noralou roos

winnipeg canada 10/04/2011 02:50:43 PM

Barbara was a special lady -- always strong opinions - based in thoughtful review of the research - and always willing to step in when asked.

She will be missed by many and I'm part of the crowd.

Eva Cohen

Berkeley, CA 10/04/2011 03:06:24 PM

Barbara was my mother-in-law. In addition to her incredible worldwide accomplishments, she was an amazing grandmother to all of her grandchildren. I've never seen anyone listen to and absorb every word and subject a child brought up with such engagement. She took her grandchildren on far away trips. Even while she carried her passion for her work with her wherever she went, she made a huge amount of time for her family and was completely present with her children and grandchildren whenever around. They and we have learned and gained so much from her. Her deep and lasting influence makes it feel as if she is still here. She lives on through all of us!

Walter Tsou

Philadelphia 10/04/2011 03:11:31 PM

Dr. Starfield (I still call her that) was my MPH advisor. How lucky of me! She was a great supporter of my academic work at Hopkins and I was an admirer and fan of hers from the moment I had a chance to meet her. Her interest in primary care, access to care and a better health care system has guided me in my post Hopkins life to this day.

I was blessed to see her once at the Giant supermarket in Baltimore and we chatted. She was a truly down to earth, remarkable woman and an international health policy professor. She remained consistent in her devotion to primary care which has never had a greater champion. She will be missed.

JOSE MARIA PAGANINI

City Bell, Argentina 10/04/2011 04:35:16 PM

I met Barbara in 1966. For almost 45 years we shared educational and equity projects. She traveled to Argentina several times. For me and my family it was a privilege to know her. An extraordinary human being.

Gustavo Gusso

Brazil 10/04/2011 05:48:40 PM

Barbara Starfield was probably the most important intelectual influence on the Brazilian health system in the last ten years. Her work helped us to develop the system toward more equity and comprehensive care. I hope we can continue her job. Her publications will guide generations.

Fran Baum

Adelaide, Australia 10/04/2011 07:58:10 PM

Our team worked with Barbara in planning the ISEqH conference that was held in Adelaide in 2006. Her depth of commitment to the pursuit of equity was evident throughout the planning process for the conference. On one occasion she was flying from Perth to US and stopped by with us for 24 hours - demonstrating the amazing energy and commitment she brought to her work. Barbara was also very encourgaing of my work when I preented at the ISEqH conference in Durban. All in all she has been a great inspiration to our movement for equity in Australia and globally - may she rest in peace knowing that the world is a better place for her life's work!

Ali Tawfik-Shukor

Toronto, Canada 10/04/2011 09:10:10 PM

My heartfelt condolences to all those who loved and respected Prof. Starfield. During my PhD, she kindled in me a fire for knowledge and truth, and always encouraged me to challenge entrenched assumptions through deep and honest self-reflection. As an advisor, she was always generous and incredibly timely in response. The philosophical underpinnings of her work in primary care deeply influenced, and enriched my understanding of life.

She challenged others to lead socially useful lives, guided by principles of honesty, humility, reciprocity and love. She is, and always will be, dearly missed.

Donald Li President WONCA Asia Pacific Region

Hong Kong 10/05/2011 10:08:13 AM

The President, Officers and council of the Asia Pacific mourn the passing of Professor Barbara Starfield. In our mind, the greatest advocate, icon and leader of family medicine. It is indeed a great loss and we are all saddened by the news.

Barbara was the most respected teacher of family medicine and is well known in the region. She has relentlessly offered assistance to many developing regions as well as encouraged the advancement of family medicine in developed regions. The Primary Care Assessment Tools which is now being adapted to many different languages and interpretation in Asia Pacific is just one of the many initiatives of this monumental leader. She was a genuinely kind individual with all the characteristics of a caring loving family doctor. She will always remain in our hearts.

The best way to honor her is carry on the advocacy of continuing to promote family medicine and practice as a good family doctor.

Our thoughts and prayers are with the family of Barbara and we send our heartfelt sympathy.

Tim, Tai-Yuan Chiu M.D., M.H.S.

