The changing concepts of health and the University

Media

Part of Acta Medica Philippina

Title: The changing concepts of health and the University
Creator: Gan, Tomas M.
Language: English
Source: Volume XV (2) October-December 1958
Year: 1958
Subject: Health education -- Philippines -- History; University of the Philippines; Medicine -- Periodicals
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Fulltext: THE CHANGING CONCEPTS OF HEALTH AND THE UNIVERSITY* TOMAS M. GAN, M.D., Dr. P.H.'~'·' Half a centur}' ago the University of the Philippines was founded. It is of significance that this Government institution of higher learning should start with a unit rledicated to tlw science and art of medicine around which all other health gciences revolve. Born in an era when epirlernics of communicable diseases ancl deplorable sanitary conditions of the environment were having great impacts on Fili11ino community life, the establishment of the College of Medicine was not only timely but also met a long felt neecl. That medicine in its preventive, curative and rehabilitative aspects would lean on so many other allied sciences seemed to have been anticipaterl in the subsequent establishment, one after another, of other related units concerned with the sciences of pharmacy, \'eterinary medicine, education, engineering, dentistry and nursing, not to mention the general role of the College of Liberal Arts in the subsequent prepuation of students for medical training. Responsi\•e to the problems arising from the increasing complexity of the community aspects of health the Vniversity established the Institute of Hygiene. The creation of the Institute of Public Administration in recent years came as a timely answer to the pressing need for further 1·esearch on effective administrative techniques and procedures in the pro,·ision of adequate medical and health services to our communities adjusted to theil' own particula!' social, economic aml cultural patterns. A mere enumeration and summing up of the achievement:: of the University in the broarl fielrl of health during the past fifty years would be relatively an easr matter. To trr to evaluate these directly, however, woulcl be a most difficult if not an impossible task. The very nature, extent and complexity • Lecture given at the UP-PGH Medical Center, No\'embcr 5, 1958, as part of the U.P. Golden Jubilee Lcclurc Series. "" Proressor am! Head. Department of Social and Pruventive Medicine. Far Eastern University, aml Professorial Lt'clurer, Institute of Hygiene. u_p, 10:~ 104 ACTA MEDICA PHILIPPINA of the field of health rules out the use of any suitable yai'dstick by which one can measure these achievements with any l'easonable degree of precision. The ever changing nature and hence scope and contents of this field which our changing society demands makes such a task doubly difficult. Furthermore, many such achievements do not lend themselves to -any but a predominantly qualitative appraisal, and it is a well-known observation that subjectivit:i,• in such a case can easily creep in. As an indirect approach to the evaluation of such achievements an attempt is therefore made to consi<ter the more significant de\•elopments in the health sciences in the University in their relation to the changing concepts of health on one hand and the more noticeable and significant changes in our society, on the other. For just it is considered a function of the University to emphasize the importance of adjustments and renovation of Government to meet the requirement of economic and social changes, it may be said that this function should be made doubly applicable in the fielrl of health if the state Unh·ersity is to maintain it.s role in setting up certain standards and in providing necessary leadership in this field. That this approach should pro\·oke discussion in an academic atmosphere such as we are in now would be most desirable. That the introduction of certain indicated changes is not alwuys an easy matter to achieve in an old institution must, of course, be borne in mind. It has been aptly said, and oftentimes repeated, however, that while change does not necessarily mean progress, there could be no progress without change. The State University by the nature of its function, organization and policies together with the know-how it has at its command would reasonably be expected to effect and achieve such adjustments and innovations that our constantly changing world requires. In the field of health this change is comparatively rapid. While health has always been a major concern of peoples and their governments throughout the world, never has this subject been given its share of extensive and intensive thioking until in recent years. While long before World War 11, some interest among medical scientists and educators had already been aroused when the concept of comprehensive medical care was defined by the then Health Organization of the League of CHANGING CONCEPTS OF HEALTH 105 Nations, it can be said that it was not until 1946 when the International Health Congress held in New York City framed and adopted the constitution of the World Health Organization that the science of health and others that contribute to it were given the attention these have been sharing since then. For the first time a universal agreement on the meaning of health was reached, and certain important principles implied by the definition to enable the new organization to realize its objective were discussed, agreed upon and accepted. Ever since the nation of the world, signatories to the constitution of the Organization, accepted, among others, the principles that "the enjoyment of the highest attainable standard of health is of the fundamental rights of every human being without rlistinction of race, religion, political belief, economic or social condition," and that "the extension of the benefits of