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To the Editors:
I would like to commend and thank the authors of “Shared Language for Shared Work in Population Health” (1) for their thoughtful suggestions for a common language for collaborations to improve population health – a topic of common confusion, within Family Medicine and without. They offer some hope for improving communication around this vital topic. As family physicians engage in this larger discussion, there are similar activities and shifts in framing and language that may be worth noting.
One is around the language of “social determinants.” While widespread in health care and public health, that language can resonate less well with partners. “Vital Conditions for Health” is an alternative, positive framing that has been suggested (2) especially in work with community organizations and businesses. The Surgeon General’s Report on Community Health and Economic Prosperity (3) is a good example of this usage.
A second is the use of “Public Health.” The usage here reflects the common meaning of governmental public health. But others cast a wider net. CDC Foundation, example, states: “Public health is the science of protecting and improving the health of people and their communities” [emphasis added] (4), while the National Association of County and City Health Officials describes Public Health systems as “all public, private, and voluntary entities that contribute to the delivery of essential public health services with a jurisdiction” explicitly including physicians and community health centers. (5) Healthy People 2030 is an example of the shift, and is framed much more broadly than the work of governmental public health (6). COVID-19 has increased the saliency of this larger view of public health, with health officials needing to work in partnership with communities and health systems – including and especially primary care. When talking with colleagues in state or local health departments, or schools and programs of public health, awareness of the larger meaning of public health may facilitate discussions and finding common grounds.
All of this is both additional support for clarifying our terminology, and as a gentle reminder that shared language requires listening to colleagues outside our field, who may see the world differently, and then engaging in the work of developing language - together. The authors have made an important step in that direction.
Lloyd Michener, MD
1. Peek CJ, Westfall JM, Stange KC, et al. Shared Language for Shared Work in Public Health. Ann Fam Med. 2021; 19(5): 450-456.
2. Vital Conditions for Well-Being. www.winnetwork.org/vital-conditions. Accessed Sept 14, 2021.
3. US Department of Health and Human Services. Executive Summary of Community Health and Economic Prosperity Engaging Businesses as Stewards and Stakeholders— A Report of the Surgeon General. 2021. https://www.hhs.gov/sites/default/files/chep-sgr-executive-summary.pdf Accessed Sept 14, 2021.
4. . CDC Foundation. What is Public Health? https://www.cdcfoundation.org/what-public-health?. Accessed Sept 14, 2021.
5. NACCHO. What is the Public Health System? https://www.naccho.org/uploads/downloadable-resources/Programs/Public-He... Accessed Sept 14, 2021.
6. US Department of Health and Human Services. Healthy People 2030. https://health.gov/healthypeople Accessed Sept 14, 2021.