Taiwan 10/05/2011 12:43:20 PM

The Taiwan Association of Family Medicine (TAFM), deeply and earnestly laments the passing away of Dr. Barbara Starfield, which took place while swimming in a pool at her place of residence in California, on June 10, 2011.

Professor Starfield was an accomplished and vigorous researcher for a strong primary care system in the U.S. and worldwide. Her work led to the development of important methodological tools for assessing diagnosed morbidity burden, including the Adjusted Clinical Groups® (ACG®) System, the Primary Care Assessment Tools.

Professor Starfield was greatly admired as researcher, teacher and mentor to many colleagues, friends and students around the world. Among her many accomplishments, Starfield was the co-founder and first President of the International Society for Equity in Health, a scientific society devoted to contributing knowledge to assist in the accomplishment of equity in the distribution of health. She served on many government and professional committees. Recently, the Johns Hopkins Bloomberg School of Public Health has partnered with the World Organization of Family Doctors (WONCA) to develop information systems to document the health needs of patients and populations in a way to encourage more effective and more efficient primary care-oriented health systems as the result of her endeavor.

On behalf of the Taiwan Association of Family Medicine, We will honor the giant through the continuation of her work for Equity in Health to reach the balance between health demands, services and technology for which she has zestfully devoted all her life to fight for. We express our deepest condolences to her husband, her four children, eight grandchildren, her extended family, and her professional family.

May she rest in peace.

Tony Mathie

Europe 10/05/2011 12:47:45 PM

For several decades Barbara Starfield has researched the relationship between health care characteristics and health outcomes demonstrating again and again the effectiveness of a well organised primary care with strong family doctors.

She has travelled to numerous places to tell that story to family doctors and governments. She demonstrated that in countries with such a well organised primary care people live longer, are healthier and there is more equity then in systems which rely on secondary hospital care.

She made many friends all around the world as she would come to assist whenever asked, and would deliver her message in a inspiring way. She would challenge both the doubtful and the believers to invest in the future.

We have to be grateful for her inspiration which will serve as a beacon for our continuous efforts to provide a family doctor for every family in the world to serve the people in the best way they can.

Our deepest sympathies go out to her husband, her children, grandchildren, and her family.

She will always be remembered.

Nilson do Rosário Costa

Rio de Janeiro - Brazil 10/05/2011 04:58:05 PM

The intellectual work of Barbara Starfield played a key role in the development of primary care in Brazil. Her vision of health care has contributed to the scientific legitimacy of the Family Health Strategy. Her thinking has been a symbolic and practical tool for action in favor of the universalist agenda. Advocates of public health will continue to read her work with enthusiasm.

Nicholas Zwar

Sydney, Australia 10/05/2011 05:04:48 PM

This is a great loss. Barbara was a giant of the field.

Grant Russell

Australia 10/05/2011 05:07:05 PM

So sad. An ornament, an inspiration, and a light on the hill to so many. Rest in piece Barbara.

Adolfo Rubinstein

Argentina 10/05/2011 05:09:13 PM

I am so sorry. Barbara contributed enormously to the development and setting of PHC in Latin America. For many of us in the region, her brightness, persistence, focus and endurance was inspiring and highly influential. It will be hard not to see our beloved little grandma around, in meetings, conferences or over the mail. It is a great loss for our cause

Thomas O'Dowd

Dublin, Ireland 10/05/2011 05:11:19 PM

Barbara Starfield's work helped those of us in primary care to make good arguments in systems dominated by secondary care. When we had the AUDGP annual scientific meeting her in Trinity College Dublin in 1998 she was our keynote speaker and stayed on to get to know a bit about our country and its healthcare.

Albert Lee

Hong Kong 10/05/2011 05:13:38 PM

If there is a Nobel Prize for Primary Care, Barbara should be the recipient. We will loose a great friend and champion for primary care.

Julian Herreja

Cali, Colombia 10/05/2011 05:16:02 PM

Dr. Starfield contributed enormously to the development of family medicine.

Trisha Greenhalgh

London, UK 10/05/2011 05:20:00 PM

It was a privilege to know Barbara. She set the foundations of a programme of work which has kept (and will keep) us all busy for all our professional lives in all our different countries and settings.

