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Meeting people's basic health needs requires addressing the underlying social, economic, and political causes of poor health.
ABSTRACT: Primary health care was declared the model for global health policy at a 1978 meeting of health ministers and experts from around the world. Primary health care requires a change in socioeconomic status, distribution of resources, a focus on health system development, and emphasis on basic health services. Considered too idealistic and expensive, it was replaced with a disease-focused, selective model. After several years of investment in vertical interventions, preventable diseases remain a major challenge for developing countries. The selective model has not responded adequately to the interrelationship between health and socioeconomic development, and a rethinking of global health policy is urgently needed.
THE HEALTH CARE SYSTEMS of many developing countries emerged from colonial medical services that emphasized costly high-technology, urban-based, curative care.1 When these countries became independent in the 1950s and 1960s, they inherited health care systems modeled after the systems in industrialized nations.2 Public health programs of international development agencies during this period were also largely targeted at eradicating specific diseases such as smallpox, yaws, and malaria. Each disease eradication program operated autonomously, with its own administration and budget and very little integration into the larger health system.3 There were some successes during this period (for example, eradication of smallpox and a decrease in tuberculosis). However, these short-term interventions were not addressing poor populations' overall disease burden.4 Analysts realized that although one disease might be controlled or eliminated, recipients of that intervention might die of another disease or its complications.5 The situation worsened into the early 1970s, as populations continued to experience failing health outcomes with rising spending.6
Recognizing that narrow targets were not the only option, countries attempted to implement comprehensive approaches to the provision of basic health services. Examples included the creation of the rural health center, staffed by medical and health assistants and supported by the Bhore Commission in India; the implementation of "community-based health programs" in Nicaragua, Costa Rica, Guatemala, Honduras, Mexico, Bangladesh, and the Philippines; and the barefoot doctor program in China.7 As part of the overall efforts to improve population health, these countries brought a new theme to international health discourse: commitment to social equity in health services....