The public health we may have lost in population health.

This post from the World Health Organization caught my eye. The leading causes of child (< 5 yr) mortality are: preterm birth complications, pneumonia, birth asphyxia, diarrhea and malaria.  If we could provide access to basic primary health care, including prenatal care, and simple public health measures – mosquito nets, clean water and nutritional supplementation – the rates of those conditions would be slashed.

WHO/C. Gaggero

This sad state of affairs gets replicated here in the US, but it looks weird because of our relative “development” status.  In my practice, I see lots of what’s well-described in this review article: the intersection of food insecurity, obesity and diabetes.  The widespread availability of sugar and fat (and salt) – access to which have traditionally been regarded as the rewards of wealth and achievement – now are the instruments of disease in those than cannot afford to eat better.  The upstream solution to this odd, new disease pattern lies in better nutrition, better food policy, less poverty, etc…not new diabetes medications and gastric bypass surgeries.

We’re learning lots about “population health” in many of our health systems – reaching out to non-attenders in our practice, looking at broad trends, using data and applying technology – all interventions which spring from the traditions of public health but are applied at the behest of our “insurance company partners.”  Is that wrong?  No.  These populations deserve care the best care also.  However, I worry that the focus on the paying customers had distracted us from (or we have chosen to ignore) the core principles of public health – care for those regardless of payor (or lack thereof), health policy that can ensure access to comprehensive primary care, and public health interventions that reach whole communities.

I’d like to bring more public health back into our population health.