Public Health Medicine/ Preventive Medicine

Public health medicine is known under a number of different names over the years: Preventive medicine, Social medicine, Public health and hygiene, Community medicine and Public health medicine. It is a branch of clinical medicine concerned with improving the health of the population and prevention of diseases rather than practicing curative medicine. Public health medicine specialist work with other professional groups to monitor the health status of the community, identify health needs, develop preventive medicine programmes to reduce risk and screen for early disease, control communicable disease, foster policies which promote health, plan and evaluate the provision of health care, and manage and implement change. They are also actively involved in preventive care in many countries.

Public health medicine (or preventive medicine) has been recognized as a separate discipline since the middle of the last century when the first Medical Officers of Health were appointed in the UK (FPHM, undated). History of this specialty dated back to 19th century. In 1855, eight years after the appointment of the first medical officer of health, a leading article in The Lancet recommended that “each Medical Officer of Health in UK ought to be well versed in vital statistics and hygiene, a well-educated and practical physician, and acquainted with at least the general principles of chemical and physical science; above all he should possess sufficient logical acumen to enable him rightly to distinguish the post hoc from the propter hoc, and enough judgement to decide between coincidences and consequences” (Leading Article, 1855; Warren, 2000). The specialty was first recognized in the UK in 1971 and in South Africa 5 years later in 1976.

The National Health Insurance Policy Paper (2012) put emphasis on prevention of diseases, promotion of health, treatment of diseases where prevention has failed, and rehabilitative services. However, the current South African health care system and training of medical professionals are geared more towards preventive than curative care.

Public health physicians (or Public Health Medicine specialists) are the medical specialists, which focuses on preventive and promotive care rather than curative care. The competency framework for Public Health Physicians includes provision of preventative health care programs in hospitals, clinics, or other medical facilities. [Source: Department of Higher Education and Training. 2013. The Organizing Framework for Occupations in South Africa].

In addition to the knowledge of clinical sciences and the skills in preventive health care, the distinctive basic components of Public Health and Preventive Medicine include: (a) Application of Health Measurement (Biostatistics and the application of biostatistical principles and methodology; and Epidemiology and its application to population-based medicine and research) (b) Application of Health services management and administration (including developing, assessing, and assuring health policies; planning, implementing, directing) and (c) Occupational and Environmental health.

PREVENTIVE MEDICINE

Preventive medicine includes both clinical and non-clinical aspects. Clinicians see patients on a daily basis and provide clinical services in screening, health counselling, and immunization for commonly occurring diseases and others who can benefit from prevention and lifestyle modification. Non-clinical preventive medicine includes health policy, social and behavioural aspects of health and disease, epidemiology, or other areas in which populations, not individual patients, are the primary focus. 

Clinical preventive medicine activities, including measures to promote health and prevent the occurrence, progression, and disabling effects of disease and injury;