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Message from the IJEqH Editors

Barbara Starfield, the founding editor of the International Journal for Equity in Health, co-founder and first president of the International Society for Equity in Health, Distinguished University Professor of Health Policy and Management and Pediatrics at Johns Hopkins University, a seminal researcher and highly praised teacher, died suddenly on Friday, June 10, 2011.

Professor Starfield's recent editorial [1] conveys the themes she has promoted uncompromisingly throughout her career - equity in health and health care, person focused view of morbidity, and the central role of primary care providers

"A "whole-patient oriented" view of disease is more accurate than a disease oriented view. It is also more equitable. Diseases are more likely to occur and to be more serious in socially disadvantaged people... Only a person-focused (rather than a disease-focused) view of morbidity, in which multiple illnesses interact in myriad ways, can accurately depict the much greater impact of illness among socially disadvantaged people and the nature of the interventions that are required to adequately manage the increased vulnerability to and interactions among diseases. Inequity is built into health systems - especially western health systems that are based on a view of health needs disease-by disease. Therefore, the benefits of primary care, which is person- and population- rather than disease-focused, are underappreciated. Data provide evidence not only of its benefit to populations but also of its preferential benefit to the socially disadvantaged [6]. Increasing referral rates from primary care to specialty care pose a special problem for socially deprived population groups, as their greater morbidity leads them to be referred to more different types of specialists with consequent increased likelihood of poor coordination, adverse effects, and unnecessarily high costs (some which will come from out-of-pocket payments) unless there is strong primary care... Primary care must inevitably assume increasing importance in health systems because it is far superior in dealing with multimorbidity over time. This is part of the explanation for its greater contribution to health in modern societies."

A decade ago Barbara wrote [2] what we, researchers in the field of health equity can strive to follow:

"The subject of the causation of inequities in health is clearly complex, but it is amenable to scientific study. The many issues concerning the nature of the pathways in different population groups, in different cohorts, and indifferent historical time periods are only some of the many challenges. We need good scientific research on the nature of the pathways and their consistency and variability ; on the best ways to specify the variables that represent the various types of characteristics in the theoretical models ; on the relative influence and mechanisms of effect of various types of interventions to reduce the effects on ill health and, perhaps, even improve the health of populations ; and on the special challenges posed by vulnerable population groups, such as children and adolescents, women and especially pregnant women, and racial and ethnic minorities. The development and application of statistical techniques that elucidate mechanisms rather than describe them are also a high priority, as are collaborative efforts across political jurisdictions and countries to improve the generalizability of research results and policy applications."

The editorial team mourns Barbara's lost, and offers condolences to her family and friends everywhere.

  1. Starfield B. The hidden inequity in health care. International Journal for Equity in Health.10(1):15.
  2. Starfield B. Is equity a scientific issue? West J Med. [Editorial Material]. 2000 Jul;173(1):7-.