Renewing primary health care in the Americas: the Pan American Health Organization proposal for the twenty-first century

Abstract

Pan American Journal of Public Health (RPSP/PAJPH), which it is my pleasure to present, is devoted to primary health care (PHC) and is part of the movement that the Pan American Health Organization (PAHO) is leading to renew PHC in the Region of the Americas. The International Conference on Primary Health Care, held in 1978 in Alma-Ata (Kazakhstan, Union of Soviet Socialist Republics), defined the PHC concept, bringing it international recognition as the principal strategy for attaining the goal of Health for All by the year 2000. This vision of PHC was stated in the principles and recommendations of the Declaration of Alma-Ata, which marked the start of a new paradigm for improving public health and providing a new platform for international health policy (1). Since 1978, the Region’s general context has changed remarkably, due not only to the changes within the countries themselves, but also to changes of a global scale that impact both the individual and society in general. There have been substantial epidemiologic, demographic, sociocultural, political, and environmental changes that have created new scenarios with their own health risks that—in addition to the existing, unresolved threats—require new strategies. This complex situation reaffirms the importance given to PHC in 1978. The connections between health and economic development are indisputable, and health is recognized as being a product of sociocultural, economic, and political processes, as well as a basic human right. Moreover, good health has a positive effect on the level of education, productivity, and general well-being of a population (2). Furthermore, inequity, poverty, abuse, violence, and injustice have a negative impact on health (3). Given the clear correlation between health and development, it is imperative that any health-improvement efforts address and integrate any determinants that exist beyond what is strictly health-related. Since PHC already approaches the individual and the family as a whole, and takes into account surrounding circumstances, PHC is the ideal strategy for taking action within the complex process that provides and protects individual and community health. The call of PHC to partner with other sectors in evaluating the determinants of health and illness clears the way for formulating public policy that is conducive to integrated, sustainable human development. Although the Region, in general, has made considerable strides in improving various health indicators in recent decades, inequities and differences still exist among countries as well as among population groups within each country. The Millennium Development Goals, adopted in 2000 by 189 counFrom the Director