Tiago Villanueva: Barbara Starfield’s legacy

Tiago_Villanueva Primary healthcare gurus can’t compete with the ranks of top film or sports stars in terms of global notoriety, but Barbara Starfield, who died earlier this month in California aged 78, was one of the most, if not the most, glistening star of the world of academic primary healthcare. She came as close to worldwide celebrity status as a primary health care academic gets.

A “paediatrician by training, a health services researcher by trade, and natural teacher by talent” very few can claim to be able to remain at the top of their game like Professor Starfield was at 78, and be known and cited by the general practice and primary health care community around the world.  A quick Google Scholar search of “Barbara Starfield” shows many of her articles and books had several hundreds of citations.

The global primary health care community publicised news of her death in hours through email, list servers, and Twitter,  ahead of mainstream media obituaries.

A Spanish colleague and friend who had worked very closely and published several articles with her emailed me news of her death in just under 12 hours.  Many professional and academic societies in the realm of general practice and primary care around the world followed suit. Medical journals around the world have published or are in the process of publishing obituaries and special feature articles about her. There is even a forum “to commemorate her life’s contributions and connect with other individuals who think similarly.”

Professor Starfield, who developed a long career at Johns Hopkins University, leaves a massive legacy. Much of the scientific basis for claiming that primary care matters a lot and that “national health care systems with strong primary care infrastructures have healthier populations, fewer health-related disparities and lower overall costs for health care” is the fruit of her work.

Due to the sheer weight of her legacy, it is expected that the current generation of doctors and researchers globally will continue to study, cite, and build on her work, and that several future generations will also be familiar with her work and admire her in pretty much the same way as William Osler, a former Johns Hopkins’ professor himself and dubbed by some as the “father of modern medicine” is still admired today because of his enormous contributions to the development of medical education and clinical medicine.

If you didn’t know who Barbara Starfield was, or you’re not familiar with her work and how influential it was, I suggest that you start by having a look at her article published in 2005 in the journal Millbank Quarterly and take it from there. It might change the way you think about healthcare.

Tiago Villanueva is a GP based in Portugal, and a former BMJ Clegg Scholar and Student BMJ editor.