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The future for the society of community medicine
Public Health The Journal of The Society ,of Community Medicine (Formerly the Society of Medical Officers o f Health) Volume 91
Number 1
January 1977
The Future for the Society of Community Medicine, Fools learn from their own mistakes, wise men from other people's. The Society o f Community Medicine was formerly called the Society of Medical Officers of Health. It was founded by Medical Officers o f Health in order to meet their real need to consult together and learn from each others experience. Each M.O.H. was employed by a different local authority. They were, therefore, geographically separated and there can have been very few occasions, if any, when an M.O.H. would see his neighbours in the course of his work. Without a society to convene meetings and arrange d~scussions the early public health doctors would have suffered severe professional isolation. When, following the report of the Interdepartmental Committee on Physical Deterioration, the personal health services were started at the beginning of this century, new ki~ds of Public Health doctors with very different interests appeared on the scene. Jt was therefore, only natura! that our Society should expand to accommodate ,them and eater for their special needs. In the course of time, therefore, the Society evolved a number o f special interest groups which were superimposed on the original regional branches. T w o of these groups comprised the Medical Officers of Health o f the Counties and County Boroughs. Their members, because o f the career structure which had evolved, tended to be the more senior and experienced members and came to dominate the Society to a degree which caused dissatisfaction among the wider membership. Consequently when reorganization of the Society came t o be discussed, the opportunity was taken to criminate groups whose existence was perceived to be divisive. Experience has shown that this decision was ill advised. A society is only viable if it serves the needs of its members. When the public health medical officers were transferred from their separate local authorities i n t o the employinent of the unified National Health Service, they were brought into an organization which itseifprovided more than Sufficient opportunities for Regional and Area meetings o f doctors engaged in CommunityMedi¢ine. T h e need for a Society t o provide the forum for :such meetings, therefore, ceased. The need for doctors with similar responsibilities t o m e e t and learn from each other did not, /however, diminish. Instead it grew. The new posts involved a mass of new duties andresponsibilities of.an unfamiliar nature. Their incumbents, under stress and in. need of e a c h others help and support in seeking solutions to s o m e o f their new problems, were barred by .the new rules o f their reforraed.Society from forming "'functional groups", and .were driven to 1
2
The fitture for the Socie O,
establish new Associations instead. Only when this had occurred did the Council of the Society perceive the resulting threat. At the same time that this was happening the country experienced an exceptional burst of inflation. The overheads and staffing costs of the Society incr,eased alarmingly while the membership went down. Financial disaster seemed imminent. The Council recommended that the Society be wound up. The special general meeting convened to effect this, however, failed to give the necessary majority, and an alternative has now to be ,sought. Despite past dissatisfaction there is a great deal of]oyalty among the membership to our Society. If it can now be restructured in such a way as to meet the needs of its members it could and should regain much of the ground it lost. No other body currently seeks to serve the needs of clinical medical officers engaged in public health work or to ~integrate the community dental and medical staff: Without some unifying body to link them there is a danger that the new associations of R.M.O.'s, A.M.O.'s, D.C.P.'s and S.C.M.'s, might pursue selfish interests to the detriment of community medicine as a whole. Although most community physicians in each kind of post see the interests of community medicine as paramount, a few are seeking to improve their own status at the expense of colleagues at different administrative levels. We are a small discipline, lfwe are t,o prove effective we must learn to support each other in disputes with other medical specialities. In advising Governmental bodies we must try to speak with one voice. If our various Associat:ions give conflicting advice our opportunity to influence events will be dissipated. No other body fulfils the role of integrator. The Faculty must remain an academic body concerned with the sciences of community medicine and epidemiology~ifit is to retain its status. The British Medical Association is an