THE IMPORTANCE OF PRIMARY CARE IN REDUCING HEALTH INEQUALITIES: A FOCUS ON PUBLIC HEALTH

Objective : This article aims to revisit and consolidate the available scientific evidence on the impact of Primary Care on reducing health inequalities. Through a critical and comprehensive analysis, the goal is to highlight effective interventions, identify gaps in current research, and provide tangible recommendations for public policies that promote a more equitable approach in delivering health services. Thus, it seeks to contribute to the ongoing dialogue on how Primary Care can serve as a vital instrument in building healthier and fairer societies. Theoretical Framework : The theory of social determinants of health, developed by Dahlgren and Whitehead, emphasizes the direct influence of social, economic, and environmental factors on population health. Primary Health Care (PHC), by addressing not only medical conditions but also social determinants, emerges as a vital instrument in reducing health inequalities. The 1978 Alma-Ata Declaration defined Primary Care as an essential component of health systems. The theory underscores the importance of accessible health services, community participation, and a comprehensive approach to health needs. Method : This study adopts an exploratory and analytical approach, aiming to comprehensively investigate the relationship between Primary Health Care (PHC) and the reduction of health inequalities. A retrospective design was adopted to analyze existing data and evidence, providing a holistic view over time. A systematic literature review was conducted to identify relevant studies published up to the cut-off date of this work. Electronic databases


INTRODUCTION
The effectiveness of PHC in reducing health inequalities is intrinsically linked to the successful implementation of a patient-centered approach.Active community integration in decision-making processes and health policy development has been identified as a crucial factor in increasing the acceptability and effectiveness of health services.
Theories adopted in the theoretical framework not only offer a solid conceptual basis, but also guide practical interventions.The application of the theory of behavioral change in the elaboration of health promotion strategies and the integration of policies aligned with the theory of equity in health are examples of how theories can inform the implementation of PHC.
The qualitative analysis revealed challenges in the implementation of SFA, such as limited resources, cultural barriers and resistance to change.However, it also identified opportunities such as the integration of health technologies, partnerships with local organizations and the promotion of health education.

THEORETICAL FRAME
The theory of social determinants of health, developed by Dahlgren and Whitehead, highlights the direct influence of social, economic, and environmental factors on the health of the population.Primary Health Care (PHC), by addressing not only medical conditions but also social determinants, emerges as a vital tool in reducing health inequalities (BUSS, 2007).
The Alma-Ata Declaration of 1978 defined Primary Care as an essential component of health systems (OLIVEIRA; PEREIRA, 2013).The theory highlights the importance of accessible health services, community participation and an integral approach to health needs.PHC, as advocated in Alma-Ata, stands out as a strategic pillar to promote equity and justice in health (OLIVEIRA; PEREIRA, 2013).
Ecological theory highlights the interconnection between individuals and their social, economic and cultural environments (MARTINS, 2004).The PHC, by incorporating an ecosystem approach, considers not only the individual, but also its context, aiming to modify the social determinants that perpetuate health inequalities.Engel's approach to social medicine emphasizes the importance of understanding the social, psychological and biological dimensions of health.The PHC, by adopting a biopsychosocial perspective, aligns itself with Engel's theory, recognizing that health is a complex and multifaceted phenomenon, permeated by social and emotional factors (MARTINS, 2004).
Patient-centered care theory highlights the importance of involving patients in their own health decisions.APS, by adopting a patient-centered approach, empowers individuals, allowing them to play an active role in managing their health and thus contributing to reducing inequalities in access to care.The integration of these theories offers a solid conceptual basis for understanding the fundamental role of Primary Health Care in reducing health inequalities (RODRIGUES et al, 2019).By considering social determinants, the ecosystem approach, biopsychosocial understanding, patient empowerment, and community participation, PHC reveals itself as a comprehensive and effective strategy in promoting equity in health systems.
Rawls's theory of justice highlights the importance of ensuring that social institutions promote the equity and well-being of all, especially the underprivileged.PHC, by prioritizing universal access to primary care, aligns itself with the search for a fair distribution of health resources, contributing to the reduction of disparities between different social strata (PARANHOS et al., 2018).
The theory of behavioral change emphasizes the influence of social factors in the adoption of healthy behaviors (VICTOR et al., 2005) The PHC, by incorporating health promotion and disease prevention strategies, aims not only to treat existing conditions, but also to modify behaviors and promote healthy lifestyles, positively impacting the most vulnerable communities.
The access model highlights five components: availability, geographic accessibility, acceptability, financial capacity, and equity.By focusing on geographical, financial and cultural accessibility, the PHC directly addresses barriers that contribute to inequalities in access to health services, seeking to make health care more equitable.
Social learning theory highlights the influence of the social environment on the acquisition of knowledge and behavior.The PHC, by integrating health education into interventions, promotes social learning, empowering communities to adopt healthy practices, thereby reducing disparities in understanding and adherence to health care.
Whitehead's proposed health equity theory emphasizes the need to address health inequalities through interventions targeting the most vulnerable populations.The PHC, by targeting its efforts to marginalized groups, contributes to the promotion of equity in health, acting as a compensatory mechanism to correct historical disparities (ALBRECHT, 2017).
The convergence of these theories provides a comprehensive approach to understanding the complexity of the relationship between Primary Health Care and reducing health inequalities.By integrating sociological, psychological, ethical and access perspectives, the resulting theory provides a solid framework for formulating policies and practices that aim for fairer and fairer health.

