Equity and PHC: Bridging Social, Historical, Geographical, and Symbolic Gaps.
Our association's 17th Congress, held in Rome in 2023, engaged with global turmoil and reaffirmed the importance and centrality of public health actions in addressing both recurring and emerging challenges in achieving universal access to health. Three years have passed rapidly, and unfortunately, this turbulence has only intensified. While we have largely overcome the pandemic, we are now faced with an increase in armed conflicts, the forced displacement of millions, persistent threats to democracy, and the escalation of climate disasters, among other crises that profoundly impact health systems. Consequently, the theme of our upcoming congress is exceptionally timely: "Health Without Borders: Equity, Inclusion, and Sustainability". Equity is a core tenet of public health and is particularly vital in the analysis of health policies and systems. Examples of this centrality can be found in the seminal works of Hart and Whitehead, as well as in Mahler's advocacy in the late 1970s for the integration of structural, social, and political changes within society, alongside comprehensive Primary Health Care (PHC).
The construction of supportive and universal health systems is a civilizing task that is increasingly necessary, guided by the principle of equity. In increasingly unequal societies, it is urgent that health systems contribute to narrowing the numerous social, historical, geographical, and symbolic gaps that segments of the population face when accessing health services. To bridge these gaps, PHC is pivotal.
Numerous studies indicate that systems anchored in PHC have a greater capacity to contribute to equity, often with superior cost-benefit ratios. It is important to emphasize that, to reduce inequities in health service utilization effectively, a robust PHC is required—one with a broad scope of services offered to the population, integrated into the healthcare network, and based on a comprehensive care model with strong territorial and community roots. This approach challenges the narrow conception of PHC as merely a single level of the system.
A PHC model that inseparably articulates the individual, collective, territorial, and community dimensions of care is better equipped to address the social determinants of the health-disease process, thereby improving population health. It is essential to note that these attributes promote both horizontal and vertical equity.
However, achieving this PHC model faces numerous challenges that must be addressed by the international public health community. Ultimately, bridging historical, geographical, and symbolic distances—and ensuring a complete and effective healthcare journey for all, particularly for vulnerable populations and Indigenous peoples—is a commitment that requires daily renewal.
We have many successful experiences worldwide, yet we also identify many difficulties analyzed in the vast global literature on the PHC-Equity binomial. Our 18th Congress will be an excellent opportunity to advance this discussion. Cape Town awaits us!