Social inequality remains an obstacle in the provision of health care. As such, countries should not only focus on the financial aspect of universal health coverage but also empowering people, according to Jos Vandelaer, World Health Organization (WHO) Representative to Thailand.
Dr Vandelaer spoke about the matter at the Public Health Ministry to mark "World Health Day 2023" on April 7.
Health for all
This year, World Health Day was held under the theme of "Health For All" to celebrate the 75th anniversary of the WHO and highlight the importance of maintaining good health.
Dr Vandelaer said the WHO constitution was signed by 61 member states on July 22, 1946. It was put into practice on April 7, 1948, and since then, the standard of living for people around the world has improved, he said.
However, he said even if member states and the WHO have improved people's lives and ensure no one is left behind, social inequality remains a constant challenge in health.
"One of the constant factors setting back the global goal of achieving 'health for all' is inequality," he said.
Many low-income countries have not fared as well as their rich peers, and poorer people have benefited less from health advances and programmes than those who are better off, he said.
This much was clear during the Covid-19 pandemic, where vaccine nationalism by some put the rest of the world at risk, prompting WHO Director-General Tedros Adhanom Ghebreyesus to remind the world that "no one is safe until everybody is safe".
Yet inequality persisted, he said. "Success has not been achieved without its share of setbacks," Dr Vandelaer said. "Campaigns to eradicate malaria have proved to be a huge challenge. We are frustratingly close to eradicating polio, and yet the last hurdle is proving to be the hardest yet.
"Primary health care remains as important as in the Alma-Ata Declaration, even as mortality from non-communicable diseases soars. Too many people fall into poverty, simply because the cost of treating a loved one is more than they can afford," he said.
The Alma-Ata Declaration was adopted during the International Conference on Primary Health Care in Almaty (formerly Alma-Ata), the Kazakh Soviet Socialist Republic (present day Kazakhstan), Soviet Union, on Sept 6–12, 1978.
The declaration expressed the need for urgent action by governments and the health sector to protect and promote good health.
It was the first international declaration underlining the importance of primary health care and later accepted by WHO member countries as the key to achieving the goal of "Health For All".
Education and empowerment
Samlee Plianbangchang, former regional director for WHO's Southeast Asia office, said although the WHO has emphasised good health as a fundamental human right, universal primary health care has not been fully implemented.
Dr Samlee said although the world has realised the importance of universal health care coverage, providing health for all requires more than financial investments.
"To me, no, [it is not] only that. If people need adequate capacity or capability to take good care of their own family and country, and ultimately through their collective action [achieve] lasting peace and security everywhere, we have to spare no effort to support people.
"It has to be done through a process of education and empowerment. Health For All cannot come without education and empowerment. We have diverted our attention to financial investment and it has been a long debate.
"It is too easy to view it that way, but it is much more complicated to think of education and empowerment, so they do not have the capacity and capability to take care their health everywhere," he said.
People need adequate knowledge on how to lead healthy lives. "My doubt now is: Have we done this adequately within the context of the country or community anywhere?"
"Have we ever assessed the adequacy of people in this direction? Not yet, I am sure; and if yes, not much," he said.
