Skip to main content


Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

The Interaction of Public Health and Primary Care: Functional Roles and Organizational Models that Bridge Individual and Population Perspectives


Introduction: Public health and primary care are often conceived as two entities providing complementary services within the health system. This scoping review aims to better understand how the two sectors interact by identifying their shared functions, and by identifying organizational models that could facilitate the interaction between the two domains.

Methodology: We conducted a review of published literature using PubMed and CINAHL journal indices. Our search yielded 179 articles. We reviewed abstracts and retained 55 relevant articles. We developed an extraction grid, based on a conceptual framework of functions of public health and primary care, in order to evaluate the relevance of selected articles, classify the information according to their functional connection, and identify interactions between them.

Results: Our search identified various activities through which public health can contribute to more effective primary care, and functions usually performed by primary care that seemed to support a population health approach. Most authors identified screening and immunization as actions that are carried out in primary care, but that can benefit from the support of public health. Health promotion and lifestyle modification are also shared responsibilities that can take the form of collective or individual intervention. The surveillance and protection function of public health, which actually takes place in primary care, consists of case identification for prevention or early treatment. Primary care is the setting where patients present, whereas public health has the role of investigation and of providing advice to clinical settings. Planning and evaluation are also emerging activities that concern both public health and primary care. Many authors recognized that public health provides tools that enhance the planning of primary care activities and are more aligned with the actual needs of populations. Others noted that public health is able to assess primary care in light of the changing health of populations, which may lead to better results for groups of patients.

Conclusion: One of the routes to a better understanding of how public health and primary care organizations can better interact is to identify the different contexts in which they collaborate successfully. Our scoping review of the scientific and gray literature identified various ways by which public health and primary care either reinforce each other through their respective functions, or increasingly act in a collaborative manner to increase population health and improve health systems performance.


  1. 1.

    Acheson D. Public Health in England: The Report of the Committee of Inquiry into the Future Development of the Public Health Function. Department of Health. London: Stationery Office Books; 1988.

  2. 2.

    Martin-Misener R, Valaitis R. Strengthening primary health care through primary care and public health collaboration. Canadian Foundation for Healthcare Improvement. Canada. Ottawa: McMaster University; 2012.

  3. 3.

    Institute of Medicine. Primary Care and Public Health: Exploring Integration to Improve Population Health. Washington (DC): The National Academies Press; 2012

  4. 4.

    Lévesque JF, Bergeron P. De l’individuel au collectif: une vision décloisonnée de la santé publique et de soins. Ruptures, revue transdisciplinaire en santé 2003;9:73–89. [In French]

  5. 5.

    Ministère de la santé et des services sociaux. 2003. Québec public health program 2003-2012. Québec. Available from URL: http://publications.msss.gouv. (Accessed 17 March 2013).

  6. 6.

    Stevenson Rowan M, Hogg W, Hudson P. Integrating public health and primary care. Health Policy. 2007;3:160–81.

  7. 7.

    Pan American Health Organization. Initiative La santé Publique dans les Amériques. Mesure de la performance des fonctions essentielles de santé publique. Guide pour l’application de l’instrument de mesure de la performance des fonctions essentielles de santé publique. PAHO; 2000. Available from URL: FESP_Guide_Application_Instrument_Mesure_Performance.pdf&sa=U&ei= d3xWUrX-MtGJhQeKlYDwDQ&ved=0CBoQFjAB&usg=AFQjCNE51JFWy7UjCXyl5UWEGTVcm0b9-Q (Accessed 10 October 2013). [In French]

  8. 8.

    Starfield B. Primary Care: Balancing Health Needs, Services and Technology. Revised edition. New York (NY): Oxford University Press; 1998.

  9. 9.

    Macinko J, Starfield B, Erinosho T. The impact of primary healthcare on population health in low- and middle-income countries. J Ambul Care Manage. 2009;32:150–71.

  10. 10.

    World Health Organization. Health systems strengthening glossary. Available from URL: (Accessed 22 April 2013).

  11. 11.

    Lee A, Kiyu A, Milman HM, Jimenez J. Improving health and building human capital through an effective primary care system. J Urban Health. 2007;84:175–85.

  12. 12.

    Starfield B. Public health and primary care: a framework for proposed linkages. Am J Public Health. 1996;86:1365–9.

  13. 13.

    Rhode Island Department of Health. Impact of primary care on healthcare cost and population health: a literature review. Rhode Island Department of Health; 23 February 2012.

  14. 14.

    Ciliska D, DeGuzman A, Ehrlich A. Public health and primary care: challenges and strategies for collaboration. Public Health Research, Education & Development Program; October 2005.

  15. 15.

