Carta de los Editores

Abstract

September of this year marked the 37 th anniversary of the adoption of the Declaration on Primary Health Care (PHC), one of the most important documents in the history of international public health. From September 6-12, 1978, over 3,000 delegates from various countries came together for a conference organized by the World Health Organization (WHO) and the United Nations International Children's Emergency Fund (UNICEF), in Alma-Ata, a city in the former Soviet Union, to discuss and approve the PHC, which subsequently became a public health icon. In later years, different agencies defended the principles of PHC. Some recent examples include the WHO and its annual report of 2008, entitled "Primary Health Care-Now More Than Ever." The Universal Health Coverage proposal promoted over the last ten years by leaders at the World Bank and other agencies is inspired by the PHC, according to its supporters. In both the WHO report and this proposal, PHC is associated with a modernization of primary care, the assignation of more healthcare resources to rural and deprived urban areas, the recruiting of community healthcare agents, universal access to basic health services and greater emphasis on disease prevention (which generally receives less attention in national Health Ministry budgets than treatment for patients). It is true that the PHC of 1978 advocated all of this. But that was not all it stood for. It had transformational political implications that faded in the conservative, neoliberal context which dominated from the 1980s on. Some international healthcare documents defended and revitalized the original political significance of the PHC. The most well-known ones are the Ottawa Charter, approved in 1986 in the first International Conference on Health Promotion, and the publications produced from 2005-2008 by the Commission on Social Determinants of Health. These documents suggested and, on occasion, openly proposed that PHC should be the center of a program for socially inclusive development in developing countries and a tool for creating more egalitarian and caring societies in industrialized countries. They also suggested that healthcare workers could become agents of change and social progress, articulating-along with union leaders, community leaders and progressive non-governmental organizations-demands and solutions for resolving social injustice, discrimination and poverty. For defenders of this holistic version, PHC could not be left up to technocratic policy within a model of society being promoted by neoliberal policies; namely, a society with less state government and fewer social services, where public health care for the neediest members of society functioned as a palliative for dire poverty. By contrast, they saw PHC as part of a reform or even a social EDITORS' NOTE