Last week was a fascinating one. On Monday I delivered a memorial lecture at the City Health 2013 conference in Glasgow in honour of Allison Chesney and Eddie Killoran, two profoundly respected harm reduction activists. Much of the lecture focused on the failure of the HIV/AIDS response to effectively engage with key affected populations.
It was quite fitting then to be speaking later in the week at an event in Kazakhstan marking the 35th anniversary of the Alma Ata Declaration.
I began by focusing on how our experience with the health-related MDGs has shown us that a limited number of goals that are measurable, easy to communicate and adaptable to both global and local contexts, can be a powerful catalyst for action.
We can be proud of the gains that the MDGs have helped us to collectively achieve over the past 15 years, including major gains in child survival; the halving of the global rate of maternal mortality; close to 10 million people receiving antiretroviral therapy; AIDS deaths falling by 25% in less than a decade; new HIV infections falling by more than 20% in the past decade; malaria mortality falling by a quarter in the last decade, saving more than a million lives; death rates from TB at the global level and in several regions are likely to have been halved between 1990 and 2015, and the world as a whole should reach the MDG target of halting and reversing the spread of TB.
I then made the point that it was remarkable to think, in hindsight, how many of these factors and approaches that proved to be the ingredients of success in our response to AIDS, TB, malaria and child mortality, can be traced to the wording of the Alma Ata Declaration which I strongly believe has guided these successes. And I was moved by the presence in the audience of Professor Shuramov, who was minister of Health of Kazakhstan in 1978 and a major inspirer of the Declaration.
Ideas such as inter-sectoral participation; peripheral delivery/ primary health care, maximum community participation, the use of appropriate technologies, the role of governments in mobilizing the necessary resources and the idea of a fairer distribution of global resources are enshrined in the Declaration.Now is our moment of opportunity.
Today, 35 years after Alma Ata, 15 years after the Millennium Declaration, and as we work to give life to our new goal of universal health coverage, we have a tremendous opportunity to replicate the successes and learn from the failures of all our efforts so far. Some of the ingredients needed to achieve this include:
1. Avoiding replaying stale debates, such as the one between "vertical" and "horizontal" approaches, between strengthening systems and tackling major health priorities, recognizing that both are essential, and ensuring that both are visible: politically, strategically, in what is delivered and in the outcomes achieved.
2. This means, for example, building on the strengths of the global partnerships that have responded urgently and effectively to diseases and democratized health governance, while at the same time helping to create the human and financial resources needed to deliver other key preventative and treatment interventions, including hygiene education, vaccinations and antenatal care.
3. We must pay much more attention to the economic and social determinants of health, to address inequity, and to remove the social and structural obstacles to care and heath delivery. Here I think particularly of stigma and discrimination in health settings, of the lack of targeted health information, and of legal and policy settings that criminalize and punish the most vulnerable in concentrated epidemic settings around the world.
I ended my presentation by reminding the audience of those challenges that still face us: after 15 years of work, marginalized groups continue to lag behind on all the MDG goals and targets; inequities are rising, despite economic growth; 19,000 children die every day from preventable diseases; only half of pregnant women in developing regions receive the minimum standard of antenatal care; nearly 50 million babies are delivered worldwide every year without skilled attendants; 2.5 million new HIV infections occur every year; more than one third of TB cases are still not treated using the DOTS protocol and drug-resistant TB remains one of our greatest public health challenges.
I believe that many of the ways to address these challenges are to be found in the text and the spirit of Alma Ata. And I am confident that if we continue to draw upon its vision, while also building upon the progress and lessons of the MDGs, we will be able to achieve so much more in public health.