The schism between medical and public health education: a historical perspective.

The separation of "medicine" and "public health" in academic institutions limits the potential synergies that an integrated educational model could offer. The roots of this separation are deeply imbedded in history. During the past two centuries, there have been repeated efforts to integrate public health education into the core training of physicians, usually in response to a perceived short-term crisis, and without widespread, lasting success. The cost of additional public health instruction and the "overcrowding" of the medical curriculum have been cited as obstacles for creating an integrated medical/public health curriculum for more than a century. Several thoughtful and prescient proposals for integration were developed at a conference convened by the Rockefeller Foundation in the early 20th century, but not all were implemented. Today, there is growing recognition of the considerable value afforded by the integration of medicine and public health education. Many schools have responded to a national call for a renewed relationship between medicine and public health by increasing the availability of MD/MPH programs and/or by incorporating one or more public health courses into the basic medical curriculum. A few schools have created more substantial and innovative changes. Review and consideration of the history and politics of past efforts may serve as a guide for the development of successful new approaches to creating a clinical workforce that incorporates the principles of both clinical medicine and public health.