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  • Understand the definitions of primary care and primary health care
  • Understand the development of primary care historically and its global importance today
  • Understand the role of primary care in health systems and how countries with inadequate primary health care are adversely affected
  • Be able to compare and contrast four countries with different health policies, priorities, and resources

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Primary health care is a phrase introduced to our lexicon in the 1970s. It is, however, an approach to health care that in fact has been present for centuries. It is important for us to understand the roots of primary health care in general practice as well as its current practice to fully understand its role in society and health. It is also important to distinguish between primary health care, as a comprehensive strategy for health promotion, and primary care, typically representing the element of clinical service delivery in that broader strategy toward health.1

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Health care has become a major issue for many countries in the 21st century. Health care includes economic, social, political, and technical issues. The questions that surround national debates regarding health care around the globe are similar. How do we best promote health and treat disease? Who should provide this care? How should the system be organized? What is the right balance and mix of health providers, and how should they be distributed? What health services should be provided for all, and who should pay? How much should health care cost? For individuals and families, the core question can be synthesized as follows: How do I attain the highest possible level of health, and how do I best access health services in times of need?

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This chapter focuses on primary health care and how it is organized and practiced around the globe. It offers a definition of primary care and looks at how it is delivered in the context of a comprehensive primary health care strategy among different health care systems. It explains how primary care can have an impact on disease and on health indicators. It looks at what some goals could be for improving health systems through advocacy for primary care education and delivery and discusses health workforce issues as they relate to models for training of primary care physicians and other members of primary care teams. The chapter focuses on primary care physicians because of the limitation of space; however, we recognize there are many other health professionals who often compose the primary care team.

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Additionally, the chapter explores how four countries with vastly different political and socioeconomic conditions have tried to improve health in their countries—some through the advent of strong primary health care delivery systems, others through systems traditionally based on specialist care, and others who have selected primary health care as the central theme for health care reform and are in the early years of implementation. It is hoped that you will gain an appreciation for ...

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