Monday, July 11, 2011

[EQ] Politics, primary healthcare and health: was Virchow right?

Politics, primary healthcare and health: was Virchow right?

Barbara Starfield*

Primary healthcare
Editors' note Just as this issue was going to press, we learned that Barbara Starfield MD, MPH, died suddenly and unexpectedly while swimming. Dr Starfield was a world-renowned scholar and tireless advocate for primary care and health inequalities research. She made an enormous impact in both of these fields and her contributions will be greatly missed by our research community.
We thank Normalie Barton for checking the proofs on behalf of Dr Starfield

J Epidemiol Community Health 2011;65:653-655 doi:10.1136/jech.2009.102780


“…..In this issue of JECH, authors from both the People's Health Movement 1 and WHO 2 agree that primary healthcare makes a considerable contribution to reducing the adverse impact of social inequalities on health.

That is, primary healthcare is a ‘health equity-producing’ social policy. Both groups of authors agree that health systems do not exist in isolation from other social systems. Both provide examples of how the market orientation of neo-liberal globalisation has worked against improvements in general and equity in health specifically. The role of world trade agreements in compromising nutritional status of socially disadvantaged populations provides a powerful case for the importance of inter-sectoral approaches in health policy activities.

Both papers speak of ‘primary health care’ rather than of ‘primary care’. The distinction between the two is at the heart of achieving greater equity in health through societal actions. Both clinical practices and system policies need consideration. 3

The literature on ‘primary care’ is largely clinical, having to do with the behaviour of health services professionals and their interactions with people and, increasingly, the subpopulations for whom they provide services. Within the last two decades there has been increasing clarity about which ‘behaviours’ are most important to adequacy of primary care: first contact accessibility and use, identification with a regular source of care that is person (rather than disease) focused care over time, comprehensiveness of services available and provided, and coordination (when care from other places is required).

Issue – content:

Related Articles:

Primary health care and the social determinants of health: essential and complementary approaches for reducing inequities in health

Kumanan Rasanathan, Eugenio Villar Montesinos, Don Matheson, Carissa Etienne, Tim Evans

J Epidemiol Community Health 2011;65:656-660 Published November 2009 doi:10.1136/jech.2009.093914

Revitalising primary healthcare requires an equitable global economic system - now more than ever

David Sanders, Fran E Baum, Alexis Benos, David Legge

J Epidemiol Community Health 2011;65:661-665 Published December 2009 doi:10.1136/jech.2009.095125

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