Primary Health Care in the Making

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Since the historieal conference held in Alma Ata in 1978, it has been possible to observe a reorientation of the medical profession. More and more, issues of health enter the stage and curative medicine is not just loosing ground but some interest. 'How effective is health education?' and 'Whose task is primary pre- vention?' are questions which stimulate great concern and public debate. It seems also to be the first time since the last decades of the 19th century that the social dimension of health receives adequate consideration. Thus the reeent publication of the so-called Black Report on Inequalities in Health (Penguin 1982) led to a heated discussion in Great Britain, certainly of relevance to many other countries. The 6 years since 1978 are much too short a time to proceed far towards 'Health for All', as the slogan of the World Health Organization puts it, but the concepts are spelled out, vaguely but convincing to many of us. It is the right time to discuss first experiences and to move from philosophy to empiri- eal work. This work - as it relates to the process evolving since Alma Ata - is characterized by participation, cooperation and prevention: Participation, because 'disease' concerns only the individual patient, his or her family and immediate social environment, while 'health' concerns everyone and should involve everyone. It is a task of the whole of society rather than the domaine of a single profession or party.