Ladies and gentlemen
Partners, Colleagues and Friends
A very good morning to you all.
I am sorry I cannot be with you in person today, but I am nonetheless pleased to address you at this, the first, AIHD International Forum.
This Forum has convened under the banner “Synergizing Global Health, Primary Health Care, and Health Promotion for a Sustainable Future.”
Before I speak to you about the future, I would first like to talk to you about the past.
Primary Health Care - PHC - is not new in our South-East Asia Region.
It was as far back as 1926 that the first community-based primary care unit was established in Sri Lanka.
Only 11 years after that, in 1937, was the Bandung Conference in Rural Hygiene, in Indonesia, which made clear that we cannot separate health from social development.
The-then WHO DG Dr. Halfdan Mahler reflected on the Bandung Conference when he wrote in 1978 that “Clearly ‘PHC' is not new. Why has it been necessary to resurrect ideas that were put forward decades ago?”
It is from these South-East Asian origins that the modern movement for PHC is galvanized in Alma-Ata, Kazakhstan.
It was in 1978 that 134 nations gathered there, convened by our World Health Organization, and our friends and colleagues at UNICEF.
All of know about the resulting Alma-Ata Declaration that reaffirmed our WHO Constitution’s declaration of health as a fundamental human right.
We know that the Declaration affirmed health as not just the ‘absence of disease or infirmity’, but a state of ‘complete physical, mental and social wellbeing’.
We know that the Declaration placed PHC as the key to attaining Health for All.
However, what many of may not know - or may have forgotten - is the spirit of social justice which runs through every word of that Declaration.
It was this spirit that Ruth and Milton Roemer, wrote about in 1990.
They placed the Alma-Ata Declaration in the chronology of the ‘world-wide
affirmation of human rights,’ - which, in the late nineteenth and twentieth century, started including ‘the concept of health services.
“Some may cynically say that these…are mere words, and do not reflect reality.
They record social values and policy goals, however, that have been forged from long social struggles—going back at least to the French Revolution and reinforced by . . . post-war movements for national liberation.
They affirm principles for social action, they shape political strategies, and they exert, in fact, substantial influence on the features of health systems.”
The reason I speak to you today about the spirit of Alma-Ata is because I believe we need to return to its spirit as we plan for the future.
We know that our world is rapidly changing. We know that global health is impacted by emerging diseases, the climate crisis, rising non-communicable diseases (NCDs), and evolving socio-economic pressures.
However, in facing these challenges, we have the opportunity to create a more resilient, inclusive, and sustainable future - guided and informed by a spirit of social justice.
Alma-Ata envisioned health care not just as the treatment of disease, but as a fundamental right that emphasized preventive, curative, and rehabilitative care.
It advocated for a comprehensive, accessible, and community-centered health system that placed people, not diseases, at its core.
However, despite this noble sentiment, and the stirring call of the Declaration, our global health efforts have too often diverged from these principles.
Disease-Specific vs. Holistic Approaches
For decades, global health efforts focused on disease-specific interventions.
This approach was not without its successes. It brought about significant achievements including reducing the burden of infectious diseases like tuberculosis, malaria, and HIV/AIDS.
But this disease-specific strategy, often driven by donor-targeted goals, at times led to a "siloed" approach where specific diseases became priorities, often at the expense of overall health system development.
In many ways, we ‘hit the target, but missed the point.’
Health becomes about numbers and metrics, sidelining the broader, holistic aspects of well-being, with limited attention to people’s experience.
I think it is fair to say that we saw health through a rather narrow lens, instead of embracing our multifaceted lives and needs.
The Need for a Holistic Approach
A holistic approach is, however, the pressing need of the moment.
Global issues like climate change are impacting every facet of our lives - including every facet of health.
Extreme weather events, environmental degradation, and shifting disease patterns affect nutrition, access to clean water, air quality and more —all of which influence health outcomes.
We are seeing a rise in non-communicable diseases (NCDs) like diabetes, cardiovascular diseases, and cancers, and growing mental health challenges.
The lessons from this are clear: we need health systems that address root causes and social determinants. We need to focus on prevention.
I think it is important to state that we cannot - and should not - afford to treat these as isolated issues.
In fact, they are intertwined, and connected to environmental, social, and economic factors.
If we therefore apply the social justice principles required of us by Alma-Ata, we understand that we need a holistic approach to these problems facing us.
It means we need to go beyond the eradication of the diseases and focus on the well-being of our people. We need to address the root causes of our current problems, rather than simply treat symptoms.
Integrating Health Promotion and Quality of Care
Therefore, we understand that an integrated approach to health promotion is central to achieving the sustainable health outcomes we all want.
We understand that we cannot separate health from social development.
We understand that health is beyond the absence of illness - it is including quality of life, empowerment, and equitable access to resources.
In this spirit, health promotion must be woven into every aspect of care.
So, we understand we should focus on people instead of conditions, and then we can create systems that serve the whole person—physically, mentally, and socially.
In fact, this person-centered approach recognizes that health also extends to community and society.
And that is why it is all the more important that we address the structural and social determinants of health.
Centering People in Health Systems
So, how do we refocus on the people that should be at the center of our health systems?
It’s time to think about each person’s overall journey to well-being, and also about that journey for communities.
In placing people and communities at the heart of health systems, we can - for example - start to break down barriers between disease treatment, mental health, and preventive care.
For example - mental health issues are connected to chronic illnesses and lifestyle diseases, yet mental health services often remain marginalized.
Current PHC Scenario in SEAR
I proud to tell you that a remarkable transformation is taking place across our countries: a transformation from focus on a few select diseases to that of the full human condition, across the life course.
Political commitments have prioritized a renewed vision of PHC as the cornerstone of UHC - at the UN General Assembly, at the G20, and at our WHO South-East Asia Regional Committee.
But I am pleased to say, we haven’t stopped there. These commitments have been accompanied with action across our countries.
However, as you know, delivering quality integrated primary health care, in the context of the diversity of 2 billion people, is not a simple task.
The twin challenges of quality and integration, raised at the South-East Asia Regional PHC Forum, are of particular concern for us.
Our PHC Forum is, by the way, a platform that brings together partners to share and implement PHC related research, development, and civil society efforts.
It is exactly the type of synergy and coordination that you are exploring at this conference today.
On that note, I would like to conclude by wishing that you a productive time at the First AIHD International Forum. I hope your time here leaves you with new information, knowledge and perspectives - and I hope you enjoy your stay in Bangkok.
Thank you.