In Memoriam: Barbara Starfield

Some sad news that escaped my attention until today. Barbara Starfield died on 10th June.

While hardly a household name, she has been a vastly important figure in my professional life— well before I’d even heard of her. For over fifty years she conducted and collated research that largely established the effectiveness of primary care-oriented health systems over and above the effectiveness of specialty-based ones (France, with its secondary care-oriented system but good health outcomes, seems to be the main exception to the rule).

Here’s how:

1. Primary care increases access to health services for relatively deprived population groups.

2. The contribution of primary care to the quality of clinical care.

3. The impact of primary care on prevention.

4. The impact of primary care on the early management of health problems.

5. The accumulated contribution of primary care characteristics to more appropriate care.

6. The role of primary care in reducing unnecessary or inappropriate specialty care.

(Contribution of primary care to health systems and health, Starfield et al. Milbank Quarterly 2005.)

In other words, the World Health Organisation’s 1978 Alma Ata declaration was on the right track.

It’s an unsexy subject for non-public health research interested people, but it would be better for all if her work got wider recognition outside of the population health community. It’s a shame this recognition, when it comes, will have to be posthumous.

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