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Health Inequalities in Primary Care

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Care Sciences".

Deadline for manuscript submissions: 31 December 2025 | Viewed by 1094

Special Issue Editor


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Guest Editor
Developmental, Capable and Ethical State Division, Human Sciences Research Council, Pretoria 0001, South Africa
Interests: sustainable human security; poverty and inequality; health systems financing; the economics of non-communicable and communicable diseases including HIV/AIDS, health systems and policy-oriented research in general

Special Issue Information

Dear Colleagues,

Achieving the United Nations’ universal health coverage goal by 2030 is becoming increasingly challenging and unlikely for some countries. Whilst it is still possible to see significant global improvements in health outcomes across countries, it is also clear that health inequalities are becoming more marked despite observable increases in investment in health. Health inequalities manifest in relation to access to care, the utilisation of quality services, and, ultimately, health outcomes. Since the Alma Ata Declaration, primary healthcare has been seen as the foundation for building healthy societies because it represents the first point of contact with communities. Despite improvements in health technology (e.g., e-health) and other health innovations, such as the use of community health workers or agents, particularly in low- and middle-income countries, there is still a disproportionate utilisation of PHC services by vulnerable and marginalised communities, including hard-to-reach, disabled, low-income, and displaced groups.

This Special Issue will address issues pertaining to the measurement of health inequalities and the drivers and/or enablers of these inequalities and how they can be addressed sustainably at the primary care level. Upstream issues related to primary healthcare policies, funding, and general resourcing are equally important. We welcome papers that address models for involving the private sector in PHC in order to achieve public health objectives, particularly reducing health inequalities, and multi-sectoral actions addressing the broader social determinants of health and community engagement.

Prof. Dr. Charles Hongoro
Guest Editor

Manuscript Submission Information

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Keywords

  • access and use
  • effective coverage
  • health inequalities
  • quality of healthcare
  • primary care funding
  • health technology
  • public–private mix models
  • community involvement
  • supportive health policies

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Published Papers (2 papers)

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21 pages, 306 KiB  
Article
Creating an Inclusive Definition for High Users of Inpatient Hospital Systems That Considers Different Levels of Rurality
by Tomoko McGaughey, George Kephart, Utkarsh J. Dang and Paul A. Peters
Int. J. Environ. Res. Public Health 2025, 22(3), 381; https://doi.org/10.3390/ijerph22030381 - 6 Mar 2025
Viewed by 447
Abstract
Multiple definitions have been used to identify individuals who are high system users (HSUs), through economic costs, frequency of use, or length of stay for inpatient care users. However, no definition has been validated to be representative of those residing in rural communities, [...] Read more.
Multiple definitions have been used to identify individuals who are high system users (HSUs), through economic costs, frequency of use, or length of stay for inpatient care users. However, no definition has been validated to be representative of those residing in rural communities, who face unique service accessibility. This paper identifies an HSU definition for rural Canada that is inclusive of various levels of rurality, longitudinal patient experiences, and types of hospitalizations experienced. This study utilized the 2011 Canadian Census Health and Environment Cohort (CanCHEC) linkage profile to assess hospitalization experiences between 1 January 2009 and 31 December 2013. A range of common HSU indicators were compared using Cox proportional hazards modelling for multiple periods of assessment and types of admissions. The preferred definition for rural HSUs was individuals who are in the 90th percentile of unplanned hospitalization episodes for 2 of 3 consecutive years. This approach is innovative in that it includes longitudinal hospital experiences and multiple types of hospitalizations and assesses an individual’s rurality as a point of context for analysis, rather than a characteristic. These differences provide an opportunity for community characteristic needs assessment and subsequent adjustments to policy development and resource allocation to meet each rural community’s specific needs. Full article
(This article belongs to the Special Issue Health Inequalities in Primary Care)

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13 pages, 830 KiB  
Perspective
Preserving Continuity and Trust in Primary Care: Strategies for Implementing Team-Based Models in South Tyrol, Italy
by Christian J. Wiedermann
Int. J. Environ. Res. Public Health 2025, 22(4), 477; https://doi.org/10.3390/ijerph22040477 - 23 Mar 2025
Viewed by 344
Abstract
Continuity of care is fundamental to the efficacy of primary healthcare, fostering trust, enhancing patient satisfaction, and improving health outcomes. However, the implementation of Ministerial Decree 77/2022, which advocates for team-based care in multidisciplinary Community Health Centers, presents challenges to these established principles. [...] Read more.
Continuity of care is fundamental to the efficacy of primary healthcare, fostering trust, enhancing patient satisfaction, and improving health outcomes. However, the implementation of Ministerial Decree 77/2022, which advocates for team-based care in multidisciplinary Community Health Centers, presents challenges to these established principles. This article proposes strategies to maintain continuity and trust whilst supporting the reform objectives, specifically tailored to the unique linguistic and cultural context of the Autonomous Province of Bolzano—South Tyrol. A synthesis of regional healthcare reports, academic literature, and practical insights from implementing Ministerial Decree 77/2022 was performed to develop strategies addressing challenges such as ensuring continuity, minimizing administrative burdens, and promoting patient and general practitioner engagement. Strategies include establishing Community Health Centers as integration hubs, assigning primary providers within teams, formalizing personalized care contracts, leveraging digital tools for collaboration, and expanding the roles of nurses and care coordinators. Additional measures focus on building infrastructure for telemedicine and home-based care, engaging patients through transparent communication and feedback loops, and preserving GP autonomy through flexible participation models and incentives. Strategies adapted to accommodate South Tyrol’s demographic, cultural, and systemic characteristics can maintain continuity and trust during the transition to team-based care. By addressing key risks and fostering collaboration among stakeholders, these reforms can enhance healthcare delivery without compromising the principles of personalized, patient-centered care. Full article
(This article belongs to the Special Issue Health Inequalities in Primary Care)
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