Introduction: Linda El Rayes, Canada (2) Primary care and public health

20 August, 2023

Hi Linda,

Nice to meet you.

Esha Ray Chauhuri who is part of the HIFA support system “How can decision-making processes for health systems strengthening and universal health coverage be made more inclusive, responsive and accountable." I imagine that this support system fits in with your interests.

Esha introduced a paper by Dzau, Laitner and Balatbat titled “Has traditional medicine had its day? The need t0 redesign academic medicine.”

In the paper, the authors write:-

“The field of medicine has traditionally focused on care for individual patients, with emphasis on disease treatment and less focus on disease deterrence and the socioeconomic and behavioural factors that impact health and wellbeing. Over the years, this model has served patient care well. However, the most pressing issues facing health and health care today — including non-communicable diseases (NCDs), an ageing global population, and complex, systemic barriers to health equity — are not easily solved with an individual patient approach.”

“In 2010, the US Government commissioned the Institute of Medicine (IOM; now known as the National Academy of Medicine), to study how the government could work to improve population health through the integration of primary care and public health. The resulting report, published in 2012, emphasised the impact of social, behavioural, and environmental factors on health outcomes. The IOM noted that, in the USA, the health-care system's unbalanced funding structure allocates substantially greater financial resources towards treating illness than it does towards prevention, leaving the country inadequately equipped to address challenges of health promotion.”

Joseph Ana and his team describe clinical medicine as standing on (or not!) 12 pillars – equipment, infrastructure, ICT, utilities and ambience, staff and staff management, education and training, clinical audit, clinical effectiveness, risk management, patient and public involvement, funding mix and policy and health acts. To a reasonable extent “medicine” is currently defined by the medical and pharmaceutical professions who respond, like all workers, to pay incentives, lifestyle and pensions.

Our record Access Collaborative and patient participation brief starting some years ago is to try to lend the tools of Joseph’s pillars of medicine to patients and communities – patients and communities often who have no doctors or nurses. It is a culture change as described in 2001in an NHS ERDIP report which I can forward to you, if you like.

« This report was commissioned as part of the ERDIP Patient Held Records, Modernisation Enabling Project[1] <#_ftn1> at Hadfield Medical Centre (HMC), in order to document and analyse the background to the organisation and its culture prior to its involvement in the current project. This report endeavours to explain the practice’s activities with respect to patient involvement, patient access to their records, and health information relative to the NHS Plan. This is achieved by examining the process of organisational change, the organisational structure, and the culture and leadership of the HMC. The report draws on empirical evidence from a variety of sources related to HMC as well as a range of theoretical models which are used to present the data. «


[1] <#_ftnref1>

HIFA profile: Richard Fitton is a retired family doctor - GP. Professional interests: Health literacy, patient partnership of trust and implementation of healthcare with professionals, family and public involvement in the prevention of modern lifestyle diseases, patients using access to professional records to overcome confidentiality barriers to care, patients as part of the policing of the use of their patient data. Email address: richardpeterfitton7 AT