Primary Health Care and Population Mortality

Description:

Population health management is being increasingly adopted by health systems yet the importance of primary health care in influencing population mortality and the mechanisms that explain it are not well understood. Too often, primary health care is regarded as a service for minor health problems and for managing access to secondary care. This limited view is no longer tenable and it is time to be much more ambitious about the place of primary health care in health systems worldwide.

In delivering and planning health care and in re-building health systems after the pandemic, practitioners and policymakers in low-, middle- and high-income countries need evidence on how primary health care affects population mortality and practical advice to effect change. Primary Health Care and Population Mortality fulfils this need. Drawing on his long experience as both a practitioner and researcher, the author Richard Baker describes how primary health is crucial to the effect of health systems on population mortality, including its potential for reducing inequalities in mortality.

This accessible new book will provide invaluable information to leaders in service development and delivery, academics in primary health care and those working within international organisations that are promoting primary health care for improving population health. It will also be of practical value to general practitioners, primary health care nurses and managers and public health staff.

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Preface

It’s time to think differently about primary health care. As the evidence assembled in the following pages shows, it is crucial to the effect of health systems on population mortality. The research responsible for this new understanding of primary health care has been conducted in the last two decades and is so extensive that it has been possible to identify 23 mechanisms that contribute to its beneficial effects. Too often in the past, the policies of many governments and decision makers appear to have been based on the belief that primary health care is the setting for dealing with minor problems and the routine management of chronic disorders, with the overriding objective being to constrain the use of costly hospital services. The consequence of this narrow understanding of primary health care is shorter lives for too many people. The new evidence demands that policymakers should be much more ambitious about the role of primary health care in health systems. Better planned and better resourced services would be followed by fewer premature deaths among current and future generations.

Policymakers should also be more ambitious about primary health care’s role in reducing inequalities in mortality. It can make a difference, yet too often services are neither designed nor managed appropriately. It is time for this state of affairs to change. The life-course theory of health inequalities has special relevance to that part of the health service that provides lifelong care – inequalities begin at the beginning of life, and action by primary health care to address them must begin with mothers and children.

The planning and delivery of primary health care must give greater priority to reducing mortality and inequality in mortality. The mechanisms of primary health care that influence mortality should be used by policymakers to inform the organisation of services. Methods are available for monitoring mortality patterns, and mortality should be one of the key outcomes routinely used to guide services. Practitioners need a supportive policy framework that allows them to learn from both mortality in the populations they care for and the deaths of individuals.

Around the world, primary health care is working hard to restore services that were stretched to a breaking point during the pandemic. But even before the pandemic there were serious problems. In low- and middle-income countries, primary health care was often poorly resourced, patchy and fragile; and in high-income countries, failure to anticipate the changing demands on health care caused by ageing populations left many services in a state of unplanned decline. For many countries, rebuilding primary health care will be a long and difficult path. The preparation of this book began during the lockdowns of the pandemic.

By the time all the evidence had been sifted, it had become clear that more than re-building will be needed if primary health care is to achieve its full potential in improving health. The evidence and ideas in the following pages are offered in the hope that thinking differently about the role of primary health care will help its potential to be reached.

Table of contents :

Cover
Half Title
Title Page
Copyright Page
Contents
Preface
Acknowledgements
Author
1. Hard times
2. From certificates to statistics
3. Variations in population mortality and some things that influence them
4. Primary health care and population mortality in low-, middle-and high-income countries
5. Communicable diseases
6. Non-communicable diseases 1: Cardiovascular disease and cancer
7. Non-communicable diseases 2: Respiratory disorders and mental health
8. Organisational features of primary health care
9. The patient–professional relationship
10. Policy and population health management
11. The mechanisms framework
12. New ambitions for primary health care
Index