An individual’s health status does not exist in a vacuum.
While the vast majority of diseases certainly do have genetic or biological underpinnings, environment also plays a critical role in determining who is most likely to fall sick—as well as who is most likely to get well once afflicted. Public health research addresses the many issues that can influence the overall health and well-being of individuals and the greater community at large.
“Understanding these issues and how they affect patient populations is key to providing more efficient and effective healthcare,” says Joshua Gordon, MD, PhD, director of the National Institute of Mental Health. “Not only will it help improve the health of patients but it will also reduce healthcare costs and increase healthcare organizations’ ability to negotiate with private insurance sectors.”
Here are the top five public health issues currently impacting healthcare organizations.
1. Behavioral health integration. Julia Andrieni, MD, vice president of Population Health and Primary Care at Houston Methodist Hospital in Houston, says that, too often, proper assessments of mental health conditions aren’t done. As these conditions can significantly impact a patient’s physical health status, she believes more healthcare organizations need to integrate behavioral health assessments into primary care.
“Assessments of a population for anxiety, depression, addiction, and with our aging population, cognitive ability, is really important,” she explains. “It’s very difficult to be effective in treating chronic conditions if you have an unaddressed behavioral health issue. For example, a diabetic with unaddressed anxiety or depression likely won’t be motivated to go to appointments, check blood glucose levels, or change their diet or exercise plan to stay healthier. Behavioral health is a vital part of a person’s whole health status.”
2. The suicide epidemic. Gordon says that the suicide in the United States is currently a national public health emergency.
“Suicide rates continue to go up—and we know there are things we can do to reduce suicide risk,” he explains. “Healthcare organizations have a large role to play in rolling out the kind of risk identification and intervention measures that can be effective to address this issue.”
3. The opioid crisis. According to the CDC, approximately 115 Americans are dying each day from opioid-related overdoses. Through integrated models of care, Andrieni argues, healthcare organizations are in a unique position to identify and treat individuals who may be suffering from a substance misuse disorder.
“So often, with opioids, alcohol, and tobacco misuse, we see that people are self-medicating and that’s what leads to addiction,” she says. “We need to be addressing the other issues that commonly appear with substance abuse, those potential dual diagnoses, or diagnoses of physical or behavioral health conditions with substance misuse disorders, to better get a handle on this growing issue.”
4. Social determinants of health. Andrieni says that two patients may present with the same physical symptoms of a disease—but if they differ in socioeconomic status, education level, healthcare accessibility, family support, or other non-clinical factors, their diseases are likely to progress in very different ways.
“Healthcare providers need to address the non-clinical as well as the clinical factors when we treat a patient. Because they do impact health,” she says. “Think of a diabetic patient again. If that patient has no transportation, food insecurity, an inability to pay for medicine, and a low literacy level, it will be a challenge to be effective in treatment. We have to address the disparities in social determinants of health so we can help our patients get healthier.”
5. The obesity epidemic. Research study after research study has shown the relationship between obesity and conditions like cardiovascular disease, diabetes, sleep apnea, and osteoarthritis.
“This is a public health issue that not only impacts adults but also is important to childhood health,” Andrieni says. “Understanding how a healthy weight can help set people toward a path of good health is critically important.”
There are, of course, many more public health issues that influence population health in the United States—and some have more impact in certain communities over others. But Gordon says that, especially regarding behavioral health issues, collaborative care models can help healthcare organizations develop the right strategies to keep their patient communities healthy and whole.
“When primary care doctors work with mental healthcare professionals of all different persuasions, we see a big difference. I would encourage hospital executives to think about integrating care across departments,” he says. “If we saw more of that in the private healthcare industry, we could see more cost-efficient and higher quality patient care.”
Kayt Sukel is a science and health writer based outside Houston.