medical, psychological and related knowledge is essential to the fullest attainment of health," statesmen, scientists and medical educators have focused a great deal of their attention on the multifarious problems of health and how best the many sciences can be effectively harnessed towarrls their solution. The new social doctrine that has emerged places high value on the health of the individual, whether as a right in a democratic country or as a means to increase his productivity in a tolalitarian state, and has considerably stimulated medical and social scientists throughout the world towards a coordinated close scrutiny of the broad field of health. The emphasis given to the principle that an "informed public opinion and active cooperation" on the part of the people are of importance in the improvement of their health has created interest in the behavioral sciences and how best to apply these to make public health education effective as well as enduring. In th.is respect the University, through its College of Erlucation and the Institute of Hygiene, has pioneered in this relatively new science, and the initial emphasis on the school health aspects of health education has since then been expanded so as to include its broader application. That new concepts as well as new trends would emerge from such principles which nations of varying cultures and st~s of development have seen fit to subscribe to can be reason106 ACTA 1'1EDICA PHILIPPINA ably expected. The rapid changes in scientific knowledge and social ideas cat.alyzed by experience during World War I served to accelerate their emergence. As each new concept has to be carefully nurtured and as time and trial must be regarded as essential elements in its growth and acceptance, it is but natural that some of these would not be able to stand on theil' feet after some time. That a significant number could be expected to survive the test of time, trial and application is, however, inevitable. Present-day thinking recognizes the great influence that economic and social factors have on health and disease. Considerable attention is being placed nowadays on the broadened concept of public health so as to emphasize the social, economic and cultural factors of community health. Eighty-eight go\·· ernments of the world have committed themselves to recognize the fact that the employment of adequate social measures in addition to medical ones is essential in the fulfillment of their responsibility for the health of their people. All of these have snowballed to give substance and strength to the concept of social medicine. Conceived during the first World War, this concept had to await another for its birth, and today social and medical scientists, as well as medical educators, singly or jointly are engaged in searching for effective ways and means of putting this concept into greater positive action in the hope of giving this new branch of medicine "the dignity of an academic discipline in its own right." In October 1957, a study group held in this city under the auspices of the WHO centered its discussion and deliberations on this concept and agreed unanimously on the role of many aspects of discipline which institutions of higher learning in all the countries participating would have to be called upon to develop in its support. It is most gratif:\ring to note that in a working paper presented to this study group, the deans of the College of Medicine and the Institute of Hygiene of the State University jointly underscored the need for closer understanding between the Department of Hygiene anrl Preventive Medicine and the other departments of the medical school in the interest of coordination and teaching of this discipline so that the promoth'e, preventive, and the social aspects of health and disease may be given its due share of emphasis. That this concept has to some CHANGING CONCEPTS OF HEALTH 107 extent already permeated the contents and the methodology of teaching in the College of Medicine was made manifest in a further information to the effect that, depending on the disease being studied in the clinics, from about 15% to 201/C of the time is devoted to the social aspects of the problems presented. That the educators concerned were not quite content with the progress that has already been gained in this respect and that more might be done to increase the participation of the Department of Hygiene and Preventive Medicine in the clinical areas was also jointly expressed. It is quite unfortunate that some confusion has been created among our medical profession as a result of the emergence of this concept, and social medicine has been confused with socialized medicine which it is not. For while the former limits itself to the effects of human societies on the behaviour of health and disease and vice vers" and the latter involves an organizational scheme in the distribution of medical care, there are still many who would confuse the Sl'lbstance of a thing for its usage. It is in controversies arising from misconceptions like this that, I believe, the State University, being in the best position to elucidate and interpret these concepts to the medical and allied professions should by virtue of its position take the initiative and assert its intellectual leadership by doing i:;o, anrl the sooner such a confusion is abaterl the better it woulrl be for the peace of mind of the confused. Another concept th1:1.t h1:1.s emerged and now enjoys universal acceptance is that which rlefines the modern practice of medicine as that which does not limit itself to earl~· diagnosis anrl treat. ment of a patient hut includes rehabilitation and the prevention of disability in him as well as the prevention of disease and the promotion of health in his family. This implies that the practitioner of medicine toda~· should not only be concerned with the curative aspect of' his