Public Health and Primary Care: Transforming the U.S. Health System
Murray, Linda Rae, The Nation's Health
IN THE United States, primary care remains a medical model. This is in contrast to much of the world, where the 1978 Declaration of Alma-Ata--which recognized that attaining health for all also requires interaction from social and economic sectors--is considered standard. Today, there is much buzz about patient-centered medical homes, a concept that promises to transform the practice of American medicine.
There is much to praise about this most recent iteration of the medical home. But the missing ingredient in all these definitions and models remains public health. A population focus that addresses the social determinants of health is an essential component of primary health care. In the United States, such a comprehensive approach has been labeled community-oriented primary care. This model is built firmly on the Alma-Ata principles and incorporates a public health approach to health services.
Community-oriented primary care organizes the delivery of health services, around a population, not simply a collection of individuals. It identifies a population--most frequently a geographically defined community--and uses epidemiology and interventions to improve community and individual health and well-being. In this model, both individual patients and the community are the foci of the delivery of health services.
Primary health care stands at the intersection of personal and population health services. It requires integrating medical models of primary care that are centered on the individual with public health models of community health that are organized around the needs of the population. …