Yacoub AA. [Editorial]. Community medicine as a movement: past, present and future. MJBU 1987;6(2):13-17.

1. The MJBU, V6, No. 2, 1987
13
Editorial
Community Medicine as a Movement: Past, Present and the Future
Alim Abdul-Hameed Yacoub
Alim Abdul-Hameed Yacoub MBChB, DPH, MSc, MFCM, MIBIOL
Lecturer, Dept. of Community Medicine, College of Medicine, Basrah-Iraq.
Where does community medicine stand among other medical and health sciences?
Although community medicine was traditionally linked with sanitation, environmental
health and control of communicable diseases, and despite its success in these aspects, many
health professionals and workers in relevant fields are increasingly aware of the new
dimensions this subject has attained. Community Medicine is not just, a new name for an
old art and science used to be called Public Health, rather it reflects changes and
developments in the scientific and philosophical bases of this specialty.
Community Medicine has recently been defined as “that medical specialty which deals
with populations rather than individual patients. Therefore, in the context of a rational
system health care it comprises those doctors who try to measure the needs of the
population both sick and well, who plan and administer services to meet such needs and
those doctors who are engaged in research and teaching in the field1
”. Such definition
describes properly the scope of community medicine as expected to be practiced. It is
emphasized that rational planning and administration of health services are important facets
of the functions carried out by community physicians. However, prevention remains the
central theme of the practice of community medicine.
In the following brief account, I would like to present community medicine from a point
of view which is thought to be complementary to that just outlined above. Such a view
will, hopefully, clear out some misconceptions and illusions about the subject which are
commonly encountered, not only from workers in other fields, but also from medical
professionals themselves.
Historical Perspective
The more I become aware of the past achievements of public health and the goals and
targets public health workers set to achieve, the more I incline to think of community
medicine as a movement in addition to being a discipline or a medical specialty. A
movement which has been initiated and maintained by dedicated workers who were and
still ready to forgo their personal interests for the betterment of the health of their people.

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The beginning of the public health as a movement could be traced back to the second half
of the nineteenth century. The poor sanitary conditions which prevailed in Europe in the
beginning of the last century and recognition, for the first time, of the relation between the
absence of sanitation and disease had stimulated the call for sanitary reforms. Such
movement was led at that time in Britain by Edwin Chadwick who is considered the Father
of Public Health not only in that country but in Europe. Chadwick laid the foundation of
British sanitary system. During the same period, the public health movement began to be
institutionalized by the appointment of medical practitioners as salaried medical officers
of health (MOH).
The movement of public health took a new turn in the beginning of the twentieth century
following the great discoveries which were achieved in the field of microbiology.
Investigation and control of communicable diseases were the central themes of public
health workers led at that time by the MOHs.
A new dimension in the field of public health was added when community physicians
started to play a key role in the development and organization of personal health services
as maternal and child health, school health and mental health services. Health
administration and organization of medical services were added to the list.
It can be inferred from the above brief historical perspective that it has been characteristic
of public health movement that community physicians were pioneers in the initiation and
development of sanitation programs, control of communicable diseases and provision of
personal health services. Then, as Godber put it, having proven their point they would pass
on to others technically equipped and qualified the full development of the programme2
.
For example, sanitation now is the responsibility of public health engineers, MCH has been
left to obstetricians and pediatricians. Community physicians maintain, however, a
supervisory role through their positions as health administrators, planners and organizers.
Present developments in community medicine movement
The declaration of Alma Ata on Primary Health Care PHC in 1978(3)
with its call to achieve
Health for All by 2000 was not the origin of PHC but represents a springboard for a
movement which has been in process for many years. In the declaration, it was clearly
stated that PHC as a strategy and framework for the delivery for health care forms an
integral part not only of the national health system but also for the overall social and
economic development of the community. Studies on inequalities in health in various
countries, notably in developed ones, led to disillusionment with current health care
systems which have been considered, until recently, leading examples of perfection and
excellence. The black report (4)
on inequalities in health in Britain is considered a classical
example of such studies. The problem of inequalities in health in developing countries are
expected to be even more pronounced but data on this aspect are scanty.

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PHC reflects a step in the progressive process by which human thinking has started to
conceptualize health. Health which is defined by WHO as a state of complete physical,
mental and social well and not the mere absence of disease or infirmity is now viewed both
as an outcome and as a resource. It is thus considered as an essential step or factor in the
process of development. It is a fundamental human right and is the responsibility of all
governments to help their citizens to attain a state of health which would enable them to
lead an active and productive life and realize their maximum potential. The attainment of
health could not be separated from the social, economic, cultural and political
developments which take place in human societies. It is now generally agreed that little can
be achieved if we continue to assume that advances in medical sciences and practice can,
of themselves, have the desired target. Much of the action that is needed lies outside the
traditional scope of medical practices and call for knowledgeable and purposeful policies
and actions at many levels in the society5
.
Community medicine movement: the way forward
In order to realize the goals to which the international community has committed itself in
the Alma Act declaration, community medicine has to perform an enormous task and play
a significant role.
Such task ranges from formulating policies and general guidelines to the actual
implementation of programes and projects conductive to the attainment of human welfare.
In their pursuit of such aim, community physicians need to address themselves to issues
which have been conventionally considered outside the scope of public health. These are
not just related to prevention of disease but to prevention of premature death ie addition of
years to life and improving the quality of life ie addition of life to years and the insurance
of equity (and not just equality) in health.
The formation of the International physicians for prevention of Nuclear War movement is
an example of the increasing awareness for the need for prevention at a primary level of
nuclear war.6
Another issue which community physicians need to address is the preservation of clean
and healthy environment. The Bhopal incident and Chernobyl disaster are just two
examples which leave no complacency as to the need for more serious attention and action
to this matter.
In conclusion, and going back to the question which we posted in the beginning where does
community medicine stand?, it is quite clear that human welfare and not just health is the
main concern of community medicine movement. Health is a necessary but not sufficient
cause for the attainment of human welfare. It is due to such movement that the link between
health, welfare and development has been put into focus. Community medicine is in a
position, because of its philosophical background and scientific basis, to press for a unified
and holistic strategy aiming at achieving human welfare considered by many political and

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social reform movements as the ultimate goal. In doing so, community physicians are
required to lay the theoretical basis and suggest practical steps to establish links with non-
medical systems; such links should not in any way be shadowed by the already existing
symbiotic relation with medicine. This, will mark a new and critical phase in the
development of community medicine movement.
References
1. The Faculty of Community Medicine of the Royal College of Physicians (U.K.).
Standing Order, London.
2. Godber, G.E. Medical Officers of Health and Health Services, Community
Medicine, 8:1-14(1986).
3. WHO. Report of the International Conference on Primary Health Care, Alma Ata,
USSR. Geneva, WHO (1978).
4. Townsend, P. and Davidson, N. Inequalities in health, the Black Report, Great
Britain, Penguin Books (1982).
5. The Faculty of Community Medicine. Health for All by the year 2000, Charter for
Action, London, (1986).
6. Joseph, D.S. and Sime, A. War planning in health services-A survey of community
physicians. Community Medicine, 8:58-71(1986).