Many doctors outside the newly formed specialty of community
medicine are still far from certain what is meant by the term:
what are the 2,000 or so Fellows and members of the newly formed
Faculty of Community Medicine going to do? At
first sight it seems difficult to see what common ground exists
for medical administrators, public health doctors, and academics
from departments of social medicine. Too often those asking for
explanations have been fobbed off with talk about
management expertise and coordination-a word-salad of
jargon, incomprehensible to those not in the business; so the
straight-talking at the recent Annual General Meeting of the
Faculty was welcome.
The scientific part of the meeting was concerned with the
contribution of community medicine to health, and the
opening session was concerned with the effects of changes in
the environment on health. Sir Richard Doll was reasonably
optimistic, despite our ignorance of much of the environmental
causes of disease. He thought the community had
learnt to control most infectious diseases and to avoid the
effects of malnutrition and of occupational exposure to industrial
hazards, and it would probably be able to contain the
effects of industrial pollution. Something akin to the American
Environmental Pollution Agency might be needed to monitor
the environment; but given this and other watchdog bodies
he saw no reason to be anxious about the direct effect on
health of the future growth of industrialization.
Where Sir Richard was more pessimistic was in human
ability to control the social environment made for itself.
Society still had to learn how to control its appetite
for concentrated food reduced in bulk by industrial
processing and its
need for mental stimulation-whether by tobacco, marijuana,
alcohol, coffee, or aggressive driving. Dr. Griffith Edwards,
giving a psychiatrist's view, had much the same message:
people shied away from a serious consideration of the social
determinants of health. The social organization of a housing
estate was as important as the purity of its water supply. More
concern was needed with value judgements and more
understanding of the effects of social isolation; and to achieve this
understanding more objective measurement was needed but
community and social psychiatrists had to take care not to
fall too easily into the trap of confusing correlation with causation.
With the greater emphasis now given to planning-at last community
medicine will have a difficult course to chart. Mr.
George Teeling Smith, though speaking particularly ofchronic
disease, gave a message that applies equally well to all health
service planning. He suggested that the specialist in community
health will have to steer the health service ship between the
Scylla of overdiagnosis (and over-enthusiastic treatment) on
the one hand and the Charybdis of underprovision of resources.
Further specific comment on the work of a community
medicine specialist was given by Dr. Henry Yellowlees, the
Chief Medical Officer of the Department of Health and Social
Security, who saw the key role in community medicine played
by the specialist at district level. He would have to make the
system work, with one of his most important tasks being to
bring the general practitioner and hospital doctor together. He
would have to be an interpreter of his own role and of the
roles of different parts of the medical profession, and it would
probably also fall largely to him to weld together the other
professions concerned in the planning and delivery of health
services. He would also have the role of interpreter in the
explanation of priorities and of statistical and epidemiological information.
-(BRITISH MEDICAL JOURNAL,27 APRIL 1974)
