COMMENTARY Learning from Alma Ata: The Medical Home and Comprehensive Primary Health Care

The patient-centered medical home (PCMH) recently has received much attention in health systems lit-erature. The PCMH holds considerable promise for improving health outcomes and re-establishing a role for family medicine in a fragmented health care system. Despite its philosophical approach to com-prehensive health care reform, the PCMH fails to offer concrete recommendations to address the social determinants of health, which include health and social policy. Political engagement to promote health is part of both primary health care and specifically family medicine’s history; the absence of practical, adaptable ways to implement this engagement may undermine the PCMH’s ultimate goals of improving individual and population health. (J Am Board Fam Med 2009;22:242–6.) “The drumbeat for the patient-centered medical home is getting louder, ” wrote Bowman, Neale, and Lupo1 in their introduction to a recent Journal of the American Board of Family Medicine. Hailed as a “polestar ” in that same issue,2 the medical home’s appearance and rapid spread in both recent primary care literature and financing legislation3 come at a