Geneva Health Forum Archive

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Primary Health Care: What Can We Learn from History?

Author(s): E. Fee1
Affiliation(s): 1History of Medicine Division, National Library of Medicine, Bethesda, United States
Key messages:

The political climate and balance of power have a powerful influence on what is perceived as possible within the realm of global health. International health organizations and individuals are often torn between inspiring ideals and budgetary or bureaucratic requirements. Committed individuals in key positions can sometimes provide leadership that maintains focus on widely shared ideals, but the task is not an easy one.

Summary (max 100 words):

This presentation will outline the changing global conditions in the 1960s and 1970s that made possible the Alma Ata Conference and the Declaration of Primary Health Care. The emergence of decolonized African nations, the organization of the Non-Aligned Movement, new theories of development, China’s re-entry into the United Nations and widespread interest in the Chinese “barefoot doctors” were among the conditions that, together with the charismatic leadership of Halfdan Mahler and like-minded colleagues, made possible the emergence of a new shared endorsement of comprehensive primary care and ‘Health for All’. Beginning in the 1980s, however, the global conditions changed with the emergence of a neo-liberal consensus on the importance of free markets, the increasing influence of the World Bank and the International Monetary Fund, the declining influence of the World Health Organization, and the growing indebtedness of developing countries. Selective Primary Care--a much narrower set of measurable, technical interventions soon to be operationalized under GOBI (growth monitoring, oral rehydration, breastfeeding, and immunization) largely displaced the broader, more holistic vision of comprehensive primary health care. The question is whether we have now reached, or are reaching, a third historical period in which a return to and renewal of, the Alma Ata vision is possible and can be realized in practice. The presentation will outline some reasons for optimism.

Conclusion (max 400 words):

There is today a renewed interest and energy in global health and in the more visionary ideals of health in the context of development that originally inspired the Alma Ata Declaration. Some thirty years later, we still need a unifying vision of global interconnectedness. As the international order shifts again with the growing influence of developing nations such as India and China, and new forms of activism in Asia and Latin America, and to some extent in Europe and the United States, we can be at least cautiously optimistic for a better future.

Lessons learned:

Ideas and visionary leadership are necessary conditions for making a difference in global health but they are not in themselves sufficient. Political will, in the form of changing power relations within and among countries, create the conditions in which dramatic new possibilities can emerge.

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