Public health medicine and primary health care: convergent, divergent, or parallel paths?
Date
1995Author
Bhopal, Raj
Metadata
Abstract
Historically, general medical practitioners and public
health doctors have striven for health goals by different
means. General practice has concentrated on personal,
continuing health care focused on the consultation, usually
at the request of the patient. Public health doctors have
emphasised changes in the environment, society, and health
service provision and organisation as the basis of interventions
impacting on whole populations, or on marginalised
groups of the population.
Changes in medical practice, social and health care
organisation, and political and public expectation have
forced a radical reappraisal of the traditional relationship
between these two branches of medical practice. These
changes include the incorporation within general practice
of staff such as health visitors and district nurses
spurring on the concept of primary health care; the deliberate
and successful shift, continuing to gather
momentum, towards preventive health care in general
practice; and the move towards greater administrative
involvement of general practitioners in the management,
organisation, and development of health services, hastened
by the NHS reforms and best exemplified by fund holding
general practices.
The increasing focus of public health medicine on the
assessment of health and health care needs, the development
of policy and strategy, the promotion of health,
the control and prevention of disease, and the organisation
of services (activities undertaken at the expense, in practice
if not in principle, of the control of environmental hazards
and the advocacy role) has coincided with these changes
in general practice.
In the UK the fusion of the district and family health
services authorities, and the increasing involvement of
general practitioners in commissioning, and the requirement
of health authority staff to support general
practice commissioners make a strong relationship between
the two medial specialties essential. In what direction has
the relationship been moving?