Larry A. Green

London, UK 10/05/2011 05:23:16 PM

The immediate words of regret and praise from all corners of the globe in response to your posting confirms her stunning impact and the warm regard with which Barbara is held, worldwide. I will forever remember and thank her for a single slide of hers that summarized so much of her life’s work: “Primary Care is Medicine’s way of improving population health and relieving disparities, while containing costs—and NO STUDY SHOWS OTHERWISE.” In many settings in many locations, often amidst a crowd unfriendly toward primary care, I have cited her with this claim and invited refutation. To date, there has been no refutation. What a life, what impact, what a woman!

Per Hjortdahl

University of Oslo, Norway 10/05/2011 05:25:14 PM

Most people understand basic elements of primary care, very few understand it all. Barbara did. I, as many of us, just lost a personal friend. Primary care, general practice, family medicine, health care in general lost one of our great thinkers and doers. Thank you Barbara for what you have given us.

Andy Haines

London, UK 10/05/2011 05:28:06 PM

Barbara was a towering figure in primary care research worldwide and she leaves a lasting legacy of research which will benefit generations of patients. I saw her in Cebu earlier this year at the WONCA Asia Pacific conference and she was in great form, generously sharing her insights from a long and productive lifetime of research. We all the poorer for her passing.

The International Journal for Equity in Health

London, UK 10/05/2011 05:42:35 PM

Professor Starfield’s recent editorial conveys the themes she has promoted uncompromisingly throughout her career - equity in health and health care, person focused view of morbidity, and the central role of primary care providers [Starfield B. The hidden inequity in health care. International Journal for Equity in Health.10(1):15.]

A "whole-patient oriented" view of disease is more accurate than a disease oriented view. It is also more equitable. Diseases are more likely to occur and to be more serious in socially disadvantaged people... Only a person-focused (rather than a disease-focused) view of morbidity, in which multiple illnesses interact in myriad ways, can accurately depict the much greater impact of illness among socially disadvantaged people and the nature of the interventions that are required to adequately manage the increased vulnerability to and interactions among diseases.

A decade ago Barbara wrote what we, researchers in the field of health equity can strive to follow:

“The subject of the causation of inequities in health is clearly complex, but it is amenable to scientific study. The many issues concerning the nature of the pathways in different population groups, in different cohorts, and indifferent historical time periods are only some of the many challenges. We need good scientific research on the nature of the pathways and their consistency and variability ; on the best ways to specify the variables that represent the various types of characteristics in the theoretical models ; on the relative influence and mechanisms of effect of various types of interventions to reduce the effects on ill health and, perhaps, even improve the health of populations ; and on the special challenges posed by vulnerable population groups, such as children and adolescents, women and especially pregnant women, and racial and ethnic minorities. The development and application of statistical techniques that elucidate mechanisms rather than describe them are also a high priority, as are collaborative efforts across political jurisdictions and countries to improve the generalizability of research results and policy applications.” [Starfield B. Is equity a scientific issue? West J Med. [Editorial Material]. 2000 Jul;173(1):7]

The editorial team mourns Barbara's lost, and offers condolences to her family and friends everywhere.

Efrat Shadmi

Haifa University, Israel 10/05/2011 05:50:18 PM

Ten years ago, during my doctoral studies, I was looking for a way to summarize the number of chronic conditions in a dataset I was using. I consulted with several of my professors at the department of Health Policy and Management, deliberating on issues such as which disease 'qualifies' as chronic and what time frame to establish 'chronicity' should I use.

I was certainly not prepared for Prof. Starfield's response. Barbara's reply was that we should challenge the classification of conditions as chronic or acute and that we should invest in thinking of whether such a classification is useful for our understanding of health conditions, their manifestation, and the care they require.

I surely didn't understand what she was talking about at that time. It took about 6-7 years for the seed that Barbara planted to sprout. As I engaged in more research on health conditions and their distribution in populations, I begun to grasp how a 'chronic disease classification' can mislead policy and health services research.

Today, I try to challenge my own students with these thoughts, beginning my class with Barbara's statement that 'there are no 'acute' conditions'. It is a great loss that these conversations can no longer be conducted with Barbara. Her greatness is that she planted many seeds and stimulated the thoughts of many, her ideas can continue to evolve.

