Adonis Diaries

Clinical medicine versus public health? What Dr. Bechara Choucair said?

From the Commissioner of public health of the city of Chicago in his Commencement Address at Feinberg School of Medicine at Northwestern University on May 4, 2011

Any intersection between clinical medicine and public health?

Clinical medicine and public health are often seen separate.

We often understand these two words as different disciplinary silos in which many of us spend entire careers. Ted Schettler, the Science Director of the Science and Environmental Health Network, frames both disciplines with respect to focus, scale, ethics, education and the nature of the science.

1. Focus: Clinical medicine focuses primarily on the individual, while public health focuses on the community.

2. Time frame: Relevant time frames in Clinical Medicine are usually single lifetimes, while public health thinks in terms of generations.

3. Ethics: From an ethics perspective, clinicians advocate for individual people. Public health practitioners advocate for the community, for a group of people.

4. Rights: In clinical medicine we focus on individual rights of a patient. In public health, we think about human rights, social justice, and environmental justice.

5. Education: From an education perspective, in clinical medicine we focus on the biomedical model with more emphasis on cure than prevention (although this is shifting now). In public health, we learn more about sociology, epidemiology, cultural anthropology, economics and more.

Think for a moment about the evidence of the science.

In clinical medicine we love to talk about controlled, double-blind clinical trials. We don’t find that type of approach often in public health.

Clearly, there are differences: differences in focus, differences in scale, differences in ethics, differences in education and differences in the nature of science.

But the reality is that the health of the individual and the health of the community are inter-related and inter-dependent. Maintaining two disciplinary silos is NOT the answer.

Bridging the gap is critical if we are serious about improving the quality of life of our residents.

Bridging the gap starts with education.

We have to enhance the understanding of public health principles among our students in the clinical field and we have to enhance the understanding of clinical medicine principles among our public health students.

Bridging the gap happens in research. We have to expand our research portfolio to focus on health disparities and other population level research.

Bridging the gap will not be successful unless we translate what we learn in research all the way into public policy.

And finally, it is people like you, like the faculty here and like me, who will take the lead in bridging this gap.

The good news is that here in Chicago, there are great people who have done great work in bridging this gap. I am forever grateful for their contributions.

At the Chicago Department of Public Health, we are exploring how to fully exploit the intersection of public health and medicine. We are excited about having the opportunity to use, as the foundation of such efforts, the proliferation of HIT initiatives, particularly in under served communities.

A major federally-funded initiative to help us achieve this goal is CHITREC, housed here at Feinberg and funded through stimulus funds (American Recovery & Reinvestment Act).

CHITREC (Chicago Health Information Technology Regional Extension Center) provides technical assistance to primary care providers serving predominantly uninsured, under insured, and medically under served populations in developing an Electronic Health Records system that will improve health outcomes.

CHITREC is collaboration between Northwestern University and the Alliance of Chicago Health Center Services, a health center-controlled network. It builds upon extensive collective Electronic Health Records implementation and clinical informatics experience.

We anticipate that as the participating providers come on line, there will be wonderful opportunities to use the wealth of data available through an Electronic Health Record to measure population health and be able to pinpoint where particular interventions are needed to improve outcomes.

Other federal funding, including the 2010 Patient Protection and Affordable Care Act, has provided additional opportunities for investments in the electronic data infrastructure supporting population health. Chicago Department of Public Health (CDPH) is positioned to become a leader in the public health applications of Health Information Technology. Current CDPH activities include:

•  Funding of 26 acute care hospitals in Chicago to assist in their efforts toward establishing capacity to transmit data of public health significance to CDPH;
• Partnering with the Centers for Disease Control and Prevention (CDC), GE Healthcare and the Alliance of Chicago in a pilot evaluation the feasibility of targeted, pubic health-oriented clinical decision support for ambulatory providers, delivered at the point of care through Electronic Health Records;
• Supporting Stroger Hospital of Cook County and two major Federally Qualified Healthcare Center (FQHC) networks (ACCESS Community Health Network and the Alliance of Chicago) in their efforts to establish robust transmission of immunization administration data to the Illinois immunization registry;
• Engaging with the Illinois Office of Health Information Technology in statewide efforts to build a sustainable Health Information Exchange (HIE);

Feinberg PPH: Commencement Address given by Bechara Choucair, May 4, 2011

Note: Dr. Bechara Choucair is Commissioner of public health of the city of Chicago.  I liked his Commencement Address at Feinberg School of Medicine at Northwestern University and decided to publish the speech and three sections of the speech on wordpress.com.

This speech covered all the grounds and it is impressive.  I found it acceptable to edit out sentences that are not closely related to the subject matter in order to shorten the message.