Triple aiming higher: dreaming big in pursuit of healthcare transformation

Public health professionals are key actors in healthcare, and their expertise around population health is critical to achieving the Triple Aim of improving the patient experience of care, improving the health of populations and reducing healthcare costs. But situating public health professionals at the clinical level within community-based primary healthcare practices would unintentionally squander the very expertise that makes them so valuable. Integrating public health at the coal face of primary healthcare delivery would risk duplicating or undermining efforts - and worse, it would limit the reach of public health intervention and evaluation to small population sizes. Further, at least in Ontario where a multiplicity of primary care models exists, the inclusion of public health in some practices but not others could further exacerbate health disparities across the population. Instead of integrating public health expertise at the level of primary care teams, our healthcare systems should be redesigned with public health professionals at the centre of our regional planning and funding bodies. The process of planning, tracking, evaluating and managing health system performance cries out for public health leadership. Perhaps this challenge might be more attractive to our public health colleagues.