"Health for all by the year 2000": a mere slogan or a workable formula?

In the last decade WHO launched its world-wide Health for All by the Year 2000 (HFA 2000) campaign. This has also been picked up by the WHO European Region and by individual countries within that region. In this context The Netherlands has started up work on a Health 2000 Report. In this article, the work on this report and its underlying model are carefully reviewed in the light of the HFA 2000 strategy, and the HFA 2000 goal is evaluated in the light of the health problems Western European countries are controlled with. The conclusion is that all three main elements of the HFA 2000 strategy are useful for long term health planning efforts in the European Region. Health for All by the Year 2000 is not a mere slogan but has proved to be a workable formula.     

HFA与PHC的全球发展政策导向及策略

30年前,世界卫生组织提出了2000年人人享有卫生保健(HFA)目标和初级卫生保健(PHC)的全球战略。至此,HFA和PHC一直引导世界各国卫生系统的发展方向,指引各成员国朝着人人享有卫生保健这一宏伟目标迈进。当世界迈入21世纪之际,HFA与PHC是否仍然是各国卫生系统的发展方向?其内涵发生了哪些变化?在评价和衡量HFA和PHC实施效果方面国际上有哪些新的进展等问题。这些问题的研究与重新思考将对我国目前卫生改革导向有重要的启迪。     

Evaluation of the European strategy for Health for All by the Year 2000.

For the first time ever, Europe has a concrete, comprehensive and forward-looking health policy framework. Forming part of the worldwide movement for Health for All (HFA) by the Year 2000, the European regional HFA strategy, embodied in 38 specific targets. has been developed by the 33 Member States of the WHO European Region. Completed in 1985, the first evaluation of overall progress in implementing this new health policy has shown that the regional targets may be ambitious but they are viable and realistic. Certain countries have already achieved some of the targets, but even in these countries efforts are still needed to improve equity among social groups. Performance in key areas such as orientation towards primary health care and the provision of safe water and adequate sanitary facilities, although improving, is still not at the levels hoped for and these remain priority items. Even more serious difficulties are apparent in other areas such as healthy lifestyles and the quality of care. The quality of the information available, even in an area as developed as Europe, also leaves much to be desired. The gaps and weaknesses identified must be tackled urgently if the goal of HFA is to be achieved, but there are encouraging signs that the HFA movement in Europe has now really started.     

Health services, health manpower, and universities in relation to health for all: an historical and future perspective.

The World Health Organization's goal of Health for All by the Year 2000 (HFA) has become a major force in national and international health policies. This paper deals with some of the historical roots of HFA and describes ways in which the major components of the health sector--health services, manpower, and universities--have evolved and should evolve in the future if they are to support the idea of HFA. One conclusion is that the changes called for in relation to HFA are not simply incremental extensions of previous values, structures, and functions. Rather a radical break with the past is often required. To expect otherwise is to misunderstand how fundamentally the concepts of HFA differ from values that have governed the health sector in the past. A second conclusion is that recent decades have seen a remarkable progression of new ideas and changes in the health sector, so much so that the changes called for by HFA are not so improbable as one might otherwise think.     

Is primary health care progressing in Europe?

Primary health care (PHC) is the key to attaining the goal of health for all (HFA) by the year 2000. Also the European countries have accepted the declarations and WHO resolutions related to global and European HFA strategies. However, the implementation of regional and national strategies has met with many obstacles, caused by reluctant attitudes and poor planning and management systems. In this review the objective of PHC in industrialized countries, the evaluation process of HFA strategy, and progress in PHC in Europe in the 1980s are discussed. Lack of defined national objectives, and health information systems which are not adopted to purposes of monitoring progress in PHC are causing most of the problems in evaluation. There is a clear positive development in PHC resources and organization in the Nordic countries. Generally speaking PHC is progressing very slowly in Europe, if there is any progress at all. This can be said both about organization of health care, planning and management systems and about application of PHC principles like community participation and intersectoral collaboration. The national health information systems should be quickly revised to allow more exact monitoring of progress towards the 38 European targets and additional national targets.     

广东省“2000年人人享有卫生保健”成果分指标分析

文章对广东省 115个有农村初保任务的县 (市、区 )进行了一次针对省级审评结果的分指标分析 ,结果表明 ,全省初保审评平均总得分为 85 .43± 5 .7。115个县级单位中有 94个达标 ,余 2 1个为基本达标。从指标的得分情况看 ,各大项指标的得分率均超过标准分值的 6 0 % ,得分率超过标准分值 70 %以上的指标数占总指标数的 90 .7%。从 12项大指标 33项分指标的进一步分析表明 ,大多数分指标的完成率较高 ,表明广东省农村初级卫生保健工作已取得显著的成效。全面分析也发现 ,有少数分指标在少数县级单位的得分率还比较低 ,甚至有零的现象 ,事实说明农村初级卫生保健是一项十分艰巨的工作 ,要取得圆满的答案 ,还需下阶段的继续努力     

Can health promotion and primary health care achieve Health for All without a return to their more radical agenda?