Gustavo Silva Paredes

Perú 10/06/2011 03:17:32 AM

I had the opportunity to talk with Dr. Barbara Starfield in March 2011, thanks to the opportunity given to us by Dr. Juan Gérvas. We talked and it was a very rich conversation. The best tribute is to keep her work alive.

Diederik Aarendonk

The Netherlands 10/06/2011 11:43:50 AM

The loss of a great woman, who spent her entire life working as a professor specializing in Primary Care. We were proud to have her presence at our last biannual conference in Pisa, 2010. She definitely enjoyed her stay and the company of the Europeans and was making plans to return to the Toscane region with her grandchildren. I was impressed by her energy and lots of EFPC members took the opportunity to have a short talk with her to get more acquainted. Now others will have to take over her role in fighting for more equity within health care and to stress the importance of investing in Primary Care. Together with linked networks the EFPC will make sure that this heritage will be secured and will be pushed further with even more energy than Prof. Starfield spent on this important issue in the past decades.

The Johns Hopkins Primary Health Care Policy Center

Baltimore, MD 10/07/2011 10:00:39 AM

Please see the tribute to Dr. Starfield from the Johns Hopkins Primary Care Policy Center at http://www.jhsph.edu/pcpc/Barbara_Starfield

DAN HAWKINS

Washington, DC 10/07/2011 01:54:01 PM

The many millions of good souls who strive to furnish primary health care – and especially those who serve the vulnerable and disenfranchised – may have only faintly heard of Barbara Starfield and her work, but they have all felt her enormous influence on their everyday work. Barbara was and remains a towering authority whose lifetime of work have improved both the quality and the availability of care for all, and in particular those most in need. She will be sorely missed.

Maria José Fernández de Sanmamed y Luis Rajmil

Barcelona, Spain 10/10/2011 08:40:04 AM

We will miss Barbara Starfield in many places worldwide, because she has defended Primary Care and equity in health. She has published with authors from several countries, and has established personal friendships with them. This is the way many of us have inherited her teachings and proposals, and it will be up to us to sustain the project which she believed in, and that we will keep developing continuously.

People who knew her personally were surprised that behind a fragile, simple and sweet appearance hid such a lucid professional, able to create theoretical frameworks that are currently still irreplaceable. It also astonished us that a person so wise and influential was so accessible and open to the views of others. She had a way of doing and being that only extraordinary people know how to transmit. Barbara Starfield also influenced in her environment and the people who met her due to her personal qualities, generosity, attitude and defense of her ethical values.

Her several visits to Barcelona were always important events, and also a perfect excuse to meet up with her friends and share special moments that were created wherever she was.

Primary care and Barbara's friends are in mourning because we have lost a wise and good woman. However, she is survived by her work. A bit of us has gone with her, but much of it will be here forever.

Sheldon G Weeks

Tlokweng, Botswana 10/12/2011 01:27:44 PM

From our student days together at Swarthmore in the early 1950s to sporadic contact over the years and more recently a visit to Botswana a few years ago, Barbara has remained a steadfast friend. She will hold us in the light and remain a beacon to follow.

Pan American Health Organization

Washington, D.C. 10/13/2011 12:00:56 PM

Barbara was a great friend of PAHO/WHO and, thus, her passing is all the more painful. I must mention her enormous contribution to the PAHO/WHO Working Group on Primary Health Care, which she co-chaired along with Dr. Carissa Etienne. This Working Group prepared the PAHO/WHO position paper on Primary Health Care and collaborated in drafting the 2005 Declaration of Montevideo on the renewal of Primary Health Care.

Barbara’s extraordinary collaboration with PAHO did not end there; it continued until just a month before her departure, when she collaborated with us on a study on Primary Health Care in the Americas, especially in the Caribbean countries. She was the keynote speaker at the launching of this project in Barbados this past May.

Barbara’s passing is, without a doubt, a loss for the public health and equity community, and for those who firmly believe in the universal call to achieve HEALTH FOR ALL. In this the Americas’ house of health, we feel her presence and weep for her premature and unexpected departure.

