This account of the events leading up to the Alma-Ata Conference in September 1978 (covering the years 1970 to 1978) is based on the author's recollections and his recent research of World Health Organization documents. The author builds his story around four themes: why the Soviets, in particular, wanted the conference; why the new WHO director-general did not; the time and energy lost by holding the conference; and what might have happened if it had not been held. The story involves not only people and their political and health ideologies but also reflections on the continuing question of how best to improve the health of commuunities. The account reveals how Alna-Ata constrained attempts by the new leadership of WHO to transform the way in which the organization fulfilled its international health responsibilities.