'Health for All' and neoliberal globalisation: an Indian rope trick

Mohan Rao


By the late 1970s widespread international disillusionment with existing technology-centred programmes in the health sector, along with recognition of the need to provide sufficient coverage to rural populations and the faltering integration of preventative and promotional programmes, together contributed to the WHO-UNICEF initiative that led to the declaration of the goal of ‘Health for All’ through primary health care at Alma Ata in 1978. At this point, the WHO saw a ‘major crisis on the point of developing’ in both the developed and the developing world as a result of the ‘wide and deep seated error in the way health services are provided’. This coincided with the growing awareness among international agencies of the failure of the family planning approach to the problem of poverty. They accepted the need for integrated programmes and the satisfaction of the minimum needs of the population in order to meet demographic goals. The World Bank and the Population Council both endorsed this ‘developmentalist’ perspective.  The 1980s however saw the Keynesian world increasingly under attack from neoliberalism and globalisation, and by the end ‘actually-existing socialism’ also had been overthrown. In these circumstances, the goals of Alma Ata became impossible to achieve. ‘Health for All’ was soon replaced by the oxymoron of ‘Selective Primary Health Care’, and both UNICEF and the WHO beat a retreat from Alma Ata.  There was a widespread misconception that primary health care was something that concerned only poor countries, and that it only had to do with the provision of the most essential health care. What was, above all, forgotten was that health is only partly an outcome of health interventions. But with neoliberal globalisation even those interventions were now to be increasingly based on market principles.

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