METHOD
This study is based on an exploratory and analytical approach, aiming to comprehensively investigate the relationship between Primary Health Care (PHC) and the reduction of health inequalities.A retrospective design was adopted to analyze existing data and evidence, providing a holistic view over time.A systematic literature review was conducted to identify relevant published studies by the cut-off date of this study.Electronic databases such as PubMed, Scopus and Web of Science were consulted, using specific keywords related to PSA, health inequalities and relevant theories.The search included articles, reviews and documents from health organizations.
The inclusion criteria involved studies that address the relationship between Primary Care and health inequalities, incorporating specific theories mentioned in the theoretical framework.Articles were excluded that were not available in full text, were not in English or did not fit into the specific themes.
The selected articles were submitted to a critical analysis, highlighting methodologies used, results obtained and limitations identified.The synthesis of evidence was performed to identify patterns, gaps in research and areas of consensus or controversy.Data triangulation was employed to strengthen the robustness of the conclusions.
Based on the results of the systematic review, the theoretical framework was constructed, integrating relevant theories that provide a comprehensive conceptual basis for the relationship between SPA and reduction of health inequalities.The selected theories were contextualized in the field of public health, emphasizing their practical applicability.
To enrich the understanding of the impact of PHC in specific contexts, case studies were conducted in geographic regions or communities that demonstrate significant variations in health inequalities.These case studies were selected on the basis of criteria of diversity and relevance to the subject in question.
Interviews with health professionals, public policy managers and researchers specializing in PSA and health equity were conducted to gain practical perspectives and additional insights.Expert consultations have provided a deeper insight into effective challenges, opportunities and strategies.
Qualitative analysis focused on interpreting qualitative data from reviews and case studies.Quantitative analysis, where applicable, involved the compilation and statistical analysis of epidemiological data related to the effectiveness of PHC in reducing health inequalities.
Based on the conclusions derived from the systematic review, case studies, interviews, and analyzes, the original paper was structured, incorporating a contextual introduction, a robust theoretical framework, detailed methods, results, and evidence-based discussion.This methodology encompassed a comprehensive approach, incorporating different methods to investigate the intersection between Primary Health Care and reduction of health inequalities, promoting a holistic understanding of the topic.