Primary health care (PHC) and health promotion (HP), codifiedin the Alma Ata Declaration of 1978 and the Ottawa Charter of1986, and aiming to achieve Health for All by the year 2000(HFA 2000), are strikingly similar in their conception and evolution.Originally conceived as global strategies to reduce inequitiesin health between and within nations and emphasising intersectoraland community action, both have tended to be reduced to a morelimited and technical approach to selected diseases within nations. In the implementation of these strategies, four trends threateningthe achievement of HFA 2000 are analysed. Managerialism, manifestingin a goals and targets approach to health promotion has cometo dominate and constrict its implementation in Australia andother industrialised countries, detracting from social and environmentalimperatives and community action in addressing these. The increasingdominance of market economics and the promotion of economicgrowth at all costs is reinforcing inequities in health experienceglobally and within countries. Individualism, the philosophicalaccompaniment of market economics, has reinforced a behaviouraland lifestyle focus and undermined a collective approach toHP and PHC. Environmental degradation, a growing global threatto public health and ultimately amenable only to global economicrestructuring has been perilously ignored in the managerialistimplementation of HFA. The elements of an agenda for action are identified with somesuggested broader goals. A return to the original more radicalphilosophy underpinning the strategies of PHC and HP, it isargued, is fundamental to the achievement of HFA, even if thisis no longer possible by the year 2000.     

Future health: coping with change

WHO's Declaration of the "Health for All" (HFA) goal was pronounced in 1978 in Alma Ata, and it was planned that HFA would be achieved through primary health care programmes and approaches by 2000. However, it is now 2002 and despite the technological advancements in medicine, science, and ICT, Health for All is far from reality. Instead, more and more conflicts are emerging with lethal consequences, such as, bioterrorism, biological agent abuse, global-terrorism, and environmental destruction is occurring at a greater scale that we have witnessed before. We may have the latest technology and knowledge today, but ironically, we are using them to inflict more suffering and pain in the world. In the Asia-Pacific, the past 30 years has seen dramatic advancement and lifestyle changes. We are now paying a high price for such progress in terms of risk factors to the health of the population, such as, ageing diseases, obesity, smoking, diabetes, hypertension, and related conditions. The social, political, economic and environmental factors appeared to have deterred and negated WHO's HFA goal to attain basic human rights and health care for all. The HFA will not be achieved in the future if we do not learn from history and start taking measures now.     

The role of the nurse in health promotion

This paper describes and discusses issues concerned with therole of the nurse in health promotion work. It represents thefirst phase of a research project designed to explore this role,and presents the evolving philosophical framework for the study.The study is taking place currently in the United Kingdom andhas been made possible by the (first) award of a Post DoctoralNursing Research Fellowship to the project director. Against the backdrop of the World Health Organization's ‘Healthfor All by the year 2000’ (WHO HFA 2000) movement therehave been repeated calls for nurses to be the leaders in healthpromotion. Policy makers and educators have responded to thesecalls by claiming a central role for nursing and putting healthpromotion high on policy and training agendas. Very little attention,however, has been devoted to exploring the legitimacy and developmentof this role in nursing. Generally, nurses seem enthusiasticabout health promotion, and sure that they have a role to play.What is less certain is what this role is. The study seeks toclarify this by exploring policy, behaviour, and attitudes.Policy provides the framework for practice, and operates ata number of levels. In this early paper we review the literatureto explore policy and practice from international to grassrootslevels. We also make some initial observation derived from ourpilot work.     

Health for All indicators in health interview surveys

The World Health Organization's strategy of health for all 2000 (HFA 2000) has, among other things, attempted to reduce the actual differences in health status between and within countries. In order to evaluate the progress made towards the attainment of the HFA strategy, each country reports their status of achievement to the World Health Organization every 3 years. This study investigates the extensiveness and the methodology of interview surveys which measure health as a source of information for HFA in the European Region. This study focuses on the comparability of data which derive from the interview survey. The study shows that the different questions (related to the same indicator) in interview surveys mostly lead to incomparable information because there is a lack of uniformity both in phrasing and in the standards and methods used.     

Health for All in the 21st Century - an executive summary of the WHO's draft policy

Health for All (HFA) in the 21st Century is a World Health Organization (WHO) draft policy developed to help attain the goals of Health for All set forth at the Alma Ata Conference in 1978. The policy establishes, for the first 2 decades of the 21st century, global priorities and targets to create conditions supportive of people worldwide to reach and maintain the highest attainable level of health throughout their lives. Built upon past achievements in the context of the major global changes experienced during the past 2 decades, Health for All (HFA) in the 21st Century continues the HFA process, and is the result of a comprehensive process of consultation both with and within countries. While progress has been made over the past 20 years using primary health care to achieve HFA, a number of factors have prevented the ultimate attainment of HFA, with health most adversely affected in the relatively poorer countries. Both new threats and opportunities will present in the 21st century. The goals and targets for attaining the vision of HFA are discussed.     

