Carrying out the medicine public health initiative: The roles of preventive medicine and community-responsive care

Leaders in medicine and public health, recognizing the inherent interdepend ency of these fields, established the Medicine/Public Health Initiative in the mid-1990s as "an evolving forum in which representatives of both sector s can explore their mutual interests in improving health and [can] define c ollaborative mechanisms to achieve that goal." The Initiative's participant s developed six goals that they and others in medicine and public health ac ross the nation should implement: engage the community; change the educatio n process; create joint research efforts by clinical, public health, and pr eventive medicine investigators; develop a shared view of illness between m edicine and public health; work together to provide health care; and work j ointly to develop health care assessment measures. The authors describe the six goals in depth and explain the important combined roles of clinically- oriented preventive medicine and community-oriented preventive medicine-as practiced in a model of health care delivery called community-oriented prim ary care (COPC)-in implementing the Initiative's goals. They then report re cent efforts, including two in Boston and Dallas, to merge medicine and pub lic health, and state that academic health centers, which are in the proces s of reshaping themselves, can help themselves as well as the public by emb racing their key role in the effort to integrate medicine and public health . In particular, they can expand and strengthen existing training programs in preventive medicine and COPC or add these programs to their curricula.