Public Health: Myth,Mysticism and Reality

Abstract

In England, public health was divorced from clinical medicine during the mid-nineteenth century, following a directive from Edwin Chadwick. Since then, the two disciplines have gone their separate ways with physicians receiving training for curative practice on the one hand and for public health practice on the other. The United States, among many other countries, followed suit. In due course, the frontiers of both curative medicine and public health have expanded.

This divorce between the two disciplines of medicine cannot be justified. Medicine includes the whole enterprise: sanitation, hygiene, genetics, nutrition, behaviour and therapeutics, all in relationship to man himself in his natural, social, economic and political environment. Each branch of medicine has its distinct role to play, but it is only a part and not the whole; all of them together make the whole. Unmindful of these realities, curative medicine on the one hand and preventive medicine on the other, each finds itself shrouded in mystery. They have become enlarged and out of proportion to their real utility and a sense of realism is called for.

The mythical dichotomy in curative medicine and public health is reflected in the various training programmes for physicians and other prof essionals for the two distinct branches of medicine as well as in the organisational arrangements for curative medicine and public health. However, there was much dissatisfaction with this arrangement around the middle of the 20th century, a dissatisfaction reflected in the social medicine movement both in England and the United States. In spite of this, medicine continues to be divided along curative and public health lines.

Several attempts were made to bring the two branches of medicine together.

Notable among these efforts were those of Lord Dawson in the 1920s when he sought a national health service integrating all branches of medicine and of the Bhor's Commission in post World War II India which sought to do likewise. The most recent attempt is the movement of Health for All by the Year 2000 with primary health care as the key. approach. This movement seeks to bring primary health care, in essence a package of social medicine, to all people, especially at the first level of the health organisation. However, among others, it poses serious challenges to health manpower education. Since schools of public health and other schools for health prof essionals are intimately concerned with health manpower education, some relevant issues are presented for reflection and deliberation. At a critical time like this, it is natural to look to these centres of excellence to prepare and to produce health leaders, wise men, and educators to forge ahead to meet these challenges.