Article Text

Download PDFPDF

On the importance of primary and community healthcare in relation to global health and environmental threats: lessons from the COVID-19 crisis
  1. Paolo Lauriola1,
  2. Piedad Martín-Olmedo2,
  3. Giovanni S. Leonardi3,
  4. Catherine Bouland4,
  5. Robert Verheij5,
  6. Michel L A Dückers5,
  7. Martie van Tongeren6,
  8. Ferdinando Laghi7,
  9. Peter van den Hazel8,
  10. Ozden Gokdemir9,
  11. Evelyn Segredo10,
  12. Ruth A Etzel11,
  13. Alan Abelsohn12,
  14. Fabrizio Bianchi13,
  15. Roberto Romizi14,
  16. Giuseppe Miserotti15,
  17. Francesco Romizi14,
  18. Paolo Bortolotti16,
  19. Emanuele Vinci17,
  20. Guido Giustetto18,
  21. Mariagrazia Santamaria19,
  22. Alice Serafini20,
  23. Samantha Pegoraro21,
  24. Raymond Agius6,
  25. Ariana Zeka22
  1. 1International Society of Doctors for the Environment (ISDE-Italy), Modena, Italy
  2. 2Escuela Andaluza de Salud Pública, Granada, Spain
  3. 3Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
  4. 4ULB-Ecole de Santé Publique, Bruxelles, Belgium
  5. 5Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
  6. 6Centre for Occupational and Environmental Health, University of Manchester, Manchester, UK
  7. 7International Society of Doctors for the Environment (ISDE-Int’l), Geneva, Switzerland
  8. 8International Network on Children’s Health, Environment and Safety (INCHES), Ellecom, The Netherlands
  9. 9Faculty of Medicine, Izmir University of Economics, Balçova/Izmir, Turkey
  10. 10Uruguayan Society of Family and Community Medicine, Montevideo, Uruguay
  11. 11Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
  12. 12Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
  13. 13Istituto Fisiologia Clinica, Consiglio Nazionale della Ricerca (CNR-IFC), Pisa, Italy
  14. 14International Society of Doctors for the Environment (ISDE-Italy), Arezzo, Italy
  15. 15International Society of Doctors for the Environment (ISDE-Italy), Piacenza, Italy
  16. 16Medical Order Trento, Trento, Italy
  17. 17Health and Environment Working Group, National Medical Orders Federation, Rome, Italy
  18. 18National Medical Orders Federation, Rome, Italy
  19. 19Local Health Authority, Foggia, Italy
  20. 20Local Health Authority, Modena, Italy
  21. 21Italian Climate Network, Milano, Italy
  22. 22Institute of Environment, Health and Societies, Brunel University London, Uxbridge, UK
  1. Correspondence to Dr Ariana Zeka; Ariana.Zeka{at}; Dr Paolo Lauriola; paolo.lauriola{at}


In the course of the COVID-19 pandemic, it has become clear that primary healthcare systems play a critical role in clinical care, such as patient screening, triage, physical and psychological support and also in promoting good community advice and awareness in coordination with secondary healthcare and preventive care. Because of the role of social and environmental factors in COVID-19 transmission and burden of disease, it is essential to ensure that there is adequate coordination of population-based health services and public health interventions. The COVID-19 pandemic has shown the primary and community healthcare (P&CHC) system’s weaknesses worldwide. In many instances, P&CHC played only a minor role, the emphasis being on hospital and intensive care beds. This was compounded by political failures, in supporting local community resilience. Placing community building, social cohesion and resilience at the forefront of dealing with the COVID-19 crisis can help align solutions that provide a vision of ‘planetary health’. This can be achieved by involving local well-being and participation in the face of any pervasive health and environmental crisis, including other epidemics and large-scale ecological crises. This paper proposes that P&CHC should take on two critical roles: first, to support local problem-solving efforts and to serve as a partner in innovative approaches to safeguarding community well-being; and second, to understand the local environment and health risks in the context of the global health perspective. We see this as an opportunity of immediate value and broad consequence beyond the control of the COVID-19 pandemic.

  • environmental health
  • health systems
  • public health
  • prevention strategies
  • health policy

Data availability statement

There are no data in this work.

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Handling editor Seye Abimbola

  • Twitter @OzdenGokdemir

  • Contributors Coordination: PL, GL, AZ. Conceptualisation of ideas: all authors. Original draft preparation: all authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.