Developing a more appropriate model for primary care requires that we create a new diagnostic algorithm and clinical care model that serves the core of personalized healthcare - the individual. For any model to be successful it must provide the foundation on which to build a system that has the depth and breadth necessary to meet the unique demands of a broad population on a personal level. The core of any new model of primary healthcare need not be redefined or reinvented as the definition presented in the Declaration of Alma-Ata, adopted at the International Conference on Primary Healthcare in 1978, is more than sufficient starting with the section highlighted below.
“Primary healthcare is essential healthcare 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 healthcare as close as possible to where people live and work, and constitutes the first element of a continuing healthcare process. .” Declaration of Alma-Ata
Bringing healthcare closer to where people live is as key to the process of developing a new model as any other part of the statement above. Lifestyle diseases (or diseases of longevity) have increased in notable frequency as countries have become more industrialized coupled with the fact that people are living longer. These diseases include Alzheimer's disease, atherosclerosis, asthma, cancer, chronic liver diseases, chronic obstructive pulmonary disease, Type 2 diabetes, heart disease, metabolic syndrome, chronic renal failure, osteoporosis, stroke, depression and obesity. Of these diseases the WHO notes that heart disease is the leading cause of lifestyle related disease worldwide.
The rate at which this shift has been happening hasn’t gone unnoticed, in fact it has been talked about now for almost 40 years. We can see how the WHO has observed trends within the system and attempted to bring notice of these trends to light via their annual reports. The information below includes select titles of World Health Reports along with a summary of those reports demonstrating the observance of trending needs. The following are summaries from each respected report offering insight as to what trends are being observed over the last two decades.
- 2000: Health Systems: Improving Performance
- The World Health Report 2000 introduced a conceptual framework and measurement approach to examine and compare aspects of health systems around the world, and better understand the complex factors that explain how health systems perform. The report provided an assessment of the performance of national health systems for all countries.
- 2002: Reducing Risks, Promoting Healthy Life
- The World Health Report 2002 described the amount of disease, disability and death in the world that could be attributed to a selected number of the most important risks to human health. It projected how much this burden could be lowered in the next 20 years if the same risk factors were reduced.
- 2006: Working together for Health
- The World Health Report 2006 highlighted the estimated shortage of almost 4.3 million doctors, nurses, midwives, and other health human resources worldwide, calling the situation a "global health workforce crisis". The report laid out a ten-year action plan for building national health workforces through better training, recruitment and management processes.
- 2008: Primary Health Care (Now More Than Ever)
- The theme of the World Health Report 2008 was the renewal of primary healthcare, and the need for health systems to respond better and faster to the health care challenges of a changing world. Focal points of the report include
- Good care is about people
- The distinctive features of primary care
- Organizing primary-care networks
- Monitoring progress
The reports above provide us with some perspective of the shifting demands worldwide, including an aging population, growing influence of chronic disease, loss of primary care support and the changing needs related to health care strategy. The WHO along with other groups like the Committee on Quality of Health in America (CQHCA) have been documenting, researching and presenting their findings on health care needs for over a decade. The depth and breadth of the issues we face in health care today are clear and the value of this research project is to dig through this information to find what information can be applied more effectively.