CDC Leaders: Time to Integrate Public Health and Health Care Delivery

Last month a team of leaders from the federal Centers for Disease Control and Prevention (CDC), including CDC Director Mandy K. Cohen, MD, published an “Perspective” article in New England Journal of Medicine calling for the integration of public health with health care delivery within the US health care delivery system. That team included Drs. Cohen and also Charlene A. Wong, MD, MSHP, who is senior advisor for health strategy at CDC, and Debra Houry, MD, MPH, who is chief medical officer and deputy director for program and science at the agency.

And, writing under the headline, “Integrating Public Health and Health Care—Health Protection as a Team Sport,” on April 10, the three CDC leaders state that “Health care is a team sport—yet the systems that aim to advance This goal has been long overdue. The United States needs an integrated system that protects public health—a system that goes beyond the capabilities of the Centers for Disease Control and Prevention (CDC), health departments, and public health. ‘traditional’ Indeed, the three physician leaders state: “The healthcare sector is on the front lines when it comes to the prevention and treatment of acute and chronic conditions. Clinicians have trusted relationships with individual patients and use clinical findings to address current and potential future health issues, while the field of public health provides data and promotes evidence-based interventions to protect and advance health in communities. Public health monitoring of health threats also allows for early detection and containment of outbreaks,” they said.

Indeed, they note, “Public health-care partnerships can also improve the delivery of routine care. For example, perinatal quality partners are a critical form of public health infrastructure in many states and contribute to quality improvement efforts in obstetrics by providing maternal health data to health systems and supporting collaborative systems-level change. These partnerships have improved treatment times for severe maternal hypertension at participating hospitals in Illinois and increased the proportion of babies born at full term by reducing early planned inductions and cesarean sections at participating hospitals in New York.

The article’s authors cite three areas in which they believe the entire health care system needs to take action: first, around data sharing; second, about harmonizing priorities and sharing investment in resources in both public health and health care delivery; and third, about the sharing of responsibility and accountability across sectors of public health and health care delivery.

For the former, they write that “[R]The real-time, two-way distribution and use of public health and healthcare data is critical to facilitating preparedness and responses to emerging health concerns. Substantial progress has been made during the Covid-19 pandemic. Now, 78 percent of emergency departments (EDs) are sending real-time respiratory syndrome data, such as data on cases of influenza-like illness, which allow the CDC to monitor for unusual domestic trends – as we did in autumn 2023 for Mycoplasma pneumoniae, after cases were reported internationally.” However, despite this progress, they noted, “Only 33 percent of health care facilities send automated electronic case reports of reportable conditions to public health agencies. CDC efforts are underway to further standardize and improve this work for all facilities,” they noted.

In the meantime, they urge the public health and healthcare sectors to “identify aligned priorities and make joint investments. “Covid-19 was a single common enemy and a generational challenge that accelerated the formation of public-private partnerships and led to significant investment in infrastructure,” they emphasize. Now, “Covid-19 is now just one of many major health threats that sectors must respond to together. Strong integration of public health and health care data can inform priorities for joint investment in prevention, management, and control efforts at all levels of the health system. CDC is prioritizing promoting preparedness and response to health threats by making investments in critical data, laboratory, workforce, and response infrastructure; combating the US overdose and mental health crises; and supporting young families. Our agency is leading multiple collaborative efforts with healthcare partners in these areas,” they emphasize.

Finally, they say: “[W]Working as a team to protect health requires clear roles and responsibilities and shared responsibility. The table outlines the roles and responsibilities for the public health and health care sectors in addressing key public health threats. There are multiple paths to sharing accountability, all of which will require agreement on success metrics. Implementation of prevention-oriented quality measures (eg, screening for cervical cancer, lead exposure, or clinical depression) is a mechanism for supporting shared responsibility. Providing incentives or setting requirements for participation in data integration activities is another. Finally, new payment arrangements and flexibilities can bridge sectors by covering community-based prevention programs (eg, school mental health support) or by rewarding improvements in population-level outcomes (eg, school-based mental health support). , the Medicare Shared Savings Program or the Agency for Advanced Research in Health Care Awards to Achieve Improved Outcomes program).

The article’s authors acknowledge that “Protecting the health of every person in every community in the United States will require action now and a sustained focus on public health and clinical care. Beyond broader public health–healthcare partnerships, a team-based approach to supporting the health of communities and addressing broader drivers of health may involve social services, academia, industry (eg, employers and technology and media companies) and global partners. Ultimately, they conclude, “Investing in strong relationships and taking action together to protect health can better prepare an integrated health system to respond to the next major health emergency and improve health and well-being.” everyday life of the population”.