In developing countries, the family persists as a key institution, the centre of the emotional, spiritual and economic life of the individual and the context of the individual's interactions with the community. The majority of the population still live in rural areas where the family-community interaction is close, indeed intense. This remains true too of peasants migrating to urban slums to exist in a new culture of poverty. The family in developing countries represents a more closely shared, psychological, sociological and economic destiny than is perhaps represented by the family in the wealthy nations of the West.
'Health for all by the year 2000' is the promise of the Declaration of Alma-Ata to which all our governments have put their signatures. It is a noble ambition which is impossible to achieve unless the issues of poverty and maldistribution of wealth are seriously addressed. Nevertheless, much progress can be made during a campaign to achieve 'Health 2000' because an opportunity presents to discuss the prerequisites to achieving 'Health for all' and there is pressure to make some progress towards this.
An important opportunity now presents itself to put into effect the new concepts of family practice on a global scale. Hitherto the World Health Organization, (of which WONCA has just become a non-governmental organization affiliate) has not found it necessary to turn to family physicians for advice or expertise whilst organizations of family physicians for their part have shown little interest in the primary health care movement. Family physicians have practised under constraints that have favoured chargeable procedures as against the preventive approach, episodic care as against continuing care, caring for the fee-paying individual as against caring for the family and large panels as against small populations. This practice falls short of our ideals. In developing countries, there is a need for a community-oriented, family-based practice in which the physician and the health care team accept responsibility to work with their community to achieve health for all. We must now give attention to develop this atrophied wing of family practice.
This is truly a historic opportunity that we must seize to make available the concepts and skills of family practice and to universalize the relevance of our way of delivering primary health care. All of us in a great co-operative endeavour can do much for the health of the people of this small globe that we share.
'There is a tide in the affairs of men,
Which, taken at the flood, leads on to fortune;
Omitted, all the voyages of their life
Is found in shallows and miseries.
On such a full sea are we now afloat,
And we must take the current when it serves,
Or lose our venture.'
[Notes added by TCL: Full text of article. The quoted phrase was uttered by Brutus in William Shakespear's Julius Caesar Act 4, scene 3]
Dr Rajakumar delivered this lecture at the 14th SMA National Medical Convention on 16.4.1983
Republished in: Republished in: Teng CL, Khoo EM, Ng CJ (editors). Family Medicine, Healthcare and Society: Essays by Dr M K Rajakumar, Second Edition. Kuala Lumpur: Academy of Family Physicians of Malaysia, 2019: 83-90
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