus attention on primary health care and its importance for efforts to meet the U.N. Millennium Development Goals.

In roundtable sessions, delegates said these events should lead to a "process of renewal" for the strategy of primary health care.

"In the delegates' opinion," said Sáenz Madrigal, "this renewal process should be participatory and inclusive, involving not only countries' governments and traditional institutions but also all other sectors of society, especially communities and individuals."