‘Socialising’ primary care? The Soviet Union, WHO and the 1978 Alma-Ata Conference

Abstract

In September 1978, the WHO convened a momentous International Conference on Primary Health Care in Alma-Ata, capital of the Soviet republic of Kazakhstan. This unprecedented gathering signalled a break with WHO’s long-standing technically oriented disease eradication campaigns. Instead, Alma-Ata emphasised a community-based, social justice-oriented approach to health. Existing historical accounts of the conference, largely based on WHO sources, have characterised it as a Soviet triumph. Such reasoning, embedded in Cold War logic, contradicts both the decision-making processes in Geneva and Moscow that led the conference to be held in the Union of Soviet Socialist Republics (USSR) and the reality that the highest Soviet authorities did not consider it a significant ideological or political opportunity. To redress the omissions and assumptions of prior accounts, this article examines the Alma-Ata conference in the context of Soviet political and health developments, drawing from Soviet archival and published sources as well as WHO materials and interviews with several key Soviet protagonists. We begin by outlining the USSR’s complicated relationship to WHO and the international health sphere. Next, we trace the genesis of the proposal for—and realisation and repercussions of—the primary healthcare (PHC) meeting, framed by Soviet, Kazakh, WHO and Cold War politics. Finally, we explore misjudgements and competing meanings of PHC from both Soviet and WHO perspectives, in particular focusing on the role of physicians, community participation and socialist approaches to PHC.

Not merely the absence of disease: A genealogy of the WHO’s positive health definition

“…Another reason for the limited and delayed ideological resistance to the WHO constitution could be that proponents of socialist politics did not openly advocate it. This included the Soviet Union, which seemed uninterested in the WHO at first and later quit the organization between 1949 and 1955 in protest against its ‘Geneva spirit’ (Birn and Krementsov, 2018; Farley, 2008: 80–3; Gillespie, 2002: 225). The State Department files show that Parran had even offered the Soviet Union the opportunity to host the WHO’s founding conference because of ‘the advanced position of the U.S.S.R. with respect to public health and medical matters’.…”

Health for all?: Histories of international and global health

“…From 1956 on, annual conferences of health ministers across the socialist world provided a venue for coordination, leading individual countries to differentially specialize in medical research and development. The USSR also engaged in medical diplomacy—the strategic use of health‐related equipment, expertise, and financing to facilitate political relationships—to provide aid to non‐aligned countries over the 1960s (Birn & Krementsov, 2018, pp. 3–4).…”

What matters in health (care) universes: delusions, dilutions, and ways towards universal health justice

“…Even so, and despite the exclusions and stratification characteristic of much of the Third World and parts of the First (especially the USA), efforts at creating publicly-financed and operated healthcare systems made undeniable gains until the 1970s. Marking the apex of these struggles at the international level, and their turning point (with dashed hopes), was the International Conference on Primary Health Care held in Alma-Ata, Kazakhstan (former USSR), in 1978 and the movement surrounding it [26]. The effort to move from disease control to the broader right to health, from top–down to community-based approaches to health—all in the context of a New International Economic Order, upending existing power asymmetries between First World and Third, between capital and labor, etc.—might have become revolutionary indeed.…”