Three global health reports: towards a growing consensus?

Abstract

keywords health policy, primary health care, financing, integrationIn 1978, the inspiring Alma Ata declaration on PrimaryHealth Care put the need for people-centred comprehen-sive primary care for the first time on the internationalagenda. But in the context of limited resources and highdisease burden in poor countries, these grand ideas wererapidly reduced to a few selective ‘cost-effective’ interven-tions deemed affordable (Walsh & Warren 1979). Thisapproach to health has dominated over the past 30 yearsand contributed more recently to the proliferation of globalhealth initiatives, but left the health systems partlyneglected with too little resources.Doubts about reaching the Health Millennium Devel-opment Goals (MDGs), in particular MDG5 on MaternalHealth, again fuel calls for a more comprehensiveapproach to health care in low-income countries. It isagainst this background that the 30th birthday of Alma Atain September 2008 was given attention by internationalagencies and academic institutions to discuss new strategiesto overcome the unfruitful international divide betweenhealth systems strengthening and disease-specific interven-tions. One focus of a conference in Antwerp was lookingfor synergies between disease-specific intervention andhealth systems strengthening. An example of HIV/AIDSprogrammes in Africa has been elaborated from this pointof view (ITG 2008).Overlooking the need for comprehensive people-centredprimary health care and for reduction of global healthinequities may also become increasingly politicallyincorrect, as the effects of neglecting these issues have beenwidely publicised, supported by a wealth of evidencerecently summarised in three important health reportspublished in the autumn of 2008: WHO’s World HealthReport (WHO 2008), the final report of the Commissionon Social Determinants of Health (CSDC 2008) and theGlobal Health Watch 2 (People’s Health Movement et al.2008).The World Health Report 2008 revisits the Alma Atavision as a set of values and principles for guiding thedevelopment of health systems: ‘Primary Health Care –Now More Than Ever’. The report thoroughly analyseshealth systems and identifies the need for major reforms infour areas: universal coverage, people-centred servicedelivery, ‘healthy public policies’ and leadership. Thereport suggests that primary health care, underpinned bysocial justice, equity and solidarity, is feasible and urgesgovernments and the international community to moreseriously consider people’s needs and to adapt servicedelivery to changing epidemiological patterns.A bit earlier a report commissioned by WHO on socialdeterminants of health, ‘Closing the Gap in a Generation’,was published. The final report summarises the work andrecommendation of a diverse international group ofscientists and practitioners. Formally launched in 2005, theCommission was organised in knowledge networks tocompile evidence on policies and interventions to addressinequalities and social determinants of health. Its recom-mendations cover three areas: daily living conditions; theinequitable distribution of power, money and resources;and methods to measure and understand the problems andassess the impact of action.The third report, ‘Global Health Watch 2’, is oftenlabelled ‘The Alternative World Health Report’. TwoNGO movements, the People’s Health Movement and theGlobal Equity Gauge Alliance, together with a largenumber of individuals and institutions wrote their secondreport aimed to draw attention to often neglected drivers ofill-health, the ‘political and economic choices, or thecurrent form of globalisation’. The report concludes thatthe current dominant model of development, based onmarket liberalisation and commercial globalisation, hasnot only failed to deliver ‘health for all’, but also places theworld at the brink of an environmental crisis.The three reports have been written with distinctivemotives, have different backgrounds and use differentperspectives. WHR 2008 concentrates mainly on the healthsystem and health policies. CSDH provides a broad range