Perspectives in Primary Care features writing from practitioners, activists, and community members representing organizations, practices, and institutions across the United States and around the world.

Incarceration is a Public Health Crisis, During COVID-19 and Beyond

The COVID-19 pandemic has made American inequality painfully clear. As case counts continue to rise across the country, some of the largest COVID-19 clusters in the US are in jails, prisons, and detention centers. As of November 2020, 38 different institutions have reported greater than 1,000 cases. One study estimates that rates of COVID-19 in US prisons are

Diversifying the Healthcare Workforce is Key to Addressing Health Inequities

When we improve the health of the most marginalized, we improve the whole nation’s health. Brian Stevenson, Executive Director of the Equal Justice Initiative, noted in the American Public Health Association (APHA) 2020 Annual Meeting, “the health of our communities must not be judged on how well the powerful and privileged are doing, but by the health and well-being of the most vulnerable ...

Recommendations for Asymptomatic COVID-19 Testing Among Healthcare Personnel

As COVID-19 cases surge nationwide, routine and regular testing of asymptomatic people is being provided on an ad-hoc basis, without clear guidance from expert recommendations. In addition to personal protective equipment (PPE) and physical distancing, routine testing is being performed in many settings based on the observation that infected patients are contagious,

Tribal COVID-19 Response Among Indigenous Populations

The COVID-19 pandemic presents American Indian and Alaska Native communities with the biggest public health crisis since the 1918 influenza pandemic. Tribal communities have experienced many major pandemics since European contact, some unintentionally spread, and some, like smallpox, intentionally used to wipe out our people. Because of this shared history, tribal communities in the United States have taken a hard line to protect tribal members and reservation residents from COVID-19. At

Practice Optimization Amidst COVID-19: A Note from Our Patient Partner

The impacts of the COVID-19 pandemic continue to be felt across the United States, and this includes the ways in which we interact with the healthcare system. As the mother of a daughter with complex medical needs and a diabetic patient myself—what many would refer to as “super-users” of the medical system—we had to quickly adjust and adapt to the ways we’d need to manage our health conditions throughout the pandemic, as COVID has not stopped our need for ongoing care management. So, when I was asked to serve as faculty for the Harvard Medical School Center for Primary Care

Mobile Clinics: A Powerful Resource for Addressing Health Disparities

The COVID-19 pandemic has laid bare the systemic limitations of the American health system when confronted with the unexpected emergence of major disease, and underserved communities are often those most affected. A possible solution to address these disparities: mobile clinics. Mobile clinics are vehicles customized with medical equipment and staffed with medical providers and other health ...

Integrating Addiction Treatment in Primary Care: Training Needs and Novel Approaches

Addiction is a chronic medical condition that carries significantly elevated risk of morbidity and mortality, as the sequelae of substance use disorders (SUD) can be severe and life-altering. While evidence-based treatments for SUD exist, many people face barriers to accessing care. For example, of the approximately 20 million people living with addiction in the United States in 2019, only 12.2% received ...

Relational Organizing Key to Addressing the Political Determinants of Health & Health Equity

As the world has watched with bated breath, the 2020 United States presidential election has unfolded into a paradigm shift marked by apprehension and anticipation. The American people—more civically engaged and politically informed than ever before—have mobilized in a historic show of democratic involvement. As American communities from all walks of life have been galvanized, a single factor has risen to ...

Child Care and Early Education is a Social Determinant of Health—For Children and Adults

More than six months into the COVID-19 pandemic, child care solutions for families remain scarce. A high-stakes problem typically confined to parents with children younger than five, lack of child care has now become a near-universal challenge, with remote K-12 learning upending care infrastructure for families with school-aged children as well. Consistent failure to provide public funding to the child care and early education sector—both traditionally and in this moment of crisis—is taking a heavy toll:
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