excdlent negotiating body. It is highly effective at negotiating terms of service. It is now a "Trades Union" which looks after the interests o f doctors as a whole, but as the vast majority of its members are clinicians it would be unrealisticto expect it to support views at variance with the interests of its clinical members. Since the clinician owes allegiance to the individual patient, and the interests of the individual are often at variance from those of the community as a whole, clashes of interest between clinical and community medicine are bound to arise. So long as the politicians evade their duty to define the aims and limitations of the se~wice, and expect unlimited demands to be met from restricted resources, the risk of such disputes will be high. The assumption that a doctor's duty is to "save life at any°price", accepted without question by many Clinicians and members of the public, is incompatible with the duty of community physicians t o s e e that scarce resources are applied i n the ways most beneficial to Society. Dissatisfaction on the part o f Clinicians and of the public is inevitable when they are denied, for financial reasons, treatment o r ~facilitieswhich they consider to be their "right". The pressures exerted by doctors whose pet schemes are tamed down; or who are denied what they perceive as vital equipment are strong. Pressure groups promoting the interests of particular types of patient can exert considerable political power. The arrangements for staff interests to be consulted within the N.H.S. have increased the already strong tendency for hospital and Primary care services to be run i n the interests of staff rather than tomeet the needs of the public. To overcome these pressures it is essential that a ur~ified corps of community phs,sicians gives unequivocal advice to the department and to Parliament. The ~aost appropriate body to give such advice would be our Society. Many problems remain for the Co tmcil to solve, By transferring their registered office to Portland Place and accepting the generous offer o f the Royal Insiitute, a big saving has been achieved. Financial solvency should be ensured providing the membershipdoes not fall.
The future for the SocieO,
3
Unless the Society is reorganized again so that it really does meet the needs o f its members, however, disaffection and resignations may follow. The Council of the Soctety is well aware of these facts. They are currently considering how they can reform the structure of the Society and 'try to re-unify our discipline. Already they have convened a jo~nt meeting between their own representatives and representatives o f the new Associations, and at that meeting suggestions for a form o f affiliation were mooted which, if adopted~ could operate to the benefit of both the Society and of the Associations. For historic reasons the Society enjoys a number of privi|eges. It may nominate or appoint representatives to a number of bodies, some of which are influential, and i: is regularly consulted b3' other bodies seeking advice on a variety of subjects. The new Associations are less well known, and though they are being consulted on many matters there are many consultative documents which fail to teach them, but which do go to the Society. It is notable that it was the Society and not any of the new Associations whom the Select Committee of the House of Commons approached ibr advice and evidence on the future role of preventive medicine. The suggested affiliation between the new Associations and the Society would give the Associations the following advantages: (1) The right to appoint a representative to the Council of the Society (who must be a member of the Society). (2) The opportunity to comment on consultative documents they might not otherwise see. f3) The right to put forward names for the Society to appoint to various outside bodies. (4) Access to the Journal as a means of communicating: with their members. In return for these advantages the Society would expect: (1) To be allowed to nominate a representative to the Executive of each Association (but who must be a member of that Association). (2) The right to see a draft or copy of any memorandum of evidence prepared by any o f the Associations. (3) The opportunity to intervene and avert disputes between the Associations. I f some arrangement along these lines proves acceptable to the Associations and to the Society, and if the Society reorganizes in such a way as to re-form appropriate special interest groups (SO that those with interests in Environmental i~Iealth can meet t o g e t h e r whatever the nature of their post, and those whose interest is in Mental Health can do the same), then al~ would benefit. The Society would be revitalized: The new Associations would become more influential. Most important of all, however~ the risks of fragmentation of the discipline o f Community Medicine would be averted.
