The Foci of the Public Health Preventive Medicine Specialty

The public health and general preventive medicine (PM) specialty's identity is deeply rooted in the houses of both public health (PH) and medicine,1Jadotte YT Leisy HB Noel K Lane DS. The Emerging Identity of the Preventive Medicine Specialty: A Model for the Population Health Transition.American Journal of Preventive Medicine. 2019; 56: 614-621https://doi.org/10.1016/j.amepre.2018.10.031Abstract Full Text Full Text PDF Scopus (13) Google Scholar which have historically been and remain very distinct enterprises.2Brandt AM Gardner M. Antagonism and accommodation: interpreting the relationship between public health and medicine in the United States during the 20th century.American journal of public health. 2000; 90: 707Crossref PubMed Scopus (0) Google Scholar Public health pursues health promotion and health protection, primarily at the population level, while medicine centers on disease prevention and disease treatment, primarily at the individual level.2Brandt AM Gardner M. Antagonism and accommodation: interpreting the relationship between public health and medicine in the United States during the 20th century.American journal of public health. 2000; 90: 707Crossref PubMed Scopus (0) Google Scholar This apparent duality of identity continues to mystify the public, other health professionals, and healthcare institutions regarding how, what, where, and when the PM specialty contributes to the health sphere. This public perception creates a perpetual need for PM to define its identity.1Jadotte YT Leisy HB Noel K Lane DS. The Emerging Identity of the Preventive Medicine Specialty: A Model for the Population Health Transition.American Journal of Preventive Medicine. 2019; 56: 614-621https://doi.org/10.1016/j.amepre.2018.10.031Abstract Full Text Full Text PDF Scopus (13) Google Scholar Consequently, PM physicians find it necessary to self-advocate for their value within the health sphere, often by adopting the latest socio-professional movement that has the contemporaneous attention of decision makers, such as health systems management and leadership,3Jamison SD Higginbotham LB Chambard ML White DP Porterfield DS Flower KB. Preventive Medicine Physicians' Role in Health Care Organizations' Pursuit of the Triple Aim.Journal of Public Health Management and Practice. 2021; 27: S133-S138Crossref Scopus (0) Google Scholar lifestyle medicine,4Pere D. Building Physician Competency in Lifestyle Medicine: A Model for Health Improvement.American journal of preventive medicine. 2017; 52: 260-261Abstract Full Text Full Text PDF Google Scholar integrative medicine,5Katz DL, Ali A. Preventive Medicine, Integrative Medicine & the Health of the Public. 2009:Google Scholar or population health.6Stahlhut RW Porterfield DS Grande DR Balan A. Characteristics of Population Health Physicians and the Needs of Healthcare Organizations.American Journal of Preventive Medicine. 2021; 60: 198-204https://doi.org/10.1016/j.amepre.2020.06.016Abstract Full Text Full Text PDF Scopus (4) Google Scholar Since the specialty's inception in 1954, many efforts have been put forward in pursuit of this goal. Some have sought greater public recognition for PM by proposing the renaming or rebranding of the specialty altogether.1Jadotte YT Leisy HB Noel K Lane DS. The Emerging Identity of the Preventive Medicine Specialty: A Model for the Population Health Transition.American Journal of Preventive Medicine. 2019; 56: 614-621https://doi.org/10.1016/j.amepre.2018.10.031Abstract Full Text Full Text PDF Scopus (13) Google Scholar,7Jadotte YT Lane DS. Core functions, knowledge bases and essential services: A proposed prescription for the evolution of the preventive medicine specialty.Preventive Medicine. 2021; 143 (2021/02/01/)106286https://doi.org/10.1016/j.ypmed.2020.106286Crossref Scopus (6) Google Scholar,8Jung P Lushniak BD. Preventive Medicine's Identity Crisis.American journal of preventive medicine. 2017; 52: e85-e89Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar Others have sought to advance the identity of PM physicians as the leaders of prevention writ large without proposing renaming or rebranding the specialty.9Jonas S What is prevention?.AMAA Journal. 2009; 22: 4-5Google Scholar, 10Jonas S A perspective on educating physicians for prevention.Public Health Reports. 1982; 97: 199PubMed Google Scholar, 11Jung P Lushniak BD. Preventive medicine's equivalence problem.Preventive Medicine. 2020; 134 (2020/05/01/)106060https://doi.org/10.1016/j.ypmed.2020.106060Crossref Scopus (5) Google Scholar, 12Jung P Lushniak BD. Do preventive medicine physicians practice medicine?.Preventive medicine. 2018; 111: 459-462Crossref PubMed Scopus (0) Google Scholar, 13Loh LC Peik SM. Public health physician specialty training in Canada and the United States.Academic Medicine. 2012; 87: 904-911Crossref Scopus (9) Google Scholar A consensus process spearheaded by the American College of Preventive Medicine (ACPM) Graduate Medical Education (GME) Committee detailed the nature and scope of the competencies of PHGPM physicians,14Lane DS Ross V. Consensus on core competencies for preventive medicine residents.American Journal of Preventive Medicine. 1994; 10: 52-55Abstract Full Text PDF PubMed Google Scholar which were initially adopted by the Accreditation Council for Graduate Medical Education (ACGME) for training requirements and by the American Board of Preventive Medicine (ABPM) for exam development. Other prior efforts include ACPM's “Power of Prevention” and “This is Preventive Medicine” campaigns.15Zaza S Krousel-Wood M Carr R. The Power of Prevention: A Shared Vision for Health and Resilience Through Prevention.American Journal of Preventive Medicine. 