'Health-for-All' in the twenty-first century: a global perspective.

Changes in the broad determinants of health since the Alma Ata Conference in 1978 necessitate a renewed examination of the underlying principles and focus of the Primary Health Care (PHC) strategy. The PHC approach has been adopted by most countries and has led to improved access to certain basic health services. However, the health gains in other areas are less encouraging. Some elements of the PHC approach, for example, the effective implementation of equity-oriented health policies and the need to improve management principles within health services, have yet to be fully implemented. Moreover, to address the underlying determinants of health status, the World Health Organization's (WHO) renewed global health policy will have to include certain issues that were not considered at Alma Ata. For example, the health impacts of global recession and globalization and the need for human-centered sustainable development strategies were not considered at Alma Ata. A renewed global health policy will also have to consider demographic, epidemiological, environmental and technological changes that have emerged since 1978. It is important that WHO's renewed policy be based on sound evidence, a commitment to ethical principles and broad use of partnerships for health at global, national and local levels. One implication of this new context of health development for the renewed health policy will be that 'thinking globally and acting locally' will have to complemented by stronger global action to protect local and national health.