During this millenium, the disasters related to Hurricane Katrina in 2005, and epidemics of SARS and H1N1 influenza brought the nation’s public health infrastructure into the evening news front stories. The health reform legislation before Congress addresses some national needs, but remains silent on others.
Richard Clover, MD, Dean of the University of Louisville’s School of Public Health and Informatics, will provide another insightful discussion of the state of the public health system in the United States at the Twenty-first National Conference on Primary Health Care Access.
Dr Clover, a fellow of the National Conferences, surveys the nation’s principal public health needs, and assesses the extent of progress towards addressing those needs provided by current legislative effots.
Doctor Clover will be joined in an extended discussion with two Senior Fellows of the National Conferences, Doctor Marc Babitz or the Utah Department of Health and Doctor Charles Q. North of the University of New Mexico School of Medicine.
Doctor Babitz, taking note of the Massachusetts experiment with universal requirements for health insurance, will argue that solving the financial barriers for many individuals through the reform proposals will not decrease the demand for traditional public health services such as surveillance, preparedness, care of special populations, and preventive health programs. In addition, the reforms being discussed appear to do very little to address the major manpower issues in health care, including the public health workforce.
Doctor North will detail new directions in physician training at the University of New Mexico, particularly a newly designed curriculum in public health. The UNM effort will incorporate a BA/MD program to expand the medical school from 75 to 100 students this year.
A feature of the revised medical curriculum will be an integrated Certificate of Public Health curriculum which we will start with the 2010 entering class to provide 17 mandatory hours of public health training for all UNM students. This is a rare example of integrating traditional medical school with public health training. The hope is that it will help meet the needs of New Mexico for primary care doctors in rural and underserved areas and address public health needs better.
Training students and residents in classic public health concepts, especially epidemiology and the social determinants of health will be more important to reach equity. New physicians will need to develop advocacy and policy sophistication to improve population health as well as providing acute and chronic care to individuals.
Doctor North argues that training in clinical effectiveness is more important given the steadily increasing cost of care and the overutilization, over-diagnosis and over-treatment that the current fee for service medical industrial complex fosters. Physicians will increasingly need to develop teams in the practice and partners in the community to be effective personal care clinicians and community advocates. It will be necessary to adopt the principles of the patient centered medical home into chronic care training. Improved data basis using epidemiology and GIS will provide focused community specific data and allow rapid prioritization and measurement of interventions allowing for improved performance in primary care.
Incentives to teach, research and publish in the Community Health Center setting with academic partners will need to be developed. A major barrier to care in the CHC setting will continue to be the high cost of hospital care and limited access to resources that the CHC cannot cover for the uninsured who will surely continue to use CHC care disproportionately. Community hospital partnerships and new mechanisms of payment will need to be developed and pursued with cities, counties, states and the federal government at a time of deficit spending and uncertain tax revenue.