Family Medicine and WONCA - The Challenges Ahead

español (muy pronto)

Keynote speech of Professor Michael Kidd, WONCA President.

Date: June 29, 2013

I love this point in our world conference. On the first day, we all tend to sit with people from our own countries. Then the WONCA magic happens. We meet colleagues from around the world, share ideas and challenges, and become friends. And we mix up. Look either side of you now. Chances are, the people sitting on either side of you are now your friends from other parts of the world.

Thank you to president Svatopluk Byma, and all the members and staff of our host, the Czech Society of General Practice, for a wonderful conference and for your warm hospitality. My special thanks to Bohumil Seifert, as chair of the conference organizing committee, and to Vaclav Benes as chair of the scientific committee, and to all those who have worked with you both on making this such a successful event.

Thank you to everybody here for being so active in the conference program and sharing your ideas and innovations and challenging each other to think deep and wide. I hope you have made many new friends and will return home inspired about the work that we do as family doctors.

And thank you to all the young doctors who attended this meeting and inspired us with your passion for family medicine and global health. The Vasco da Gama Movement, the European young family doctor group, has run a wonderful program over the past week. And here in Prague a new group has been established for young family doctors in Africa, led by Kayode Alao from Nigeria.

Together we strengthen family medicine across the world to the benefit of our patients, our communities and humanity. During this presentation I will share with you some images of our colleagues in Indonesia working in some of the family medicine clinics I visited there last month. They have agreed to share their images with you. The patients you see in these images are other family doctor colleagues role playing so that we do not breach patient confidentiality.

I also need to begin with a word about words. When I say family doctor, I mean you. Whether you call yourself a general practitioner, a GP, or a family physician or a primary care doctor. Whatever you call yourself, and whatever your patients call you, when I say family doctor I mean you, my sisters and my brothers in family medicine. The language we use to describe who we are, doesn’t matter. What matters is the common work that we do, the vision that we share, the outcomes that we achieve.

I am going to speak about WONCA, our world organization of family medicine, and the challenges ahead for family medicine around the world.

This week I asked some young Czech family doctors who is the most famous Czech person ever. If you are from the English-speaking world, like me, it might be Good King Wenceslaus, St Vaclav if you are Czech. Or if you love literature it might be Frank Kafka, or if you love music, Antonin Dvorak. When I asked my taxi driver coming here from the airport he assured me the most famous Czech person is Martina Navratilova.

The name I was seeking is my Czech hero - this man, Vaclav Havel, the first president of the Czech Republic, a playwright as well as a global political figure and a voice for world peace. Vaclav Havel once wrote, “The salvation of this human world lies nowhere else than in the human heart, in the human power to reflect, in human meekness and human responsibility.”

I think this is a wonderful message for family doctors with our combination of compassion and intellect and humility and responsibility, we have within us the power to do great good, to make a real difference in the world. WONCA allows us to come together to work together to make this a reality.

In the words of our very first WONCA president, Dr Monty Kent Hughes, speaking to the first WONCA world council in 1972: “the future of our professional discipline will depend on our ability to work together in the service of humanity.”

WONCA is the global voice of family medicine. We are also the eyes and ears of global health care observing and listening to our individual patients and our communities and identifying their health care needs. And we are the head and heart of global medicine – combining our scientific knowledge as medical practitioners with tender loving care. Indeed this is the Latin motto of several of the member organisations of WONCA: cum scientia caritas – “with scientific knowledge and tender loving care”.

WONCA represents you and your professional college or society at a global level. WONCA advocates for the important work you do every day in meeting the health care needs of your patients and your communities.

Why do we do this? Because family medicine is important.

Because the evidence is clear that health systems based on strong primary care, which includes strong family medicine, are the most efficient, equitable and cost-effective.

Because strong family medicine is the best way to improve the health of individuals, families and communities.

Because every family should have a family doctor who the members of each family can trust for their medical care and advice.

