Closing the Divide Between Public Health and Clinical Care

Integrating public health efforts and clinical care will address emerging global health challenges and ever-growing health disparities, according to a new Rutgers article.

The paper, published in American Psychologist, explores how integrating the social and structural deterministic perspectives inherent to public health efforts with the individualistic and behavioral focus of medicine, can improve the health of all people and populations.

Whereas health care providers such as medical doctors attend to the biological, behavioral, and occasionally psychological drivers of health, public health focuses on the structural drivers of disease and disease surveillance.

Taken alone, neither public health nor clinical care have effectively attended to psychosocial conditions like fear, loneliness, medical mistrust, powerlessness, and stigma, all of which fuel disease, according to Perry N. Halkitis, dean of the Rutgers School of Public Health and author of the paper.

Public health psychology – as reimagined by Halkitis to address both the shortcomings of public health and clinical care – can act as a means of closing the divide between the two disciplines to advance health and wellbeing.

“Psychological principles provide the means of coalescing the efforts of public health with clinical care by addressing psychosocial stressors that undermine health and perpetuate disease,” says Halkitis. “In this regard, there is a need to reorient the discipline of public health psychology to provide a framework to both identify and intervene on health conditions.”

Halkitis shares the untimely and early death of his Greek immigrant parents as an example of, how when taken alone, the public health and clinical care systems fail to address psychosocial conditions.

“My father passed away at age 57 after a two-year battle against gastric cancer and my mother died peacefully in her bed at age 75,” recalls Halkitis. “The manner in which my parents transitioned out of their bodies might seem unrelated, however, their fear and mistrust of the health care system contributed to their refusal to seek care when they first became symptomatic.”

Clinical care and public health professionals have traditionally functioned separately, failing to build upon the multiple synergies that exist between these complementary approaches. Due to this chasm, patients do not receive the preventive health services needed to avoid the onset of disease or assist in the management of chronic disease.

According to Halkitis, neither system enacts approaches that attend to psychosocial stressors – which recognize the complex interplay of biological, behavioral, psychological, and social-structural factors – that fuel disease and diminish wellbeing.

Using the AIDS epidemic as an example to show how diseases have psychological and social components, Halkitis explains that if HIV were solely a biological phenomenon it would equally infect all. Instead, the disease disproportionally impacts sexual and gender minorities, communities of lower socioeconomic status, and populations of color. As a result, HIV infection rates are higher in poor, gay, and transgender African Americans.

The paper proposes that in order to integrate the two disciplines, public health psychology must adopt a new model that proposes that the health of individuals cannot be remedied solely by clinical care and requires tackling the structural and social constructs that drive health conditions. Enacting this strategy requires the efforts of academia and university health systems, communities, businesses, and government –  who working in unison while utilizing a multipronged approach – can address the psychosocial drivers of disease.

“The enhancement of health care delivery and the health of populations will ultimately improve if we marry the efforts of public health with clinical care,” concludes Halkitis.

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Rutgers School of Public Health The Rutgers School of Public Health – New Jersey’s leading academic institution in public health – is committed to advancing health and wellbeing and preventing disease throughout New Jersey, the United States, and the world, by preparing students as public health leaders, scholars, and practitioners; conducting public health research and scholarship; engaging collaboratively with communities and populations; and actively advocating for policies, programs, and services through the lens of equity and social justice. Learn how the Rutgers School of Public Health is “keeping the ‘public’ in public health,” by visiting them at https://sph.rutgers.edu.