As we focus future efforts on addressing health equity in low-and middle- income communities, there is value in reflecting on past approaches to health care for the world’s most disadvantaged people. Newly independent countries were emerging in mid-twentieth century – and along with new governments also came the need for new infrastructure, including health care. By the 1970s, the public health field recognized that Primary Health Care (PHC) was not being served or accessible to where many people live and work. Enter the Alma Ata Declaration, which urged governments, health and development workers, and the world community to protect and promote the health of all people.
To achieve the vision of Health for All, the Declaration advocated decentralizing power and decision-making away from government offices in the capital city and away from doctors and nurses providing care in hospitals, to the people at the grassroots level. In 1978 when the Declaration was adopted, Primary Health Care meant working with community members to take stock of their health and living conditions, and by taking maximum advantage of the commitment and skills of local people to achieve health. Now in 2018, in an era of global climate change and environmental degradation, it is no longer sufficient to empower local people to take action locally as a standalone approach.
The Commission on Planetary Health, led by The Lancet and Rockefeller Foundation, took the Alma Ata Declaration a step further with their Planetary Health program. They are investing in a new multidisciplinary field that incorporates global and local-level action to improve health and wellbeing of low-income communities and to reduce consumption by wealthy communities – all while also maintaining ecosystems and biodiversity for future generations.
Primary Health Care that incorporates Planetary Health must also work to reduce global consumption of fossil fuels and other resources, reduce the environmental impacts of food production, maintain ecosystems and promote biodiversity. For health systems, this means continuing to work toward decentralizing decision-making, empowering local stakeholders, and localizing health system inputs such as energy, construction materials and food.
The New Primary Health Care
This expanded concept of Primary Health Care is summarized in the following table. It animates and informs the work of several thematic areas in the Alliance for a Healthier World, particularly for the Healthy Environments area.
We are rapidly approaching the 40th anniversary of the International Conference on Primary Health Care held in September 1978, and that issued the Declaration. Carl Taylor, the Chair of the Department of International Health at the Johns Hopkins School of Public Health at the time, played a major role in drafting the Alma Ata Declaration.
Currently, Johns Hopkins faculty and students are spearheading a working group, the Alma Ata 40 Campaign to mark the anniversary in September 2018, and renew collective commitment to the vision of health for all and health equity enshrined in the Declaration. The global health community will mark the 40th anniversary of the Alma Ata Declaration with a conference on Oct 25–26, 2018 in Almaty, Kazakhstan.
Editor's Note: This article is the first in a series we’ll publish about the Health for All principles underpinning the Alma Ata Declaration and the roles that all members of the Johns Hopkins community can adopt to help achieve its vision.
Dalglish SL, Poulsen MN, Winch PJ. (2013). “Localization of health systems in low- and middle-income countries in response to long-term increases in energy prices.” Globalization and Health. 9:56.
United Nations Environment Programme. (2012). Global Environment Outlook: Environment for the future we want. Progress Press.
Whitmee S, Haines A, Beyrer C, Boltz F, Capon AG, de Souza Dias BF, Ezeh A, Frumkin H, Gong P, Head P, Horton R, Mace GM, Marten R, Myers SS, Nishtar S, Osofsky SA, Pattanayak SK, Pongsiri MJ, Romanelli C, Soucat A, Vega J, Yach D. (2015). “Safeguarding human health in the Anthropocene epoch: report of The Rockefeller Foundation-Lancet Commission on planetary health.” The Lancet. 386(10007): 1973-2028.
Peter Winch is the Theme Leader for Healthy Environments at the Alliance for a Healthier World (AHW). As Professor in the Social and Behavioral Interventions Program in the Department of International Health at the Bloomberg School of Public Health, he teaches courses on qualitative and formative research and applied medical anthropology. His work aims to: 1) improve the health of mothers and children in areas where access to health facilities is poor or non-existent, and 2) develop and evaluate behavior change interventions and health system responses to global environmental threats.