From Australia,
 
I want to thank Dennis and the network for his stamina and the support this work gives people even far away, like here.
 
I find the PRIMER inspiring and will try to get people to emulate it here. Practical and founded on good science.Surely a great combination.
 
However, since I'm emailing:
 
Folk, even good ones (like this network) often tend to begin their history of global movement towards SDH in 1986 at Ottawa. Though the Charter was/is important this does two things:
 
1) By ignoring the initatives of Alma Ata and Primary Health Care (PHC), we (surely inadvertently), give a "Euro/N American-centric" perspective to this progressive force. Despite its aim to "re-orientate the health services", Health Promotion/Ottawa Charter CAN tends to ignore the discussions and efforts to incorporate the SDH approach (even if this language isn't used) in many countries in South America, Asia and Africa. To make this a global push, I urge people to widen their perspective and think back at least to 1978 and Alma Ata. (I don't think there is deliberate racism in this approach: I put it in my subject line to get your attention, though I think there IS an underlying discrimination in our blindness to the lessons from so-called "developing"countries and in our case, from the Aboriginal people's embracing of the PHC ideals.)
 
2. By ignoring the PHC initiative, we take the focus away from whole systems approaches, acting as though we could promote the SDH and ignore the need to work at and with health services, to make them more equitable, participatory etc. Without this wider perspective Medicine will go on its merry way consuming the vast bulk of resources and not really care if we work at SDH in the community.
 
I won't go on, but I do think these things need saying.
Immodestly, let me say I have written about this, e.g. in my 2005 book, Environments for Health published by Earthscan.
 
Once again, thanks to Dennis and the network for  keeping this flame burning,
 
John 

Professor John J Macdonald
Foundation Chair in Primary Health Care
Co-Director Men's Health Information and Resource Centre
P11 Hawkesbury Campus
Locked Bag 1797 Penrith South DC NSW 1797
Tel (61) 2 45701123/(0404008760)
Fax (61) 2 45701552

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