From the President - think global, act local

Family doctors and the Millennium Development Goals


In September I attended the United Nations General Assembly in New York, representing WONCA at a summit called to examine progress in meeting the Millennium Development Goals (MDGs), and to discuss what happens beyond the end of 2015 when the current MDGs conclude.

You are no doubt aware of the MDGs. They are eight aspirational goals, agreed by all the world’s countries in 2000, which aim to halve extreme poverty rates by 2015, provide primary school education to all children, empower women, reduce infant and maternal mortality, combat HIV, tuberculosis and malaria, and ensure the sustainability of our environment. Image: Millennium Development Goals (source: United Nations)

The MDGs have galvanized unprecedented efforts across the globe to meet the needs of the world’s poorest people. And progress has been impressive with rates of extreme poverty halved ahead of schedule, and significant reductions in infant and maternal mortality and HIV infection rates in many countries, with millions of lives saved through reductions in preventable deaths. Some of the coordinated partnerships created to achieve these gains have been wonderful.

Examples of successful global programs include the United Nation’s Every Woman Every Child initiative, which has been adopted by governments in many countries and includes ensuring access for women and children to quality health care facilities and skilled health workers, and the Global Fund to Fight AIDS, Tuberculosis and Malaria, which has led to a decline in new HIV infections in many of the countries most affected by the epidemic.

Attendees at the United Nations MDG summit included the Secretary-General of the United Nations, the Director-General of the World Health Organization, the President of the World Bank, presidents and prime ministers of several countries, and representatives of philanthropists and global non-government organisations, such as Oxfam, the Bill and Melinda Gates Foundation, World Vision and WONCA.

Image: Millennium Development Goal Summit, United Nations, New York, September 23, 2013

The summit debated actions needed to further diminish global poverty, improve health worldwide, and achieve sustainability of the environment, and provided recommendations for consideration by the leaders of the nations of the world.

Among the key messages that I took away from the summit was how success has occurred when there has been national and local ownership to give the MDGs traction, and the importance of allowing the local adaptation of the MDGs to target local conditions. And it was no surprise to be reminded that developing countries want capacity, not charity – and that building self-reliance is critical; this is a key role for WONCA in our support through our member organisations for education and training for the members of the family medicine workforce in every nation.

High-level statements and commitments are one part of the solution, but they are meaningless without effective in-country action. Part of the challenge with the MDGs has been in their, sometimes patchy, implementation. Often initiatives to support the MDGs in a country have failed to engage with the existing primary care workforce, setting up parallel programs that can diminish, rather than strengthen primary care provision.

The MDGs have also come in for some criticism because of what is missing. They don’t tackle the need to strengthen the primary care basis of each country’s health system, or to tackle chronic disease or mental health, or to address the social determinants of health, or to ensure universal health care access for all people in both rural and urban areas. This is part of the challenge looking beyond 2015. What should be the focus of the next set of global challenges?

As the world debates what happens next, with the clamour of thousands of interest groups and self-interested industries, WONCA needs to ensure the clear voice of family medicine on behalf of our patients and communities continues to be heard during these debates. 
We need to be clear about our role as family doctors in working with our patients and communities to increase life expectancy and achieve equitable outcomes. 
And we need to support the focus on the social determinants of health and how we ensure marginalized populations, those groups of people in our communities most at risk of poor health, are not excluded from health care.

A specific focus of this year’s United Nations General Assembly was on people with disabilities and how persons with a disability are being excluded from a number of the initiatives set in place to meet the Millennium Development Goals.

People with disabilities make up an estimated 15 % of the world’s population, or one billion people. At least 80 % of people with disability live in developing countries and are at greater risk of living in absolute poverty due to their exclusion from equitable access to resources such as education, employment, health care, and social and legal support systems. Think about the challenges which must face a person who is blind or deaf or unable to walk in some of the world’s poorest nations.

With the adoption by the United Nations of the Convention on the Rights of Persons with Disabilities in 2006, some progress has been made in improving the situation of many people with disability. However, in spite of such gains, the need for a specific focus on disability remains largely invisible in most mainstream development processes, including the MDGs. The nations of the world attending the United Nations General Assembly were urged to ensure that greater efforts be made.

As family doctors we provide care and are advocates for all our patients, and especially for those who are most marginalized or disadvantaged in our communities. We have a responsibility to ensure that our services are accessible and available to all people in our communities, including those with disabilities.

Following the United Nations Summit I went to San Diego to attend the annual Congress of Delegates of the American Academy of Family Physicians (AAFP).

The AAFP is the largest member organization of WONCA with a membership of over 100,000 family doctors. The Congress is the annual meeting of the AAFP where policy is debated, advocacy is planned, and the leadership for the coming year is confirmed.

This is democracy in action with strong debate about key issues affecting the delivery of primary care to the people of the United States of America. Many topical and important public health issues were being debated including the role of patient-centred medical homes. The top story in the US media that week was about the Affordable Care Act, called “Obamacare” by some, and the attempts of the US President to ensure that affordable health insurance, and so access to health care, is available to all people in the USA.

I attended the presentations by the AAFP members seeking leadership positions as president-elect and as board members. I was impressed by the commitment, eloquence and passion of the members of our professional discipline who put themselves forward for consideration for leadership.

Later in the week the newly installed AAFP President, Dr Reid Blackwelder from Tennessee, addressed the AAFP annual conference. Reid reminded our colleagues that, “regardless of the challenges, family physicians are leading the way in transforming the US health care system.”

Image: AAFP President,  Reid Blackwelder MD addressing the AAFP opening session. Photo courtesy of AAFP News Now, © Cindy Borgmeyer AAFP

He spoke how, amid the uncertainty currently surrounding the business of medicine in the USA, family doctors have the opportunity to effect a positive change, that people want patient-centered care, and that people are choosing family medicine because family doctors treat the person, as well as the disease. Reid said, "Family medicine is about making a connection. It's about relationships, and this ability to make that connection in the moment is what defines us as family physicians. No one does that as well as we do. Our role is unique and it is critical. We're remaking the system into one that's truly about health and caring.”

Listening to Reid reinforced for me the role each of us plays as a family doctor, working with our health care team in our local community each day towards achieving the improvements sought by our world’s leaders through initiatives like the Millennium Development Goals.

Michael Kidd
World Organization of Family Doctors (WONCA)
October 1, 2013