The promise and pitfalls of generalism in achieving the Alma-Ata vision of health for all

Jane M Gunn, Victoria J Palmer, Lucio Naccarella, Renata Kokanovic, Catherine J Pope, Judith Lathlean and Kurt C Stange
Med J Aust 2008; 189 (2): . || doi: 10.5694/j.1326-5377.2008.tb01933.x
Published online: 21 July 2008

Defining the ideal generalist medical practitioner is essential to effective primary care

It is 30 years since 3000 delegates from 134 governments, 67 international organisations and many non-government organisations gathered in Alma-Ata, Kazakhstan, to agree upon a declaration about how primary health care could achieve “health for all by 2000”.1 The conference was convened by the World Health Organization and the United Nations Children’s Fund (UNICEF) in response to the growing inequality among large sections of the world’s population. The conference was influenced by global political and social change in the preceding decades and a strong desire to move away from medical dominance and elitism,2 to focus on developing countries rather than dominant Western nations, and to propose a model of health as a tool for economic development.1 The leadership of WHO Director-General Halfdan Mahler (1973–1988) was crucial to the direction of the declaration, as he had been impressed by developments in China, India, Africa and Latin America that provided health care via local community-controlled services using lay participation, and he envisioned such programs addressing health inequalities across the world.3 The resulting Declaration of Alma-Ata consisted of 10 sections (Box 1).

  • 1 Primary Care Research Unit, Department of General Practice, University of Melbourne, Melbourne, VIC.
  • 2 School of Nursing and Midwifery, University of Southampton, Southampton, UK.
  • 3 Case Western Reserve University, Cleveland, Ohio, USA.



The research reported in this paper was funded by the APHCRI, which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research, Evaluation and Development Strategy. The information and opinions contained in it do not necessarily reflect the views or policies of the Department.

Competing interests:

None identified.

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