Nowadays,the goals of Alma-Ata 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 programmes of the World Bank have not been conclusively shown to improve inequities;in some cases they may have worsened them.

We now confront 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 together should move into a learning and problem-solving 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.