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21 April 1923–14 December 2016

Halfdan Mahler, the father of the primary health care movement, died aged 93 in Geneva on December 14th 2016. A Danish physician, he was the third director general of the World Health Organization from 1973 to 1988.

Dr Mahler oversaw the historic meeting in Almaty, Kazakhstan (then Alma Ata in the Soviet Union) in 1978, which culminated in the Alma Ata Declaration on Primary Health Care. This declaration was strongly supported by countries, support that is still influencing the shape of health systems 40 years later, and is reflected in the current New Zealand Primary Health Care Strategy.

In developing the declaration, Mahler was assisted by a New Zealander, Dr Ken Newell, who was head of policy at WHO at the time. Both men had come to the conclusion that health care systems were evolving along narrow technical lines, were increasingly fragmented and inequitable in the way they focused on hospitals and specific diseases, and were alienating those they were meant to help. Mahler’s experience of the limitations of TB campaigns he had been engaged in, particularly in India, and Newell’s experience of community power and engagement, and the negative impact of its absence in malaria control programmes, were crucial influences on the declaration. The declaration placed health care within a social justice framework, and the pursuit of health within what are now referred to as the social determinants. Community participation in health policy and planning was seen as fundamental to effective health systems.

The comprehensive approach to primary healthcare as articulated at Alma Ata was challenged within a year, by what Newell later referred to as the counter-revolution of selective Primary Health Care. The selective approach dominated health systems thinking for the next decade. However, the ideas underpinning PHC persisted, re-surfacing in the 2000s, and reinvigorated by WHO in its 2008 World Health report, and now form part of the current focus in the Sustainable Development Goals on Universal Health Coverage.

Mahler’s passion and foresight influenced a generation of doctors, both in New Zealand and across the world. His profound understanding of health systems, and ability to inspire the future health workforce, was evident when he visited University of Otago in Dunedin in 1979.

Mahler challenged the audience with five key behaviours he felt medical schools should instil within their graduates.

“Do you truly think in terms of prevention and promotion, rather than just cure?”

“Do you think about the family and the community, and not only your individual sick customer?”

“Are you a member of the team, not an isolated person running a grocery shop in distribution of pharmaceuticals? A member of a health team, a leader of a health team, that is concerned about the problems in the community.”

“That whatever you do, do you relate to the priority health problems in the country in which you are living and focus first and foremost on those?”

“All of this, do in the most effective and in the most efficient way, compatible with the resources in your country, and in a way which is acceptable to the population and which puts trust into the population.”

These attributes have strong resonance some 38 years later. Mahler had an extraordinary impact across the world’s health systems, which is likely to be enduring.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Professor Don Matheson, Griffith University, Queensland, Australia; Dr Julia Carr, Senior Lecturer Primary Health Care, Griffith University, Queensland, Australia; Dr Kumanan Rasanathan, Senior Health Specialist, UNICEF, New York.

Acknowledgements

Correspondence

Correspondence Email

Competing Interests

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

c


21 April 1923–14 December 2016

Halfdan Mahler, the father of the primary health care movement, died aged 93 in Geneva on December 14th 2016. A Danish physician, he was the third director general of the World Health Organization from 1973 to 1988.

Dr Mahler oversaw the historic meeting in Almaty, Kazakhstan (then Alma Ata in the Soviet Union) in 1978, which culminated in the Alma Ata Declaration on Primary Health Care. This declaration was strongly supported by countries, support that is still influencing the shape of health systems 40 years later, and is reflected in the current New Zealand Primary Health Care Strategy.

In developing the declaration, Mahler was assisted by a New Zealander, Dr Ken Newell, who was head of policy at WHO at the time. Both men had come to the conclusion that health care systems were evolving along narrow technical lines, were increasingly fragmented and inequitable in the way they focused on hospitals and specific diseases, and were alienating those they were meant to help. Mahler’s experience of the limitations of TB campaigns he had been engaged in, particularly in India, and Newell’s experience of community power and engagement, and the negative impact of its absence in malaria control programmes, were crucial influences on the declaration. The declaration placed health care within a social justice framework, and the pursuit of health within what are now referred to as the social determinants. Community participation in health policy and planning was seen as fundamental to effective health systems.

The comprehensive approach to primary healthcare as articulated at Alma Ata was challenged within a year, by what Newell later referred to as the counter-revolution of selective Primary Health Care. The selective approach dominated health systems thinking for the next decade. However, the ideas underpinning PHC persisted, re-surfacing in the 2000s, and reinvigorated by WHO in its 2008 World Health report, and now form part of the current focus in the Sustainable Development Goals on Universal Health Coverage.

