I’ve been toying recently with writing another book or putting out a special issue about the conversation between public health and medicine today: how prevention and treatment are interdependent, what programs are currently under way that depend upon partnerships and collaboration between medical and public health researchers and professionals, and what are the policy implications for state and federal policy makers. The differences between the two fields have always been described as those between population-level issues (like STDs) and individual-level issues (like heart attacks). With the rise of chronic disease, and ever more convincing evidence of how prevention has an impact upon individual health outcomes, the lines are getting blurred.
Some of the recent Management Academy plans that Monecia Thomas described in her last post are great examples of how the two fields are coming together: the primary care clinic being set up by New Hanover County on the same campus as the emergency room; and the Making A Successful Teen (MAST) program dedicated to providing maternity care for pregnant teens, as well as ongoing contraceptive services, support and services for the young fathers, and dental care going forward. That team came to their issue through a desire to provide dental care, which has been linked with health outcomes, including the outcomes of pregnancy.
None of this is easy. There’s a reason many public health agencies are reluctant to provide primary care and dental care: it’s expensive in terms of space and personnel. It’s also difficult to draw in the paying customers who can balance the budget in ways that the poor and uninsured – even if they have Medicaid – can’t always do (particularly in the case of dental care). It is sometimes thought of as a stigma to get your health care at the public health department. In both cases described here, planners thought about this issue. In the case of the primary care clinic on the hospital grounds, users, even those who have a primary care doctor, may find it convenient to visit when their doctor is unavailable. In that case, it’s good that it is a separate facility from the public health agency. In the case of pregnancy services for teens, the team placed the clinic in the area of their county with the highest teen pregnancy rate so that transportation would not be an issue, and it is housed with other public health agency offerings, to protect teens’ privacy.
More and more, prevention is key. Also, individual health problems, if not treated early, have huge impacts on cost for all of society. Both of these Management Academy teams’ projects are promising and impressive ways to address these challenges.
-- Anne Menkens