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Alma-Ata Declaration of ’Health for all’: A generation old quest with trivial conquest

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Health is the most precious asset of every human being, as we all endure the right to live in a full state of bodily, mental, social harmony without the pain and suffering. But, as of today, not everyone relishes such a sacred possession. According to the estimates by the United Nations statistics, the most current world population is 7.7 billion as of November 2019. By another report published in lancet as of 2015, Over 95% of the world’s population had health problems, with over a third having more than five disorders. Ten percent of the world’s population presently lives in deprivation without access to adequate medical care and clean water. It encompasses one billion populations living below the World Bank poverty line of $1.90 per day.

Although Global life expectancy increased by 5.5 years to 72.0 years between 2000 and 2016, and healthy life expectancy improved by 4.8 years to 63.3 years, nonetheless, progress has hampered, or trends are in the wrong direction for a specific population. The proportion of children aged less than five years who are overweight, malaria incidence, harmful use of alcohol, deaths from road traffic injuries, and water-sector official development aid.

Poverty is the impetus of inadequate health and Poor health that ambushes communities in scarceness with Infectious; and neglected diseases while killing and weakening millions of the neediest and the most vulnerable each year, creating a vicious cycle of illness and economic disaster. Lives lost is an economy under attack, undermines productivity as well as a personal value. In heavily affected countries billions of dollars of economic activity is lost each year as a result of illness and death from HIV, TB, and malaria, where even the most charitable foundations won’t be able to sustain it unless a fundamental solution is executed.person walking on hallway in blue scrub suit near incubator

This brings us back to the International Conference on Primary Health Care (PHC), Almaty (formerly Alma-Ata), Kazakhstan, in September 1978 when the Declaration of Alma-Ata was adopted at the former Kazakh Soviet Socialist Republic. The avowal of 1978 was deemed the significant milestone of the twentieth-century public health initiative, defining and positioning primary care medicine as the crucial part to achieve “Healthcare for All” around the globe. The primary care model was inspired from the 1930s rural reconstruction movement in China (The barefoot doctor) who pioneered village health workers by training them in primary healthcare as part of a coordinated system, hence was formally adopted after 1965. Today we can appreciate a myriad of contemporary versions of barefoot Doctors as paramedics, nurse practitioners, and physician assistants. The declaration was organized to bring governments, the international organizations including the World Health Organization (WHO), UNICEF, agencies, non-governmental organizations, funding agencies, health workers and the world community to support national and global commitment to primary health care and to channel increased technical and financial support to its cause, particularly in developing countries.

The Alma-Ata announcement represented first of a kind initiative in history, holding up the vision of ” health for all”, which once again in 2004 was further underscored upon by the founder of Microsoft; Bill Gates, as he established the health for all foundation with the mission to revive war-torn areas like Syria and Africa. Although the agenda to start the project was made 20 years ago, but it came into existence long after on 4th of January 2004. The widespread vision of the evolving health for all campaign was primarily to help people live healthier, prolonged, prosper, and thrive. Still, despite the commonality of intuition, the mission is extensively diversified between the prevailing connoisseurs. Reasons pointing to the present-day controversies, but the most fundamental that I can come up with is the sociopolitical dissimilarities among International congregations. Such differences are on and about defining what equality, health, disease, rights, states role and primary care are, as every person, culture, and society have its interpretation of the embodiment.

In general term health for all is a plausible term to interpret a universally shared Mission, but I would confer healthcare without borders is a more realistic by character of what it stands for in the long run. It compels a practical application of the definition to every phrase we intend to use for this mission, but within the individual socio ideological framework.

Definition of health and disease

The WHO defines health as “a state of complete physical, mental and social well-being and not purely the absence of disease or infirmity.” The intention focuses on modernizing what common-sense connotation of health and disease would be in the 20st-century universally applicable norm, considering the availability of resources and technological development. Definition hence includes social and economic sectors within the spectrum to fulfill health as well as re-affirming health as a basic human right. Today as we are living through the 21st-century lifestyle; still not only we beget a long way to carry out a journey which was initially launched in 1978, but also since the World of science, technology and communication have quadrupled; this call for another revisit to definitions and reform of what is anticipated, rational and attainable.

Today health is considered the complete state of physical, mental, and social well-being that is in coherence with every individual subjective and objective expectations,  provided in particular moment, location, settings, and scenario. And it innately does not pertain directly to the absence of disease or infirmity.