Because family doctors are part of the social fabric of our societies and we work to keep the fabric of health care together.

The family doctor has an important role to play in the life of every family in every community in every nation of the world.

WONCA, like me, was born in Melbourne many years ago. It started with a small group of family medicine colleges and academies that banded together to create a world body which shared an ideal of training and education for family medicine and high standards for clinical care in all nations of the world.

WONCA now has 118 Member Organisations representing over 400,000 family doctors in over 130 countries and territories around the world. As I mentioned on Thursday, the 400,000 family doctors represented by WONCA, and including all those of us here, each year have over two billion consultations with our patients. Two billion. That’s the scope of our current work and our influence.

But we need to do more. We need to work to ensure that every family doctor, every GP, every primary care doctor, joins us in our commitment to deliver high quality primary care to our patients and communities. And we need to expand our commitment to the education and training of family doctors and quality care and primary care research to the 80 nations of the world where WONCA does not yet have a presence.

WONCA calls for a family doctor for every family. This means that every family has access to a caring committed family doctor working with other primary health care providers, including dedicated nurses and midwives and community health workers, to provide comprehensive continuing care to all people.

And by family I mean family in its broadest context. Not just families with a mum and a dad and 2.3 kids and a dog. We provide care for every member of every family in the global family. As family doctors, we don't discriminate. We care for all families - nuclear families, extended families, rich families, poor families, gay families, sad families, and families of just one person.

The beauty of family medicine is that we put the patient in the centre of care and have a focus on the whole person, rather than on individual diseases.

In the words of Ian McWhinney, one of the giants of our profession who passed away last year, “The family doctor is committed to the person rather than to a particular body of knowledge, group of diseases, or special technique.”

Ian also advised us that, “ideally, family doctors should share the same habitat as their patients.” This allows us to best understand the social context of our patients’ lives.

While our clinics may be different from country to country, what is important is the way we are the same – through our commitment to comprehensive, continuing, coordinated whole person care. Through care that is person-centred, and family and community-oriented. Through first-contact care, acute care, chronic disease management, prevention and health promotion. And through our understanding of the interplay between population health and the health of individuals in our communities.

Karen Kinder has reminded us about the wonderful legacy of
Barbara Starfield, and how Barbara, through her research, provided us with the evidence of the benefits of primary care in lowering the cost of care, improving access to services, and reducing the inequities in a population’s health.

I last met with Barbara a few months before she died in 2011. Barbara was keen to talk about the biggest challenges she saw for family medicine in the future, and what WONCA, and what Michael Kidd as your incoming president, should be doing. I wrote it all down and here is Barbara’s last message for WONCA:

“Here are the three challenges I think you should focus on:
“How do we develop primary care research to address the challenges of care for people with comorbidities?
“How do we truly adopt patient-centredness into family medicine?
“How do we use the information from primary care to improve population health?”

There is enough in that simple statement for a dozen PhDs in family medicine. Barbara recognised the failure of guidelines to accommodate comorbidity and multimorbidity and the need to turn our evidence-base upside down.

Barbara recognised that primary care is person-focused, rather than disease-focused and that our health systems need to be reformed to focus on person-centred care and to embrace our greatest allies in family medicine – our patients.

And Barbara recognized the power of the information that we are starting to collect through digital means in primary care and how this can be used to improve population health? We need to build our own evidence base from primary care. And where do we get this evidence from? The answer is right in front of us. It is from our encounters with our patients. In the words of immediate past WONCA president, Rich Roberts, “If we want evidence-base practice, we need practice-based evidence.”

Research like this is critical to family medicine. We all appreciate that research is a core component of family medicine training, scholarship and clinical practice in all our nations. WONCA brings together some wonderful primary care researchers who put their heads together to provide solutions to some of the world’s greatest health challenges. This week, WONCA’s working party on research, led by Waris Qidwai from Pakistan, has drafted an excellent statement on the importance of research and research training in family medicine.

