In the first part of this article (Sept. 14, 2006 issue), I noted that chiropractors and public health providers have a similar vision of disease prevention and health promotion. In fact, chiropractors and public health practitioners are unique in that most health care expenditures are for treatment after diseases and unhealthy conditions have taken their toll; chiropractors and public health practitioners urge that the focus shift to primary prevention.
Additionally, public health emphasizes the often-underrated importance of primary care. Many chiropractors do provide primary care and for many American families, they are the only sources of primary care. A public health principle is that the level of provider intervention should match the stage and/or severity of the health problem, with the lowest level and least invasive interventions possible utilized to obtain the desired clinical result with the least side effects and at the lowest cost. In teaching community health for many years in chiropractic colleges, Dr. Rand Baird has pointed out how this principle parallels the older and simpler chiropractic saying: "Chiropractic first, medicine second and surgery last."
All chiropractors can be more involved in public health and call for prevention and health promotion in our communities. How? As noted in the first part of this article, the Institute of Medicine (IOM) described the three main functions of public health as assessing community health needs, creating policy supportive of health, and assuring that needed services are provided. Chiropractors can do this, although it can be difficult to know exactly what to do at times. Chiropractic public health education may have left us somewhat uninspired about public health practice, even as our desires to prevent human suffering and promote full expression of individual and community health grew as we progressed through the chiropractic curriculum.
To more specifically see how chiropractors can get involved in public health, I turn to the Centers for Disease Control and Prevention, which broke down the IOM's three main functions into 10 major categories of public health activities. These activities include the following:
- Monitor community health.
- Diagnose and investigate community health problems.
- Educate and empower the public about health issues.
- Mobilize the community to solve health problems.
- Develop policies and plans to support individual and community health efforts.
- Enforce laws to protect public health and safety.
- Link people to health services and ensure care provision when unavailable.
- Ensure a competent public health work force.
- Evaluate the quality and accessibility of population health programs.
- Research new public health solutions.
I'm sure you've noted that chiropractors can and already do many of these tasks, sometimes quite notably. Karen Konarski-Hart, DC, serves as president of the Arkansas Board of Public Health. Andrew Cohen, DC, serves as president of the Hawaii Public Health Association. Mitchell Haas, DC, MA, is a member of the executive board of the Oregon Public Health Association. Ron Kirk, DC, of Life University, helped chiropractors play a major role in the International Bone and Joint Decade through the "Straighten Up America" initiative. Rand Baird, DC, MPH, earned a place for chiropractic within the APHA and currently serves as the global chair of the Public Health Committee of the World Federation of Chiropractic, an organization affiliated with the World Health Organization.
These and other prominent chiropractors serve as examples to all of us in working on those 10 public health tasks. Obviously, all chiropractors won't work on public health with this level of visibility. Most chiropractic public health practice happens in private practices, clinics and colleges around the globe, and you can do it, too!
Academic chiropractors can present practical, evidence-based materials on injury prevention, fall prevention, healthy sexual behaviors, substance abuse prevention, physical activity promotion, geriatric health, and related topics that graduating doctors will be able to use with their patients. New York Chiropractic College (NYCC) is introducing just such a course to be taught by two individuals - one with an MPH degree and the other with a DC degree. NYCC also recently had an effort led by Matthew Cote, DC, to develop a public health/wellness protocol to help student interns, clinicians, and patients connect with community public health resources. Furthermore, academicians can help students become aware of health care policy developments and help them get involved in supporting policy that promotes community health.
Field doctors can familiarize themselves with community and government resources available to help their patients prevent disease and promote health. Many states and organizations have programs available to citizens to help them stop smoking, prevent osteoporosis, or engage in more physical activity (these are just a few examples). By connecting patients with these effective and often free resources, chiropractors enhance their roles in the community, make important connections with the health care infrastructure, and support their patients in ways that will improve the doctor/patient relationship. Also, field doctors can connect with their local public health department. I've recently spoken with the director of public health in my county, and she was very cordial and open to discussion. Volunteering to help any of your local health department's programs or community projects is one of the best ways to start multidisciplinary efforts that will include chiropractic. Additionally, field doctors have an opportunity to influence public policy at every level of government.
Students can join the APHA now and get involved politically, just as they would through SACA or SICA, except that the student APHA presents an integrated and multidisciplinary setting to get involved. Further, as student interns (and later as field doctors after graduation), you can help the patients you serve to prevent injuries and falls, improve ergonomics and nutrition, avoid substance abuse and risky sexual behaviors, and engage in health-enhancing physical and social activities. Be a true health promoter.
Everyone can join the APHA and their state public health associations. The APHA is the largest public health organization in the world and has an active Chiropractic Health Care (CHC) section. It's an easy way to get involved and find out more about how to help. Chiropractors interested in joining can visit http://secure.apha.org/scriptcontent/custom/join/apply.cfm and select "Chiropractic Health Care Section" as "Primary Section" under "Section Affiliation." Also, feel free to contact me at j.t.egan@gmail.com. As membership chair of the CHC for 2007, I'm more than willing to answer your questions, as is any chiropractic member of the APHA.
You can do it. All chiropractors can join the APHA and get more involved in public health. Chiropractic and public health have truly common purposes. They are truly two great tastes that taste great together.
Editor's note: To access a printable version of part 1 of this article, visit
www.chiroweb.com/archives/24/19/02.html.
