Is Public Health Medicine Throwing the Baby Out with the Bathwater?

Last century saw public health advance from what was essentially a communicable disease surveillance activity to a public health and help entity. Public health activists not only described problems in a global way but worked with governments and agencies to prioritise so that real change could occur. In short it became the motivator and effector arm for major interventional advances in health care.

In the communicable diseases, twenty first century achievements were as enormous as they were global: the eradication of smallpox; the prevention of serious infective diseases including measles, mumps, chicken pox and polio. Within communities, non-communicable problems such as tobacco control and drink driving legislation were major wins.

Public health work also played a major progressive role in the clinical arena where treatments for conditions like dietary modification for heart disease and thyroid insufficiency were based on sound public health-led detection and alteration of clinical practice.

Infodemiology, infoveillance, datafication and dataism are just a few of the new terms to describe what is now being described.

But in this century, the age of informatics, we are seeing public health regress to a monitoring role. Infodemiology, infoveillance, datafication and dataism are just a few of the new terms coined to describe what is now being described.

Unfortunately, no new field of medical endeavour has stepped up to be both chronicler and activist across the spectrum of domains. As clinicians, we have learnt to rely on statistics to help us prioritise. However, the “p value” no longer denotes priority but rather a small and, increasingly difficult to interpret, statistical artefact.

The research factory continues. Only this month, significant p values for treatments for a variety of cancers have churned out at ASCO’s annual meeting.

Each finding occupies a small space in the global funding picture that health insurance agencies and health legislators, like NICE and the FDA, are grappling with – even global statistics cannot determine whether a drug for colon cancer should be funded over and above a drug for leukaemia or heart disease.

That’s because good decisions about how our health funding is spent require a broad view across healthcare (as opposed to a deep dive into individual diseases and their datasets) if we are to ensure they do not fall prey to media or political whims such as a Cancer Drugs Fund.

It may be prudent then to create a new doctor specialism – a public help doctor say – to avoid throwing the baby out with the bathwater. We now have a growing body of ethically sound information on which to base decisions but few trained specialists to holistically interpret the data and bring knowledge to life across paradigms. Just as the Cochrane Collaboration’s statistical analyses required doctors to think in an integrated and synthesised way a new medical curricula and an alumni of thinking doctors could prevent stagnation when progress is what is most needed.

One thought on “Is Public Health Medicine Throwing the Baby Out with the Bathwater?

  1. Sorry, Deb, but I hate the heavy underlining. As you know, Public Health has been booted out of mainstream health into Local Government. Will it ever recover from this vantage point?


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