Deep End Kawasaki/Yokohama: A New Challenge for GPs in Deprived Areas in Japan

Dear Editor,

We read with great interest the article by Kaneko et al., "Deep End Kawasaki/Yokohama: A New Challenge for GPs in Deprived Areas in Japan" [1]. Their initiative to support general practitioners (GPs) in resource-deprived areas resonates with the challenges faced by the Spanish public health system. As family physicians practicing in Spain, we recognize the similarities between the situation in Yokohama and the difficulties in recruiting and retaining GPs in both deprived urban neighborhoods and rural regions of our country.

In Spain, deprived urban areas often struggle with socioeconomic disadvantages, leading to increased health needs and complexities in patient care [2–4]. Similarly, rural areas face significant healthcare access issues due to depopulation, aging populations, and limited infrastructure [5]. Physicians working in these settings frequently cover extensive territories, traveling long distances to reach patients in remote villages or providing home visits to those with reduced mobility [6].

The phenomenon of the "España vaciada" (Emptied Spain) highlights the severe depopulation of rural areas, resulting in diminished public services, including healthcare [7]. The aging population in these regions presents unique healthcare needs, requiring continuous and comprehensive care that is often challenging to provide due to staffing shortages. In urban deprived areas, socioeconomic factors contribute to health inequalities, placing additional burdens on primary care services [8].

Recruitment and retention of GPs in these areas are hampered by factors such as professional isolation, limited access to continuing education, and fewer opportunities for career advancement [9]. The demanding nature of the work, coupled with personal and professional challenges, makes these positions less attractive to new graduates and experienced practitioners alike.

Kaneko et al.'s program offers valuable insights into addressing these challenges. By fostering collaboration between a clinic and a university, supported by local government funding, they have created an environment that supports both healthcare delivery and professional development [1]. The involvement of medical students and trainees in community activities enriches their educational experience and may inspire a commitment to serve in underserved areas.

This model aligns with the concept of community-oriented primary care, which integrates public health and primary care services to address the health needs of specific communities [10]. Such approaches have the potential to improve healthcare access and outcomes in both urban and rural deprived areas.

While the contexts differ, the principles underlying Kaneko et al.'s initiative may inform strategies in Spain. Enhancing collaboration between healthcare centers and academic institutions could provide GPs with opportunities for professional growth, reducing feelings of isolation. Educational programs that immerse medical students in underserved communities may foster a greater understanding of the social determinants of health and encourage future practice in these areas.

Moreover, community engagement is crucial. By involving local stakeholders and tailoring services to the specific needs of the population, healthcare providers can deliver more effective care [11]. Such engagement may also enhance the perceived value of working in these settings, contributing to better recruitment and retention.

The challenges of providing healthcare in deprived urban and rural areas are complex and multifaceted. Kaneko et al.'s experience demonstrates that collaborative efforts, supported by appropriate funding and focused on education and community involvement, can make a meaningful difference [1]. While solutions must be tailored to local contexts, the underlying principles of their initiative offer valuable guidance.

We believe that continued dialogue and shared learning between international healthcare communities are essential. By reflecting on successful initiatives like that of Kaneko et al., we can explore innovative approaches to address the challenges faced in Spain and elsewhere. Our collective goal should be to ensure equitable access to quality healthcare for all populations, regardless of geographic or socioeconomic barriers.

References:
[1] M. Kaneko, R. Kansaku, Y. Kanakubo, A. Yumino, Deep End Kawasaki/Yokohama: A New Challenge for GPs in Deprived Areas in Japan, The Annals of Family Medicine 22 (2024) 456–456. https://doi.org/10.1370/afm.3146.
[2] R. Tenajas, D. Miraut, The strength of connection: The virtual adaptation of Twelve-Step programs’ meetings, Frontiers in Health Informatics 12 (2023) 148. https://doi.org/10.30699/fhi.v12i0.471.
[3] C. Borrell, E. Fernandez, A. Schiaffino, J. Benach, L. Rajmil, J.R. Villalbi, A. Segura, Social class inequalities in the use of and access to health services in Catalonia, Spain: what is the influence of supplemental private health insurance?, Int J Qual Health Care 13 (2001) 117–125. https://doi.org/10.1093/intqhc/13.2.117.
[4] M. Garrido-Cumbrera, C. Borrell, L. Palència, A. Espelt, M. Rodríguez-Sanz, M.I. Pasarín, A. Kunst, Social class inequalities in the utilization of health care and preventive services in Spain, a country with a national health system, Int J Health Serv 40 (2010) 525–542. https://doi.org/10.2190/HS.40.3.h.
[5] M. Marí-Dell’Olmo, M. Gotsens, L. Palència, B. Burström, D. Corman, G. Costa, P. Deboosere, È. Díez, F. Domínguez-Berjón, D. Dzúrová, A. Gandarillas, R. Hoffmann, K. Kovács, P. Martikainen, M. Demaria, H. Pikhart, M. Rodríguez-Sanz, M. Saez, P. Santana, C. Schwierz, L. Tarkiainen, C. Borrell, Socioeconomic inequalities in cause-specific mortality in 15 European cities, J Epidemiol Community Health 69 (2015) 432–441. https://doi.org/10.1136/jech-2014-204312.
[6] A. Borda-Olivas, P. Fernández-Navarro, L. Otero-García, B. Sanz-Barbero, Rurality and avoidable hospitalization in a Spanish region with high population dispersion, European Journal of Public Health 23 (2013) 946–951. https://doi.org/10.1093/eurpub/cks163.
[7] F. Collantes, V. Pinilla, Extreme Depopulation in the Spanish Rural Mountain Areas: A Case Study of Aragon in the Nineteenth and Twentieth Centuries, Rural History 15 (2004) 149–166. https://doi.org/10.1017/S0956793304001219.
[8] R.M. Urbanos-Garrido, B.G. Lopez-Valcarcel, The influence of the economic crisis on the association between unemployment and health: an empirical analysis for Spain, Eur J Health Econ 16 (2015) 175–184. https://doi.org/10.1007/s10198-014-0563-y.
[9] R. Tenajas, D. Miraut, An ounce of prevention, a pound of passion: Unveiling medical students’ affinity for family and community medicine in spain, ACH Medical Journal 2 (2023) 262–263. https://doi.org/10.5505/achmedj.2023.88598.
[10] S. Gillam, A. Schamroth, The Community-Oriented Primary Care Experience in the United Kingdom, Am J Public Health 92 (2002) 1721–1725.
[11] N. Wallerstein, B. Duran, Community-Based Participatory Research Contributions to Intervention Research: The Intersection of Science and Practice to Improve Health Equity, American Journal of Public Health 100 (2010) S40. https://doi.org/10.2105/AJPH.2009.184036.