Table 1

Timeline of selected major paradigm and policy events post-1978

DateParadigm/policy event
19781978: Alma Ata Declaration on PHC and goal of ‘Health for All in the Year 2000’
1979–1990
  • 1979: African Charter on Human and Peoples’ Rights, adopted by the OAU: ‘Every individual shall have the right to enjoy the best attainable state of physical and mental health’.

  • 1980: OAU Lagos Plan of Action for the Economic Development of Africa, 1980–2000.

  • Oil crisis, global recession, rising external debt, repeated food crises.

  • Bretton Woods structural adjustment/neoliberal policies.

  • Neoliberal reforms in India, rise of Bharatiya Janata Party (BJP,) Hindu nationalism and corporate medical sector.

  • Selective PHC promoted by Rockefeller Foundation, World Bank and others.

  • Postindependent ESA countries’ comprehensive PHC policies, aid support for selective PHC.

  • End of the Cold War.

  • 1987: African health ministers’ adoption of the Bamako Initiative to accelerate PHC practice.

  • 1988: Rights-based constitution and creation of the national health service (SUS) in Brazil.

  • 1980s: Spread of HIV and high levels of AIDS mortality in ESA countries.

  • GFATM, Gates Foundation focus on high mortality HIV, malaria and TB.

  • UN World Commission on Environment and Development and 1992: Earth Summit.

  • 1986: Ottawa Charter for Health Promotion promoting IAH/MAH on social determinants.

1990s
  • 1992: Negotiations in the Convention on Biological Diversity and the UN Declaration of the Rights of Indigenous People.

  • USA CDC, Institute of Medicine point to and set strategy for ‘global infectious disease threats’.

  • 1993: World Bank World Development Report: investing in Health promotes selective cost-effective interventions using DALY analysis in ESA and India.

  • UNICEF promotion of ‘adjustment with a human face’ in ESA countries.

  • Bamako Initiative funding of public healthcare from cost recovery from medicine charges.

  • The Washington consensus neoliberal model applied in Chile.

  • India: eficiency reforms, World Bank soft loans and targeted safety nets for poverty alleviation.

  • Commission on Macroeconomics and Health identifies disease priorities for intervention.

  • 1998, Yach and Bettcher, ‘The Globalisation of Public Health’ on global health determinants.

  • WHO publication of Social Determinants of Health: the Solid Facts.

  • Promotion of BV, SM and ICH by indigenous and social movements and newly elected left governments in selected Latin American countries; creation of Alianza Bolivariana para los Pueblos de Nuestra América (ALBA) left political grouping.

2000UN Millennium Development Goals with three health-related goals on child mortality, maternal mortality, access to reproductive healthcare and HIV, TB and malaria to be met by 2015.
2000–2009
  • 2000: People’s Health Movement People’s Health Charter’ affirming comprehensive PHC.

  • 2001: New Partnership for Africa’s Development calls for fairer returns from globalisation.

  • United Progressive Alliance Coalition: India opens space for civil society, rights approaches.

  • 2001 Doha Declaration on Trade-Related Aspects of Intellectual Property Rights (TRIPS) and public health.

  • 2003 WHO Framework Convention on Tobacco Control.

  • 2005 WHO International Health Regulations binding standards for international health security.

  • 2006 EU HiAP approach promoted by Finnish presidency

  • 2006: Harmonisation for health in Africa led by WHO AFRO to coordinate partner support.

  • 2006: Launch of the BRICS forum.

  • 2008 Report of the WHO Commission on Social Determinants of Health.

  • 2008: Japan promotes human security as the core of its health diplomacy.

  • 2008–2009 Ecuador, Bolivia Constitutions integrate BV/ICH.

  • 2009: Sarkozy Commission on Measurement of Economic Performance and Social Progress.

  • Growing attention to climate and biodiversity losses.

  • 2008: International financial, energy, food crisis, especially in the USA and Europe.

2010–2015
  • 2010: Adelaide Statement on HiAP and United Nations Development Programme (UNDP) integration of capability and freedoms.

  • 2010: COP United Nations. United Nations Environment Programme (UNEP), WHO adopt 20 global Aichi Biodiversity Targets including ecosystem for health, livelihoods and well-being.

  • 2010: USA Affordable Care Act (Obamacare).

  • 2011 World Conference on Social Determinants of Health in Brazil.

  • 2011: Launch of the ‘One Health’ agenda at the InternationalCongress on Pathogens at the Human-Animal Interface in Ethiopia.

  • 2012 COP Secretariat of the Convention and WHO Strategic Plan for Biodiversity 2011–2020.

  • 2012: European Policy Framework for Health and Well-being, Bhutan Gross National Happiness.

  • 2013: African Union adoption of30 Agenda 2063 focusing on inclusive, sustainable development.

  • 2013: Eighth Global Health Promotion Conference on Health, Helsinki Statement on HiAP and the Whole-of-Government approach.

  • 2014: Global Health Security Alliance launched.

  • 2014: Bharatiya Janata Party (BJP) in India promoting Hindu nationalism, commodification and civil society controls.

  • 2014: West and Central African Ebola epidemic; concern over rising multidrug-resistant TB.

  • 2015: World Bank, USAID promote performance-based financing, essential service packages.

  • 2015: Report of the Lancet (UK) Commission on Planetary Health.

2015UN Sustainable development Goals in General Assembly Resolution A/RES/70/1,
2016–2019
  • 2016: Ninth Global Conference on Health Leaders and Shanghai declaration calling for whole of society response and global collective action on commercial forces counteracting health.

  • 2016: UN Commitment on Antimicrobial resistance and promotion of One Health.

  • MERS, SARS and Ebola pandemics.

  • 2017: Pan American Sanitary Conference, PAHO adoption of policy on ethnicity and health.

  • 2017: Lancet Commission on Health in Africa advocating people-centred health systems.

  • 2018: Astana Declaration on PHC, with UHC as the rallying point.

  • Climate and biodiversity crisis stimulating youth climate strikes and extinction rebellions.

2020COVID-19 pandemic
  • Costa Rica call for patent pool for distributed production of essential health products.

  • World Health Assembly 2020 resolution on COVID-19 and COVAX on diagnostics, medicines and vaccines.

  • United Nations General Assembly (UNGASS) on COVID-19 call for collective security, global public goods and equitable recovery.

  • Vaccine approvals, vaccine nationalism and COVAX underfunding.

  • Authors from Loewenson et al.3

  • AFRO, Regional Office for Africa; BRICS, Brazil, Russia, India, China and South Africa; BV, buen vivir; CDC, Centers for Disease Control and Prevention; COP, Conference of the Parties; DALY, disability-adjusted life year; EHP, essential health product; ESA, East and Southern Africa; EU, European Union; GFATM, Global Fund for AIDS, TB and Malaria; HiAP, Health in All Policies; IAH, intersectoral action for health; ICH, intercultural health; MERS, Middle East respiratory syndrome; OAU, Organisation of African Unity; PAHO, Pan American Health Organisation; PHC, Primary Health Care; SM, social medicine; SUS, Sistema Único de Saúde; TB, tuberculosis; UHC, universal health coverage; USAID, United States Agency for International Development.