Vira| .Haemorrhagic Fevers There are now~ at least five different newly isolated irtfeetive agen,ts which cause haemorrhagic fever's with high ease fatality rates. They are readily transm~ssable to the nurses and doctors eating for eases and are rapidly replacing the now nearly extinct smallpox virus as the major:threat to international health. Although the agent isolated from the Zaire epidemic morphologically resembles Marburg virus i t is immunologicalty quite distinct. Surprisingly it is also immunologically distinct from the virus whichhas been isolated from the concurrent outbreak of a similar disease in
Number 1
January 1977
The Future for the Society of Community Medicine, Fools learn from their own mistakes, wise men from other people's. The Society o f Community Medicine was formerly called the Society of Medical Officers of Health. It was founded by Medical Officers o f Health in order to meet their real need to consult together and learn from each others experience. Each M.O.H. was employed by a different local authority. They were, therefore, geographically separated and there can have been very few occasions, if any, when an M.O.H. would see his neighbours in the course of his work. Without a society to convene meetings and arrange d~scussions the early public health doctors would have suffered severe professional isolation. When, following the report of the Interdepartmental Committee on Physical Deterioration, the personal health services were started at the beginning of this century, new ki~ds of Public Health doctors with very different interests appeared on the scene. Jt was therefore, only natura! that our Society should expand to accommodate ,them and eater for their special needs. In the course of time, therefore, the Society evolved a number o f special interest groups which were superimposed on the original regional branches. T w o of these groups comprised the Medical Officers of Health o f the Counties and County Boroughs. Their members, because o f the career structure which had evolved, tended to be the more senior and experienced members and came to dominate the Society to a degree which caused dissatisfaction among the wider membership. Consequently when reorganization of the Society came t o be discussed, the opportunity was taken to criminate groups whose existence was perceived to be divisive. Experience has shown that this decision was ill advised. A society is only viable if it serves the needs of its members. When the public health medical officers were transferred from their separate local authorities i n t o the employinent of the unified National Health Service, they were brought into an organization which itseifprovided more than Sufficient opportunities for Regional and Area meetings o f doctors engaged in CommunityMedi¢ine. T h e need for a Society t o provide the forum for :such meetings, therefore, ceased. The need for doctors with similar responsibilities t o m e e t and learn from each other did not, /however, diminish. Instead it grew. The new posts involved a mass of new duties andresponsibilities of.an unfamiliar nature. Their incumbents, under stress and in. need of e a c h others help and support in seeking solutions to s o m e o f their new problems, were barred by .the new rules o f their reforraed.Society from forming "'functional groups", and .were driven to 1
2
The fitture for the Socie O,
establish new Associations instead. Only when this had occurred did the Council of the Society perceive the resulting threat. At the same time that this was happening the country experienced an exceptional burst of inflation. The overheads and staffing costs of the Society incr,eased alarmingly while the membership went down. Financial disaster seemed imminent. The Council recommended that the Society be wound up. The special general meeting convened to effect this, however, failed to give the necessary majority, and an alternative has now to be ,sought. Despite past dissatisfaction there is a great deal of]oyalty among the membership to our Society. If it can now be restructured in such a way as to meet the needs of its members it could and should regain much of the ground it lost. No other body currently seeks to serve the needs of clinical medical officers engaged in public health work or to ~integrate the community dental and medical staff: Without some unifying body to link them there is a danger that the new associations of R.M.O.'s, A.M.O.'s, D.C.P.'s and S.C.M.'s, might pursue selfish interests to the detriment of community medicine as a whole. Although most community physicians in each kind of post see the interests of community medicine as paramount, a few are seeking to improve their own status at the expense of colleagues at different administrative levels. We are a small discipline, lfwe are t,o prove effective we must learn to support each other in disputes with other medical specialities. In advising Governmental bodies we must try to speak with one voice. If our various Associat:ions give conflicting advice our opportunity to influence events will be dissipated. No other body fulfils the role of integrator. The Faculty must remain an academic body concerned with the sciences of community medicine and epidemiology~ifit is to retain its status. The British Medical Association is an excdlent negotiating body. It is highly effective at negotiating terms of service. It is now a "Trades Union" which