Commentary — February 2017
Tex Med. 2017;113(2):13-14.
By Jeffrey L. Levin, MD; Umair A. Shah, MD; and Philip P. Huang, MD
In the United States, the definition of the relationship between medicine and public health in terms of professional scope and optimal training models dates back at least 100 years. As noted by Alfred Sommer, MD, dean of the Johns Hopkins School of Hygiene and Public Health in his introduction to the re-release of the 1915 Welch-Rose Report: Blueprint for Public Health Education in America:
The Welch-Rose report remains refreshingly current, an essential starting point for planning the future of public health and the training of its practitioners. It propounds the need for close collaboration with medical schools and hospitals; a continual refining of the interface of preventive and curative medicine; the importance of continuing studies for "those already engaged in health work"; translation of research results into policy and practice; the necessity for developing close working relationships with local, state and federal agencies and incorporating field experience into the educational experience (foreshadowing by 74 years the Institute of Medicine report, The Future of Public Health).
In 2012, the Institute of Medicine (IOM) released the final of a series of more recent reports pertaining to population health. This latter report examined funding and sustainability in public health while also recognizing the diversity of roles in the health care system, including clinical care. In particular, the report summarized, "In order for health outcomes to improve in the U.S., we will need to transform the way the nation invests in health to pay more attention to population-based prevention efforts; remedy the dysfunctional manner in which public health funding is allocated, structured and used; and ensure stable funding for public health departments."
In this special symposium issue of Texas Medicine dedicated to infectious diseases, the article by Gaul and Hellerstedt titled "Typhoid Fever on the Half Shell" is an intriguing story of detective work. The story illustrates the many components in a sophisticated system that must operate with precision to address simultaneously a clinical therapeutic challenge and a potential public health threat.
There are many clinical and public health issues represented in this illustration, and the role of surveillance and communication through appropriate and timely reporting can't be overestimated. From the clinician who diagnoses and orders testing, to the local, regional, and state epidemiologists who investigate, and, ultimately, to the local health authority who handles the critical response, each plays an important role. The article shows how complex such an investigation can be with involvement of multiple jurisdictions in the process.
The case also exemplifies the importance of collaborative and integrated efforts on the part of the medical and public health communities to identify a serious and potentially fatal communicable illness and its source, and to take steps toward intervention and containment of spread. Though infectious diseases frequently offer the clearest opportunity for collaboration and integration, many other serious and potentially fatal health risks/threats, including those relating to chronic diseases, intentional and unintentional injuries, natural disasters, and even emergency response events (such as biological, chemical, and radiological disasters), can benefit from this approach in the health care setting, as well as in the community at large.
We would be wise to heed the importance and pressing nature of the challenge to prevent and cure many fatal and nonfatal health threats, along with the types of lessons learned in this specific case. This is especially true as we face many emerging public health concerns, such as Ebola, Zika virus, and the next threat lurking around the corner.
It is essential medicine and public health continue to work closely and collaboratively to improve the health of the individual and community while sustaining the resources necessary to do so.
Jeffrey L. Levin, MD, is professor and chair of the Department of Occupational and Environmental Health Sciences and Occupational and Environmental Medicine at The University of Texas Health Science Center at Tyler. He is past chair of TMA's Council on Science and Public Health and remains a consultant to the council.
Umair A. Shah, MD, is the executive director of Harris County Public Health and serves as the local health authority for Harris County. He is president of the Texas Association of City and County Health Officials and a member of the TMA Committee on Infectious Diseases.
Philip P. Huang, MD, is health authority and medical director for the Austin/Travis County Health and Human Services Department and is chair of the TMA Committee on Infectious Diseases.