A social contract for health

A social contract for health Delegates from almost all of the 156 Member States of WHO gathered in Geneva in May at the Thirty-fourth World Health Assembly. As the main governing body of the Organization, the Assembly endorsed the strategies which will impel the world towards the goal of Health for all by the year 2000 Dr Halfdan Mahler, Director- General of WHO. Director-General's speech In an address at the start of the World Health Assembly Dr Halfdan Mahler, WHO's Director-General, told the dele- gates: "Four years ago you decided to adopt as your target what is popularly known as Health for All by the Year 2000. During the present Assembly you will be considering a Global Strategy for reaching that target... Now what will you do with the strategy once you have adopted it, in whatever final form you decide to adopt it? Much will depend on how you conceive of it. According to my conception it is 'no less than a contract, a contract for health, not legally bind- ing, morally binding, a social contract for health, accepted voluntarily by equal partners ... More than 200 years ago Jean- Jacques Rousseau, citizen of this very Geneva in which this Assembly takes place, described the nature of such a social contract. Now listen to how he described it : " ... a form of association which defends and protects with the whole force of the community the per- son and property of every associate, and by means of which each, coalesc- ing with all, nevertheless obeys only himself and remains as free as before." 28 Dr Mahler went on: "I have had occasion before to remind you that world health is indivis- ible. This is certainly equally true of the Global Strategy. Its success will clearly depend on the extent to which it is be- ing reflected in regional strategies and translated into action in countries. For it is there, in countries, where people live and work and learn and dream and suf- fer, it is there that health is made or bro- ken. lt is there that the world's many, living in squalor, can each spare only a few dollars a year to maintain their health, in spite of the dire social and economic consequences of their ill health. And it is there that the world's few, living in affluence, each spends hundreds and hundreds of dollars a year in the mad r.ush to keep up with the latest in medical technology, without much thought for its social and eco- nomic consequences. Dr Meropi Violaki-Paraskeva, of Greece, President of this year's World Health Assembly. Harmony and cooperation As the elected President of the As- sembly, Dr Meropi Violaki- Paraskeva (Greece) called for harmony and co- operation among nations to achieve the goal of Health for all. She told the delegates: "The pro- gress so urgently required in the field of health, where needs are so great, can only be achieved through harmony and cooperation among all of us who are gathered here today. The people of the world have high expectations of us all-every one of us." The nations of the world working in concert had made possible the eradica- tion of smallpox, she said, but there was a need in both developing and devel- oped countries "to look as well at our inadequacies." Among the problems she cited were : - In developing countries, half of the babies born die before they reach one year of age, and 50 per cent of all deaths occur among children under five. - Infectious and parasitic diseases take a heavy toll in life. Yet, water supplies, sewage disposal systems, and immun- izations have proved effective in reduc- ing the incidence of these diseases and diminishing their devastating effects. - Malaria has made an alarming reap- pearance after briefly subsiding. - The "diseases of civilization"-car- diovascular diseases, cancer, diseases of the nervous system, and degenera- tive diseases-are "formidable and frightening because their treatment is still somewhat unknown." - Alcoholism, drug addiction, and traf- fic accidents, once regarded as prob- lems only in the industrialized world, now cause unnecessary disability and death in both developed and develop- ing countries alike. M rs Gandhi at the Assembly "Life is not mere living but living in health, the Right Honourable Mrs lndira Gandhi, Prime Minister of India, told the Assembly. She went on: "The health of The Right Honourable Mrs lndira Gandhi, Prime Minister of India, addressed a special session of the Assembly. the individual, as of nations, is of pri- mary concern to us all. Health is not the absence of illness but a glowing vitality, a feeling of wholeness with a capacity for continuous intellectual and spiritual growth ." Mrs. Gandhi said: "Smallpox has been the latest of the epidemics to be eradicated, and an estimated billion dollars have been saved by giving up compulsory vaccination. But is it being used to assist other developmental work on health? In fact the story of international assistance tells us that development does not command the enthusiasm that defence does." She underlined the need for primary health care to be within reach of all people, in terms of' distance as well as money, and for health to go to homes instead of larger numbers of people gravitating towards centralised hospi- tals. She told the delegates : "A coun- try's progress is generally judged in terms of its Gross National Product. But surely the health of the people is also a significant yardstick ... That is why we must stress the need for a health revolu- tion in developing countries, not only to wipe out diseases and to make available specialised treatment, but what is equally essential, to provide basic health care and to take preventive measures." Referring to the campaign against malaria in India, Mrs Gandhi comment - ed : "The cunning and urge for survival of thE? ubiquitous mosquito has outwit- ted us, and has proved stronger than we had realised , and he--or rather she, for I am told that the female is far more deadly-has returned to disturb our sleep." She also called for a special interna- tional programme to safeguard children from blindness by encouraging the addition of green vegetables in early childhood diet and by simple treatment. A general view of the assembled delegates during their three weeks of talks at the Palais des Nations in Geneva, Switzerland. Global strategy The delegates attending the Thirty- fourth World Health Assembly held in Geneva in May approved a Global Strategy which describes the broad lines of action to be undertaken at poli- cy and operational levels, nationally and internationally, in the health and in oth- er social and economic sectors, to attain Health for All by the Year 2000. The kind of global targets that coun- tries will consider by the end of this century, taking into account their social , economic and health situations, include: - all people in every country will have at least ready access to essential health care and to first-level'referral facilities; - all people will be actively involved in caring for themselves and their families, as far as they can , and in community action for health ; - communities throughout the world will share with governments responsi- bility for the health care of their mem- bers; - all governments will have assumed overall responsibility for the health of their people ; - safe drinking water and sanitation will be available to all people; - all people will be adequately nourished ; - all children will be immunized against the major infectious diseases of childhood ; - communicable diseases in the devel- oping countries will be of no greater public health significance in the year 2000 than they are in developed countries in the year 1980 ; - all possible ways will be applied to prevent and control non -communicable diseases and promote mental health through influencing life style and con- trolling the physical and psychosocial environment ; - essential drugs will be available to all. The text of the Strategy concludes : " If the world's political, socio-econom- ic and health leaders are provided with suitable information, and heed this in- formation, there is every reason to believe that the intercountry coopera- tion required to implement the Strategy will take place, and that the necessary resources can be generated and mobi- lized .. . In spite of the seriousness of the problems involved and of the complex- ity of the measures to resolve them, there is every reason for optimism that the Strategy can be implemented, and that its successful implementation will be a landmark in the social history of mankind ." 29