The political economy of primary care and “health by the people”: An historical exploration

The historical development of personal health services within the Third World, as background to the current discussion of primary health care and so-called “health by the people” efforts, is reviewed. This development is located within broader societal relationships, both at the national and international levels. It is argued that most of the Third World is in a state of advanced crisis characterized by static or even worsening life conditions for the mass of the population of those countries. The roots of this crisis lie in the colonial period, but contemporary national and international relationships are perpetuating essential characteristics of the inherited health care and other systems. Partly in response to this growing crisis, the narrow emphasis on growth of national product as the primary solution to underdevelopment has been largely replaced, at least in international discussion, by an approach that requires the meeting of everyone's basic human needs. In the health sector, primary health care and/or “health by the people” is perceived as the major vehicle for this. The paper examines some of the issues involved in the development and application of these concepts. It is concluded that in the Third World improved health is not primarily a matter of medical systems, but rather a broader question requiring better understanding of the nature of underdevelopment itself. As a consequence, all activities concerned with health must begin with the specifics of underdevelopment in particular circumstances. Only from this background will it be possible to come to grips with the issues of improved health status as well as more relevant health and medical services in the Third World. As long as it remains essentially impossible to deal seriously with existing social and property relations, so long will it remain impossible to alter significantly the health status of the world's poorest, say, one billion people.