By:
Dr. Mirta Roses Periago, Director of the Pan American Sanitary Bureau;
Pan American Health Organization.
Washington, DC. October 20, 2008.

Health Care Must Not Replicate Social Inequalities

Throughout the life cycle, from the womb to old age, human beings need adequate health care in varying degrees of complexity, ranging from routine check-ups and the relief of common ailments to delicate surgeries and the treatment of chronic diseases.

The health care required at the individual, family, or societal level calls for a wide gamut of medical specialties and health interventions.

All of this requires integrated health services networks with the necessary strength, reach, and flexibility to provide an appropriate, timely response to health needs throughout the life cycle.

Constructing these networks poses major challenges. Notwithstanding the enormous progress in health in our region, much remains to be done to improve its public health systems.

This is what has been driving the renewal of primary health care (PHC) as a crucial tool for overcoming existing weaknesses.

Launched at the successful international conference Buenos Aires 30/15, with the Argentine government and the World Health Organization (WHO), the global development of this initiative continued with subsequent meetings in China, Thailand, Burkina Faso, Estonia, and Indonesia.

It culminated at the International Conference of Almaty, Kazakhstan, Oct. 15-16, commemorating the 30th anniversary of the Declaration of Alma-Ata, which launched the global PHC strategy.

A central aspect of the renewed PHC approach is its emphasis on reducing health inequalities in a world of growing social disparities.

As co-chair of the WHO Global Task Force on PHC Revitalization, I had the honor of serving as moderator for the discussions on this issue in Almaty, together with our hosts.

For our region, which sadly, is the most unequal on Earth, the commitment not to replicate those inequalities in health and to ensure that primary care and health for all bridge the social gaps is especially important.

The Almaty conference also examined the major role of PHC-based systems in achieving the Millennium Development Goals, given their emphasis on universal access to services and targeted interventions to address needs.

In the Americas, United Nations agencies are promoting the "Faces, Voices, and Places" initiative, which focuses on neglected regions, communities, and populations that suffer from social exclusion, rather than focusing on misleading national averages.

Other relevant issues for the Americas discussed in Almaty were the urgency of promoting social inclusion and community participation, as well as intersectoral action to address the many social determinants of health.

We are simultaneously working to deliver on the commitment from the region's countries to making the values, principles, and essential elements of primary health care an integral part of their national health systems.

A methodology for the accreditation of primary health care service networks has already been developed and tested in a number of Central and South American countries, and will be widely disseminated in 2009.

A course for developing the competencies of leaders in primary health care through the Virtual Public Health Campus of PAHO is also under way, training 80 participants from 20 countries. This platform is being used to prepare a course on competencies for primary health care teams.

Significant progress has also been made in improving the quality of services, with sound training criteria, incentives for primary health care teams, and greater civil society participation in decisions on the quality of care.

Next November, moreover, a regional advisory meeting will be held in Brazil, followed in Chile in December by the IX International Meeting of Observatories of Human Resources for Health to discuss basic aspects of primary health care and human resources.

Our region is an acknowledged leader in the fight to ensure that the integrated vision of health expressed in the primary health care strategy becomes a priority on the political agenda and in public health policy-making.

We must continue this endeavor, so critical for achieving the greater goal of health for all, with all, and by all, at every level of action in health throughout the life cycle.

Media Publication:
Tierramérica (APS). Environment and Development: Health Care Must Not Replicate Social Inequalities [October 21, 2008]
Tierramérica (APS). Medio Ambiente y Desarrollo: Que la salud no replique la desigualdad social [20 de Octubre de 2008]
Tierramérica (APS). Meio Ambiente e Desenvolvimento : Que a saúde não reproduza a desigualdade social [20 de Outubro de 2008]