In Mexico City earlier this month, the PAHO, members of its High-level Commission and the United Nations presented a report outlining how countries in Latin America could, and must, ensure everyone had access to health. The 'Universal Health in the XXI Century: 40 years of Alma-Ata' report provided ten recommendations on how best to drive a 'health for all' strategy in the region; the result of years in the field and national-local public policy-making.
“The report reaffirms that health is a fundamental human right. It is not a privilege, nor a commodity,” said Carissa Etienne, director of PAHO. For universal health to be a possibility, Etienne said it would need necessary resources, a firm commitment of the state and political will.
Michelle Bachelet, the United Nations high commissioner for human rights, said health was a right that had to be ensured, without any exclusion. “The right to health is built by leaving unequal relationships behind and by investing in health services that are close to people. ...It is time to act. Governments, civil society and the private sector must all get involved.”
Private sector influence 'must be guided'
One of the report's ten recommendations outlined the importance of creating mechanisms to regulate and oversee the private sector to ensure efforts were consistent with universal health objectives.
The “influence and complexity” of the private sector, the report said, had “grown significantly” in the past four decades, particularly in terms of technology development, financial resources, and growing political influence. Globalization and commercialization of living conditions had also driven up mass consumption of goods and services that had become determinants of the population's health status.
“Given that the growing participation of the private sector can be attributed to the motive of profit, it is important to recognize the challenges that this poses in terms of working towards more equitable conditions of universal access,” the report said.
“The private sector is also increasingly present through non-governmental organizations and in the form of donors and funders, with heavy influence on the agenda of international organizations and on the global health agenda. Accordingly, this influence must be guided so that it helps bolster the leadership capacity of health authorities in the implementation of national policies.”
The PAHO Commission said it was “indispensable” to establish transparent and accountable regulatory and oversight provisions that met set standards and considered firstly the population's wellbeing.
Addressing non-communicable diseases a 'very important issue'
Néstor Méndez, president of the High-level Commission and assistant secretary general of the Organization of American States (OAS), said non-communicable diseases (NCDs) had been and would continue to be a strong focus in Latin America.
“A very important issue in our discussions was the use of comprehensive health public policies as a strategy to address the common risk factors for NCDs (tobacco and alcohol use, sedentary lifestyles, and unhealthy diets),” Méndez wrote in the report.
“...Public health policies are not limited to prevention. It is also essential to initiate health promotion plans aimed at developing activities and lifestyles that foster health through collective and individual action.”
Importantly, he said it was important to understand this need was occurring in the context of new socioeconomic, demographic, and environmental factors, including globalization and private sector expansion; commercialization of living conditions; greater urban growth; and irregular and forced migration of populations.
Méndez said while the region clearly continued to face “significant challenges”, universal health could be achieved it the region's accumulated knowledge, experience, technological advances and available resources were well utilized.
“We are convinced that through the political will of States and concrete actions to produce the necessary changes in health – including fostering real, inclusive, accessible social participation and effective accountability mechanisms – we will achieve health for all and sustainable human development.”
The full ten recommendations outlined in the report were:
- Ensure the establishment of an institutional model that guarantees the right to health
- Develop people and community-centered primary health care models
- Generate social participation mechanisms that are genuine and accessible
- Create mechanisms to regulate and oversee the private sector that work to ensure a right to health
- Eliminate the barriers to universal health access
- Address social determinants with inter-sectoral interventions to promote change
- Reposition public health as the guiding axis of the State's response to transform health systems
- Value human resources as protagonists of primary health care
- Promote the rational use and innovation of technological resources
- Develop a model that ensures efficient and sustainable financing