Tropical medicine or tropical health: the Heath Clark lectures, 1988

Tropical medicine as a specialty began during colonialization of the tropics. From the outset, controversy focused on scientific research (tropical medicine) vs. public health (tropical health). The former became associated with parasitology to the relative exclusion of microbiology. Remarkable discoveries made before 1912 were followed by sixty years of slow progress. In the last decade, however, not only has parasitic disease research flourished, but the major importance of bacterial and viral diarrheas and respiratory infections has also been revealed. Tropical health did not evolve as a major strategy in the colonial era. Later, a global eradication policy developed, first for hookworm infection, then for yellow fever and malaria, but failure led to disillusionment with technology and development of an undifferentiated approach to primary health care. In the last decade a selective approach has focused on diseases for which cost-effective control measures exist. Moreover, several developing countries have achieved good health at low cost by equitable distribution of health care, education, and food. Today, the conflict between tropical medicine and tropical health is being resolved with the realization that they are truly complementary disciplines.