How is public health different from clinical healthcare? This is a question that I often get asked. The simplest way to answer it is that public health deals with health from the perspective of populations rather than individuals. It extends beyond the individual and focuses on the health outcomes of an entire group, community, culture or country. Public health takes into consideration the social determinants of health which includes socioeconomic status, education, income and access to healthcare. These factors, along with behavior, influence health and may contribute to the success or failure of a treatment. It's also about monitoring trends of diseases, and understanding why and whom they affect, hence using this information to influence health policies and practice.
On the other hand, clinical healthcare providers (e.g. physicians, nurses, hospital administrators) help individuals with their personal health issues. Their primary role is diagnosis and treatment of illness in individual patients. Hospital administrators focus on the efficient management of a healthcare facility, ensuring they operate within budget without compromising the quality of care provided to individual patients.
To illustrate this in an example, let's look at the handling of cardio-vascular diseases by both perspectives. A physician's role would be to listen to the patient's complains, perform the necessary tests and prescribe the appropriate medicine's that would improve symptoms and reduce the risks of death from cardiovascular disease (CVD).
A public health perspective identifies that the major risk factors for cardiovascular disease are poor diet, physical inactivity and tobacco use - explaining 75% of new cases of cardiovascular disease and without these risk factors CVD is a rare cause of death. This shifted focus from individual research towards identifying ways to enable populations to lower their risk of CVD. This redirection of resources towards population-wide measures needs to be supported by government leadership.
How can this be translated into prevention priorities?
At the end of the day, public health and clinical practice are not mutually exclusive and both approaches compliment each other. If public health professionals do their job right, this should improve clinical outcomes. There has already been a lot of effort in the past decades to consolidate efforts on both sides and integrate them as preventive medicine. This includes immunization programs, nutrition counseling, smoking cessation clinics and other lifestyle services. Other ways to track and incorporate population health is to expand intake of centralized data to include patient socioeconomic factors which can be allow clinical care to address health problems more effectively. Moving forward, it is necessary that public health and health care recognize their overlaps and possibilities for mutual progress.
Today's news of pausing the Astrazeneca/Oxford vaccine has been alarming to many. Here's the breakdown:
In clinical trials, there are 2 entities that ensure the safety of a new drug. There's the IRB/Ethics committee who provide the approval that it's safe to start the study. Then there's the Data and Safety Monitoring Board (DSMB) which is an independent committee of experts who have no conflicting interest with the success or failure of the drug and regularly monitor the data from the trial. Before a trial starts, the protocol specifies any adverse events that would call for it to be paused or completely stopped.
It's reported that the vaccine was paused by the DSMB to investigate the event of a volunteer falling sick to ensure that it's not related to the vaccine. This is actually the second time that the trial is paused, which is very common during trials.
I'll leave it at these 2 positive thoughts:
1) Those who are making sure the vaccine is safe are doing their job, in spite of so much political pressure to have a vaccine available! Hopefully, it will resume again.
2) There are 8 other vaccines in phase 3 clinical trials (which is the last phase before it's widely available to the market)