Department of Social Policy, London School of Economics, London, England.
Int J Health Serv. 2013;43(3):459-71. doi: 10.2190/HS.43.3.e.
The year 2008 marked the 30th anniversary of the Alma Ata Declaration that made Primary Health Care (PHC) the global health policy of member states of the World Health Organization (WHO). Why has PHC remained relevant? In part, this is because of growing evidence that health is a result of social, political, and economic environments, not merely of control of diseases and infirmities through interventions based on biomedical science. Using the conceptual framework developed by Thomas Kuhn, this article traces the emergence of PHC as a new paradigm based on social determinants to address poor health among populations (not individuals), especially those that are low-income. It traces the history of PHC over the last 30 years, focusing on policy developments within WHO. It selects three issues: definitions of PHC; financing and delivery of health services, including lay people's involvement in health care, as examples of the new paradigm; and opposition by those whose concept of health is based on the control of disease and infirmities paradigm. The article concludes by asking whether PHC will continue to be relevant and whether the question mark in the title of this article will be removed in the future.
2008 年标志着《阿拉木图宣言》发表 30 周年，该宣言使初级卫生保健（PHC）成为世界卫生组织（WHO）成员国的全球卫生政策。为什么 PHC 仍然具有相关性？部分原因是越来越多的证据表明，健康是社会、政治和经济环境的结果，而不仅仅是通过基于生物医学科学的干预措施来控制疾病和虚弱。本文使用托马斯·库恩（Thomas Kuhn）开发的概念框架，追溯了 PHC 作为一种新范式的出现，这种范式基于社会决定因素来解决人群（而非个人）的健康问题，特别是那些低收入人群的健康问题。它追溯了过去 30 年来 PHC 的历史，重点关注世卫组织内部的政策发展。它选择了三个问题：PHC 的定义；卫生服务的融资和提供，包括非专业人士参与医疗保健，作为新范式的例子；以及那些基于疾病和虚弱控制概念的人的反对。本文最后提出了一个问题，即 PHC 是否将继续具有相关性，以及本文标题中的问号将来是否会被删除。
