How many people in my neighborhood suffer from hypertension, diabetes, or arrhythmias? And how many are overweight or obese? How many smoke? And how many would want to leave it? And of all the girls, boys and adolescents in the neighborhood, how many feel sad, alone, absolutely misunderstood? How many already have established mental health problems? And of the little ones, how many have cavities? How many have a very poor diet? How many do practically no sports?
All these questions, and health problems, are present in our neighborhoods and are worked on daily in primary care centers.
Ana is a community nurse at the El Natahoyo Health Center, Gijón. She has been working in the smoking cessation clinic for years. A very difficult job. She, along with the doctor María Luisa, are in luck today. Susana has been smoking for 26 years, more than half of her life. She has left him several times, but she relapsed. This time they are happy, Susana has not smoked for six months and she is more than proud.
Antonio is a specialist in family and community medicine at the Daroca health center, Madrid. This morning, together with two colleagues, he gave a talk on mental health at the Francisco de Goya Institute. It is a very important task for him and his colleagues during which they have been able to share and get to know adolescents and young people like those who, increasingly, come to their consultations to request professional help for problems of anxiety, depression and self-harm. In the afternoon, Antonio has two hours of consultation and will finally attend to Luisa at her house, a third party without an elevator. Luisa is 87 years old and has been his patient for fourteen years. In recent years, Luisa can barely leave her home, so Antonio goes to her house where he adjusts the treatments. To ensure compliance, Antonio coordinates with the neighborhood pharmacist.
Mireia is a nutritionist and works at the La Mina Primary Care Center (CAP) in Barcelona, where overweight/obesity affects the majority of families. Mireia and her colleagues have just finished a participatory project with neighborhood families on feeding girls and boys. They have been photographing and discussing how to achieve a healthier diet for weeks and have chosen the following topics as the most relevant: food labeling, sugar, breakfasts and snacks, and the different diseases related to diet in their families. Working with neighbors is enriching CAP professionals and families. And they are having a great time creating community.
These are examples of professionals who work in health centers in the center of our cities and take care of the health of their neighbors. I will always remember the conversation with one of my professors at Johns Hopkins University when we were walking through my neighborhood. What is this big red brick building? And do you all use it in the family? And do you collaborate with them in research studies? As a good researcher and social epidemiologist, he kept asking about daily life in the neighborhood and suggesting relevant questions.
Barbara Starfield, one of the most important researchers in the field of primary care, worked precisely at Johns Hopkins. Her work in the eighties and nineties helped develop and evaluate health systems, focusing on primary care. Primary care has at least four pillars: it represents people’s first contact with the health system, it offers continuous monitoring (this is the concept of longitudinality), it offers comprehensive care (not specialized by organs or physiological functions) and it is a coordinated care with other specialties and entities of the health system. In primary care, 90% of patients’ health queries are resolved, considerably reducing the use of other, much more inefficient levels of care.
Our societies have changed a lot since the nineties. For example, in Spain and in Europe in general we are much older and, therefore, the chronic diseases that link us to each other, multimorbidity, is a health reality where longitudinality continues to be key. A study published in the British Journal of General Practice in February 2022 analyzed data from 4.5 million Norwegians and showed that having a primary care reference doctor with a duration of 15 years or more reduced hospital admissions by 30%, 28% the use of emergencies and 25% mortality compared to patients with a duration of less than one year. In Spain, progress is being made in incorporating new professional profiles that can meet the current health needs of our populations. For example, in Catalonia, professionals dedicated to dental hygiene, emotional well-being, dieticians-nutritionists and physiotherapists are joining the CAPs.
In 2023, WHO Europe has prepared a report on the transformation of primary care in Spain, focusing on the challenges and opportunities to increase public trust and the prestige and value of primary care, such as the integration of care levels, sufficient financing (the recommendation is to spend 25% of health spending on primary care and in Spain it is 14%), the development and training of its workforce and research based on primary care. An example of a primary-based scientific project was developed at the University of Alcalá in collaboration with the Foundation for Biomedical Research and Innovation in Primary Care of the Community of Madrid. We analyzed the relationship between the availability of sports facilities and the prevalence of obesity and type 2 diabetes taking into account the socioeconomic level and sex of inhabitants aged 40 to 75 years in the entire city of Madrid. The results showed that, in neighborhoods with a lower availability of sports facilities, the population has 22% more obesity and 38% more diabetes than those with a higher availability of sports facilities. This type of research is the basis of what is today called prescription of physical exercise as therapy from health systems and which is beginning to be used in different cities in Europe.
Primary care, with a community and preventive orientation, is a key service to increase levels of health and well-being in our neighborhoods, our cities. Research based on primary care in Spain would undoubtedly be able to provide knowledge to achieve this objective.
Finally, I want to show my respect and admiration to primary school professionals who carry out an enormous task, often unknown and undervalued, to improve health in our neighborhoods.
Health goes by neighborhoods It is a section that explains in a simple and friendly tone the concepts and advances in research in Urban Health, an area of Public Health that is necessarily interdisciplinary. Research in Urban Health aims to improve our cities to improve the health of the millions of people who inhabit the complex and unequal cities that today characterize life on our planet.
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