health for all according to park text book of community medicine

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Health for All (HFA) - Park's Textbook of Preventive and Social Medicine

Background and Historical Context

The "Health for All" movement emerged from a growing recognition of stark health inequalities between developed and developing countries. John Bryant captured this challenge eloquently: "Large numbers of the world's people, perhaps more than half, have no access to health care at all, and for many of the rest, the care they receive does not answer the problems they have."

In developed countries (and among the elite of developing nations), people enjoyed all the determinants of good health - adequate income, nutrition, education, sanitation, safe drinking water, and comprehensive health care. In contrast, only 10-20% of the population in developing countries had ready access to health services. Death claimed 60-250 per 1000 live births, and life expectancy was 30% lower than in developed countries.

The global conscience was stirred, leading to a new awakening that the health gap between rich and poor - within countries and between countries - must be narrowed and ultimately eliminated.

The HFA Phase (1981-2000 A.D.)

This is recognized as a distinct phase in the history of medicine and public health. In 1981, WHO member countries pledged themselves to an ambitious target: to provide "Health for All" by the year 2000, meaning the attainment of a level of health that will permit all people "to lead a socially and economically productive life."

The WHO Resolution of 1977

The 30th World Health Assembly resolved in May 1977 that:

"The main social target of governments and WHO in the coming decades should be the attainment by all citizens of the world by the year 2000 of a level of health that will permit them to lead a socially and economically productive life."

This culminated in the international objective of HEALTH FOR ALL by the year 2000 as the social goal of all governments.

Definition and Meaning of HFA

The goal of Health for All has two perspectives:

Long-term context: The realization of WHO's objective of "attainment by all peoples of the highest possible level of health."
Immediate relevance: As a minimum, all people in all countries should have at least such a level of health that they are capable of working productively and of participating actively in the social life of the community in which they live.

Health for All means that health is to be brought within the reach of every one in a given community. It implies:

Removal of obstacles to health
Elimination of malnutrition, ignorance, disease, contaminated water supply, and unhygienic housing
Continued progress in medicine and public health

HFA was a holistic concept calling for efforts in agriculture, industry, education, housing, and communications - just as much as in medicine and public health. It has been described as a "revolutionary concept and a historic movement" in terms of its own evolutionary process.

Alma-Ata Declaration, 1978

At the Joint WHO-UNICEF International Conference on Primary Health Care (1978) at Alma-Ata (USSR), governments of 134 countries and many voluntary agencies called for a revolutionary approach to health care.

The conference declared:

"The existing gross inequality in the health status of people, particularly between developed and developing countries as well as within countries, is politically, socially and economically unacceptable."

The Alma-Ata conference:

Reaffirmed HFA as the major social goal of governments
Stated that the best approach to achieve HFA is by providing Primary Health Care (PHC), especially to the vast majority of underserved rural people and urban poor
Called on all governments to formulate national policies, strategies and plans of action to launch and sustain PHC as part of a national health system

Fundamental Principle of HFA

The fundamental principle of the HFA strategy is EQUITY - an equal health status for people and countries, ensured by an equitable distribution of health resources.

WHO's Global Strategy for HFA (1981)

In 1981, a global strategy for HFA was evolved by WHO. The global strategy provides:

A global framework broad enough to apply to all Member States
Flexible enough to be adapted to national and regional variations of conditions and requirements

This was followed by individual countries developing their own national strategies, which were then synthesized into regional strategies.

WHO's 12 Global Indicators for HFA

The WHO established 12 global indicators as the basic point of reference for assessing progress towards HFA. Examples include:

A minimum life expectancy of 60 years
Maximum Infant Mortality Rate (IMR) of 50 per 1000 live births

HFA Monitoring Indicators (4 Categories)

The WHO listed four categories of indicators for monitoring progress towards HFA by 2000 AD:

(1) Health Policy Indicators

Political commitment to "Health for All"
Resource allocation
Degree of equity of distribution of health services
Community involvement
Organizational framework and managerial process

(2) Social and Economic Indicators related to Health

Rate of population increase
GNP or GDP
Income distribution
Work conditions
Adult literacy rate
Housing
Food availability

(3) Indicators for the Provision of Health Care

Availability
Accessibility
Utilization
Quality of care

(4) Health Status Indicators

Low birth weight (percentage)
Nutritional status and psychosocial development of children
Infant Mortality Rate (IMR)
Child Mortality Rate
Life expectancy at birth
Maternal Mortality Rate (MMR)
Disease-specific mortality
Morbidity - incidence and prevalence
Disability prevalence

National Strategy for HFA in India

As a signatory to the Alma-Ata Declaration (1978), the Government of India committed to providing HFA to its citizens by 2000 AD. Two important reports guided India's strategy:

Report of the Study Group on "Health for All - an Alternative Strategy" (sponsored by ICSSR and ICMR)
Report of the Working Group on "Health for All by 2000 AD" (sponsored by Ministry of Health and Family Welfare, Government of India)

These reports formed the basis of the National Health Policy (1983), which committed the Government and people of India to the achievement of HFA.

Goals set under India's National Health Policy (to be achieved by 2000 AD):

Reduction of Infant Mortality Rate from 125 (1978) to below 60
Raise life expectancy at birth from 52 years to 64 years
Reduce Crude Death Rate from 14 per 1000 to 9 per 1000
Reduce Crude Birth Rate from 33 per 1000 to 21 per 1000
Achieve a Net Reproduction Rate of one
Provide potable water to the entire rural population

HFA and Primary Health Care (PHC)

The Alma-Ata Conference proclaimed Primary Health Care as the key vehicle for achieving Health for All. PHC integrates at the community level all the factors required for improving the health status of the population - it consists of at least 8 essential elements of health care. The services must be both simple and accessible to all.

HFA and the Millennium Development Goals (MDGs)

The HFA movement laid the groundwork for subsequent international health commitments. In September 2000, representatives from 189 countries adopted the Millennium Declaration at the Millennium Summit (New York), with MDGs placing health at the heart of development - 3 of 8 MDG goals, 8 of 18 targets, and 18 of 48 indicators were health-related.

This was followed by the Sustainable Development Goals (SDGs) adopted in 2015, which integrated health into a broader 2030 agenda across 17 goals covering economic, social, and environmental development.

Source: Park's Textbook of Preventive and Social Medicine - Chapter 1 (Concepts of Health) and Chapter on National Health Programmes

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