In late August, I received an email from Duke Family Medicine Residency Program Director Viviana Martinez-Bianchi, M.D., FAAFP, inviting residents to apply as a World Health Organization (WHO) young leader to attend the WHO/UNICEF Global Conference on Primary Health Care in Astana, Kazakhstan. After reading the application, I knew being accepted out of a global group of young health professionals would be a long shot, but the advice of a long-time mentor popped into my head. He told me to always shoot for 50 percent success in what I apply for, because if I am always successful, I will be missing many incredible opportunities.
In early October, I was invited to experience one of these incredible opportunities as part of a group of 50 young global primary care health professionals invited to attend the conference, as well as special preconference. During the preconference, I met individuals across the spectrum of health professions to discuss issues facing primary health care in our countries and determine policy priorities to building a future that puts primary care at the center of our health care systems. It was stimulating and inspiring to work with people coming from backgrounds and professions so different than mine and to brainstorm solutions to problems as diverse as reliable power sources for rural African clinics to the need for comprehensive payment reform that better compensates primary and preventive care. While we each had unique challenges, we realized that we shared many of the same struggles to bring primary care to the forefront of our health systems.
During a small group I took part in, we distilled a wide range of issues into one actionable policy priority of advocating for community-accountable education across the spectrum of health care specialties. While this would look somewhat different depending on whether an individual is in the United States or Bangladesh, and whether they are training to become a family physician or community health worker, core tenants of community-accountable education include moving health professions education away from academic institutions that provide the bulk of reactive, tertiary care, and placing the training at the community level in clinics, community hospitals, and even in the homes of the patients we serve. We were told to prepare a message for leaders we would meet at the conference the next day, but I don’t think any of us expected to have the direct audience of the director general of the World Health Organization, Dr. Tedros Adhanom Ghebreyesus, the executive director of UNICEF, Henrietta Fore, and several other dignitaries including ministers of health and foreign ministers. Our message was well received, and all who heard it appreciated both the intention and importance of our policy recommendation.
'An inspiring experience'
The Global Conference for Primary Health Care itself was also an inspiring experience. It brought together individuals from over 130 United Nations member states to recommit to the tenants of the Declaration of Alma-Ata, signed 40 years prior, which among other things declared health care as a fundamental human right and brought primary care to the forefront in health systems around the world. Member states also ratified the Astana Declaration, a modern version of the declaration of Alma-Ata. While this was exciting, it was also disheartening that specific stakeholders — including but not limited to family physicians and youth which were previously named as signing the declaration — were taken out of the declaration with the focus being solely on member states.
I was also disheartened that in negotiating its willingness to sign the Astana Declaration, the United States government included a footnote on the bottom of the declaration to draw attention to a point, stating, “in no case should abortion be promoted as a method of family planning.” Even in Astana, U.S. politics loomed large over what was supposed to be a unifying gathering of world nations. It was also clear that while the United States may have some of the best specialty care in the world, we have a lot to learn from the rest of the world to make primary care the base of our healthcare system.
However, there was much to be learned at the conference. It was humbling to listen to a minister of health speak about an innovative program their government is implementing in one session, and to find myself sitting in the seat next to them during the next session, with everyone learning from one another. Two such persons I met were both the current and previous minister of health of Ecuador, where I spent six months studying abroad in 2011, and then returned for six weeks as a medical student in 2014. I spoke with these women about how impressed I was by the changes in the public health system between these years, and they attributed much of the success to better training of family physicians as a specialty. It was great connecting with them, and I look forward to what doors this connection can open for future work in Ecuador. This is just one example of the incredible collaborative nature of the event.
The preconference and conference were incredible opportunities I am grateful to have had, and it was inspiring to see the great work everyone is doing in their own countries and communities. I am encouraged to pursue opportunities for advocacy in my local community and nationally around areas of health equity, community-accountable medical education, and payment reform that reimburses not the cost of services provided, but the value of care provided in terms of health care dollars saved and quality of life-years added. I hope that through my participation, I can continue to move the needle toward health care systems both in the United States and globally that put primary care, and specifically family medicine, at the center.
Clayton Cooper is a first-year resident with the Duke Family Medicine Residency Program. Email clayton.cooper@duke.edu with questions.
Editor’s note: Duke Family Medicine residents guest blog every month. Blogs represent the opinion of the author, not the Duke Family Medicine Residency Program, the Department of Community and Family Medicine or Duke University.