HEALTH  FOR  ALL  BY  2000 AD

In 1977 the 30th World Health Assembly resolved that the main social target in coming decades for Governments, as for the WHO, should be ‘the attainment by all citizens of the world by the year 2000 A.D. of a level of health that will permit them to lead a socially and economically productive  life’ (WHO, 1979). This goal got coined into a slogan Health for All by the Year 2000 A.D. Health for all meant that every individual should have access to Primary Health Care — a very important concept which we shall discuss later — and through it to all levels of a comprehensive health system. An year later, in 1978, the famous Alma Ata World Conference identified Primary Health Care as the key to the achievement of Health for all by 2000 A.D. In May 1979, the World Health Assembly endorsed the Declaration of Alma Ata and invited Member States to formulate national policies, strategies and plans to attain this target. One of its important guidelines was that each Member State should have a National Health Policy (NHP).

Now, the WHO definition of health is not how health is commonly understood. Health as the absence of disease is a negative definition. The WHO, in the Preamble to its Constitution, defined it positively way back in 1948 and threw a challenge to community workers to construct suitable models of health care:

Health is a state of complete physical, mental and social well-being, and notmerely an absence of disease or infirmity. (Emphasis added.)

This definition encouraged researchers to work out positive parameters of health, which they did. For example, the parameters of physical health were (Crew, 1965):

A good complexion, a clean skin, bright eyes, lustrous hair with a body well clothed with firm flesh, not too fat, a sweet breath* a good appetite, sound sleep, regular activity of bowels and bladder and smooth, easy, co-ordinated movements. All the organs of the body are of unexceptional size and function normally; all the special senses are intact; the resting pulse rate, blood pressure and exercise tolerance are all within the range of “normality” for the individual’s age and sex. In the young and growing individual there is a steady gain in weight and in the mature this weight remains more or less constant at a point about 5 Ibs. more or less than the individual’s weight at the age of 25.

i) Freedom from internal conflicts. No internal wars, no self-condemnation or self-pity.

ii) One well-adjusted with others. Who accepts criticism and is not easily upset. Who understands the emotional needs of  others and tries to be considerate and is courteous in his dealings with them.

iii) One with good self-control. Not overcome by emotion; not dominated by fear, anger, love, jealousy, guilt or worries. Who faces problems and tries to solve them intelligently.

Social health took account of the social and economic conditions and wellbeing of the individual in the context of his social network, his family, his community and his nation. This definition of social health was modified in 1978 to include the ability to lead a socially and economically productive life (WHO, 1978). Many factors of social wellbeing are yet to be identified (Ahmed and Coelho, 1979), to rectify which lacuna the 29th World Health Assembly took note of the importance of social health (World Health Assembly, 1975). A useful definition which resulted was that by Donald et al (1978), ‘social health is the quantity and quality of an individual’s ties and the extent of his involvement with the community.’

As should be immediately obvious, the WHO definition of health mentioned earlier is idealistic rather than realistic. Ideal health will always remain a mirage. Health in this context is to be considered a potentiality — to be promoted, to be supported, for the maximum good of the maximum number. In working for positive health, the role of health experts or doctors is the same as that of a gardener faced with insects, moulds and weeds. Their work is never done (Dubos, 1969).