The Global Health Debate

Alongside the opening up of intellectual space in the United States on the government role in providing health care, a number of civil society groups are exerting a push for PHC on the international level. In December 2000, when governments were originally slated to meet the Alma-Ata vision of "health for all," the People's Health Assembly took place in Bangladesh with over 1,400 participants from civil society movements and non-governmental organisations. After more than a hundred sessions, the participants formulated The People's Charter for Health, which soon became a common tool of a worldwide citizen's movement committed to making the Alma-Ata dream a reality. On the 30th anniversary of the Declaration of Alma-Ata in 2008, the People's Health Movement again reiterated its call. Meanwhile, in April 2008 the Ouagadougou Declaration also called for a renewal of the principles of PHC and its implementation in developing countries. A further impetus was given to the concept of PHC by the publication of three prominent reports in 2008: the WHO's World Health Report 2008, the WHO's Commission on the Social Determinants of Health (CSDH), and the Global Health Watch II. While the three prominent reports released by the UN and civil society in 2008 signal a shift in the right direction, a PHC strategy is still far from implementation. Although the WHO is again attempting to foster PHC, there are no adequate global initiatives and no sufficient coalitions of global institutions to address the social and economic determinants of health. Civil society has long criticized the WHO itself for being too "disease-focused" and supportive of selective, vertical interventions that undermine its own PHC vision.