Physicians, public health agencies need shared accountability to improve health outcomes

A first-time joint publication by the American Journal of Preventive Medicine and the American Journal of Public Health highlights how the two sectors of public health and primary medicine intersect and the work ahead to achieve true integration. This special supplement complements the recent Institute of Medicine (IOM) study released in late March, "Primary Care and Public Health: Exploring Integration to Improve Population Health (www.iom.edu/Reports/2012/Primary-Care-and-Public-Health.aspx)."

"Only by working together to create an integrated health system that leverages the complementary strengths of public health and health care will we truly be able to do our best job of caring for our communities and the U.S. population," said Denise Koo, MD, MPH, with the Scientific Education and Professional Development Program Office of Centers for Disease Control and Prevention, along with her coauthors in an editorial entitled "A Call for Action on Primary Care and Public Health Integration."

Four agencies of the U.S. Department of Health and Human Services, including the Agency for Healthcare Research and Quality, Centers for Disease Control and Prevention, Health Resources and Services Administration, and the National Institute on Minority Health and Health Disparities of the National Institutes of Health, sponsored this special supplement to showcase and support additional efforts in this critical area.

The supplement highlights examples of primary care and public health integration, showing how shared accountability can lead to improved community and population health outcomes. A joint referral system developed by a health care center and its local public health department eliminated duplication and competition. In Seattle-King County, Washington, a health department effort to promote influenza vaccination by all primary care providers – obstetricians and midwives as well as family practitioners – contributed to higher vaccination rates among pregnant and postpartum women. The Healthy Weight Collaborative has deployed 50 teams of primary care, public health, and community representatives to apply evidence-based interventions to prevent and treat obesity in children and families.

A fundamental challenge to realizing the vision of integration is that primary care and public health have evolved as distinct disciplines with different perspectives, goals, and skills. Physicians often remain unaware of health department resources and priorities. Both public health and primary care have limited resources, and integration can sometimes be an additional burden rather than an opportunity. Several articles recommend changes in financing to provide incentives.

According to Dr. Koo and her coauthors, increasing emphasis on healthy behaviors to reduce the burden of disease, as well as new developments in the reform of health care, including the passage of the Patient Protection and Affordable Care Act, offer powerful new opportunities to achieve the vision of an integrated health system in the U.S.

"Today, new opportunities, needs, and tools provide a platform to reintegrate public health and medicine—specifically primary care—in a way that improves population health outcomes and enhances quality of life in the United States," conclude the authors of a commentary entitled "Are We There Yet? Seizing the Moment to Integrate Medicine and Public Health."