Important elements of Kark’s COPHC are
found in Pickles’ approach to primary care in the
1920s and 1930s. Pickles practiced primary care in
a defined geographic area; kept records of births,
deaths, and illnesses in the area; and used a multidisciplinary
team of priests, schoolmistresses, and
community members to track disease. While Pickles
struggled to understand how disease spread,
Kark, having that knowledge, struggled to impart it
to a traditional culture with few resources. In South
Africa and Israel, Kark benefited from government
funding and an association with the University of
Natal and Hebrew University and their faculty in
medical and nonmedical disciplines. Kark’s system
failed only after losing funding subsequent to the
political change in South Africa during the late
1940s. Given government support in Israel, Kark
effected substantial community health improvement
in an urban environment by implementing
COPHC.