President's address 35th annual meeting association of teachers of preventive medicine (original) (raw)
Related papers
The Role of Medicine: Dream, Mirage or Nemesis
In a book that is often grouped with Effectiveness and Efficiency (Cochrane) and Limits to Medicine (Illich), Dr McKeown attempts to calculate the role of medicine in the improvement in health seen over the preceding centuries. He also points out the current problems with medicine (in the 1970s, anyway) and makes suggestions for the future of medical practice, education and research. Fortunately, many of his suggestions have been realised, but unfortunately, the contribution of medicine to the continuing improvement in health remains overestimated. The main part of the book concerns the role of medicine in improving health, concentrating on the change in life expectancy. His argument is that the increase in life expectancy seen over decades and centuries has been largely due to increased access to food, and decreased exposure to harmful bacteria. The latter through public health measures such as clean water sources, treating and disposing of sewerage, changing living conditions, and the improved handling, packaging and transport of food (e.g. pasteurisation, bottling, fast transport).
It was Alan Gregg who described supporting departments of preventive medicine and public health in American medical schools as a “hitherto untried process”. This was in October 1938 in response to being asked by a new foundation for his advice on what role they could play in American medicine. Gregg, who had been with the Rockefeller Foundation since 1919, was then Director of its Medical Sciences Division. Gregg obtained his medical degree from Harvard in 1916. His first assignment with the Foundation was to work against hookworm in Brazil; in 1922 he was offered a position in the new division of medical education (see below). From 1922 until 1931, he was involved in numerous medical education surveys in Europe. Although Gregg’s response might be interpreted as implying that the Foundation had been indifferent to this issue, this was not the case. However, in comparison to the support provided by the Foundation and other Rockefeller philanthropies to other aspects of medical education and public health, the teaching of preventive medicine and public health to medical students was a very minor priority. Why this was the case is explored in this paper.
An ounce of prevention A pound of cure for an ailing health care system
Canadian Family Physician Medecin De Famille Canadien, 2007
A mong first-world countries blessed with abundance, as well as within developing nations struggling to move forward, achieving and sustaining acceptable health care services are priorities for civic leaders, medical workers, and citizens. When epidemiologic trends, including escalating rates of chronic illness, 1,2 rapidly aging populations, and greater-than-ever health care use, are juxtaposed with a milieu of limited funding and resources, the sustainability of public health systems becomes a concern. Inadequate numbers of medical personnel to care for increasing numbers of patients has facilitated the genesis of "fast-food" medical encounters where provision of care is sometimes aimed at quickly addressing signs and symptoms rather than uncovering and managing the causes of affliction. With escalating health care costs, with some public health care systems in relative disarray, and with compelling research delineating specific determinants of much contemporary affliction, it is time for the medical community to revisit the current clinical practice construct-incorporating preventive medicine should be considered. Vol 53: april • aVril 2007 Canadian Family Physician • Le Médecin de famille canadien 599
American Journal of Public Health, 2000
Throughout the course of the 20th century, many observers have noted important tensions and antipathies between public health and medicine. At the same time, reformers have often called for better engagement and collaboration between the 2 fields. This article examines the history of the relationship between medicine and public health to examine how they developed as separate and often conflicting professions. The historical character of this relationship can be understood only in the context of institutional developments in professional education, the rise of the biomedical model of disease, and the epidemiologic transition from infectious disease to the predominance of systemic chronic diseases. Many problems in the contemporary burden of disease pose opportunities for effective collaborations between population-based and clinical interventions. A stronger alliance between public health and medicine through accommodation to a reductionist biomedicine, however, threatens to subvert public health's historical commitment to understanding and addressing the social roots of disease.