Health and Health Care News Stories During 2002 to 2004

During this Triennium, the world faced old foes to global health, including HIV-AIDs and tobacco related illnesses. The world also confronted a new risk to global health, Severe Acute Respiratory Syndrome, or SARS. Wonca continued to implement initiatives and advocate for measures to meet people's health needs and collaborate with such efforts with the World Health Organization. The following are brief excerpts of such events covered in Wonca News during the 2002 to 2004 Triennium.

Family Medicine Researchers in Six Countries Analyze Errors in Family Practice

Eighty family doctors from six developed countries with similar primary health care systems ---- Australia, Canada, England, the Netherlands, New Zealand and the United States --- reported on the first international, collaborative study of errors in family medicine. The so-called Linnaeus Collaboration is among the first study of its kind to focus specifically on identifying what kind of errors take place outside the hospital setting.

The international study of medical errors in family medicine is coordinated by Susan Dovey, M.P.H., an analyst with the American Academy of Family Physician's Robert Graham Center in Washington, D.C. The purpose of the Linnaeus Collaboration was to describe errors reported by general practitioners in six developed countries with relatively similar primary care systems and to develop an international taxonomy.

The researchers found that the most medical mistakes in family medicine are administrative or process errors, such as filing patient information in the wrong place, mistakenly ordering the wrong tests or prescribing the wrong medication. Only about one-fifth of the errors come from a lack of knowledge and skills. Overall, the 80 physicians from the six countries reported 340 process or administrative errors and 89 knowledge and skill errors. From these error reports, the International family practice researchers drafted the first international taxonomy of medical errors. The types and numbers of reported errors are listed in the table below.

The researchers found that the kinds of mistakes that occur in family medicine office can be reduced through the use of computerized clinical-information systems that replace paper-based patient records. With the new, computerized patient record systems, family doctors can properly record patient demographics, track diagnostic tests, preventive services and other clinical data, prompt evidenced-based clinical interventions and provide patient medication and educational information. Today, a growing number of companies are now designing computerized record systems that can be used by individual family doctor's offices.
(Excerpted from December 2002 issue)

The World Confronts Severe Acute Respiratory Syndrome (SARS)

As the SARS pandemic passes the midpoint of its first year, a cumulative total of more than 8000 probable SARS cases and 700 deaths have been reported from 28 countries. The countries and areas most affected include China (more than 5000 cases and 300 deaths), Hong Kong China (more than 1700 cases and 250 deaths), Taiwan (more than 475 cases and 60 deaths), and Singapore (more than 200 cases and 25 deaths). As the SARS pandemic passes the midpoint of its first year, the global pandemic is still evolving. No drug or vaccine has been developed and some health officials believe that SARS will reappear next flu season in Europe and North America. Yet, there is some room for cautious optimism in the rapid global response and collaboration against the SARS epidemic.
(Excerpted from the June 2003 issue)

The Brisbane Initiative: International Education for Leadership in Primary Care Research

The Brisbane Initiative brought together leaders in primary care research from eight different countries in Brisbane, Australia in 2002. The goal of the Brisbane Initiative is to develop international support for and coordination of education for future research leaders in General Practice and Family Medicine. As this is directly related to the research program of the World Organization of Family Doctors (Wonca), the Brisbane Initiative will pursue its goals under the aegis of Wonca.

Internationally, there is clear disproportion in the amount of funding for research on uncommon problems versus what is spent for the common problems in health care. This has been called "the 10/90 gap", in reference to the fact that only about 10% of the research resources are directed at 90% of the health problems of the world population.

Improving the health of populations requires a strong primary health care system founded in good science. Future research leaders in general practice/family medicine need to possess scientific skills: the ability to design projects with rigorous science, collaborate with researchers in other disciplines, apply for funding, and administer projects and research groups. But at the same time, they must be able to analyze the need for research from a general practice/family medicine perspective, to communicate results, and to pursue strategies to implement research into practice. These leaders will be instrumental in the further capacity building of primary care research as they will lead research programs, develop research strategy and educate future research leaders.

The Brisbane Initiative will address the international shortage of scientific leadership in primary care by enlarging the pool of available training resources and enriching the educational environment through cooperation both between existing primary care research units and between these units and other disciplines (e.g. industrial engineering, public health) with a program that transcends national boundaries. Further, the Brisbane Initiative will help to establish a critical mass of current and future leaders in primary care research by bringing together leaders from many nations.

Building upon our two-year history of success will require financial support for secretariat and clearinghouse functions and ongoing operations. Funding will be required for the support of fellowships at all levels, especially fellowships for physicians from developing countries.

Chris van Weel, Convenor, Wonca Task Force on Research (The Netherlands), John Beasley (US), Geert Jan Dinant (The Netherlands), Frank Dobbs (Northern Ireland), Michael Kochen (Germany), Andre Kottnerus (The Netherlands), David Mant (England), Chris del Mar (Austalia), Lucy McCloughan (Scotland), and Walt Rosser (Canada).
(Excerpted from June, 2004 issue)

Newly Elected WHO Leader Calls for Global Response to Disease Outbreaks

In his first speech as newly elected Director-General of the World Health Organization (WHO), Dr Jong-Wook Lee announced a major new expansion of a global disease surveillance and response system. Doctor Lee was elected by the World Health Assembly during their May, 2003 annual meeting in Geneva, following his nomination to the post at the Executive Board meeting in January. He is the first person from the Republic of Korea chosen to head a United Nations agency.
Dr Lee announced that he would immediately expand and strengthen the Global Outbreak Alert and Response Network to identify and respond to disease outbreaks around the world. "SARS is the first new disease threat of the 21st century, but it will not be the last," Dr Lee said in his acceptance speech to the Assembly.

