As part of health reforms announced in April 2009, China plans to expand and strengthen primary care (i.e., provision of first contact, person-focused, ongoing care over time, and coordinating care when people receive services from other providers). Other nations of Asia continue to grapple with how to promote population health and constrain healthcare spending. What is the evidence about the effectiveness of primary care in improving population health and making healthcare accessible and affordable?

In this talk, Dr. Starfield will speak about the robust evidence of the association between primary care and better health outcomes at lower cost; ways of measuring the effectiveness of primary care; how selected Asian countries compare in such rankings; and the broader implications of primary care research for health policy in Asia.

Dr. Starfield, a physician and health services researcher, is internationally known for her work in primary care; her books, Primary Care:  Concept, Evaluation, and Policy and Primary Care: Balancing Health Needs, Services, and Technology, are widely recognized as the seminal works in the field.  She has been instrumental in leading projects to develop important methodological tools, including the Primary Care Assessment Tool, the CHIP tools (to assess adolescent and child health status), and the Johns Hopkins Adjusted Clinical Groups (ACGs) for assessment of diagnosed morbidity burdens reflecting degrees of  co-morbidity.   She was the co-founder and first president of the International Society for Equity in Health, a scientific organization devoted to furthering knowledge about the determinants of inequity in health and ways to eliminate them.  Her work thus focuses on quality of care, health status assessment, primary care evaluation, and equity in health. She is a member of the Institute of Medicine and has been on its governing council, and has been a member ofthe National Committee on Vital and Health Statistics and many other government and professional committees and groups. She has a BA from Swarthmore College, an MD from the State University of New York, Downstate Medical Center, and an MPH from Johns Hopkins University School of Public Health.

Ambassador Sheinwald discusses how he envisages international relations will form in the near and far future. He places particular emphasis on the growing importance of the US-China relationship. At the same time, Ambassador Sheinwald explores the EU as a key global power and its necessary cooperation with the US.

Synopsis

Ambassador Sheinwald clearly feels that the international stage is moving. In fact, for him, the change in the international order is accelerating due to the global financial crisis. In this sense, Ambassador Sheinwald explains that the UK has long supported expanding decision-making international institutions such as the UN Security Council. However, the UK still sees the value in intimate, power-focused bodies such as the G8. Ambassador Sheinwald discusses the fact that there is increasingly a sense that a ‘G2’ is developing between the US and China. To Ambassador Sheinwald, this model would not literally work as he argues China needs, at this stage in its development, a multilateral setting to grow into the active and cooperative power we would all like to see it become. At the same time, Ambassador Sheinwald believes that the partnership between the US and China is important in paving a solution to the current economic state and shaping the future global economy. In fact, the UK and the EU welcome this new cooperation between the two powers. Ambassador Sheinwald feels the US and the EU can harness China’s shared global interest on issues such as climate change, in which the EU has played a front role, to develop at stable global relationship. Moreover, he believes that if the US and EU can cooperate to form low carbon economies, it could incentivize China and India to act similarly. However, Ambassador Sheinwald stresses that for non-economic issues the US and China’s relationship is still important but slow moving, and he expresses the belief that it will take decades for any real ‘G2’ to emerge.

In the meantime, Ambassador Sheinwald argues that while the US looks round the world for support on key issues, it will find that the EU shares the most values and has the capacity to promote them. He cites the enormous investments between the two in comparison to the US and China to show the scale of the US and the EU’s relationship. Ambassador Sheinwald argues that financially the US and EU need regulatory cooperation, using a scientific basis, to set global standards. He stresses as well that the EU is a major global power on its own. It is increasingly seen as an honest, multilateral broker and plays a crucial in global economic recovery. Moreover, it has strong interest in fighting world terrorism. In comparison to other partners, the US can find similar values, intelligence, and capacity in the EU. In addition, the US can see more stability in Europe’s own backyard than perhaps 20 years ago. Looking to the future, Ambassador Sheinwald hopes that the Lisbon Treaty would help the EU organize itself further. Further stressing the importance of the US-EU partnership, Ambassador Sheinwald explains “nothing is more likely to be as dependable a foundation.”

In taking the time to answer questions, Ambassador Sheinwald discusses a number of issues. One partiuclar area of focus much emphasized was Europe's role in the conflict in Afghanistan. In addition, he addresses the issue of Britain and the US's relationship with China. Moreover, he also explains that he hopes that as developed countries deal with increasing security threats, their resolve in keeping their borders open will remain strong. Finally, Ambassador Sheinwald stresses the need to employ methods of sustainable, intelligent, and low carbon growth.

About the Speaker

Nigel Sheinwald joined the British Diplomatic Service in 1976 and has served in Washington (twice), Brussels (twice) and Moscow and in a wide range of policy jobs in London. 

He took up his position as British Ambassador to the United States in October 2007.  In that role he leads the Embassy in Washington and nine Consulates-General around the United States.   He had an earlier posting to Washington in 1983-87 as First Secretary (Political) in the Embassy. 

Before becoming Ambassador in Washington, Sir Nigel served as Foreign Policy and Defence Adviser to the Prime Minister from 2003-2007.

Sir Nigel was the UK Ambassador and Permanent Representative to the European Union in Brussels from 2000-2003.  Before that he was Europe Director in the FCO (1998-2000).  He had an earlier posting in the UK Representation in 1993-95 as Head of its Political and Institutional Section.  He began his career in EU work as Deputy Head of the FCO's European Union Department in 1989-92. 

Sir Nigel's first foreign posting was in Moscow in 1978-79.  He was also Head of the Foreign Office's Anglo-Soviet Section in 1981-83.

Sir Nigel has had a wide variety of other appointments in the FCO in London.  From 1995-98, he was the FCO Press Secretary and Head of News Department.  He was Deputy Head of the Foreign Office's Policy Planning Staff in 1987-1989, responsible for transatlantic relations and other issues.  He also worked in London on the Japan Desk (1976-77) and on Zimbabwe (1979-81), including the Lancaster House Conference.

Sir Nigel was born in 1953 and educated at Harrow County Grammar School and Balliol College, Oxford.  He is married with three sons.

This event is jointly sponsored by the Office for International Visitors at the Bechtel International Center, the Forum on Contemporary Europe, and the British Consulate General in San Francisco.