Primary health care: when and where did it all begin?
Continuing the primary health care theme of the previous post, health policy expert Professor Philip Davies investigates the history of the terms “primary care” and “primary health care” – a topical matter given the legal action recently dropped by Primary Health Care Ltd.
Tracking the long history of primary health care
Philip Davies writes:
After months of legal tussling, Primary Health Care Limited has abandoned its attempt to restrict the use of the term “primary health care”.
According to Henry Bateman, the general manager of Primary Health Care’s medical centres, it was “important … to ensure the brand Primary Health Care was not used in a way that would mislead or create confusion”.
On the other hand, Patrice Cafferky, a Director of one of the organisations potentially impacted by Primary’s action, described the attempt to prevent the use of the term as “abominable”.
When health care insiders refer to primary health care they typically make reference to the Alma Ata Declaration that was produced following the International Conference on Primary Health Care convened by the World Health Organization (WHO) in Alma-Ata, USSR from 6‑12 September 1978. That definition states that:-
Primary health care is essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination. It forms an integral part both of the country’s health system, of which it is the central function and main focus, and of the overall social and economic development of the community. It is the first level of contact of individuals, the family and community with the national health system bringing health care as close as possible to where people live and work, and constitutes the first element of a continuing health care process.
But was that the first use of the term?
To the best of my knowledge, the first reference to “primary care” (as opposed to “primary health care”) in the context of health services is to be found in the Interim Report on the Future Provision of Medical and Allied Services (commonly known as the ‘Dawson report’) produced by the Consultative Council on Medical and Allied Services in London in 1920.
That report states that:-
“A Health Centre is an institution wherein are brought together various medical services, preventive and curative, so as to form one organisation. Health Centres may be either Primary or Secondary, the former denoting a more simple, and the latter a more specialised service” [emphasis added]
The report then goes on to explain that:-
“The domiciliary services of a given district would be based on a Primary Health Centre – an institution equipped for services of curative and preventive medicine to be conducted by the general practitioners of that district, in conjunction with an efficient nursing service and with the aid of visiting consultants and specialists.”
The report envisages that services offered at a Primary Health Centre would include, inter alia, “curative and preventive medicine … conducted by … general practitioners”, “care and instruction of pregnant women”, “labour and after-care”, laboratory and dental services.
The specific term “primary health services” arises in the Report’s discussion of teaching hospitals where it is suggested that “The academic influence, and the spirit of inquiry and progress associated with a Teaching Hospital, would permeate the system of secondary and primary health services within the allotted sphere of influence of such a medical school.” (para 75).
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