The World Health Report 2008

"There is today a recognition that populations are left behind and a sense of lost opportunities that are reminiscent of what gave rise, thirty years ago, to Alma-Ata's paradigm shift in thinking about health. The Alma-Ata Conference mobilized a "Primary Health Care movement" of professionals and institutions, governments and civil society organizations, researchers and grassroots organizations that undertook to tackle the "politically, socially and economically unacceptable" health inequalities in all countries. The Declaration of Alma-Ata was clear about the values pursued: social justice and the right to better health for all, participation and solidarity. There was a sense that progress towards these values required fundamental changes in the way health-care systems operated and harnessed the potential of other sectors. The translation of these values into tangible reforms has been uneven. Nevertheless, today, health equity enjoys increased prominence in the discourse of political leaders and ministries of health, as well as of local government structures, professional organizations and civil society organizations. The PHC values to achieve health for all require health systems that "Put people at the centre of health care". What people consider desirable ways of living as individuals and what they expect for their societies--i.e. what people value--constitute important parameters for governing the health sector. PHC has remained the benchmark for most countries' discourse on health precisely because the PHC movement tried to provide rational, evidence-based and anticipatory responses to health needs and to these social expectations. Achieving this requires trade-offs that must start by taking into account citizens' "expectations about health and health care" and ensuring "that [their] voice and choice decisively influence the way in which health services are designed and operate". A recent PHC review echoes this perspective as the "right to the highest attainable level of health", "maximizing equity and solidarity" while being guided by "responsiveness to people's needs." Moving towards health for all requires that health systems respond to the challenges of a changing world and growing expectations for better performance. This involves substantial reorientation and reform of the ways health systems operate in society today: those reforms constitute the agenda of the renewal of PHC." - p. xii.