Family medicine

It is 2021. The imperative to move health care services outside of hospitals is evident. Before the coronavirus disease 2019 (COVID-19) pandemic, Canadian media had switched its tune from “shorter surgical times” to demanding the end of “hallway medicine.” During the COVID-19 pandemic, the message is to keep patients safe at home and out of high-risk settings. With a greater focus on care received outside of the hospital, there is growing emphasis on the role played by communitybased care sectors and, in particular, family medicine. However, confusion remains around this sector, including terminology and the role it plays in keeping patients healthy in their communities. Clarity around terminology is essential to guide health system reform both in Canada and globally, and to ensure health system actors are using a single vocabulary. In this article, we clarify the distinctions between primary health care (PHC), primary care, and family medicine and highlight how family medicine is an adaptive and evolving field that meets the needs of patients and communities. Primary care is an essential component of a well-functioning PHC system. Family medicine is a subset of primary care delivered by family physicians. In 2019 we celebrated the 50th anniversary of Certification in Family Medicine. Despite being a field with a unique certification for more than 50 years, the distinctions between family medicine, primary care, and PHC are often blurred. The confusion in the language is evident given the recent statement released by the College of Family Physicians of Canada to protect family medicine terminology, given a trend where “family practice” and “family medicine” are being used outside of the field.1 Misunderstanding in terminology not only signals a lack of understanding of the different skill sets and roles of providers, but risks affecting how health care is organized and delivered. Family medicine is a unique field focused on delivering “high-quality, evidence-based care from family physicians trained to meet the health care needs of their patients and communities.”1 It is critical to the delivery of primary care and PHC in Canada and continues to evolve to meet the needs of our population. Globally, countries are introducing family medicine as a way of strengthening PHC. As this happens, researchers, educators, policy makers, and the family medicine community need to have a clear understanding of the distinctions and interrelationships between these 3 sectors. Primary health care The concept of PHC has been redefined repeatedly since the concept first emerged in 1920 in the Dawson report, where PHC was identified as the first level of care, “equipped for services of curative and preventive medicine.”2 In 1978, the World Health Organization (WHO) formalized its commitment to PHC globally. It defined PHC as “essential health care made universally accessible to individuals and families in the community by means acceptable to them through their full participation.”3 Essential health care was meant to include health promotion, disease prevention, and curative, rehabilitative, and supportive care. The WHO further identified PHC as the key to achieving “health for all” through the Declaration of Alma-Ata.4 While the Declaration of Alma-Ata led to an agreement on the importance of PHC, it did not define how to operationalize this commitment. In 2018, 40 years after the Declaration of Alma-Ata, global partners reconvened at the Global Conference on Primary Health Care not only to renew their pledge to PHC through the Declaration of Astana but also to agree on a single operational definition of PHC (Box 1).5 The Declaration of Astana provides us with a complete and precise definition of what PHC encompasses and the various ways to strengthen PHC. Family medicine is at the core of item 1.6,7