Taking a Look at How Clinical Care and Public Health Intersect

By | March 11, 2020

Undeniably, individual rights are foundational to our civil liberties. However, we are also socially minded, meaning thinking beyond individual needs, and therefore, we must bridge this polarity. From a care perspective, these dualities remain in two different verticals,1. medical care/treatment, and 2. public health. For example, when I discuss a condition and treatment options with a patient, the denominator in which I focus my entire context, is one, the individual. If I treat you as a public health specialist, the denominator is much different, emphasizing the number of people similar to you with comparable conditions. Doing this will lead to different interventions. Individually, my primary goal is to ensure that you do not have a terrible illness or dreadful disease, and I rule out all possibilities. From a public health perspective, I focus on what is likely. One is not right while the other is wrong; they merely arise from different viewpoints.

Currently, we are beginning to question the value (quality, service, and cost) of the former approach. Both financial concerns and quality of life are driving this conversation. When we address health, we fail to address the quality metrics of economic health, i.e., affordability.

Furthermore, we are beginning to bridge this gap as we focus on the Social Determinants of Health (SDOH). SDOH describes the social and economic circumstances in which people live and work and how such elements influence health and quality of life. At its core, SDOH is a public health principle. If we fail to address the human psychosocial condition, we will never be able to treat their physiologic axis; the treatment of the “dis-eases” of life are foundational to our health and wellbeing, which leads us to the root causes that are social and community driven.

Consequently, our interventions are numerous versus just the individual. This is a seismic shift for the better. Instead of looking at these as opposites, we are viewing them as interdependent, thus requiring intervention simultaneously. We also understand that treating SDOHs may be a focus at the individual encounter; but this can be considered inefficient as it is much more beneficial to create living conditions that mitigate them at a fundamental level.

Why is this changing? With the arrival of the accountable care model of care, we are structuring ourselves to comprehend fully and to address these root causes. Thus, we are now placing our focus on delivering value-based care. Additionally, we are also creating value-based payment models, which shifts our financial incentives from delivering on a unit of service to a unit of value. Additionally, health systems are adjusting their focus on community needs in a much different way. No longer are we merely stipulating it is our responsibility to treat you when you are sick; instead, we are here to create a society of health and wellbeing.

When it comes to our methods, we are shifting from an either/or model towards one of co-creating a healthier society. We still have a journey ahead, in both concept and design, and in the business models that will allow us to succeed, but fortunately, we live in a time where addressing the needs of all is possible. Sure, we feel the stressors of the present situation as we navigate this valley of transition; however, the possibilities are life-changing for those we serve.