The potential of e-health, especially the aggregation of patient data from electronic medical records, is extraordinary. It will assist us in identifying the health care needs of populations and highlight those areas where we can work together to make improvements.
In the words of Sir Muir Gray, Chief Knowledge Officer for the National Health Service in the United Kingdom, “In the 19th century we needed clear clean water. In the 21st century, we need clear clean information.”

The paramount responsibility of WONCA, and of each of our member organisations, is to our patients and our communities. Family doctors, no matter where we work, ensure that health is affordable, safe, appropriate and equitable.

At a time of rapid change and social unrest and conflict in many parts of our world, family medicine provides comfort to our patients, our communities and our nations.

We can provide comfort because we are used to dealing with complexity and uncertainty.

We provide comfort at a time when uncertainty is increasing for our patients who are faced with a barrage of choices and options and a wealth of misinformation thanks to the Internet.

We provide comfort to our nations, which are facing uncertainty about their capacity to provide health care to all people and know that they should be keeping people out of expensive hospitals, but are not sure how to do this.

At this time of uncertainty about the future of health care, the role of the family doctor continues to grow. And this need for comfort moves our global organization into an increasingly strategic role with the World Health Organization and other global health organisations.

We can take on this role because we are familiar. People know who we are and what we do. Family doctors have been around for a long time.

The first family doctor to record his thoughts about medical practice and medical education was Hippocrates. We now recognise that Hippocrates was a genuine family doctor, sitting under a plane tree, seeing patients of all ages, treating all conditions, providing first point of contact as well as continuing and comprehensive care and recognizing the links between the physical, psychological, social and spiritual influences on his patients’ health and wellbeing.

Few of us get to practise medicine nowadays sitting under a plane tree, like Hippocrates, although you can still sit under the descendent of his tree on the Island of Cos. One of the things that unites us as family doctors is our differences. Each country has developed a system of primary care to meet the needs of its own population - as village healers, as apothecaries, as state funded community health providers, as country doctors, as hospital based primary care providers, as community-based family physicians, as general practitioners, as gate keepers to the rest of the health care system.

I believe this is the beginning of a new Golden Age for family medicine. This is a painting of the Golden Age by Lucas Carnach the Elder; perhaps you can see yourself here. In countries all around the world, the message is getting through about the importance of strong primary care and the role of family doctors in ensuring universal access to health care and equitable health care outcomes.

You know the many health care challenges our word is world is facing. It is becoming increasingly apparent that our generalist tradition of primary care is the only way that nations will be able to effectively tackle the diverse health challenges facing the people of our world. Indeed Dr Margaret Chan, the Director-General of the World Health Organisation spoke earlier this week about the renewed focus of the WHO and all its activities on primary care and family medicine.

Primary care is the key to the control of major communicable diseases — dreaded diseases like HIV, tuberculosis and malaria, and new and emerging diseases like SARS and new strains of influenza and other viruses. This is a remarkable time in human history with the ability to turn pandemics of infectious diseases like HIV, into controllable low-level endemic diseases but this will only happen through engagement with strong primary care.

Primary care is the only way we will be able to effectively fight the rise of non-communicable diseases in many nations, especially the rising rates of cardiovascular diseases, respiratory diseases and cancers as rates of smoking, obesity, poor nutrition and lack of physical activity continue to rise. Perhaps you have seen this movie?

Primary care is the only way that we will be able to effectively address the rapidly rising burden of mental health problems across the world.

Primary care is the only way nations will be able to effectively manage the health care needs of the increasing proportion of elderly people.

Primary care in the only way we will be able to effectively contain rising health care costs in our nations, through support for preventive care, health promotion and improvements in chronic disease management and the management of co-morbidities.

And primary care is the only way we will be able to meet the challenge of rising consumer expectations fuelled by the Internet.

