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Health for all: the dream and the reality.


 What has become clear in the 10 years since Alma-Ata is the global split between the health of the "haves" and the "have nots". This split is not a clean one and there are a number of countries spread out along the line from poorest to richest. Many of these countries are progressing along this line at a speed measurable with familiar indicators: increases in per capita income and literacy, decreases in maternal and under-5s mortality rates. Progress is uneven: 64 countries (40% of the world's population) experience more than 80% of the world's under-5s deaths and more than 90% of the maternal mortality. Although under-5s mortality is projected to be much lower by the year 2000, Africa and southern Asia are predicted to have unacceptably high rates of 100 deaths/1000 live births. Even though solutions are available to fundamental health problems, the progress has been slow. In the industrial countries an important step has been the creation of a European region-wide strategy for health for all. In 1980 the 33 European Member States of WHO set 38 targets and designated 65 indicators for systematic and routine monitoring by countries. An evaluation in 1985 revealed that European members had made strong efforts to monitor progress and a number of countries had formulated national strategies in line with the regional one. Canada and the US have also taken steps in adopting national strategies: Canada has made strides in organization of health services, the US in recognizing the inequities in the availability of health services to low income populations. In developing countries a few countries have made significant progress beyond what had been expected, especially Costa Rica, Sri Lanka, and Kerala State in India as measured in reduced infant mortality rates. An analysis by Caldwell showed that these countries had a number of conditions in common: reasonable level of female education and female autonomy, a politically active community, and easy access to health services promoting maternal and child care, immunization, family planning, home visits and food availability. The poorest countries have lacked these conditions and their progress has been slow and painful.
