Barbara Starfield was born in 1932 to a family of academics in Brooklyn, New York. She received her BA from Swarthmore College in 1954. Upon receiving her MD from the State University of New York, Downstate Medical Center in 1959, she came to the Johns Hopkins Hospital for her pediatrics residency. She received her MPH from the Johns Hopkins University School of Hygiene and Public Health in 1963, with a focus on epidemiology. Starfield spent her entire professional career at Johns Hopkins. In 1963, she began working at The Johns Hopkins Hospital Harriet Lane Clinic as the Medical Director of the Pediatric Medical Care Clinic and of the Community Nursing Project. It was here that she met Vicente Navarro and Kerr White, pioneers of health services research and primary care medicine, both of whom would be close colleagues throughout her career. In 1965, Starfield became an instructor in the Department of Public Health Administration within the School of Hygiene and Public Health, where she rose from assistant professor in 1966 to associate professor in 1969, and full professor in 1975. From 1975 to 1994, she was the head of the Division of Health Policy within the department of Health Services Administration, later Health Policy and Management. Starfield was named University Distinguished Service Professor in 1994. She also held a joint appointment in Pediatrics in the School of Medicine.
Over the course of her career, Starfield came to be known as the “Grand Lady” of primary care. She authored more than 400 publications and trained 150 people directly, with teaching comprising a significant aspect of her working life. Her paper, “Is US Health Really the Best in the World?” reflects her concerns about the American health care system. Her books have become seminal works in the field including, The Effectiveness of Medical Care: Validating Clinical Wisdom, 1985; Primary Care: Concept, Evaluation, and Policy, 1992, known as “the book” for the field of primary care and published in five languages; and, Policy and Primary Care: Balancing Health Needs, Services, and Technology, 1998. In 1996, she helped to found the Johns Hopkins’ Primary Care Policy Center (PCPC) and served as its Director. The PCPC trains health care professionals and conducts research on health care policy and on primary care delivery services, particularly for underserved populations.
Starfield made major contributions to the field of health services research. She began her career witnessing the health disparities that exist for children in Baltimore and went on to become a leader in efforts to measure health services and inequity. To that end, she created three key tools throughout the course of her career. Along with Anne Riley, she developed the Child Health and Illness Profile (CHIP), a comprehensive assessment of health and functioning for children and adolescents intended to “characterize the potential for resilience, risk avoidance, future health and achievement.” Starfield was also central to the development of Ambulatory Care Groups (ACGs) that is used worldwide for measuring morbidity burden of patient populations based on disease patterns, age and gender. The Primary Care Assessment Tools (PCAT) is a set of measurement tools designed to evaluate the quality of states’ primary care services, particularly for children.
Starfield travelled extensively researching health systems, serving as a consultant to policy makers around the world, and collaborating on projects to promote primary care and understanding of inequities in health. She was a co-founder and the first President of the International Society for Equity in Health (ISEqH) and the founding editor of the organization’s International Journal for Equity in Health (IJEqH). Over the course of her career, she won many awards and served in a leadership role at numerous scientific societies and on dozens of editorial boards. Starfield was married for 56 years to Neil A. (Tony) Holtzman, a pediatrician at Johns Hopkins and a genetics specialist, with whom she had 4 children.
1959-2011 - Johns Hopkins Hospital
1959-2011 - Johns Hopkins University School of Medicine
1962-1963, 1965-2011 - Johns Hopkins University School of Hygiene and Public Health
Scope and Content:
The Barbara Starfield collection spans her entire career and documents her extensive contributions to the field of Primary Care Research, including her leadership in carrying on the work of her early mentor Kerr White. Materials document her involvement in creating programs and courses at Johns Hopkins to train future researchers and policy makers in the fields of health care services and primary care research. Johns Hopkins institutional records include records for the Division of Health Care Organization, which Starfield headed at the School of Hygiene and Public Health. Included are files pertaining to her assessment tools, the Child Health and Illness Profile (CHIP), the Primary Care Assessment Tools (PCAT), and adjusted clinical groups (ACG). The collection documents the formation of the International Society for Equity in Health (ISEqH), which Starfield founded. Included are several boxes pertaining to Starfield’s extensive involvement in state, national, international, and professional organizations, as a member, leader, consultant, officer, program/project director, and on Advisory Boards and Advisory Panels. There are also records of Starfield's testimony as an expert and representative of professional organizations before congressional hearings and court depositions.
There are numerous records from Starfield’s speaking engagements at conferences and symposium, as a keynote speaker, and as a visiting lecturer. There are also extensive records of Starfield’s international collaborative projects, including international research projects, conferences, journals, and her work as a consultant. Research files document her numerous research projects and publication files pertain to Starfield’s journal articles, editorials, book chapters, and books.
The collection contains biographical materials about Starfield and her family, including Starfield’s educational records, early training, materials pertaining to awards, honors, and tributes to her and her work; biographical sketches and CVs; personal correspondence; and family photographs. There are about .5 cubic foot of photographs and 8.18GB of electronic files.
Boxes 1-53 were packed by Barbara Starfield and were numbered as she transferred them to the Medical Archives. Throughout the collection, Starfield inserted notes made while packing up materials for the archives, about the documents and her projects. Starfield later interfiled additional materials into the boxes so that related materials are together. Starfield's notes have been retained. After her death, boxes 54-76 were packed by Phoebe Evans Letocha as she cleaned out Starfield's office. Additional materials were transferred by her husband Neil Holtzman and her assistant Normalie Barton. Boxes were inventoried by Medical Archives processing staff, and then linked to the appropriate series and sub-series as identified. Folders were then rearranged according to the arrangement plan.
Restrictions on Access: This collection contains some restricted records. Materials pertaining to patients, students, employees, and human research subjects, as well as recent administrative records, carry restrictions on access. Information identifying restricted series are noted throughout the collection. Researchers would need to obtain individual authorizations or waivers of authorizations for access and use of protected health information and medical records. For more information about the policies and procedures for access, see the Archives Policy on Access and Use.
Restrictions on Use: When citing material from this collection, credit The Alan Mason Chesney Medical Archives of The Johns Hopkins Medical Institutions. For permission to reproduce images, contact the holder of the copyright.
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