Public health and emergency medicine

Introduction

Public health (PH) is an organized attempt by society to ensure a healthy population. It is recognized as key to a sustainable and effective health care system. The UN Universal Declaration of Human Rights (1948) states that all people are equally entitled to good health and decent living conditions and it is this humanistic ideal that drives much of PH.

Emergency medicine (EM) is an important but is an under-recognized and -utilized player in PH. While at first glance it may appear non-core to EM, PH and EM interact over a number of domains. These include disease surveillance, health care access, disease and injury prevention and advocacy. The International Federation for Emergency Medicine provides a clear mandate for PH in its definition of EM as: ‘A field of practice based on the knowledge and skills required for the prevention, diagnosis and management of acute and urgent aspects of illness and injury’.

Emergency departments (EDs) in Australia and New Zealand see over 8.7 million attendances annually. This population is receptive to PH intervention in a concept described as the ‘teachable moment’. This has been described as a brief opportunity to intervene to change behaviour. This is particularly pertinent when patients present as a consequence of risky health behaviour. The large majority of emergency physicians (EP) see PH as part of their role as a health care advocate and ED clinician. PH intervention in the ED setting is challenging. EDs have limited resources and strive to provide safe and timely acute care. PH roles may be seen as simply adding to the burden.

Increasingly, the social determinants of health affect individuals’ opportunity to have a healthy life. Examples include access to safe and affordable housing, education and exposure to violence. Many ED patients have poor social determinants and limited access to alternate health care options. EM should, through its surveillance and advocacy role, help to highlight and address these issues at a community and policy level. Social and environmental factors can be influenced by advocacy both at a local and national level. EP and the Australian College of Emergency Medicine (ACEM) are credible and persuasive health care advocates to provide effective PH and policy messages.