Although a little slower, technology has paved the way for public health, along with other areas of health, and offered new solutions to promote community health. Now, with the spread of the corona, this trend has accelerated. Corona showed that although we have made significant progress in drug production and infection control in recent decades, microbes may still be found that we cannot easily control. A pandemic of a contagious viral disease reminds us of the importance of basic levels of health and care .

 

Public health and population health

Public health, also known as public health, is the science and art of disease prevention, longevity, and health promotion through organized efforts and informed choices by communities, organizations, public and private communities, and individuals. In other words, public health is the knowledge of caring for and promoting the health of people and their communities. Achieving this goal is achieved by promoting a healthy lifestyle, studying diseases, injury prevention and diagnosis, prevention and response to infectious diseases .

For several years, in addition to public health, another concept called population health has been defined. Although the two concepts are very close and it is difficult to draw a clear line between them, it is not without merit to know the health of the population .

Population health focuses on recognizing the conditions and factors that affect community health throughout their lives. It also examines the pattern of occurrence of health problems and suggests appropriate interventions and policies to maintain and promote community health .

 

What are the components affecting health?

Factors affecting health can be defined at both individual and social levels. At the individual level, there are unique and unchanging traits such as genetics, age and gender .

Access to healthy water and food, knowledge and education, access to health services, employment, occupational safety and health, poverty, etc. are social factors affecting health. The World Health Organization defines social components that affect health (SDH) as the conditions in which a person is born, grows, lives, works, and ages. Individual factors are only responsible for 10 to 20% of health, and the rest is determined by social factors. This 80% can be divided as follows :

• 40% socio-economic conditions;
• 10% physical environment;
• 30% of health behaviors .

Public health has a holistic approach to health and, along with the individual level, considers all three mentioned social levels important and strives to improve all of them .

 

Why is public health important?

Society is made up of individual people, so to have a healthy society, the health of all people must be taken into account. Even by providing the best services to patients referring to health centers, it is not possible to be sure of the health status of the community. What public health emphasizes is paying attention to people before the disease occurs. Public health has an action-oriented approach, not a reactionary one .

The importance of this issue is better determined by considering the increase in life expectancy and the increase in the incidence of chronic diseases. Whereas until a hundred years ago, the main concern was the occurrence of infectious and acute diseases, now people face health conditions that accompany them for the rest of their lives and, if managed properly, may not affect their quality of life .

Another issue is the impact of individuals on the health of society as a whole. This issue became clearer with the spread of coronavirus. In an infectious disease epidemic, any person can continue or break the chain of transmission. In these cases, the level of knowledge and culture, financial status and living environment of the individual, in addition to determining his own health and the likelihood of his illness and recovery, affect the health of those around him and even society as a whole .

Another reason for addressing public health and population health is health costs. The health system is one of the most costly components of governing any country. Therefore, countries aim to reduce health costs while maintaining the quality of care. "Prevention is better than cure" and one of the reasons is that preventive measures cost less than therapeutic interventions .

 

Prerequisites for public health innovation

There are prerequisites for implementing public health policies in the community and promoting community health .

A culture of holistic care

During their studies, medical students become familiar with the concepts of holistic and societal medicine. The holistic and sociologist knows that in his actions he should not be satisfied only with the patient's complaint. He must look at him as a whole and consider all aspects of a person's existence. He also knows that he must consider social and cultural factors that may affect his understanding of health, his access to care, his adherence to treatment, and so on .

However, when the overall approach to service delivery is not in line with this, these lessons are not being implemented in practice as they should be. The current structure of our health system does not pay attention to the social components of health. In order for care to be directed towards promoting community health, it is necessary for health managers to first consider such a perspective. Then, set the center's operational goals in line with it and design the organization's processes in a way that facilitates attention to public health .

Of course, it is not enough to just target and provide tools to encourage employees to accept change. Employees and health care providers should be trained in this and also have an appropriate motivational structure in place to encourage them. In this way, holistic and socialist care can be gradually put into practice .

 

Reform of the payment system

As mentioned, health care professionals need motivation to pursue this goal. Although some of this motivation is made possible by intangible encouragement and attention, people's performance must also be reflected in their pay .

Currently, the common payment model in Iran and many countries is fee for service . In this model, the service provided is evaluated and the long-term impact of care is not considered. For example, it does not matter how appropriate and effective the medication or therapeutic intervention performed is and prevents the patient from returning to the treatment center (outpatient or inpatient) .

