今天，阿拉木图（Alma-Ata）宣言的目标比起25年前反而离实现更为遥远了。深刻的经济不平等和社会不公正继续拒绝给许多人提供良好的健康，继续扮演全球持续性健康受益的障碍。全世界的国家间及国家内部在健康成就的步伐上和等级上仍有巨大的差异。一个可能的解释是开始于20世纪80年代作为世界银行结构性调整计划一部分的健康部门的改革还没有显示出改进不平等的结果；在某些情况下，它们反而让这些不平等更为严重了。
现在我们面临健康研究中的四大挑战：道德价值、公平和美德、可持续的健康研究体系、良好的研究环境及知识的产出和应用。为了应对挑战，保健体系和健康研究体系两者应向一个学习的和解决问题的模式推进，把创新包括在运作之中，更好地掌握未来发展的机遇。没有效果明显的锦囊妙计，没有简单的解决方法，只是有许多事情要去学习。
Today, the goals of Alma-Ata Declaration seem even more distant than they were a quarter of a century ago. Deep economic inequalities and social injustices continue to deny good health to many and persist as obstacles to continued health gains worldwide. There is also great variation in the pace and level of health achievements both between and within countries around the world. One possible explanation is that health sector reforms that began in the late 1980s as part of the structural adjustment programme of the World Bank have not been conclusively shown to improve inequities; in some cases they may have worsened them.
Now we are faced with four key challenges for health research: values of ethics, equity and excellence, sustainable health research systems, favorable research environment, and knowledge production and application. To rise to the challenge, health systems and health research systems together should move into a learning and problemsolving mode, integrate innovation into their operations and better manage opportunities for future growth and development. There are no quick fixes, no simple solutions and much remains to be learnt.
