2 - Mental health and primary healthcare: an international policy perspective

Summary

It is impossible to imagine that the officials who proposed Alma-Ata as the venue for the International Conference on Primary Health Care, a ministerial meeting held under the auspices of the World Health Organization (WHO) in September 1978, did so because of the symbolism of the apple. Yet, in many ways this would have been a good choice. It is the apple from the tree of knowledge that was involved in the eviction of Adam and Eve from the paradise of ignorance; and primary healthcare has been seen by many as the knowledge-based answer to health problems – that led, however, to a rude awakening in the paradise of thinking that the health problems of the world can be resolved by relying on specialists. It was an apple that Paris was to give to the most beautiful goddess. By choosing Aphrodite, who promised him the most beautiful woman, Paris voted against wisdom, represented by Athena, and against becoming the ruler of a kingdom, offered to him by Hera, thus triggering the Trojan War; primary healthcare has been described as an emotional rather than rational choice and its promotion led to discord in the field of health and wars between its partisans and opponents. The apple was a symbol of fertility offered to Hera by Gaia when Hera was to marry Zeus; and primary healthcare was to be the way to a vast improvement in healthcare, enabling many more people to get treatment than would any other system. And even more than that, the island of the apple trees (Avalon) was the place to which the select could come to enjoy heavenly delights.

The conference which, in the town of the Father of the Apple – Alma- Ata – formally defined primary healthcare, had consequences that were condensed in the symbolic meanings of the apple. Primary healthcare summarised the essence of experience and evidence about the improvement of health conditions and was a true step forward in our knowledge about healthcare. The introduction of primary healthcare created discord at all levels of the healthcare system in many countries.