TY - JOUR T1 - November Focus JF - British Journal of General Practice JO - Br J Gen Pract SP - 754 LP - 754 DO - 10.3399/bjgp08X376087 VL - 58 IS - 556 AU - David Jewell Y1 - 2008/11/01 UR - http://bjgp.org/content/58/556/754.abstract N2 - It is 30 years since the Alma Ata declaration of ‘Health Care for All by the Year 2000’. At the time its commitment to universal health care, and the clear statement that it could only be achieved through the establishment of comprehensive primary healthcare felt like a wind of change. It would be easy now to view such thoughts as naïve optimism, but the article on page 806 is by four authors, all of whom have been involved in bringing about fundamental changes to primary healthcare systems in their respective countries. In their analysis of the challenges facing ‘Primary health care in a changing world’, they examine how many of the principles we take for granted are threatened by social and medical shifts. Trisha Greenhalgh's Pickles lecture on page 798 picks up on the same theme, and identifies trends … ER -