INSIGHT & INSPIRATION FROM APHA’S 2012 MIDYEAR MEETING

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26 Survive All In This Friends Prevention, Strategies & Thrive Together For Health Opportunity & Equity for Health Bringing Health Care Into the Fold In 2000, an Institute of Medicine report stated: “It is unreasonable to expect that people will change their behavior easily when so many forces in the social, cultural and physical environment conspire against such change.” Larry Cohen, executive director of the Prevention Institute, couldn’t agree more. During his Midyear Meeting presentation, Cohen talked about an emerging approach to improving health known as community-centered health homes. The approach grows out of the fact that medical care alone cannot solve the nation’s health problems or close disparity gaps, nor is medical care the primary determinant of a person’s health. Public health practitioners must help health care providers recognize and address the broader contributors to poor health, injury and disease. “This is really the first time that we intentionally said ‘How do we bridge prevention and health services,’” Cohen said. “And we did it, frankly, from the perspective that health care has most of the resources, most of the credibility, most of the weight in our health system, and if we want to focus on health, not health care, it must be done as a very thorough partnership.” In 2011, the Prevention Institute published “Community-Centered Health Homes: Bridging the gap between health services and community prevention,” which outlines how community health centers can offer quality care while also addressing the roots of patients’ health problems. Cohen told attendees he was surprised at the level of enthusiasm the concept received from the health care community, noting that “we need medical participation to make things fair and that’s why the environment is a key opportunity for prevention.” In other words, changing people’s environments must be part of a physician’s role too.
27 Survive All In This Friends Prevention, Strategies & Thrive Together For Health Opportunity & Equity for Health Cohen said that clinicians’ existing skills set — patient intake, diagnosis and treatment — can also be applied outside the clinic doors to community prevention, which requires inquiry, assessment and action. Clinicians already engage in inquiry (in medical terms, cataloguing symptoms and vital signs; in public health terms, gathering relevant data); assessment (in medical terms, diagnosis; in public health terms, measuring community conditions); and action (in medical terms, treatment; in public health terms, engaging in work to change community conditions and create opportunity.) Understanding the link between a person’s health and their environment means taking two steps back, Cohen said. For example, in addition to prescribing medicine for a patient with a stomach ailment, a community health center clinician should also take two steps back by inquiring about underlying behaviors and then what environmental factors contributed to that behavior. “We can speak up for community change,” Cohen said. From sessions 2002/2007, Best of Partners: Reconnecting Public Health and Clinical Care, June 27 John Auerbach, 2010–2011 president of the Association of State and Territorial Health Officials STEPS FOR ACTION: • DON’T be wary of approaching the private sector. Their familiar brands, not to mention financial resources, can be a real boost for public health goals. • EMPOWER organizations and residents with the tools and data to take ownership of their communities’ health. This strategy will also increase the chance that efforts will sustain over the long term, despite the ups and downs of funding. • ADVOCATE for new models of clinical care that take into account a patient’s life outside the doctor’s office and utilize a populationbased approach to health and prevention.
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INSIGHT & INSPIRATION FROM APHA’S 2012 MIDYEAR MEETING

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