Primary Health Care conference attendees on the front steps of conference site under the conference banners.

The WHO’s Alma-Ata Declaration of 1978

Ted Brown, Ph.D. will give a Special Lecture in honor and memory of Elizabeth Fee (1946–2018) on Thursday, October 17, 2019 at 2:00 ET in the Lister Hill Auditorium at the National Library of Medicine. Dr. Brown is Professor of History and Medical Humanities at the University of Rochester. Circulating Now interviewed him about his upcoming lecture and long collaboration with Dr. Fee.

Circulating Now: Tell us a little about yourself. Where are you from? What do you do? What is your typical workday like?

An informal portrait of Ted in front of a bookshelf.Ted Brown: I’m a Professor Emeritus of History and Public Health Sciences at the University of Rochester in Rochester, NY where I recently retired after 42 years on the faculty. I was born in Brooklyn, NY, grew up mostly in Queens, went to high school (Stuyvesant) and college (City College of the City University of New York) in Manhattan, and as a Yankees fan traveled to the Bronx to watch home games of my favorite team. I crossed Staten Island to go to New Jersey and graduate school at Princeton University where I earned a Ph.D. in the History of Science. My first teaching jobs were at Princeton where I served for a few years as Instructor and Assistant Professor. I then returned to City College in the seventies in both academic and administrative positions and in 1977 moved to Rochester.

Now that I am retired, I continue to do everything I had been doing before retirement—research, writing, editing, giving talks, staying professionally engaged—except teaching, although I have accepted invitations to give guest lectures and seminars in colleagues’ courses. I still work a very full day almost every day and spend a good deal of time in my University offices, one in History and one in Public Health Sciences.

CN: How did you originally become interested in the History of Medicine?

TB: I developed interests in the history of medicine as well as the history of science as an undergraduate. I dipped into some of the history of medicine literature during my first years as a graduate student at Princeton but got more deeply interested during the course of my doctoral research when it became clear to me that I needed a more thorough understanding of seventeenth and eighteenth century medicine (and their antecedents) in order to thoroughly investigate my dissertation topic, “The Mechanical Philosophy and the Animal Oeconomy in Seventeenth and Eighteenth Century England” (Princeton, 1968). After I received my Ph.D. from Princeton in May, 1968 I accepted an NIH-funded Postdoctoral Fellowship in the History of Medicine at the Institute of the History of Medicine of the Johns Hopkins University. I then returned to Princeton as an Assistant Professor and, among other courses, introduced Princeton’s first history of medicine course. During my early teaching career I considered myself both an historian of science and an historian of medicine, but I gradually shifted focus almost exclusively to the history of medicine and over the years I added interests in the history of public health, health policy, and international and global health.

CN: Tell us a little about the work you will present in your upcoming lecture, “The World Health Organization’s Alma-Ata Declaration of 1978: What Was It Then, Where Is It Now“?

TB: The adoption of the Alma-Ata Declaration at an international conference on primary health care held in Alma-Ata, Kazakhstan in the Soviet Union from September 6 to September 12, 1978 has been regarded by many as one of the shining moments in the history of international and global health. It was the occasion for the World Health Organization (WHO), the United Nations Children’s Fund (UNICEF), and 134 signatory nations to declare the need to refocus medical priorities on primary as opposed to tertiary care and to set a goal of “Health for All by 2000.” The Declaration also made very strong commitments to “development in the spirit of social justice” and to “essential health care” that was “universally accessible” and an integral part of “the overall social and economic development of the community.”

Primary Health Care conference attendees on the front steps of conference site under the conference banners.
International Conference on Primary Health Care, Alma-Ata, Kazakhstan, 1978
In Against the Odds: Making a Difference in Global Health
Courtesy WHO

Very soon after the formal declaration of Alma-Ata, however, efforts began to reshape or even nullify it. In 1979 the Rockefeller Foundation sponsored a conference in Bellagio, Italy that formulated an alternative “selective primary health care” agenda which differed substantially from the spirit of Alma-Ata. A leading WHO official, Kenneth Newell, called the limited technical interventions of selective primary care—like vaccinations and the administration of rehydration salts—a “counter-revolution.” With the strong backing of the World Bank, the U.S. Agency for International Development, and the Rockefeller Foundation, technically-focused selective primary care largely displaced the “Spirit of Alma-Ata” whose social justice principles seemed to vanish into the ether.

But in recent years, the spirit may be reviving. Beginning in the early twenty-first century, “Universal Health Care” has become a stated goal of WHO and other international health agencies and has been included among the UN’s “Sustainable Development Goals” of 2015. In addition, the Commission on the Social Determinants of Health led by Sir Michael Marmot of Great Britain gave sustained attention to several of the principles of Alma-Ata, which was evident in the Commission’s Final Report in 2008. Influential civil society organizations such as the Peoples Health Movement have explicitly returned to the spirit of Alma-Ata. In October 2018 a conference on Primary Care held in Astana, Kazakhstan revisited many aspects of the 1978 Alma-Ata Declaration.

My lecture will review the pre-history and history of the Alma-Ata Declaration and will assess recent developments in the early twenty-first century in an attempt to offer a prognosis for the future role of Alma-Ata principles in the world of global health.

Title page of an article by Halfdan Mahler, 1978.
“Promotion of primary health care in member countries of WHO,” 1978, by Halfdan Mahler
NLM PubMedCentral

CN: The Alma Alta Declaration was a global vision. In researching this subject, were you drawn to any particular individual’s story?

TB: Yes, to Halfdan Mahler, Director General of WHO from 1973 to 1988, who was very closely identified with the Alma-Ata Declaration and who in many ways was its architect and guiding spirit. I have been exploring Mahler’s biography and studying his career and have published a few short essays about him. I have recently joined with two colleagues, both leading scholars in the history of global and international health, to plan a full-length critical biography of Mahler. Those two colleagues are Marcos Cueto of Brazil and Niels Brimnes of Denmark.

CN: This lecture is given in honor and memory of Elizabeth Fee (1946–2018), with whom you worked on this topic and others for many years. Would you like to share a few words about your collaboration?

TB: Liz and I worked very closely together for many years, as co-editors of the History section of the American Journal of Public Health (AJPH) and as the co-authors of several books and a large number of essays, editorials, and articles. I like to think of our collaboration as something akin to the famous and fruitful collaboration of Richard Rodgers and Oscar Hammerstein, not that we produced great musical theater but in the way we worked synergistically together. The Alma-Ata Declaration and what it meant historically, philosophically, politically, and morally was a particular fascination of ours, which we have written about in several articles published in AJPH and in our 2019 book with Marcos Cueto, The World Health Organization: A History (Cambridge University Press). Continuing to work on this topic will not only contribute to scholarship on a central topic in international and global health but will also help keep alive Liz’s memory and spirit.

Ted Brown’s presentation is part of our ongoing history of medicine lecture series, which promotes awareness and use of the National Library of Medicine and other historical collections for research, education, and public service in biomedicine, the social sciences, and the humanities. All lectures are live-streamed globally, and subsequently archived, by NIH VideoCasting. Stay informed about the lecture series on Twitter at #NLMHistTalk.

This lecture coincides with World Health Organization: Picturing Health for All, a new special display now on view at NLM through April 17, 2020.


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