Prior to my Masters application, I'd had never even heard of this area before. I always been taught that there's clinical, or the treatment of disease, and public health, the prevention. The idea that there's this whole other field that's dedicated to bridging the gap between these two silos fascinated me. Check out my latest article to learn more!
My Masters training at the University of Toronto was rooted in this concept of 'clinical public health', but prior to 2018 I didn't know a whole lot about what it is or why it mattered. It wasn't until application time rolled around that I was encouraged to watch this video of Aaron Orkin, an emergency, family, and public health physician at the division of public health at the Dalla Lana Schools explaining it. I was immediately hooked.
While I was exposed to health promotion strategies at the community level in my undergrad degree, this idea that you can combine both clinical and public health to address some of the most pressing issues in society was something I'd really never considered before. When I think clinical I think of the treatment of disease, or what we call 'downstream' measures in public health. On the contrary, I had always thought of pubic health at the prevention side of things, or 'upstream' interventions to protect the population. All of the sudden I was learning about this new field can be used to help to contain costs, increase patient experiences and improve population health. I mean, that sounds like a win-win to me! It's been two years since I graduated from UofT and I continue to look for opportunities clinical public health can be used in dietetic practice. For those of you who have never heard of this concept before, clinical public health combines primary care, preventive medicine, and public health within academia, hospitals, community health care centres, and public health agencies.
According to Orkin, CPH is rooted in not only asking how we can prevent disease but rather how can we address disease at the individual and population level once someone does have it? Helping to bridge the gap between these two silos can help us address some of the most pressing issues. In doing so we can more holistically tackle core issues such as safe sex, assisted dying, vaccinations, basic income, housing, food fortification, fire safety, car safety, housing and more. As a dietitian, I believe that being able to demonstrate compassion and care at the bedside, on top of having an understanding of the ‘upstream’ factors influenced by social determinants of health, health policy, health promotion, community and population health is imperative. In Eating Disorders, for instance, that could look like weight restoration followed patient education and coordination of care to a social worker post-discharge.
In times like these, we can see a clinical public health approach being used when it comes to vaccine distribution. Long-term care residents, seniors, and healthcare workers are getting the vaccine first in order to mitigate the burden of the disease on those facing greater health disparities. The intersection between clinical (vaccine administration) is being used to keep people alive and prevent further death and complications.
To give you a better idea here are a few more examples:
A family physician taking the initiative to address safe sex with young adolescents during an annual physical, PRIOR to the patient asking to oral contraceptives
Policy reform coupled with harm reduction services and safe injection sites run by public health nurses where drug users can freely access this life-saving service while accessing pre-obtained drugs from staff
Using new technology like GEM, or ‘Grain quality enhancer, energy-efficient and durable material” to parboil rice, an essential crop in west Africa, in order to improve the nutritional quality and tackle malnutrition in the region #ZeroHunger
In healthcare it looks like participating in IPE (interprofessional) rounds to collaborate on with healthcare professions like SLP’s, OT’s, PT’s and pharmacists on a patient case. Having done this myself I can say first-hand how eye-opening and beneficial it is to learn about other roles and how nutrition impacts not only their recommendations but yours as well
It might look like deploying a mobile medical unit to at risk communities during times of crises and or/ or natural disasters like reserves or rural areas. While at the same time policy initiatives pertaining to safe water access is sought out in indigenous communities to protect those most vulnerable to cholera
In nutrition, another example is fortifying food with folic acid to help prevent NTD while at the same time having hospitals ready to treat these babies in the NICU
The idea is that treatment and prevention should be tackled from a systems perspective, in order to make the greatest impact. It’s like treating the bruise on your shin after walking into your desk, WHILE rearranging your bedroom so it doesn’t happen again. Makes sense to me.
Have you heard of clinical public health before? What are your thoughts on it.
Yours in Health,
