Starfield's Legacy: Integration of Primary Care and Public Health!

In 2009 Barbara Starfield was the star guest speaker at The Nordic Congress in Copenhagen, Denmark.

After her keynote she chaired a workshop, it was by far the most popular of the parallel sessions. People were sitting on the floor and on the window sills, they even crowded outside the room listening, when there were no space left inside. Looking back, it reminds me of a master class with a virtuoso in music. Questions were asked by the audience, and she improvised. Consistent, pedagogic, and tailored to the Nordic context.

The workshop focused on the overlap between primary care and public health. What I took home from the workshop with Barbara in Copenhagen is this:

A prime task for family doctors, - in addition to diagnosing and treating, is to identify the needs of the community she is serving and convey this knowledge to policy makers and public health professionals. Synergies emerge where siloed, disease specific Public Health programs are integrated with the longitudinal and continuous primary care.

The vertical, public health projects are carried out by primary care professionals. They live and work in their communities, and hold people`s trust. Trust is key, and a prerequisite to make people follow advice. Involvement of the local communities is another requirement to achieve people`s support to preventive programs and to create synergies. 

In a paper in Milbank Quarterly, a journal on Population Health and Health Policy in 2005, Barbara and co- authors described the Rationale of Primary Care for Health(1).

“Six mechanisms, alone and in combination, may account for the beneficial impact of primary care on population health. They are (1) greater access to needed services, (2) better quality of care, (3) a greater focus on prevention, (4) early management of health problems, (5) the cumulative effect of the main primary care delivery characteristics, and (6) the role of primary care in reducing unnecessary and potentially harmful specialist care.”

The ongoing COVID 19 pandemic has proved that strong primary care is a requirement to ensure preparedness in health systems, and to build resilient systems. Barbara Starfield gave us an overwhelming amount of evidence which should guide policy makers and health professionals on the way forward in planning for future health systems. She paved the way for reseachers who have reproduced her findings over the years that have followed, and still do, not least through the current pandemic. 

I was fortunate to meet Barbara Starfield several times, she even visited the annual family medicine conference in Norway many years back.


Let`s take the opportunity which is given us in the current situation, to advocate for primary care and integration of primary care and public health. That is the best way we can honour Barbara Starfiled`s legacy.

Dr Anna Stavdal
WONCA President-Elect

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