Margaret Bourdeaux (
Annmarie Sasdi, Harvard University.
Health Aff (Millwood). 2023 Mar;42(3):310-317. doi: 10.1377/hlthaff.2022.01255.
The operational cleavage between the US public health and medical care systems contributed to the country's difficulty in containing community spread of COVID-19 in the pandemic's first months. We provide an overview of the independent evolution of these two systems, drawing on case examples and publicly available outcome data, to demonstrate how three fundamental elements of epidemic response-case finding, mitigating transmission, and treatment-were undermined by the lack of coordination between public health and medical care and how these gaps contributed to health disparities. We propose policy initiatives to address these gaps and facilitate coordination across the two systems: build a case-finding diagnostic system to quickly identify and mitigate the emergence of health threats in communities, develop data systems that facilitate the transfer of critical health intelligence from medical institutions to public health departments, and establish referral pathways for public health practitioners to connect people with medical services. These policies are practicable because they build on existing efforts and those currently in development.
美国公共卫生和医疗保健系统之间的运作脱节，导致该国在大流行的头几个月难以控制 COVID-19 的社区传播。我们通过案例示例和公开可用的结果数据，概述了这两个系统的独立发展，以说明发现病例、减少传播和治疗这三个基本的疫情应对要素是如何因公共卫生和医疗保健之间缺乏协调而受到破坏的，以及这些差距是如何导致健康差距的。我们提出了一些政策举措来解决这些差距，并促进两个系统之间的协调：建立一个病例发现诊断系统，以便快速识别和减轻社区中健康威胁的出现，开发数据系统，以便从医疗机构向公共卫生部门传递关键健康情报，并为公共卫生工作者建立转诊途径，将人们与医疗服务联系起来。这些政策是可行的，因为它们建立在现有努力和目前正在开发的努力的基础上。
