Following on from our Rebel Lives piece on Dr. Noel Browne the following is the first in a series of pieces on Public Health which we hope will address not only the state in which our Public Health Service is currently in, but also how it should perhaps operate. Often we hear the term “Primary Health Care” being thrown around by the political and medical elite as they continue the neo-liberal decimation of our Public Health Service. This short piece aims to give a very brief overview as to the origins of this term and what exactly it means.
In September of 1978 the World Health Organisation (WHO) and the United Nations Children’s Fund (UNICEF) hosted the widely attended International Conference on Primary Health Care in Alma-Ata, a regional city in the former Union of Soviet Socialist Republics (USSR). At this junture in time when the ecconomic influence of Soviet ‘communism’ and western neo-liberalism were facing their respective periods of demise and rise, an international delegation convened, and en masse, declared that they would commit themselves to the attainment of what they deemed ‘health for all’ by the turn of the millenium.
The culmination of this gathering would be the collective approval of and commitment to the Declaration of Alma-Ata, an ambitious if not “revolutionary” (Lawn et al, 2008) document encompassing ten declared principles aimed at achieving universal health care for all the people of the world. What was to be the core element of the Declaration, and key policy in it’s implementation, was what they defined as Primary Health Care (PHC). In short this referred to a multi-disciplinary approach to the provision of health care focussing on preventative interventions and health promotion, integrating the community and clinical resources accessible to the particular population.
Despite the best intentions of those that committed to this declaration, for a number of reasons the targets set out at Alma-Ata were not achieved. The millenium passed with more health inequality than ever, with domestic health policy in most countries being largely influenced by the dictates of the free market. Consequently this has resulted in the embracing of the more financially beneficial Selective Primary Health Care approach, which promotes a more vertical and singular means to tackling health issues. Unlike the comprehensive mode, which seeks an overall improvement in the health of an entire population through a community based integrative approach, the selective mode is more focused on cure than prevention and deals exclusively with the health sector rather than involving the other stakeholders, ie community organisations, schools etc. (Cueto, 2004 & Baum, 2007).
The 2008 publication of WHO’s Primary Health Care – Now More Than Ever (WHO, 2008) seeks to relaunch the international organisations commital to the strategy of primary health care as the means to provide equal access to health care for all. Furthermore WHO identifies five key components to achieving this – providing universal coverage to reduce segregation and social discrepancies in health; ensuring service delivery meets the needs and expectations of people; incorporating health into other relevant sectors; following mutual modes of strategy dialogue; and promoting increased stakeholder participation. As previously alluded to, Lawn et al (2008) compliment what they see as the “revolutionary principles” of the Declaration – “equity, social justice, and health for all” – ideas which should be central to all primary health care ventures.
Lar Ó Tuama
– Cueto M. (2004) The Origins of Primary Health Care and Selective Primary Health Care. American Journal of Public Health, 94(11) pp 1864-1874.
– Lawn J.E., Rohde J., Rifkin S., Were M., Paul V.K. & Chopra M. (2008) Alma-Ata 30 years on: revolutionary, relevant, and time to revitalize. Lancet, 372, pp 917–27.