Connection Between Health Care and Public Health: Q&A with Eduardo Sanchez
NewPublicHealth spoke with Eduardo Sanchez, MD, the chief medical officer for Blue Cross Blue Shield of Texas and Chair of the Partnership for Prevention, at the AcademyHealth annual National Health Policy Conference in Washington, D.C. Dr. Sanchez shared his perspective on the intersection and potential opportunities for collaboration between public health and health care.
NewPublicHealth: How do you think public health is being redefined now?
Dr. Sanchez: I think the health system needs to be thought of as being made up of two interdependent components—public health and medical care—that traditionally have been thought of as two different systems. The reason is that a high quality, cost-effective health system that is going to achieve optimal health for all Americans, depends on appreciating that “public health” is important for a truly successful effort to optimize health.
NPH: Where does the responsibility lie for making the critical changes needed for public health?
Dr. Sanchez: It is going to take all of us to wake people up to the fact that cutting an interdependent piece of the system is going to make that other part of the system more challenged. We need to explain that better, we need to describe that better. In the 20th century the primary drivers of public health interventions were communicable disease and injury. Now there is a significant shift that must take place as it relates to non-communicable diseases and that is addressing the factors that play into the development of cardiovascular disease, cancer, lower respiratory disease and stroke. Those are the things that are causing the majority of death and disability in our country today.
I think one other transition is that public health doesn't have to mean governmental. It is a set of functions, a set of activities, a set of interventions, a way of thinking about health and disease and preventing disease on the one hand and promoting health on the other. Part of the shift is not only to non-communicable disease but beginning to think differently about who does public health, where does public health live and how we grow the competencies, where they need to be, and again, even more importantly, how we resource those competencies and those activities in a way that they are optimized and in a way that that reduces the demand for medical care that could have been prevented or averted by good upstream health promotion and disease prevention activities.
NPH: What changes, if anything, for public health, if the Affordable Care Act were to be struck down?
Dr. Sanchez: Well, traditionally public health has identified one of its essential functions as linking individuals with the resources that are needed to address individual medical care needs. If the Affordable Care Act was struck down, that function would rise in priority compared to where it might be otherwise. There will always be individuals who, for one reason or another, are not tied to individual medical care, whether it be because their citizenship status is unclear, or they’re in transition, or dealing with a severe mental illness and they require very intentional linkage.