Public health and clinical medicine need to work in partnership in the US
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Department of Public Health, School of Health and Health Professions, Coastal Carolina University, United States
Department of Public Health Sciences, Pennsylvania State University, Hershey, United States
Publication date: 2023-04-27
Popul. Med. 2023;5(Supplement):A977
a)   Introduction: The US was ranked first in terms of health security in 2019, yet it became the epicenter of the Corona virus disease pandemic in 2020, threatening its fundamental leadership in matters of world health, polarizing an already deeply divided society, rife with disparities and inequalities in access to care and medical outcomes. Even before the pandemic, the US had worse outcomes and higher healthcare costs than its contemporaries. b) Methods: Document analysis using READ approach, qualitative interviews and a networks framework were utilized to study the landscape of adoption of DIT. c)  Results: The US is the only developed country without universal health coverage. The Affordable Care Act (ACA) was introduced in 2010 to make health insurance affordable and accessible to everyone.  Implementation has been partial, and nearly 28 million people remain uninsured and another 18 million have inadequate health insurance. These deprived sections of society already have mortality higher than the general population, higher rates of mental and chronic illnesses, substance abuse and delayed diagnoses. They present to the health system later in the course of a disease when treatment costs are higher and outcomes less satisfactory. This is the results of a long-standing divide between clinical healthcare and public health, inadequate financing of public health, bureaucratic turf protection, partisan politics and distrust of government within the populace. Correction requires a health systems redesign by instituting changes in the structure of public health, health care delivery and medical education, increasing population health literacy, and integrating preparedness for national healthcare challenges. Details of the structure of the US health system, lapses and way forward will be elaborated. d) Conclusions: Public health and clinical medicine must function as a seamless continuum with public health at the forefront to ensure all Americans have access to affordable preventive and promotive healthcare.