By Stephanie Bonne
Who remembers the public health class you took in medical school? More likely than not it was a pass/fail class, maybe a couple of credit hours, that was taught at 4pm on a Thursday. Do you remember what you learned? For those of us without formal training, like an MPH or similar degree, we might not be able to describe what it really means to “take a public health approach” to a problem.
This has come to my attention recently in the corner of the world that I work. As a trauma surgeon interested in injury prevention, violence prevention and gun violence, my research and nonclinical interest lives in a highly charged political environment. I frequently hear politicians, advocates, and even peers calling for “us” (society) to take “a public health approach.” So what does that mean? If 20 people lock themselves in conference room until they figured out the public health approach, what exactly will they be doing?
Fortunately, science and experience tell us what this means. Public health is a multidisciplinary, multifaceted field that includes health care, psychology, social systems, anthropology, policy and law just to name a few. The public health approach to any of the problems we see whether injury, cancer, infection or the numerous other surgical conditions is a 4-step process.
1. Surveillance. No, this is not peering through people’s windows with binoculars to figure out who has a disease. We have to know how many people (and who) are affected by a problem before we can propose to fix it. Reliable data collection is of paramount importance. If we misrepresent or don’t understand who is at risk of a problem, we don’t know how to deploy prevention strategies to fix it. Imagine what would have happened if we knew colon cancer was a problem but didn’t know that it’s the population over 50 who is more frequently affected – colonoscopies for 15 year olds?
2. Identify risk factors. Once we know who is affected, we need to know what makes those populations different. Is it age, race, sex, socioeconomic status, or access to a specific risk factor like an environmental agent or stressor? This is key to knowing how to mitigate the risk.
3. Develop and test prevention strategies. Once we know who is at risk and why, we can seek to act upon risk factors that are modifiable. We may not be able to change sex or age, but we can change environmental factors, social factors, and, importantly, the social determinants of health that lead to disease.
4. Once we know what works, it has to be disseminated. This is where policy can be especially important. Whether institutional, state, or national, creating policies that put prevention strategies in place and helping people understand why these policies are important will help ensure that prevention is applied across the population.
A public health approach to any problem requires many stakeholders from many backgrounds to work together. Although the strategy may not always be perfectly clear, public health gives us a framework to solve really hard, really big problems in health care. This is what it will take to continue to further the agenda of creating health populations.
Dr. Bonne is a board-certified general surgeon with additional training and certification in Surgical Critical Care. Her clinical interests are in trauma and injury prevention, trauma epidemiology, and infections in the surgical intensive care unit. She participates in the American College of Surgeons, the American Association for the Surgery of Trauma, the ACS Committee on Trauma, the Eastern Association for the Surgery of Trauma, and the Society of Critical Care Medicine. She leads the American Medical Women’s Association Gun Violence Prevention Task Force, and is the surveillance core director of the New Jersey Center for FIrearm Injury Research at Rutgers University. Dr. Bonne is the current Communications Chair for the AWS, a co-editor for AJS, and also serves as the faculty advisor for the Rutgers New Jersey Medical School chapter. She is a wife and mother to three young children. You can follow her on Twitter: @scrubbedin.
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