But in value-based care, the determining factor in health care providers' salaries is the quality of services provided and the rate of improvement of people's health status. Care measures are compensated based on how much value they create for the patient and the health system. Promoting public health is another reason why it is necessary to change the payment model and implement value-based care .

You can read more about this topic in the article "Value-based care and the role of startups in its realization" .

 

Community health data

Evaluating practices and services in value-based care is highly dependent on one's health information, from background information and past care to adherence to treatment and post-treatment conditions .

Indeed, access to relevant data is a serious barrier when we are aware of the role of social components on health and seek to improve them. This data is not limited to individual health care information, but the information of all components of the social components affecting health must be collected, organized and accessible. Information such as food security, having a safe home or place of work, job security, psychological comfort at work and living, the possibility or history of criminal activity, etc. are all important and required .

Some of this data is not currently collected, and some is decentrally collected in one organization and not available to others .

For example, in the structure of our country's health system, a health record is created for people who refer to health centers. The doctor of the center is obliged to ask questions about the living environment, nutrition, etc. in his history and register them in the apple system. But how this information is organized and used is questionable. For example, this information is only available to the Deputy Minister of Health and it is not possible to access it when people visit doctors' offices or hospitals .

The situation is probably the same in other organizations. Data on employment, housing, criminal history, education and employment are collected in different institutions, trapped there, and sometimes even in the same institution, they are not used optimally .

The first step in solving this complex and multifaceted problem is to be aware of the value of this data in community health management. Existing data sources must then be identified, an integrated infrastructure must be provided to integrate and add this information and new data entry, and secure access to data-related stakeholders must be provided .

 

Inter-sectoral partnership

The Ministry of Health or no other institution can be held solely responsible for promoting population health. From the Ministry of Education to the Ministry of Labor, from the Prisons Organization to the Social Security Organization, everyone must contribute to the management of community health. SDH- related data sharing , risk assessment, collaboration to design solutions and implement programs all require the involvement of public, private and non-profit organizations. Forming these relationships and collaborations in a way that aligns with and benefits the goals of all stakeholders may seem difficult, but with innovation and a long-term vision for the health future, most organizations will be motivated enough to participate .

Startup Unite Us has designed an integrated care network that enables communication between health care providers and social service providers. The startup is working with Kaiser Permanente, a nonprofit health care provider, to identify patients' social needs and refer them to nearby authorities .

 

Modify the structure of care delivery

In the current structure of the countries' health system, the hospital is the main unit for providing care services. But while the hospital is optimal for acute care, it is not very efficient in the process of shifting to preventive care. In the care delivery structure, units should be designed that both communicate effectively with different stakeholders and act proactively to promote social components affecting health .

In the Iranian health system, the first level of health services provided by health centers and bases to some extent plays such a role. But how much this structure has been able to adapt to changes in society and technology is debatable. Perhaps, if the country's health system is reviewed and reformed with a new look at the new trend of public health management, it will be able to implement the appropriate structure more quickly .

 

Use of technology ‌

What has transformed the traditional process of addressing public health is the emergence of new technologies and the identification of the impact they can have on health. Collecting and organizing data, anticipating the needs of at-risk communities, facilitating communication between organizations, etc. are all facilitated by the tools that technology provides to human beings .

Staple Health Startup provides analysis of the impact of social components affecting health on acute care, behavioral health, and more. This bank startup has SDH data and with the help of this data and health care data with the help of artificial intelligence and machine learning, it identifies people at risk and offers effective care based on the individual's condition. The startup was acquired last month in June 2020 by Uniteas .

 

Innovation in public health requires a driving force

As mentioned, technology is a very effective tool for promoting public health. But the problem is that public health innovation requires informed and enthusiastic policymakers, a strong infrastructure, and cross-sectoral partnership. These three can seem like a tough barrier for startups to enter the field .

The existence of this obstacle cannot be ignored, but the fact is that the way to remove this obstacle is to start innovating in this field and prove its effectiveness in practice. The structure of government decision-making is slower and more cautious than itself leading the way in change. But if startups show what value they can create in this area and innovate in their revenue models and partnerships, we can hope to see good things happen in the future .

 

Source: medleanmag