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Addressing the social and economic determinants of health is largely an upstream task, beyond the scope of practitioners working on the front line, even if as Henry E Sigerist wrote, ‘they are well aware of the factors which confound all their efforts’.1 What then is the role of GPs and family doctors in addressing the social and economic determinants of health? The usual answer (‘not much’) is insufficiently imagined. Primary care could do lots more.
First, although most clinical care needs to take account of the social context, this is most true and necessary for patients with multiple problems, as found particularly in deprived areas. Practitioners whose lives are separate from those of their patients are less likely to understand this context. There is a clear challenge for education, training, and continuing professional development.
Second, the social capital and trust that is built up via long-term relationships between practitioners and patients is a crucial resource when discussing preferences and choices, especially in old age, when the consequences of impersonal care may result in healthcare experiences and expenditure that no one really wants.
Thirdly, as populations get older, it is clear that the problems of looking after people cannot and should not be over-professionalised. While services may be resource poor, communities are potentially people rich. In facing the challenges of ageing populations, professionals need to work in new ways with communities, reducing professional distance, while increasing partnership and accountability.
In these ways, practitioners can be important social and economic determinants of health in the populations they serve. Whether they perceive themselves in this way, and provide examples such as those described by Paes and De Maeseneer,2 and pioneered by the likes of Sam Everington3 and Scott Murray4 in the UK, depends less on their professional knowledge and expertise, than on their values, on how they see their professional role and on their relationships with patients and communities. As yet we have only a few wild flowers, but with time, imagination and effort, this part of primary care could surely bloom.