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Well, that's the problem, isn't it? Health care and public health were severed early in the 20th century, and we've been paying the price for that decision ever since. I had been a practicing critical care nurse for years when I began to wonder if preventing all the health disasters I was seeing might not be preferable to throwing technology at them. I found no support -- and I had never even heard of public health. It took me a while to find out how to proceed. When I entered my MPH program, I found that, as a clinician, I spoke a completely different language from those in public health. It was a complete re-socialization process.

I would submit that we re-think that initial disastrous decision. Training in population health should be integrated into the education of all health care professionals. As for non-clinical public health professionals -- a few clinical facts of life wouldn't hurt them either.

As with provider-based improvement, population-based improvement is dependent on transparently shared, frequent observations of results. To paraphrase Lord Kelvin, as many others have, one can not improve unless one measures. Applying triple aim principles to population health requires a geographically defined population and simultaneous, frequent, transparent, interpretable measurement of population health, experience of care and cost per capita. Adherence to these principles prevents viewing only the silver lining without the cloud.

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