Mirta Roses Director

Please see PAHO/WHO Memorial at: http://new.paho.org/hq/index.php?option=com_content&task=view&id=5629&Itemid=1926

Debora Tajer

Buenos Aires 10/14/2011 10:10:11 AM

Barbara was a wonderful example of a commitment to public health that is connected to peoples' needs. An excellent human being and a leader for us women in these areas. My warmest regards to her family.

Claudia Travassos

Brazil 10/16/2011 02:45:38 PM

Barbara was a very gentle person. Her contributions to public health are incommensurable, but my memories are of her leadership in putting equity and social justice into health and the healthcare agenda. Her inspirations will last with all of us. I send my regards to her family.

Merle Ann and Stan Siegelman

Baltimore, MD 10/17/2011 02:27:58 PM

Barbara,

I am blessed to have shared your friendship for 50 years, ever since your son Jon and my Jon entered kindergarten together, having been born 1 day apart.

Your dedication to spreading the word on Primary Care around the world with your energetic and peripatetic existence, combined with a loving devotion to family, maintaining 4 homes to be near your children and grandchildren, was amazing. My heart goes out to them upon this dreadful loss.

We are grateful that you and Neil/Tony Holtzman, your husband of nearly 56 years, maintained close ties with us even when you left Baltimore. Barbara, you are greatly missed now and will be in our thoughts always. Thank you for being you, a fine friend and an example to all!

Supasit Pannarunothai

Phitsanulok, Thailand 10/18/2011 08:42:24 AM

Barbara was so kind to me, to Naresuan University and to Thailand. She visited us and encouraged all our PhD students to undertake research on primary care systems to support Thailand's health care reforms to achieve better quality primary care and equity in health. She even asked me whether I was happy playing the role of dean of a medical school. What’s more challenging is to follow her efforts in moving Thailand’s health systems to be more efficient and equitable through good quality primary care systems.

Silvina Berra

Córdoba, Argentina 10/18/2011 09:29:48 AM

The unfortunate news of the death of Barbara was surprising and unexpected because she was working in meetings until few weeks before, giving support to all anywhere, and writing her ideas and guidance until her last day. We lost a brilliant mind, a critical and timely view on health services and equity, a woman of inexhaustible vocation, a sweet person. However, she will be ever present because she left a huge legacy in lectures, articles, forums and thousands of letters and responses even to modest researchers like me. Now it seems a dream to have collaborated with her, a teacher worried about our lives as much as our careers and objectives. I was fortunately working close her during the last year, and the most amazing fact I realized was the construction and support of a large network of researchers, healthcare professionals and policymakers around the world. Those are some of the reasons because it is not surprising the number of people feeling the challenge and the conviction of continuing her ideas and projects.

JOSEFINA CAMINAL

Barcelona, Spain 10/18/2011 10:34:07 AM

Barbara Starfield, "Field of Stars", we miss you and it will take time to get used to not having you near.

All the stories shared during your life will bring to mind your presence. A piano concert, an academic activity, a starry night, a simple but delicious meal, a nature walk, an intimate conversation...always sensitive, always present, always cheerful, always thoughtful... Thank you Barbara for sharing your life with us.

Barbara reminds us that life should be lived intensely, joyfully, it should be shared and engaged. She has been a seed of peace and happiness for the world. Now, is up to us to continue extending her message of peace as a way of being in the world.

One embrace ad infinitum.

Ann S. O'Malley

Center for Studying Health System Change 10/18/2011 02:03:04 PM

Barbara's contribution to primary care conceptualization is unparalleled. Her work has had an enormous impact on health care delivery across the world. When it came to casual conversation, I never knew quite what she'd say, but I knew it would be direct. She was always supportive. I won't forget her strolling the halls of Hopkins in her purple hat. You will be missed Barbara!

RANDY BARKER

BALTIMORE 10/19/2011 01:08:33 PM

Following yesterday's moving memorial, I savoured memories of Barbara at a number of stops along my way. I too am a Johns Hopkins "lifer", dating my career here from July 1968 when I joined the RWJ Clinical Scholars Program. That program brought residents training at Baltimore City Hospital together with the memorable faculty in the SPH Dept of Medical Care and hospitals, meaning that I and my fellow clinical scholars met Barbara early on. The exuberance prompting, and clarity that she extended to us is unforgettable.

