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.