School of Public Health, University of the Western Cape, P Bag X17, Bellville 7535, South Africa.
J Epidemiol Community Health. 2011 Aug;65(8):661-5. doi: 10.1136/jech.2009.095125. Epub 2009 Dec 1.
The promised revitalisation of primary healthcare (PHC) is happening at a time when the contradictions and unfairness of the global economic system have become clear, suggesting that the current system is unsustainable. In the past two decades, one of the most significant impediments to the implementation of comprehensive PHC has been neoliberal economic policies and their imposition globally. This article questions what will be required for PHC to flourish. PHC incorporates five key principles: equitable provision of services, comprehensive care, intersectoral action, community involvement and appropriate technology. This article considers intersectoral action and comprehensiveness and their potential to be implemented in the current global environment. It highlights the constraints to intersectoral action through a case study of nutrition in the context of globalisation of the food chain. It also explores the challenges to implementing a comprehensive approach to health that are posed by neoliberal health sector reforms and donor practices. The paper concludes that even well-designed health systems based on PHC have little influence over the broader economic forces that shape their operation and their ability to improve health. Reforming these economic forces will require greater regulation of the national and global economic environment to emphasise people's health rather than private profit, and action to address climate change. Revitalisation of PHC and progress towards health equity are unlikely without strong regulation of the market. The further development and strengthening of social movements for health will be key to successful advocacy action.
初级卫生保健（PHC）的振兴承诺正在兑现，此时全球经济体系的矛盾和不公平已经显现，表明当前的体系是不可持续的。在过去的二十年中，实施全面 PHC 的最大障碍之一是新自由主义经济政策及其在全球范围内的实施。本文探讨了 PHC 蓬勃发展所需的条件。PHC 包含五个关键原则：公平提供服务、综合护理、跨部门行动、社区参与和适当技术。本文考虑了跨部门行动和综合性及其在当前全球环境下实施的潜力。通过全球化食品链背景下的营养案例研究，强调了跨部门行动的限制。它还探讨了新自由主义卫生部门改革和捐助者做法对实施综合卫生方法所带来的挑战。本文认为，即使是基于 PHC 的精心设计的卫生系统，对塑造其运作和改善健康的更广泛经济力量也几乎没有影响力。改革这些经济力量需要对国家和全球经济环境进行更大的监管，以强调人民的健康而不是私人利润，并采取行动应对气候变化。如果不对市场进行强有力的监管，PHC 的振兴和实现健康公平的进展是不可能的。进一步发展和加强卫生运动将是成功倡导行动的关键。
