January 04, 2017

There is an often used story in public health about two people fishing in a river. A person who comes floating down the river needs to be rescued by two fishermen. Soon after the first rescue, more and more people are floating down the river, needing assistance. After rescuing numerous people, the fishermen head up river to investigate why all these people are falling in. They find out that there is a beautiful view downriver, but no fence to prevent people from falling into the water when they lean too far. By getting the town to build a fence, the fishermen save others from needing to be saved in the future. This story is used as a parable for understanding disease prevention, in this case, falling in the river, and disease progression, floating down it.

This river analogy can also be used to showcase the relationship between public health, medical research and, even further downstream, health-care delivery. Each of these sectors on its own is a complicated system with many different stakeholders, needs, incentives, barriers and moving parts. But it is important to also consider how they are interdependent and how building bridges between them can strengthen and improve the other systems.

While public health is primarily focused on prevention at a population level, when individuals get sick public health systems begin to interact with medical research fields and health-care delivery. Even if a patient’s experience is limited to receiving a prescription drug from his or her doctor, the medical research system made it possible for him or her to get that product and become well again. In the same way, that product is only available because of healthy participants helping the product gain Food and Drug Administration approval from successful clinical trials.

Having strong bridges of collaboration and connection between these sectors is important because, at the end of the day, individual patients are at the center of all of these systems. By having the ability to exchange data and provide feedback loops to the other sectors, public health, medical research and health-care delivery can be a more coordinated system overall and more effectively prevent and treat disease.

In the past few years, we have seen examples where the connections among these three sectors are quickly strengthened to address emerging conditions, like Ebola or Zika. With the large-scale outbreak of Ebola in 2014, the U.S. medical and public health systems had little time to prepare for the potential of domestic cases and to educate our communities about the virus, how it spreads and prevention measures. While the Ebola virus had been studied in laboratory settings for many years, it was important to research the virus in the real-world experiment the outbreak created. Developing and reflecting on case studies and current data on the virus could impact both the development and delivery of treatment, as well as the prevention tactics employed to stop the virus from spreading. The response to Ebola showcased a need for a robust and coordinated emergency preparedness system that unites public health, medical research and health-care to effectively and rapidly respond to future outbreaks.

A coordinated response to a new threat was tested this summer with the emergence of the Zika virus in the southern U.S. The White House, Congress, Centers for Disease Control and Prevention and National Institutes of Health (NIH), along with state and local health departments, worked together on all three types of prevention for this virus. Emergency funding from Congress was slated to speed vaccine development by the NIH, allow quicker testing of populations at risk and provide resources to states with outbreaks to fight the mosquitos that carried the virus.

Coordinating and collaborating at this level is not easy. With separate systems for prevention, research and treatment, our responses to health concerns may not be as efficient as our communities need. However, some of these bridges between sectors are being built and strengthened through these responses to emerging threats and a culture change in fields of medicine and public health bringing practitioners closer together.

Related Resources

  • FasterCures is focused on speeding up the medical research system to save lives
  • The Milken Institute has long been engaged in topics related to prevention of disease


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