Am Fam Physician. 2009 Jun 15;79(12):1051.
The World Health Organization's (WHO's) 2008 World Health Report critically assesses the way health care is organized, financed, and delivered, and it refocuses global attention on primary health care.1 The report, “Primary Health Care—Now More Than Ever,” was released on the 30th anniversary of the Alma-Ata International Conference on Primary Health Care. In 1978, WHO members signed the Alma-Ata Declaration, which set an ambitious goal of “health for all” by the year 2000. Health systems emphasizing primary health care were seen as the means of achieving this goal. However, the approach was misunderstood by some who viewed primary health care as poor care for poor people, with an exclusive focus on public health and basic preventive care.
The 1978 “health for all” movement struggled without a unifying and complete definition of primary health care or a set of principles for organization, delivery, and financing. However, the 2008 World Health Report demonstrates that global health status has significantly improved since the Alma-Ata Declaration. For example, 18,329 fewer children died each day in 2006 than in 1978.1 Yet the report found significant inequities across countries in health outcomes, access to care, and health care costs. Many nations have failed to respond to rising social expectations for health care that is patient-centered, fair, affordable, and efficient.
To steer health systems toward better performance, the report calls for a return to primary health care. When comparing countries at the same level of economic development, those countries with health care that is organized around the tenets of primary health care produce a higher level of health for the same investment.2
The WHO proposes four core primary health care principles of effective health systems, which redefine in a more comprehensive and modern way the limited definition of 30 years ago:
Enhanced patient-centered primary care services
Strengthened community-centered public health policies
Effective health system leadership
These principles are aimed at realigning specialist-based, fragmented, and commercialized health systems to meet rising public expectations for effective, efficient, accessible, and affordable care. Although family physicians may not find an acceptable level of detail about their specific role in the primary health care–oriented system, going forward, the 2008 World Health Report provides a relevant and enabling foundation for family medicine.
1. World Health Organization. The World Health Report 2008. Primary Care—Now More Than Ever. http://www.who.int/whr/2008/en/index.html. Accessed February 17, 2009.
2. Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q. 2005;83(3):457–502.
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