Having a place at the oval table with the flags of the G7 countries was intimidating. Nevertheless, the cordial greetings from the delegates showed their receptivity as they trickled in to take their seats for the Second G7 Working group of Health Experts meeting.
ERPIC, the Emerging Researchers in Integrated Care, was invited to present at this G7 preliminary meeting as part of civil society. As the executive team member closest geographically and available, I had the honour of representing ERPIC.
The meeting took place in Paris, France at the Ministry of Solidarity and Health on Tuesday, April 16th. Youth involvement in the future of primary health care was the theme of the session, prompting the presence of four early career associations: Y7, the youth engagement group of the G7; Young Leaders for Health; ONE, the global forum for young leaders; and ERPIC. Delegates included not only chief medical officers of the G7 countries, but also international organizations such as OECD (Organisation for Economic Co-operation and Development), WHO (World Health Organization), The Global Fund, and U.S. Aid.
The French delegation began the session with welcoming addresses by the Ambassador for global health, Mrs. Stéphanie Seydoux; the Delegate for European and International affairs of the Ministry of Solidarity and Health, Mrs. Christiane Labalme; and the Director General of Health of the Ministry of Solidarity and Health, Mr. Jérome Salomon who chaired the session. Strengthening of primary care, gender equality, and creating a common culture incorporating LMICs were the key themes to develop through inclusivity, sustainability and taking into consideration life changes.
As civil society spokespersons, our colleagues from Y7 spoke first, followed by Young Leaders in Health, and ONE presented last after me. The three representatives urged the delegates to consider the provision of primary healthcare to all as a human right. They also requested that G7 sustain movements that are especially critical for new generations, such as climate change and migration.
I went to the G7 working group session with three specific goals: to explain who ERPIC are, to describe our vision and values as ERPIC, and to present models of integrating primary care that have been proven to be effective around the world.
The brief introduction outlined ERPIC as an international platform for collaboration and knowledge transfer through tools to promote networking and training in integrated care. As an example, our newly launched international Mentorship Program has matched emerging professional mentees from 13 countries to senior IFIC associate mentors from 7. I was most keen to highlight our fundamental guiding principles of inclusivity and leadership in promoting integrated care.
“The focus today is youth and the young. But some of us are not chronologically young.” As I said this, the room broke out in hearty laughter. “Yet we are young to integrated care or some of us even new to healthcare.” I continued. We of the ERPIC executive team chose the term emerging because we embrace a life course perspective, a sequence of social events and roles as opposed to a chronological approach. In fact, referring to gender equality and life transitions, points made by the
Ambassador and Ministers, emerging researchers and professionals include women on their second careers, like me. After life changes, such as motherhood, migration, and/or divorce, women may begin a new career or further their education to become part of the formal and informal carers of people with chronic and complex needs.
Additionally, climate change refugees and migrants who may not meet the language skills or qualifications of the new country, are also not only users of primary health and social care, but also join the workforce.
A report published in March of this year by the WHO entitled ‘Delivered by Women, Led by Men, an investigation of gender and equity in the global health and social workforce’, found that women make up 70% of the global workforce yet hold only 25% of senior roles. I used this as evidence for ERPIC’s drive to train leaders in integrated care, with a natural predilection toward women (in our Mentorship program mentees are 21 female, 5 male; mentors 19 female, 6 male).
Recent data of median ages of Italy’s, Japan’s, UK’s and US’ health and social care workers portray a middle-aged workforce. These data further supports ERPIC’s life course perspective. These are frontline workers, many in primary care, who are also emerging in the movement of integrating care, in what is traditionally a fragmented system. Professionals, organizations, sectors, disciplines, generations, nationalities, languages and levels need to collaborate, communicate and cooperate in order to strengthen primary health and social care.
This brought me to the final aim of my presentation. I wanted to remind the G7 health
experts how primary care can be integrated. As a first stop, primary care can act as a filter of needs. Following Leutz’s model of integration, the more complex an individual’s needs are, the more integrated the care system s/he will need. People with mild needs require a linked care system; moderate needs require a coordinated system; and complex and chronic needs require a fully integrated system. This filtering can lead people to receive the care they need, reducing redundancy and duplication, increasing prevention and early-intervention, thus improving cost efficiency and care quality.
Context based models of integrated care was the second example. Adopted from Glasby & Dickinson (2014), this model puts outcomes first (what do we want to achieve), evaluates the context (environment, structures, resources in place), and finally explores what processes are needed to attain those outcomes in that context. I offered my own PhD research in Central America as an example of setting outcomes based on context. Even in the same region, the same country, the same city, contexts can be strikingly different. I also described the Jigsaw project in Ireland, which integrated the youth mental health system through participatory action research involving adolescents and young adults.
We four presenters were applauded and thanked for advising on such important topics. The reactions of the delegates were positive, with the chair praising our enthusiasm. The Ambassador of Global Health stated that we are “very important spokespeople”. The OECD representative affirmed “we will take into account what you’ve said”. The Chief Medical Officer of Italy stated that having us at the session was “a great opportunity for dialogue with the future of healthcare”. “It is inspiring to have civil society [in the session]” was U.S. Aid’s comment. Representatives from Japan, Canada and UK echoed these comments.
Ultimately, this was a very important experience, on a personal level as well as for ERPIC. I feel proud to have sat at the table of global health experts and decision makers, and in awe of their enormous tasks. We of ERPIC see this event as an opportunity to grow our network and our collaborations, and to believe that our contributions help lead the movement of integrating health and social care.
Nereide Alhena Curreri is a Gerontologist and the Research & Development Lead for Emerging Researchers in Integrated Care (ERPIC). She is also currently researching integrated care for her PhD in Dementia Studies at the University of Stirling, UK.