Equality in health and healthcare delivery and realistic expectations

One of the intriguing aspects of the Alma-Ata proclamation is its indictment of inequality in healthcare salvage between the developing and developed realm. The declaration specifically highlights the spur of such imbalance as politically, socially, and economically motivated, therefore unflattering by all standards. What the treaty appears to overlook is what equality pertains to and how empirical would be! It comes off to me the equality between two people, entities, or societies are rhetorically motivated, as, practically, no two agents are meant to be identical. Besides, it does not cut the fact that everyone is entitled to equal opportunity because the recourse is the particular factor that would ultimately dwindle the quality rift by endowing individuals. The unevenness of opportunity is socio-politically inappropriate. A juncture that necessitates further articulation is the conception of conceding the significance of the realistic expectation. No matter how empowering our collective feats as responsible constituencies or individuals may be still, the core individualism within every soul will counterbalance the replica of quality. And we must all ratify and remember equality within its given context, be it in developed countries or developing societies by no means is the reflection of a decent quality of healthcare.

Health socioeconomic and right

The declaration calls for economic and social development to the success of health for all with emphasis on its positive effects on economic and social development as well as world consensus through publicity and insurance of the health of the people. So, under the notion that specifically underscores health as a “human right” and duty; the individual Participation of citizens or as a group was called for in the direction of planning and implementing their health care. Undoubtedly health is a fundamental human right. Yet, the context of declarations announcement on the fact that everyone must contribute to staying healthy in the eyes of a layperson brings about health as equal to healthcare, as we often meet socio-political catchphrases like” healthcare is a right.” The erroneous misrepresentation of the latter can be justified from the fact that a” right” is not and can’t be honored at the expense and undertakings of another person or persons, and since healthcare is a service that obliges another individual action (be a physician, nurse, etc.), thus, makes healthcare nothing short of a privilege.

Role of the governments in healthcare delivery

Another paragraph within the proclamation of 1978 emphasizes on the role of the government in furnishing adequate health and social standards to make sure the delivery of ” Health For All”; with even more articulation about the culmination of their responsibility by the year 2000. The latter evolved to be the campaign of the WHO in the following years post assertion. It defined Health for all as the accomplishment for all people of the world by the year 2000. Supported by the WHO; yet, as of this year, 2019, the mission is far from accomplished. The statute also urged governments, international organizations, and the whole world constituency to take this goal as an essential civic mark in the essence of companionable righteousness.

The concept of “Health for All by 2000” was initially denounced by experts due to limited feasibility and that the declaration lacked a clear purpose. Too, the idea of Primary Health Care (also referred to as Selective Primary Health Care) that originally was conceptualized by Marcos Cueto was condemned as being unrealistic, idealistic, and sweeping. In response to heavy criticisms, the Rockefeller Foundation too sponsored a Health and Population Development Conference held in Italy the following test at the Bellagio Conference Center in 1979 to further outline the objectives of primary health care and how to effectively fulfill the objectives of the “health for all” mission.

grayscale photography of nursing bed

Today looking back in time, we can behold; the majority of efforts done through direct state participation have been mostly focused on redistribution of wealth, utilitarianism, and bureaucratic overtures. All can be summarized under the notion of a top-down collective approach to a problem that is utterly buried within the grassroots of every society; the individuality of medical care and health. It’s profound that healthcare has become a sociopolitical inspired economic demon, but is the pervasive uninfected process that has not only ceased to function by failing to deal with the fundamental right of every individual but also has created a vicious circle of increasing costs and desperately wanted services that could be otherwise affordable to everyone. To cultivate and conserve the later environment would impose a high-level administrative oversight by enduring transparency, accountability, and fair access to everyone. Instead, what we have seen over and over again is partial transparency, micromanagement, and monopoly from the typical authority. Health for all is a rudimentary chore of every individual in an allotted society, given all the boundaries and blocks are eliminated by the remedy of the elected government officials.

Primary care, is it medicine or bureaucracy?

According to the common definition of the 1978 era adapted by the WHO the Primary Health Care is believed primarily to be the essential scientific-based health care system that is sound, socially acceptable medical practice and technology, which also make universal health care available to all individuals, and families in a community. It merely encompasses the common treatment of familiar problems by physicians with broader skill sets comprising family practice, pediatrics, internal medicine and Obstetrics and Gynecology. Although in theoretical sense, such a strategy may have a wailed standard; it faces significant challenges in the 21st-century application.

