Alma Ata at 40 - Doctors Without Boredom

Yesterday was the 40th anniversary of the Alma Ata Declaration (PDF) — the landmark 1978 World Health Organization statement by 134 countries affirming the vital role of primary health care. This article explains why it’s so important to still focus on primary health care: even though we can make a huge impact and save millions of lives by intentionally targeting diseases like HIV/AIDS, TB, or malaria (and we should), that shouldn’t come at the expense of building a good primary health care system that deals with all of the other diseases people get — because those kill people, too!

In too many other countries, however, PHC has devolved into a selective focus on the top-down distribution of important commodities related to health, such as vaccines, contraceptives, antivirals and other necessary, good things. Selective interventions like these are effective and important. They are also lucrative—which is why vested interests often push their particular “magic bullets” targeting specific diseases.

Top-down solutions rely on funding for a workforce to deliver them. Without the community’s political buy-in, they are unsustainable. And they are limited in the conditions they can address: There are no good top-down solutions for combating obesity, diabetes, cancer, substance abuse and suicide. Solving these problems requires changes in the behavior of individuals, along with changes in social norms and social supports from the community.

I wrote more about the history of Alma Ata and the role that missionaries have played in global health. On that note, I also want to highlight my friend Dr. Ray Downing’s delightful book on pioneers in global health, which is also being released as a podcast!