In 1979, we re-connected as she helped, as a member of our planning committee, to compose and submit the HRSA training grant that brought to JHUSOM a residency programs in Primary Care Internal Medicine and Pediatrics, based at BCH. Yes, Hopkins committed to the formation of future primary care physicians! The PCIM program flourishes to this day, deeply rooted in the model of Primary Care that Barbara was putting on the map when we first met. What energy and fun went into the process of getting our program going...and how we valued access to the monster copying machine in Sam Shapiro's dept when at midnight before the grant due date, we used it to make 12 copies of that monster grant. The first study of that residency, on which I was co-author with Barbara, used her savvy method for measuring coordination of care in a continuity practice.

In 1995, I encountered Barbara's presence in the friendship she and Tony had developed with Juan Gervas, GP and over the top enthusiast from Madrid. That friendship became a shared friendship during a one year sabbatical in Spain where I did faculty development with GP tutors in Spain's primary care health centers, which , as noted by Vicente Navarro, were designed to embrace Barbara's model of primary care. Juan Gervas by then had launched a home grown network of primary care scholars who were generating studies that used Barbara's savvy methods for measuring continuity, coordination, comprehensiveness and access. Whenever I was together with Juan, Barbara was ever present in our minds.

Yesterday at our division's monthly faculty meeting we were pondering the future of primary care residency training, and for a moment we stopped to acknowledge, with professional love, the enormous gift that Barbara has made and continues to make to the mission we treasure.

Greg Stevens

Los Angeles, California 12/22/2011 07:02:17 PM

I’ll never forget meeting and working with Barbara. Within 24 hours of being accepted into the doctoral program at Hopkins in 1997 , I received an exciting call from her inviting me to become one of her trainees in primary care. I readily accepted, but without any idea of what was to come…

She was an immediate mentor, which included both incredible support (helping me to navigate a delicate switch of doctoral advisors and introducing me to Leiyu Shi, who is one of the greatest advisors one could ask for) and brutal criticism (telling me I could not get up to speed quick enough to write a meaningful dissertation on an early favorite topic). Walking into Barbara’s office was equally welcoming and terrifying.

Visiting her often required a short wait with Ruth Hurd, her wonderful assistant at the time. And Barbara would always make herself available and would always join you at a chair rather than speak to you from behind her desk. This was her effort to make the playing field seem level, even though there was clearly no such thing. My doctoral student nerves, however, appreciated this small gesture.

And her office screamed knowledge. Books and papers held up the walls and ceiling of her office, and it was only after a couple years that I realized she had a table in the middle of her room, since it had been completely hidden by stacks of paper. It was daunting to know that she had likely read, critiqued or written most of these items herself. When she had a recommendation of a report for you to read, it would undoubtedly be sandwhiched between the top of one of her shelves and the ceiling.

To celebrate my dissertation defense, we planned a dinner with friends and my parents, and I extended an invitation to Barbara and the rest of my committee. I never expected in a million years that she would come, but she and her husband showed up early, brought a bottle of champagne and stayed until very late to chat. It was at this dinner, four years after first meeting her, that I finally felt like I knew her just a little.

And like all those who have written here, her thinking still drives my work today. While I will never come even remotely close to her rigor and intellectual contributions, I would like her to know that I at least carry on her small tradition of sitting as equal partners with my students and, because of her, will always show up to celebrate their successes.

You’re very missed, Barbara…

Barry Pless

Montreal (retired) 12/29/2011 06:12:33 PM

Barb and I were good friends and worked together in the sixties when paediatric epidemiology was just getting off the ground. We wrote several papers together and these were labours of love because we did not always agree on such minor matters as concepts, substance, or wording. But typical of Barb's special-ness, we remained friends in spite of these experiences. We also followed one another as presidents of the Ambulatory Pediatric Association and this proved to be another opportunity to work closely with this remarkable person. Like so many who are greater prophets in lands other than their own, I think she was not as admired in the US as she deserved or as she was abroad.