    Bradley S, David McKelvey S. General practitioners with a special interest in public health; at last a way to deliver public health in primary care. J Epidemiol Community Health. 2005;59:920–3.

  16. 16.

    Hannay DR. Primary care and public health. BMJ. 1993;307:516–7.

  17. 17.

    Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q. 2005;83:457–502.

  18. 18.

    Welton WE, Kantner TA, Katz SM. Developing tomorrow’s integrated community health systems: a leadership challenge for public health and primary care. Milbank Q. 1997;75:261–88.

  19. 19.

    Kringos DS, Boerma W, Van Der See J, Groenewegen P. Europe’s strong primary care systems are linked to better population health but also to higher health spending. Health Affairs. 2012;32:686–94.

  20. 20.

    Peckham S, Hunter DJ, Hann A. The delivery and organization of public health in England: setting the research agenda. Public Health. 2008;122:99–104.

  21. 21.

    Stange KC, Ferrer RL. The paradox of primary care. Ann Farn Med. 2009;7:293–9.

  22. 22.

    Stead LF, Lancaster T. Behavioural interventions as adjuncts to pharmacotherapy for smoking cessation. Cochrane Database Syst Rev. 2012;12:CD009670.

  23. 23.

    Brown T, Avenell A, Edmunds LD, Moore H, Whittaker V, et al. Systematic review of long-term lifestyle interventions to prevent weight gain and morbidity in adults. Obes Rev. 2009;10:627–38.

  24. 24.

    Garceau LM, Paine LL, Barger MK. Population-based primary health care for women. An overview for midwives. J Nurse Midwifery. 1997;42:465–77.

  25. 25.

    Weinstein LC, Lanoue MD, Plumb JD, King HF, Stein B, Tsemberis S. A primary care-public health partnership addressing homelessness, serious mental illness, and health disparities. 2013;26:279–87.

  26. 26.

    Koo D, Felix K, Dankwa-Mullan I, Miller T, Waalen J. A call for action on primary care and public health integration. Am J Public Health. 2012;102:S307–9.

  27. 27.

    Reingold AL. Outbreak investigations—a perspective. Emerg Infect Dis. 1998;4:21–7.

  28. 28.

    Scutchfield FD, Michener JL, Thacker SB. Are we there yet? Seizing the moment to integrate medicine and public health. Am J Public Health. 2012; 102:S312–6.

  29. 29.

    Stange KC. Power to advocate for health. Ann Fam Med 2010;8:100–7.

  30. 30.

    Peckham S, Hann A, Boyce T. Health promotion and ill-health prevention: the role of general practice. Qual Prim Care. 2011;19:317–23.

  31. 31.

    Etz RS, Cohen DJ, Woolf SH, Holtrop JS, Donahue KE, et al. Bridging primary care practices and communities to promote healthy behaviors. Am J Prev Med. 2008;35:S390–7.

  32. 32.

    Breton M, Denis JL, Lamothe L. Incorporating public health more closely into local governance of health care delivery: lessons from the Quebec experience. Can J Public Health. 2010;101:314–7.

  33. 33.

    Macinko J, Starfield B, Shi L. The contribution of primary care systems to health outcomes within Organization for Economic Cooperation and Development (OECD) countries, 1970–1998. Health Serv Res. 2003;38:831–65.

  34. 34.

    Kamien M. The tasks of general practice. A new kind of GP? Aust Fam Physician. 2002;31:857–9.

  35. 35.

    Neuwelt P, Matheson D, Arroll B, Do well A, Winnard D, et al. Putting population health into practice through primary health care. N Z Med J. 2009;122:98–104.

  36. 36.

    Solaridis S, Oandasan I, Kimpton S. Family Health Team. Can health professionals learn to work together? Can Fam Physician. 2007;53:1198–99

  37. 37.

    Glazier R, Redelmeier D. Building the Patient-Centered Medical Home in Ontario. JAMA. 2010;303:2186–7.

  38. 38.

    Rosser WW, Colwill JM, Kasperski J, Wilson L. Patient-Centered Medical Homes in Ontario. N Engl J Med. 2010;362:e71–3.

  39. 39.

    Baudier F, Clément MC. Recommandations: concevoir et faire vivre une maison de santé. Santé Publique. 2009;21:103–6. [In French]

  40. 40.

    Nutting PA, Crabtree BF, Miller WL, Stange KC, Stewart E, Jaen C. Transforming physician practices to patient-centered medical homes: lessons from the national demonstration project. Health Aff (Millwood). 2011;30:439–45.

  41. 41.

    Breton M, Lévesque JF, Pineault R, Hogg W. Primary care reform: can Quebec’s Family Medicine Group Model benefit from the experience of Ontario’s Family Health Teams? Healthc Policy. 2011;7:el22–35.