If we are going to have strong primary care in each of our nations then we need strong family medicine. If we are going to effectively tackle these major healthcare challenges then our academies and colleges need to join together and share our knowledge and resources. This is a major role for WONCA. Bringing our member organisations together to share our knowledge and our experience to benefit the people in each of our nations.

As family doctors we are all specialists, whether or not our governments provide us with specialist recognition.

We are specialists in primary medical care and in the generalist tradition of medical practice.

We are specialists in preventive care and health promotion; in early diagnosis and management; in the management of undifferentiated illness, acute conditions, medical emergencies, and people with complex chronic diseases and multiple morbidities; in the management of mental health challenges and the impact of social and environmental issues on health; in palliative care and the ways to support our patients to die with dignity. And each of us is a specialist in the unique health care needs and concerns of our own unique patient populations. We are all specialists. Don't let anyone tell you otherwise.

To support our important work we need strong standards for clinical care and standards for education and training and we need strong government and community support.

Governments need to value our generalist traditions. Workforce arrangements need to support the generalist approach to high quality primary medical care.

What percentage of our medical graduates do we need to train in each country in the specialty of family medicine? If we are to meet the true health needs of our communities, in most of our countries it is likely to be at least 50% and probably more. You might like to reflect on the current percentage in your own country. Many nations continue to train large numbers of consultant specialists and sub-specialists way beyond their nation’s needs. We need more family doctors because we provide our health systems with a healthy dose of common sense. We can say, “What, really, we need 20% of our medical school graduates training to be cardiologists? I don’t think so.”

We also have an unbalanced distribution of our family doctor workforce around the world. What role can WONCA play in addressing the redistribution of our global workforce? How do we support family doctors who would like to spend part of their career working in other countries? How do we support and encourage family doctors to spend part of their career working in rural and remote locations? How do we support and encourage family doctors to spend part of their careers working with disadvantaged and vulnerable communities?

Should WONCA take on a role similar to Médecins Sans Frontières, Doctors Without Borders, not providing doctors to work in conflict zones, but providing skilled family doctors to work in areas of medical workforce crisis?

So why do I say that this is the start of a worldwide golden age for family medicine?

Well it is because in 2008 something extraordinary happened. The world rediscovered the importance of primary health care and the role of the people working providing primary care services to their local communities. Now I know that you probably didn’t realise that we needed to be rediscovered. After all we have been doing the work we had been doing for a very long time.

But in 2008 the World Health Report from the World Health Organization was devoted to the reinvigoration of primary health care.

The following year, at the Annual World Health Assembly of the WHO, a resolution was passed committing all the member nations to reinvigoration of their primary health care systems. This included recognition of the important roles of the members of each nation’s primary care workforce including mentioning, for the first time in a WHO resolution, the role of family doctors. Yes!

And on Tuesday this week, here in Prague, Dr Margaret Chan delivered her historic speech about the rising importance of family medicine.

A focus on primary health care by the WHO is nothing new. The 1978 Declaration of Alma Ata committed the nations of the world to strive to attain “Health for all by the year 2000” and recognised that strong “primary health care is the key to attaining this target.”

However the world failed to achieve health for all people by the Year 2000.

As a consequence, in 2000, the United Nations agreed to the Millennium Development Goals, the MDGs, eight goals with targets to be reached by 2015, eight goals “to free people from extreme poverty and multiple deprivations.”

Sadly progress in the health related MDGs, numbers 4, 5 and 6, is not as significant as we would like to see but we have seen millions of lives saved through reductions in preventable deaths.

Part of the problem with the MDGs is in their implementation. Often initiatives to support the MDGs in a country fail to engage with the existing primary care workforce.

This week I discussed with Dr Chan the challenges of meeting the polio eradication targets and how our members in Pakistan had commented on a lack of engagement with many of the family doctors and other primary care workers in the remaining endemic areas; doctors with the trust of the local populations who may be able to be part of assisting in the final moves towards global eradication.

