Intended for healthcare professionals


Alma Ata and primary healthcare: back to the future

BMJ 2018; 363 doi: (Published 22 October 2018) Cite this as: BMJ 2018;363:k4433
  1. Zulfiqar A Bhutta, professor1 2,
  2. Rifat Atun, professor of global health systems3,
  3. Navjoyt Ladher, head of scholarly comment4,
  4. Kamran Abbasi, executive editor4
  1. 1Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
  2. 2Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
  3. 3Harvard University, Boston, MA, USA
  4. 4The BMJ, London, UK
  1. Correspondence to: Z A Bhutta zulfiqar.bhutta{at}

After 40 years, global health is returning to the vision of the Alma Ata declaration

In 1978, when the world looked different geopolitically, the Soviet Union hosted a landmark international conference on primary healthcare. Organised by the World Health Organization and Unicef, the conference took place at Alma Ata (now Almaty) and considered the role of primary healthcare in population health. It finished with a declaration that promised “health for all by the year 2000.”1

The Alma Ata declaration was signed by 134 countries and 67 international organisations and was groundbreaking in several ways. The declaration promoted a holistic definition of health “as a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity.” The 10 statements of the Alma Ata declaration stressed the large inequality in health and its social determinants and recognised primary healthcare as integral to achieving health for all by 2000.

The conference and declaration also espoused three important principles. Firstly, primary healthcare is an integral part and central function of health systems. Secondly, it is essential to social …

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