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Public Health Faces a Paradigm Shift

Public Health Faces a Paradigm Shift


public-health-paradigm-shiftBy Dr. Karen A. Cieslewicz
Faculty Member, Public Service and Health at American Public University

With the passing of the Patient Protection and Affordable Care Act (ACA), public health is now shifting from a focus on epidemiology, tracking new diseases, food safety and sanitation to a focus on preventive health in partnerships between public and private sectors.

Public health has always involved tracking trends in the disease process, but historically it has not been actively involved in preventing disease. However, the future of public health will involve helping people to make healthier choices–regardless of their social-economic circumstances–in order to prevent disease and minimize the effects of chronic disease. Public health will make prevention a core mission, seeking to help protect entire populations through efforts like better sanitation, broad inoculation against communicable disease, and health education.

In the new paradigm, public health and clinical medical services will work together. For example, public health screeners will refer patients to private caregivers, while caregivers will look to public health or social service providers to address behavioral issues or environmental problems not amenable to the current medical model of service.

As the ACA is implemented, public health professionals will work with partners to co-design policy and strategy that reflects the reality of people’s lives — as citizens, patients, service users, health care providers, and educators (ACA, 2010). Partnering with the medical community’s daily operations is fast becoming a good modus operandi for public health departments across the United States (Zahner 2005; Casey, Prentice, Williamson, Boyle, Hsu, and Beery 2007; Johnson 2009).

Under the ACA, public health will most likely be the gatekeeper for federal funding used for preventive healthcare programs. The intent is to ensure appropriate distribution of resources, avoid wasteful duplication of efforts, and reduce redundancies.  Most importantly, public health will need to reassure the public that the standard of care is not being reduced.

Public health in the future will concentrate on population health problems such as obesity and inactivity; alcohol and substance abuse; mental health, especially depression; violence; and tobacco use. It will also educate the public on preventing chronic diseases through partnerships with clinical practices. It will be the responsibility of public health officials to find improvements to health department operations and develop new tools for lifestyle related problems. Lastly, public health will depend on monitoring the overall performance of the healthcare system.

The passing of the Patient Protection and Affordable Care Act has created both opportunities and challenges for the future of public health. It is an exciting time to be in public health as it shifts its mission so intensely. It is indeed one of the professions most greatly empowered by the Affordable Care Act.


Association of Schools of Public Health. 2011. “What is Public Health?” ASPH website, http://www.whatispublichealth.org/what/index.html.

Casey, Maria, Bob Prentice, Julie Williamson, Kathryn Boyle, Clarissa Hsu, and Bill Beery. 2007. “Strategies for Building Community-Public Health Partnerships: Lessons Learned from the Program Office of the Partnership for the Public’s Health Initiative.” Oakland: Public Health Institute.  Retrieved from http://www.partnershipph.org/downloads/Strategies_for_Building_Community-Public_Health_Partnerships.pdf.

Institute of Medicine. 1988. The Future of Public Health: A Consensus Report. Washington, D.C.: National Academy Press.

Institute of Medicine. 2002.  The Future of the Public’s Health in the 21st Century: A Consensus Report.
Washington, D.C.: National Academy Press.

Lavizzo-Mourey, Risa. 2008. “Public Health’s ‘A -Ha!’ Moment and What it Means for the American People.”
Presentation to the 2008 ASTHO-NACCHO Conference, Sacramento, CA, September 10, 2008.
Retrieved from http://www.rwjf.org/files/research/rlm2008asthonaccho.pdf

Libbey, Patrick. 2009. “Take the Path to New Opportunities.” Editorial. “Bridges to the Future.”
Symposium issue of North-west Public Health26(1, Fall/Winter): 4—6. Retrieved from http://www.nwpublichealth.org/archives/f2009.

The Patient Protection and Affordable Care Act (ACS), Public Law 111-148, 124 Stat. 111-1025, March 23, 2010,
as amended by the Health Care and Education Reconciliation Act of 2010, Public Law 111-152, 124 Stat. 1029-1083,
March 30, 2010, Retrieved from http://www.gpo.gov.

Zahner, Susan J. 2005. “Local Public Health System Partnerships.” Public Health Reports 120(1): 76 — 83.
Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1497678/pdf/15736335.pdf.


About the Author:

Dr. Karen Cieslewicz is a licensed general surgeon and physician in the states of Maryland and Michigan. She earned her M.A. in Homeland Security and Emergency Management from American Public University and her MD from Ross University School of Medicine. In 2009, she earned her Certified Emergency Manager (CEM).

Dr. Karen Cieslewicz maintains a private medical practice in Maryland. She is also involved in many aspects of Emergency Management and Disaster Medicine. She serves in the Fl. Civil Air Patrol as a Captain in the Medical Corps, Critical Incident Stress Management in Pennsylvania; and the Medical Director for Safety and Technical Rescue Association in Michigan.



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