The MDGs have also come in for some criticism because of what they are missing. They don’t tackle the need to strengthen primary care, or to tackle chronic disease and mental health, or to address the social determinants of health, or to ensure universal coverage for people in both rural and urban areas.

The global policy pendulum is now swinging back to a focus on universal coverage. And for good reasons.

Universal health coverage has been part of the charter of the United Nations since 1948. And universal coverage does not mean meeting the needs of 80% of the population – it means ensuring that health care is available to everybody.

People-centred care is a core component of universal health coverage, and there will be an increasing role for family medicine over the coming few years in many countries to ensure this happens.

As Dr Chan advised us on Tuesday, the United Nations is now starting the discussions about its focus following 2015 – the post-MDG era. Above the clamour of thousands of interest groups and self-interested industries, WONCA needs to ensure the clear voice of family medicine on behalf of our patients and communities is heard during these debates.

We need to be clear about our role in increasing life expectancy and achieving equitable outcomes.

And we need to support the focus on the social determinants of health and how we ensure marginalized populations are not excluded from health care.

Indeed, how do we support the de-marginalization of marginalized populations, those groups of people in our communities most at risk of poor health?

How do we meet the challenge of meeting the health and wellbeing needs of the many diverse communities around the world? We do so by continuing to adapt to changing health needs and expectations.

Fortunately one of the greatest strengths of the people working in family medicine is our diversity, our community leadership, our resilience and our unwavering commitment to our patients and our communities. These are qualities that we need to reinforce and cherish.

These are some of my family medicine colleagues in Central Australia, in Alice Springs. This week, in a historic move, WONCA has established a new working party on health issues for Indigenous people and minority groups, led by Tane Taylor from New Zealand.

This is the chart of life expectancy in the nations of the world – as you can see there is significant disparity in life expectancy based on the accident of where you are born. A difference of more than half a century. Two and a half times the life expectancy for one over the other, all based on the accident of where a child happens to be born. It’s 2013. We have to do better.

Family medicine, as a component of primary care, has the power to play a transformative role in the shaping of societies. We have the power to tackle this disparity and transform the world we live in but we’ve got a lot to do.

There are seven billion people on this planet. The WHO tells us that one billion have no access to any health care services.

In the words of equal justice advocate, Bryan Stevenson, in an inspiring presentation on TED:

“You judge the character of a society, not by how they treat the rich and the powerful and the privileged, but by how they treat the poor, the condemned, the incarcerated.”

This is one of the challenges for 21st century family medicine. How do we prepare our young doctors and our medical students to tackle these challenges of health inequity, of inequity of access to health care, of inequity of outcomes of health care, and ensure our health systems are socially accountable?

And how do we work together to ensure that high quality health care is available to all people in every nation of the world?

There are those who say that family medicine has no real role to play in low and middle-income countries. Well we have blown that theory out of the water. The new edition of the WONCA guidebook includes the chapter from the WHO showcasing the research into the impact family medicine is having in improving health outcomes in many middle income nations including Brazil, China, Thailand and countries of the Eastern Mediterranean region. And there is a chapter outlining the remarkable work that is underway across Africa to strengthen family medicine, especially involving WONCA member organisations within Africa supporting developments in neighbouring nations.

What these development demonstrate is the need to strengthen the whole health care workforce, including family doctors, community nurses, community health workers, and traditional birthing assistants, and support working together to deliver appropriate care to all people. People in low income countries still want and deserve access to health care, access to caring clinicians, access to life saving medications.

We also need to embrace the concept of reverse innovation. What can health systems in high-income countries learn from the health systems in lower income countries? It is something that each of who spends time working in another health system in another country learns very quickly.

It is also a lesson which was emphasised by another of our past WONCA presidents, Rajakumar from Malaysia who wrote that: “Experience in different health systems will make us better doctors and better human beings.”

It reminds me also of the wise words of past WONCA president, Dr Michael Boland from Ireland, who addressed the World Health Forum in 1995 on the question of what do people expect from their doctors. Michael said that people expect: A doctor who will listen, A doctor who is flexible, A doctor who will help sort out problems, and A doctor who will be there when I need her or him.

