“Health for All”: An Ethical Imperative or Unattainable Ideal?

Abstract

“Health for all,” the universal vision that has guided health promotion efforts for the past two decades (Nampudukam, 1998), envisages the attainment of a health level that permits all people to lead socially and economically productive lives. Yet we continue to live in a world with enormous health disparities. For example, the life expectancy in Japan is 80 years, whereas in Angola, Malawi, Mozambique, Zimbabwe, and Zambia it is fewer than 40 years (see “World Life Expectancy Chart,” U.S. Census Bureau, 2000). Although the youngerthan-5 mortality rate in Norway is 4 per 1,000, in Sierra Leone it is 316 per 1,000. This situation is actually worse than figures suggest because average rates tend to mask inequalities within a country, which affect the poor disproportionately (Dwyer, 2003). Furthermore, the United States, the world’s richest country, has the second-worst newborn mortality rate in the developed world, according to a new report. As reported by Save the Children researchers (Green, 2006), American babies are 3 times more likely to die in their first month as children born in Japan, and newborn mortality is 2.5 times higher in the United States than in Finland, Iceland, or Norway. In particular, for African Americans, the mortality rate is nearly double that of the United States as a whole, with 9.3 deaths per 1,000 births (Green, 2006). The disparities in social, mental, and physical health between the most advantaged and the most disadvantaged population groups are, in general, as great today, if not greater, than they have ever been and occur in both rich and poor countries. This editorial reflects on the prevailing health inequities observed in the United States and attempts to address some of these health determinants and related injustices. In light of the health educators’ obligations put forth in the Health Education Code of Ethics (http://www.sophe.org/about/ ethics.html), we feel that this is an important issue as well as an ethical imperative. We specifically focus here on potential directives for achieving the lofty goal of “health for all,” along with those of Healthy People 2010 (U.S. Department of Health and Human Services [USDHHS], 2002), through a diverse array of health promotion efforts. Our aim is to provide some practical suggestions for fostering this nation’s health and advancing the ideal of “Health as a human right.” We believe the potential role of health educators in minimizing all those