CAN HEALTH PROMOTION AND PRIMARY HEALTH-CARE ACHIEVE HEALTH FOR ALL WITHOUT A RETURN TO THEIR MORE RADICAL AGENDA

Primary health care (PHC) and health promotion (HP), codified in the Alma Ata Declaration of 1978 and the Ottawa Charter of 1986, and aiming to achieve Health for All by the year 2000 (HFA 2000), are strikingly similar in their conception and evolution. Originally conceived as global strategies to reduce inequities in health between and within nations and emphasising intersectoral and community action, both have tended to be reduced to a more limited and technical approach to selected diseases within natiom In the implementation of these strategies, four trends threatening the achievement of HFA 2000 are analysed. Managerialism, manifesting in a goals and targets approach to health promotion has come to dominate and constrict its implementation in Australia and other industrialised countries, detracting from social and environmental imperatives and community action in addressing these. The increasing dominance of market economics and the promotion of economic growth at all costs is reinforcing inequities in health experience globally and within countries. Individualism, the philosophical accompaniment of market economics, has reinforced a behavioural and lifestyle focus and undermined a collective approach to HP and PHC. Environmental degradation, a growing global threat to public health and ultimately amenable only to global economic restructuring has been perilously ignored in the managerialist implementation of HFA. The elements of an agenda for action are identified with some suggested broader goals. A return to the original more radical philosophy underpinning the strategies of PHC and HP, it is argued, is fundamental to the achievement of HFA, even if this is no longer possible by the year 2000.