Having A Primary Care Physician Can Offset Some Adverse Health Effects of Poverty

A primary care physician, one who establishes long-term personal relationships with patients and coordinates their care, can protect poorer patients from some of the adverse health effects of poverty. This protective effect has particular relevance in the United States, where social policy is not explicitly aimed at reducing either income inequalities or their adverse effects, as it is in many European countries. The study of this relationship, done by researchers at the Johns Hopkins School of Public Health, was the first to indicate that primary care by itself can ameliorate some of the adverse health effects of poverty. It appeared in the April 1999 issue of The Journal of Family Practice.

Author Barbara H. Starfield, MD, MPH, professor, Health Policy and Management, Johns Hopkins School of Public Health, said "In the absence of social policy that addresses income inequality, the promotion of access to primary care may serve to overcome some of the adverse impact of social inequality."

The researchers, who also included Leiyu Shi, DrPH, associate professor, Health Policy and Management, Johns Hopkins School of Public Health, analyzed 1990 data from a variety of sources, including the Census Bureau, the American Public Health Association, and the Centers for Disease Control and Prevention (CDC), to learn how such factors as income inequality, access to primary care, physician-to-population ratios, and smoking affect health outcomes. The scientists also included median household income, education, health insurance, minority status, poverty, cigarette smoking, and specialist physicians-to-population ratios.

The findings suggested that a lack of primary care physicians in a population serves as one way that income inequality can compromise health. Even controlling for the strong influence of socioeconomic (income inequality) and behavioral (smoking) determinants, having a primary care physician remained an important correlate of health outcome that was significantly associated with lower total mortality, lower death rates due to stroke, post-neonatal mortality, and longer life expectancy. The data also suggested that the higher the specialist-to-population ratio, the poorer the overall health of a population.

In spite of mounting evidence that the industrialized nations which promote primary care have healthier populations at lower overall health care costs, the United States continues to have a low proportion of physicians who are primary care generalists. Among western industrialized nations, the United States also has the widest gap in income between the affluent and the poor.

Support for this study was provided by the Bureau of Primary Health Care, HRSA, and the Department of Health and Human Services.