commentary
PUBLIC HEALTH AND MEDICINE WORKING TOGETHER
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 col- laboration with medical schools and hospitals; a continual refin- ing of the interface of preventive and curative medicine; the impor- tance 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 recogniz- ing 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 Hell-
erstedt titled “Typhoid Fever on the Half Shell” (pages 39–41) is an intrigu- ing story of detective work. The story illustrates the many components in a sophisticated system that must oper- ate with precision to address simul- taneously a clinical therapeutic chal- lenge and a potential public health threat. There are many clinical and public
health issues represented in this il- lustration, and the role of surveillance and communication through appro- priate and timely reporting can’t be overestimated. From the clinician who diagnoses and orders testing, to the lo- cal, regional, and state epidemiologists who investigate, and, ultimately, to the local health authority who handles the critical response, each plays an impor- tant role. The article shows how com- plex such an investigation can be with involvement of multiple jurisdictions in the process. The case also exemplifies the im-
portance of collaborative and inte- grated efforts on the part of the medi- cal 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 collabora- tion and integration, many other seri- ous and potentially fatal health risks/
We would be wise to heed the importance … of the challenge to cure and prevent many fatal and nonfatal health threats.
February 2017 TEXAS MEDICINE 13
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