It's time for some straight talk. Did you ever wonder why chiropractic students have to take board exams in public health? Does public health ever matter to chiropractic practice? For that matter, does public health matter at all?
I'll answer the last question first. There is fairly good evidence to suggest that in the overwhelming majority of cases, the increase in lifespan that has been realized over the previous century is essentially due to public health - improvements in hygiene and sanitation, infectious disease control, public safety, and so forth. The average U.S. citizen may owe as many as 30 years of their life to public health running quietly in the background. Public health has literally nearly doubled lifespan over the prior century. Conversely, improvements in clinical care have added less than five years to the average lifespan compared to last century. As mentioned in a previous article, the American Public Health Association (APHA) refused for many years to admit medical doctors as members for fear that the organization's focus might be shifted from life-lengthening prevention to treatment.
Public health is highly underappreciated and perhaps only noticed when something goes wrong: a food-borne illness outbreak, an outbreak of infectious disease, sale of products that have harmed consumers and require recall, or distribution of a chemical, food additive or medication that turns out to have unacceptable harms. Public health may appear ineffective at addressing some of the larger issues of the day: obesity, chronic disease, bioterrorism. Yet upon closer inspection, public health is hard at work and is often unnoticed, underfunded or underappreciated. Chiropractors may understand this feeling.
So, to the other question: Does public health matter to chiropractic practice? Have you ever detected an abdominal aortic aneurysm in an older adult that should have been screened long before the patient presented to your office with low back pain? There is a public health screening guideline to that effect. Have you ever had an older patient in your office for back pain who had fallen in their home? Fall prevention is a key part of public health for the elderly. Have you treated patients with chronic pain secondary to infectious disease or secondary to the long-term treatment of the disease? Do you have patients 40, 50 or 60 years of age who need preventive screens demonstrated to have benefits that outweigh risks?
Have you ever detected a medication side effect in a patient and referred the patient back to their medical care provider? Have you ever treated a patient for cervicogenic headache? Have you ever reassured a patient with acute low back pain that they were likely going to get better with or without treatment, and not to face their pain with fear, but with optimism? These are all issues of enormous public health significance. Public health is prevention, treatment and mitigation, and chiropractors are involved intimately.
Reduction of incidence, prevalence, morbidity and mortality are critical components of public health concepts of wellness, and are equally important to chiropractic practice. Prevention can reduce the incidence of a given disease or condition, treatment may reduce the prevalence of a disease or condition, and intervention may limit the morbidity or the mortality associated with a chronic condition. Chiropractors often try to use these concepts with their patients. Physical activity and nutritional guidelines may be given to a patient to attempt to prevent episodes of back pain or overcome a current pain episode. Ongoing care may be provided to limit or control chronic back pain while striving to improve activities of daily living. These are public health roles.
While it is true that public health is most properly a population-based enterprise, a public-health-aware clinical approach can make a population-level difference. Practice that is informed by public health themes can affect patients for good. In short, public health is a population-wide enterprise that affects everyone.
Here's some more straight talk. A successful public-health-informed patient encounter is the beginning. Joining APHA may be the next step. If you believe public health matters - and if you believe chiropractic participation in mainstream public health activities benefits everyone - please join APHA's Chiropractic Health Care section. As noted, APHA is strongly committed to the prevention of disease and the promotion of health in every individual. APHA is a key to committed, organized, integrated public health practice, and the chiropractors within APHA welcome you.
To learn more about chiropractors working in public health, read Dr. Rand Baird's "Chiropractic in the APHA" column, which appears regularly in DC. To join the APHA, visit www.apha.org and click on "Membership" and then "Join." Remember to select "Chiropractic Health Care" as your primary section affiliation.
Dr. Jonathon Egan is a graduate of New York Chiropractic College and current chief of staff of the NYCC Campus Health Center. Formerly a clinician at the VA facility in Rochester, N.Y., he now chairs the Seneca County Board of Health.