Dr Margaret Chan, in her meeting with the WONCA executive last year, spoke about the world’s post-2015 development agenda, and how even if the only focus is on universal coverage, the WHO will continue to have as its priorities, communicable diseases, noncommunicable diseases, health promotion throughout the life course, strengthening health systems, capacity to deal with outbreaks and emerging diseases, and healthy life expectancy.

And Dr Chan outlined how all this matches with the United Nation’s development agenda because development means economic growth, and health is a precondition to economic development.

But Dr Chan has also recognised that primary care is not cheap and must not be a “B-team” version of health care delivery.

But in order to provide universal coverage, we need to stem the costs of health care, and can do so through increasing our investment in community-based health services, and reducing the amount spent on hospitals. And at the same time there must be a movement of funding from hospitals to the community, rather then expecting more community-based care to be delivered with no increase in resources.

We need to work with our global partners, the WHO, the World Bank and others to bring high quality primary care to the 1 billion people on this planet who currently have no access to any health care at all.

The same model of care is not going to work for each community. Which is why family medicine is so important. We adapt to our community needs.

I want to share some thoughts on what drives doctors to work with marginalised communities. Some of the focus of my own research team’s recent activity has been on the pathways followed by family doctors who work with marginalised communities and what family doctors describe as motivating their initial engagement. These are interest and inspiration, community calling, and being in the right place at the tight time. The perceived rewards that support and sustain our continuing engagement include the motivation presented by the challenges, feeling that we are able to make a difference, and enhanced professional identity as a result of our meaningful work.

I have learned many things about family doctors as I have the opportunity to visit many of your countries and watch you at work. As family doctors, we all recognise that no one is perfect. We all have our flaws. We all make mistakes. This is part of being human. And because we have a deep understanding as family doctors about what it is to be human, we tend to be less judgmental than many of our peers. We don't tolerate stigma and discrimination. We accept people for who they are and we get on with our important work.

Many of our countries are responding to the global impact of health system reform that is shaking up the delivery of primary medical care around the world and this brings about challenges for the training of family doctors. Many countries have large numbers of general doctors who have received no postgraduate training but who wish to be recognized as specialist family doctors. We need to embrace all our colleagues in primary care. We need to find innovative ways that work in each of our countries to upskill and support the professional development of our peers. We can’t afford to disregard the contributions of all doctors working in primary care.

At the same time we need to develop greater clarity around how we educate our future family medicine workforce to ensure we meet the future health care needs of the people of our nation.

We need to better support our GP trainers and teaching practices and provide incentives and motivation for those who don’t teach at present to join us. After all teaching the next generation is a fundamental responsibility of each medical professional as part of our Hippocratic tradition.

It is clear that there are challenges to the enhanced apprenticeship model of family doctor training that has served many of our nations well, yet by its very nature the apprentice ends up cast in the mould of the master. It is a confronting reality for today’s family doctors that tomorrow's family doctors may look quite different to what we have all been used to. Family medicine trainers need the flexibility to train the next generation for some quite different roles. Family medicine training must allow our registrars to develop into what they need to be to best meet the future health care needs of their patients and their communities.

And the training we provide to our family medicine trainees must be based in primary care. Effective training for family medicine does not take place on the medical and surgical wards of hospitals. Our trainees are not fodder to carry out the menial tasks of other specialists. The training of our future family doctors needs to be based in our communities working as members of primary care teams.

These challenges are nothing new. Family medicine and family medicine training is always changing, although many of the fundamental underlying principles remain the same. WONCA’s education working party, led by Allyn Walsh from Canada, has this week released our new global standards for family medicine education, and I commend them to you.

