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EditorialEditorials

In This Issue: Equity—Global Theme Issue on Poverty and Human Development

Kurt C. Stange
The Annals of Family Medicine November 2007, 5 (6) 482-483; DOI: https://doi.org/10.1370/afm.788
Kurt C. Stange
MD, PhD
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In this issue, we join with more than 200 medical journals around the world in featuring articles on poverty and human development.1 The Annals’ research, essay, and commentary on this theme focus on equity in health care.

Other articles in this issue shed new light on post-partum health,2 the risk of injury in children with hearing loss,3 validation of a new measure for evaluating the risk of osteoporosis in men,4 and a unique study of residency practices with low no-show rates and high visit volume.5 Annals Journal Club6 features this last study, which uses a unique method of studying exemplars to identify tested techniques that others may wish to adapt, reinvent, or emulate.

EQUITY

An editorial by Hagopian7 considers a study in this issue by Starfield and Fryer8 in terms of how to “balance the rights of individuals to move about the globe in pursuit of their own happiness with the needs of the communities that have equipped them for their mobility.” The study in question comes to the scandalous conclusion that the United States is stealing graduates of medical schools in the world’s most deprived nations to compensate for our own inability to design a health care system that attracts graduates into primary care.

Reductions in the US primary care workforce will differentially affect disadvantaged populations, particularly children, according to Ferrer’s careful analysis of nationally representative data.9 In documenting that family physicians are the only clinician group which does not show disparities in access across patient income levels, he shows that reductions in the family physician and primary care workforce are likely to increase inequalities in health care and health.

The inverse care law was first articulated by Julian Tudor Hart to describe the phenomenon that those who need medical care the most are least likely to get it.10 Now Mercer and colleagues identify mechanisms by which this law operates, studying a sample of physicians and patients in deprived and affluent areas of western Scotland.11

Focusing on low-income families, DeVoe and colleagues analyze the patient voice to identify a typology of barriers that parents face in obtaining health care for themselves and their children.12

The complex causality in obesity and diabetes in vulnerable populations are difficult to handle because of multilevel interrelationships. Candib’s elucidation helps us to understand and ultimately to act on the many lever points.13

Together, these studies show a consistent pattern of societies ignoring the needs of the disadvantaged. This is easy to do, particularly when we segregate our living and work places by economic status. This segregation of place promotes narrow vision and a stunted sense of commonality.

Physicians tend to feel good about what we do with the people who come through our doors. We may try to optimize our care of individuals by applying evidence-based guidelines based on studies of even more selected people. We rarely consider the greater good that could be accomplished by using a bit less of the many marginal and expensive technologies we wield and providing basic services to those who have limited access to care.

Policy makers point to programs designed to increase access to medical care. We do not consider the possibility that the health of the population could be enhanced more by spending less on health care and more on education, particularly targeted toward those whose educational opportunities are substandard.14

Macaulay lights a path through this darkness by showing how participatory research can be a method for developing evidence that is relevant to the care of often underserved communities.15 She provides a mechanism for integrating evidence-based practice and policy with efforts to increase equity—not through advocacy from the outside but through partnership that promotes inclusion.

WELCOMING A NEW EDITOR

We are delighted to welcome John J. Frey III, MD, as a new associate editor at the Annals. Dr Frey joins us at a time when the number of manuscripts received is increasing and when the diversity of topics that make up the field of primary care and health care require broadening our expertise.

Dr Frey is a family physician, educator, and leader. He has experience in medical editing for Family Medicine and the Wisconsin Medical Journal. He recently completed his second term as a member of the National Library of Medicine Literature Selection Technical Review Committee. Dr Frey brings to his role as editor an international perspective, a strong grounding in the fundamentals of generalist practice, and a sanguine vision of the future.

Please share your insights by joining the Annals online discussion at http://www.AnnFamMed.org.

  • © 2007 Annals of Family Medicine, Inc.

