Recently, I watched a videotaped lecture by the famed Dr. Carl Taylor, MD DrPH (1916-2010), the founding father of then-new academic discipline called International Health. Dr. Taylor’s lecture, taped few years before he died at the age of 93, was called The Key Studies of Primary Health Care and it was available on the Johns Hopkins open access website. This interesting lecture was actually a part of Dr. Taylor’s teaching curriculum at the Department of International Health that he established at his beloved Johns Hopkins. His love, however, was to travel around all corners of the earth and help communities empower themselves!
Currently, I am taking Health for All Through Primary Health Care class through Johns Hopkins, and if we realize that by all accounts the most important Alma Ata Conference was held in 1978, that we are faced with a certain crisis of unfulfilled Millennium Development Goals (MDG) by 2015, and that more people live in abject poverty today than ever before – we begin to truly appreciate the genius of Dr. Carl Taylor’s approach and his vision for not only health care as such, but for PRIMARY HEALTH CARE especially!
WHY is primary or community health care THE point? Simple: If the government doesn’t do it for you (i.e. the Top-Down model) the people must do it for themselves (Bottom-Up model)… Hopefully with some help and guidance from global health or international organizations, sure, but by leading themselves nonetheless.
As for me, I would have never believed I would be interested in a discipline that does not have all the critical & intensive bells and whistles that only Code Blue, cardiac arrests, Swan-Ganz and ICP or resuscitation in hallways can provide and only critical intensive nursing can deliver. However, as my professional development began to move forward, I very slowly started to move away from all that acute rush in hospitals to seeing ‘Public Health’ from not only an administrator point of view, but also from the level of public health policy.
And that’s where it really hits you!
Saving people’s lives one by one thus making a difference in my patients and their families lives in ICU or OR or ER or PACU was wonderful and I loved every minute of my 13+ years on 2 continents and 3 countries! But, if you really want to make a difference, difference on a much broader global scale that is, you must look at the discipline of Public Health – and specifically, International or Global Public Health (as is my Masters Degree) through a different set of eyes and through completely different prism.
And this why I LOVE it so much!
In order to be successful and effective here, you must fully understand the intricacies of health care / patient care delivery, from there you must be abreast on how to deliver said services in a department or an organization, which is finally leading you to realization you can have influence through your earned knowledge and understanding over global issues, politics and public policies that are determined by international decisions via foreign policies. Those in turn deeply affect all those other social determinants of health which decide the actual individual health and well being – or not – of your people. … when they come to ICU and I can save them…
The astounding combination of my 3 professional loves and passions: [Global] Healthcare, Politics & Administration all lead to my overall passion and I believe a certain inner sense of Global Public Health Administration. And that is why I slowly moved, over the span of several years and large sums of money for university education) from all the bells and whistles in intensive and critical care units to a global view of social determinants of health, determinants affected by political decisions.
From Dr. Taylor’s lecture, we learned that the idea behind ‘community-based primary health care‘ is as ancient and as old as Hippocrates himself, as he began to treat sick people in the open, as in village squares where every person from the village could come and offer advice on treatment and getting better! While I don’t really agree with openly spreading germs to the village, the fact that Hippocrates did not isolate the sick, that he did not put them somewhere ‘away’ from the others, shows his initial foresight of holistic / community approach to healing and showed his outlook to the future foundation for community-based primary health care.
What I also did not know is that it was Hippocrates who first started to separate medicine from public health as he started to recognize that different geographical areas meant different patterns of diseases. That was a major fork in the road for healthcare where medicine has clearly different goals and different strategies from community-based primary health care.
Dr. Carl Taylor stated that in the early days, U.S. physicians viewed primary care as ‘individual’ care, while following approach originating in South Africa encompassed and recognized all aspects of health care in its Community Oriented Primary Care approach (COPC). Here again, many years after Hippocrates, we see the resurgence of the core idea that community is at the center of “health” and well-being of an individual thus of the collective “health” of the whole community.
In a historic context, I would compare this community centered resurgence of the South African (and later American and Israeli) approach to the recent resurgence of the principles of the Alma Ata Declaration. Lancet article (Walley et all. 2008) clearly states that the community-based or community-centered approach to public health is going through a re-birth of sorts as more and more studies show that Dr. Taylor’s SEED-scale approach, which clearly encompasses Kerrer’s South African COPC model, is an approach that takes all other, not only health and disease, but also other social determinants of health in account when dealing with “health“.
Walley says: “The emphasis must shift from single intervention to creating integrated, long-term sustainable and ethical health systems…” Nobody, not the U.N. or any NGO, can achieve this Alma Ata-centered goal without dealing with a host of other determinants. Sadly, for our global health care objectives, those determinants are decided and implemented (-or not-) by sovereign national governments.
Herein resides the problem.
Health does not happen in a vacuum! Very rarely do people get sick out of nowhere…
“Health” happens as a result of… or a consequence to… certain political actions or social events.
The primary public health care problem we are discussing here, is a problem originating in poverty, lack of potable water, lack of safe environment, lack of developed infrastructure, lack of knowledge and awareness, and lastly, as a lack of political will.
That is why I applaud the resurgence of the Alma Ata principles taught by Dr. Carl Taylor and the ongoing recognition of the variety of other important aspects that influence, directly or indirectly, the overall status of public health and primary health care in particular.
In fact, it was Hippocrates who preceded Alma Ata Declaration with his vision, when he involved and engaged the whole community in the treatment and planning of healing solutions… And that concept is THE cornerstone of Alma Ata Declaration!