Tuesday, November 1, 2016

Public health is not healthcare” is one of the first things I learned when I started attending public health conferences as a healthcare IT vendor. A number of concepts, standards and workflows overlap and appear to be the same in both sectors. But in reality, they’re very different worlds.
Healthcare is about treating one patient at a time using medicine. Public health, especially epidemiology, is about treating whole populations using statistics and policy tools. The different goals, funding, oversight and outcomes of public health and healthcare stem from this fundamental difference.
The ONC’s 10-year interoperability roadmap recognizes this distinction by explaining that individual episodes of care within the healthcare system can be rolled up to the public health level and used to create new interventions that elevate the overall level of community health. The roadmap’s goal is to reduce the time it takes to iterate between lessons learned within the healthcare system and implementing new public health policies.
One difference between public health and healthcare is the source of funding. Healthcare is funded (mostly) privately, while public health typically relies on government funding. Time after time we see how government funding – typically requiring legislature – is too slow to effectively react in some public health scenarios, such as natural disasters or a disease outbreak.
A perfect example is the recent Zika crisis. The first Zika case in the U.S. was identified in July 2015. The President requested funding on February 22, 2016. Congress finally passed a bill that included Zika funding in September 2016. During the protracted funding process, some otherwise unallocated funds were identified to help combat the outbreak, but overall the reaction time of the public health system was too slow and ineffective.
Last week, in response to systemic problems such as these, the Department of Health and Human Services (HHS) released a white paper entitled Public Health 3.0: A Call to Action to Create a 21st Century Public Health Infrastructure. The whitepaper encourages stakeholders in the public and private sectors to work in a different way by envisioning healthcare and public health as two ends of a spectrum rather than separate silos that communicate rarely and begrudgingly.
The white paper contains five recommendations:
  1. A health leader in each community should assume the role of Chief Health Strategist, who will work with relevant parties to address areas of concern and plan ahead for public health crises.
  2. Cross-sector partnerships can help streamline funding, services, governance and collective action.
  3. Public Health Accreditation Board (PHAB) criteria for department accreditation should be enhanced to encourage best practices, so that 100% of the US population is covered by a nationally accredited health department. Today, about 80% of the population is covered by such a department.
  4. Data, metrics and analytics should be used to provide focus on important issues.
  5. Funding for public health should be expanded and more flexible, so that sources of funding can be combined and easily reallocated.
After learning that public health is not healthcare, the second thing I learned about public health is that “all public health is local,” meaning that different cities and even different neighborhoods have different priorities when it comes to public health. The Public Health 3.0 plan embraces this maxim by improving flexibility, empowering public health workers at a more local level, and increasing the focus on social determinants of health.
It remains to be seen how and at what pace public health organizations will adopt the white paper’s recommendations, but the good news is that it identifies best practices already in place across the nation and proposes their universal implementation.

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