2022; 62: 647-649https://doi.org/10.1016/j.amepre.2021.12.006Abstract Full Text PDF Google Scholar, 16Ghosh T Buitron de la Vega P Berenji M Smith HJ The Role of Preventive Medicine in Improving Societal Health.American Journal of Preventive Medicine. 2022; 62: 653-655https://doi.org/10.1016/j.amepre.2021.12.005Abstract Full Text PDF Google Scholar, 17Jadotte YT Muzaffar S Zaza S. Preparedness in Routine Prevention: Levers for the Preventive Medicine Specialty in the Healthcare Context.American Journal of Preventive Medicine. 2022; 62 (2022/04/01/): 656-660https://doi.org/10.1016/j.amepre.2021.12.007Abstract Full Text PDF Google Scholar, 18Oliver K Iser J Brumage M Lushniak B. The Power of Prevention: Prevention and Preparedness in Public Health.American Journal of Preventive Medicine. 2022; 62: 650-652https://doi.org/10.1016/j.amepre.2021.12.004Abstract Full Text PDF Google Scholar One initiative that may contribute to advancing the aim of better defining and branding the PM specialty is a collaborative effort by the journal AJPM Focus to define its own identity. The history of the birth of this journal and its mission and vision have been detailed elsewhere,19Jadotte YT. AJPM Focus: A Guide and Road Map on Inclusivity in People, Methods, and Outcomes.AJPM Focus. 2022; 1 (2022/09/01/)100001https://doi.org/10.1016/j.focus.2022.100001Abstract Full Text Full Text PDF Scopus (1) Google Scholar and expanded perspectives are also available, courtesy of the journal's highly diverse founding editorial board, regarding the specific components or foci of the journal's aims and scope.20Arkhipova-Jenkins I Rajupet SR. Population Medicine, Population Health, and Population Health Management: Strategies That Meet Society's Health Needs.AJPM Focus. 2024; 3https://doi.org/10.1016/j.focus.2023.100164Abstract Full Text Full Text PDF Google Scholar, 21Caron RM Noel K Reed RN Sibel J Smith HJ. Health Promotion, Health Protection, and Disease Prevention: Challenges and Opportunities in a Dynamic Landscape.AJPM Focus. 2024; 3 (2024/02/01/)100167https://doi.org/10.1016/j.focus.2023.100167Abstract Full Text Full Text PDF Scopus (0) Google Scholar, 22Chevinsky J Chirumamilla S Caswell S Nyoni LM Studer K. Clinical Preventive Medicine, Integrative Medicine, and Lifestyle Medicine: Current State and Future Opportunities in the Development of Emerging Clinical Areas.AJPM Focus. 2024; https://doi.org/10.1016/j.focus.2023.100166Abstract Full Text Full Text PDF Google Scholar, 23Knecht A Akolkar N Molinari A Palma M. Community Medicine, Community Health, and Global Health: Interdisciplinary Fields with a Future Lens Inclusive of Local and Global Health Equity.AJPM Focus. 2024; https://doi.org/10.1016/j.focus.2023.100165Abstract Full Text Full Text PDF Google Scholar, 24Perry I. Assessment, Policy Development, and Assurance: Evolving the Core Functions of Public Health to Address Health Threats.AJPM Focus. 2024; https://doi.org/10.1016/j.focus.2023.100172Abstract Full Text Full Text PDF Google Scholar This editorial article highlights the results of this collaborative effort by various entities affiliated with the journal AJPM Focus, which simultaneously advances recognition of the PM specialty's identity and contributions to public health, medicine, and society. A four-year Delphi study was implemented, from June 2019 to September 2023. A total of 90 experts in the field, hailing from the governing boards of ACPM (n = 12), the Association for Prevention Teaching and Research (APTR) (n = 12), and the American Journal of Preventive Medicine (AJPM) (n = 14), as well as the editorial board and editorial leadership of AJPM Focus (n = 52), were engaged in a multiphased process to explore definitions, models, trends, challenges, and opportunities in clustered areas of relevance (i.e., foci) of public health and PM. The identified foci were integrated into and form the basis of the journal's scope and aims statement, and they are further explored and explained in this dedicated special series of 7 editorial articles, written by members of the journal's editorial board, and published by the journal AJPM Focus. These 7 articles are made widely available to the broader academic community and general public via the journal's open access model, including both online publication in a dedicated special collection and dissemination of a limited number of print versions to members of APTR, ACPM, and AJPM, to facilitate greater engagement with this content on the PM specialty between health systems, the public, and all health professionals. Based on this high-level and longitudinal engagement between the AJPM Focus journal and the identified affiliated groups of experts, the journal proposes an organizing framework for defining the work of PM that centers on 5 logical and holistic foci within the full spectrum of prevention teaching, research, practice, and policy. The term “focus” (or “foci” in plural form) was explicitly adopted as an important element in the structure of the journal due to its many connotations. On the one hand, “focus” implies a narrowing of one's view to concentrate on one given aspect of a phenomenon, as in, “Let's focus on this or that.” This is helpful for the PM specialty, which is often perceived as lacking focus by the public, given the breadth of