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December 24 2008

The Physician as Public Health Professional in the 21st Century

Author Affiliations

Author Affiliations: Division of Health Policy and Management and the Joint Medical Program, University of California, Berkeley, School of Public Health.

JAMA. 2008;300(24):2916-2918. doi:10.1001/jama.2008.882

The notion that individual health and public health occupy separate domains is not new. The ancient Greeks venerated both Asclepius, the god of medicine and healing, and a separate god, Hygeia, who embodied aspects of what is now considered the realm of public health: sanitation, cleanliness, the maintenance of good health, and the prevention of illness. These gods are no longer worshipped—but as symbols, they persist in conceptual models of health and health care.

Throughout much of the 20th century, the pedagogy that has informed US physicians has been based on the idea that the important problems in public health had been answered and only details were left. In 1953, Burnet1 stated that “In many ways one can think of the middle of the twentieth century as the end of one of the most important social revolutions in history, the virtual elimination of infectious disease as a significant factor in social life.” As late as the early 1970s, epidemiologic models supported the impression that tuberculosis would be eliminated in the United States by the end of the century.