Primary care is a managed care concept that merely focuses on putting the hard majority of duty burden on physicians who selected to have extensive skill base vs abrupt sub specialties, hoping to reduce costs and create some organization. The primary care concept was applicable to the 20th-century because patients had restricted access to information, retained by limited proficiency of science and technology, and hence had lower expectations. In contrast, today, even the people under poor socioeconomic conditions have access to information, the standard of care has been diversified; broader duties to be dealt by primary care physicians. Not to mention the overwhelming bureaucracy that follows a conventional medical practice. Having said that primary care has been around for over three decades in the United States and is still the subject of major controversy as the contributor to physician burn out. This trend will potentially be ridden with more challenges; and the advent of value bases reimbursement models. During the last decades the common misconception has been to improve the supply of primary care services by expanding the scope of allied healthcare providers to cover some essential duties that initially had been within the set expanse of a medical doctor. But enabling allied providers such as Nurse practitioner, physician assistants to ease the burden has not worked much, as it represents nothing but expansion of capacities under different functioning. The educated person does not yearn to work under harsh, impoverished condition, live and in underserved neighborhoods. They expect a better life. It’s always preferable and essential to make the underserved communities a better place to live by nurturing and furnishing them with the logistics to prevail themselves rather than piecemeal funding the cause indiscriminately and enforcing protocols and mandates without a proper strategy to empower every single member within that population.

Criticisms of and reactions to the Alma-Ata Declaration

The major challenge is poor choice and opportunity, not insufficient availability and fiscal aids. Understandably, financial support and formulating resources are critical at the initial phases, but what is it good for, if not backed by solutions and supervisions that would govern the proper allocation of reserves in the hands of the constituency.

What UNICEF, WHO, and other world organizations can do is to offer Kickstarter through components using donations and temporary workforce, but the bottom line lays at the mercy of the government to lend a hand to their citizens, not through arm twisting cookie-cutter mandates but high-level supervision and executive surveillance.

Health for all is a glamorized sentiment of equal opportunity to stay healthy for everyone. Healthcare without socioeconomic and geographic boundaries is the realistic term, as no one in the real world is guaranteed healthy life. Because even given all the alternatives and resources, is the limited capability of every individual that sustains mighty ambition.

In the Modern healthcare the human intellect is diverse, thus making the already complicated socioeconomic factors of medical service delivery even harder. That points to why Bundling the healthcare visions and missions thru definition that observes every person (be it patient or physician or provider) under the same lens is impulsive and short cutting. Remedying healthcare system with a mission to expand quality care option for everyone requires fixing poverty; but not through distribution of obligation and consolidative efforts but through collaborative strategies and empowering hand which will move everyone from their comfort zone and will incentivize them to be independent, proactive and productive to themselves and to their fellow collaborators.

woman having blood pressure monitor

We are now headed to the era of high expectations, fictitious economic hyperinflation sprinting at the speed of light with a healthcare delivery system development wandering sluggard. Adapting the good judgment mission and Pacing it against accessible resources is crucial. To prevail, every government must guarantee transparency and barb accountability across the full scope of that mission. The passive solution, like monetary support, infrastructure development must occur commonly as a stepping stone to a more fundamental, active resolution that merely concentrates on procuring every individual within a given community and era the competitive edge, incentivizing them to restore the missing piece of the puzzle for their immediate neighborhood. Patient expectations are on the rise as current strategies are nothing but one-size-fits-all remedies and place all the responsibilities on primary Physicians.

The physician’s role is inadvertently shifting for the guiltier, from active participation to passive devotee of outdated bureaucratic protocols. It’s merely transpiring when they should be expanding their mindset to encompass technology and data science. Instead, physician’s practices have been taken over by corporate bureaucracy. Population health protocols do not suffice the contemporary medical practice, as it falls short attempting to deal with the growing expectations and poor distribution of physician power at a given juncture, under the erroneous assumption of physician shortage. The Alma-Ata declaration is a clear example of such shortfall of bureaucratic solutions; not because is unrealistic or ornamental, but because is outdated and the pace of adapting to change about other industries sluggish. The treaty would create a vacuum of urgent wish that gasps in more challenges. The end result is what we see today; a vicious circle of spending, high costs, poor delivery, and even higher cost. Worth speaking of the failure in the application of the exact solutions at hierarchy to everyone without taking into account the significance of uniqueness within every community. Application of the practical model under population health also requires a populist attitude with the authoritarian climate of policies. In the era that every system is shifting towards social autonomy, in the face of internet and data liberty, such an approach is destined obsolete.