  42. 42.

    Bindman AB, Weiner JP, Majeed A. Primary care groups in the United Kingdom: quality and accountability. Health Aff (Millwood) 2001;20:132–45.

  43. 43.

    Gillam S, Schamroth A. The community-oriented primary care experience in the United kingdom. Am J Public Health. 2002;92:1721–5.

  44. 44.

    Gillam S. Community-oriented primary care. Br J Gen Pract. 2002;52:854–5.

  45. 45.

    Rittenhouse D, Shortell S, Fisher E. Primary care and accountable care — two essential elements of delivery-system reform. N Engl J Med. 2009;361:2301–3.

  46. 46.

    Bobbitt JD. What family physicians need to know about ACOs. Fam Pract Manag. 2011;18:17–22.

  47. 47.

    Bao Y, Casalino L, Pincus HA. Behavioral health and health care reform models: patient-centered medical home, health home, and accountable care organization. J Behav Health Serv Res. 2013;40:121–32

  48. 48.

    Miller HD. How to create accountable care organizations. Center for Healthcare Quality and Payment Reform; 7 September 2009.

  49. 49.

    Nicholson C, Jackson CL, Marley JE, Wells R. The Australian experiment: how primary health care organizations supported the evolution of a primary health care system. J Am Board Fam Med. 2012;25:S18–26.

  50. 50.

    Nourevitch M, Cannell T, Boufford J, Summers C. The challenge of attribution. Responsability for population health in the context of accountable care. Am J Prev Med. 2012:42;180–3.

  51. 51.

    Guirguis-Blake J, Calonge N, Miller T, Siu A, Teutsch S, et al. Current processes of the U.S. Preventive Services Task Force: refining evidence-based recommendation development. Ann Intern Med. 2007;147:117–22.

  52. 52.

    Iliffe S, Lenihan P. Integrating primary care and public health: learning from the community-oriented primary care model. Int J Health Serv. 2003;33:85–98.

  53. 53.

    Nutting PA, Wood M, Conner EM. Community-oriented primary care in the United States. A status report. JAMA 1985;253:1763–6.

  54. 54.

    Marks L, Weatherly H, Mason A. Prioritizing investment in public health and health equity: what can commissioners do? Public Health. 2013;127:410–18.

  55. 55.

    Kousoulis AA, Angelopoulou KE, Lionis C. Exploring health care reform in a changing Europe: lessons from Greece. Eur J Gen Pract. 2013;19:194–9.

  56. 56.

    Sweeney SA, Bazemore A, Phillips RL Jr, Etz RS, Stange KC. A reemerging political space for linking person and community through primary health care. Am J Public Health. 2012;102:S336–41.

  57. 57.

    Alpert JS, Shapiro E. The anatomy and physiology of the US health care system in 2050? An exercise in prognostication, fantasy, and hope. Am J Med. 2012; 125:1151–2.

  58. 58.

    Polikowski M, Santos-Eggimann B. How comprehensive are the basic packages of health services? An international comparison of six health insurance systems. J Health Serv Res Policy. 2002;7:133–42.

  59. 59.

    Iliffe S, Lenihan P, Wallace P, Drennan V, Blanchard M, Harris A. Applying community-oriented primary care methods in British general practice: a case study. Br J Gen Pract. 2002;52:646–51.

  60. 60.

    Australian Government. Improving primary health care for All Australians. Commonwealth of Australia; 2011. Available from URL: (Accessed 10 October 2013).

  61. 61.

    U.S. Department of Health & Human Services — Agency for Healthcare Research and Quality. Welcome to the PCMH Resource Center. AHRQ. Available from URL: pcmh_home/1483/pcmh_home_v2 (Accessed 1 May 2013).

  62. 62.

    Royal College of General Pratitioners. GP with a Special Interest (GPwSI) accreditation. Available from URL: aspx (Accessed 1 May 2013).

  63. 63.

    Kirch W, (editor). Encyclopedia of Public Health. Heidelberg: Springer-Verlag; 2008. p.701–2.

  64. 64.

    Wallack LM, Dorfman L, Jernigan DH, Themba-Nixon M, Media Advocacy and Public Health: Power for Prevention. Sage Publications Inc; 1993.

Download references

Author information

Correspondence to Jean-Frédéric Levesque MD, PhD, FRCPC.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Levesque, J., Breton, M., Senn, N. et al. The Interaction of Public Health and Primary Care: Functional Roles and Organizational Models that Bridge Individual and Population Perspectives. Public Health Rev 35, 14 (2013).

Download citation

Key Words

  • Public health
  • primary care
  • population health approach
  • system performance