Abstract
The right to health is proclaimed by the United Nations in the Declaration of Human Rights of 1948. In 1981, the right to health became a goal of the new Millennium. Nevertheless, in the Millennium goals, the concern for health occupies only the fourth position. Why is health not, for the Millennium, a priority goal and, more precisely, the first? What are the implications of a “secondarization” of health care? Our point will be to demonstrate why we should not count on the Millennium goals to achieve “health for all,” In this paper, we will first refer to the theories of justice implicitly evocated by policies that give or do not give a priority to health care. Secondly, we will describe the ethical basis which supports the primary health care definition and the policies which pursue this aim. Finally, we will show that we would take a better account of both poverty and “health for all,” if we would conceive primary health care not only as fundamental needs but also as capabilities (as A. Sen or M. Nussbaum does).
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Notes
- 1.
Declaration of Alma-Ata, International Conference on Primary Health Care, Alma-Ata, USSR, 6–12 September 1978, § 5.
- 2.
Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948.
- 3.
Unanimously adopted by the Health World Assembly in 1981.
- 4.
International conference on primary health care organized by the WHO and the UNICEF in 1978.
- 5.
Originally, the basic principles and values of PHC recognized during the Alma-Ata Conference were: (a) essential health care based on practical, scientifically sound and socially acceptable methods and technology; (b) universal access to and coverage of health services based on health needs; (c) commitment, participation and individual and community self-reliance; (d) intersectoral action for health; (e) cost-effectiveness and appropriate technology, as the available resources permit; (f) health service provision and health promotion.
- 6.
Declaration of Alma-Ata, § V.
- 7.
Considering that some very important health-related problem areas are not covered by the MDGs, including noncommunicable diseases, human resources, health systems functions and health information systems (see Kekki 2003: 1).
- 8.
Target 1 of the Millennium goals is to “Halve, between 1990 and 2015, the proportion of people whose income is less than one dollar a day.”
- 9.
Another reason that reinforces this position is that only the MDGs targets of halving income poverty and halving the proportion of people with access to safe water may be, actually, achieved.
- 10.
In fact, attitudes, such as communitarian social assistance, were different throughout history and will still change.
- 11.
In fact, primary health care is not a “limited package of interventions for poor people” but the basic strategy of health systems to ensure greater coverage and equity.
- 12.
The goal’s Millennium 4 is to: “Reduce child mortality.” It is associated with Target 5: “Reduce by two thirds, between 1990 and 2015, the under-five mortality rate.” Likewise, Goal 5 is to “Improve maternal health” and Target 6 is to: “Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio.”
- 13.
Reciprocally, primary health care also facilitates, by itself, the attainment of MDGs in the time limits envisioned (see P. Kekki 2003: 1).
- 14.
“In getting an idea of the well-being of the person, we clearly have to move on to ‘functionings’, to wit, what the person succeeds in doing with the commodities and characteristics at his or her command. For example, we must take note that a disabled person may not be able to do many things an able-bodied individual can, with the same bundle of commodities. A functioning is an achievement of a person: what he or she manages to do or to be. It reflects, as it were, a part of the ‘state’ of that person. It has to be distinguished from the commodities which are used to achieve those functionings” (Sen 1985: 6–7).
- 15.
Each functioning refers to what is valuable in human life, as, for instance, the absence of illness, health, social participation, etc.
- 16.
Goal 6 of the Millennium is to “Combat HIV/AIDS, malaria and other diseases” and Target 7 is to “Have halted by 2015 and begun to reverse the spread of HIV/AIDS”.
- 17.
See M. Nussbaum’s Capabilities 2 and 3.
- 18.
Functional capabilities are, therefore, components of a positive liberty and freedom is thus understood as an absence of internal and external constraints.
- 19.
Because, as we saw, a more relevant interpretation of functional capabilities is to conceive of them as components of a positive liberty.
- 20.
As Kekki recalls it, “it is unrealistic to expect attainment of the MDGs without organized PHC [primary health care]. A proper way must be found through which these two apparently contradictory approaches support and supplement each other (Kekki 2003: 12).
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Lafaye, C.G. (2013). The WHO Policy of Primary Health Care. In: Merle, JC. (eds) Spheres of Global Justice. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-5998-5_50
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