The capital of Kazakhstan, Astana, recently re-named Nur-Sultan, could hardly be further from our preoccupations with Europe and concerns about the NHS. It lies almost 2000 miles east of Moscow. The country’s healthcare system is stretched to breaking point; life expectancy and other health indicators are among the lowest in the world, and the health impacts of the environmental disaster of the Aral Sea are still being felt. Yet this was the location chosen by the World Health Authority for its Global Conference on primary health care last year, and which has given its name to a Declaration on Primary Health Care marking 40 years since the landmark Declaration of Alma-Ata, which itself affirmed that health is a fundamental human right. It also emphasised that primary health care is an essential component of any health system and included a plea for peace, détente, and disarmament. Our editorial by Sophie Park and Ruth Abrams considers the implications of Astana for the future of health care, and examines some of the ideological and practical tensions within it.
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