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[The university and "health for all by the year 2000"].


 Universities should constitute the critical conscience of a society and should serve as the principal instruments for promoting needed changes. The highly politicized social processes in Latin America have been characterized by inertia and resistence to change. The university as a reflection of society has perpetuated itself as a conservative structure whose main function has been to consolidate the status quo. In the area of health care, the university should provide training for the personnel required to fill the needs of the population as a whole, but in fact training has responded to the needs of only the wealthier and more powerful population sectors who are able to voice their demands. The university, in its function of forming professionals, does not respond to the health needs of the population but rather to social needs expressed in effective demand. Another problem is that the quest for technology has produced imbalances and rigidity in the health care system. At present, health systems in Latin America devote 80-90% of their resources to secondary and tertiary level care. The demand for health promotion and primary health care has thus far failed to produce significant changes in the structure of services or distribution of resources. Evaluation and revision of the role of technology will be prerequisities for achievement of the goal of health for all in an equitable, effective, efficient, and participatory way. There have been various movements and initiatives in the training of health professionals in the 20th century, from the early focus on technical and scientific training to a more recent effort to improve educational technologies. Movements requiring the university to take a more active role in the provision of health care to the entire population have for the most part been limited to isolated trials. Primary health care is based on the 3 fundamental concepts of equity, effectiveness, and the need for all of society and not just health professionals to participate in health care. Projections for the year 2000 indicate that 180 million persons will be added to the Latin American population, all them in cities. The population will contain more elderly persons requiring complex care. At present, not even the most simple and easily preventible health problems have been solved, but the challenges posed by chronic degenerative diseases will increase as the population ages. Only a revolution in the field of health, in which primary health care is fully utilized as a strategy for the entire health care system and technology is brought under control to serve the needs of the population, will enable the new challenges to be met. The process will demand that health be considered an integral part of development and not a residual benefit of the manipulation of economic variables. It will also demand greater cooperation between different societal sectors and different nations. The university should take an active role in the needed transformations.
