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The achievement of ‘Health for All by the Year 2000’ has been the declared goal of the international community for almost 20 years. The 1978 Alma Ata Declaration acknowledged that health and well-being depend as much on social justice and community participation as on technical or medical interventions. Yet, with deepening economic disparity within and between nations, and with near-universal cuts in public spending on health services, millions of people today are denied access even to basic care. Community participation is reduced to paying for treatment, a cruel parody of the right to participate in shaping health and social-welfare policies which was affirmed two decades ago.

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