"Health for all by 2000 AD"
A plan that failed to deliver
R.N. Malik

THE World Health Organisation (WHO) launched a highly publicised and ambitious health programme in 1980. The slogan of this programme was very catchy: "Health for all by the year 2000 AD" A lot of publicity material was prepared and distributed. The programme was ratified and pledged by member nations of WHO in 1981. When WHO realised that people hoped that this programme would lead to a total eradication of disease in 20 years, its headquarters hastened to clarify that the success of this programme in next 20 years will only mean that "people would become health-conscious and lay more stress on prevention rather than curative side of the diseases and that treatment of diseases would become easily accessible and at an affordable price". Now the year 2001 has arrived and 80 per cent of humanity (particularly in developing and underdeveloping nations) is still struggling with diseases and malnutrition. In India, except in the case of polio, DPT, tetanus, guinea worm, cholera, the percentage of people affected by other diseases has increased.

The philosophy behind this programme was very simple. It was felt that 80 per cent of the affected persons were suffering from communicable diseases, which were preventable. If people drank only potable water, they would get rid of all water-borne diseases. Likewise, if people cared to eat clean food and live in a clean and hygienic environment, free from mosquitoes, they would get rid of other infectious diseases as well. The only communicable disease of consequence left would be AIDS (Acquired Immuno Deficiency Syndrome). This could be controlled through successful awareness programmes. Strangely, WHO remained silent on non-communicable diseases, some of which were highly debilitating in nature e.g. anaemia, arthritis, cancer, blindness, gastritis, obesity etc. WHO, therefore, aimed at ensuring a disease-free world by 2000. The targets adopted by India are given in the table. The table does not set parameters for the incidence (morbidity) of infectious diseases.

In order to meet these objectives, WHO exhorted world nations to chalk out a health programme policy. It held regional conferences to see if the member nations had chalked out such policies which it then approved. Finally, a conference was held by WHO in Calcutta with the objective of having a midterm appraisal. Thereafter, the member nations as well as WHO virtually forgot about this programme for the next ten years.

When the year 2001 started, WHO did not claim either success or failure for this programme. People in under-developed countries continue to suffer from communicable diseases. The incidence of serious communicable diseases like dengue, Japanese encephalitis, malaria-falciparum, malaria vivax, worm infestation, tuberculosis is as common as it was in 1980. The accessibility to hospitals and dispensaries has improved in some countries, but availability of treatment at affordable prices is still a far cry.

What is most distressing is the fact that people living in urban areas, too, have started suffering from non-communicable (pathological disorders) diseases extensively during this period. These diseases are also known as lifestyle diseases. These are diabetes, arthritis, high blood pressure, coronary heart diseases, obesity, gastritis, depression, backache, spondylitis and osteoporosis. These diseases have started occurring partly due to sedentary habits and partly due to a high intake of sugar and fats. Even villagers have started suffering from these diseases. These diseases were virtually non-existent prior to 1980.

Instead of admitting failure, WHO has silently launched another programme, "Health for All By The Year 2020". This programme aims to achieve following.

— The percentage of children (age below 5 yrs) with stunted growth to be less than 20.

— Maternal Mortality Rate (MMR) < 100 per 1 lakh live births.

— Child Mortality Rate (CMR) < 45 per 1000 live births.

— Life expectancy at birth > 70 years for all countries.

— Substantial reduction of disability caused by TB, AIDS, malaria, tobacco-related diseases and trachoma.

— Eradication of measles, lymphatic filariasis, Chagas’ disease, leprosy, trachoma, vitamin A and iodine deficiency.

Another six targets are general in nature e.g. improvement of health information and surveillance system.

The reasons for the failure of this programme are not far to seek. The four main reasons are:

None of the developing country took this programme seriously. The target of providing potables w/s to every citizen by the year 1990 has not been achieved even by 2000. Likewise, the target for sanitation remained unachieved and ignored.

The World Health Organisation, too, did not take this programme seriously. WHO never prepared a sound strategy. It completely failed to guide the developing nations in launching this programme aggressively and effectively. WHO did not touch the two most serious and sensitive issues which had a direct bearing on the success or failure of this programme. These were poverty and rising population in underdeveloped countries. The very least that was needed to protect people from contracting any disease was to ensure a minimum level of nutrition. The governments in underdeveloped countries could not ensure a wholesome diet to its people. Providing adequate nutrition to the people was an herculean task for underdeveloped or developing countries and WHO knew it. Therefore, it was unwise on the part of WHO to set its sights on targets which could not be achieved. Even the new slogan of "Health for all by 2020" is impossible to be realised until poverty is wiped out from the world.

WHO did not advise member nations to launch a scientific programme to educate people about health and incidence of diseases. Health education was the soul of this programme. Almost 50 per cent of the success of this programme can be ensured if health education is introduced as a subject at the graduate level in the country.

The fate of this programme seems to lead one to two conclusions. One, that international programmes rarely succeed and two, international agencies like UNO, FAO and WHO just touch upon a problem but never take the fight to a logical end.