From the CEOs desk: new special interest groups

Photo: Some WONCA Working Party and SIG chairs and members of WONCA executive in Rio.

Greetings to all WONCA members from the WONCA Secretariat in Bangkok. We wish all members a very happy and successful 2017, and we hope to meet as many of you as possible at WONCA events throughout the year.

In last month’s article I reported that Council had endorsed the establishment of six new WONCA Special Interest Groups (SIGs) for the triennium. Well…that in fact should have been seven, so my apologies to the WONCA SIG on Quaternary Prevention for failing to mention them.

WONCA is blessed with many Working Parties (WPs) and SIGs which work between world council meetings to progress specific areas of interest to WONCA and its members around the globe. These groups comprise hundreds of family doctors who meet at world conferences, sometimes more often, and in between they work by correspondence. Over the years they have carried out groundbreaking studies and research, and have produced a variety of important publications. These seven new SIGs thus add to WONCA’s portfolio of special groups which offer members a chance to collaborate with others with a shared interest, and with the aim of enhancing WONCA’s knowledge base and expertise.

This month and next I will feature some of these new SIGs, to give members a flavor of where their interest lies, and give details of how to join the groups for anyone who shares their interests. And, having omitted Quaternary Prevention from last month’s list, let’s start with them:

Quaternary Prevention

“Medicine increasingly focuses on the problems that result from an excess of medical care, in particular overscreening and overdiagnosis. In a new framework or paradigm, based on patient doctor relationships, quaternary prevention (P4) describes the protection of patients from diagnostic tests, interventions and treatments that offer no benefit for overall morbidity or mortality for the individual, and may cause physical or psychological harm. It includes the protection of patients from misled well-meaning doctors and from a system in which the commercial interests of pharmaceutical and diagnostic companies, and governments working in a marketised model of health care, that can distort care, medicalize normal life and waste resources”. Jamoulle M, Mangin D (not published).

The original definition of Quaternary Prevention was formulated in 1986
Action taken to identify patient at risk of overmedicalization, to protect him from new medical invasion, and to suggest to him interventions, which are ethically acceptable.

Quaternary prevention provides a complex but necessary approach oriented to provide person-focused care; promote equity in healthcare; prevent over-diagnosis, unnecessary interventions, and avoid harm: and so, in few words, to humanize medicine. All the efforts within this global movement combine ethical sustainability with critical thinking, to oppose the vision of health as a commodity.

Convenor of the SIG is Miguel Pizzanelli of Uruguay. He can be contacted on miguelpizzanelli@gmail.com

Non Communicable Diseases (NCDs)

NCDs account for over 63% of deaths in the world today. Every year, NCDs kill 9 million people under 60. The socio-economic impact is staggering. Global leaders met at the United Nations General Assembly in New York on 19th and 20th September 2011 in a High-level meeting on non-communicable disease prevention and control, and set a new international agenda on NCDs (UN General Assembly. Sixty-sixth session. Agenda item 117, Resolution 24 January 2012). This was only the second time in the history of the UN that the General Assembly met on a health issue (the last issue was AIDS). The aim was for countries to adopt a concise, action-oriented outcome document that will shape the global agendas for generations to come.

Sustainability of health systems regarding NCDs implies that a new approach is needed. This approach includes prevention, continuity of care and integration of care; these are values of family medicine. Improving care for patients for NCDs means improving Family Medicine and Primary Health Care. The Declaration pursues a comprehensive strengthening of health systems that support primary care recognizes the importance of universal coverage in national health systems, especially through PHC.

Chair of this SIG is Dr Domingo Orozco Beltran of Spain. He can be contacted on signcds@wonca.net

Health Equity

There is a clear link between poverty and poor health. And health inequities are not simply dichotomously distributed among the rich and the poor but also occur within socioeconomic classes. A wealth of evidence by Barbara Starfield and her colleagues have shown repeatedly the strength of a country’s primary health care system was found to significantly improve determinants of population health even after controlling for determinants of population health both at the macro-and micro-levels. At the same time, many areas such as the provision of health promotion and preventive services from the perspective of “equity in health care services” are not explicitly addressed by general practice.

There is an indissoluble link between health equity/ social justice and our success as a discipline in making a difference for our patients that heavily relies on all frontline doctors and health professionals to advocate for greater socioeconomic equity and the health rewards that would follow. On working with marginalised community, the incoming WONCA President, Prof Michael Kidd, remarked in his keynote speech in Prague in 2013,
“As family doctors we have social responsibilities. Each of us needs to be an advocate for social justice and human rights… We need to speak out for what is right, to say “this is not OK”, and in so doing contribute to social change.” And the benefits of this approach are mutual: “The perceived rewards that support and sustain our continuing engagement include the motivation presented by the challenges, feeling that we are able to make a difference, and enhanced professional identity as a result of our meaningful work.”

Convenor of the SIG is Dr William Wong of Hong Kong. He can be contacted on sighealthequity@wonca.net

Genetics

Advances in genetics and genomics research are not reaching clinical practice in primary care. There are several examples of these advances being translated into secondary specialist care whilst there remains barriers to implementation in primary care, such as lack of knowledge, skills, decision support tools, and organisational issues. It is only through collaborations between interested primary care practitioners, genetic clinical specialists, genomic health service researchers, educationalists and knowledge transfer experts to develop new approaches to implement genomic advances into primary care.

A WONCA affiliated group provides one of the few practical platforms for achieving this.
This group aims to raise the profile of genomic advances and traditional clinical genetics into primary care through both translational health service research and educational activity.

Convenor of this SIG is Professor Imran Rafi of UK. He can be contacted on siggenetics@wonca.net

I will feature several of the other WONCA SIGs next month, but of course full details of all WONCA WPs and SIGs is always available via the WONCA website.

Until next month
Garth Manning (CEO)

The following Working Parties and Special Interest groups have new reports online since Rio:

> WICC
> Mental health
> Research
> Cancer and Palliative Care
> NCDs