This could also allow for more contemporary competencies to be added to the family doctor’s traditional skill set, for example skills in management, teaching, research, quality and safety, teamwork, e-health, leadership, personal resilience and personalised medicine. Better horizontal links must be established with other craft groups to strengthen interprofessional learning as family medicine moves increasingly more to team based care to better meet the complex needs of many of our patients and our communities. The WONCA working party on quality and safety, led by Daniel Thuraiappah from Malaysia, has this week drafted a statement, The Prague Statement, on the contemporary competencies in quality and safety in family medicine. It is an excellent document which we will share with you over coming months for your comments via the WONCA website.

We need to be flexible and acknowledge that there are multiple ways in which each new doctor can acquire the competencies required for safe, independent and appropriate family medicine.

And do not underestimate the opportunities for our medical students and family medicine trainees to make a difference to health care and to outcomes while they are students and trainees. The key is to give our learners enough space to be the amazing creative individuals they are.

The digital world also provides a lot of challenges. In our asynchronous world, how do we achieve continuity of care? But it will also bring benefits. We are starting to learn how teleconsultations can allow us to conduct home visits with our patients from a distance – we know the best way to understand our patients is through visiting them in their homes.

We need to embrace the opportunities provided by new technology. This is nothing to be afraid of. We are experts at adopting innovations into our practice and acting as translation agents for new technology. We are used to working quickly. We are used to change. We can accommodate innovation quickly when we see a direct benefit to the care of our patients.

Connectedness is important. We need to find ways to engage everyone in our global family. This week we launched WONCA’s new social media platform. I invite you to join me, through the WONCA website, on Twitter, Facebook and LinkedIn and discover new ways that we can work together to achieve our goals. Details are on our website: www.globalfamilydoctor.com

Something our chair, Iona Heath from the United Kingdom, said a few years ago really struck a chord with me, “I believe that general practice/family medicine is a force for good throughout the world.”

I am impressed with the commitment of family doctors to human rights issues. I am convinced that family doctors care about human rights. The basic expectations we all have about how we and our families and all people should be treated.

As family doctors we have social responsibilities. Each of us needs to be an advocate for social justice and human rights.

We need to stand up for freedom and justice and peace. 1.5 billion people live in countries affected by violent conflict with the associated terrible immediate and longer-term health outcomes.

We need to speak out for what is right, to say “this is not OK”, and in so doing contribute to social change.

We need to contribute towards ensuring equity of access to health care – “a fair go for everyone”

And we need to care for the health of our planet as well as the health of our patients. What is good for the climate is also good for our patient’s health – reducing obesity, increasing physical activity and healthy improvements in diet.

After all if we, as family doctors, with our privileged position in society, and our access to pretty much the entire population in our communities, don’t stand up for these things, who will?

Are you familiar with the term “a fair go”? It is an Australian expression meaning that we treat everyone equally. I want to be known as the WONCA president who called for a fair go for every person in this world.

And we have a great opportunity to do all this. We see the consequences of social inequality on the health of our patients and our communities. In the words of the German pathologist, Rudolf Virchow, who worked not far from here, doctors “are the natural attorneys of the poor, and social problems fall to a large extent within their jurisdiction.” These days this role falls to the family doctor. We understand the social determinants of health.

As family doctors we all work hard. I know that many of you work under very difficult conditions, that the resources that you need to do your job are often not available, that the hours you work and the demands on your time can be arduous, that your resilience is tested regularly. And we often feel unappreciated. And don't often hear the words thank you. It is why WONCA has established World Family Doctor Day, held on May 19 each year, to acknowledge the important work that we do.

So today, on behalf of the two billion people around the world who benefited from your care and support over the past year I say thank you. Thank you for your commitment to being a great family doctor.

And always remember, no matter what our governments do, our important work as family doctors will continue.

Never forget that we are privileged to work in family medicine and to work with our local communities. We are here to stay.

And never forget that through our work each of us makes a positive difference in the lives of our patients and our communities every single day.

Thank you all.

Michael Kidd
Prague
June 29, 2013