The role of primary care in response to the global liver disease syndemic: a Lancet Gastroenterology & Hepatology Commission.

Liver disease causes substantial global morbidity and mortality, with a growing burden from steatotic liver disease driven by alcohol use and metabolic dysfunction, alongside persisting challenges from chronic viral hepatitis. Liver disease burden is unequal between and within countries, with high rates in people with low socioeconomic status and marginalised groups due to increased exposure to risk factors and compounded by reduced access to prevention, diagnosis, and treatment. Liver disease frequently coexists with multimorbidity-including diabetes, cancer, and mental illness-with bidirectional relationships that demand integrated, person-centred pathways of care. Primary care, as the cornerstone of first-contact, comprehensive health care, is uniquely positioned to deliver population-level prevention, early detection, and management of liver disease while reducing health disparities. However, despite increasing emphasis on prevention and long-term condition management globally, liver disease has received scarce attention within primary care policy, training, and system design. This Commission brings together multidisciplinary global expertise to review current evidence and provide recommendations to strengthen primary care-led liver health care. Central themes include reducing inequalities in liver care, defining a minimum package of primary care services, embedding liver health within non-communicable disease strategies, leveraging digital innovation, enhancing multidisciplinary collaboration, and advancing a coordinated research and implementation agenda focused on real-world care pathways and stigma reduction.