The Role of The Health Workforce in Tackling Health Inequalities: Action on the social determinants of health
Consultation Questions
Please add your comments to the following boxes and send to by 18th May 2012.
Name: Diederik Aarendonk
Job Title: Coordinator
Organisation: European Forum for Primary Care
Contact email:
Please add me to the IHE mailing list: already on the list
OVERALL APPROACH
- Do you agree that practice, education and incentives, monitoring and directives (sections in the following report) are the most important areas for action?
The European Forum for Primary Care (EFPC) agrees with the focus on these three areas.
- Can you identify any further mechanisms, not identified in the report that could be used to facilitate action on the social determinants of health by the health workforce?
If it comes to practice, the EFPC recognizes the importance that there are no vested interests with the different professional groups which have to cooperate to tackle health inequalities. This will hamper an effective use of the added value of each professional in the care process to achieve the highest level of care for the citizen/patient.
For this,radical changes in the educational system will be needed to enable the different professionals working in the health care system to become peers rather than acting as different professionals. The current educational system in which professionals are receiving training in their own silos has to be changed into a system in which professionals are trained in a practical collaborative way.
Regional and local health authorities could develop appropriate mechanisms facilitating actions on the social determinants of health; involving health stakeholders it is an urgent priority in enhancing this suggested mechanism in Europe.
- Are there any activities or themes that feature in the report that you think should not? If so, please state.
The EFPC agrees with the activities and themes stated.
COVERAGE
- Are there any activities or themes that do not feature in the report? If so, please could you give examples?
Multimorbidity.
There should be a clearer focus on multimorbidity which is of a high urgency of large numbers of citizens suffering more than one chronic disease and subsequently the need for support to Primary Care professionals in tackling the complex care for those patients/citizens.
Half of people aged over 65 suffers from 3 chronic diseases and 20% even has more than five. In general practice multimorbidity is becoming the rule rather than the exception. Patients concomitantly taking over 10 different drugs are not uncommon which leads to interaction and additional medical consumption. Despite the fact that an increasing number of chronically ill suffers from co-morbidities disease management programmes constitute a single-disease approach and tend to neglect co-morbidities. This related to the fact that most evidence has been collected in single disease trials excluding patients with comorbidity.
Multimorbidity is currently effecting the poor population and underserved as it has been observed in certain European countries under financial crisis, like Greece. Recommendations to primary care practitioners to identify those people and putting in priority in terms of the chronic disease determinants is a key issue.
Hence , prioritize improvement in chronic disease care, in particular for patients with multiple, high-cost conditions and severe health loss. Local communities should involve all chronically ill residents, regardless of health insurance status or source of coverage, in care improvement initiatives utilizing three evidence-based tools: payment reform, to encourage accountability; primary care, to improve care coordination; and health information technology, to promote information use and sharing. It is important to note that "communities" is defined broadly as any area where providers, payers, residents, and others work together to achieve common goals related to improving care and reducing costs for the high-cost chronically ill. Armed with these tools and with sufficient flexibility in approach, such community-based initiatives would achieve synergies to fuel rapid progress in care for a population that bears a high burden of illness.[1]
The EFPC observes a need to formulate a clear vision on contemporary and future education of professionals, to facilitate inter professional and multidisciplinary collaboration in primary health care. Professional education is fragmented, often out-dated, or there is a mismatch of competences to population and patient needs.[2]
- Are there specific health professional groups that do not feature adequately in the following report?
The EFPC agrees with the professionals mentioned in the report, recognizing the difficulty that it is always difficult not to forget one specific professional.
- Do you have any examples of work that you do/are aware of on the social determinants of health that we could share with stakeholders (via case studies in the report or our website)? If yes, please include in your consultation response
The Position Paper of the EFPC on Primary Care and interprofessional collaboration within primary care teams including 5 practice examples from Spain, The Netherlands, Belgium, Slovenia and Sweden.
COmpetences for POverty REduction (COPORE)
with the survey of good practices with 9 selected European projects.
ACTIONS
- What action are you thinking of taking as a result of this report?
A further exchange of good practices including the specific practice settings, not only within the UK but also within Europe.
For this the report should be translated into other national languages and to be also
adapted to national settings.
- What would help you take action after reading this report?
The involvement of strong partners in the UK to launch similar consultations for Primary Care professionals in Europe would help the EFPC to bring this further. The EFPC, together with all its’ institutional, individual and associated members[3], is interested to play a key-role in bringing this further in Europe. As a start polls could be enrolled within our network to collect opinions in the European Primary Care network.
The EFPC in itself is the ideal platform to discuss/debate the different roles to tackle health inequalities of professionals working in Primary Care. At our meetings (next one in September ¾ in Gothenburg, Sweden[4]) a variety of Primary Care professionals are present and could be involved in such a debate.
- Do you think you/professional groups would find the appendix illustrative example useful? If no, please state what you think would be more useful
The EFPC recognizes the need for each professional group to have a critical look on their own role in tackling health inequalities but wants to warn for a silo way of addressing this issue. It would probably even more effective to initiate an interprofessional approach!
DISSEMINATION AND IMPLEMENTATION
- How can the Report findings be most effectively disseminated and implemented?
All professional journals and events in the UK and Europe.
The EFPC events which attracts the different professional groups active in Primary Care in Europe could be a very effective vehicle as it will be possible not only to disseminate the findings but also stimulate further discussion and debate on the issues mentioned in the report.
After translation the report should be disseminated among professional groups, in particularly in countries where health inequalities are a result of the current financial crisis.
- What can the IHE do to improve the likelihood that its proposals will be adopted locally, nationally and internationally?
An active approach towards the different professionals associations, as well the national as the international groups.
Besides the IHE has to start approaching educational facilities which are responsible for the training of future professionals in the UK and Europe. These are crucial for the way professional groups will be able to collaborate to tacklehealth inequalities.
- What do you think should be the priority actions the IHE should take following the publication of this report?
Involving health care professionals on an equal basis addressing their roles in tackling health inequalities.
Formulate a clear vision on contemporary and future education of professionals, to facilitate inter professional and multidisciplinary collaboration in tackling health inequalities.
Discussing the report within undergraduate education should be also an important action
- Any further comments
MANY THANKS FOR TAKING PART
[1] The Performance Improvement Imperative: Utilizing a Coordinated, Community-Based Approach to Enhance Care and Lower Costs for Chronically Ill Patients
The Commonwealth Fund Commission on a High Performance Health System April 2012
[2]Health professionals for a new century: transforming education to strengthen health systems in an interdependent world; The Lancet, global independent commission, Dec. 2010
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