A/HRC/7/11 page 8 (d) Maternal and child health care, including family planning; (e) Immunization against major infectious diseases; (f) Prevention and control of locally endemic diseases; (g) Appropriate treatment of common diseases and injuries; (h) Provision of essential drugs. 24. Since 1978, a number of other issues - such as gender, the environment, disability, mental health, traditional health systems, the role of the private sector, and accountability - have been increasingly recognized as important. When revisiting the Declaration, they need to be taken into account. 25. One of the most striking characteristics of the Declaration is that it encompasses the interrelated domains of medicine, public health and human rights. For example, it includes medical care, such as access to essential drugs, and public health, such as community participation and access to safe water, all of which are major preoccupations of the right to the highest attainable standard of health. The Declaration is situated on the common ground between medicine, public health and human rights. This convergence is reinforced by Committee on Economic, Social and Cultural Rights general comment No. 14 (2000) on the right to the highest attainable standard of health (art. 12), paragraph 43, according to which “the Declaration of Alma-Ata provides compelling guidance on the core obligations arising from” the right to the highest attainable standard of health. 26. Since its adoption, some of the elements of the Declaration have developed. The Ottawa Charter for Health Promotion (1986), for example, laid the foundations of modern health promotion. Looking beyond a curative-oriented health sector, the Charter emphasizes the vital role of multisectoral prevention and promotion in relation to many health problems. 27. For the most part, however, the central messages of the Declaration of Alma-Ata were obscured in the 1980s and 1990s. For a variety of reasons, there was a shift towards vertical (or selective) biomedical interventions. Driven by neoliberal economics, structural adjustment programmes led to reduced health budgets and the introduction of user fees. As WHO recently observed: “The results were predictable. The poor were deterred from receiving treatment and the user fees yielded limited income. Moreover, maintaining a network of under-resourced hospitals and clinics, while human and financial resources were increasingly pulled into vertical programmes, increased pressures on health systems sometimes to the point of collapse.”9 28. This quotation is astonishing - and shaming. International and national policies were introduced that - predictably - brought health systems “to the point of collapse”. 9 Everybody’s Business ... (note 2 above), p. 9.