23RD WONCA Europe Conference

Mukesh Chawla

Advisor, Health, Nutrition & Population at the World Bank, Washington, USA


Evolving Family Medicine to Meet 21st Century Demands

We are living in times of greatest improvements in living standards and health in history of the world. Globally, over a billion people have been lifted out of poverty since 1990. Life expectancy has increased more in the last 50 years than the previous 1,000 years. Childhood deaths, maternal mortality, malaria and HIV deaths have halved since 1990. Closer home, Europe, with one-tenths of the world’s population, now controls more than one-thirds of the world’s wealth, and boasts over 3 million millionaires. Incomes in the European Union have risen over 350 percent in the last 50 years, taking average income per person to almost 300 percent of the world’s average. And a child born today in this region can expect to live seven to nine years more than her grandfather and ten to fifteen years more than children born in most other countries of the world.

Paradoxically, however, Europe’s health care systems aren’t feeling very well. Every day we hear of doctors threatening strikes to protest pay and conditions. Costs of individual drugs do come down, but any resulting gains are taken over by highly specialized medicines, for diseases like cancer, which are entering the market at sky-high prices. Governments are being forced to choose between the need to treat their citizens and the need to spend wisely, and no matter what they decide, one group or the other will remain unhappy. And in many countries, people head straight to the hospital when they’re feeling sick, which makes treating patients especially expensive.

At the same time, Europe’s population is getting older. By 2050, more than thirty percent or of the region’s population will be over 60. This translates to 4 out of every 5 visits to a doctor being that by a person over the age of 65. Add the pressure and costs of managing chronic diseases, and we are looking at mid-to-high double-figure percentages of income being spent on health.

This situation is not tenable. Something needs to be done, and urgently.

The practice of family medicine presents the most convincing and sustaining solution, and the burden falls on family doctors, who stand at the intersection of hope and despair as we move deeper into the 21st century. Three things must change. First, we must move from volume to value. Blame or bless science – but dealing with patients on counts of inputs and processes must give way to judging success by results. Second, we must move from information to intelligence. Information is merely data, which by itself is dry and does not include any context. Intelligence, on the other hand, is determining what that data means in the context – and then using it to act. Third, we must move to a health care system that is judged not only on how it treats patients but also on the richness of the experience it offers. This is especially important as we are living longer and spend more time worrying interacting with the health system than we did when we were younger.

This is the new role, the new responsibility and the new raison d’etre of the family doctor.


Mukesh Chawla, PhD, Adviser, Health, Nutrition and Population at the World Bank, and Coordinator, Pandemic Emergency Financing facility, has worked for over twenty years with governments and international development partners in Europe, Asia and Africa on a variety of health sector issues, including insurance solutions for global public goods, design and diffusion of complex innovations in health, identification of innovative business solutions to address systemic and process issues in the health sector, and economics of health. His current area of interest and responsibility is helping countries get better prepared to respond immediately and effectively to disease outbreaks that have the potential of assuming pandemic proportions. He has written extensively on the role of markets and market-like institutions in the creation of incentives that strengthen health systems, fiscal space for health, innovations in health financing, design of health sector reforms and economics of aging populations. Prior to joining the Bank, he held a research faculty position at Harvard University, Boston, USA. Before that, as member of the Indian Administrative Service in India, he held several key government positions between 1980 and 1998. He attended St. Stephen's College and Delhi School of Economics, Delhi, India, and Boston University, Boston, USA.


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