It ought not to be necessary to comment on the link between any given level of national equity and concern for social justice on the one hand, and the possibilities for improving the health status of a weak social group such as the children of the poor, on the other. Indeed, international experience with regard to this link is now sufficiently clear. In general, those nations which have been most successful in keeping their children alive--in relation to any particular level of available resources or technology--have been the ones most concerned with the issue of social justice and consequent achievement of high levels of equity. (Yes, as with any other such wide-ranging statement, there are exceptions to the rule.) One manifestation of such notional concerns has been the building of integrated PHC-oriented systems which, though specially attentive to the needs of children and their mothers, are not based on programmes that are narrowly selective and thus exclusive, vertically organized, often externally initiated and financed, and minimalist in their approach to child health/survival.
Two final questions arise. First, could a set of minimum PHC (child survival or other) interventions be expected to "work," even if nationally implemented, in the absence of more significant socio-political changes? By "significant" changes is meant giving people the right and means to do that which is necessary to keep themselves in good health; namely, eat adequately, live in reasonably hygienic surroundings, achieve basic levels of education, be part of democratically run communities, and so on. The second question is whether or not a society which denies its citizens such opportunities--within any given resource limits--can be expected to carry out effectively the particular set of minimum health service interventions which are being proposed by the "child survivalists"? No blanket answers to these questions will be attempted; those who are interested must do so to their own satisfaction.
This article is a revision of a paper delivered at an international workshop on "Child Survival: Problems and Priorities" held at Teotihuacan, State of Mexico, Republic of Mexico, August 21-24, 1985. The workshop was sponsored by the Centre for Public Health Research of the Mexican Ministry of Health.
Kenneth Lee and two anonymous referees made many very useful suggestions about both the structure and content of the article. The author managed to convince himself that most of these were actually his own ideas, and thus worthy of incorporation into the published text: sincere appreciation is hereby expressed.
In short, the views and interpretations in this article are those of the author; they should not be attributed to the World Health Organization, to its affiliated bodies, or to any individual acting on their behalf.