Primary Health Care and Population Mortality

229 Pages·2023·10.93 MB·English

by  Richard Baker

PRIMARY HEALTH CARE AND
POPULATION MORTALITY
Population health management is being increasingly adopted by health
systems, yet the importance of primary health care in influencing popu-
lation mortality and the mechanisms that explain it are not well under-
stood. Too often, primary health care is regarded as a service for minor
health problems and for managing access to secondary care. This limited
view is no longer tenable and it is time to be much more ambitious about
the place of primary health care in health systems worldwide.
In delivering and planning health care and in re-building health
systems after the pandemic, practitioners and policymakers in low-,
middle- and high-income countries need evidence on how primary
health care affects population mortality and practical advice to effect
change. Primary Health Care and Population Mortality fulfils this need.
Drawing on his long experience as both a practitioner and researcher,
the author Richard Baker describes how primary health is crucial to the
effect of health systems on population mortality, including its potential
for reducing inequalities in mortality.
This accessible new book will provide invaluable information to lead-
ers in service development and delivery, academics in primary health
care and those working within international organisations that are pro-
moting primary health care for improving population health. It will also
be of practical value to general practitioners, primary health care nurses
and managers and public health staff.

Primary Health Care and
Population Mortality
Richard Baker
Department of Population Health Sciences
University of Leicester, UK
First edition published 2023
by CRC Press
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and by CRC Press
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CRC Press is an imprint of Taylor & Francis Group, LLC
© 2023 Richard Baker
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ISBN: 9781032409313 (hbk)
ISBN: 9781032397375 (pbk)
ISBN: 9781003355380 (ebk)
DOI: 10.1201/9781003355380
Typeset in Sabon LT Std
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Contents
Preface vii
Acknowledgements ix
Author x
1 Hard times 1
2 From certificates to statistics 14
3 Variations in population mortality and some things
that influence them 27
4 Primary health care and population mortality in
low-, middle- and high-income countries 47
5 Communicable diseases 76
6 Non-communicable diseases 1: Cardiovascular
disease and cancer 101
7 Non-communicable diseases 2: Respiratory
disorders and mental health 120
8 Organisational features of primary health care 141
vi Contents
9 The patient–professional relationship 164
10 Policy and population health management 184
11 The mechanisms framework 195
12 New ambitions for primary health care 207
Index 213
Preface
Richard Baker
It’s time to think differently about primary health care. As the evidence
assembled in the following pages shows, it is crucial to the effect of
health systems on population mortality. The research responsible for this
new understanding of primary health care has been conducted in the
last two decades and is so extensive that it has been possible to identify
23 mechanisms that contribute to its beneficial effects. Too often in the
past, the policies of many governments and decision makers appear to
have been based on the belief that primary health care is the setting for
dealing with minor problems and the routine management of chronic
disorders, with the overriding objective being to constrain the use of
costly hospital services. The consequence of this narrow understanding
of primary health care is shorter lives for too many people. The new evi-
dence demands that policymakers should be much more ambitious about
the role of primary health care in health systems. Better planned and
better resourced services would be followed by fewer premature deaths
among current and future generations.
Policymakers should also be more ambitious about primary health
care’s role in reducing inequalities in mortality. It can make a difference,
yet too often services are neither designed nor managed appropriately. It
is time for this state of affairs to change. The life-course theory of health
inequalities has special relevance to that part of the health service that
provides lifelong care – inequalities begin at the beginning of life, and
action by primary health care to address them must begin with mothers
and children.
viii PrefaCe
The planning and delivery of primary health care must give greater
priority to reducing mortality and inequality in mortality. The mecha-
nisms of primary health care that influence mortality should be used by
policymakers to inform the organisation of services. Methods are avail-
able for monitoring mortality patterns, and mortality should be one of
the key outcomes routinely used to guide services. Practitioners need a
supportive policy framework that allows them to learn from both mor-
tality in the populations they care for and the deaths of individuals.
Around the world, primary health care is working hard to restore ser-
vices that were stretched to a breaking point during the pandemic. But
even before the pandemic there were serious problems. In low- and mid-
dle-income countries, primary health care was often poorly resourced,
patchy and fragile; and in high-income countries, failure to anticipate
the changing demands on health care caused by ageing populations left
many services in a state of unplanned decline. For many countries, re-
building primary health care will be a long and difficult path. The prepa-
ration of this book began during the lockdowns of the pandemic. By the
time all the evidence had been sifted, it had become clear that more than
re-building will be needed if primary health care is to achieve its full
potential in improving health. The evidence and ideas in the following
pages are offered in the hope that thinking differently about the role of
primary health care will help its potential to be reached.
Acknowledgements
The most important mentor and catalyst to my thinking about and
research into primary health care is Robin Fraser, Head of the Department
of General Practice during my formative years as a general practitioner
researcher. He developed a vision about the core clinical skill – the
clinical method – that has inspired me to think systematically about how
primary health care affects population mortality, and it is a privilege to
acknowledge his influence here.
It is a pleasure to thank George Freeman, Mayur Lakhani, Tim Stokes,
Steven Levene and Harini Sathanapally for reading selected chapters.
Thanks are also owed to Jo Koster of Taylor & Francis/CRC Press and
Meeta Singh for their guidance in the preparation of the manuscript. The
feedback made an enormous difference to the original text; the errors that
remain are all my own.
I am grateful to a group of organisations that have made data freely
available under Creative Commons Licenses. Many of the tables and
figures draw on data they have published; they include the Institute
for Health Metrics and Evaluation (IHME) and its associated Global
Burden of Disease (GBD) programme, the National Records of Scotland,
the Office for Health Improvement and Disparities, NHS Digital that
published information from the Health Survey for England, the Office
for National Statistics (ONS), the UK Government, the World Bank and
the World Health Organisation (WHO).
The process of seeking and sifting through the research evidence that is
presented in the pages that follow began with the first lockdown in 2020. My
partner in life these last 50 years was a calm presence from those first stages
and on to the completion of the manuscript. As ever, thank you, Christine.
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