Improving Equity Through Primary Care

Proceedings of the 2019 Toronto International Conference on Quality in Primary Care

Braden O'Neill, MD, DPhil, CCFP; Robert Ferrer, MD, MPH; Patricia O'Brien, RN, MScCH; Graham Watt, MD; Laura Gottlieb, MD, MPH; Andrew Pinto, MD, MSc, CCFP; Sara Willems, MPH, PhD, MHS; Jody Currie; Dawnmarie Harriott; Jonathan Leitch, MPH & TM; Alexander Zsager; Michael Kidd, MD; Tara Kiran, MD, MSc, CCFP


Ann Fam Med. 2020;18(4):364-369. 

In This Article


This conference brought together individuals passionate about the role of primary care in improving health equity and showcased innovative work across several countries. Several key themes emerged.

First, primary care plays a central role in addressing health equity through continuous relationships with patients over time and also through relationships with those delivering services in the health and social sectors. To do so effectively, primary care practices need to have the appropriate resources, that are proportional to patient population needs.

Second, primary care practitioners need to both be ambitious about the possibilities for the person in front of them in terms of improving and maintaining health as well as take a whole-population approach.

Third, team-based approaches are critical, especially those that include team members in the community, outside the walls of traditional clinics.

Fourth, people with lived experience of discrimination must be involved in generating solutions.

Finally, many participants discussed that truly addressing health inequities will require us to confront structural determinants including racism, capitalism, and colonialism.

Participants identified potential actions but also many unanswered research questions. More work is necessary to understand the "determinants of the determinants" of how societal factors impact health outcomes, and how to effectively go upstream beyond the social determinants of health to address the economic, political, and ethical determinants of health. A great number of examples were provided by conference presenters of promising interventions in their own settings. The evaluation and knowledge translation of effective interventions to other settings where appropriate was identified as a key research and quality improvement challenge.

As the world addresses the unprecedented challenge of mitigating the effects of COVID-19, deliberate efforts to work together across settings will be necessary. The current situation has shown that rather than being a great leveler, this global pandemic has exacerbated existing disparities.[19] There has never been a greater urgency to address inequity, not only to protect all of us from the most immediate threat but to ensure a better, more just, future.