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Revitalising primary healthcare requires an equitable global economic system - now more than ever
  1. David Sanders1,
  2. Fran E Baum2,
  3. Alexis Benos3,
  4. David Legge4
  1. 1School of Public Health, University of the Western Cape, Bellville, South Africa
  2. 2Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, Australia
  3. 3Medical Department, Aristotle University, Thessaloniki, Greece
  4. 4School of Public Health, Latrobe University, Victoria, Australia
  1. Correspondence to Dr D Sanders, School of Public Health, University of the Western Cape, P Bag X17, Bellville 7535, South Africa; sandersdav5845{at}


The promised revitalisation of primary healthcare (PHC) is happening at a time when the contradictions and unfairness of the global economic system have become clear, suggesting that the current system is unsustainable. In the past two decades, one of the most significant impediments to the implementation of comprehensive PHC has been neoliberal economic policies and their imposition globally. This article questions what will be required for PHC to flourish. PHC incorporates five key principles: equitable provision of services, comprehensive care, intersectoral action, community involvement and appropriate technology. This article considers intersectoral action and comprehensiveness and their potential to be implemented in the current global environment. It highlights the constraints to intersectoral action through a case study of nutrition in the context of globalisation of the food chain. It also explores the challenges to implementing a comprehensive approach to health that are posed by neoliberal health sector reforms and donor practices. The paper concludes that even well-designed health systems based on PHC have little influence over the broader economic forces that shape their operation and their ability to improve health. Reforming these economic forces will require greater regulation of the national and global economic environment to emphasise people's health rather than private profit, and action to address climate change. Revitalisation of PHC and progress towards health equity are unlikely without strong regulation of the market. The further development and strengthening of social movements for health will be key to successful advocacy action.

  • Primary health care
  • health policies
  • social determinants
  • global economic system

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  • See Commentary, p 653

  • Linked articles 93914, 102780

  • All authors are members of the Global Steering Council of the Peoples' Health Movement.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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