This issue on Academic-Practice Linkages updates our January 2000 publication with the same title. Parallel to the earlier issue, one of the articles published, "Demonstrating Excellence in Practice-based Teaching for Public Health," is based on an Association of Schools of Public Health report. Since the 2000 issue, there has been a notable trend, described in the series of articles, about the use of health departments for teaching both public health and medical students. Conte et al describe a project sponsored by the Association of Schools of Public Health stimulating linkages between health departments and schools of public health for the purpose of education of public health students. In her commentary, Rika Maeshiro refers to Regional Medical Public Health Education Centers. The program, sponsored by the Association of American Medical Colleges, is aimed at a similar goal for health department-academic relationships but for the education of medical students.

Both the Association of Schools of Public Health and the Association of American Medical Colleges projects were funded by the Centers for Disease Control and Prevention. As documented by articles in this issue and other reports,1,2 they were highly successful in introducing students to the importance and reality of population-based practices in which local and state health departments are engaged. Unfortunately, at the time this issue of Journal of Public Health Management and Practice goes to press, the renewed funding for these valuable initiatives still has not been committed.

For more than 75 years, it has been recognized that a teaching health department can provide significant advantages for the education of students in public health and clinical and population-based preventive medicine. Because health departments are the focus of public health activities for the community, they can provide students with ideal opportunities to acquire and apply skills just as a teaching hospital can provide a learning environment for clinical skills.

The impetus for the teaching health department can be directly traced to the apathy and lack of interest that greeted education in public health and prevention as early as the 19th century. According to Smillie,3 hygiene, sanitation, preventive medicine, and public health were taught most casually in medical colleges throughout the 19th century. "The subjects were assigned to one or more professors who were most interested in these fields, and a series of didactic lectures were given to apathetic and uninterested students."3 In 1881, J. M. Gregory, an educator, writing in the American Journal of Education, noted that "the omission of hygiene as a subject for study in medical colleges is a serious defect in the educational system" and the "[horizontal ellipsis] trend of the century was to limit the teaching of medical students to the intensely practical fields of diagnosis and treatment."3 Those of us committed to the teaching of preventive medicine and public health in the 21st century are struck by the clear parallels.

The principle that preventive medicine was integral to the education of every medical student is evident in the famous Report of the Sanitary Commission of Massachusetts-1849 authored by Shattuck. Referring specifically to medical schools, Shattuck stated, "The science of preserving health and preventing disease should be taught as one of the most important sciences."4 By the early 20th century, others were embracing the same principle. In 1910, Flexner recommended the addition of population-health-based education for future physicians stating that "[horizontal ellipsis] the physician's function is fast becoming social and preventive, rather than individual and curative."5 Unfortunately, compared to Flexner's other recommendations for reform of medical school education, this recommendation for education in prevention was met with less success. The same year Flexner made this recommendation, Charles W. Eliot, then-president of Harvard, decided that a full-time professor of preventive medicine should be on the faculty with the same status as a professor of anatomy, medicine, or surgery. Dr Milton Rosenau was recruited to fill this position.3

The seeds for a teaching health department were sown in the early 20th century when, in 1932, plans initially started by William H. Welch resulted in the establishment of the Eastern Health District as a cooperative endeavor of the Baltimore City Health Department, the Johns Hopkins School of Hygiene and Public Health, and several voluntary agencies. This district permitted the training of personnel and students, thereby serving as an early example of the "teaching health department."6 Both public health students and senior medical students at Johns Hopkins were able to rotate through the health district. The public health students spent six mornings observing district activities for a required public health administration course while the senior medical students spent two mornings a week in district clinics. Medical students received patient assignments and accompanied public health nurses on home visits.7 Similarly, in New York City, teaching of public health students was facilitated by co-location of the Columbia University School of Public Health with the Washington Heights District Health Center in the Washington Heights Health District of the New York City Department of Health.2

In the Association of Schools of Public Health report on practice-based teaching, Atchison and coauthors conclude that "without incorporating practice into a public health curriculum, public health education lacks purpose." This maxim is equally true for the preventive health education of medical students. This second Academic-Practice Linkages issue of the Journal of Public Health Management and Practice documents progress. We are headed in the right direction, but more education in community settings is needed.

Lloyd F. Novick, MD, MPH, Editor

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