From Local Clinics to Global Strategies for Inclusive Health Care

Dear Editor,

We are writing in response to the article "Support for the WHO Resolution on Social Participation" by T.C. (Tim) olde Hartman and Tom Vansaghi, published in The Annals of Family Medicine (1). As family physician researchers in Spain, we find the discourse on social participation in health particularly pertinent, especially in light of the recent decision by the United States to withdraw from the World Health Organization (WHO). This development introduces complexities that may influence global health initiatives, including those promoting community engagement. In this letter, we aim to explore the implications of these changes, particularly from the perspective of primary care in Spain, and discuss strategies to advance social participation in health amidst evolving global dynamics.

The WHO's resolution emphasizes the importance of involving individuals, families, and communities in shaping health policies and practices. Participatory approaches have been associated with improved health outcomes and enhanced equity. In Spain, the integration of community engagement within primary care has been a subject of growing interest. Studies have highlighted the potential of participatory health research to address public health challenges effectively. For instance, a systematic review by Cassetti et al. (2) identified key facilitators for successful community processes, including inclusivity, information flow, deliberative quality, decision-making, institutional commitment, and community empowerment. These dimensions are crucial for the effective implementation of participatory approaches in primary care settings.

The U.S. withdrawal from the WHO introduces uncertainties, particularly concerning the funding and support of global health initiatives. The U.S. has been a significant contributor to the WHO's budget, and its departure may result in financial constraints that could affect programs promoting social participation in health. This situation necessitates a reevaluation of strategies to sustain and advance community engagement initiatives, especially in countries like Spain where such approaches are integral to primary care.

In Spain, primary care centers have been at the forefront of implementing community engagement strategies. The experiences from these centers offer valuable insights into the practical aspects of fostering social participation in health. For example, the "AdaptA GPS Project" aimed to translate and adapt health promotion guidelines to the Spanish context, emphasizing the importance of community engagement (3). Such initiatives demonstrate the feasibility and benefits of integrating community participation into primary care.

The potential reduction in global health funding underscores the importance of developing sustainable, locally-driven initiatives. Spanish primary care centers can focus on building strong partnerships with local organizations, leveraging community resources, and advocating for policy support at the national level to ensure the continuity of community engagement programs. Additionally, exploring alternative funding mechanisms, such as public-private partnerships and community-based fundraising, may provide financial resilience.

Moreover, the use of technology can play a pivotal role in educating (4) and facilitating community engagement. Digital platforms can enable broader participation, allowing community members to contribute to health discussions, access information, and provide feedback on health services. Implementing such technological solutions requires careful consideration of accessibility and digital literacy to ensure inclusivity (5).

The ethical imperative of inclusivity in participatory health initiatives cannot be overstated. Ensuring that marginalized and vulnerable populations have a voice in health decision-making processes is essential for achieving health equity. This involves not only inviting participation but also addressing barriers that may hinder engagement, such as language, cultural differences, and socioeconomic factors.

In our opinion, while the U.S. withdrawal from the WHO presents challenges to global health initiatives, it also offers an opportunity also for other countries to strengthen their commitment to social participation in health. By focusing on sustainable, locally-driven strategies, taking advantage of technology, and prioritizing inclusivity, primary care centers can continue to advance community engagement, ultimately contributing to more responsive and equitable health systems.

REFERENCES

1. Hartman TC (Tim) olde, Vansaghi T. Support for the WHO Resolution on Social Participation. Ann Fam Med. 2025 Mar 1;23(2):174–5.

2. Cassetti V, León García M, López-Villar S, López Ruiz MV, Paredes-Carbonell JJ. Community engagement to promote health and reduce inequalities in Spain: a narrative systematic review. Int J Public Health. 2020 Apr 1;65(3):313–22.

3. Martínez MJC, Peralta ER, Cassetti V, Díaz BB, Botalla RM, Moreno CB, et al. Evaluación cualitativa de un proceso participativo de adaptación de una guía de promoción de la salud : e202106097. Rev Esp Salud Pública. 2021 Jun 17;95:

4. Miraut D. El sueño de Isaac y la transformación de los sistemas educativos en la sociedad de la información. Teoría Educ Educ Cult En Soc Inf. 2011;12(1):240–66.

5. Miraut D, Mendoza Á. Iniciativas educativas para una sociedad de la información sostenible. Teoría Educ Educ Cult En Soc Inf. 2011;12(3):241–64.