the specialty. The latter is a blessing for PM physicians who are seasoned in the specialty and often seek to diversify their practice across a variety of areas, but it can also feel like a curse for students, trainees, and early career professionals seeking to find their footing in the world. AJPM Focus aims to help bring focus, and hopefully clarity, to the work of PM physicians as they explore and apply the prevention evidence base to structure and guide their practice. On the other hand, the term “focus” also implies the clustering or synthesis of the essence of a set of ideas, thoughts, models, tools, interventions, and approaches to addressing something, as in, “What's the focus of your work?” This too is directly related to the journal and the PM specialty: the work of prevention can be understood and presented as a coherent synthesis of ideas, thoughts, models, tools, interventions, and approaches. Table 1 provides a detailed overview of these 5 foci, their definition, public health foundation, and examples of their applications in the PM specialty. Figure 1 depicts an integrated conceptual model of the 5 foci of the PM specialty, and their place relative to the houses of medicine and public health.Table 1The Definitions, Public Health Foundations, and Applications of the Foci of the PM Specialty.Foci of PM SpecialtyFoci LevelsFoci DefinitionsPublic Health FoundationsExamples of Applications in PMCommunity medicine, community health, and global healthLevel 1Mutually exclusive and distinct areas of practice of the PM specialty, which serve as lenses or sets of tools, models, knowledge bases, or skills via which PM physicians approach their work and deliver their services in and contributions to medicine, public health, and society.The practice or application of community-level interventions to improve health outcomes; called community medicine (or community preventive medicine) when this practice includes clinical components that depends on physicians and other clinicians for implementation, community health when the emphasis is program evaluation and interventions at the local level, and global health when the emphasis is on issues of global scope.The practice of community preventive medicine is grounded in the core PH function of assessment, which provides the evidence base for monitoring the health status of populations, understanding the root causes of health, disease, and inequity. Using this foundation, community medicine then implements interventions to mitigate or prevents the effects of these factors.Implementing communicable disease control programs (such as directly observed therapy for TB; STI surveillance and treatment guidance for primary care doctors).Educating a local community about the benefits of vaccines and providing vaccines at points of distribution, informed by active epidemiologic surveillance evidence.Population medicine, population health, and population health managementThe practice or application of population-level interventions to improve health outcomes; called population medicine (or clinical population medicine) when this practice includes clinical components (or direct patient care) that depends on physicians and other clinicians for implementation, population health management when the emphasis is on non-clinical components (or indirect patient care), and population health when the healthcare system has a broader focus on the health of the public, beyond their narrower population of patients.The practice of clinical population medicine is grounded in the application of epidemiologic methods to study, evaluate, and optimize clinical care and outcomes. These methods, though now widely adopted in multiple professions and disciplines, originate from the profession of public health.Addressing the social determinants of health for patient populations outside of their brief stay within hospitals, in partnership with other community entities such as schools and libraries.Designing or reimagining a healthcare system's structures and processes to facilitate better care coordination, streamlining of clinical services, and achievement of the quadruple aims of cost, quality, patient outcomes, and provider wellbeing.Clinical preventive medicine, integrative medicine, and lifestyle medicineThe practice or application of individual or group-level interventions to improve health outcomes, with a focus on prevention as compared to treatment. Clinical preventive medicine is inclusive of lifestyle medicine or integrative medicine, depending on the desired practice goals and settings of individual PM physicians.While often thought of as not being directly related to PH, clinical preventive medicine is in fact deeply aligned with PH. Namely, PH provides a framework for linking the individual patient's diseases, physical signs, symptoms, and laboratory findings to the broader social and environmental determinants of health that may impede or facilitate positive health changes for the patient.Applying the various public health behavior change theories models in the context of lifestyle medicine prescriptions to identify and mitigate known barriers to successful accomplishment of patient goals.Assuring that a primary care clinic that seeks to optimize the delivery of clinical preventive services adequately accounts for what community-based resources are available to assist patients in their journey towards health and that patients can access and utilize these resources.Health promotion, health protection, and disease preventionLevel 