Public Health and Medicine - They Need Each Other

Our grandparents understood the need for both public health and medicine. When ruthless epidemics - smallpox, cholera, plagues, diphtheria - flooded our urban areas in the late 19th and early 20th centuries, those unfortunates who were affected were quarantined (public health) and those who could be, were ministered to by a physician (medicine).

Hippocrates wrote about the combination of the two disciplines 2,500 years ago because they were then, and remain, two sides of the same coin. But what public health is and does and how it relates to the practice of medicine, is poorly understood today.

The origins of public health can be traced to two roots: the necessity that a community protect itself from mass disease and a benevolent desire to provide some measure of health for the children of the underserved. Today, rather than enforcing quarantine once a disease has manifested itself, public health practitioners work toward prevention of sickness and poor health conditions - be it water or air quality, the prevalence of neural tube defects in certain parts of the world, or education on the dangers of tobacco usage.

My friend and colleague, former Surgeon General Dr. C. Everett Koop, suggested during a recent visit to The University of Texas-Houston Health Science Center, that we think of medical doctors - the ones who see patients - as the eyes and ears of a community. Conversely, we should think of the public health folks - the ones who study population health and create prevention strategies - as the arms and legs of the same community. That is significant because, implicit in the comparison, is each discipline's need for the other.

For many decades, however, the two professions took divergent paths - sharing neither knowledge nor educational quarters. It happened for a number of reasons.

Around 1890-1910 or so there was an explosion of knowledge that began to change our country. Biomedical researchers identified specific microbial agents of disease and were able to begin the development of immunology, making prevention possible.

Because of the complexities of public health officials' responsibilities, the numbers of specially trained staff grew.

Thanks to engineering advances, we were able to provide pure water, remove noxious waste from the environment and construct more hygienic dwellings and safer work places.

Educational programs for public health began to grow and evolved into separate, specialized schools of community and public health.

After World War II, the emphasis in community health changed. Chronic disease displaced infection as primary causes of death. Public concern turned toward personal medical care and potential and real health hazards at home and at work.

While physicians continued to treat patients one on one, those in public health began to work for boards of health and health departments.

By 1993, it was patently obvious to many of us that the two needed to renegotiate their relationship so they could, once again, work in tandem. Mass problems and mass solutions cannot be managed by individuals. Public health initiatives are not "grown" by treating individuals. But individual and communal health can improve if people from both disciplines work together.

And so it was six years ago that Dr. Koop; Dr. Roy Schwartz, senior vice president of the American Medical Association (AMA); Dr. Fernando Trevino, executive director of the American Public Health Association (APHA); Dr. Stanley Reiser, the Griff T. Ross Professor of Humanities and Technology at UT-Houston; Dr. Palmer Beasley, dean of our School of Public Health; Dr. John Ribble, former dean of our Medical School; and I became the instigators of the Medicine and Public Health Initiative, a national movement to bring the two disciplines back together. And it is working. By 1994, the presidents and senior staffs of the AMA and APHA came together in Houston - for the first time ever - to talk and to reestablish a connection between their viewpoints and practitioners. Rapprochement has begun. We now have dialog between public health and medicine that is producing results.

Our collective goals are to:

• Change the thinking within academic health centers, health-oriented community organizations, health care delivery systems and providers so that they focus on improving the health of the community.
  
  
• Change the way physicians and public health practitioners are educated - so that they share common knowledge and mutual interest.
  
  
• Create joint research efforts. As Dr. Koop says, "If we speak with a united voice, we will not duplicate research efforts."
  
  
• Develop a common approach to health and illness.
  
  
• Develop ways to measure the quality and effectiveness of health care.
  
  
• Translate initiative into action.

There are other very exciting related initiatives being formed, such as our Texas Program in Society and Health, a collaborative effort of UT-Houston, Rice University, their Baker Institute of Public Policy, the University of Houston, the University of Michigan, University College, London, and the Population Health Program of the Canadian Institute of Advanced Research. As Robert Frost said in one of his poems, "We have miles to go before we rest." But we are en route and the travel conditions are excellent.

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©2006 Texas Medical Center

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