In the world of global health, there is much talk these days about the 30thanniversary of what is known as the Declaration of Alma Ata. Alma Ata was the city, in today’s Kazakhstan, in which a landmark call was made, during the International Conference on Primary Care, to all governments and all people involved in the work of public health "to protect and promote the health of all people."
This declaration certainly did not begin the work of public health, but its key role was in creating a common global understanding of preventive care and public health and in elevating their importance as the primary way of assuring health for all people. Since 1978, and especially more recently, the principles declared at Alma Ata have been a driving force by many in global health, in particular at the World Health Organization.
The declaration states that primary care includes, among other things, "education about health problems and methods of prevention; promotion of food supply and proper nutrition; adequate supply of safe water and basic sanitation; maternal and child health care, immunization against infectious diseases; prevention and control of endemic diseases…."
Public health and human rights are inextricably linked, and that linkage becomes clear, implicitly, as one reads the declaration. How does one, for example, educate people whose rights are being compromised? People who are being discriminated against are less likely to receive the education that they need and/or will be less able to act on their knowledge. Actually, as Jonathan Mann has pointed out, the needs of those being discriminated against are likely to remain unrecognized.
Quoting some recent examples of this health and human rights linkage from a new UNICEF publication about the health of children in Asia, notice that assuring health will also require that we work to ensure some basic rights and the removal of discrimination:
- "The right to a name and a nationality is well established by the Convention on the Rights of the Child. Yet in 2006, 22.6 million births in South Asia and 5.1 million in the rest of Asia-Pacific went unregistered. These children are almost always from poor, marginalized or displaced families …and the consequences for their health and well-being are often severe and long-lasting."
- In India, which by itself accounts for 20 per cent of the world’s under-fives, "an entrenched social structure based on caste has made it difficult or impossible for 167 million Dalit (the outcaste or untouchable communities) to access basic primary health and educational services. Dalit children are often served inferior meals at school; their parents, meanwhile, are barred from most employment and from owning land, keeping them in abject poverty, and they are discouraged from using medical services."
- "Research has shown repeatedly that the empowerment of women and girls is inextricably linked to improved maternal and child survival rates. At a most basic level, women are unable to or prohibited from seeking health care, and girl children in most countries (in Asia) are often denied food to the benefit of their brothers."
For all of us, regardless of where we live, social status and the various roles we have profoundly influence and constrain our choices. And, for those whose basic rights are being denied, the choice and the chance to live in health can be remarkably difficult. It is for us then to promote health by also promoting justice and rights.
Here is a link to the entire Alma Ata declaration (it is short): http://www.who.int/hpr/NPH/docs/declaration_almaata.pdf
And here is a link to the full UNICEF report quoted above: http://www.unicef.org/publications/index_45086.html
Here is a link to an excellent and new publication from the WHO that explicitly describes the links between justice/rights and health: http://www.who.int/social_determinants/final_report/en/index.html