health care Jean-Luc LUYSSEN/Gamma-Rapho/Getty Images

“Health for All” Forty Years On

In September 1978, the international community adopted the Declaration of Alma-Ata, one of the most important global agreements ever reached in the effort to achieve universal health coverage. Although not all of the declaration's goals have been achieved, the vision it articulated remains as relevant as ever.

GENEVA – Forty years ago last month, thousands of delegates from 134 countries gathered in Kazakhstan, then a part of the former Soviet Union, to adopt the Declaration of Alma-Ata. This landmark agreement committed the world to expanding health access, and the principles it enshrined in a mere three pages continue to have a profound effect on the field of public health.

The declaration’s continuing appeal consists in its dual character: it is part gospel of applied science, part political manifesto. Among its key messages are increasing community leadership in health planning; reducing elitism in modern medicine; and tackling social inequality for better health outcomes. The declaration’s central contribution was its articulation of “health for all,” a precursor to universal health coverage (UHC). Examining the origins and evolution of UHC’s founding doctrine could prove useful in the ongoing struggle to achieve it.

One of the biggest differences between 1978 and today is the breadth of health vulnerabilities. Climate change and shifting diets have created new risk categories, while wealth inequalities and political exclusion have produced deeper pockets of vulnerability. Consider, for example, the issue of migration: the politicization of this age-old phenomenon has serious public-health consequences.