Systems change: Why local public health?

 
Although primary care and public health have historically operated independently, opportunities are emerging for collaboration.
 
Health care reform under the Affordable Care Act will increase access to a range of preventive care, such as cancer screenings and checkups, by eliminating cost-sharing and expanding insurance coverage. The U.S. Centers for Disease Control and Prevention believes this is an opportunity for public health to expand its role to ensure the delivery of clinical preventive services.
 
A report by the Institute of Medicine in March 2012 took an in-depth look at the integration of primary care and public health and concluded that these two entities can accomplish more together than they can alone. “There is a growing recognition that the current model of investment in the nation’s health system is unac­ceptable,” the report states, “and the dramatic rise in health care costs has led many stakeholders to explore innovative ways of reducing costs and improv­ing health.”
 
 
Successful collaborations
 
The report includes a literature review that examined primary care and public health collaborations. Successful collaborations were found to result in better health service delivery, funding and resource allocation, and population health outcomes. Chronic disease was cited as one of the main focus areas, as it has a large public health impact.
 
The report examined several successful collaboration efforts across the country. In each of these case studies, the agencies shared a goal of population health improvement. One such study is New York City’s Colonoscopy Patient Navigator Program, in which the local health department helped patients overcome barriers to screening and partnered with local providers to carry out the screenings.
 
Although the health department took on the initiative, partnerships with local providers made the improved outcomes possible. In 2009, 66 percent of New York City adults over age 50 had been screened for colorectal cancer, up from 43 percent in 2002.
 
Such examples illustrate that local public health agencies can use their community connections to encourage patients to seek health services, while providers can use their relationships with patients to complement population-level interventions.
 
The health of the community can benefit from partnerships between clinics and local public health agencies, and the timing is right for these partnerships to be established.