2Cross-cutting approaches that span the level 1 foci of the PM specialty, and illustrate the continuum and complexity of the bridging work that is performed by PM physicians.The levels of prevention that precede disease treatment, focusing on true prevention. Health promotion focuses optimization of health through social and environmental interventions; health protection facilitates the provision of protective factors to allow people to remain healthy; and disease prevention applies early detection efforts or clinical interventions to avert the emergence of disease.The levels of prevention provide a lens that informs how the houses of medicine and public health can conceptualize the continuum of their interdependent but mutually beneficial relationship and complementary roles in society.Implementing the United States Preventive Services Task Force and Community Preventive Services Task Force that apply to the same diseases, screening tools, or preventive interventions.Advocating for changes in policies, regulations, statutes, and laws to promote and protect the health of the public.Assessment, policy development, and assuranceThe core functions of public health (PH), which define the scope of practice of public health as a profession; organizing framework for defining public health for the profession and the general public.The core functions of PH serve as an essential lens that informs the practice of PM based on the different contexts of this practice.Developing and providing culturally appropriate materials to communities or patients in a hospital to minimize health literacy challenges.Applying quality assessment, control, improvement, and assurance methods within healthcare systems to improve patient outcomes. Open table in a new tab On the basis of these findings, which fully capture the breadth and depth of the scope of practice of PM physicians, the authors propose the following additional thoughts to further aid in naming and branding the PM specialty. First, there is a need to the of the specialty. the in the health and general preventive was to better PHGPM from the specialty areas of medicine and medicine, this creates First, the term implies that the specialty has distinct the of or articles that define and the of PH and into one specialty for and board in by the of the American Board of Preventive journal of preventive medicine. 22: Full Text Full Text PDF PubMed Scopus (0) Google Scholar further that is not a distinct from PH. Consequently, the authors propose that the for the specialty at this is Health Preventive Medicine” This is not to of the specialty that may not of as PH. it the number of in the of the PH as the core for all of the specialty's practice, as detailed further in table the of PH in the of the and continues to on the for Disease and Prevention Public Health United Google for Disease and Prevention Public Health United Scholar public and AM Gardner M. Antagonism and accommodation: interpreting the relationship between public health and medicine in the United States during the 20th century.American journal of public health. 2000; 90: 707Crossref PubMed Scopus (0) Google Scholar of PH. is also to the branding of the specialty with the that the and the training and of PM physicians, ACPM, and that the authors and Clinical Preventive Medicine” as to what the specialty includes for branding These for the specialty with the of (i.e., and with the level 1 foci of the specialty as detailed in Table 1 (i.e., community preventive medicine, clinical population medicine, and clinical preventive all PM physicians to identify their focus of practice while the for branding Community Preventive Medicine the term which PM physicians may not fully though it was by PM Community Medicine: A at the of College of Medicine. Scholar many to primary which is academic medicine or have community medicine to their Clinical Population Medicine is by a J S prevention and population framework for health Journal of Preventive Medicine. 27: Full Text Full Text PDF PubMed Scopus (0) Google YT Lane DS. Population Health A for in Population Medicine and Clinical Preventive of Public Health Management and Practice. 2021; 27: PubMed Scopus (0) Google Scholar and the of public health and primary AM A J R. Clinical Population Medicine: Clinical Medicine and Population Health in of Medicine. 2017; PubMed Scopus Google Scholar which is a that PM physicians clinical medicine and population to from Journal of Public 2019; Scopus (4) Google Scholar Clinical Preventive Medicine is widely in Clinical Preventive 1994; Google Scholar and is to the public and other health professionals. This facilitate greater engagement between ACPM and all physicians who are not members of the such that the to and on the specific of physicians, as compared with the of in medicine and medicine are by their own specialty is also a need for ACPM and physicians to work with and to the specialty to the successful renaming of to and environmental in which aligned that specialty's to its (i.e., and as a core of that specialty. and clinical preventive be as core of the specialty. The PM specialty to better its identity and its value to health systems and the general The in with various groups of experts affiliated with the journal AJPM Focus, propose that the PM specialty has 5 foci that can aid in this and that health preventive is the appropriate for the specialty, and and clinical preventive are for the foci of the specialty.

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