From the President: Leading and learning - reflections half way through

February, 2012

As 2011 came to a close, which is about halfway through my term as WOCNA President, it seemed appropriate to reflect on the experience thus far. Traveling to more than 50 countries, meeting with heads of governments and global leaders, and leading WONCA through significant changes have been exciting, enlightening, and exhilarating. It has been an extraordinary 20 months.

Sweet sorrow

A painful task was informing WONCA members of the sudden and unexpected passing of Professor Barbara Stanfield, in June. Barbara’s death shocked all of us. She was such a giant intellect and was always so energetic that we thought we would have her forever. Her loss is inestimable – she was a true friend of Family Medicine and enormously influential among policy makers. We have lost a great thinker and a valued mentor. Her legacy will be the many young researchers she mentored and the many health systems she helped steer down the right path of primary care.

High level highlights

A leadership challenge this past September was the High Level Meeting on Non-Communicable Disease (NCD) that was convened by the United Nations (UN) in New York City. WONCA was concerned that health care would become even more fragmented if the UN were to adopt the proposed resolutions that focused too narrowly on the four favored NCDs (cancer, cardiovascular disease, chronic respiratory disease, and diabetes). Linked through a well coordinated global alliance, more than 250 international organizations spent millions to market their message and lobby UN delegations, hoping for billions for their diseases. A disease-focused approach gained momentum in April at a Global Ministerial Conference, in Moscow, sponsored by the World Health Organization (WHO).

WONCA was determined to bring balance to the discussion, and to remind the health systems of the world that a solid primary care foundation was essential if progress was to be made on these four, or any, diseases. Yet, WONCA had virtually no funds and limited capacity to mount a campaign to broaden the focus from vertical to horizontal programs, from disease-centered to person-centered care. Since we could not afford to run splashy public relations advertisements or fly in patients to lobby UN delegations, WONCA had to work differently to make our case.

Our first step was to meet with numerous groups during the World Health Assembly, in May, in Geneva, to better understand all sides of the issue and to encourage world health leaders to take primary care into account. With considerable effort, we were able to secure a two minute slot to give testimony, in June, at the UN interactive meeting for civil society, in New York. Yet, we remained on the outside looking in, with little apparent input into the resolution writing.

Our next step was to target the countries that had been identified as important to the drafting of the resolution, especially Argentina and Norway. We were able get the support of family doctors in those and other countries to communicate our message to their countries’ UN delegations. Just before the start of the meeting, an Argentine family doctor now living in the United States was selected to serve on the Argentine delegation. Doctor Viviana Martinez-Bianchi was a superb ambassador for Family Medicine during the High Level Meeting. The end result of all of this was a UN resolution that was much better balanced. A special thanks goes out to Viviana and the many other family doctors from around the world who responded to our request for help and reached out to their UN delegations.

UN general assembly meeting in June

Dutch discord

In November, I was honored to speak in The Hague at the 60th anniversary celebration of the Dutch Association of General Practitioners. The Netherlands is rated as the top primary care system in Europe. So, while there was much to celebrate, there was also significant concern about Dutch GPs. In an attempt to drive more chronic care into the GP setting, the Dutch government provided incentives to GPs to hire more staff to provide increased services. With a change in government came a change in priorities, and the current government was threatening to withdraw the support for the additional staff that the GPs had recently hired.

The ceremony took place in the throne room of the Ridderzaal (Knights’ Hall). Nearly 800 years old, this magnificent building was the symbolic birthplace of the Netherlands. Heavy with history, the room was resplendent in red carpet, high timbered ceilings, and stained glass windows commemorating Dutch cities. The secured throne reminded us that this is where the Queen opens the Parliament each session. The proceedings began with a trumpet fanfare by costumed footmen.
The first speaker was the Health Minister, who described necessary changes given current economic realities. Against this regal backdrop symbolizing continuity, it struck me as ironic that I – an American from a health care system that glorifies specialism, technology, and everything new – should be asked to remind the Dutch government and health care leaders of the enduring value of primary care. But that is exactly what I did. My message was that there was a reason that primary care was so successful in the Netherlands: it was a reflection of the shared commitment and investment of the Dutch government, people, and professionals who make it work. When outcomes validate the wisdom of that investment, it is unwise to retreat from the commitment. I do not know if my words had any impact on the assembled, but my understanding, as of this writing, is that there has been some softening of the Ministry’s position.

Prof Roberts at the Ridderzaal, The Hague

Best of all

The best part of my travels has been the chance to meet with, and observe, so many amazing family doctors. I often hear concern about today and worry about tomorrow from those I meet in my travels. I believe those concerns and worries would evaporate if I could share only a small portion of the passion, ingenuity, commitment, and respect from others, that I have witnessed among the family doctors of the world. And it is getting only better – just visit with young family doctors, and those in training. Our future is bright and in very good hands.

Errata, mea culpa et cetera

It seems that some read my last column on Chile with a very sharp eye. It was noted that I had written that Chile was the first country in “Latin” America to be admitted to OECD. In fact, it was Mexico that was the first Latin country. I knew that. For reasons unknown, my initial draft, which read “South”, became “Latin” on the final draft. Mea culpa. Another concern was that I was thought to be equating the murderous regime of Pinochet with the overthrown Allende government that preceded it. That was not my intent. More importantly, that such a concern was raised validated the point that I was trying to make: that there remain deep wounds in Chile, as in many countries, that shape the current reality. Finally, there was a question about whether I had my statistics correct when describing the numbers of doctors in primary care. My data were taken from speakers that I heard in Chile and from a presentation by the primary care division of the Ministry of Health that I found online, which can be found at the following URL:

Thanks for reading the columns so carefully – your compliments and corrections are always appreciated.

Professor Richard Roberts