Thirty years on from Alma-Ata: Where have we come from? Where are we going?

Abstract

The 2008 William Pickles Lecture coincided with a number of important anniversaries: 60 years since Pickles published his landmark monograph ‘ Epidemiology in Country Practice ’;1 40 years since Pat Byrne gave the first William Pickles Lecture at the Royal College of General Practitioners; and 30 years since the publication of the Alma-Ata Declaration.2 In my lecture, I cover four themes. First, whatever happened to what is sometimes depicted as the idyllic life of the William Pickles-style country GP? Second, whatever happened to Alma-Ata? Third, what — more generally — do these changes represent? And finally, what (if anything) can we salvage from our nostalgic memories of old-fashioned general practice that will help us in our contemporary role as primary care practitioners? William Pickles was a GP in the glorious setting of Wensleydale in the Yorkshire Dales from 1922 until the mid 1960s. He demonstrated that high-quality epidemiological research can be achieved if family doctors think hard about their practice, pursue their clinical and scientific hunches, and keep meticulous records.1 His intimate knowledge of the local rural community and its ways; his simple hand-drawn epidemiological charts; and his ruthless hunting down of the social contacts of people with contagious diseases, equipped him to make significant contributions to the science of epidemiology — including documenting the incubation period of measles, influenza, hepatitis A, and dysentery, as well as helping to establish the link between chickenpox and shingles. Wensleydale in the early 20th century was a quintessentially English farming community. It was by no means affluent but it was close-knit, hard-working, and focused almost exclusively on the core business of growing crops, tending livestock, and getting products to market. Records suggest that the family doctor was a unique and respected member of such rural communities, who tended to suffer …