The issue of public health

In 2005, the College of Family Physicians of Canada released a discussion paper entitled “The Role of the Family Doctor in Public Health and Emergency Preparedness.”1 In this issue of Canadian Family Physician, several articles provide further insight into the opportunities and importance of collaboration between family medicine and public health.

Highlighting the role of public health in family medicine in Canada, Russell and McIntyre ( page 1102) found that 1693 (15.3%) primary care physicians responding to the 2004 National Physician Survey (NPS) identified public health as one of their areas of practice. While the NPS doesn’t provide any further details about the public health aspects of respondents’ practices, several examples and insights are outlined in this issue.

Sikora and Johnson ( page 1061) describe several situations in which family medicine and public health interface, such as in recognizing outbreaks, identifying adverse environmental exposures, and implementing strategies to increase the provision of preventive services.

While Romain and Schillaci ( page 1104) remind us that the delivery of immunizations is often shared by public health and primary care providers, Visscher et al ( page 1071) illustrate the importance of coordinating public health and primary care. The authors argue that efforts to discourage clinicians from prescribing ophthalmic antibiotics to treat conjunctivitis are being negatively affected by public health policies.

Levitt and Lupea (www.cfp.ca) describe Cancer Care Ontario’s primary care and cancer engagement strategy, which was initiated in part to improve the capacity of primary care practices to participate in and strengthen colorectal screening. The authors share an important insight: “No individual partner alone understands the culture of the other, and only by working together in a mutually respectful manner will effective changes be implemented.”

What then is known about the cultures of public health and primary care? As Sikora and Johnson point out, the functions of public health can be separated into 6 key domains: health protection, health surveillance, disease and injury prevention, population health assessment, health promotion, and disaster response. They also remind us that “Family medicine, at its core, requires physicians to be resources for their practice communities, as well as for their individual patients.”

In their text, Hill et al2 discuss the importance of understanding the contrasting but complementary nature of the 2 disciplines: public health practitioners serve populations via the organized efforts of society, using epidemiologic and statistical tools to inform interventions, while FPs provide clinical care to individual patients, using medical and technical interventions and guided by clinical training and knowledge of local patterns of disease.

The 2003 SARS outbreak and the current H1N1 pandemic understandably highlight the importance of and need for collaboration between public health and primary care to prepare for and respond to infectious disease emergencies. This issue of CFP builds on several previously published articles3–5 to further emphasize the potential breadth of opportunities for interaction and overlap. Consider the following:

• Primary care is an important channel through which public health initiatives are delivered (eg, screening, immunizations, counseling, health education).

• Primary care is a key front-line “window” to identify public health threats (eg, disease outbreaks, environmental health exposures), enabling initiation of public health strategies (eg, tracing contacts of patients with communicable diseases, environmental investigations).

• Public health organizations provide expertise and support to primary care (eg, potential rabies exposures, pandemic preparedness and responsiveness) and services to which FPs might refer their patients (eg, maternal and child programs).

• Primary care is a source of clinical expertise (eg, able to provide clinical services at public health clinics and pandemic influenza centres).

• Primary care and public health professionals collaborate with other partners to advocate for healthy public policies (eg, banning smoking in public places, mandatory seat-belt use, drinking and driving legislation).

Canadian Family Physician plans to heighten its focus on family medicine and public health. Your suggestions for topics, submission of manuscripts, and public health questions are welcome.

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