[Ip-health] Halfdan Malher champion of health equity and social justice...

German Velasquez gvelasquez.gva at gmail.com
Mon Dec 19 05:15:06 PST 2016


*Halfdan Malher champion of health equity and social justice.*


By Germán Velásquez


Halfdan Mahler, W.H.O. director general from 1973 to 1988 passed away on 14
December 2016 in Geneva.  The history of public health will remember him as
the greatest leader of public health of the twentieth century. He left a
rich heritage full of teachings that would serve well to guide the W.H.O.
course today. He was a charismatic leader with vision, independence and
courage. “Malher was a relentless champion of health equity and social
justice, in fact, he once called ‘social justice’ a ‘holy phrase’.”[1]
<#_ftn1>


In the first year of his mandate, 1973, Mahler issued the report
“Organizational Study on Methods of Promotion the Development of Basic
Health Services” report that criticized the idea of vertical approach
methods of focusing on specific diseases as well as adding western
approaches to developing countries.


Mahler led the transformation of WHO in 1978 with the declaration of Alma
Ata, former capital of Kazakhstan, that created the concept of *primary
health care, *and launched the challenge of *“health for all” by the year
2000. *This was the passage from curative medicine to preventive care. The
adoption of Alma Ata declaration in September 1978 is one of the bright
moments of the public health history.


“Very soon after the formal declaration at Alma-Ata, however, efforts to
reshape or even nullify it were under way. Major donor nations, such as the
United Kingdom and the United States, froze contributions to the WHO
budget. (…) In 1979, the Rockefeller Foundation sponsored a small
conference at its Bellagio conference center in Italy. The Bellagio
conference included representatives of the World Bank, the US Agency for
International Development, the Rockefeller Foundation, and the Ford
Foundation, and they formulated an alternative “selective primary health
care” agenda, which differed sharply from the agenda and spirit of
Alma-Ata.”[2] <#_ftn2>


In the early eighties Malher launched the concept of *essential drugs* as
one of the Alma Ata components of primary health care. The work on
essential drugs is one of the biggest successes of the WHO since its
creation, though it cost Malher criticism and pressure from the
pharmaceutical industry and some industrialized countries.


Mahler was outspoken on many issues. In several occasions he mentioned that
the Alma Ata primary health care strategy was killed by the World Bank and
the International Monetary Fund. He pressured infant-formula manufacturers
not to discourage mothers from breast-feeding. In 1982, he invited the
Danish doctor Ernst Lauridsen to start the Action Programme on Essential
Drugs, and when the Big Pharma complained about Lauridsen's criticisms of
the pharmaceutical industry, Malher's response was: “they are not
criticisms of Lauridsen, it is my criticism, when he speaks in public he
does it on my behalf, on behalf of the director general of WHO”.


During the emergence of AIDS, 1981, Dr. Malher valiantly recognised that
“we’re running scared; (…) We stand nakedly in front of a very serious
pandemic as mortal as any pandemic there ever has been. I don’t know of any
greater killer than AIDS, not to speak of its psychological, social and
economic maiming.” He also admitted that he had not taken the disease
seriously enough. “Everything is getting worse and worse in AIDS, and all
of us have been underestimating it, and I in particular,” he said.


Halfdan Mahler did not follow WHO member States, it was he who guided
member States, and all those captivated by his vision of “health for all”.

------------------------------

[1] <#_ftnref1> Paul Farmer, Jim Yong Kim and al. “Reimagining Global
Health”. University of California, 2013.

[2] <#_ftnref2> Theodore M. Brown, and al.“ Halfdan Mahler: Architect and
Defender of the World Health Organization “Health for All by 2000”
Declaration of 1978”



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