Dr. Halfdan Mahler passed away in Geneva on 14th December at the age of 93. Dr Mahler’s vision inspired the Alma Ata Declaration on Primary Health Care in 1978, and the related call for ‘Health for All by the Year 2000’ Dr.Mahler squarely placed health in the domain of the ‘public’. Dr.Mahler was a Danish physician who joined WHO in 1951 and went on to be elected thrice as the Director General of the organisation, between 1973 and 1988. Before moving to the organisation’s headquarters in Geneva he worked for a decade in India in the National Tuberculosis programme in a mutually respectful relationship with national counterparts.
When Dr.Mahler moved to Geneva in 1962 WHO was very different from its current state. It was still recognized as the leader in international health. Dr.Mahler’s later dissatisfaction with the demise of WHO’s leading role (and the usurpation of this role by agencies such as the World Bank and private foundations such as the Gates Foundation) was clear in his address to the 61st World Health Assembly in 2008 when he said: “Most importantly, the very first constitutional function of WHO reads: ’To act as the directing and coordinating authority on international health work.’ Please do note that the Constitution says ’the” and not ’a’ directing and coordinating authority”. The 1960s and 70s were the ‘cold war’ period with the then Soviet Union and the United States vying with each other to assume leadership. It was also the era of ‘disease control’ when health systems were primarily designed to control infectious diseases through what were known as ‘vertical programs’.
Dr.Mahler and some of his colleagues sensed the widespread dissatisfaction with top-down systems that had little place for local communities and in most Low and Middle Income Countries were driven by Western perceptions and priorities. Working with colleagues in the WHO and in tandem with Henry Labouisse, then Executive Director of UNICEF, Dr.Mahler was responsible for crafting the Primary Health Care approach to address health holistically. Dr.Mahler and his colleagues adroitly negotiated contradictory perceptions in the then bipolar globe and produced the declaration on Primary Health Care ratified in 1978 by 134 Member States of the World Health Organization gathered in the former Kazakh capital, Alma-Ata. The Primary Health Care approach was both elegant in its simplicity and startlingly bold in the sweep of its vision. At its core the approach stressed the importance of allocating most focus and resources to the community and primary levels (clinics and health centres), where people live, work , fall ill and first seek care. The Declaration defined Primary Health Care (PHC) as “essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and the country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination”.
Later in life Dr.Mahler would lament the dilution of the vision of the Primary Health Care approach as a consequence of both the medicalisation of PHC through the introduction of the ‘selective’ child survival initiative and the imposition of conservative economic policies – structural adjustment programmes in the global South – by international agencies such as the World Bank and the IMF. He commented: “When people are mere pawns in an economic and profit growth game, that game is mostly lost for the underprivileged”. However, he remained optimistic about the intellectual and visionary power of the approach. He began his address in 2008 to the World Health Assembly by quoting Milan Kundera: “The struggle against human oppression is the struggle between memory and forgetfulness” He ended his address by saying: “And so, being an inveterate optimist I do believe that the struggle between memory and forgetfulness can be won in favour of the Alma-Ata Health for All Vision and its related Primary Health Care Strategy”.
Dr.Mahler remained a champion of primary health care and of people’s movements striving to make its vision a reality. Many health activists will recall his towering presence at the National Health Assembly in Kolkata in 2000 and subsequently in Dhaka at the First People’s Health Assembly (PHA) – which was the precursor to the formation of the global People’s Health Movement. He was also an active participant in the second PHA in Cuenca, Ecuador in 2005 and said in an interview given to the People’s Health Movement in 2007: “People’s Health Movement is the only movement that understands and works towards comprehensive Primary Health Care unlike other civil society networks who focus on specific diseases”.
With Dr.Mahler’s passing the movement for creating a just and equitable society where health is not a commodity but a universal right has lost a great thinker, dear friend and comrade in arms. Today the WHO has been reduced to a mere pawn of both rich countries which have starved it of resources and of private corporations and foundations which promote commercialised and technocratic solutions to health problems rooted in growing inequitiesAt this sad time it is worth recalling WHO’s constitution which states: “The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.”
PHM Global Secretariat
People’s Health Movement