Bridging Clinical Medicine and Public Health

terry-allanThis post was originally published on the Public Health Newswire as part of a series on the impact of the Affordable Care Act written by contributing authors with varying public health perspectives. This piece is from NACCHO President Terry Allan, RS, MPH, Health Commissioner of the Cuyahoga County (OH) Board of Health. Allan says the health reform law is a catalyst for innovation in the way clinical medicine integrates with public health. He shares examples of ways this partnership transforming health delivery and generating real results in the Buckeye State.

Now that the Affordable Care Act (ACA) stands as the law of the land, the focus on elevating the quality of care, improving patient outcomes, and taming runaway costs for treatment have now become a national imperative. This will be no easy task. The reverberations from this profound transformation will impact all sectors of our health system, which currently accounts for approximately 18 percent of the gross domestic product. Providers, payers, and consumers must abandon business as usual and public health practitioners must find their way in this evolving landscape.

As a local public health officer serving 850,000 greater Clevelanders in Cuyahoga County and president of the National Association of County and City Health Officials, I have had the opportunity to share health reform experiences with colleagues from across the nation. It is clear that state and local health departments must define their new role and demonstrate our distinct value proposition among the many players in this complex delivery system.

In this context, it makes sense to concentrate first on what public health does best. Local health departments have long been identified as ideal conveners of community partners. They are uniquely qualified to marshal the substantial resources of nonprofits, academia, private businesses, community hospitals, and other governmental agencies, all working together to solve complex health problems. Preventing hospital readmissions necessitates meaningful community dialogue on linking medical providers with local prevention programs that work to increase access to healthy food choices, increase opportunities for physical activity, and connect patients to smoking cessation programs. This collaborative approach has proven successful in the past in greater Cleveland, where a partnership to reduce tobacco use in Cuyahoga County decreased adult smoking rates from 26.5 percent in 2003 to 18.8 percent in 2007, lower than the state of Ohio (23.1%) and the nation (19.7%) in 2007. A similar collaborative effort reduced childhood lead poisoning rates in Cuyahoga County by over 50 percent between 2004 and 2010.

Sustaining these gains can be a real challenge to communities, given the inconsistency of public health resources and the lack of historical emphasis on funding for prevention. The Prevention and Public Health Fund established under the ACA represents a genuine opportunity to change this dynamic. We can demonstrate how local health departments can be the eyes and ears of the healthcare system, outside the walls of hospitals and community heath centers, working as extenders in the neighborhoods and homes of their patients. We can work with primary care practices and specialists to support accountable care organizations to reduce environmental triggers in the homes of asthmatics and reduce emergency department admissions. We can employ and train outreach workers and health coaches to navigate the community health and social service system, advocating for patients to reduce costs and improve outcomes. We understand the dynamics of how the actual causes of morbidity and mortality often have more to do with unhealthy neighborhood conditions and the compounding disadvantages that many low-income minority communities face.

All of these examples represent real value to the system and are consistent with the tenants of the National Prevention Strategy.

A former state health director in Ohio called public health “the greatest story never told.”  It’s time to tell it.

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