REFERENCES

  1. ↵
    Council of Science Editors. Global Theme Issue on Poverty and Human Development Planned for October 2007. http://www.council-scienceeditors.org/globalthemeissue.cfm. Accessed October 12, 2007.
  2. ↵
    McGovern P, Dowd B, Gjerdingen D, et al. Mothers’ health and work-related factors at 11 weeks postpartum. Ann Fam Med. 2007;5(6):519–527.
    OpenUrlAbstract/FREE Full Text
  3. ↵
    Mann JR, Zhou L, McKee M, McDermott S. Children with hearing loss and increased risk of injury. Ann Fam Med. 2007;5(6):528–533.
    OpenUrlAbstract/FREE Full Text
  4. ↵
    Shepherd AJ, Cass AR, Carlson CA, Ray L. Development and internal validation of the male osteoporosis risk estimation score. Ann Fam Med. 2007;5(6):540–546.
    OpenUrlAbstract/FREE Full Text
  5. ↵
    Johnson BJ, Mold JW, Pontious JM. Reduction and management of no-shows in family medicine residency practice exemplars. Ann Fam Med. 2007;5(6):534–539.
    OpenUrlAbstract/FREE Full Text
  6. ↵
    Stange KC. Annals journal club. Ann Fam Med. 2007;5(6):0–0.
  7. ↵
    Hagopian A. Recruiting primary care physicians from abroad: is poaching from low-income countries morally defensible? Ann Fam Med. 2007;5(6):483–485.
    OpenUrlFREE Full Text
  8. ↵
    Starfield B, Fryer GE, Jr. The primary care physician workforce: ethical and policy implications. Ann Fam Med. 2007;5(6):486–491.
    OpenUrlAbstract/FREE Full Text
  9. ↵
    Ferrer RL. Pursuing equity: contact with primary care and specialist clinicians by demographics, insurance, and health status. Ann Fam Med. 2007;5(6):492–502.
    OpenUrlAbstract/FREE Full Text
  10. ↵
    Hart, JT. The inverse care law. Lancet. 1971;1:405–412.
    OpenUrlCrossRefPubMed
  11. ↵
    Mercer SW, Watt GCM. The inverse care law: clinical primary care encounters in deprived and affluent areas of Scotland. Ann Fam Med. 2007;5(6):503–510.
    OpenUrlAbstract/FREE Full Text
  12. ↵
    DeVoe JE, Baez A, Angier H, Krois L, Edlund C, Carney PA. Insurance + access ≠ health care: typology of barriers to health care access for low-income families. Ann Fam Med. 2007;5(6):511–518.
    OpenUrlAbstract/FREE Full Text
  13. ↵
    Candib LM. Obesity and diabetes in vulnerable populations: reflection on proximal and distal causes. Ann Fam Med. 2007;5(6):547–556.
    OpenUrlAbstract/FREE Full Text
  14. ↵
    Wilkinson RG. Putting the picture together: prosperity, redistribution, health, and welfare. In: Marmot MG, Wilkinson RG, eds. Social Determinants of Health. 2nd ed. New York, NY: Oxford University Press; 2005.
  15. ↵
    Macaulay AC. Promoting participatory research by family physicians. Ann Fam Med. 2007;5(6):557–560.
    OpenUrlAbstract/FREE Full Text
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The Annals of Family Medicine: 5 (6)
The Annals of Family Medicine: 5 (6)
Vol. 5, Issue 6
1 Nov 2007
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In This Issue: Equity—Global Theme Issue on Poverty and Human Development
Kurt C. Stange
The Annals of Family Medicine Nov 2007, 5 (6) 482-483; DOI: 10.1370/afm.788

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In This Issue: Equity—Global Theme Issue on Poverty and Human Development
Kurt C. Stange
The Annals of Family Medicine Nov 2007, 5 (6) 482-483; DOI: 10.1370/afm.788
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