Primary Health Care and Public Health


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White
Med Princ Pract 2015;24:103116
Most health systems around the world remain heavily
. Failure to improve the
. While
. Health systems are
All health systems, to be effective and efficient, must
.
An insightful study of low- and middle-income coun-
. These are
Terminology in Context
The terms primary health care and public health, in
. Such an approach is un-
Primary Health Care and Public Health
Med Princ Pract 2015;24:103116
.
Defining PHC
(1) Health or medical care that begins at time of first con-
. It is only a partial definition
. Important as this clinical
The literature points to the fact that PC (the clinical
.
A continuum thus exists within PHC from the indi-
.
(2) PH is the art and science of promoting and protecting
.
The Alma Ata Declaration as Historical Context
Careful reading reveals that the broader concept of
. How-
, but this group enjoyed little support
Both approaches were genuine attempts to improve
. Local com-
White
Med Princ Pract 2015;24:103116
.
The Alma Ata Declarations ill-fated slogan of health
. In addition, the refusal of experts and politicians in
. The disproportionate influ-
. While there have been
, as William Foege, former leader of
: Spectacular Progress, Spectac-
Clinical, Social and Environmental Approaches as
Ever since the dawn of medicine and PH, both of which
. Sir Michael Marmot, Chair
.
Similarly, the US National Academy of Sciences, Insti-
.
But little of the contribution from the WHO Commis-
, there is increasing recognition that
Moving beyond Health Policy to Healthy Public
The developments outlined in the preceding para-
The term healthy public policy may not be familiar to
policy, which relates primarily to the policies de-
government ministries
. This recog-
. Also referred to as health in all policies
, a crit-
Regarding the intersectoral collaboration which un-
Primary Health Care and Public Health
Med Princ Pract 2015;24:103116
, when applied
has
, such
Applying the Social-Ecological Model to Health
. Indeed, its principles were applied in developing the
[28]
, and utilized by the Institute of Medicine (US Na-
on the future of PH in the 21st century. The SE Mod-
Spheres of influence
Global
UN Universal
WHO Consultative
Group on Equity and
Universal Health
Coverage
Interpersonal
Family support
Personal beliefs
Attitudes
Behaviors/habits
Knowledge base
Circumstances
Other life course
Workplace
Places of worship
organizations
Health literacy
The social-ecological model spheres of influence.
White
Med Princ Pract 2015;24:103116
and to other PH issues; in both the USA and
38]
. Regardless of complexity, all variations of this model
It can be appreciated that the illustrative SE Model
Primary Health Care and Public Health
Med Princ Pract 2015;24:103116
Universality as a Core Principle of an Integrated
The achievement of universal access to health services,
: I regard
The goal of universal health coverage (UHC) is to en-
For a community or country to achieve universal health cover-
Strategic alignment of policy and services
across the continuum of health needs (schematic)
Public health, primary health care and community services
Acute and specialist services
Population
System leadership
Coordination
Referral (2-way)
interventions
Transform
EvaluateMonitor
At-risk
keep healthy
People with
People with
long-term
prevent
People with
support
Strategic alignment of policy and
White
Med Princ Pract 2015;24:103116
Implementing Universality
UHC in the sense outlined has been advocated for de-
. However, it has taken a long gestation for this idea
(1) Categorize services into priority classes. Relevant cri-
(2) First expand coverage for high-priority services to ev-
.
Within this aim, 5 principles are upheld: public adminis-
. However, perhaps more relevant is the WHOs
. Sev-
. Lack of incentives for self-education and
. Histori-
Primary Health Care and Public Health
Med Princ Pract 2015;24:103116
.
From a global perspective, it is noteworthy that in
, as recently reviewed
. With encouragement from this prog-
.
. If adopted, it will be difficult
While the health systems of most high-income coun-
Aligning the Components of an Integrated Health
The WHO defines integrated service delivery as orga-
. One may thus contrast the more
.
Drawing from the sources referenced
, the
White
Med Princ Pract 2015;24:103116
Notwithstanding the need to develop more effective
.
Implications for Health Professional Education
The perspective outlined in this review aligns with the
. It is
, the USA and Canada
,
. His legacy was 2-fold: that medical
Although this review gives purposeful recognition to
. Consider
Such exploitation of medical educa-
This admonition duly recognized, the value of an ap-
. In
. In transitioning from a centrally planned economy,
Primary Health Care and Public Health
Med Princ Pract 2015;24:103116
.
Furthermore, the WHO-sponsored
(2005)
noted that the corporate sector directly impacts on the
Change as the Challenge
Although the main aim of this review was to advocate
The anachronistic mode of organizational thinking
. Such evolution should
White
Med Princ Pract 2015;24:103116
It is appropriate now to take note of a similarity be-
In advocating a transition to more integrated approaches, re-
Globally, there is reason for encouragement regarding
Conclusion
Whenever seriously addressed as a matter of health
Primary Health Care and Public Health
Med Princ Pract 2015;24:103116
6 Freeman P: Why health professions educa-
33:S1S2.
7 Balabanova D, McKee M, Mills A: Good
8 Ramirez NA, Ruiz JP, Romero RV, Labonte R:
27:
18751890.
9 Last JM (ed): A Dictionary of Public Health.
10 White F, Stallones L, Last JM: Global Public
57:
259260.
19 Hall JJ, Taylor R: Health for all beyond 2000:
178:
1720.
20 White F: Development assistance for health
102,6:
421423.
21 White F: The imperative of public health edu-
22:
515529.
22 Evans T: An optimists view of global health
23 Gottleib LM: Learning from Alma Ata: the
22:
242246.
24 Marmot M: Health in an unequal world. Lan-
120:
142144.
41 World Health Organization: What is univer-
42 World Bank: World Development Report
43 World Health Organization: Making fair
44 Madore O: The Canada Health Act: over-
Parliamentary Information and Research
researchpublications/944-e.htm (accessed
June 19, 2014).
White
Med Princ Pract 2015;24:103116
62 Flexner A: Medical Education in the United
63 Yunus M: Banker to the Poor. Micro-Lending
64 Nayani P, White F, Nanan D: Public-private
4:
135142. [Note:
shut down in 2008; pdf avail-
name=Contentpub&pa=showpage&pid=36
5 World Health Organization: Bangkok Charter
66 Frenk J: Reinventing primary health care: the
E-Mail [email protected]
Review
Med Princ Pract 2015;24:103116
DOI: 10.1159/000370197
Primary Health Care and Public Health:
FranklinWhite
Pacific Health & Development Sciences Inc. and School of Public Health and Social Policy, University of Victoria,
Victoria, B.C., and Department of Community Health and Epidemiology, Dalhousie University, Halifax, N.S., Canada
2015 S. Karger AG, Basel
Introduction
This review is for two main audiences: clinicians and
.
Franklin White
Pacific Health & Development Sciences Inc.
PO Box 44125 RPO Gorge
Victoria, BC V9A7K1 (Canada)
E-Mail fwhite.pacificsci
@
shaw.ca
2015 S. Karger AG, Basel
www.karger.com/mpp
is is an Open Access article licensed under the terms of the
Creative Commons Attribution-NonCommercial 3.0 Un-
ported license (CC BY-NC) (www.karger.com/OA-license),
applicable to the online version of the article only. Distribu-
tion permitted for non-commercial purposes only.

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