Are Primary Care and Public Health Already Integrated? My First-Hand Experience at Bridging the Two…

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Last week I gave testimony to the Oak Park Village Board in support of a youth bicycle helmet ordinance (passed 5-2!). It was pure policy work for population-based health safety outcomes. Using my voice as a primary care physician (who just happens to bike to work regularly) was instrumental to the broader public health arguments made.

The “integration” of the two realms, primary care and public health, came up regularly throughout my year on the Board of Directors for the AAFP (American Academy of Family Physicians), especially through my Commission liaison role on the Health of the Public and Science.

I learned something new: public health and primary care aren’t integrated, and a number of groups are working to bridge the two.

That surprised me! It surprised me mostly because I couldn’t understand how primary care and public health aren’t seen in symbiosis throughout our health care infrastructure. The work we do during individual primary care patient care is so dependent on what is occurring in the broader community and efforts in population-based public health care.

Our adult vaccines come from the city’s public health department. My patients with asthma have more exacerbations and difficulty breathing when the air quality is poor. The children I see have healthier teeth thanks to the fluoride in Chicago’s water supply. My diabetic patients ability to improve their nutrition is affected by the ratio of convenience stores and fast food restaurants to fresh produce markets; their ability to exercise directly related to the safety of their streets in the evening allowing them to get out and walk.

For me, the connection between population-based health advocacy and individual patient care has always been obvious, and integrating the two vital to my work in each. When I fought for a Chicago ordinance to limit soot emissions from coal power plants in the Little Village and Pilsen neighborhoods of Chicago, I fought for the patients at my clinic sites to breath better cleaner air and have less asthma and COPD attacks. I helped address STD rates at the high school health center I led through a large two-day screening campaign that tested over 400 students for gonorrhea and chlamydia. Reaching out to local community groups and partnering with the Cook County Department of Public Health to provide education to each of the screened students was an obvious extension of this effort.

I would argue that the two are already integrated in all but name. The work remaining is to make sure that primary care providers have access to the same public health resources I tapped into to help my patients, and that the public health infrastructure builds bridges on the local and state level with providers to help with initiatives and to educate front-line docs on broader community needs.

Finally, if you are a primary care physician or other health care worker, I encourage you to get more involved in the health of the public you serve. It’s incumbent on us to get out and partner with local departments of public health and community groups so that we can more effectively address all the factors and mitigate the barriers affecting our patients’ health.

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