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The Declaration of Alma Ata on Its 30Th Anniversary: Relevance for Family Medicine Today

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The Declaration of Alma Ata on Its 30Th Anniversary: Relevance for Family Medicine Today Essays and Commentaries The Declaration of Alma Ata on Its 30th Anniversary: Relevance for Family Medicine Today Allen L. Hixon, MD; Gregory G. Maskarinec, PhD The Declaration of Alma Ata, issued on September 12, 1978, provides a moral vision for primary care that remains valuable today at a time of transformation of the specialty of family medicine. The Declara- tion asserts a comprehensive definition of health that recognizes health as a fundamental human right, argues persuasively that gross inequalities in health status are politically, socially, and economically unacceptable, and identifies primary health care as the key to improving health and reducing health status inequalities. The values of Alma Ata can guide the specialty of family medicine to lead positive health system change through renewed collaboration, addressing inequalities, efficient use of resources and appropriate technology, and advocacy in the spirit of social justice. (Fam Med 2008;40(8):585-8.) In 1978, the International Confer- national development economists of family medicine and requires ence on Primary Health Care held were calling for a “New Interna- us to work at the systems level for in Alma Ata, USSR, made an ur- tional Economic Order” in response social justice in the distribution of gent call for the world community to economic disparities between the services to those in need. to come together to improve global developed and developing worlds. The Declaration of Alma Ata also health. This was issued as the “Dec- These political and economic re- defines health comprehensively. It laration of Alma Ata,”1 a document alities helped reshape the arenas of states that health systems should that continues to be the sociopo- public health and primary care. grow from specific economic, litical cornerstone expressing the political, and socio-cultural condi- moral underpinnings of primary Key Elements of the tions of countries and communities. health care. Now on the 30-year Declaration of Alma Ata It should address the principal and anniversary of the conference, it is The declaration (Table 1) de- pervasive health problems in a useful to examine the declaration in fines health as “a state of complete society with prevention, curative, its historical context and to see what physical, mental, and social well- and rehabilitative approaches. The guidance it offers us today. being and not merely the absence health care system should address The Declaration of Alma Ata of disease” and declares health to education, nutrition, food supply, emerged within a historical period be a fundamental human right. and clean water. It should embrace characterized both by optimism and This statement that health care is family planning, maternal-child possibility and by the geopolitics a human right set the stage for an health, immunization, and infec- of the continuing Cold War. Inter- entire movement in public health, tious disease control and treatment. characterizing health disparities In addition, it must address chronic and providing the ethical basis for illness care and the availability of providing health care for all. This, appropriate pharmaceuticals. The From the Department of Family Medicine and perhaps more than any other public Declaration goes on to identify Community Health, University of Hawaii. statement, articulates a core value other sectors such as communica- 586 September 2008 Family Medicine tion, agriculture, and industry and for a “fuller and better use of the medicine in particular. Three key calls for coordinated efforts to world’s resources, a considerable steps can be identified. promote health. Individuals from part of which is now spent on ar- First, we must accept a compre- the community are called upon maments and military conflicts,” hensive definition of primary care to play a role in the development a statement as relevant today as it leading to effective interdisciplin- and direction of a community- was 30 years ago. ary collaboration. To be successful responsive health care system. The The Declaration of Alma Ata in the spirit of the Declaration of Declaration calls on all health care insists that health improvements Alma Ata, we must embrace the workers to collaborate as teams to must reach everyone. It provides broad definition of primary care realize its vision. an opportunity to reflect on our with all its implications for family The Declaration of Alma Ata own contributions to the health care medicine and community health. specifically prioritizes health care system and demands that we refo- We must do a better job linking to those most in need. While this cus our priorities to make health with our colleagues in public health view of primary health care may care affordable, responsive to local and preventive medicine, while go beyond what many of us think needs and conditions, and univer- developing new models of educa- about on the way to the office, it sally available. The declaration tion and care that include working challenges us to reflect on how suggests there may be new oppor- collaboratively with nursing and al- health care delivery fits into other tunities to bridge family medicine, lied health professionals. The moral community services for the public public health, preventive medicine, imperative of Alma Ata requires us good. Issues of food security, af- and community-based care to to move beyond practice redesign fordable housing, and health lit- reach those in need of services. and the “medical home” to a more eracy are issues we cannot ignore in Finally, the declaration speaks to enduring linkage with the commu- our communities. Team-based care efficiency—cost-effectiveness and nities we serve. This relationship is a genuine necessity for quality the work of collaborative multidis- must be more widely inclusive of health care. ciplinary health care teams—both other health care professionals, edu- The document further declares themes of great importance at a cators, and leaders. Alma Ata calls that gross inequalities in health time of diminishing resources. upon us to think globally about how status are politically, socially, our efforts to promote advances in economically, and morally unac- Progress in Accomplishing health articulate with community ceptable. These inequalities persist the Goals of the Declaration well-being. today, 30 years later, not only in the of Alma Ata Second, a core focus of our work developing world but within our The goals of primary care for all must be to advocate for social own communities. Closing the gap were projected to be attained by justice and address inequalities in on health disparities must become the year 2000. While significant health. Family medicine as a spe- one of the key quality indicators for improvements have been made both cialty has often quietly gone about our health care system and a direc- domestically and abroad, particu- its business of delivering health tive for our own practices. larly in areas of infant mortality, care. But to thrive, family medicine The document links health and maternal child health, and immu- must be relevant not only to the economic improvement to quality nization, much remains to be done. health care system but also to com- of life and, ultimately, to world Family medicine as a specialty has munities. One need not advocate for peace, arguing that promoting developed over the same 30-year our own specialty as much as for health improvement is not only period encompassed by this decla- our patients and for social justice. important for the population but a ration and holds many of the same As the health of our patients and moral imperative incumbent on all principles. As family medicine communities improve and as new nations. The Alma Ata declaration goes through its own period of models of care and efficiencies are gives the people the rights and re- introspection and transformation, introduced, so too will our chosen sponsibilities for the planning and the Declaration of Alma Ata may specialty thrive. implementation of health care and act as a moral compass to help us Alma Ata challenges us to col- goes on to describe primary health collectively keep our bearings. laborate with those who work for care as foundational to any health social change. An emphasis on care system. Three Action Steps social justice should be incorpo- The declaration goes beyond for Family Medicine rated into our mission statements vision statements to describe ac- Out of the moral mandates of the and educational programs as “the tion. It describes a world of shared Declaration come specific action seventh competency” against which responsibility and calls for a part- steps for health care in the United our overall performance is mea- nership between nations to achieve States in general and for family sured. health goals. The declaration calls Essays and Commentaries Vol. 40, No. 8 587 Table 1 Declaration of Alma-Ata1 International Conference on Primary Health Care, Alma-Ata, USSR, September 6–12, 1978 The International Conference on Primary Health Care, meeting in Alma-Ata this 12th day of September in the year 1978, expressing the need for urgent action by all governments, all health and development workers, and the world community to protect and promote the health of all the people of the world, hereby makes the following Declaration: I. The Conference strongly reaffirms that health, which is a state of complete physical, mental ,and social well-being, and not merely the absence of disease or infirmity, is a fundamental human right and that the attainment of the highest possible level of health is a most important world-wide social goal whose realization requires the action of many other social and economic sectors in addition to the health sector. II. The existing gross inequality in the health status of the people particularly between developed and developing countries as well as within countries is politically, socially, and economically unacceptable and is, therefore, of common concern to all countries.
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