Personalization is fair and flexible

Health is an individual endeavor. To thrive within the boundary of our lifespan, each one of us needs to stay in a greatest state of physical, emotional, psychological, social wellbeing, but given the opportunities and resources we have been able to make available for ourselves. Within the journey, we may temporarily but sure sporadically collaborate by holding hands, giving each other a push to kick start a practical solution, hence, living healthy. But no reflexive solution will sustain itself, if does not precede a fundamental proletarian active way out that will empower individuals. That is why personalized healthcare provides flexibility and liberty of achieving the vigorous participation of those in desperate needs; a mastery that the preponderance have lost through generations of authoritative system.

 Choice not obligation

No one is obliged to make sure quality care for others; even though is a good thing to do! Keeping in mind; undertakings driven by objective mandate of authorities or subjective sense of responsibility of its members is ultimately preordained to be short-lived and inclines to victimize individuals, hence counterproductive. What required is, reversing the victimization cycle affecting people along with empowering them by lending Choices and opportunities without prejudice. Alternatives and diversity of options in the face of necessary enlightenment cultivates curiosity. Curiosity in turn is the mother of all inducements and self-fulfillment. Rewarding the good deed is the key to a healthy life, a trait that has been missing from the latter declaration. The Alma-Ata treaty places the burden of obligation and responsibility on organizations, governments, and administrations that, in the majority of cases, are the ones that were the elements of impoverished healthcare accessibility to the communities in the first place. The declaration places poverty in the classification of the irresponsible and unintelligent population of people who need a higher authority to help them endure. Yet, I respectfully disagree! Any individual is born with the ability to survive and prevail against all odds and every person possesses their own set of unique talents, irrespective of his or her formal education. But they are merely the victim of their circumstances overruled by monopolistic culture of bigotry and fascism. The cycle must sever before clasping reforms via multifaceted collaboration. That is conceivable through decentralization and personalization

It is about individual values, quality and reign. The amount of money and resources allocated towards putting patients and physicians at the center of healthcare equation is an investment with the highest return. It’s about rigging individual citizens with jobs, fiscal security and independent reasoning, as one without the other would cease to function. The consolidative approach is a shortcut. The new versions of Alma-Ata declarations envision Governments and societies prioritizing, facilitating and protecting people’s health and well-being, at both population and individual statuses, through strong health systems. It sounds closer to what I have been contemplating all long, but not enough as it’s still too general and vague. It utterly declines to elaborate on the level of individual stake. It also underlines on Primary health care and health services that are high quality, safe, comprehensive, integrated, accessible, available and affordable for everyone and everywhere, provided with compassion, respect and dignity by health professionals who are well-trained, skilled, motivated and committed. Enabling health-conducive environments is vital; in which individuals and communities withstand empowered and immersed in maintaining and enhancing their health and well-being. Partners and stakeholders must be aligned in providing effective support to nationwide health policies, strategies, and plans. 

Surely the words are aligned in the right direction but the efforts are suggestive of crossbred population health with touch of patient engagement. Nonetheless, sounds like a consolidative approach merely using collaborative rhetoric. It is okay to think differently as are ways to solve a crisis, but if we approach them collaboratively. Healthcare without borders is reasonably put than health for all, as is founded on realistic expectations, patient empowerment at its foundation, but substantiated by physicians; the kind of system that functions on opportunity, liberty of being able to make independent judgments, choices, work and collaborate. A procedure that incentivizes everyone to work towards that mutual objective that reaches beyond all borders and not common disease for ordinary folks.

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Adam Tabriz
Dr. Adam Tabriz is an Executive level physician, writer, personalized healthcare system advocate and entrepreneur with 15+ years of success performing surgery, treating patients and creating innovative solutions for independent healthcare providers. He provides critically needed remote care access to underserved populations in the Healthcare Beyond Borders initiative. His mission is to Create a highly effective business model which alleviates the economic and legislative burden of independent practitioners, empowers patients and creates ease of access to medical services for everyone. He believes in Achieving performance excellence by leveraging medical expertise and modern-day technology.

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