Health for all by the year 1990? Part Two: Primary care and environmental aspects

In 1985 the World Health Organization proposed 38 health targets towards Health for All by the Year 2000. Twenty of these were due by the year 1990. A questionnaire study of activity towards these targets was conducted in two phases; the second phase, covering mainly primary care and environmental issues (Targets 13-30), is reported here. The National Health Service (NHS) is obviously based on primary care, so Target 30 is met. However, primary care is poorly linked to local planning (Target 29), is reactive rather than broadly health promoting (Target 28), and is not always well distributed (Target 27). Likewise, the United Kingdom enjoys good water supplies (Target 20) but the picture is less clear on foodborne health risks (Target 22), environmental control (Target 19), green policy (Target 18), health education (Target 15) and family support (Target 14). We clearly do not have healthy national policies on many topics (Target 13). In general, where target areas looked healthy, this reflected a strong baseline position rather than recent progress. Progress has been inhibited by the incessant NHS changes, but there is a vicious circle: the Government's failure to acknowledge the logic of Health for All means that the pressures of costs and expectations continue unabated, and more change is demanded.