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The International Context for Global Health 



The World Health Organisation

Efforts to improve health at a global level have their beginnings with the inception of the World Health Organisation (WHO) in 1948. Its early work focused on communicable diseases and then in the 1960s it began to address the issue of how to provide services for people living in rural situations.

In 1977 the World Health Assembly of WHO called for the attainment by all people of the world of a level of health tht would permit them to lead a socially and economically productie life. This was summarised as the goal of Health for All (HFA)

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Alma Ata and Health for All by the year 2000

In 1978, WHO and UNICEF co-sponsored the historic International Conference on Primary Health Care in Alma-Ata. Here the international development community adopted Primary Health Care as a key to attaining the goal of Health for All and set a date of the year 2000 for the achievement of this.

1979 saw the official launch of the Global Health Strategy by the World Health Assembly and in 1981 it adopted a series of targets and indicators to give tangible effect to its aspiration of Health for All by the year 2000

As the fundamental conditions and resources for health are 

  • peace
  • shelter
  • education
  • food
  • income
  • stable eco-system
  • sustainable resources
  • social justice and equity

it was recognised that health could not be achieved by health services alone and intersectoral action was required as well. 

It also recognised that individuals also need to be able to have control over and to improve their health. This involves empowering individuals and creating the environment around them whereby this is possible - a process of health promotion.

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Health Promotion, Healthy Settings and Healthy Cities

These were enshrined in the Ottowa Charter in 1986. This recognised the need for environments to support health and the value of placing a focus on settings that would promote health. 

1986 also saw the launch in Europe of the Health Cities Project, an intersectoral approach to health with the setting being at the level of cities and towns. It engages local governments in health development through a process of political commitment, institutional change, capacity-building, partnership-based planning and innovative projects. The project now includes cities from around the world, though uptake has been greatest in Europe where uptake where are are now 1,200 health city projects in around 30 countries.

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Millenium Declaration

The UN Millenium Summit, Millenium Declaration and the Millenium Development Goals are closely linked. The setting approach of the Millenium Villages initiative was developed as a way achieving the Goals. 

As the year 2000 approached it was realised that the aspiration of Health for All would not be achieved in that timescale and planning had to be made for the years beyond the turn of the millenium. 

Significantly, the next step was not a WHO initiative. Instead it was it came from  the General Assembly of the United Nations at its Millenium Summit on 6 - 8th September, 2000. 

At its conclusion world leaders unanimously adopted a "United Nations Millennium Declaration" . The declaration contained eight chapters covering 

  1. Values and Principles
  2. Peace, Security and Disarmament
  3. Development and Poverty Eradication
  4. Protecting our Common Environment
  5. Human Rights, Democracy and Good Governance
  6. Protecting the Vulnerable
  7. Meeting the Special Needs of Africa
  8. Strengthening the United Nations

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Millenium Development Goals 2000 - 2015

The Millennium Declaration led on to the Millenium Development Goals, originally developed by the OECD, were particularly promoted in the years following the summit.

The Millenium Development Goals are

  • Eradicating extreme poverty and hunger
  • Achieving universal primary education
  • Promoting gender equality and empowering women
  • Reducing child mortality rates
  • Improving maternal health
  • Combating HIV/AIDS, malaria and other diseases
  • Ensuring environmental sustainability
  • Developing global partnerships for development

In a similar way to Health for All 2000, a set of targets were identified for each of these goals for achievement by the year 2015. These were developed by The Millenium project, which was commissioned by the United Nations Secretary-General in 2002 to develop a concrete action plan for the world to achieve the Millennium Development Goals.

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Millenium Villages

Meanwhile the UN Millennium Villages initiative, which represents a settings approach to achieving the millenium development goals, was initiated in 2004. There are now 11 of these based on the idea that impoverished villages can transform themselves and meet the Millennium Development Goals if they are empowered with proven, powerful, practical technologies. 

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Agenda for Sustainable Development : The Sustainable Development Goals 2015 - 2030  

After widespread consultantion involving over 60 countries, the United Nations developed an Agenda for Sustainable Development and adopted 17 Sustainable Development Goals to cover the period 2015 - 2030. Each goal has targets to achieve by 2030. 

The agenda "provides a shared blueprint for peace and prosperity for people and the planet, now and into the future. At its heart are the 17 Sustainable Development Goals (SDGs), which are an urgent call for action by all countries - developed and developing - in a global partnership. They recognize that ending poverty and other deprivations must go hand-in-hand with strategies that improve health and education, reduce inequality, and spur economic growth – all while tackling climate change and working to preserve our oceans and forests".

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