HJBR May/Jun 2023

24 MAY / JUN 2023 I  HEALTHCARE JOURNAL OF BATON ROUGE The Intersection of Public Health and Medicine Thank you all. It’s great to be back home and to see many of my classmates here. It’s interesting [the intersection of public health and medicine] because when I was thinking about my journey and how I ended up with public health and clinical medicine, I think a lot of us with our work in NewOrleans have the same spirit. We’re very familiar [with this intersection], particularly my class hav- ing been at Charity Hospital, where you’re on the front lines and seeing all the oppor- tunities to intervene early on. I think that’s really that community service and seeing the patient but also the population. Today, I want to talk about some of the work we’re doing at CDC with a hope that all of you will see a part of the work that you do in this and be able to bring it back to your communi- ties as well. When you talk about public health versus clinical medicine, it’s certainly easy and sim- ple to say the difference is a patient versus the population; but it’s certainly more com- plex than that. Public health, you can say, could be more of a focus on global popula- tions, regional populations, or having differ- ent sectors at the table. Also, I think really focusing on things like upstream factors and how do you prevent things or reducing exposures. Whereas in clinical medicine, the focus largely does tend to be, although on individual patients, interprofessional teams looking at at-risk or established diseases. When you look at the many differences between the sectors, public health, health- care systems, and clinical medicine are all interrelated (See Image 1). Using data to drive action, we know that prevention works to protect health. Simple things like access to clean drinking water can prevent illnesses like diarrheal diseases. Things like a helmet can prevent traumatic brain injuries, and hand washing can reduce the spread of things like respiratory illnesses. Something that I hope all of you take back, too, is that given the direct relationships that clinicians have with patients, you play a critical role in being a trusted messenger regarding pub- lic health. Clinicians also have a role in preventing misinformation from spreading, as do all of you. That is something that I have wit- nessed unfold over the past two years. As public health, community health workers, all of us in the field, we have a role to be that trusted messenger and to prevent misinfor- mation. Right now, we have a critical role to play when we’re talking about vaccines such as the COVID bivalent and being up to date on vaccines. If we’re doing a good job, it often goes unnoticed; and that’s OK. What it means is we were able to prevent an issue from hap- pening in the first place or to keep it from progressing. Looking at different levels of prevention, like primary prevention when you’re talk- ing about something like drug overdose — starting somebody from misusing in the first place, looking at things like childhood trauma and how you can intervene early. Taking it to the next level of secondary pre- vention — maybe if somebody’s coming to see you, you give a low-dose opioid pre- scription and not a high-dose or linking somebody to treatment. Tertiary would be naloxone overdose prevention where some- body is already experiencing disease, and you’re preventing the long-term sequelae. One example that I think is really pow- erful is talking about adverse childhood experiences (ACEs) (See Image 2). To me, this is primary prevention — as basic as you can get. Looking at things that happened to children such as abuse in the home, whether it’s physical, sexual, or emotional, but also witnessing violence in the home or experiencing a family member with mental health issues or somebody who’s incarcer- ated — these are considered childhood trau- mas. More than half of the adults in the U.S. have experienced one in their lifetime, and one in six have experienced four or more. When you look at how this has a cumula- tive effect on health, what you see is that the more ACEs you have, the more likely you are to have these chronic health conditions; Image 1 Source: Hunter, D.J. “The Complementarity of Public Health and Medicine — Achieving ‘the Highest Attainable Standard of Health.’” New England Journal of Medicine. https://www.nejm.org/doi/full/10.1056/NEJMp2102550