Academic health centers can bridge the gulf between medicine and public health

The authors review why the gulf between clinical medicine and public health has existed since the first schools of public health were established in 1 916. They emphasize that academic health centers (AHCs) have the potential to bring together these two perspectives-as well as the health services per spective-to clarify what they offer and to find creative ways to build upon their combined strengths. The authors describe institutional approaches th at can he taken to narrow the gulf, with examples from the initiatives of t his type that are under way at The George Washington University Medical Cen ter in Washington, D.C. For example, the authors state and discuss in detail that an AHC's medical, public health, and health services institutions should be physically and i nstitutionally closer that collaboration between them requires well-structu red interaction; that institutional structures are needed to ensure coopera tion when internal competition is likely; and that collaboration is fostere d by new opportunities and the potential for new resources. The authors conclude by stating that the future will require that the healt h education and prevention perspective of public health, the treatment pers pective of medicine, and the financial and management perspective of health services be developed and integrated into the work of AHCs, and give examp les of specific activities that would be possible with such integration.