HEALTH-FOR-ALL IN THE 21ST CENTURY - A GLOBAL PERSPECTIVE

Changes in the broad determinants of health since the Alma Ata Confere nce in 1978 necessitate a renewed examination of the underlying princi ples and focus of the Primary Health Care (PHC) strategy. The PHC appr oach has been adopted by most countries and has led to improved access to certain basic health services. However, the health gains in other areas are less encouraging. Some elements of the PHC approach, for exa mple, the effective implementation of equity-oriented health policies and the need to improve management principles within health services, have yet to be fully implemented. Moreover, to address the underlying determinants of health status, the World Health Organization's (WHO) r enewed global health policy will have to include certain issues that w ere not considered at Alma Ata. For example, the health impacts of glo bal recession and globalization and the need for human-centred sustain able development strategies were not considered at Alma Ata. A renewed global health policy will also have to consider demographic, epidemio logical, environmental and technological changes that have emerged sin ce 1978. It is important that WHO's renewed policy be based on sound e vidence, a commitment to ethical principles and broad use of partnersh ips for health at global, national and local levels. One implication o f this new context of health development for the renewed health policy will be that ''thinking globally and acting locally' will have to be complemented by stronger global action to protect local and national h ealth.