This year marks the 40th anniversary of the Alma-Ata Declaration, a landmark global health policy document that reinforced health as a fundamental human right and emphasized that gross health inequalities are by no means acceptable. It also prescribed primary health care (PHC) founded on essential health services and community participation as a vital strategy towards achieving ‘Health for All’ by year 2000.

In 2018, we still do not have health for all. While significant progress has been achieved throughout the decades, from increasing life expectancy to dramatic reductions in child and maternal mortality, new global health problems have since emerged. Chronic diseases such as diabetes and cancer are on the rise, now killing more people than infectious diseases. The 2013 Ebola outbreak triggered efforts to solidify global health security worldwide. And although many states are preoccupied with achieving universal health coverage, scandalous levels of health inequality continue to exist between and within countries.

Climate Change – Our Biggest Threat

But on top of all these global health problems is climate change, the defining challenge of our time. When Alma-Ata was adopted in 1978, climate change was only beginning to be recognized by scientists—today, it is dubbed the 21st century’s biggest global health threat. From disability and death due to natural disasters, and climate migration due to sea level rise, to slow-onset increases in mosquito-borne diseases, heat-related illnesses and worsening undernutrition, climate change will cause additional stress to already overburdened health systems, reverse the health gains of PHC, and make the fulfillment of ‘Health for All’ much more difficult, if not impossible.

Unfortunately, in global health we do not say it as much as we should—that climate change is the biggest threat to PHC, to our universal health coverage goal, and to the sustainability of health systems worldwide. The way PHC is discussed today—as indicated in recent journal series and conferences commemorating Alma-Ata’s 40th anniversary, such as the one happening this week in Astana—is as if health systems and communities are totally detached from the climate reality we live in. Thankfully, the just-adopted Astana Declaration acknowledges “climate change and extreme weather events” as causing an additional public health burden today.

Since this climate reality is inescapable, the global health community has no other recourse but to embrace it. The vision for ‘Health for All’ must be rewritten, and it must be extended beyond the health of people to the health of the planet. Since human health and the environment are tightly intertwined and inseparable, the new approach to health improvement worldwide must encompass both. In short, a revitalized PHC—Alma-Ata 2.0—must now stand for ‘Planetary Health Care’.

This article was published in Health and Human Rights Journal. Read more here.