Dr Lee told the World Health Assembly, "The world today needs leadership in the ongoing struggle for security and justice. Security from infections, and justice for those worst affected by diseases of poverty." He recalled the commitment of the WHO Constitution to work for the highest attainable standard of health for every human being without distinction of race, religion, political belief or economic or social condition.

The Director-General Elect emphasized his clear commitment to improving primary health care across the world and to achieving clear, measurable results in countries. "We must renew the fundamental commitment to equity expressed by "health for all," he said. "WHO must work to translate this ideal into measurable results."

Dr Lee said his five key priority areas will be: 1) meeting the health targets of the Millennium Development Goals; 2) shifting resources to serve countries more effectively; 3) running WHO more efficiently; 4) ensuring that WHO becomes more accountable, both financially and in its contribution to health outcomes; and 5) strengthening human resources both inside WHO and within Member States.
(Excerpted from the June 2003 issue)

World Health Assembly adopts historic Tobacco Control Pact

The 192 members of the World Health Organization, meeting in Geneva in May, 2003, unanimously adopted the Framework Convention on Tobacco Control (FCTC) aimed at curbing tobacco-related deaths and disease. This is the first international treaty negotiated under the auspices of the World Health Organization (WHO).

The Convention requires countries to impose restrictions on tobacco advertising, sponsorship and promotion, establish new labeling and clean indoor air controls and strengthen legislation to clamp down on tobacco smuggling.

"Today, we are acting to save billions of lives and protect people's health for generations to come. This is a historic moment in global public health, demonstrating the international will to tackle a threat to health head on," said Dr Gro Harlem Brundtland, Director-General of the WHO to the 56th World Health Assembly.
"Now we must see this Convention come into force as soon as possible, and countries must use it as the basis of their national tobacco-control legislation," she said. Four years in the making, the Framework Convention on Tobacco Control has been a priority in the WHO's global work to stem the tobacco epidemic. Tobacco now kills some five million people each year. This death toll could double to reach 10 million by 2020 if countries do not implement the measures of the FCTC. While smoking rates are declining in some industrialised countries, they are increasing, especially among the young, in many developing countries. These will account for over seventy percent of that projected death toll.

"We must do our utmost to ensure that young people everywhere have the best opportunities for a healthy life. By signing, ratifying and acting on this Tobacco Convention, we can live up to this responsibility," said Dr Brundtland.
(Excerpted from the June 2003 issue)

The WHO Recognizes Wonca's Important Role in Global Health

In a series of high level interactions with the World Health Organization, Wonca communicated its global vision and action plan for improving people's health. In response, the WHO responded positively and affirmed the importance of the Wonca-WHO strategic collaborative activities.

In January 21, 2004, at a 113th meeting of the WHO Executive Board, Wonca's Executive Member At-Large and Liaison to the WHO, Dr Ilse Helleman, delivered a statement on behalf of Wonca and its Working Party on Rural Practice. The statement delivered to WHO Director General Dr. Lee and Executive first described Wonca's global mission. In her opening remarks, Dr Hellemann told Dr Lee and the Executive Board, "Wonca, the World Organization of Family Doctors, at this time has 93 member organizations in 77 countries, and represents about 160,000 General Practitioners and Family Physicians worldwide.

"Wonca´s primary goal is to improve the health of the peoples in the world through fostering and maintaining high standards of care in general practice and family medicine", Dr Hellemann said. "In many countries where it is active, Wonca is a strong supporter of a primary health care orientation in health system development."

Dr. Hellemann went on to add, "Wonca recognizes though that many developing nations cannot afford a full complement of highly-trained family physicians. However, all nations can afford to adopt the concept of family medicine for all its primary care workers. Doing so, the quality of health care will be improved substantially."

In her remarks, Dr Hellemann told the WHO Executive Board, "In 1994, Wonca and WHO conducted a conjoint strategic action forum in Canada to discuss the theme "Making Medical Practice more relevant to People´s Needs: the Contribution of the Family Doctor". In 2000, Wonca published a guidebook in collaboration with WHO, entitled, Improving Health Systems: The Contribution of Family Medicine. In 2002, a WHO co-sponsored global conference was organized by Wonca on "Health for All Rural People". Following the conference, a draft global plan "Creating Unity for Action: An Action Plan for Rural Health" was developed as a model for improving health care delivery in underserved areas." Ending her formal comments, Dr Hellemann offered a draft resolution and Wonca's assistance to the WHO Delegates to pass a resolution seeking a global effort to enhance health services to rural, disadvantaged and vulnerable populations.

In addition to the oral presentation to the WHO, Wonca submitted at the end of 2003 to the WHO its "Structured Report on Wonca- WHO Collaborative Activities: 2000 - 2003" and Wonca's "Proposed Action Plan for 2004 - 07". These reports summarized the broad spectrum of collaborative activities between Wonca and the WHO during the past triennium and plans for the upcoming triennium. In a letter dated March 4, 2004 to the Wonca World Secretariat from Dr Kazem Behbehani, WHO Assistant Director-General for External Relations and Governing Bodies, the WHO acknowledged Wonca for its leadership and reaffirmed its collaborative relationship for the upcoming 2004-2007 triennium. In making its decision, the review board commended the efforts of Wonca for its collaborative work with WHO.

These important recent developments bode well for Wonca's collaborative agenda with the WHO in the upcoming triennium. The positive feedback from the WHO should help strengthen Wonca's global role in enhancing health systems to better meet people's health needs.
(Excerpted from April 2004 issue)