Posyandu: a community based vehicle to improve child survival and development

The Indonesian government views health as a basic human need in order to live a productive life. HFA 2000 is a program that is part of Indonesia's national philosophy of Pancasila. Intercensal data indicates that women and children are not being reached by Indonesia's Health program, HFA 2000. Infant morality is 70/1000, maternal mortality is 4.5/1000 and the birth rate of 31/1000. These figures clearly show that the Trilogy of National development is not being shared by women and children. Indonesia developed a national health care system in the early 1980's in an attempt to bring progressive orientations and systems to mobilize all potential resources to increase health service coverage, community involvement, and intersectorial collaboration. In an effort to reduce infant and mother mortality and reduce the number of pregnancies, the 4th-5 year development plan formed an integrated service post called Posyandu which is the focus of this article. Special emphasis is paid to the role of Posyandu in efforts to overcome the major health problems faced by the women and children of Indonesia. The health care delivery system has several level, home and self care in 1st followed by community based preventative and promotive care (Posyandu), followed by basic professional care at health centers and clinics which are followed by 1st and higher referrals to district and advanced hospitals. Posyandu is a significant step towards HFA 2000 bring an integrated program of MCH, FP, nutrition, immunization and diarrheal control at the village level.     

脊髓灰质炎流行现状及控制对策

脊髓灰质炎（脊灰）是由脊灰病毒引起的急性肠道传染病,人是脊灰病毒的唯一宿主。1988年世界卫生组织提出2000年在全球范围内消灭脊灰,目前仅有阿富汗、印度、尼日利亚、巴基斯坦4个国家有脊灰野毒株本土病例报告。随着无脊灰目标的逐渐实现,口服脊髓灰质炎减毒活疫苗（OPV）的缺点逐渐凸现,如OPV在热带地区效力低,可引起疫苗相关麻痹脊灰（VAPP）及免疫抑制者长期排毒等,因此,继续使用OPV不能最终消灭脊灰。1996年,美国免疫实践咨询委员会推荐通过先使用脊灰灭活疫苗（IPV）再使用OPV的连续接种程序来增加IPV的使用,IPV的大量使用消除了活疫苗病毒的散播,也消除了VAPP。2008年,我国提出脊灰疫苗的免疫策略可借鉴国外成功的经验,逐步采用IPV替代OPV。目前已有学者进行了前瞻性研究,证实在中国以IPV替代OPV是可行的。     

Review of the radioactive waste management system in Nigeria.

The management of radioactive waste in Nigeria from early 1960 to date is reviewed. As in many developing countries, waste management in Nigeria has been shown to be ineffective. The factors that are responsible for this ineffectiveness are identified and discussed. The steps being taken by and the opportunities available to the newly established Nigerian Nuclear Regulatory Authority towards addressing this problem of ineffectiveness are discussed. The efforts of this newly set up body towards managing the resultant radioactive wastes that will be generated during the use of a reactor and an accelerator that will soon be commissioned in Nigeria are also mentioned. Likely ways of further addressing the problems militating against waste management in developing countries are suggested.     

Transfer of Health for All policy - What, how and in which direction? A two-case study

BACKGROUND: This article explores the transfer of World Health Organization's (WHO) policy initiative Health for All by the Year 2000 (HFA2000) into national contexts by using the changes in the public health policies of Finland and Portugal from the 1970's onward and the relationship of these changes to WHO policy development as test cases. Finland and Portugal were chosen to be compared as they represent different welfare state types and as the paradigmatic transition from the old to new public health is assumed to be related to the wider welfare state development. METHODS: The policy transfer approach is used as a conceptual tool to analyze the possible policy changes related to the adaptation of HFA into the national context. To be able to analyze not only the content but also the contextual conditions of policy transfer Kingdon's analytical framework of policy analysis is applied. CONCLUSIONS: Our analysis suggests that no significant change of health promotion policy resulted from the launch of HFA program neither in Finland nor in Portugal. Instead the changes that occurred in both countries were of incremental nature, in accordance with the earlier policy choices, and the adaptation of HFA program was mainly applied to the areas where there were national traditions.     

