Page 149 - Prioridades en salud y salud intercultural

At the crossroads between global health and local cultures: a critical perspective
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which remains to be acknowledged
by health and social scientists.
7. In recent years, there seems to
be growing consensus that public
health as a profession, as a gov-
ernmental activity, and as a global
commitment for the improvement
of collective health, is neither clear-
ly defined nor fully understood.
Following the recent turn toward
adopting the biomedical paradigm
in public health, most international
health agencies and private founda-
tions have followed the strategy of
applying massive biomedical in-
terventions (i.e., vaccines, oral
re-hydration salts, contraceptives,
condoms, vitamin A, etc.), target-
ing specific diseases categories and
behaviours. The implementation of
these interventions, often requir-
ing a central locus of control, were
largely based on the risk approach
focussing on “diseases of poverty,”
and received ear-marked funding
from multi-lateral agencies, govern-
ment sources and private donors.
Almost 30 years ago, under the
auspices of WHO, the Alma-Ata
Declaration(19) launched primary
health care as an overall strategy
to improve health across the globe.
This was followed by the WHO ini-
tiative of Health for All in the Year
2000(20) and years later by other
internationally-driven global initia-
tives such as Child Survival and Safe
Motherhood, where medical tech-
nologies were widely promoted,
targeting specific disease categories
prevalent in the developing world.
Although there is neither consen-
sus nor sufficient data yet available,
there is little doubt that these ini-
tiatives have contributed to wide-
spread improvement of health con-
ditions, considerably improving the
chances for survival in various pop-
ulation groups who had been pre-
viously plagued by disease, famine
and early death. However, it is also
true that for many, health progress
has stagnated or even reversed,
once enthusiasm and funding from
donors have waned. For instance,
after the 80 percent population tar-
get for vaccination against measles
has been reached, large numbers
of the cohort of newly born chil-
dren remain unprotected, so that
measles is today highly prevalent in
certain regions and the global death
toll for this preventable condition