Academic journal article Public Health Reviews; Rennes

The Interaction of Public Health and Primary Care: Functional Roles and Organizational Models That Bridge Individual and Population Perspectives

Academic journal article Public Health Reviews; Rennes

The Interaction of Public Health and Primary Care: Functional Roles and Organizational Models That Bridge Individual and Population Perspectives

Article excerpt

INTRODUCTION

Public health and primary care are often understood to be two entities providing complementary services within the health system, given that both ahn to address health problems that are coimnon in communities.1" Public health may be defined as "the art and science of preventing disease, prolonging life and promoting health through the organized efforts of society"1 and includes activities encompassing all organized efforts to promote, protect and improve, and when necessary, restore the health of individuals, specific groups, or populations.2 Its functions mainly focus on population-based services and include surveillance and analysis of the population's well-being, including health status and detenninants; health protection and the control of risk factors and diseases; prevention of diseases, injuries and social problems; promotion of health and well-being; the development and implementation of regulations, legislation and public policies that have an impact on health; research and innovation, including production, dissemination and application of scientific knowledge; and development and maintenance of skills and competencies.5 Other suggested functions include aid in the planning of services and evaluation of their hnpacts from a population perspective,6 7 supporting coimnunity participation, and ensuring equity in access.8

Primary care is described as the first point of entry into the health care system. It is responsible for the provision and delivery of first-contact, person-centered, longitudinal, comprehensive, and coordinated care.911 Primary care represents one of the health sectors, alongside public health, that interacts regularly with the majority of the population. Depending on the local context, it often includes disease prevention and treatment of coimnon diseases and injuries, screening and early diagnosis, treatment, and palliative care. A well-developed primary care system creates benefits in terms of population health, with the reduction of avoidable morbidities and mortality, and hospitalizations.12

Despite the fact that public health and primary care are often con- ceptualized, organized, and funded as two separate entities, there is an emerging consensus that strengthening primary care can support some public health functions and that public health can in return enhance the provision of population-wide primary care. A health system based on a strong primary care infrastructure and a strong public health sector, each with carefully defined complementary roles, appears necessary in order to achieve the optimum health of the population and individual patients.3

This perceived need for increased interaction between primary care and public health takes root in epidemiological, economic, and technological change. The rise in chronic non-communicable diseases generates health problems that are relevant for both sectors. Prevention, early detection, treatment and management of chronic diseases and risk factors in aging populations therefore requires increased collaboration between primary care and public health. Escalation of health care costs are forcing stake- holders to explore innovative ways to increase efficiency and value for money.3 Therefore, the need for prioritization implies recognition of the respective contributions of public health and primary care in providing services that respond to local needs. This is consistent with evidence that indicates that increased performance of primary care (e.g., enhanced access to care, increased utilization by underserved populations, unproved primary care infrastructures) reduces health care costs through improvement of health outcomes and reduction of health disparities.13 Finally, advances in genetic, diagnostic, therapeutic, and information technologies generate greater capacity to identify health problems and individualize treatments. These processes require a better understanding of the epidemiology of disease and the impact of the organization of services. …

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