WONCA Special Interest Group: Health Equity

Health Equity

A new WONCA Special Interest Group on Health Equity was approved by the WONCA Executive in January 2014.

“Inequity is built into health systems- especially western health systems that are based on a view of health needs disease by disease. Therefore, the benefits of primary care, which is in person- and population- rather than disease-focused, are underappreciated. Data provide evidence not only of its benefit to populations but also of its preferential benefit to the socially disadvantaged.” (Barbara Starfield 2011)

With this vision, a Special Interest Group (SIG) on health equity was approved. Health Equity SIG hopes to bring the essential experience, skills and perspective of interested GPs around the world to address the differences in health that are unfair, unjust, unnecessary but seemingly avoidable. It aims to provide a focus of support, education, research, and policy on issues relating to promotion of health equity within primary care settings.

Therefore we call on any interested practitioners working within primary care to join us on:
• Understanding and utilising the current evidence base for promoting health equity in primary care;
• Exchanging ideas for developing new initiatives for primary care health equity promotion; and,
• Encouraging education and training for primary care health equity promotion.

General membership is open to interested family doctors. For more information email convenor

Convenor / Chair

Convenor: Dr William Wong (Hong Kong)

email convenor

Dr William Wong is the Convenor for the Special Interest Group (SIG) on Health Equity.

Graduated from The University of Edinburgh in 1993, Dr Wong completed his GP Training in London having worked in the UK, Australia, China and Hong Kong. In 2007-10 he was appointed Director of GP and Primary Care Education at The University of Melbourne, Australia and a member of RACGP National Standing Education Sub-committees on Education and Quality Assurance. He is currently Clinical Associate Professor & Chief of Research at Department of Family Medicine & Primary Care, The University of Hong Kong.

Dr Wong conducts research on sexual health and health equity amongst marginalised groups such as sex workers and African refugees, and published over 100 manuscripts in peer-reviewed journals including BMJ, Social Science & Medicine, Sociology of Health & Illness, Epidemiology & Community Health, Family Practice etc. He is Associate Editor for Sexually Transmitted Infections and BMC Infectious Diseases. He was appointed Temporary Advisor for WHO on HIV issues (2012-2014). He is a board member for WONCA Research Working Party representing the Asia-Pacific region. In 2012 he was elected Council Member of Hong Kong College of Family Physicians and now chairs its Research Committee. In 2004 he was awarded Hong Kong Medical Association Community Service Gold Award in recognition of his contribution to the profession and the marginalised groups in the community.

He believes, having the SIG platform in WONCA and, shared experience and forces from GPs around the world, together we could support and sustain continuing engagement to make a difference presented by the challenges of health equity at structural, interpersonal and individual levels.

Co-Convenor or other office bearers

Deputy convenor

Dr Efrat Shadmi (Israel)

Efrat Shadmi is a Senior Lecturer at the Cheryl Spencer Department of Nursing at the University of Haifa, Israel. As a Fulbright grantee, she received her doctoral education from the Department of Health Policy and Management, at the Johns Hopkins University Bloomberg School of Public Health.

Dr Shadmi serves as the co-editor in chief of the International Journal for Equity in Health. Her research focuses on evaluating equitable health care delivery and its outcomes, evaluation of organizational mechanisms to reduce inequity in care, and on methods to better understand multimorbidity and the distribution of morbidity between population groups. Dr Shadmi is the author of dozens of papers covering topics such as – equitable health care resource allocation, minority patients' experience during care transitions, health beliefs in chronically ill minority populations, and evaluation of primary care programs aimed at reducing inequity in health and patient care. Dr Shadmi is also a senior policy consultant to the Department of Health Policy Planning at the largest Israeli non-for-profit health care organization (Clalit Health Services).

International Advisory Committee

Prof Iona Heath

Iona Heath worked as an inner city general practitioner at the Caversham Group Practice in Kentish Town in London from 1975 until 2010. She is the Immediate Past President of the Royal College of General Practitioners. She was a member of the WONCA World Executive from 2007 to 2013.

She has written regularly for the British Medical Journal and has contributed essays to many other medical journals across the world. She has been particularly interested to explore the nature of general practice, the importance of medical generalism, issues of justice and liberty in relation to health care, the corrosive influence of the medical industrial complex and the commercialisation of medicine, and the challenges posed by disease-mongering, the care of the dying, and violence within families. Her book ‘Matters of Life and Death’ was published in 2007.

Prof Amanda Howe

Professor Amanda Howe has been a GP since 1983, and is a practising academic at the University of East Anglia where she joined the foundation team in 2001 to set up the new Norwich Medical School. She is Vice Chair (Professional Development) for the Royal College of General Practitioners, previously holding posts as Chair of Research and Honorary Secretary where she led initiatives on generalism, GP careers, and workforce. She has also been active in the World Organisation of Family Doctors (WONCA), working in particular on equity initiatives, and is now their President Elect.



Prof Michael Kidd

Professor Michael Kidd is an Australian family doctor and the current president of the World Organization of Family Doctors (WONCA). He is the dean of the faculty of medicine, nursing and health sciences at Flinders University, honorary professor of general practice at The University of Sydney, and a past president of the Royal Australian College of General Practitioners.




Dr Karen Kinder

Dr Kinder is an associate faculty member of the Health Policy and Management Department at Johns Hopkins University, Bloomberg School of Public Health where she received her doctorate. Through both educational and professional experience, Dr. Kinder has accumulated in-depth knowledge of health care systems worldwide.

With an emphasis on promoting the importance of primary health care delivery, Dr. Kinder’s research interests center on how countries can improve the equity, efficiency and effectiveness of their primary health care systems. She has contributed her expertise to numerous international projects in developed and transitional countries.