The rural health care system in China

The implementation strategy for health for all (HFA) in China is presented as a targeted effort toward the rural population which makes up 900 million of the total 1160 million population. The WHO objective of HFA by 2000 was accepted by China in 1983 and 1986. Socioeconomic development has improved considerably since 1949. Targets were established 1) to double the 1980 gross national product (GNP) and guarantee food, clothing, and shelter between 1981 and 1990; 2) to quadruple the 1980 GNP between 1991 and 2000, and 3) to attain the average income per capita of medium-developed countries. The political system is the Communist Party of China (CPC). The Chinese People's Political Consultative Conference, which is comprised of members of the CPC and other individuals from democratic and other organizations, fills an advisory role. The National People's Congress is the highest organ of state power and serves to legislate, supervise, and make decisions in some matters including personnel. The Standing Committee exercises state power when the Congress is not in session. It is a 1-chamber system (state administration, judicial system, and chamber system) and members of the People's Congress do not resign. Since 1949, the health system has grown to 209,000 medical and health institutions, 2.6 million hospital beds, 4.9 million medical and health workers, an average life expectancy that has increased from 35 years to 69 years, an infant mortality rate that has declined from 20% to 5.1% from 20%, and a maternal mortality that has declined from 150/10,000 to 9.4/10,000. Diseases such as cholera and smallpox have been eliminated and other diseases such as malaria and goiter have been brought under control. A cooperative medical and health care system which was established in the 1960s was replaced with a fee system in the 1980s, which has led to medical care problems for the rural poor. At present there is a rural medical insurance system and a cooperative health system with 3 tiers (health clinic, township hospital, and county professional hospitals). In 1990, there were village clinics in 87% of the villages. In 1990, central government and local management are implementing the objectives stated in 1) Program Objectives of Global Goals for Health by 2000 in Rural Areas, 2) Management Procedures for Primary Health Care, and 3) Evaluation Standards of Health for All by 2000. Implementation began in 1989-90, and stage 2 is to begin in 1991-95, and stage 3 in 1996-2000. The problems that will be encountered are investment, population growth, and personnel training.     

Mobilizing indigenous resource for primary health care in Nigeria: a note on the place of traditional medicine

Noting the challenges posed by the goal of health For All by the Year 2000, this paper re-echoes the need to mobilize traditional medicine for Primary Health Care in Nigeria. The paper points to the inadequacy of modern health facilities and the obstacles that stand in the way of providing enough modern health facilities to meet the demand of Nigeria's population by the year 2000. It is observed that traditional medicine offers an alternative model not only because it is relatively inexpensive both to the practitioners and patients who often settle their bills in kind or cash but also because of its acceptability among Nigerians. Finally, it is suggested that government and traditional medical practitioners should cooperate for it is in this way that the practice of traditional medicine can be improved and the practitioners encouraged to add Primary Health Care activities to the repertoire.     

Image--reality cleavage in development goals

Within a relatively short time since its inception a lot has been said on the concept of 'Health for All' (HFA). Its meaning and implications have been explored from various angles. Some have praised the idea as the very one we have been waiting for to improve health more effectively. Others have been sceptical. A few, particularly the hard core clinicians and laboratory-oriented health professionals, have been cynical. The overall outcome from the different viewpoints has been almost irreconcilable contradiction. HFA ideas will definitely work, say the proponents; if only we can objectively analyse the meaning and import of HFA, we could select what is feasible and reject the rest, advise the sceptics; HFA, insist the conservative and radical sceptics, is a terminological hotch-potch loaded with so many inexactitudes that the idea lacks direction, feasibility and acceptability even among the ranks of the majority of its proponents. Consequently, planning for HFA has been rather lacklustre in most countries. Failure is often hidden in obscurantist masses of data manipulated to support whatever position is sought to suit the desired situation. Curiously, while there is no dearth of experts on the meaning of data, the reliability of some data leaves much to be desired, their sources and method of collection being as peculiar as the results they imply. But, if the source is unreliable, so must be the outcome. What, then, is HFA and what are the needs to be met?     

Lethal inhalation exposure during maintenance operation of a hydrogen fluoride liquefying tank

Calcium sulfate adheres to the inside of liquefying pipes during the production of liquefied hydrogen fluoride. It is regularly washed away with water jets every six months. Two days before the operation, the pipes were experimentally washed down with water and the safety of the operation was confirmed with acidic washing fluid (pH 5). A 65-year-old man was severely sprayed on his face just after the start of the operation. He died half an hour later from acute respiratory failure. High serum concentrations of ionized fluoride indicated massive exposure to hydrofluoric acid (HFA). Pathological findings revealed severe bilateral pulmonary congestion and edema. It was hypothesized that calcium sulfate hardened with the water during the experimental washing and caused some blockages in the pipes. Consequently, choking of the pipes caused the HFA to collect and the washing fluid ran back. Weak HFA is not pungent to skin and mucous membranes. Therefore, it was suggested that a low concentration of HFA was inhaled directly into the peripheral respiratory tracts. No risk management against HFA exposure was in place during the operation. It is especially important to take thorough safety measures against inhalation of HFA. It is also essential that there are no stoppages of the pipes before the operation.