Academic health centers can bridge the gulf between medicine and public health

The authors review why the gulf between clinical medicine and public health has existed since the first schools of public health were established in 1916. They emphasize that academic health centers (AHCs) have the potential to bring together these two perspectives--as well as the health services perspective--to clarify what they offer and to find creative ways to build upon their combined strengths. The authors describe institutional approaches that can be taken to narrow the gulf, with examples from the initiatives of this type that are under way at The George Washington University Medical Center in Washington, D.C. For example, the authors state and discuss in detail that an AHC's medical, public health, and health services institutions should be physically and institutionally close; that collaboration between them requires well-structured interaction; that institutional structures are needed to ensure cooperation when internal competition is likely; and that collaboration is fostered by new opportunities and the potential for new resources. The authors conclude by stating that the future will require that the health education and prevention perspective of public health, the treatment perspective of medicine, and the financial and management perspective of health services be developed and integrated into the work of AHCs, and give examples of specific activities that would be possible with such integration.