CDC Leaders: Time to Integrate Public Health and Healthcare Delivery

Last month a team of leaders from the federal Centers for Disease Control and Prevention (CDC), including CDC Director Mandy K. Cohen, M.D., published a “Perspectives” op-ed in The New England Journal of Medicine calling for the integration of public health with healthcare delivery inside the U.S. healthcare delivery system. That team included Dr. Cohen and also Charlene A. Wong, M.D., M.S.H.P., who is senior advisor for health strategy at the CDC, and Debra Houry, M.D., M.P.H., who is chief medical officer and deputy director for program and science at the agency.

And, writing under the headline, “Integrating Public Health and Health Care—Protecting Health as a Team Sport,” on April 10, the three CDC leaders state that “Protecting health is a team sport — yet the systems meant to advance this goal have been siloed for too long. The United States needs an integrated system that protects the public’s health — one that goes well beyond the reach of the Centers for Disease Control and Prevention (CDC), health departments, and ‘traditional’ public health.” Indeed, the three physician leaders state, “The health care sector is on the front lines when it comes to preventing and treating acute and chronic conditions. Clinicians have trusted relationships with individual patients and use clinical findings to address current and potential future health issues, whereas the public health field provides data and promotes evidence-based interventions for protecting and advancing health in communities. Public health monitoring of health threats also permits early detection and containment of outbreaks,” they contended.

Indeed, they note, “Public health–health care partnerships can also improve routine care delivery. For example, perinatal quality collaboratives are a critical form of public health infrastructure in many states and contribute to quality-improvement efforts in obstetrics by providing maternal health data to health systems and supporting systems-level collaborative changes. These partnerships have improved the timeliness of treatment for severe maternal hypertension at participating hospitals in Illinois and have increased the proportion of babies born at full term by reducing scheduled early inductions and cesarean sections at participating hospitals in New York.”

The article’s authors cite three areas in which they believe that the whole of the healthcare system must take action: first, around data-sharing; second, around aligning priorities and sharing in investing in resources in both public health and healthcare delivery; and third, around sharing responsibility and accountability across the public health and healthcare delivery sectors.

Per the first, they wrie that “[R]eal-time bidirectional sharing and use of public health and health care data are critical for facilitating readiness and responses to emerging health concerns. Substantial progress was made during the Covid-19 pandemic. Now, 78 percent of emergency departments (EDs) are sending real-time respiratory illness syndromic data, such as data on cases of influenza-like illness, which allows the CDC to monitor for unusual domestic trends — as we did in the fall of 2023 for Mycoplasma pneumoniae, after cases were reported internationally.” Yet despite that progress, they noted, “Only 33 percent of healthcare facilities send automated electronic case reports for reportable conditions to public health agencies. CDC efforts are under way to further standardize and streamline this work for all facilities,” they noted.

Meanwhile, they urge the public health and health care sectors to “identify aligned priorities and make shared investments. Covid-19 was a singular common enemy and a generational challenge that accelerated the formation of public–private partnerships and led to substantial investments in infrastructure,” they note. Now, “Covid-19 is now just one of many major health threats that the sectors need to respond to together. Robust integration of public health and health care data can inform priorities for shared investments in prevention, management, and control efforts at all levels of the health system. The CDC is prioritizing promoting readiness and response to health threats by making investments in critical data, lab, workforce, and response infrastructure; combating the U.S. overdose and mental health crises; and supporting young families. Our agency is leading multiple collaborative efforts with health care partners in these areas,” they note.

Finally, they say, “[W]orking as a team to protect health requires clear roles and responsibilities and shared accountability. The table outlines the roles and responsibilities for the public health and health care sectors in addressing major public health threats. Multiple pathways exist for sharing accountability, all of which will require agreeing on metrics of success. Implementing prevention-oriented quality measures (e.g., screening for cervical cancer, lead exposure, or clinical depression) is one mechanism for supporting shared accountability. Offering incentives or enacting requirements for participating in data-integration activities is another. Finally, new payment arrangements and flexibilities can unite sectors by covering community-based prevention programs (e.g., school-based mental health supports) or rewarding improvements in population-level outcomes (e.g., Medicare’s Shared Savings Program or the Advanced Research Projects Agency for Health’s Healthcare Rewards to Achieve Improved Outcomes program).”

The article’s authors recognize that “Protecting the health of every person in every community of the United States will require action now and a sustained focus across public health and clinical care. Beyond more extensive public health–health care partnerships, a team-based approach to supporting the health of communities and addressing broader drivers of health could include social services, academia, industry (e.g., employers and technology and media companies), and global partners.” Ultimately, they conclude, “Investing in strong relationships and taking action together to protect health could better prepare an integrated health system to respond to the next major health emergency and improve the day-to-day health and well-being of the population.”