The revised European Definition of General Practice/Family Medicine. A pivotal role of One Health, Planetary Health and Sustainable Development Goals

Introduction

WONCA is the World Organisation of National Colleges and Academic Associations of General Practitioners/Family Physicians (GP/FP). The WONCA Europe Council is composed of representatives of member organisations – national colleges and academic associations of family medicine across Europe which brings together over 90K family doctors. Moreover, all are members of the general public.

At its plenary meeting in June 2023 in Brussels, the Council unanimously adopted an amendment to The European Definition of General Practice/Family Medicine [1]. This policy document is important for the entire community of European family physicians, as it informs the curriculum for GP training, continuing professional development, research and quality initiatives.

This editorial aims to discuss the scope of the latest revision amendment to the European Definition and to promote it among EJGP readers.

Changes in the 2023 Definition: Why?

The 2023 revision emphasises ‘three components,’ i.e. One Health, Planetary Health and Sustainable Development Goals (SDGs). One Health can be described as an integrated, unifying approach to balance and optimise the health of people, animals, and the environment [2]. Planetary Health is defined as the health of humans and the natural planetary systems on which that health depends such as good quality water, air and soil and these also impact food and energy systems [3]. Finally, the SDGs adopted by the United Nations in 2015 are a call for action by all countries to promote prosperity while protecting the planet. The SDGs ‘recognise that ending poverty must go hand-in-hand with strategies that build economic growth and address a range of social needs including education, health, social protection and job opportunities while tackling climate change, social health inequities and, environmental protection’ [4].

The common theme of these three separate components is the interdependency of human health on the overall health of the natural world. Human health and well-being depend on the natural environment, which provides humans with essential components for life such as clean water to drink, clean air to breathe, and healthy soil for food production and food security.

Our natural world, a stable climate and a healthy environment is vital for human populations’ physical and mental health. The climate crisis poses a risk to human health and well-being with increased risk of respiratory illness from air pollution from fossil fuels and wildfires, heat-induced illness, increased infectious diseases from waterborne illness from pollution or flooding, increased transmitted diseases from new migratory paths of insects such as mosquitos, malnourishment and dietary illness from food shortage and crop failures, increased risk of zoonotic diseases and future pandemics, and a rise in climate anxiety, to name but a few.

Human health cannot be packaged and prioritised as a separate part of the global system of functioning of the Earth because it must progress in harmony with the other components.

An update of the Definition: Why now?

The climate and biodiversity crisis is a health crisis. In the 2021 Special Report ‘The Health Argument for Climate Action,’ the WHO states, ‘Climate change is the single biggest health threat facing humanity’ [5]. Three months after the launch of the WONCA Europe 2023 Definition, over 200 health journals [1], including the European Journal of General Practice, coordinated to publish the same editorial at the same time, calling on the United Nations, political leaders and health professionals to recognise that the overall environmental crisis is now so severe as to be a global health emergency [6].

The COVID-19 pandemic has clearly shown that protecting and maintaining human health is closely related to the health of flora and fauna and the entire natural environment. Humanity paid a price for encroaching on the natural world, the lesson we learned cannot be underestimated. Only consolidated and multidisciplinary actions can reduce the future threats of diseases that are unknown to us.

Health and healthcare are impacted by climate change but we now know that healthcare itself has a significant environmental footprint through the production of healthcare and consumption of healthcare, estimated to be up to 5% of global human activities due to variation between countries [7].

Integration of components in the revised Definition

The 2023 update of the European Definition of General Practice/Family Medicine keeps the six core competencies, twelve characteristics and three additional features of GP/FM in the European Definition of GP/FM as they already encompass the concepts of planetary health, one health and sustainability. The revised document enhances their details and expands some for the new context. The named components of One Health, Planetary Health and SDGs receive a new, significant place in the 2023 Definition. Together, they create the bedrock of family medicine, allowing a new integrated approach to all the competencies, characteristics, and additional features essential in their application.

The three components are integrated because there cannot live healthy people on an unhealthy planet. The importance of those components and their mutual relations have been widely acknowledged, also in the community of family doctors [8–10]. Now, it is time for them to be reflected in this document which sets the priorities and future directions of clinical practice, education, and research in the field of family medicine.

What are the implications of the new Definition?

A primary goal of Family Doctors around the world is to provide continuity of care to protect, prolong and improve patients’ quality life in the community. When people seek help from their family doctor, it diverts the burden of care from other services. Family doctors assess peoples’ symptoms and health concerns at an early stage with the unique skills of a primary care physician, including prevention, diagnosing, advising, and/or treating acute and chronic health conditions. However, GPs/FPs worldwide need a new emphasis to improve the quality and safety of patient care in terms of planetary health. They are obliged to act as global citizens to help reduce the consumption of the earth’s finite resources, to reduce unnecessary clinical activity and waste of resources. Finding better ways to conserve and use the resources we access is quality improvement, which is a professional responsibility.

The notion of co-benefits for humans and the planet is important to share with our patients when planning clinical management. For example, we can improve the rational prescribing of antibiotics for acute illnesses and the quality of prescribing and de-prescribing for chronic conditions. We can negotiate shared decision-making on low-value care where the intervention, test, or action does not improve patient outcome or the overall risks are greater than the benefit [11]. We can better support patient self-management of chronic conditions. Healthier people need fewer interventions, tests, and referrals to high-intensity services. Motivating and supporting personal lifestyle behaviour changes to promote health and well-being of humans within their environment have significant gains for the planet as well as people [12,13].

Next steps: Adaptation, advocacy, and interdisciplinary action

The three new elements emphasise the need for holistic, interdisciplinary and multi-sectoral action for the health of people and the planet. The implementation of the new Definition into professional activities of family physicians across Europe is a challenge for WONCA Europe, all member organisations, network organisations and special interest groups (SIGs). It is also a challenge for every family doctor to implement and perhaps even above all, we think it is a moral and professional obligation of each of us.

European GPs/FPs need a solid scientific base with context to educate and communicate these concepts with patients. They also have a unique position as a role model for patients in leading a sustainable way of life. Family Medicine is at the heart of primary care for patients, and primary care is at the heart of the health system, so GP/FM has a strategic advocacy role into linking with other sectors at the community, regional and national levels, and with policy makers for health and environment [14].

At European governments’ level, the 2023 Seventh Ministerial Conference on Environment and Health launched a Declaration defining the future environment and health priorities and commitments for the WHO European Region, with a focus on ‘addressing the health dimensions of the triple environmental crisis of climate change, biodiversity loss and environmental pollution’ [15].

Neither the family doctor nor the health system alone is solely responsible for health outcomes; people and their families also have a role. Many other factors influence health outcomes, for example, the social determinants of health [16]. Moreover, health is just one factor among several important for the complex human experience of quality of life [17].

The 2023 revised Definition of GP/FM adapts One Health, Planetary Health and Sustainable Development Goals and embraces them in delivering the curriculum for GP training and GP continuing professional development. Each WONCA Europe Member Organisation may wish to consider this policy statement during their next curriculum review for medical education, training, and continuous professional development and adapt to their context and priorities (Figure 1). Shared learning between countries is vital, as we will all share the outcomes on this planet.

Figure 1. WONCA tree.

Disclosure statement

No potential conflict of interest was reported by the author(s).