Public health has got to want to participate!

The lead paper makes a clear case for why better linkages between public health and primary care are necessary in order to address the very significant challenges faced by health systems. Millar and colleagues observe that many public health professionals do not appear to be prepared to take part in the reform of the acute care system. But while Millar et al. provide some historical analysis of how this situation has come about, their article largely refers to recent history in Canada. In this commentary, the author presents a longer-term historical analysis and the experience of other countries to illustrate that there have been, and are, times and places with excellent links between public health and primary care.

Goel V 《-》

Improving collaboration between public health and primary healthcare.

This paper responds to the ideas set forth by Millar et al. in their exploration of whether public health is ready to participate in the transformation of the healthcare system. In this commentary, the author proposes a number of novel solutions to address these challenges, categorized into four areas: experimenting with joint planning, using innovative ways to share and analyze data, employing joint training and networks and facilitating how primary healthcare engages in health promotion in the local community. The author asserts that, ultimately, no single solution will address the multiple barriers to collaboration, but the implementation of some of these ideas can move Canada forward in this area.

Pinto AD 《-》

Public health readiness and role in transformation to a community-based primary healthcare system.

Millar et al. provide a high-level vision for transforming primary care into a community-based primary healthcare system, arguing that public health involvement is critical to the success of this transformation. The authors discuss a number of approaches to mitigate challenges to public health's readiness to participate. In this commentary, the author addresses selected points encouraging the avoidance of high-level conceptual language, a focus on specific value-added linkages and addressing the complex range of critical success factors needed to effect this transformation.

Moloughney BW 《-》

Transformational change: short-term gain for long-term pain?

Transformational change as envisioned by Millar and colleagues forecasts a closer relationship between public health and primary care. In this commentary, public health readiness and the fiscal feasibility of the suggested model are examined from a pragmatic perspective based upon past and current experience. In the face of finite resources and compelling evidence on the merits of public health retaining its traditional involvement with community partners, the utility of late-stage secondary prevention collaboration with primary care is queried. Pursuing partnerships motivated by alleviating pressures in the healthcare system may be superficially attractive but might have a long-term negative impact on the health of the overall population.

Stanwick R 《-》

Reorienting the healthcare system: population and public health need to step forward.

It is suggested by Millar et al. that many public health leaders across Canada have been somewhat reticent to fully engage in health system transformation initiatives, including those in primary care, despite their support of the concept of collaboration. Public health leaders and staff should bring their unique population health perspective to these initiatives by applying health promotion strategies, which include methods to "reorient the health system" to better apply this perspective across the spectrum of health services and work in partnership with other sectors to support the needs of individuals and communities to lead a healthier life. Healthcare transformation efforts across the country would benefit from a more balanced approach between the Triple Aim goals: containing costs, enhancing the patient experience and improving population health.

Neudorf C 《-》