The International Conference on Primary Health Care (PHC), promoted by WHO and UNICEF, was held in Alma Ata in 1978. It promoted progress in health rights. He proposed to overcome the models focused on the disease that favor curative, expensive services, based on hospitalization establishments and specialists, by models based on health promotion and prevention at reasonable costs for the population. The PHC implies a cultural change that locally could not yet finish establishing. The APS strategy is still in force to address today’s problems. Starting in the 1970s, a system worked that improved the care of patients, mostly with acute problems (eg, diarrhea, pneumonia).
Today most problems are chronic. Disorders like anxiety and depression are an epidemic. The main causes of death are cancer, cardiovascular conditions and injuries from accidents or family or social violence. Diabetes and hypertension are prevalent and bad habits drive obesity, smoking and addictions (we have a high consumption of cocaine per inhabitant).
At the same time, malnutrition and TB are advancing in a province with high incomes that has doubled poverty and indigence in the last 4 years. PHC is “more necessary than ever” to address chronic problems.
The health system must leave hospitals and clinics to meet potential patients for the prevention and promotion of their health. You should look for silent pathologies present, but not yet identified. 50% of diabetics are unaware that they are sick. Arterial hypertension is diagnosed and treated in less than half of the adults who present it (only 42%).
Early diagnosis in cancer is key to cure. Many mental illnesses are diagnosed up to 8 years after they started (eg Alzheimer’s disease). Atherosclerosis, coronary heart disease and stroke require changes in habits and lifestyles before they wreak havoc.
The health system cannot wait for patients to attend the consultation. But the problem goes further because once all these chronic diseases are diagnosed, they must be controlled and monitored throughout life, which demands a health strategy that is very different from the current one, where access is made through guards (in public health) or specialists (in the private system).
Within the framework of PHC, a powerful first level of care must be developed to lead the battle for health and from there the demands of the second level (specialists and hospitalization) and third level (high complexity) are ordered. If we don’t implement this improvement we will sit in our offices waiting for barrages of brain hemorrhages, heart attacks, advanced cancers, deep depressions, psychotic addicts, etc. etc that will produce a high number of premature, preventable deaths, and an increase in the costs and expenses of their care.
There should not be different care models according to the size of each person’s pocket (public health for the poorest and the ISSN for the salaried middle class). It is necessary to have the same care model for everyone.
Although most of the problems raised are known, it is also true that it will be difficult to control them if we continue the same. On the contrary, they will tend to increase. The changes require that the health authority once again play a leading role in its role of stewardship and regulation over the entire system. Public health and the ISSN must lead this crusade for health and become the locomotive that drives the rest of the system.
Art. 134 of the Provincial Constitution clearly mandates: “it is an unavoidable obligation of the province to ensure public health and hygiene, especially with regard to the prevention of diseases, making free and compulsory services available to its inhabitants in defense of health, for what it means as social capital”.
Doctor. Entrepreneur. Member of the Board of Directors PRO Neuquén.