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  Home Page » Opinion » The Publics Health

The public's health

Invest in community by providing upfront preventive care

by Joelle Riddle
As a member of Colorado's State Board of Health, it has been interesting and enlightening for me to learn firsthand about the critical role of public health locally, regionally and nationally, particularly as it relates to the health crisis that grips our country today. It is also both timely and important for all of us as Americans to clearly understand the respective roles of public health and primary medical care as we contemplate how best to meet both our community's and our nation's health-care needs.

The roles can be summed up succinctly: Public health is primarily preventive while medical care is primarily curative. Public health is community-based and focuses on populations, while medical care focuses on individuals. With that framework in mind, it's easy to see that population-based public health services are the foundation of our nation's health care pyramid.

Health care pyramid levels•Tertiary medical care - specialty care.

•Secondary medical care - special attention to an ongoing medical condition.

•Primary medical care - clinical preventive services - first contact of treatment.

•Population-based public health services.

The National Public Health Performance Standards Program of the Centers for Disease Control and Prevention (CDC) describes 10 essential public-health services, which can be categorized under three core functions:Assessment•Monitor health status to identify community health problems.

•Diagnose and investigate health problems and health hazards in the community.

•Research for new insights and innovative solutions to health problems.

Assurance•Assure a competent public health and personal health care work force.

•Evaluate effectiveness, accessibility and quality of personal and population-based health services.

•Link people to needed personal-health services and assure the provision of health care when otherwise unavailable.

Policy development•Enforce laws and regulations that protect health and ensure safety.

•Mobilize community partnerships to identify and solve health problems.

•Inform, evaluate and empower people about health issues.

•Develop policies and plans that support individual and community health efforts.

So how does knowing this impact our health-care system and what are the implications for primary care? The answer is clear: Investments in public-health activities such as chronic-disease management, promotion of healthy lifestyles and prevention of disease on the front end can ease the burden on our primary-care system (and ultimately reduce costs) by reducing the number of people who need medical care.

For example, if our public-health system is effective at prevention, fewer people will smoke and fewer people will be diagnosed with lung cancer; more people will exercise and fewer will have chronic heart disease; more people will eat healthfully and control their weight and fewer people will have diabetes. The correlation is direct, and the results are tangible. But as a society, we must take the long view - these types of changes do not occur overnight, yet they can occur within a generation. We must be persistent and focused. Indeed, to achieve the greatest public-health benefit, we must focus our resources on those public-health issues that we can impact the most.

Public health also is making an impact in not-so-traditional ways. Community planners and public-health professionals are new partners in creating communities that are livable, healthy and sustainable. By developing neighborhoods in ways that encourage walking over driving, that ensure the availability of local healthy food, and that align physical development of property and the associated socio-economic systems with the natural environment, we have not only created a livable community, but we also have planted the seeds of a healthy lifestyle. This is "prevention" of the best kind. Conversations like this are occurring around the country. Indeed, at the recent New Partners for Smart Growth National Conference in Albuquerque, N.M., the correlation between public health and the built environment was an overarching theme. And, of course, public health also is about environmental health (prevention and control of human health problems related to the environment) and emergency preparedness (the responsibility to plan, train and prepare for public health emergencies such as pandemic influenza). Here again, our public-health system is intended to protect against, prevent and control public-health problems, while our medical system treats individuals affected.

Senate Bill 194, enacted by the Colorado General Assembly in 2008, establishes requirements for the State Board of Health, Colorado Department of Public Health and Environment, county government, local public health agencies and local boards of health to ensure statewide and local public health improvement planning. La Plata County has gained a full understanding of the mandates of Senate Bill 194, and we will be sharing with the community soon how we expect to fulfill our obligations to the citizens of La Plata County with respect thereto.

Joelle Riddle is a La Plata County commissioner, a gubernatorial appointee to the Colorado State Board of Health and a member of the San Juan Basin Health Department board of directors.