Public health and Primary Health Care: The oil and vinegar of the health care system.

Oil and vinegar when mixed together make for a lovely combination of flavours that can enhance salads, vegetables or as a dip.  But no matter how hard you try, shaking, stirring, blending or other form of agitation, the two substances will separate out into their separate layers.

Thus it is with public health and primary health care.  

Sir Michael Marmot who continues to be a major influencer of social and health policy on both sides of the Atlantic touches on the issue in an editorial in the Lancet October 12 2013.  He even tries to find ways to blend the great works in the fields of population heath and primary health care, and concludes that even with the best efforts, there are still areas like the social determinants of health that become excluded from the primary health care agenda.  

Certainly there is a need  to support primary health care workers in embracing a population health mentality, and a need to acknowledge that the shift of public health workers to predominately individual/family services is a migration into primary care provision.

The astute reader will note the subtle variances in use of primary health care and primary care, and between public health and population health.  Building on something that has been attributed to past CPHA president and University of Waterloo MPH program director Christina Mills “ population health is the way we think, public health is what we do”.  Likewise “primary health care is a way of thinking, primary care is the delivery of the service”.

The tension faced by public health practitioners is twofold, first that because much of public health workers now do is primary care, in the regional authority megaliths they are being forced into marriage with primary health care entities.  Secondly,   since there remains a poor understanding of population health by administrators of these bastions of service delivery, there is a belief that the primary care provided by public health professionals is the de facto mysterious population health, and as such a natural union should be encouraged.

When resources are tight, and they are tight across the country, trying to kill two birds with a single dollar is natural, but highly myoptic. While the primary health care community covets the public health resources, less commonly are population health folks moving to maximize the opportunities provided by primary health care practitioners.

So who is the oil and who is the vinegar?  It probably doesn’t matter, neither is very good by themself – both will benefit from being mixed together, and nature will still dictate that they will be separate solutions.