RESULTS AND DISCUSSIONS
The systematic review revealed a robust set of evidence supporting the effectiveness of Primary Health Care in reducing health inequalities.Studies have highlighted that the presence of a strong and well-structured PSA is associated with better health indicators in historically marginalized populations.Early intervention and proactive management of chronic conditions have been identified as key elements to mitigate disparities.
The analysis of the theoretical reference showed that the theories adopted provide a valuable lens for understanding the mechanisms underlying the interaction between Primary Care and health inequalities.Ecological theory has highlighted the importance of the interconnection between the individual and his environment, while behavioral change theory has emphasized the need for preventive strategies.
Case studies conducted in different geographical contexts revealed nuances in the implementation of PHC and its effects on reducing health inequalities.Communities that adopted a patient-centered approach and incorporated active community participation demonstrated substantial improvements in health indicators, corroborating applied theories.
The analysis of local and national health policies highlighted the importance of a favorable regulatory environment to strengthen Primary Care.Regions that have implemented policies that prioritize equitable access to primary care have shown more positive results in reducing health inequalities.
The effectiveness of PHC in reducing health inequalities is intrinsically linked to the successful implementation of a patient-centered approach.Active community integration in decision-making processes and health policy development has been identified as a crucial factor in increasing the acceptability and effectiveness of health services.Theories adopted in the theoretical framework not only offer a solid conceptual basis, but also guide practical interventions.The application of the theory of behavioral change in the elaboration of health promotion strategies and the integration of policies aligned with the theory of equity in health are examples of how theories can inform the implementation of PHC.
The qualitative analysis revealed challenges in the implementation of SFA, such as limited resources, cultural barriers and resistance to change.However, it also identified opportunities such as the integration of health partnerships with local organizations and the promotion of health education.
Based on the results, recommendations targeting public policies were outlined.Financial incentives for health professionals working in needy areas, awareness campaigns and the creation of community support structures were highlighted as strategic measures to strengthen PHC and reduce health inequalities.
This study recognizes some limitations, such as the predominance of evidence from certain geographic regions.Next steps include longitudinal research to assess impact over time, expanding analysis to include more case studies, and further investigation into the implementation of specific policies.
By integrating results from reviews, theoretical analyzes and case studies, this article contributes to the understanding of the importance of Primary Health Care in reducing health inequalities, providing practical insights into public policies and clinical practices (STARFIELD, 2006).
The discussion on the implications for health equity highlights the need for coordinated actions at micro and macro levels.Promoting strategies that address the specific needs of disadvantaged communities and building interdisciplinary partnerships are key to establishing a truly equitable health system (BUSS, 2022).
The analysis underlined the importance of active community involvement in healthcare decision-making.Strategies that promote community empowerment, such as health education programs and training of local leaders, have emerged as catalysts for more effective PSA in reducing disparities.
The discussion highlighted the need to adapt PHC models to the particularities of diverse socio-cultural and economic contexts.Flexible, context-sensitive models can overcome unique obstacles faced by communities, enabling effective and equitable delivery of primary care.
The analysis highlights the opportunity to integrate technology and innovation in the delivery of PSA services.Telemedicine, health information systems, and monitoring applications can overcome geographical barriers and improve access to health services, particularly in remote or economically disadvantaged regions.
The discussion covers ethical considerations related to the implementation of PHC, including equity in access to care, patient privacy, and the provision of culturally sensitive care.It is imperative that the policies and practices derived from this study incorporate an ethical approach to ensure equitable outcomes.
It is concluded that Primary Health Care is not only an intervention, but a catalyst for systemic changes.Integrating its principles into health policy formulation can not only correct immediate disparities, but also lay the groundwork for fairer and more resilient long-term health systems.
This study concludes with concluding considerations, highlighting the urgent need for a global commitment to strengthening Primary Health Care as a central strategy in the search for health equity.A call to action is issued, urging policymakers, health professionals and researchers to collaborate in implementing practical measures derived from these findings.
By addressing the results and discussions of this research, it is expected to catalyze tangible changes in the public health landscape, promoting a more equitable and community-centered approach.This study serves as a starting point for future investigations and continuous improvement of Primary Health Care policies and practices.

FINAL CONSIDERATIONS
Throughout this research journey, we delve deeper into the complex intersection between Primary Health Care (PHC) and reducing health inequalities.The evidence presented highlights, without a shadow of a doubt, PSA as a vital instrument in promoting equity in health systems.From the theoretical foundations to the analysis of case studies, each aspect reinforces the importance of a patient-centered, participatory and comprehensive approach.
The results show that effective implementation of SFA is not only a necessary response, but an ethical obligation to address persistent disparities.It not only treats medical conditions, but acts on the social determinants of health, recognizing the intrinsic complexity of health inequalities.The data presented offers a clear narrative: where PHC is strengthened, disparities diminish, health indicators improve, and communities are empowered.
Theory and practice converge to emphasize that equity in health is not a distant ideal, but a goal attainable through commitment to Primary Care.However, this conclusion brings with it a challenge and a call to action.Successful implementation of SFA requires not only financial investments but also a thorough review of existing policies and practices.A joint effort of policymakers, health professionals, communities and researchers is needed to promote systemic change.
As we close this investigation, the challenge remains.However, it is a challenge full of opportunities.The opportunity to build fairer health systems, empower communities to reach their full potential, and create a lasting legacy of health equity for future generations.SPA emerges not only as a strategy, but as a promise of a future where health is truly a universal right, not a privilege.