When you look at our disease patterns in
the U.S. today, we’ve had a shift. We’ve gone from a time when acute disease was the major cause of death to a time when chronic disease is the major cause of death. The challenge there is the problems that we have now, diabetes or heart disease, no one, neither public health
nor medicine alone can defeat these challenges because these are problems that originate
outside of the clinic walls. We’ve gone from a time when they were biological, physical and biological origins of disease to a time now when they’re actually social and environmental origins of disease. It’s not as simple to treat those. It’s not a pill. This is further complicated by our lifestyles. There was no one who ever really wanted you to get syphilis. No one benefited from that. But now there are corporations that if we don’t buy guns, or smoke, or eat a high calorie diet, it impacts their bottom line. So there’s a lobbying interest to keep us making choices that aren’t always the best for us. Primary care and public health together can work towards a community where health is the best choice, the default choice and that’s where we have to go. But we’re only going to do this if we work together. Otherwise, we’re going to continue just to treat our individual problems in our silos, which won’t actually change anything. When you think of primary care and public
health together, there are three areas where integration, collaboration, partnership could be easily achieved and would be a very powerful change agent for health in our communities. One is data, and that’s data for the public health department getting the outcome data that they need from the EHR, the Electronic Health Record, and for primary care, contextualizing
the data that they already have in their EHR. So data, extraordinarily important, and one place that we all can work together. Aligning health messaging, so if we know working with our primary care providers and our public health leaders that there’s an asthma problem
in our community, let’s really align. Let’s make sure that every billboard is talking about asthma, and that every clinical encounter talks about asthma. Think about how powerful
that one-two punch would be in a community and could really change behavior. Lastly, it’s policy and environmental change.
The number of challenges that… the health challenges that we have that originate because there’s not a policy that protects us, or there’s an environmental irritant. Take something for example, there was research that showed that if you pass an alcohol outlet on your way to school, you’re more likely to experiment with alcohol as a teen. We could make a policy to prevent that, but policy development takes a lot of things. It takes stories and information
from the clinical provider that can fortify the quantitative data that we have on the
public health side, and together we will be more effective in making policy than if we try to do it alone. For the primary care folks, going to the legislature on their own, they may be less effective than if they actually partner with the public health department and get the community level data that they need to make a very powerful case. Good policy action is good stories, married with good data. That’s how you change policy. We can
only do that if we’re working together.