2024-10-30 07:23:00
Social determinants, such as gender or socioeconomic situation, have a direct impact on people’s health. Several studies have shown that these factors can increase vulnerability to certain non-communicable diseases. A report analyzes equity in primary care services from this perspective and suggests keys to reducing inequalities, focusing on prevalent diseases such as cardiovascular disease, one of the main causes of death in Spain.
The Ministry of Health has welcomed the presentation of the new report “Towards equity in healthcare: proposals to transform primary care in Spain”.
A multidisciplinary group composed of representatives of scientific societies, social organizations, patient associations, professional associations, primary care professionals and social scientists participated in the document, promoted by Novartis.
Pedro Gullón, director general of Public Health and Health Equity at the Ministry of Health, stated in the presentation the importance of these reports to ensure that these issues are not only on the political agenda of epidemiologists, but also on the agenda of others political leaders, other ministries, civil society and the pharmaceutical industry itself.
“This shows us that the time has come to take action to reduce social inequalities and how primary care services can act as a catalyst for all actions taken to improve the equity of our healthcare system,” Gullón said.
The need to strengthen primary care in areas of greatest social vulnerability
The report highlights that groups such as the Roma population and migrants have difficulty accessing health services.
Rural areas have worse health outcomes than urban areas, and women report poorer health due to factors such as age and socioeconomic status.
People with low levels of education are at greater risk of non-communicable diseases.
Furthermore, climate change and pollution have a disproportionate impact on vulnerable populations.
These inequalities highlight the urgent need for policies that improve access to healthcare, despite the deterioration and pressure on current services, the report notes.
Social inequality in cardiovascular diseases
In 2022, cardiovascular diseases were the leading cause of death, with over 120,000 deaths, 26% of the total attributable to non-communicable diseases, 52.9% in women and 47% in men.
Furthermore, regarding risk factors, a 2020 study revealed that people from the lowest social class had 2% more hypercholesterolemia, 13% more diabetes, 6% more hypertension, the 17% more obesity and 9% more smoking than those of the highest social class.
Proposals to transform primary care in Spain from equity
Him relationship offers a series of proposals to address the primary care situation and which are classified into four areas of intervention:
1. Social-health coordination and equitable access of the most vulnerable population to primary care
- Social-health coordination: Greater collaboration between primary care professionals and social services is needed through effective communication channels and protocols.
- Community Connector: One of the proposals is a professional who facilitates the identification of vulnerable people, collaborating with primary care, social services and local organizations to offer information on available health resources.
- Shared social and health history: Integrating socioeconomic and clinical data into a single document, accessible to health and social services professionals, would improve comprehensive and personalized care.
- Digitalization and training: Improving interoperability between health and social care systems and training staff in accessibility and digital health is essential to avoid barriers and improve care, especially for migrants and people with disabilities.
2. Primary care resources in areas of high social vulnerability
- Resource allocation in primary care: Currently, resources are allocated based on population, age and dispersion, but the demand and intensity of care in vulnerable areas are not taken into account. It is proposed to reformulate the parameters to ensure a more equitable distribution.
- Retention of professionals in vulnerable areas: Staff shortages in high-pressure care areas, combined with reductions in afternoon shifts, impact care in these areas. Incentives are needed to attract and retain professionals in these sectors.
- Expansion and redefinition of professional roles: Primary care teams, including doctors, nurses, pharmacists and social workers, need to be strengthened by adapting their functions to the specific needs of each area to improve efficiency.
- Better coordination between professionals: Collaborative working guides and knowledge exchange mechanisms must be implemented to optimize patient care and monitoring by integrating social determinants of health into care.
3. Health promotion and preventive activities in a community perspective
- Health promotion in primary care: The primary care center must be recognized for its role not only in the treatment of diseases, but also as a space for health promotion and community support.
- Healthy environments: It is necessary to facilitate access to environments that promote health (physical activities, healthy eating, emotional well-being) from an early age, through adequate infrastructure and community health education.
- Community participation in health: Promote spaces for citizen participation, such as Area Health Councils, to encourage dialogue between institutions, social services and neighbors, improving individual and community health.
- Schools for patients and caregivers: Strengthen these spaces that promote healthy habits and co-responsibility in healthcare, with particular attention to people in situations of social vulnerability.
- Sports recipe and collaboration with educators: It is proposed that GPs can prescribe regulated physical activity through sports prescription and collaborate with sports physical educators to prevent disease and promote health.
4. Treatment of non-communicable diseases and secondary prevention in vulnerable populations
- Care of chronic patients: The NHS should focus more on chronic care, with support and liaison units in primary care and the use of telemedicine to improve monitoring and avoid unnecessary hospital admissions.
- Access to innovative medicines: It is essential to facilitate access to innovative medicines by primary care, as they are currently only available in hospitals.
- Secondary prevention: Primary care must guide the early detection and treatment of noncommunicable diseases, especially in vulnerable populations with a higher risk of cardiovascular disease.
- Patient associations: The avenues for participation and collaboration of patient organizations in the healthcare system must be expanded, integrating their vision into the care of chronic diseases.
- Programs for experienced patients: Increased funding for these programs is recommended to promote peer education and improve the management of noncommunicable diseases at the national level.
