Cutting Edge Research or Primary Care?

Anushka Reddy Marri

Final Year Part II

Rajiv Gandhi Institute of Medical Sciences, Adilabad

At its heart, primary health care is about caring for people, rather than simply treating specific diseases or conditions. It is usually the first point of contact people have with the health care system providing them with a comprehensive, accessible, community-based care that meets the health needs of individuals throughout their life. This includes a spectrum of services from prevention (i.e. vaccinations and family planning) to management of chronic health conditions and palliative care. Primary health care can meet 80-90% of an individual’s health needs over the course of their life. A health system with a strong primary health care as its core delivers better health outcomes, efficiency and improved quality of care. We need health systems with strong primary health care if we are to achieve universal health coverage¹.

Research is a systematic investigation including research development, testing and evaluation, designed to contribute to generalizable knowledge. Health research has high value to society. It can provide important information about disease trends and risk factors, outcomes of treatment or public health interventions, functional abilities, patterns of care, and health care costs and use. The different approaches to research provide complementary insights.  CUTTING-EDGE RESEARCH is a ground breaking research that explores new frontiers and implies latest advancements in the tools for any field that has importance and applications.

Research and Primary Health Care are two integral and important parts of the health care system, whose needs cannot be generalized all over the world. The world consists of developed, developing and underdeveloped countries. One of the criteria used to categorize the countries based on development is HDI. Human Development Index is a composite statistic of life expectancy, education, and per capita income indicators. A country scores higher HDI when the lifespan is higher, the education level is higher and the GDP per capita is higher. For example, Norway has the highest HDI of 0.949 with a perfect universal health care and an average life expectancy of 81 years². In general, the developed countries have a well established primary health care system. Developing countries on the other hand, suffer from basic problems like unsafe drinking water, improper sanitation and hygiene, high incidence of malnutrition, tropical diseases, and pollution and have very low life expectancy with high Infant Mortality Rates and Under 5 Mortality rates. For example, India has an HDI of 0.624 with an average life expectancy of 69 years³. Primary Health Care is highly deficit in developing countries.

The right to health is a universal human right which underpins the continuous call for universal health care. This call is ever more so in developing countries where there is limited access to basic health care. As a result, the World Health organization (WHO) advocates primary health care (PHC) as the key towards achieving universal health. Studies have shown that the growing burden of diseases is inversely related to economic growth especially in developing countries. For example, in Zambia, two-thirds of families that lose the head of the household in death to HIV/AIDS experience a staggering 80% drop in monthly income. Furthermore, the uneven distribution of social determinants of health such as income, housing, healthy environment, employment as well as the limited accessibility, affordability and availability of essential health services has led to widening health inequities between the high and low socio economic communities. This shows that achieving universal health is still a tall vision for resource limited countries (developing countries). Resource limited countries continue to be plagued with rising prevalence of malaria, tuberculosis, HIV/AIDS as well as other re-emerging diseases despite the huge financial support provided by bilateral and multilateral agencies to combat these diseases. While progress may have been made in reducing the global burden caused by these diseases on one hand, there has also been a weakening of the primary health care facility on the other hand which was the hallmark to the Alma Ata declaration of 1978⁴. The under par PHC in developing countries is made worse by the unequal and insufficient utilization patters by the people of the country. To combat this problem, funds are to be provided for spreading awareness and information about PHC in the rural and tribal areas. A proper research requires large amount of resources and thus capital, which will have to be diverted from the PHC, given the already low GDP of the developing countries. It’s more useful and better if the developing countries focus on building and strengthening a fully developed primary health care system.

On the other hand, Developed countries with their well established PHC and well controlled death rates and high life expectancy can focus on improving and updating the health care system. Patients should be offered that latest modalities of investigations and treatments. Research plays a pivotal role in this process and has brought us a long way.

Research techniques and their findings have evolved continually throughout the last century.  In the early 1900’s there was much investigation of the role of vitamins on the human body. The British Physician, Sir Edward Mellanby (1884 – 1955), in 1916 discovered how increasing Vitamin D in the diet could cure rickets, a common disease at the time. Sir Frederick Gowland Hopkins (1861 – 1947) was awarded the Nobel Prize (1929) for his pioneering work on the importance of vitamins.  Thence forward was a new era of enthusiastic research. There followed breakthroughs in finding new treatments for numerous infections that previously had resulted in many deaths in the early 1900’s: meningitis, pneumonia, septicemia. In 1929 Sir Alexander Fleming (1881 – 1955) discovered penicillin which remains one of the most widely used drugs today. There were advances in metabolic medicine such as the discovery of two types of diabetes mellitus. The study of life styles and their effects on the human body were studied. It became clear that tobacco smoking was a major cause of lung cancer and contributes heart disease and stroke. Research into cell function and molecular biology are areas of focus today (e.g. the discovery of interferon and its role in cancer treatment and that of multiple sclerosis). The discovery of double helix of DNA (accredited to James Watson and Francis Crick in 1953) was a huge advance leading to the understanding of many diseases. The amazing work of Audrey Smith in the 1960’s led to Cryobiology research which has enabled the storage of frozen sperm, eggs and embryos for In Vitro Fertilization (IVF)⁵.

Research will help us to revolutionize health care in the world but requires high amount of capital. Developed countries can emphasize on path-breaking research and bring out latest and evolved health care

Citations:

1. Stated at “The Global Conference on Primary Health Care by WHO and UNICEF”
2. Human Development Report 2016 by UNDP
3. Journal of public health in Africa, 2013
4. Stated in “The importance of research in healthcare” by Emma Young from Ashford and St Peters Foundation Hospitals NHS Trust, Research and Development Department.