profe.:;sion but must likewise be concerned with its preventive 1:1.1ul rehabilitative phases. It further implies that one's practice of merlicine is not only centered. in the patient but should permeate the family and even the community they are a part of, if necessary. The concept thus ca.t"l"ies with it certain responsibilities in that to ~ successfully 108 ACTA MEDICA PHILIPPINA carried out, a physician's understanding of the social, economic and cultural factors which influence his patients' and their families' lives is necessary. Many can recognize in this conC'ept a return to the old Hippocratic ideal which always included the whole environment of man. I have already mentioned that the concept of comprehensive medical care is by no means a post World War II development. However, it took a global event of such magnitude and consequence to spark the speed-up of the maturation and acceptance of the idea. This concept which places at the disposal of people all the facilities of modern medicine and related sciences for the prevention of disease, the promotion of health, the early detection and treatment of illness and rehabilitation of the sick has re-emerged to conform with social changes and scientific advancement of the time. The ratification of the constitution of the WHO has given further substance and meani!'l.g to this concept which additionally provides that all these facilities for adequate medical care are to be determined for any individual or group not by financial capacity but by actual need, and that no government should allow its people to die or remain unhealthy solely because they are unable to pay for what modern medicine can do for them. As our government is committed to uphold this concept and its various implications, the training of a physician imbued with these ideas and ideals becomes a responsibility of the State University if it is to maintain certain standards for other institutions to follow. That this responsibility falls primarily on its medical school and all its departments of instruction and secondarily on its other units which contribute to the science of health is clearly indicated. Hand in hand with these changing concepts of health we have come to accept, we find a number of manifest changes in our society today which can significantly affect them. Trends which have become noticeable long ago and accelerated by the last war have already begun to assert themselves with greater persistence. The encouragement our government is now giving our country's program of industrialization and the social upheaval this is creating as a result of the inevitable movement of the CHANGING Cf?NCEPTS OF _HEALTH 109 population have already created and is bound to create further problems of health the university might as well anticipate and prepare for. Our transition from an agi·icultural economy to an industrial one has assumed a quickening pace so that traditional patterns of living of our people are being upset to an increasing degree. The rapid urbanization of many of our areas which is an expected offshoot of these deYelopment is bound to a,dd to the health problems already created. The belated realization that our rural population have long been neglected has shifter! government attention to this sector of our population. This has led to the present program of community development which has underscored the role of the health sciences in this cooperative undertaking and medical educators have been exhorted to give due emphasis to the rural practice of medicine and, if at all possible. create a rural type of physician. Technological advances of this age which are bound to be introrluced here are also apt to create new health situations and problems. The hazard of ionizinv rarliation as man begins to harness the atom m0re and more for peaceful uses is an example of this. Some degree of success already achieved in Olli" public health fielcl resulting in the s~l\'ing of young peo1>le are bound to develop an aging population with all its attendant problems of mental health. eance1·, degenerative and long term illnesses of the ager!. This latter den.'lopment calls for preparation in geri;:1,trie.s. The State Unin.'rsity is considered by om· people as the institution which should be most sensitive to these perceivable present-day changes in our society and one in a position to meet or anticipate the impacts of such changes on our people in the foreseeable future. In this connection we find ourselves fortunate in that more mature and more developed countries of the worl<I have passed thru such changes long before and whatever experiences they may have accumulated in the process can very well guide us in our investiiations of the problems as these fit into the va1;ous facets of the way of life Peculiar to our country and people. This is an opportunity for the University, through its various basic and related units dedicated to the health sciences, to contribute effeetive1y to the presen.t task of na.tion building that it can ill affor~ to ignore. 