In her current capacity as Executive Director of ACG International, Dr. Kinder oversees the application of the Johns Hopkins ACG® System, the most widely used population based case-mix system in the world and supports users in its implementation.

Prof Gabriel Leung

Gabriel Leung became the fortieth Dean of the Li Ka Shing Faculty of Medicine at the University of Hong Kong in 2013. Leung, a clinician and a respected public health authority, is also Chair Professor in the School of Public Health. Previously he was Professor and Head of Community Medicine at the University and served as Hong Kong’s first Under Secretary for Food and Health and fifth Director of the Chief Executive's Office in government.






Executive Members

Membership Open?

Vision and Mission of WONCA SIG on Health Equity

Aims

The Special Interest Group on Health Equity will bring the essential experience, skills and perspective of interested GPs around the world to address the differences in health that are unfair, unjust, unnecessary but avoidable. It is hoped this group will use as WONCA as a platform for exchange of ideas, advice, support and advocate for better equity in health.

Objectives of the WONCA SIG on Health Equity

Why health equity is central to primary care?

There is a clear link between poverty and poor health. Moreover health inequities are not simply dichotomously distributed among the rich and the poor but also occur within socioeconomic classes. A wealth of evidence by Barbara Starfield and her colleagues have shown repeatedly the strength of a country’s primary health care system was found to significantly improve determinants of population health even after controlling for determinants of population health both at the macro-and micro-levels (3, 4). At the same time many areas such as the provision of health promotion and preventive services from the perspective of “equity in health care services” are not explicitly addressed by general practice.

There is an indissoluble link between health equity/ social justice and our success as a discipline in making a difference for our patients that heavily relies on all frontline doctors and health professionals to advocate for greater socioeconomic equity and the health rewards that would follow. On working with marginalised community, our WONCA President, Prof Michael Kidd remarked in his keynote speech in Prague, “As family doctors we have social responsibilities. Each of us needs to be an advocate for social justice and human rights… We need to speak out for what is right, to say “this is not OK”, and in so doing contribute to social change.” And the benefits of this approach are mutual: “The perceived rewards that support and sustain our continuing engagement include the motivation presented by the challenges, feeling that we are able to make a difference, and enhanced professional identity as a result of our meaningful work.”

Activities

Plans of Health Equity SIG

• Contact exiting centres on health equity- invite membership and map some of the existing work and evidence on health equity
• Organise regional/ international workshops/ seminars to keep up with the health equity agenda
• Conduct/ Facilitate literature review on research gaps
• Collaborate/ Identify/ Set up resource centre on health equity
• Formulate a framework on a medical curriculum on health equity
• Meetings of Health Equity SIG members at WONCA meetings for advancement of the agenda
• News update and event organization

Expectation and Impact of Health Equity SIG

Building upon the existing membership, we would like to network and gain as many members as possible in the first years of SIG which would help facilitate exchange of ideas and needs. It is hoped that by engaging the members a more sustainable structure will be set up within Health Equity SIG. The impact of this SIG will be evaluated and measured using community impact score.

History

At the WONCA World conference in Prague, in 2013, a successful workshop on health equity was jointly delivered by Prof Michel Kidd and, Drs Iona Heath, Karen Kinder and Efrat Shadmi. Over 120 delegates from across the globe attended and discussed how uneven distribution of social determinants of health had resulted in poor health outcomes, and how health systems that had operated in different countries could systematically affect people’s affordability as well as access to healthcare services and fundamental rights to good health.

The workshop explored how a better understanding of the health inequities present in a population could enable the general practitioners (GPs) to adopt strategies that could improve health outcomes in the delivery of primary health care; it explored the development of a health equity curriculum and opened the discussion of the future and potential impact of health equity training among GPs.

The workshop was very well attended with an estimated 120 delegates across the globe, many ended up sitting on the floor, on the passage way or even outside the room. They recognised how uneven distribution of social determinants of health could have affected poor health outcomes such as life expectancies and risk behaviours, and how health systems that operated in different countries could systematically affect people’s affordability to healthcare services and fundamental rights to good health. They identified health workforce shortage, lack of communications between primary & secondary care and, low political incentive & priority for marginalised groups as well as low health literacy & expectation of the patients as contributions in meeting the health equity agenda. Signposting for how to navigate healthcare system and training should be provided to the leaders of vulnerable groups as community awareness should be provided to the public and the patients. They believed that training in inequity should be provided to medical students as well as general practitioners to improve health equity through primary care. (A full report can be obtained here

A survey amongst the workshop participants looking at the current and expected levels of engagement is shown in Appendix 1. Generally the group believed there were a lot GPs could do to initiate or promote health equity issues. Over 50 participants have left the contact and would like to be further contacted for further events in this area of interest.

As a flow from this workshop, Dr William Wong put a submission to WONCA Executive to form this special interest group.

Relevant Resources

>  International Journal for Equity in Health

1. WHO. Closing the gap in a generation: Health equity through action on the social determinants of health. 2011. www.who.int/social_determinants/final_report. Assessed on 20th November 2013.

2. Loyd, D, Newell, S & Dietrich U 2004, Health inequity: a review of the literature, prepared for Health promotion Unit, Northern Rivers Area Health Service, Lismore, NSW.

3. Starfield B, Global Health Equity and Primary Care, 2007, JABFM 20:6.

4. Macinko, J, Starfield B, & Shi L 2003, The Contribution of Primary Care Systems to health Outcomes within Organization for Economic Cooperation and Development (OECD Countries, 1979-1998), Health Services Research, 38:3.

5. Rogers, W, Veale B, 2000, Primary Health Care and General Practice, Flinders University Scoping Report.

6. WHO. Health Literacy:

7. The Helsinki Statement on Health in All Policies. The 8th Global Conference on Health Promotion, Helsinki, Finland, 10-14 June 2013: