Vision for the future: Role of family doctors in public and population health
Focus on our nation’s public health challenges has never been greater. The events of September 11, 2001, the subsequent threats of bioterrorism, and the effects of sudden acute respiratory syndrome (SARS), mad cow disease, Escherichia coli contamination of our water supply, air pollutants, pesticides, avian and other new strains of influenza, West Nile virus, and institutional outbreaks of Clostridium difficile have all increased public concern about emergency preparedness and system response. People want to know how they will be protected and how quickly and effectively our system can react to known and unknown threats. 
 
As a society we have become more aware of the value of programs for illness and injury prevention and health promotion, including activities related to prenatal and child health, immunization, smoking cessation, healthy eating, weight control, physical activity, prevention and treatment of sexually transmitted diseases, substance abuse, mental health promotion, communicable disease prevention and control, and prevention and management of chronic diseases (such as HIV and AIDS, diabetes, hypertension, asthma, and coronary artery disease). 
 
All these programs are central to a strong and cohesive public health strategy. They are also part of the discipline of family medicine and the practices of family physicians. Addressing these issues successfully will require a health care system that strongly supports the education, training, and integrated roles of public health leaders, family physicians, and other caregivers throughout our communities. 
 
The attacks on the World Trade Center and the SARS crisis focused governments on strengthening our public health infrastructure. In December 2003, Dr Carolyn Bennett, a family physician, was appointed Federal Minister of State for Public Health. The Public Health Agency of Canada and a Chief Medical Officer for Canada, Dr David Butler-Jones (also a family medicine graduate), have now been introduced. The September 2004 First Ministers’ Accord included commitments to developing a new public health network to coordinate responses to infectious disease outbreaks and public health emergencies and to accelerate work on a pan-Canadian public health strategy. Interest and support for research into public and population health has increased. 
 
For many years, the College of Family Physicians of Canada (CFPC) and thousands of Canadian family physicians have been active in public health, promoting good health, screening for early detection of disease, and managing patients with chronic illnesses. Hundreds participate in the CFPC’s National Research System (NaReS), playing a key role in surveillance and treatment of disease outbreaks. Unfortunately, the support family doctors need to fulfil their responsibilities effectively has not always been available. The Naylor Report, Learning from SARS, analyzed the experiences of those involved in Toronto’s 2003 outbreak and emphasized the challenges family doctors face when the health care system pays insufficient attention to their role.1 
 
An effective public health system requires strong links with family medicine. In its position paper, Family Medicine in Canada: Vision for The Future,2 the CFPC proposes strategic integration of family physicians into Canada’s public and population health strategies. Recommendations include the following. 
 
 
Family physicians should be recognized and provided with the education and practice support they need to be an integral part of Canada’s public health system. 
 
 
Governments, public health systems, medical schools, and professional colleges should support undergraduate and postgraduate education, training, and continuing medical education and professional development for family physicians related to their potential public health roles. 
 
 
Public health officials and hospitals should communicate and collaborate with family physicians to manage public health crises and emergencies. 
 
 
Community family practices must be provided with the resources, including funding, support staff, information, and supplies, needed to carry out their role in community health crises and emergencies. 
 
 
Electronic records to aid surveillance, monitoring, reporting, research, and quality control should be developed and implemented to link networks of community-based family physicians to public health offices and officials. 
 
 
 
In addition to serving on the front lines of practice, family physicians must also offer leadership in public and population health education, training, research, and policy development and dissemination. 
 
For family doctors, issues that define the public health agenda have always been core to their day-to-day work as clinicians, teachers, and researchers. Knowledge gained from research and information about new advances related to ever-changing public and population health challenges must be readily available to family physicians to incorporate into their practices and share with their patients and communities. There is both opportunity and need for family doctors, linked to public health offices and officers, to play important roles in local, regional, and national surveillance, prevention, and treatment networks. The potential benefit for all Canadians to have their family doctors central to developing our nation’s public health policies and strategies and providing preventive care and active treatment is immense, but to date has largely been overlooked. The futures of family medicine and public and population health in Canada could well be inextricably linked.