“To promote the spirit of Alma Ata, conditions are better than ever”
The 30th anniversary of the 1978 Alma Ata Declaration was marked by a celebration in Brussels on October 17, 2008. During the program, two PHM activists were interviewed on the significance of Alma Ata and the way forward in the struggle for the right to health. Here are some excerpts from this interview with Arturo Quizhpe from Ecuador and Wim De Ceukelaire from Belgium.
What do you remember from Alma Ata and how did you learn about it?
Arturo: This brings me back to the years I was active still in a youth movement. In Latin-America there was a lot of hope and mobilization back then, and we are glad to see the same spirit again, thirty years later, specially in South-America. So, Alma Ata has been a part of our lives since we were medical students.
Wim: I learned about this conference much later, when I was a medical student. At that time I had this idea that I'd chosen the wrong course. I thought a doctor can help one individual, but an economist can help billions of people who live in poverty. When I learned about the principles of Alma Ata, I realized you can have it all: you can be a doctor and an economist! I discovered the political economy of health.
You've been involved in international health meetings and conferences. Did you ever have any similar experience?
Arturo: Three years ago, we hosted the second People's Health Assembly in Cuenca where representatives of more than 85 countries registered. After the assembly we realized 105 countries were actually represented at that meeting!
At this meeting, a spiritual feeling took hold of us: an identification with the people. The four elements, fire, wind, water, earth, were presented in a ceremony by different indigenous artists, giving a holistic sense of health to those present. It was a feeling best expressed in this way: nothing is possible without health.
In 1978, the experience of the barefoot doctors in China had a big influence on Alma Ata. It must also have been felt in the Philippines where you've worked for several years. Could you tell us more about it?
Wim: In the Philippines there were similar experiences but they came from a completely different background. They also appeared in the 70s, which is why I don't think they are related. The Community Based Health Programs started as experimental programs of religious sisters. I've actually worked with some of them. Even in the 90s, the pioneers of this movement were still active. They're trying to go beyond primary health care. They are actively try to empower communities so they are able to assert their right to health.
Arturo, did you have similar experiences in Latin-America?
Arturo: Thirty years ago, when we were studying, there were only three medical schools in the countries. Barefoot doctors were a simple fact, especially in the regions inhabited by the indigenous population. Most of what I've learned about Western medicine, I've learned from traditional healers. As a student I endeavoured to 'teach' the local healers many things: it turned out the other way, and I adopted many of their ideas and practices. For instance, we still have group of healers called, Weseros, popular traumatologists. In medical school we had only one specialist in traumatology. It was when we went to the community that we discovered a lot of expertise.
Six years ago, I had the opportunity to invite many of the traditional healers to the medical faculty where I am the dean. Some of the teachers found this gravely insulting, because they could not accept being lectured by a 'bunch of ignorants'. Afterwards, many of them changed their minds.
Did development aid help to bring about better health in the South?
Arturo: A lot of the money intended for development aid, has been wasted on selective, 'horizontal' programs. We have been working on the issue of child malnutrition for the last ten years, because it affects 70 percent of children. When it was decided action was needed, the advisory committee wasted all the available funds in one single year, with nothing to show for. That's why we need to empower the people, so they can speak up for themselves, especially in these trying times.
Why is it, that Alma Ata faced so much resistance?
Wim: It always comes down to a question of priorities. After Alma Ata, the idea of selective primary health care was popularized by people from the Rockefeller Foundation. That's the same organization that had promoted colonial medicines in the US in order to increase the productivity of the local labor force. That's why they introduced disease specific programs against the ailments that posed a threat to the productivity in the colonies. Today the same choice has to be made: profit or social justice.
Another example can be found in the ideas the World Bank promoted in the 90s: they assumed the management of a small clinic was similar to running a supermarket, or that a hospital was essentially like a huge factory. They thought that they could invest in the health sector like any other economic sector. Hence the privatization of health care facilities. Today, privatization is not just limited to health care. Also health policy making is being privatized. The budget of the Gates Foundation is bigger than that of the World Health Organisation. The bottomline is always the same: it's a choice between money and social justice.
Do you think the principles of Alma Ata are still relevant today?
Arturo: Of course. I think the principles are very relevant and we need to empower the people with these principles. We have to look for the principles, for the spirit of Alma Ata; That means health needs to be considered a human right, just like other rights. For any human being, bad health means there is no or little work available. Food security deteriorates, the quality of life is lost. That is why it is so important to work towards better health for all. This implies that we must face the many obstacles, national and international. It's important to remain vigilant on these issues.
What can we do to keep the spirit of Alma Ata alive?
Wim: I think it's important to acknowledge that we are in a much more favorable position than 30 years ago. A couple of weeks ago I attended a meeting with Sir. Michael Marmot, the chair of the WHO Commission on Social Determinants of Health. When someone asked him about the difference with the time of Alma Ata he answered that the most important difference is the enormous amount of evidence we have now for the importance of social determinants of health. Today we have a much stronger evidence base, much more scientific evidence to support these principles.
I think it is very important for us to realize this, before we start thinking about what kind of action we can take.
What can we do? We are already doing many things. Our activities with the Platform for Health and Solidarity here in Belgium, for instance, are a success. Academics meet with trade unions and other social organizations, such as NGOs, from North and South. I am convinced that are very successful movements that are able, even today, to put these principles of social justice for health on the agenda.
