At the very base of all human development is health. Before you have anything else in this world – you have your health. With your health you are able to do many things: be a productive citizen, attend school, go to work, and any other number of activities that require at least a basic good health and mobility. If you do not have your health, then all this disappears: You are too sick to go to work, to attend school, provide food for your family, grow and develop your community, among other things. Without your health you cannot fulfill the basics for living and therefore cannot improve your situation or that of your community.

Within the international development field, gross national product (GNP) and the global economy are often referenced. This broad macro view of development has contributed to foreign aid/ development failures for many decades. For far too long a macro, “modern” perspective has driven development practice allowing Western institutions and dollars to “intervene” and “develop” the underdeveloped. Gustavo Esteva does well to point out that in order to be involved in development an individual has to recognize that she or he is “underdeveloped.” This term more often signifies something that is not Western or modern, which is extremely problematic for many different peoples of many different cultures.

The paradigm of international development needs to shift from being focused on macro, modern initiatives and instead focus on individuals’ abilities to control and contribute to the development of their own communities. Once these tools are in place, then there will be effective and sustainable development where all needs are met. At the very core of development is health. We must understand that all development springs from the previously stated definition of health.

Development became a field for Western experts to push the ideas of “modern” society on “underdeveloped” [“uncivilized”] populations. Development was an arena focused on exerting power over others and it was very successful. The field of health care was not immune from the macro, modern failures of development practice. There needs to be a significant commitment to reversing the trends of the past to allow individuals and communities greater agency in their own development.[1] Development writer, Alan Thomas states,

The alternative vision, based on the realization of human potential in diverse ways, allows for the immanent development at the level of individuals and communities, which should become ‘empowered’ to develop themselves to their full capacities. However, there is no clear model for how development of this kind might build on itself to create a self-reproducing process of social change […][2]

This alternative vision requires a shift in the paradigms of development from a focus on Western “big plans” and a greater focus on the abilities of individual and communities to provide their own basic needs.

The people have the right and duty to participate individually and collectively in the planning and implementation of their health care.[3]

Especially in relation to health care, people should be able to determine their own level of participation in attaining better health.

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[1] Development as Freedom, Amartya Sen, 190.

[2] Development and Social Change, Alan Thomas, 36.

[3] Declaration of Alma Ata, IV.