J Am Board Fam Med
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In July 2023, primary health care experts from more than 20 countries, the World Health Organization (WHO), and most agencies within the US Department of Health and Human Services (HHS) met at the National Academy of Sciences in Washington, DC, to catalyze action toward revitalizing primary care in the United States align efforts to advance primary health care worldwide, and improve health and security for all.1 This meeting was informed by the NASEM's critical primary care report, which highlighted the need for federal leadership to strengthen primary care services in the United States, especially for underserved populations, and to inform primary care systems around the world. To that end, this meeting was designed to explore the challenges and opportunities of investing in primary health care as a common good and critical for health security and resilience across the globe.2 In this issue, you will find {number} special communications from this conference that highlight the need to evolve from primary care to primary health care, the importance of primary care and public health collaboration, and the necessity for ongoing external scientific expertise to inform US federal government coordination efforts. Despite the clear consensus among global stakeholders regarding the importance of Primary Health Care to health equity, behavioral health, health security, and pandemic resilience, a year later the anticipated HHS Action Plan to guide implementation of the NASEM primary care recommendations has yet to be launched. While some agencies are moving ahead with initiatives and programs within their purview, the lack of a Primary Care Action Plan remains a missed opportunity to coalesce politically powerful stakeholders around a united and much-needed vision for a US health system centered on Primary Health Care, particularly in light of our challenges in responding to COVID-19.
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The COVID-19 pandemic was a stress test that revealed critical weaknesses in the foundation of the US health care delivery system, which left unresolved will ultimately lead to catastrophic population health consequences. Primary care and public health are the most fragile and important parts of that foundation. Collapse of either of these disciplines would lead to cascading failures harming the health of individuals and the health security of the nation. ⋯ Every day and in every corner of the world primary care and public health are already relying on each other in many ways. However, this relationship most often functions without formal acknowledgment. To better understand this intimate relationship, it is useful to first describe the core components of each.
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The 2021 National Academies of Sciences, Engineering, and Medicine (NASEM) report Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care outlined an implementation framework with recommendations for federal, state, and local policy makers, health systems, educational institutions, the interprofessional workforce, and others across the health care ecosystem to ensure that high-quality primary care is available for everyone in the United States. Based on 1 of the report's recommendations, the Department of Health and Human Services, in collaboration with the Department of Veterans Affairs and the Department of Agriculture, launched the Initiative to Strengthen Primary Health Care in 2021 to coordinate and prioritize primary care activities across the federal government. Formation of this federal coordinating body is a critical step for improving primary care in the US, but it is equally important to enable external primary care policy experts, researchers, and working clinicians to provide input on urgent primary care needs and priorities as primary care policy evolves. The newly launched NASEM Standing Committee on Primary Care will provide a venue for input that is independent, objective, and evidence-based to inform policy, spark progress and innovation, and confront challenging issues facing primary care today and in the future.
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Growing commodification of health care has resulted in a system that is impersonal, fragmented, and inequitable. A potential antidote to this poisonous situation is to understand and treat primary health care as a common good. ⋯ They can be actualized through a Collective Impact approach of a developing a common agenda, shared measurement systems, mutually reinforcing activities, continuous communication, and backbone support organizations. Investing in primary health care as a common good, with investments in primary medical care spending, support, and workforce development, complemented by integrated support of public health and social drivers of health, can launch a transitional period that moves US health care toward greater accessibility, effectiveness, equity, and sustainability.