Barbara Starfield, perhaps the most influential figure in the primary care research community, died unexpectedly at home on June 10 this year while swimming in her pool. She was steadfast in her belief that primary care is central to the delivery of high quality cost-effective health care. Her second passion was as a champion of primary care as the key way to address healthcare inequalities, and she was founding editor of the International Journal for Equity in Health. She was highly critical of health care in her own country, (the US), viewing it as dominated by specialists who provide expensive, inequitable, and sometimes damaging health care. Her influence was truly international both in Europe and most especially in Latin America (she had a passion for Spanish-speaking countries). She travelled the world to promote the importance of primary care to family doctors and governments, demonstrating that in countries with well-organised primary care, people live longer, are healthier and there is more equity than in systems which rely on secondary hospital care. To her great regret, her influence was perhaps least in the US, where health care remained dominated by specialist interests. In addition to many publications in journals from countries around the world, she was perhaps best known for her book Primary Care: Concept. Evaluation and Policy first published in 1992.
Originally, from Brooklyn, NY, Professor Starfield gained her medical degree from The State University of New York, where she graduated magna cum laude in 1959. In the same year she arrived as a fellow in paediatrics at Johns Hopkins University in Baltimore where she spent the whole of her professional life. She went on to lead the Division of Health Policy in the Department of Health Policy and Management from 1975 to 1994. After stepping down as Division head, she remained an active member of the faculty and was founding director of the Primary Care Policy Center. She was named Distinguished University Professor in 1994. Barbara remained very active right up to the time of her death in research, in writing, and as a highly sought-after keynote speaker.
I was privileged that she agreed to take a part-time appointment with Manchester University and was a visiting professor from 2005 to 2010. She contributed to our work often responding by email within hours despite a travel schedule that would have exhausted someone half her age. When she visited us, she was always an incisive and stimulating critic of our work. She never accepted orthodoxy and loved to challenge us out of complacent ways of thinking.
Barbara's work has influenced how policymakers and researchers think about the delivery of health care worldwide. Her legacy will be the influence which she has had and the ongoing relevance of her publications. Despite being 78 years old when she died, PubMed lists 11 research papers published in 2010 and 2011. There can scarcely be anyone in the world who has made a case for the importance of primary care without quoting from Barbara Starfield. She was truly a giant of her age (despite being tiny), and it is our responsibility to see that her ideas live on.
- © British Journal of General Practice 2011
