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“I kept thinking about the difference between individual health and population health—treating one patient versus treating many. A doctor might see an individual child with an elevated blood-lead level, but it would take a study of many patients—a population—to figure out what was happening to all the kids. If one doctor alone could see all the Flint kids, maybe that doctor could start to make helpful connections. But with so many doctors in our clinic, and throughout the city at other clinics, that connection couldn’t happen. Each doctor might see a few higher-than-usual lead results, but they wouldn’t be able to see it as an epidemic on their own. This is why training in public health is so critical for all physicians. We need to be able to step back from the individual patient and look at the bigger picture.
What the eyes don’t see. That is precisely why public health surveillance programs are crucial. They regularly monitor population-wide trends that individual doctors can’t detect on their own—whether it is the flu, HIV, cancer, or blood-lead levels. This is what government public health people are charged to do. It is[…]”
“Years ago the CDC recommended that all kids have their lead levels tested, but the public health victory that got lead out of gas and paint—and caused rates of lead exposure to go down steadily—also caused the recommendations to relax. That should never have happened. Because just as the CDC relaxed its recommendations, new research revealed that even the smallest levels of lead in a child’s blood were more damaging than we ever thought possible. We should have been doing more screening, not less.
And the blood-lead screening rates, even in Flint, were low. As in Detroit, many kids had trouble getting to their regular pediatrician due to an array of poverty-induced obstacles, from inadequate transportation to complicated childcare arrangements. I have Flint patients who’ve never left the city limits; they’ve gone only as far as the unreliable and limited bus line allows.
Even so, Hurley had the screening data for children treated at our clinic, and it wouldn’t be that hard to get it, thanks to our sleek electronic medical record (EMR) system. In 2011 we started using Epic, the Cadillac of EMR software, and being the early-adopter tech dork that I am[…]”
Answer the discussion questions below. The response to each question should be a minimum of 150 words. Question #1 – P 98: “I kept thinking about the difference between individual health and population health – treating one patient versus treating many.” Explain the difference between individual and population health as discussed in this section. Why is it important for health care providers to also be trained in public health?
Question #2 – This chapter connects the economic collapse of the auto industry to numerous social determinants of health, including poverty, transportation, toxic stress and lack of access to health care. As one example notes on P 105, “And the blood-lead screening rates, even in Flint, were low. As in Detroit, many kids had trouble getting to their regular pediatrician due to an array of poverty-induced obstacles, from inadequate transportation to complicated childcare arrangements….they’ve gone only as far as the unreliable and limited bus line allows.”
Discuss the social determinants of health outlined in this chapter and how those contribute to accessing health care such as routine screenings. Do you think health care systems should be addressing social determinants of health in their patients?
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