The Declaration of Alma Ata and the movement it inspired was aspirational and ambitious. By reducing PHC to a cornerstone of UHC, as opposed to an umbrella under which UHC resides, the Declaration of Astana confines the health sector to a much more restricted role. With unprecedented threats to population and planetary health, the Declaration of Astana should have been more honest, bolder, and an inspirational guide for those working under increasingly difficult conditions to make health equity a reality. There are concerns that the upcoming UN High-Level Meeting on UHC will compound this policy retreat. Replacing the lodestar of PHC with UHC threatens to be one step forward and two steps back for health policy.