A Tribute to Barbara Starfield

The first encounter I had with Barbara Starfield – and I think many in European primary care – was in 1994, when she published her paper ‘Is primary care essential?’ in the Lancet. It was what we now would call a virtual meeting, but virtual with an impact that still can be felt today.


The stronger the role of primary care in the health system, the better the population health was; and with primary care’s strong role in the health system  health costs were lower.

This evidence could not have come at a better moment: it supported the WHO policy of  Alma Ata – still on the health policy agenda at that time – and it supported the process of integration of European primary care that had already been triggered by the political integration after the fall of the Iron Curtain in 1989. Until that moment, primary care operated in countries with each their own health system, and international exchanges were mainly directed at explaining and understanding how their roles differed. 

Now, with the Lancet evidence at hand, primary care had a common external marker of its success: with a central role in the health system, primary care was core function to create the values of the system to improve health of individuals and populations and at the same time contain precious health costs.

Ten years later, my virtual meeting with Barbara was matched with a meeting in person, when she gave a keynote lecture at the WONCA 2004 World Conference in Orlando. This meeting made it clear that her work had had a similar impact in other parts of the world as it had made in Europe. I had the privilege of introducing her as keynote speaker, no need to say that her lecture, in front of a large attendance in the main hall went down very well. As expected it was followed by an intensive discussion that could have go on for the better part of the conference. The organizers had anticipated this, and we had arranged separate meeting in facilities aside to allow the discussions with a core group of interested delegates to continue there, while the conference program could continue.

So, after pushing our way through the crowd, Barbara and I found ourselves back in a nice, cosy small meeting room filled with the better part of the attendees from the main hall. As improvisation is an essential skill in primary care, we found a way to satisfy most of their questions. This occasion stands-out in my memory as one of the best post-keynote discussions at WONCA.
    
After 2004 Barbara became a regular contributor to WONCA meetings and conferences. Her sudden death in 2011 was a devastating shock, but her legacy lives-on until this day and is still as refreshing as it was in 1994.

Prof Chris van Weel,
WONCA Past President

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