Starfield Summit II: Carving a Path to Health Equity

Letter From the Chair

08/28/17  Portland, Ore.

By Jennifer DeVoe, M.D., D.Phil., OHSU Family Medicine Chair

Starfield Summit

Left to right: OHSU Family Physicians, Drs. Brian Park and Luis Manriquez take notes at this year's Starfield Summit II.

I am proud to serve this department and to be a part of such a committed community of people supporting each other and seeking opportunities to speak up on behalf of equity and inclusion. Recently, several of our faculty, residents, and students volunteered to serve as leaders and participants in the second Starfield Summit: Expanding Primary Care's Role in Achieving Health Equity. Held in Portland in April 2017, this Summit was a collaborative effort between OCHIN, Family Medicine for America's Health, the American Board of Family Medicine Foundation, the North American Primary Care Research Group, the Pisacano Leadership Foundation, and OHSU's Department of Family Medicine.

This second Summit followed the first Starfield Summit, which was held in Washington DC in April 2016 to honor and advance the work of Dr. Barbara Starfield.[i] Barbara Starfield (1932-2011), a physician and health services researcher, is internationally known for her work demonstrating that strong primary care is associated with improved population health outcomes, higher quality of care, and lower costs.[ii],[iii],[iv],[v],[vi] After a successful first Summit, our department was among several primary care leaders who committed to supporting an ongoing series of such events to provide unique opportunities for reflection and action amongst a diverse, interprofessional, international, cross-generational group of leaders in primary care. Organizers aimed for an event to galvanize participants, generate important discussion for public consumption, and enable research and policy agenda-setting, supporting the primary care function as an essential catalyst in health system reform. Further, the Summit embraces the principles of implementation science, a discipline promoting the integration of research into policy and practice.[vii],[viii] As the co-founder and first president of the International Society for Equity in Health, Dr. Starfield conducted landmark studies reporting that primary care-oriented countries demonstrated improved health inequities.[ix],[x],[xi],[xii] Thus, it was fitting that this second Starfield Summit focused on equity with sessions organized around three domains: social determinants of health in primary care, vulnerable populations, and economics and policy.

Thank you to Erika Cottrell, Ph.D., M.P.P. and Sonja Likamahuwa-Ackman, M.P.H., M.I.D. who spent countless hours serving on a national team planning and coordinating the event. Thank you to Khaya Clark, Ph.D.; Katie Dambrun, M.P.H.; Melinda Davis, Ph.D.; Brian Frank, M.D.; Leah Gordon, M.P.H.; Brigit Hatch, M.D., M.P.H.; John Heintzman, M.D., M.P.H.; Carly Hood, M.P.A., M.P.H.; Betty Izumi, Ph.D., M.P.H., R.D.; Brian Park, M.D., M.P.H.; and Lewis Raynor, Ph.D., M.P.H., M.S., who took detailed notes during all small group proceedings and reported back key messages during large group sessions. Thank you to the 60 students and residents who participated in the Summit. These folks joined a group of nearly 200 people from around the nation (and the world!) to think critically about how we can increase primary care's role in achieving health equity.

Several Oregon-based efforts were highlighted and applauded. For example, Senator Elizabeth Steiner-Hayward spoke about Oregon's coordinated care organizations and other organizations collaborating in Oregon to reduce health disparities. Craig Hostetler presented the Oregon Primary Care Association's work on alternative payment methodologies and how to pay for equitable care. OCHIN's work on bringing social determinants data into the clinical setting was profiled. Multnomah County's Equity Framework was used an example of how an institution moves beyond social responsibility and toward social accountability in order to deliberately apply an equity lens to every decision.

The second Starfield Summit provided a wonderful opportunity to share ideas and recommit ourselves to health equity efforts, and I am proud that so many people from our department joined a great team of sponsors to help make this event such a tremendous success. I am also proud of the many daily and ongoing efforts by so many people in our family medicine community to conscientiously and proactively address health disparities. Thank you to all of you in this courageous and caring community. In light of recent violent acts in Charlottesville and continued discriminatory behavior across the country, it is important that we continue to speak up and to speak out for equity and inclusion of all. Thank you for supporting and inspiring each other to expand primary care's role in achieving health equity.

[i] Doohan, N., Coutinho, A. J., Lochner, J., Wohler, D., &DeVoe, J. (2016). "A Paradox Persists When the Paradigm Is Wrong": Pisacano Scholars' Reflections from the Inaugural Starfield Summit. The Journal of the American Board of Family Medicine, 29(6), 793-804.

[ii] Starfield, B., Shi, L. (2002). Policy relevant determinants of health: an international perspective. Health Policy, 60, 202-221.

[iii] Starfield B. Primary Care. Balancing health needs, services, and technology. New York: Oxford University Press, 1998.

[iv] Macinko, J., Starfield, B., &Shi, L. (2003). The contribution of primary care systems to health outcomes within Organization for Economic Cooperation and Development (OECD) countries, 1970–1998. Health services research, 38(3), 831-865.

[v] Starfield, B., Shi, L., Grover, A., &Macinko, J. (2005). The effects of specialist supply on populations' health: assessing the evidence. Health Affairs, 24, W5.

[vi] Macinko, J., Starfield, B., &Shi, L. (2007). Quantifying the health benefits of primary care physician supply in the United States. International journal of health services, 37(1), 111-126.

[vii] Glasgow, R. E., Vinson, C., Chambers, D., Khoury, M. J., Kaplan, R. M., &Hunter, C. (2012). National Institutes of Health approaches to dissemination and implementation science: current and future directions. American journal of public health, 102(7), 1274-1281.

[viii] Dissemination and implementation research in health (R01). Bethesda (MD):National Institutes of Health; 2012. Available from: Accessed August 15, 2017.

[ix] Starfield, B., Shi, L. (2002). Policy relevant determinants of health: an international perspective. Health Policy, 60, 202-221.

[x] Shi, L., Macinko, J., Starfield, B., Politzer, R., &Xu, J. (2009). Primary care, race, and mortality in U.S. states. Health Policy: Crisis and Reform in the US Health Care Delivery System: Crisis and Reform in the US Health Care Delivery System, 185.

[xi] Shi, L., Starfield, B., Politzer, R., &Regan, J. (2002). Primary care, self‐rated health, and reductions in social disparities in health. Health services research, 37(3), 529-550.

[xii] Starfield, B., &Shi, L. (2004). The medical home, access to care, and insurance: a review of evidence. Pediatrics, 113(Supplement 4), 1493-1498.