The year 2000 has arrived, but the World Health Organisation s aspiration that it should be accompanied by health for all throughout the globe remains blatantly unfulfilled. The last 20 years have seen the advent of 30 new diseases, including HIV/AIDS, which alone has claimed 16 million lives.

Old diseases like TB and malaria, which once seemed almost defeated, have surged anew , while 840 million people worldwide still suffer malnutrition. Environmental catastrophe is a far more imminent problem threatening the health of populations now than in the 1970s.

Re-reading the Health For All goals today , it is hard not to be struck by a certain naive idealism. But in 1978 the year 2000 seemed a long way off, a date by which even the most extravagant of contemporary science-fiction fantasies might have been realised, perhaps. In reality, the odds were always stacked heavily against Health For All. Of course, WHO itself lacked the power to implement the programme; it has to rely on influencing governments - and that influence waned sharply during a protracted period of lacklustre, if not downright corrupt, leadership under Hiroshi Nakajima. But beyond that, global politics and economics were always going to be the decisive influences on the outcome of the Alma-Ata declaration. This ensured that, however noble its aims, its path would be hopelessly perilous.

And yet despite the formidable obstacles, the successes have been remarkable.

Life-expectancy has increased in most countries, and infant mortality has decreased. Some old diseases are in retreat: the fight against leprosy has made a significant difference, while polio has been eradicated in the Americas and may possibly be soon wiped out in Europe too.

Ultimately, it may not have mattered that Health For All targets were unrealistic or even ridiculous . They helped raise aspirations and expectations; if they had been set lower , perhaps efforts would have been correspondingly weaker and the achievements smaller . So they were in the end a kind of benign confidence trick. Nothing wrong with that - so long as we all remember that such a trick can only be pulled once, and that lasting disillusionment may be an unfortunate side-effect.