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elimination of Iodine deficiency disorders in Tamil Nadu, India. Indian J Public Health 2010;54:120-5. Abramson JH, Abramson ZH. Survey methods in community medicine. 5th ed. Edinburgh, United Kingdom: Churchill Livingstone; 1999. Lemeshow S, Robinson D. Surveys to measure programme coverage and impact. A review of the methodology used by expanded programme on immunization. World Health Stat Q 1985;38:65-75. Bennett S, Woods T, Liyanage WM, Smith DL. A simplified general method for cluster-sample surveys of health in developing countries. World Health Stat Q 1991;44:98-106.
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Hoshaw-Woodard S. Description and comparison of the methods of cluster sampling and lot quality assurance sampling to assess immunization coverage. Geneva: WHO; 2001. Available from: http://www.who.int/vaccinesdocuments/DocsPDF01/www592.pdf. [last accessed on 2011 May 19]. International Institute for Population Sciences (IIPS) and Macro International. 2007. National Family Health Survey (NFHS-3), Vol 1. 2005-06, Mumbai, India: IIPS. Sullivan KM, May S, Maberly G. Urinary iodine assessment: A manual on survey and laboratory methods. 2nd ed. UNICEF, PAMM, 2000.
Community Medicine Departments and Public Health Education in India at Crossroads! Access this article online Website: www.ijph.in
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DOI: 10.4103/0019-557X.82564 PMID: ***
Sir, Negandhi et al., have provided their perspective on “How departments of community medicine shape public health education in India?”1 The authors have made the argument based on commonality of community medicine training and public health education. However, certain distinct differences exist between community medicine and public health in their scope, training and applications.2 Secondly, the authors have equated public health education with Masters of Public Health education. Ideally, the term public health education should include education of different cadres of public health professionals. It is true that community medicine departments have their share in public health education in India. Before undertaking the task of shaping public health education, it is important to take a stock of community medicine departments. Questions were raised about the need of community medicine specialty altogether as early as 1980 in the United Kingdom.3 With passage of time, the need of community medicine specialty is well established globally and in India. In this context, it is imperative to capitalize on the strengths of the departments and work on the weaknesses of community medicine departments.
The weak areas of the department have been aptly highlighted with possible solutions.1 The strongest point in favor of the departments has been the partnership with the community, i.e. the urban health training center and rural health training center which serve as community medicine labs. However, it is high time we accept the fact that the partnership is not strong enough to demonstrate our skills. One needs to think out of the box how to strengthen the partnership with community. On the flip side, by focusing on public health education, are community medicine departments going to be distracted from their original mandate? Whether the mandate of community medicine specialty to produce social physicians is at stake? Are we clear about our mandate? The origin of the discipline has followed different paths in different parts of the world with a common agreement that community medicine is a linear descendent of public health. While in South Africa community medicine was a product of unification of family medicine and preventive and social medicine, in the United Kingdom the discipline was formed to spearhead the management of health services in National Health Service.4,5 Indian scenario is a little different. On the academic front, community medicine is the successor of public health, while the reverse is true in practice. This makes the case complex for outlining the boundaries of community medicine and public health. Some public health professionals have lamented, “Public health education in India has been too disease oriented rather than determinant oriented and too program oriented rather than systems oriented and lacks multidisciplinary approach”.6 This highlights the lack of understanding of
Indian Journal of Public Health, Volume 55, Issue 1, January-March, 2011
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roles and functions among the fraternity. Similar concerns were raised in the United Kingdom during 1980s about the uncertainties of Community Medicine discipline.7 As mentioned, at present in India, 21 schools of public health are offering Masters of Public Health with specialization in health services management, field epidemiology, social epidemiology, etc. in India.1 Opening the doors to Masters of Public Health courses has certainly challenged the identity of MD Community Medicine, more so when there is scarcity of public health professionals in the country. Masters of Public Health professionals are considered as low-cost alternatives of MD Community Medicine. Creating parallel structures definitely undermines the importance of the discipline in Indian set-up where a discipline is valued on how tall it is and how strong is the base. On careful observation, these specializations are the nonclinical subspecialties of community medicine. It can be argued that short-cut decisions were taken in opening up these courses to achieve the national goals, meeting the donor pressure and following the western model, at the cost of identity of discipline. These subspecialties could have served as super-specialty discipline of the MD (Community Medicine). By focusing on public health education, the growth of clinical community medicine is certainly going to be hampered. The clinical subspecialties of community medicine such as community ophthalmology, preventive oncology, social pediatrics, social obstetrics, preventive cardiology and human nutrition are going to be placed on the back seat. The clinical subspecialties have been well established in India, but these have been growing at a snail’s pace owing to their poor attachment to the parent departments. It is also forecasted that the discipline of community medicine shall branch into two major specialties in 21st century, namely, Family Medicine and Public Health.8
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With passage of time, it will be clear how things move from the present confusing state. Indian Association of Preventive and Social Medicine and Indian Public Health Association should take lead in the present confusing state in defining the domains of community medicine and public health. *Binod Kumar Patro1, Amarjeet Singh2 1
Assistant Professor, 2Professor, School of Public Health, PGIMER, Chandigarh, India *Corresponding Author: Dr. Binod Kumar Patro, Assistant Professor, School of Public Health, PGIMER, Chandigarh, India. E-mail:
[email protected]
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Negandhi H, Sharma K, Zodpey SP. How can departments of community medicine shape the future of Public Health Education in India? Indian J Public Health 2010;54:184-9. Bhalwar RV, Singh M, Jayaram J. Introduction, Definitions and General Concepts in Public Health and Community Medicine. In Text book Public Health and Community Medicine. 1st ed. New Delhi: Dept of Community Medicine, AFMC with WHO India; 2009. p. 1-8. Acheson RM. Community medicine: Discipline or topic? Profession or endeavour? Community Med 1980;2:2-6. Kark JD, Abramson JH. Sidney Kark’s contributions to epidemiology and community medicine. Int J Epidemiol 2003;32:882-4. Warren MD. The creation of the faculty of community medicine (now the public health medicine) of Royal Colleges of Physicians of United Kingdom. J Public Health Med 1997;19:93-105. Thakker P, Reddy KS. The development of the discipline of public health in countries in economic transition: India, Brazil. China. Oxford Textbook of Public Health. 5th ed. New York: Oxford University Press; 2009. p. 65-81. Horner JS. Community medicine: Future imperfect? J Epidemiol Community Health 1980;34:69-75. Kumar R. Academic community medicine in 21 century: Challenges and opportunities. Indian J Community Med 2009;34:1-2.
ADDENDUM In the article “Monitoring of Mass Measles Campaign in AILA-affected Areas of West Bengal” published in Vol 54(4) Oct.-Dec. 2010 issue of IJPH, the authors inadvertently missed to acknowledge WHO-NPSP, which is regretted. The authors sincerely acknowledge the SMOs and Field Volunteers of WHO-NPSP for their support in supervision and monitoring of the mass Measles campaign in AILA-affected areas of North 24 Parganas & South 24 Parganas districts. Editor, IJPH Indian Journal of Public Health, Volume 55, Issue 1, January-March, 2011
