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In their classic paper "Ecology of Medical Care," White et al1 demonstrated that for every 1000 adults, 750 per month had a symptom of illness, 250 sought medical care, 9 entered a community hospital, and only 1 entered a university hospital. In a study we did in Boston in the early 1960s, we documented that only 8% of children's illnesses were seen by a physician and 2% were admitted to a hospital, while more than 60% of these illnesses were dealt with entirely by the mother alone. Trius, if education and research are limited to patients in teaching hospitals, there will be a great deal of bias. Community pediatrics seeks to provide a far more realistic and complete clinical picture by taking responsibility for all children in a community, providing preventive and curative services, and understanding the determinants and consequences of child health and illness, as well as the effectiveness of services provided. Thus, the unique feature of community pediatrics is its concern for all of the population - those who remain well but need preventive services, those who have symptoms but do not receive effective care, and those who do seek medical care either in a physician's office or in a hospital.
This concept traditionally has been the province of public health, but public health is best concerned with environmental health, health education of the community, health assessment, and where necessary, provision of services for those who endanger the public's health, such as those who have sexually transmitted diseases, tuberculosis, or other communicable diseases. Clinical medicine, on the other hand, generally is concerned only with patients who have entered the curative health system. Community pediatrics blends these two fields. The basic science of community pediatrics is epidemiology, literally meaning the study of disease among populations.
My own conversion to this concept came as I progressed from caring for individual children to caring for families in the Harvard Family Health Care Program in the 1950s and 1960s. In this familyfocused program, we carried out a controlled trial that demonstrated the beneficial effects of a comprehensive health-care program with fragmented but technically competent ones.^sup 2^ This was the era of so-called comprehensive medical care programs. Later, I was exposed to Dr Kerr White, who was the...