• health policy
• public health
• health systems

In a recent article in BMJ Global Health, Kraef and Kallestrup1 presented a comprehensive review of the potentials and challenges to primary health care (PHC) since its inception in the Alma Ata Declaration in 19782 and its latest iteration in the Astana Declaration in 2018.3 The challenges include threats such as disease outbreaks, conflicts and resulting insecurity, lack of support and commitment by politicians, inadequate monitoring and evaluation approaches and tools, weak financial systems, weak support of health professionals and their organisations and poor responses to community needs. These challenges are well documented and long standing. They are also difficult to overcome.

It can be argued that there is one major obstacle to meeting these challenges. It is the restricted approach for identifying problems and how possible subsequent improvements are most often investigated and presented. WHO defined health as ‘the state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’.4 The Alma Ata declaration provided rhetoric and idealism to put meat on the bones of the WHO definition. However, the last 40 years have tended to focus on the microcosms such as disease eradication, health service delivery and most recently physical and mental rehabilitation. This focus has resulted in addressing health challenges in silos that block the critical importance of viewing improvements in health in the much wider environment of social, political and economic contexts.

This narrow and siloed focus can be seen in two recent special issues of BMJ Global Health devoted to examining the potentials and challenges presented in the PHC approach to heath (May 2018, Volume 3, Suppl 3;5 September 2019, Volume 4, Suppl 8).6 Both issues have articles looking in depth at the past and future of PHC, some in great geographic …