Editor's Briefing

GLOBAL HEALTH

This year’s RCGP annual conference in Glasgow is a new, joint initiative by the College and the Society for Academic Primary Care, the main UK organisation for researchers and undergraduate teachers in general practice and primary care, and whose membership also includes many non-clinical researchers. Collaboration between these two organisations emphasises the links between research and clinical practice, and also with undergraduate teaching, postgraduate training, and continuing professional development.

Global health is theme of the conference, and also of this month’s BJGP. The leader by Wass and Mather highlights the critical, global role of primary health care in the context of human rights and the long journey towards achieving the Millennium Development Goals. They also describe College initiatives aimed at increasing the capacity and effectiveness of primary care in areas of need, through education, research, and political leverage. Articles in the Journal emphasise three central aspects of global health: connectedness, common challenges, and common core values. In their editorial on exotic travel, Coltart and Behrens look at some of the new and strange medical problems that now find their way to our shores and into our surgeries as a result of the global movement of people and micro-organisms. The index of suspicion for the rare and unexpected needs to be high in anyone with a recent — or not so recent, as Morgan and colleagues remind us in relation to malaria — history of tropical travel. Coltart and Behrens‘ article is also a metaphor for the spread of other entities that have the capacity to affect many lives, simply because they are so inter-connected: examples include the Euro crisis, civil insurrection, and the consequences of cultural and religious intolerance.

We share many challenges too. Ballard and Wright describe the problems of establishing effective maternity care in Ethiopia, which go beyond simply not having the money, and Kousoulis and colleagues’ report reflects all too familiar problems in driving primary care reform, in this case in Greece. The spiralling costs of health care affect us all, but the difficulty of changing ways of working and thinking at national, governmental, institutional, and personal levels cannot be overestimated.

There is, indeed, a common core of ethical, professional, and clinical values, of skills, attitudes, and knowledge, which underpins high quality medical practice, but it cannot be taken for granted, and has been subverted in the past. There is much to admire about modern medicine but there are clearly concerns about lack of commitment, the erosion of altruism, and the increasingly bureaucratic systems that have been allowed to creep into medical practice, along with decreasingly effective means of recognising and promoting professionalism. The commodification and politicisation of health care may be partly responsible, but I can’t help sensing a poorly-defined low-grade malaise in medicine, although I need help in coming to a more definitive diagnosis.

This is the BJGP team’s last month in Bow Churchyard. The November issue of the Journal will be put together in our wonderful new College building in Euston, and I will miss my journeys to the City: a bus trip up Ludgate Hill, down which a river of lead flowed during the Great Fire of London in 1666, to St Paul’s. A stroll across the cathedral gardens to the south east of Wren’s masterpiece, past the bust of John Donne, ‘Poet and Divine’, and of course Dean of St Paul’s in the 1620s. Over New Change to Watling Street, a reminder of the Roman occupation of Britain, where there is a statue of Admiral Arthur Phillip, who settled Sydney Cove in 1788 and was the first Governor General of New South Wales. Along Bread Street and down John Milton Passage — he was born in Bread Street in 1608 — into Bow Churchyard in the shadow of the tower of St Mary-le-Bow Church and its famous bells, where there is a monument to Captain John Smith who settled Virginia, and whose life was saved by Pocahontas. She came to London at about the same time that Donne was preaching in St Paul’s. There will be geographical compensations: we’ll be near the West End, just across the road from the Wellcome Trust, a few hundred yards from Regent’s Park, and reassuringly close to the General Medical Council. We will be celebrating the 60th anniversary of the RCGP and featuring its new headquarters building in the November issue of the Journal.