There are some confusing messages in the acupuncture community about how public health is defined. It isn't only acupuncturists who are confused, however. Even public health officials have had a hard time creating public awareness and a consensus definition. The lack of understanding has been so widespread that the Association of Schools of Public Health has recently launched the "This is Public Health" campaign that includes red stickers to teach people what public health is. We hope this article will illustrate and clarify any misperceptions about what public health encompasses.
Statement #1 - Public health is about health services for the poor: False. Although public health originated in developing approaches to deal with epidemics and infectious disease, it now refers to a variety of areas such as environmental efforts and advances in sanitation to assure clean air, water and food. Public health efforts have also resulted in decreases in infant mortality and improved maternal and child health. Auto and transportation safety are also included under the "big umbrella" of public health. Professional education, standards, monitoring and licensing are also under the purview of public health.
Statement # 2 - You must receive public funding or grants if you provide public health services: False. The cornerstone of public health is not who pays the bill, but rather who has access to care. In many industries, it may mean that services are paid by grants, but this does not need to be true in the acupuncture profession. One of the major public health priorities as defined by the American Public Health Association is access to care. If you are providing affordable acupuncture, sliding-scale care, home care, care to non-English speakers in their language of origin, and even community acupuncture - surprise, you are providing public health.
Statement # 3 - You cannot make a profit providing public health: False. Public health clinics and nonprofit programs are not necessarily synonymous; you do not need to be one to be the other. Even as a registered nonprofit agency, you can make a profit. It's what you do with that profit that makes the difference. Profit can be used for competitive salaries and benefits for your staff, it can be saved for an operating reserve, or it can subsidize your sliding scale.
Statement # 4 - If you have a public health mission, your patients will be homeless, have parole officers and not be able to afford to pay for services: False. Everyone in our society, even the wealthiest, utilize and benefit from public health. Seatbelts, flu shots, clean water from your faucet and bicycle safety helmets; these all are derived from public health initiatives.
Statement # 5 - "Public health clinics do not create a living for acupuncturists in the way that community clinics have the potential to do": False. Both types of clinics can provide a living wage for acupuncturists. In an article in The Integrator Blog about community acupuncture, John Weeks reported that acupuncturists can earn between $35,000 and $65,000 annually doing a group-style practice.1 We have found the same range for acupuncturists providing public health care. However, most public health positions also include health insurance, paid time off and other benefits, in addition to the salary.
Statement # 6 - You can provide public health, in a private practice or be employed by someone else, make a solid salary and love your job: True. Public health is a call to action. It is the context in which we work, and provides standards for accountability. It neither defines who our patients are, nor our practice structure or income. It is rooted in strategy and manifests in our vision for our practice. In addition to accessibility and affordability, other aspects of public health include building partnerships and linkages with resources and colleagues who might also be serving our patient base (MDs, DOs, massage therapists, local gyms, Mommy and Me groups, etc), providing appropriate care and evaluating our results through data analysis. These analyses can include tracking referral sources of patients and using these to create strategy for future education in the community.
Statement #7 - Although acupuncturists may be interested in working with local public health departments, there is no reciprocity on the part of public health officials to recognize acupuncture: Absolutely false! Although a number of public health departments at the city and state levels are involved with funding, licensing and overseeing acupuncture programs. The city of San Francisco, for example, has an acupuncture department within its public-health structure.2 Aligning our work with local public health officials can be included as part of a strategy to integrate acupuncture care. Local public health departments are not only involved with efforts to reduce substance abuse and control communicable disease, but are also devoted to highly prevalent conditions such as asthma, diabetes and obesity. Acupuncture can have a role in addressing all of these issues, but only if acupuncturists are aware of these potential opportunities. By arbitrarily cutting ourselves off from partnering with public health colleagues, we not only risk continued marginalization of our medicine but also put public health in jeopardy by limiting access to innovative and effective care.
No matter how you look at it - public health, community health or commonwealth - the principles of health and wellness are intrinsic to our medicine and approach to healing. Discussions about how we create our visions about healing contribute to the vitality of our profession and give rise to the ongoing legacy and tradition of Asian medicine.
Click here for more information about Kristen E. Porter, PhD, MS, MAc, LAc.
Click here for more information about Elizabeth Sommers, PhD, MPH, LAc.