Mahler’s passion and foresight influenced a generation of doctors, both in New Zealand and across the world. His profound understanding of health systems, and ability to inspire the future health workforce, was evident when he visited University of Otago in Dunedin in 1979.

Mahler challenged the audience with five key behaviours he felt medical schools should instil within their graduates.

“Do you truly think in terms of prevention and promotion, rather than just cure?”

“Do you think about the family and the community, and not only your individual sick customer?”

“Are you a member of the team, not an isolated person running a grocery shop in distribution of pharmaceuticals? A member of a health team, a leader of a health team, that is concerned about the problems in the community.”

“That whatever you do, do you relate to the priority health problems in the country in which you are living and focus first and foremost on those?”

“All of this, do in the most effective and in the most efficient way, compatible with the resources in your country, and in a way which is acceptable to the population and which puts trust into the population.”

These attributes have strong resonance some 38 years later. Mahler had an extraordinary impact across the world’s health systems, which is likely to be enduring.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Professor Don Matheson, Griffith University, Queensland, Australia; Dr Julia Carr, Senior Lecturer Primary Health Care, Griffith University, Queensland, Australia; Dr Kumanan Rasanathan, Senior Health Specialist, UNICEF, New York.

Acknowledgements

Correspondence

Correspondence Email

Competing Interests

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

c


21 April 1923–14 December 2016

Halfdan Mahler, the father of the primary health care movement, died aged 93 in Geneva on December 14th 2016. A Danish physician, he was the third director general of the World Health Organization from 1973 to 1988.

Dr Mahler oversaw the historic meeting in Almaty, Kazakhstan (then Alma Ata in the Soviet Union) in 1978, which culminated in the Alma Ata Declaration on Primary Health Care. This declaration was strongly supported by countries, support that is still influencing the shape of health systems 40 years later, and is reflected in the current New Zealand Primary Health Care Strategy.

In developing the declaration, Mahler was assisted by a New Zealander, Dr Ken Newell, who was head of policy at WHO at the time. Both men had come to the conclusion that health care systems were evolving along narrow technical lines, were increasingly fragmented and inequitable in the way they focused on hospitals and specific diseases, and were alienating those they were meant to help. Mahler’s experience of the limitations of TB campaigns he had been engaged in, particularly in India, and Newell’s experience of community power and engagement, and the negative impact of its absence in malaria control programmes, were crucial influences on the declaration. The declaration placed health care within a social justice framework, and the pursuit of health within what are now referred to as the social determinants. Community participation in health policy and planning was seen as fundamental to effective health systems.

The comprehensive approach to primary healthcare as articulated at Alma Ata was challenged within a year, by what Newell later referred to as the counter-revolution of selective Primary Health Care. The selective approach dominated health systems thinking for the next decade. However, the ideas underpinning PHC persisted, re-surfacing in the 2000s, and reinvigorated by WHO in its 2008 World Health report, and now form part of the current focus in the Sustainable Development Goals on Universal Health Coverage.

Mahler’s passion and foresight influenced a generation of doctors, both in New Zealand and across the world. His profound understanding of health systems, and ability to inspire the future health workforce, was evident when he visited University of Otago in Dunedin in 1979.

Mahler challenged the audience with five key behaviours he felt medical schools should instil within their graduates.

“Do you truly think in terms of prevention and promotion, rather than just cure?”

“Do you think about the family and the community, and not only your individual sick customer?”

“Are you a member of the team, not an isolated person running a grocery shop in distribution of pharmaceuticals? A member of a health team, a leader of a health team, that is concerned about the problems in the community.”

“That whatever you do, do you relate to the priority health problems in the country in which you are living and focus first and foremost on those?”

“All of this, do in the most effective and in the most efficient way, compatible with the resources in your country, and in a way which is acceptable to the population and which puts trust into the population.”

These attributes have strong resonance some 38 years later. Mahler had an extraordinary impact across the world’s health systems, which is likely to be enduring.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Professor Don Matheson, Griffith University, Queensland, Australia; Dr Julia Carr, Senior Lecturer Primary Health Care, Griffith University, Queensland, Australia; Dr Kumanan Rasanathan, Senior Health Specialist, UNICEF, New York.

Acknowledgements

Correspondence

Correspondence Email

Competing Interests

Contact diana@nzma.org.nz
for the PDF of this article

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