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Collaborative Networks of Health Systems and Social Service Agencies: Clinical Public Health in Action.

In this issue of Medical Care, Dr Brewster and her colleagues provide a timely and much needed report on a mechanism by which health systems might achieve greater impact on the social determinants that affect the health and health care utilization of their patient populations.1 The mechanism is the collaborative network, comprised of the health system and social services agencies, that previous work shows can reduce health care utilization by addressing the social needs of patients. In their report, Brewster and colleagues describe the nature of high-performing and low-performing networks. Although their report focuses on older adults, the approach is broadly applicable to other patient populations. It is a representative example of the emerging discipline of clinical public health. What is clinical public health? At first glance, the term gives the impression of a discipline that is an improbable chimera, a mishmash of clinical medicine and public health that is arguably an oxymoron. Clinical medicine is highly focused on the individual —the patient—in terms of how to promote health, prevent disease, and treat the illnesses of that unique person. Public health, by contrast, is focused on the population in terms of how to promote health, prevent disease, and manage illness among the multiple persons who comprise the population. But with such disparate foci incorporated within it, the ability of clinical public health to add scientific value and hence its rationale for being, is not obvious. Clinical public health is the interface of clinical medicine (and health systems) and public health that has as its focus the health outcomes of the individual, the determinants of those outcomes, and the policies and practices (interventions) that link the health outcomes with the determinants. It is not interchangeable with population health.2,3 The health system is not viewed as just another factor; it is a primary driver by which to improve health, but one that often needs to coordinate with public health–serving organizations. Clinical public health organizes its activities around the individual, not the population, and seeks to advance the provision of health care through health systems to promote the individual patient’s health, prevent disease, achieve earlier diagnosis, and provide appropriate treatment to reduce or eliminate the burden of disease. The array of considered activities includes efforts to manage the physical, social, and psychological determinants at the population level that affect the individual’s health. The population is seen as a reservoir of exposures that may either cause or accentuate disease or, alternatively, may be salubrious to maintaining or improving the individual’s health. Clinical public health is in keeping with the concept of “herd immunity,” wherein the emphasis is on the individual’s susceptibility to disease because that susceptibility is both influenced by, and influences, the disease risks of others in the population in which the individual resides. In his now classic article, Geoffrey Rose reminded us that the question of “Why do some individuals have a given condition” is quite distinct from the question of “Why do some populations have much of a condition while in others it is rare?”4 Using the example of disease