To what extent do health departments find the necessary community resources to solve public health problems, and to what extent do they need to build from scratch?
“The issue of funding in public health is a big one,” says Joneigh Khaldun, Director and Health Officer for the Detroit Health Department. “We never quite feel that we have enough to do what we need to do.”
Despite the lack of resources, Khaldun is excited that health systems are focusing more on population health and prevention.
John Ayanian, Director of the Institute for Health Policy and Innovation at the University of Michigan, asks where those resources come from. Voting and advocacy? Partnering with communities that can advocate on their own behalf?
“Absolutely,” says Khaldun. “There’s nothing more powerful than a physician in a white coat going up to their congressperson to advocate and say what they see when they’re seeing patients. You don’t have to be a big public health leader to do that; people do actually listen to you as a physician.”
In addition to that political will, she says, “we also just need to work with the community.” Public health funding comes from many places: federal, state, local, and private.
“I can add a resource,” says Michael Englesbe, Professor of Surgery at the University of Michigan. “If there’s any single theme or topic that brings together young medical students, it’s around care for at-risk populations.” Medical curricula need to do better at fostering education in that area, but Englesbe is optimistic about progress in the future.
Building on that point, Ayanian asks about interprofessional education — nursing, pharmacy, dental, social work, public health, and other students of health care. “Does our academic system have more responsibility to bring teams together at that early stage of training so that they’re prepared to function more effectively as team members and partners in their careers?”
Day one of medical school is introduction of interprofessionalism and equal partnerships, says Englesbe. He believes this comes naturally to the generation currently attending medical school. For example, a first-year medical student recently greeted him with a wave and, “Hey Mike, how’re you doing?”
“There’s an informality,” he says. “They don’t necessarily see these hierarchies, which is a great thing for our patients going forward, because the silos will break down.”
From the NEJM Catalyst event Essentials of High-Performing Organizations, held at the University of Michigan’s Institute for Healthcare Policy and Innovation, July 25, 2018.