Primary health care in a changing world

Abstract

This article considers the changing nature of primary health care in a changing international context. Four family physicians from four continents and all involved in the change process, reflect on the developments in primary health care as they perceive them. Jan De Maeseneer was involved in the incremental strengthening of primary health care in Belgium and has an international perspective as Chairman of the European Forum for Primary Care. Shabir Moosa is the acting chief specialist of District Health Services in Gauteng (South Africa) and coordinates a project on strengthening family medicine training in Africa. Yongyuth Pongsupap is the primary care component manager of Health Care Reform Project and expert in health policy at the National Health Security Office in Nonthaburi (Thailand). He has been working as a GP in a new established health centre since he was assigned as a pilot family doctor in 1991. Arthur Kaufman is involved in programmes for better access to health care for vulnerable groups and in primary care innovations in the state of New Mexico (US). Today, we face unprecedented demographic and epidemiologic transitions. The world population is aging rapidly. In 2005, 19% of all deaths were among children and 53% were among people aged 60 years and older. By 2030 the respective proportions will have changed to 9% and 62%.1 Non-communicable disease mortality will increase from 61% to 68% worldwide, and a similar trend will occur in Africa despite the HIV/AIDS pandemic and poor socioeconomic circumstances. As the population ages, the number of people with multimorbidity (two or more chronic conditions) will increase.2 There are wide differences in healthy life expectancy across the world: for Africa, healthy life expectancy is 40 years for males and 42 years for females, for Europe it is 62 and 68 years respectively.3 Encouragingly, …