What is "public health" anyway?
One way to look at life is the clinical approach: we see a new stream of urban gunshot victims coming into the Emergency Room, and decide to do things like:
- Expand the ER
- Add staff
- Develop a specialty in treating gunshot wounds
- Improve communications between the ambulance and ER
Then we ask the annoying question that parents and teachers often discouraged, "Why?", five time more after that to get to the root-cause, and find a place we can intervene that has "leverage". The problems often spring from culture, beliefs, society, industry, economics, and other issues. Unless those are fixed, we're just fixing symptoms and the root problem may get worse.
The illness we are treating is the tendency of society's members to shoot each other, not the wounds themselves. The point is that if we can put out the fire, it will stop the smoke.
These days, the problems hospitals have are more often too many patients, not too few, and the interests of public health and clinical health coincide. If half as many people got shot, or got sick, then the hospitals would have capacity to deal with the others more promptly, and get rid of 3 month delays for surgery. There would be room to treat those we currently leave in the gutter, figuratively or literally, as a society. It would be a win-win.
The current president of the American Medical Association has a specialty in preventive medicine, and understands this overlap -- which has not always been true in the past.
Which one is more important? They're both more important, just on different scales. Life has different levels, and a good solution to a problem will address them all. We need clinical doctors to fix individuals, and public health to fix societies. They both matter.
It doesn't matter which end of the boat we're in has a hole in it -- we need to fix the hole. Right now, there are holes at both ends.
Wade
No comments:
Post a Comment