The strength of primary care systems

It is over 30 years since the World Health Organizations global meeting at Alma-Ata, where primary health care was adopted as the principal mechanism for healthcare delivery.(1) The conference called for urgent national and international action to develop and implement primary health care throughout the world. It should be noted that here the World Health Organization was using the primary healthcare concept in its broadest form.

Subsequently at a major international conference, a crucial document of the new public health was produced: the Ottawa Charter.(2) The charter was influential in guiding the development of the settings approach. Internationally, examples of a wide range of settings can now be found including: health promoting schools; health promoting workplaces; health promoting prisons; health promoting hospitals; and healthy cities. In relation to some of these settings there has been a considerable amount of academic literature produced, including theoretical papers, descriptive studies and evaluations. However, despite its central importance, the health-promoting general practice has received little attention.(3,4)

In order to become a health promoting general practice, the staff must undertake a commitment to fulfil the following conditions: create a healthy working environment; integrate health promotion into practice activities; and establish alliances with other relevant institutions and groups within the community.(3) These partnerships within the community are crucial with the time restraints placed on those working in primary care to try and deliver preventive medicine with the resources already available.(5) The health promoting general practice is the gold standard for health promotion.(4)

Settings such as health promoting schools developed as they have had the support of local, national and European networks. Crucial to the future development of health promoting general practices is government support. This will be needed both directly and in relation to the capacity and resourcing of public health in general.

References
1) World Health Organization. Declaration of Alma-Ata. Geneva: World Health Organization, 1978
2) World Health Organization, Ottawa Charter for Health Promotion. Copenhagen: World Health Organization, 1986.
3) Baric L. Health Promotion and Health Education in Practice. Module 2. The organisational model. Altrincham: Barns Publications, 1994.
4) Watson, M., Going for gold: the health promoting general practice. Quality in Primary Care. 2008; 16:177-185.
5) Yarnall KS, Pollak KI, Ostbye T. Primary care: is there enough time for prevention? Am J Public Health. 2003;14:635–641.