Kerr White and the Concept of Primary Health Care:

In "The Ecology of Medical Care, " an article that appeared in the New England Journal of Medicine in 1961, Kerr White and his colleagues observed that traditional indexes of public health--including mortality and morbidity--do not adequately describe the actions of individual patients and doctors. They argued that doctors should combine research of pathologic processes with exploration of the use of medical-care resources, their relative availability in different contexts, and the patient's decision-making processes. In their view, "the patient may be a more relevant primary unit of observation than the disease, the visit, or the admission."

White and his team studied sample populations in England and the United States, and established a basic statistical relationship between the population and its experience of illness and different levels of medical treatment. The findings were summarized in the now-famous "cube" diagram of health ecology below:

These findings indicated to White and his colleagues that health care delivery and the training of physicians did not bear any logical relationship to the actual experience of illness in a given population.They argued that greater attention should be devoted to primary, continuing medical care, as opposed to more exceptional episodes of hospitalization or consultation of specialists. Further, medical education and research should take greater account of the environment of health care and consider more systematically how health care resources should be deployed.

The Dawson report of 1920

Health Services Research in an International Context