looks after the interests o f doctors as a whole, but as the vast majority of its members are clinicians it would be unrealisticto expect it to support views at variance with the interests of its clinical members. Since the clinician owes allegiance to the individual patient, and the interests of the individual are often at variance from those of the community as a whole, clashes of interest between clinical and community medicine are bound to arise. So long as the politicians evade their duty to define the aims and limitations of the se~wice, and expect unlimited demands to be met from restricted resources, the risk of such disputes will be high. The assumption that a doctor's duty is to "save life at any°price", accepted without question by many Clinicians and members of the public, is incompatible with the duty of community physicians t o s e e that scarce resources are applied i n the ways most beneficial to Society. Dissatisfaction on the part o f Clinicians and of the public is inevitable when they are denied, for financial reasons, treatment o r ~facilitieswhich they consider to be their "right". The pressures exerted by doctors whose pet schemes are tamed down; or who are denied what they perceive as vital equipment are strong. Pressure groups promoting the interests of particular types of patient can exert considerable political power. The arrangements for staff interests to be consulted within the N.H.S. have increased the already strong tendency for hospital and Primary care services to be run i n the interests of staff rather than tomeet the needs of the public. To overcome these pressures it is essential that a ur~ified corps of community phs,sicians gives unequivocal advice to the department and to Parliament. The ~aost appropriate body to give such advice would be our Society. Many problems remain for the Co tmcil to solve, By transferring their registered office to Portland Place and accepting the generous offer o f the Royal Insiitute, a big saving has been achieved. Financial solvency should be ensured providing the membershipdoes not fall.
The future for the SocieO,
3
Unless the Society is reorganized again so that it really does meet the needs o f its members, however, disaffection and resignations may follow. The Council of the Soctety is well aware of these facts. They are currently considering how they can reform the structure of the Society and 'try to re-unify our discipline. Already they have convened a jo~nt meeting between their own representatives and representatives o f the new Associations, and at that meeting suggestions for a form o f affiliation were mooted which, if adopted~ could operate to the benefit of both the Society and of the Associations. For historic reasons the Society enjoys a number of privi|eges. It may nominate or appoint representatives to a number of bodies, some of which are influential, and i: is regularly consulted b3' other bodies seeking advice on a variety of subjects. The new Associations are less well known, and though they are being consulted on many matters there are many consultative documents which fail to teach them, but which do go to the Society. It is notable that it was the Society and not any of the new Associations whom the Select Committee of the House of Commons approached ibr advice and evidence on the future role of preventive medicine. The suggested affiliation between the new Associations and the Society would give the Associations the following advantages: (1) The right to appoint a representative to the Council of the Society (who must be a member of the Society). (2) The opportunity to comment on consultative documents they might not otherwise see. f3) The right to put forward names for the Society to appoint to various outside bodies. (4) Access to the Journal as a means of communicating: with their members. In return for these advantages the Society would expect: (1) To be allowed to nominate a representative to the Executive of each Association (but who must be a member of that Association). (2) The right to see a draft or copy of any memorandum of evidence prepared by any o f the Associations. (3) The opportunity to intervene and avert disputes between the Associations. I f some arrangement along these lines proves acceptable to the Associations and to the Society, and if the Society reorganizes in such a way as to re-form appropriate special interest groups (SO that those with interests in Environmental i~Iealth can meet t o g e t h e r whatever the nature of their post, and those whose interest is in Mental Health can do the same), then al~ would benefit. The Society would be revitalized: The new Associations would become more influential. Most important of all, however~ the risks of fragmentation of the discipline o f Community Medicine would be averted.
Vira| .Haemorrhagic Fevers There are now~ at least five different newly isolated irtfeetive agen,ts which cause haemorrhagic fever's with high ease fatality rates. They are readily transm~ssable to the nurses and doctors eating for eases and are rapidly replacing the now nearly extinct smallpox virus as the major:threat to international health. Although the agent isolated from the Zaire epidemic morphologically resembles Marburg virus i t is immunologicalty quite distinct. Surprisingly it is also immunologically distinct from the virus whichhas been isolated from the concurrent outbreak of a similar disease in