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 | Medicine Public Health Concept In Action
M. Roy Schwarz, M.D.
|  | Ten Years Later
Leslie M. Beitsch, M.D., J.D.
|  | Marriage Counseling for Medicine and PH
Ronald M. Davis, M.D.
|  | Clinical Medicine and Public Health
Carolyn V. Brown M.D.
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| | Title: Medicine Public Health Concept In Action
Author: M. Roy Schwarz, M.D.
Date: 2006-02-08
Medicine Public Health Concept In Action
M. Roy Schwarz, M.D.
American Public Health Association Meeting
San Francisco, California, November 17, 2003
I Introduction
Thank you all ladies and gentleman for inviting me to be with you today. Jay Glasser, your President, has asked me to review why the medicine public health initiative was important in 1993 and compare it with why it is important now. Second, he asked me to raise potential challenges that are facing the initiative at this point. Third, he asked me to discuss the role of the China Medical Board (CMB) and China in a medicine public health initiative. Fourth, he asked me to do all this in five to six minutes.
II 1993 vs. 2003
The speech I gave at the University of Texas Health Science Center in Houston was entitled “The High Price We Are Paying For the Separation Of Medicine And Public Health”. In that speech I began by tracing the history of public health as a discipline in the United States. It began with the Shaddock Report which was commissioned by the Massachusetts Medical Society in 1850. It led then to the first teaching program at M.I.T. in 1883 to the first certificate teaching program – a joint effort of M.I.T. and Harvard in 1889 – to 1914 when the Rockefeller Foundation announced it would train hygiene officers to the Welch-Rose Report of 1915 which called for a separation of medicine and public health as disciplines. This report was largely followed in the development of public health during the 20th century.
In my speech in 1992 I outlined six forces that were acting upon the world of health.
1) The development of a global marketplace where U.S. businesses are trying to compete and as a result where they are very sensitive to health care costs. In 2003 I see no change.
2) The Federal Budget Deficit is very large and is robbing the U.S.A. of flexibility of program dollars. In 2003 I see no change.
3) Behavioral health epidemics are responsible for 50% of our costs and are preventable. In 2003 there is no change.
4) Education reform is sweeping the United States school system beginning with kindergarten and extending thru high school. The goal is to increase the quality of the education. No change in 2003.
5) Scientific revolution and the genome project is putting a prevention base under the nature/nurture debate and is changing the face of medicine forever. There has been no change in 2003.
6) The U.S. health care system is trying to control runaway costs. It is looking for ways to deliver high quality care at cost effective levels. Nothing has changed here. In fact it is as bad as it was in 1992.
In 1992 I suggested we needed a new paradigm. This is because the Welch-Rose paradigm and the Flexner paradigm were not adequate for the 21st Century. I have not changed my mind in 2003. In 1992 I said health is a continuum with prevention at one end and tertiary high-tech care at the other. In the middle you will find bio-medical sciences. And that has not changed. Moreover, medicine and public health are two cousins or siblings from the same family and the current separation is inadequate if we are faced with an unexpected health care challenge. I did not foresee SARS nor the terrorist attack but clearly there has been no change.
III 2003
If the forces in 1993 continued, is there anything new? The answer is yes. There are four things that are new:
1) The awareness of the global village and its existence has become widespread. It has been created by one global economy, one global language of commerce (English), single global communication system (satellites and cable have wired the world) and a global travel system.
2) SARS has become a global epidemic. It reminded us all of the following:
a) We all live in the global village and cannot escape it.
b) Forces of globalization facilitated the spread and control of the disease.
c) Medicine public health is a continuum. In SARS the epidemiology, reporting, isolation, quarantine, identifying the agent, sequencing the agent, developing the laboratory test and applying high-tech care for respiratory failure was a continuum. There were no breaks in it. All were involved and they were involved on a global basis. Hence, in just over two hundred days at the advent of the first case WHO was able to announce that the epidemic was under control. All of this made possible in the global village in which we live.
3) The emergence of China as a world power has changed things. Napoleon was once asked about China and he responded “Let the dragon sleep for if he awakes the world will tremble.” China is not only awakening but is also open to any new ideas. Hence, China is an ideal partner for medicine public health initiative with its 1.4 billion people or 1/5 of the world’s population. The Minister of Education Zhou Ji and the highest ranking physician in the Ministry of Health, Professor Huang Jiefu (Deputy Minister of Health) both are very enthusiastic about a medicine public health initiative in China. They both observed that it will be easier than in the U.S. because they never followed the Welch-Rose Report and allowed the disciplines to be separated. Clearly SARS frightened them and frightened the leaders at the highest level of government. They are, therefore, open to new ideas as they never been before.
4) Dr. M. Roy Schwarz became President of the China Medical Board. The China Medical Board was the Rockefeller Foundation which had two thrusts to impact public health and to bring western science based medicine to China. From its Foundation in 1917-1928 it operated Peking Union Medical College (PUMC). From 1928-1951 the China Medical Board operated PUMC. We then left China to return in 1980 and now support thirteen institutions in China and thirteen in Mongolia, Nepal, Laos, Thailand, Myanmar and Vietnam. While the primary thrust of the China Medical Board is medical education it has also a number of significant public health programs including establishing the first masters degree program in health in China.
The China Medical Board is interested in funding a conference to explore the actions/steps that are necessary to make medicine public health initiative in China a reality. It is interested because the China Medical Board believes that what might emerge in China could be a prototype or a model for other countries. Clearly, time has passed for this initiative to “go global”.
IV Closing – A Closing Thought
Mr. Rockefeller’s dollars in the early 20th century supported the establishment of public health as a discipline and at the same time supported the Flexner Model of medical education. As such, it supported the separation of medicine and public health. Now, the same money in the late 20th and early 21st century is supporting a return to partnerships in the country where the Rockefeller Foundation first began, namely, China.
In closing, I would like to share a Chinese proverb:
• If you plant for one year, plant rice.
• If you plant for ten years, plant a fruit tree.
• If you plant for a hundred years, educate your children.
We are responsible for educating our children, i.e.: the next generation of health professionals and we better make sure in the global village we live in we do it right. That requires us to establish a continuum of health with no interruptions.
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