Defining the ideal generalist medical practitioner is essential to effective primary care
It is 30 years since 3000 delegates from 134 governments, 67 international organisations and many non-government organisations gathered in Alma-Ata, Kazakhstan, to agree upon a declaration about how primary health care could achieve “health for all by 2000”.1 The conference was convened by the World Health Organization and the United Nations Children’s Fund (UNICEF) in response to the growing inequality among large sections of the world’s population. The conference was influenced by global political and social change in the preceding decades and a strong desire to move away from medical dominance and elitism,2 to focus on developing countries rather than dominant Western nations, and to propose a model of health as a tool for economic development.1 The leadership of WHO Director-General Halfdan Mahler (1973–1988) was crucial to the direction of the declaration, as he had been impressed by developments in China, India, Africa and Latin America that provided health care via local community-controlled services using lay participation, and he envisioned such programs addressing health inequalities across the world.3 The resulting Declaration of Alma-Ata consisted of 10 sections (Box 1).
The full article is accessible to AMA members and paid subscribers. Login to read more or purchase a subscription now.
Please note: institutional and Research4Life access to the MJA is now provided through Wiley Online Library.
- 1. Declaration of Alma-Ata. International Conference on Primary Health Care, Alma-Ata, USSR, 6–12 September 1978. http://www.euro.who.int/AboutWHO/Policy/20010827_1 (accessed Jun 2008).
- 2. Friedson E. The profession of medicine. New York: Dodd Mead, 1970.
- 3. Tejada de Rivero DA. Alma-Ata revisited. Perspectives in Health 2003; 8 (2): 2-7.
- 4. Cueto M. The origins of primary health care and selective primary health care. Am J Public Health 2004; 94: 1864-1874.
- 5. Chabot HT. Primary health care will fail if we do not change our approach. Lancet 1984; 2: 340-341.
- 6. World Health Organization. International conference on primary health care, Alma-Ata: twenty-fifth anniversary. WHO Secretariat, 2003. http://www.who.int/gb/ebwha/pdf_files/WHA56/ea5627.pdf (accessed Jun 2008).
- 7. World Health Organization. Primary health care: 25 years after Alma-Ata. Cairo: WHO Regional Committee for the Eastern Mediterranean, 2003. http:// gis.emro.who.int/HealthSystemObservatory/PDF/TechnicalandDiscussion Papers/PRIMARY%20HEALTH%20CARE%2025%20YEARS%20AFTER%20 ALMAATA.pdf (accessed Jun 2008).
- 8. Montegut AJ. To achieve “health for all” we must shift the world’s paradigm to “primary care access for all”. J Am Board Fam Med 2007; 20: 514-517.
- 9. Starfield B, Lemke KW, Bernhardt T, et al. Comorbidity: implications for the importance of primary care in ‘case’ management. Ann Fam Med 2003; 1: 8-14.
- 10. Starfield B, Lemke KW, Herbert R, et al. Comorbidity and the use of primary care and specialist care in the elderly. Ann Fam Med 2005; 3: 215-222.
- 11. Fortin M, Lapointe L, Hudon C, Vanasse A. Multimorbidity is common to family practice: is it commonly researched? Can Fam Physician 2005; 51: 244-245.
- 12. Fortin M, Bravo G, Hudon C, et al. Prevalence of multimorbidity among adults seen in family practice. Ann Fam Med 2005; 3: 223-228.
- 13. Australian Government Department of Health and Ageing. National chronic disease strategy [archived website]. http://www.health.gov.au/internet/wcms/publishing.nsf/Content/pq-ncds-strat (accessed Jun 2008).
- 14. Fendall NR. Declaration of Alma-Ata. Lancet 1978; 2: 1308.
- 15. Stange K, Zyzanski SJ, Jaén CR, et al. Illuminating the ‘black box’: a description of 4454 patient visits to 138 family physicians. J Fam Pract 1998; 46: 377-389.
- 16. Passmore R. The declaration of Alma-Ata and the future of primary care. Lancet 1979; 2: 1005-1008.
- 17. Greenhalgh T. Primary health care: theory and practice. Oxford: Blackwell BMJ Books, 2007.
- 18. Horder J. General practice in 2000. Alma Ata Declaration. Br Med J (Clin Res Ed) 1983; 286: 191-194.
- 19. Canadian Health Services Research Foundation. Teamwork in healthcare: promoting effective teamwork in healthcare in Canada. Policy synthesis and recommendations. Ottawa: CHSRF, 2006. http://www.chsrf.ca/research_themes/pdf/teamwork-synthesis-report_e.pdf (accessed Jun 2008).
- 20. Grumbach K, Bodenheimer T. Can health care teams improve primary care practice? JAMA 2004; 291: 1246-1251.
- 21. Gunn J, Naccarella L, Palmer L, et al. What is the place of generalism in the 2020 primary care team? Canberra: Australian Primary Health Care Research Institute, 2007. http://www.anu.edu.au/aphcri/Domain/Workforce/Gunn_25_approved.pdf (accessed Jun 2008).
- 22. Starfield B. Is primary care essential? Lancet 1994; 344: 1129-1133.
The research reported in this paper was funded by the APHCRI, which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research, Evaluation and Development Strategy. The information and opinions contained in it do not necessarily reflect the views or policies of the Department.
None identified.