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| EDITORIAL |
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| Year : 2017 | Volume
: 61
| Issue : 2 | Page : 65-66 |
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Community medicine: Beyond boundaries
Arun Kumar Sharma
Director Professor, Department of Community Medicine, University College of Medical Sciences, New Delhi; Joint Editor, Indian Journal of Public Health, India
| Date of Web Publication | 2-Jun-2017 |
Correspondence Address:
Arun Kumar Sharma
Director Professor, Department of Community Medicine, University College of Medical Sciences, New Delhi; Joint Editor, Indian Journal of Public Health
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ijph.IJPH_93_17
How to cite this article:
Sharma AK. Community medicine: Beyond boundaries. Indian J Public Health 2017;61:65-6 |
Many a times, the nomenclature that has seen modifications from Hygiene to SPM to PSM to the current day avatar of community medicine has been questioned. Even I was once at the receiving end from the Vice Chancellor of my university during a career promotion interview, and he wanted to know what exactly we do if we at all do anything? Unfortunately, the expert panel also chose to keep silent on this topic during that discourse. But it did raise a hornet's nest in my mind. What do we do? Community pediatrics, community ophthalmology, community obstetrics, preventive cardiology, etc., are being hailed as subdomains of their parent fraternity. On the other hand, public health is growing slowly but steadily as a separate entity albeit on borrowed concepts from American shores and European grounds. Is it not time to make our own grounds clear and concise and define the future course of growth for the subject? Unfortunately, the subject is restricting itself to defining and redefining the syllabus in MBBS program and takes pride in considering its MD syllabus as undefined and therefore infinite. On the other hand, due to lack of funds and opportunities for research, a large number of departments in state medical colleges are reduced to classroom teaching and bare minimum practical training, which reflects poorly when a PG student from such department cuts a sorry figure at the final examinations. The apathy also reflects in the dwindling attendance and lack of quality contributions by the teachers in some places. This approach has brought us to the current sorry state of affairs. However, all is not lost. We need to take stock of the situation and push things ahead.
Without sounding rhetorical in my approach, I suggest that community medicine as a fraternity has to look beyond its conventional, self-imposed boundaries, and explore opportunities in allied sciences to enrich and strengthen the applicability and relevance of the subject. Subject domains such as medical geography, information technology, environmental sciences, management, and not to forget veterinary sciences are so far neglected by us, but these subjects have very important stake and relevance in near and distant future of community medicine. We need to promote the culture of adopting an allied stream, join hands with scientists from those streams and innovate newer products for the policy makers to take note of and give due push to such partnerships. It also will be in congruence with the emphasis laid in the 12th Five Year plan of Government of India about the need of PAN-India mission mode projects addressing national needs and priorities through the extensive participation of stakeholders to achieve the goals and targets in a defined time frame.[1] Stakeholders are spread across specialties such as hydrology, environment and forest sciences, agriculture, electronics, management, surface, air and water transport, to name a few. We need to forge partnerships with them to explore innovative solutions to the challenges of public health. Moreover, the best way to begin such endeavors are by starting small research projects involving postgraduates and senior residents/demonstrators from the departments of community medicine joining hands with their counterparts in aforementioned sectors in exploring joint solutions to the public health issues at the local level. Besides research, it is also important to understand each other's scientific strengths, limitation, and potentials. This can be achieved by holding skill building workshops and hands-on training in using the technologies available in other sectors. I shall illustrate my point of view with following examples.
World over, medical geography is gaining ground through advancement and utilization of spatial epidemiology, which goes hand in hand with information technology. I found a very miniscule participation of community medicine students and faculty in the only international conference on Health GIS held in Mysore in November 2015, but there were several researchers from the Departments of Geography, Education, Biostatistics, Environmental Engineering who had done community-based research on topics that are most relevant to community medicine, but there were sadly no coresearchers from community medicine fraternity. Similarly, in the field of environmental sciences, I see very little participation from our fraternity. Several associations have come up, like Society for Internal Environment, Indian Pollution Control Association. In meetings and workshops of these associations, health sector is least represented because we are not proactive in joining these organizations, and the health sector remains either poorly represented or is filled up by reluctant clinicians. As a result, other sectors such as water resource management, forest sciences, agriculture surge ahead with mega research projects and health sector lags behind. In our knowledge, agencies such as BURD-UK, IUSSTF-USA, UKERI, NERC-UK turned down several research proposals citing reason that representation of public health sector was inadequate or the health component of the proposal was poorly drafted. It happened because a public health expert was missing from the team.
Epigenetics is a branch that plays a crucial role in understanding the gene-environment interaction as a key to understanding the pathogenesis of a large number of noncommunicable diseases. When the clinical departments in collaboration with the Department of Biochemistry prepare proposals in this field, their sample sizes are small, and most of the projects are hospital based. Thus, community-based projects with large sample sizes, which may provide evidence for the role of gene-environment interaction in the context of the Indian population, are not being prepared simply because the community medicine department, which has the potential resources to conduct community-based studies, are not participating. A serious opportunity to augment understanding of non-communicable diseases in India is lost in the process.
There has been a trend seen among the young doctors with MD in community medicine to get into civil services and also to opt for an MBA degree, realizing the need to strengthen their managerial skills, but again in the management institutes, health management topics are not taught by community medicine faculty, neither are we carrying out any meaningful research in addressing the issues of workforce shortage in health-care setting, optimization in delivery of universal health care and improving the supply chain system for peripheral institutions. This can be best done in collaboration with experts from the field of Human Resource Development, Organizational Behavior and Operations Research from Institutes of Management.
To conclude, I must say that time has come to expand the horizons of community medicine and forge partnerships, because structures with complex, intertwined pillars are stronger, have more stability, and better potential for growth.
For all this to materialize, we need to come out of our shells, join hands with relevant departments and subject specialists to innovate and execute, to regain the lost ground for the all-important fraternity of community medicine.
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