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In this issue of JECH, authors from both the People's Health Movement1 and WHO2 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). These characteristics, all amenable to assessment in reliable and valid ways, are now so well-known that tools for their assessment are rapidly being adopted in many different places around the world.4
International comparisons demonstrate that good clinical primary care depends on good primary healthcare—that is, on specific health system policies for population. Critical among these policies are attempts to distribute …
Footnotes
↵* 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.
Competing interests None declared.
Provenance and peer review Commissioned; not externally peer reviewed.