In my work I have had numerous occasions to collaborate with the chief epidemiologist of the Kent County Health Department of Michigan-Mr. Brian Hartl. Through these contacts and through an introductory epidemiology course I have found that health departments are experts at providing population level health services. This is in contrast to most clinical providers who excel at working with their patients on a face-to-face level. Both staff of physician offices and staff of health departments are concerned with the health of individuals and groups of people.
Clinicians most often work with individuals during face-to-face encounters.
They treat the disease or injury of an individual one at a time. For instance, if a physician is treating a patient with hypertension, she will plan a course of treatment with the individual in mind. If the physician considers the population level in her work, then she is looking at how the treatments and instructions that she provides affect a group of her patients. For instance, she may consider how effective she is in treating her patients with hypertension collectively.
The patients of a county health department are the population of the county. Only in a few instances do health departments treat individuals one at a time. Much of their work would not be considered clinical interventions. However, their work does affect the population as a whole. For instance, health departments are responsible for seeing that food at restaurants is handled and cooked correctly. Health departments track reports of communicable disease to identify potential clusters or outbreaks, such as measles, in order to mobilize the community and physician groups to respond and prevent further transmission.
Can these two health groups benefit each other in improving the health of their patients and, if so, how?
I recently interviewed Brian Hartl about this and he shared some thoughts that I believe can help clinical providers do a better job. As an expert in population level health, Mr. Hartl sees much of his work as preventive in nature. In the emerging world of population level medicine it is important for physicians and other clinical staff to focus on prevention too-prevention of chronic diseases worsening for patients, such as prevention of patients diagnosed with prediabetes advancing to diabetes, and prevention of teen patients from misusing alcohol and other drugs, including tobacco. The Kent County Health Department has many resources that can help physicians achieve their goal and would be very willing to collaborate with clinical groups. In fact, KCHD currently has a grant whose funds can be used to improve patient opportunities for chronic disease prevention, risk reduction or management through clinical and community linkages.
Mr. Hartl believes there is potential to work together with physicians to establish a system for prescribing healthy living activities and lifestyles as non-clinical interventions for the prevention/management of chronic disease. For instance, the Kent County Health Department is actively engaged in helping communities develop walking paths in underserved areas in the City of Grand Rapids. He thinks that patients with chronic diseases can greatly benefit if they became more active by walking. He is willing to share maps and information about the location of such paths so that a physician can prescribe a walking agenda for a patient and then point them to nearby paths that they can easily access.
