Abstract
In the public health service sector, chronic diseases are a serious economic and social burden, affecting individuals and entire communities. Chronic diseases increase the mortality rate and are a primary reason for the rising costs of medical care (WHO 2017, 2018). Great emphasis has been placed on the necessity for preventive measures and the promotion of health-related measures, which is a guide to chronic care improvement. These measures can slow down or even stop the process of chronic diseases. This cannot be completed without an interprofessional and community-based approach with focus on current and future needs of people within the community (Lionis et al., 2019; Kringos et al., 2013).
Rural lifestyles may be less comfortable than urban lifestyles, which may influence health-related quality of life. Both scientific studies and government programmes concerning health concentrate on health-related behaviours demonstrated by individuals and whole communities as primary fundamentals of prevention programmes (US Department of Health and Human Services, 2010). Positive health habits have been proven to postpone mobility problems or disability in later life (Liao et al., 2011). Reports show that we can delay death by increasing the number of healthy behaviours and reducing the number of detrimental or risky ones (Shaw and Agahi, 2012). Scientists predict that the average life span will decline unless the number of unhealthy behaviours is reduced. Residents of rural areas are being increasingly identified as people at risk of health disparities (US Department of Health and Human Services, 2010). Rural areas are characterised by higher unemployment and more severe poverty, as well as lower levels of education, and more difficult access to health and social services. Differences in health results of rural and urban dwellers can be caused by these factors. The research involving adult rural residents suggests the importance of abode for social epidemiology and public health concerns (Berke, 2010). Place of residence and geographical factors play a role in the assessment of health status, healthcare utilisation and health-service deficits, adequacy of health care and health-related behaviours. It has long been believed that where people live, work and relax either protects and promotes health or generates health hazards (European Commission, 2019). Summarising, the rural and remote communities are in urgent need of an interprofessional community-based approach aimed at health.
The purpose of this study by Widmer and colleagues was to describe how a pedagogical project, introducing students to ethnographic research, can initiate new ways of thinking for possible future health interventions in rural communities. An inductive approach based on ethnography was used during the fieldwork, including observations, interviews, focus groups and local documentation. The authors concluded that actions in rural health cannot be initiated without: promoting an interprofessional and interdisciplinary perspective and a culture of complexity and reflectivity; considering local populations in transition and not in a fixed homogenous situation; understanding more than imposing; taking into account local disease classification and local pragmatic solutions; considering the dialogue between bio-medicine and therapeutic pluralism; considering local perceptions and practices; considering care itineraries/pathways; and finally being conscious of their function.
I suggest the paper to everyone who is interested in public health and community-based interventions in countries with low capacity. Especially interesting is the historical background of the project showing the 20-year pathway from the creation by Dr Patrick Ouvrard (France) of a CME programme for general practitioners in Asia and Africa (Ouvrard et al., 2017) to a community-based project described in the article.
If you are primary-care clinicians, analyse the section about the pedagogical process and learning, and about two included dimensions with a focus on both an innovative interprofessional pedagogical experience and on a bottom-up approach for exploring health perceptions and practices among tribes in India. This is knowledge poorly explored during medical studies.
This qualitative project focuses on really interesting issues connected with multi-professional projects in rural and remote areas, emphasising the importance of: promoting an interprofessional/interdisciplinary perspective; a culture of complexity and reflectivity; the need for avoiding rigid categorisation of local populations and understanding more than imposing; taking into account local disease classification and local pragmatic solutions; considering the dialogue between bio-medicine and therapeutic pluralism; considering local perceptions and practices, care itineraries and pathways; having consciousness of our apostolic function.
The paper brings fresh perspectives for remote primary-care clinicians and leaves readers hoping that bottom-up and top-down initiatives can meet and build a community-based interprofessional team which will see to the current needs of people from rural and remote communities.