Adonis Diaries

Posts Tagged ‘public health

Re-inventing Public Health: Covid-19 inequity

COVID-19 and inequity — public health needs a third revolution

For many Americans, George Floyd’s murder ignited a new level of momentum to confront police violence against people of color.

The COVID-19 pandemic — which is killing black Americans at nearly two and a half times the rate of whites — has put a spotlight on our nation’s shameful racial divide in public health.

While the first and second public health revolutions vastly extended life expectancy by making strides against communicable disease (cholera, typhoid and dysentery) and chronic illness (heart disease and diabetes), racial gaps (and minority ethnic groups) remain a persistent contributor to negative health outcomes.

In a nation with growing economic disparities, scarred by centuries of systemic racism, the third revolution in public health must address the root causes of our remaining pervasive health inequities — poverty, pollution, housing, food security and other basic needs.

Since our systems have resulted in these issues disproportionately impacting communities of color, we need to conceive, develop and implement solutions that prioritize the wellbeing of people and communities that have been overlooked for far too long.

COVID-19 and inequity — public health needs a third revolution

It’s a daunting task, to be sure. But, with an approach I call precision community health, we can target our limited resources to be effective at addressing the most urgent public health inequities, while also supporting the eradication of racism throughout our society.

Investment is needed in public health systems, including state-of-the-art data collection and communications tools.

With these we can collect granular data on everything from asthma rates to housing conditions and police violence, broken down by race and income.

That data can then be transformed into knowledge to guide decision-making.

We can leverage social media and other communications strategies to deliver precisely targeted messages to ensure people have information they need, when and where they need it, to make informed decisions for themselves and their loved ones.

We can also invest in people by creating a national Public Health Corps, similar to AmeriCorps.

Recruitment could start with our country’s community health workers, our invaluable set of frontline public health workers who are already trusted members of the communities we serve today.

But importantly, these workers’ expertise and training can also build equity in communities today, by linking people to resources on housing, food security, employment and more.

Community health workers are also uniquely positioned to have an immediate impact on the spread of COVID-19 by performing the critical task of contact tracing — reaching out to those who test positive for COVID-19, helping them identify others they may have been exposed, then supporting them through quarantine and testing.

For any of our efforts to succeed, we must account for and honestly confront the distrust many people feel in our public institutions.

In this time of massive societal upheaval, we have a tremendous opportunity to shift our focus and resources to fully embrace public health solutions. But our field will need to reckon with our own painful history of systemic racism to realize our full potential.

If we are to continue making the breakthroughs that improve and extend lives as public health has done for decades, we must embrace the moment we are in.

It’s time to rethink public health by understanding the inequities that are making people sick and targeting resources where they are needed most.

Bechara Choucair, a family physician by training, was commissioner of the Chicago Department of Public Health from 2009 to 2014.

He is currently senior vice president and chief health officer at Kaiser Permanente and author of “Precision Community Health: Four Innovations for Well-being.”

Note: My Daydreaming health re-structuring project https://adonis49.wordpress.com/2011/12/17/daydream-project-restructuring-medical-and-health-care-providers/

 

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.

Obama-metrics: What to expect?

In the previous two posts I enumerated the promises of Barack Obama campaign promises and how to rebound. Bill Adair (Pulitzer Prize) published the Obama program that included 510 promises. Promises being executed are 240 promises, 86 promises were kept, 26 were compromised, and 62 were blocked by the oppositions.

            Russell Banks reported the restrictions of the US political systems on the initiatives of President Barack Obama campaign program.  The US system is Not democratic for two reasons: First, in a democratic system the leader of the winning party is the leader of the nation and it is the way around in the US except when the President is running for a second term: Once a President is elected then his party appoint him leader of the party. Thus, the President is controlled by the heavy weight politicians and administrators of his party.  Actually, the President is not elected by the majority of popular votes but by the delegates of the States.  There are many instances when the majority of the popular vote was defeated (Bush Junior is the most recent example)

            Second, even if the winning party has majority in the Senate, any text of law needs 60 out of 100 Senators to agree on reading a text.  A Senator from Nebraska has as much power as the one representing New York State. Thus, the President is constantly managing the heavy weight politicians and Senators of his party to passing any law before even negotiating with the opposing party.  Anything in the US to get moving needs frequent popular active pressures on the Senators of the States of both parties to reaching a law favorable to the neediest: a Senator has to realize that financial backing by lobbyists cannot counter balance the angry voters.

            The US is a Republic trying for a century to becoming a plutocracy (run by the heavy weight politicians and lobbyists); the US political system might get there if Obama fails to capitalize on his landslide victory. We can understand why for a century the successive Administrations did their best to alienate people from getting involved in politics by making the political process more complex and by extending activities that shun people away from politics such as sports and entertainments.

            In a bipartite system it is the center that is the determining factors; mainly the economic and internal policies. Obama shifted the center a bit to the left by moving from total privatization concept that began 40 years ago to involving the Federal government.  Obama re-appointed the culprits of the financial disaster such as Timothy Geithner, Lawrence Summers, Peter Orszag, and Ben Bernanke; all of whom coming from Wall Street related institutions. For example, the Administration refrained from selecting among the syndicate leaders, militant associations, intellectuals and university professors. It seems that Obama started with a high dose of confidence in the authority of the richest class in matter of financial and economic management.

                        Obama managed to bring public opinion around the classes that need more attention and care or what is more likely, it is the American people that opened Obama eyes to new realities and he grabbed the opportunity. If the public was not convinced that banks, lobbyists, and multinational financial institutions are pure robbers of their public wealth then Obama could not have won with such a landslide.

            So far, Obama was successful in forging ahead and putting in execution many promised reforms of his program announced during his campaign trail by shear momentum: The public that supported him failed to get on the move; thus, Obama had to relent and bend before the opposition public activities before launching new “controversial” initiatives. The new public health program added 30 million more citizens but it is to kick in by 2013.  More citizens are demanding and expecting to witness a Presidential will for stringer regulations and control on the banks and multinational financial institutions.

            Unfortunately, in foreign policies Obama is playing the traditional and exhausting Washington provincial game that requires internal consensus: Obama is resuming the traditional strategy save in his rhetorical ability in the selection of words, tones, and style.

            Obama did not prove to the public that he exercised good imaginative alternatives to redressing the financial and economic crisis.  Obama has to remind the public that he is the victor so that the public may extend him voluntary rights to guide the nation against the many political restrictions that are erected against public opinion pressures.  For the time being, if you inhale deeply then you realize that US policies didn’t make a qualitative dent for long-term reforms.


adonis49

adonis49

adonis49

October 2020
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