110 ACTA MEOICA PHILIPPINA We are all aware that we al'e no longer living in that form of society in which the physician has to do little more than relieve pain. As our societies become more complex, medical practice becomes more and more interwoven with medical and health services furnished by the government and some voluntary agencies. This together with other developme.nts mentioned before have made the present day practice of medicine and public health a cooperative venture of many groups of professionals. Thus the problem of professional relationship between people engaged in the health field has now become an important consideration in the education of physicians, health practitioners, nurses, etc. ln this particular development the Univel'sity with its units of public administration, sociology, psychology and anthropology, etc. is in a singular position to contribute effectively, altho it is the considered opinion of many medical educators that the examples set by the various professional staff concerned play a more important role in the educa. tio11 of om· young people along this line. I have stated that the State University by the nature of its mission, is expected to be sensitive to the implications of these changing concepts and what health problems our chang. ing sodet,\' brings along with it. That these should find expres· sions in its curriculum offerings, course revisions, methodology of teaching and its investigate activities is, in a way, a measure of such sensitiveness. We have to grant, however, that there are inherent clifficulties in adopting any course to conform with social changes an<l scientific advancement. That this difficulty woulc\ be greater in an older institution has already been pointed out. Whether we would place the University of the Philippines in this category is, however, a moot question. Again a certain reasonable lag in application must be allowed. In the health sciences, howe\'CI', this could initially entail no more than a meeting of minds of the clinical and the social and preventive medicine departments and supplementary participation of other relevant units that can contribute to them. It is encouraging to note that some move along this direction has already been started. To inculcate the desired preventive and social outlook throughout medical teaching only among the students of the State University would n·ot achie\•e the desired effect. They CHANGING CONCEPTS OF HEALTH 111 would just constitute the proverbial drop in a bucket. The idea shou1d be made to permeate ali our private medical and related schools and the Bureau of Private Schools which has supervision and control over these institutions should look up to the State University for guidance, and the latter shoukt be prepared and willing to give this as a matter of duty. The introduction of a hospital care and a family health program singly or jointly would serve as an illustration of a teaching program designed to conform with social changes and scientific advancement of the present-day. That such a program could offer great opportunities for Supervised extramural experience which would give our medical students the opportunity of working closely with patients and their families in their natural environment under supervision has been successfully demonstrated. The program also serves to illustrate what role a medico-social worker can assume in organized medical care. It furthermore serves as a springboaJ'd for the introduction into the clinical area of the sociology of communal life and the elements of anthropology as well as the elements of individual and group psrcholog;r. That this experience can be made available not onlr to medical students but also to nurses in training has also been successfully shown. Another merit of the students' participation in such programs lies in givi.1g them the opportunity to gain understanding of the professional and other relationships they have to meet in the future practice of their professions which their training in a hospital alone could not very well pro\·irle. In the field of health the State University is in an advantageous position in that it has not only developed, within a short span of time, a first class medical school anc\ internationally known Institute of Hygiene but has also been the recipient of considerable assistance from both bilateral a111\ international organizations for the p1·oper growth and development of these institutions. l<'or its department of hygiene and preventive merlicine, the College of l\'lerlicine has the entire resources of the Institute of Hygiene which has earned a reputation for being always able, willing anrl ready to cooperate in any undertaking to which it can contribute its share within the litnits of its resources. Within the past half century the Uni112 J\Cl'A MSDICA PBILIPPINA versity has est.ablished and selectively staffed many other units and departments of learning which together constitute rich resources which her coordinative machinery can tap to assist in the many aspects of the health problems which our changing and growing society creates. Being a government institution itself, the University could be most vigorous in rendering advisory, consultative and direct service, thru these units, singly or collectively, to other related government agencies whose functions are to contribute to the attainment of optimal health of our people. Towards the successful accomplishment of the taRk expected of her she would need to identify whatever internal and external obstacles-institutional, psychological, or sociological-may have to be solved first so as not to impede progress towards the desired end. On the whole it may be said that in the field of health the State University, within a relati\"ely short span of time and during an important period in its growth and development has already made a creditable contribution to the task of nation building. In its graduates in medicine, public health and other related professions, this contribution is indeed considerable. With such an auspicious past much more is expected of her in the future. Now past that period of growing pains, the scope, extent, and usefulness of these expected contributions will have to depend on its more \•igorous policy of mustering its existing resources into a coordinated and unified approach to our growing problems of health and medical education in response to accepted concepts and significant trends in our society. Fm· the nation to profit from this, the University must endeavor to have its influence felt by related government agencies more and more and thus make these look up to it for guidance and assistance in this important field more often and with lesser hesitation.
pages: 103-112