HJAR May/Jun 2023

24 MAY / JUN 2023 I  HEALTHCARE JOURNAL OF ARKANSAS When you talk about public health versus clinical medicine, it’s certainly easy and sim- ple to say the difference is a patient versus the population; but it’s certainly more com- plex than that. Public health, you can say, could be more of a focus on global popula- tions, regional populations, or having differ- ent sectors at the table. Also, I think really focusing on things like upstream factors and how do you prevent things or reducing exposures. Whereas in clinical medicine, the focus largely does tend to be, although on individual patients, interprofessional teams looking at at-risk or established diseases. When you look at the many differences between the sectors, public health, health- care systems, and clinical medicine are all interrelated. Using data to drive action, we know that prevention works to protect health. Simple things like access to clean drinking water can prevent illnesses like diarrheal diseases. Things like a helmet can prevent traumatic brain injuries, and hand washing can reduce the spread of things like respiratory illnesses. Something that I hope all of you take back, too, is that given the direct relationships that clinicians have with patients, you play a critical role in being a trusted messenger regarding public health. Clinicians also have a role in preventing misinformation from spreading, as do all of you. That is something that I have wit- nessed unfold over the past two years. As public health, community health workers, all of us in the field, we have a role to be that trusted messenger and to prevent misinfor- mation. Right now, we have a critical role to play when we’re talking about vaccines such as the COVID bivalent and being up to date on vaccines. If we’re doing a good job, it often goes unnoticed; and that’s OK. What it means is we were able to prevent an issue from hap- pening in the first place or to keep it from progressing. Looking at different levels of prevention, like primary prevention when you’re talk- ing about something like drug overdose — starting somebody from misusing in the first place, looking at things like childhood trauma and how you can intervene early. Taking it to the next level of secondary pre- vention — maybe if somebody’s coming to see you, you give a low-dose opioid pre- scription and not a high-dose or linking somebody to treatment. Tertiary would be naloxone overdose prevention where some- body is already experiencing disease, and you’re preventing the long-term sequelae. One example that I think is really pow- erful is talking about adverse childhood experiences (ACEs). To me, this is primary prevention — as basic as you can get. Look- ing at things that happened to children such as abuse in the home, whether it’s physi- cal, sexual, or emotional, but also witness- ing violence in the home or experiencing a family member with mental health issues or somebody who’s incarcerated — these are considered childhood traumas. More than half of the adults in the U.S. have experi- enced one in their lifetime, and one in six have experienced four or more. When you look at how this has a cumulative effect on health, what you see is that the more ACEs you have, the more likely you are to have these chronic health conditions; and they are actually associated with five of the 10 leading causes of death. So, if you can pre- vent childhood trauma early on, you can reduce things like kidney disease by 16% or nearly 44% of depressive cases. How do you do that? Because that seems really high level and nebulous, but look- ing at things like early childhood educa- tion, nurse-home family partnerships, and home visitation, those are things you can do early on to ensure families have support and kids have support. If you’re screening in clinical practice forACEs, you can also refer people that are experiencingACEs to things like cognitive behavioral therapy to lessen the sequelae. And what is really important is this has intergenerational effects. There have been studies that show that if you do ACEs treatment or trainings, it can reduce it in your children. That’s why this is so impor- tant. It has lasting effects. A few examples: Starting with social Image 1 The Intersection of Public Health and Medicine Source: Hunter, D.J. “The Complementarity of Public Health and Medicine — Achieving ‘the Highest Attainable Standard of Health.’” New England Journal of Medicine. https://www.nejm.org/doi/full/10.1056/NEJMp2102550