The BMJ Today: Global health, socioeconomic differences, and other matters

primarycare_Nurse_training_uganda• To achieve universal health coverage by 2030, as required by UN Sustainable Development Goals, primary care must be strengthened in middle and low income countries. Educational resources and decision support tools for primary care workers in these settings are critically needed.

In an editorial, Fairall and Walsh argue that educational materials must be developed in partnership with local institutions and focus on multimorbidity rather than individual conditions. These educational materials must also address the challenges posed by limited availability of resources.

• In a blog, Richard Smith argues that healthcare systems in developed and developing countries can learn and benefit from each other. He says that the experience of providing care where resources are limited can also benefit organisations in rich countries, such as the NHS.

payslip• Health outcomes differ by socioeconomic level, even in the most affluent countries. Teed and McCarthy argue, in a feature article, that medical organisations must lead by example and pay a living wage to all its employees and contractors. But this is currently not the case in the UK. They surveyed several health organisations and found that some, including the NHS, are “not a formal living wage employer.”

Other organisations paid a living wage to their direct employees but did not have formal policies regarding contractors. “The medical colleges and charities should lead fair employment practices and aim to reduce in-work poverty, thus minimising its potential effect on health inequalities. Bearing witness to inequality is not enough when the profession and medical charities are actively contributing towards it,” they conclude.

uterine_fibroids• Fibroids are the most common benign tumours in women. They are often found incidentally during a routine ultrasound and do not require treatment. A variety of treatments are available for symptomatic fibroids but, as Lumsden and colleagues explain in a clinical review, the evidence for different medical, surgical, and radiological treatments is sparse. They conclude that, “Women should be made aware of all available treatment options; medical, radiological, and surgical, and why they may or may not be appropriate.”

• “Where does medical responsibility meet patient autonomy?” Shared decision making is a messy issue, explains McCarthy in her column this week, and physicians and patients may not weigh the risks and hazards of treatments equally. Patients and physicians must work together to “negotiate a reasonable path of mutually acceptable risk” but this may not always be possible. She concludes that physicians should not feel pressured to prescribe therapies that they believe are harmful.

José G Merino is the US clinical research editor, The BMJ.