Medicine started retreating from health in 1979

Editorial, Academia Medicine and Health, April 2026 — Markou-Pappas, Fugazzola, Ansaloni (University of Pavia)

Claude AI summary

This editorial argues that over the past century the concept of health expanded outward — from the WHO's 1948 definition (complete physical, mental, and social well-being), through the 1978 Alma-Ata Declaration (health embedded in social and economic development), the 1986 Ottawa Charter, and on to Global Health and One Health — while medicine as actually practiced contracted toward what is "manageable, measurable, and profitable."

The authors locate the hinge in 1979, when a New England Journal of Medicine paper introduced "selective primary health care": discrete, disease-centered, cost-effectiveness-driven interventions that displaced Alma-Ata's comprehensive, community-anchored vision. They characterize this shift as a deliberate political and economic project that "quietly and deliberately" converted health into a commodity. The piece then turns to surgical care and armed conflict as the settings where the cost of that retreat is most measurable, and frames the journal's renaming (adding "Health") as a corrective.

There is no vitamin D, nutrition, or prevention content in it. What it offers is a clear, citable articulation of the same mechanism this site invokes repeatedly: health systems systematically abandon the unprofitable and the preventive first, while resources concentrate on the discrete, billable, and patentable. The editorial applies that logic to global surgery and primary care; the parallel to underresearched, unpatentable interventions like vitamin D is left for the reader to draw.

Key claims:

The idea of health has moved consistently away from the clinic and toward the world — more inclusive, ecological, political, and human across a century of WHO-era scholarship.
Medicine moved the opposite way, pulled back toward the measurable and profitable; the 1979 "selective primary health care" paper is named as the turning point.
The Lancet Commission on Global Surgery is cited for the scale of the gap: roughly five billion people lacking access to safe surgical and anaesthesia care, ~143 million additional procedures needed annually, ~90% of the burden in low- and middle-income countries.
Prevention, preparedness, and education are "health projected forward" — and the first investments cut when medicine narrows its self-definition.

⚠ What this editorial does NOT show:

It presents no new evidence. Every empirical figure is borrowed from cited sources (chiefly the 2015 Lancet Commission); nothing here is original data.
The central historical claim — that selective primary health care was a "systematic dismantling" and "a political and economic project" — is the strong interpretive reading, presented without its counter-reading. Even the authors' own cited source (Cueto 2004) tells a more mixed story: selective PHC also arose from genuine, good-faith arguments that comprehensive primary care was too diffuse to fund or measure, and from targeted interventions (immunization, oral rehydration) that demonstrably saved lives. Treat the commodification narrative as a contestable argument, not settled historiography.
The surgery-and-war material, while the emotional core of the piece, is illustrative rather than evidentiary for the broader thesis about health-vs-medicine divergence.

Bottom line: Useful as a well-sourced, eloquent statement of the structural-incentive argument — citable when explaining why unprofitable interventions get neglected — but it is an opinion editorial, and its strongest historical claim should be flagged as one interpretation among several.

Medicine started retreating from health in 1979

Editorial, Academia Medicine and Health, April 2026 — Markou-Pappas, Fugazzola, Ansaloni (University of Pavia)

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