PUBLIC-HEALTH HAS NO PLACE IN UNDERGRADUATE MEDICAL-EDUCATION

It is time to review the reasons for including public health in medica l education. Undergraduate medical students are interested above all i n the diagnosis and treatment of individual cases of disease; populati on-based health care means little to most students, and is seldom rega rded as important. Should public health teachers concentrate their eff orts in other areas, where students are more receptive? This paper pre sents arguments for and against the proposition that public health has no place in the undergraduate medical course. In favour of the propos ition, it is argued that the clinical imperative is so firmly entrench ed in the minds of students and in the cultures of medical schools tha t public health will always be diminished and elbowed to one side in m edical curricula. Moreover, the major gains in the health of populatio ns will be won in other arenas. Therefore public health should rupture the links with medical schools that were formed in another age and, i n any event, are now weakening as public health strikes a new identity . The effort that currently goes into teaching unwilling medical stude nts would have better returns if it was invested elsewhere. Against th e proposition, it is argued that the health of populations will not be improved without participation of all groups with an interest in and an influence on health care. No group is more influential in the organ ization and delivery of health services than the medical profession, s o it would be foolish for public health to withdraw from medical educa tion. Moreover, effective medical practice requires an ability to thin k in terms of populations as well as individuals. Public health cannot be taken out of medical education - it is just a question of whether or not it is done well.