The Sustainable Development Goals (SDGs) are now steering the global health and development agendas. Notably, the SDGs contain no mention of Primary Health Care (PHC) – reflecting disappointing implementation of Alma-Alta over the past four decades. The recently-published draft Astana declaration (Alma-Ata 2.0) restates the key principles of PHC and renews these as driving forces for achieving the SDGs, emphasizing Universal Health Coverage (UHC). We use accumulating evidence to demonstrate that countries that reorientate their health systems towards primary care are better placed to achieve the SDGs than those with hospital-focused systems or limited investments in health. We then argue that an even bolder approach which fully embraces the Alma-Ata vision of PHC could deliver substantially greater SDG progress – by addressing the wider determinants of health, promoting equity and social justice throughout society, empowering communities, and as a catalyst for advancing and amplifying UHC and synergies among SDGs.