Primary Care - First Line of Defence

n August 8, 2014, the World Health Organization (WHO) declared the Ebola outbreak in West Africa to be a public health emergency of international concern (WHO 2014b).This step helps to raise global awareness and mobilize resources to support outbreak management, reflecting the seriousness of the situation in affected countries and the strong need for an internationally coordinated response.At the time of the declaration, there were 961 deaths and 1,779 confirmed, probable or suspect cases in Guinea, Liberia, Nigeria and Sierra Leone (WHO 2014a).Without question, the outbreak is very serious and enormously difficult for the individuals, families and communities affected.A proactive and coordinated response is essential.While much of the media attention has been directed towards the Ebola virus itself, as Dr. Keiji Fukuda, Assistant Director General for Health Security, pointed out in his remarks at the press briefing held by WHO on the declaration: "... this outbreak really underscores the importance of having strong health systems.It is really the poster child for why those things are important, and they are not theoretical" (WHO 2014c).Likewise, the Ebola outbreak has reinforced the importance of broader social determinants of health, as well as raised questions about equity of access to care.Related challenges also affect health promotion and the management of many other health problems.More familiar, if less currently newsworthy, diseases have an even larger impact on morbidity and mortality, even in the countries most affected by the Ebola outbreak.For instance, the current outbreak began in Guinea in December 2013 (WHO 2014b).WHO reported an estimated 430 confirmed, probable or suspect deaths related to it as of August 26, 2014 (WHO 2014d).By comparison, the organization estimates that more than 10,000 people died of diarrhoeal diseases, 12,000 of perinatal conditions, 16,000 of malaria, 17,000 of respiratory infections and 19,000 of cardiovascular diseases in 2008, the latest year for which cause-of-death estimates are available (WHO 2011).Primary healthcare, the focus of this issue of the journal, is often the first port of call for both everyday and rare health problems.Authors cover a range of different policy questions, including efforts to address social determinants of health, new models of care and performance measurement.In this, our first issue of the tenth volume of Healthcare Policy / Politiques de Santé, we are delighted to add their findings to the broad range of research and policy debate that we have Primary Care -First Line of Defence

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