Division of Disease Control and Health Protection

The reason for collecting, analyzing and disseminating information on a disease is to control that disease. Collection and analysis should not be allowed to consume resources if action does not follow.

--Foege WH et al. Int. J of Epidemiology 1976; 5:29-37.

I wish you to see that more and more through the ages the altruistic note has become dominant in human affairs…And with each recognition of altruistic obligation has come further surrender of the individual and further advance of civilization. Today it may be prophesied safely that no individual right, whether of property or person, will be allowed permanently to stand which conflicts with the prosperity, happiness or health of the organized whole…. The right of society to health is one of the latest rights to be recognized…. Medicine began and has continued until recently quite strictly as an individualistic calling. The nature of the profession led inevitably to this history. Men are sick as individuals. Treating their ailments began as a personal service. As society advanced the intimate relation of patient and physician came more and more to be emphasized. Reasons of business expediency, of personal modesty and of family intimacy made the relation confidential. The individualistic desire to get well is an instinct ever clamorous and insistent, whereas the social value of health is an intellectual concept only slowly gaining acceptance and still more slowly becoming a moving force… We have not yet achieved such breadth of vision as to pay to be protected from that which threatens the social body, but may not come to us individually.

With the knowledge; however, of the nature and cause of disease acquired in the last half century, a change has begun whose effects are already plainly perceptible and whose eventual far-reaching results over your profession on one at present can foresee. Some diseases are predominantly social. Consequently your relation as physician, to persons afflicted with these diseases must involve a relation to the whole body. You cease to be merely a seller of merchandise. Your dealing is no longer exclusively with the individual. You become the servant of the whole people…

If there is such a thing as social consciousness, if there is such a thing as group activity, then each of us must either engage in that activity or act as a drag on social progress. If there is such as thing as group responsibility, then each one of us is responsible… It behooves us; therefore, each and every one to study, endorse, support and actively engage in the public health campaign. If we do less we are false to our duty as men. This applies to all men. It applies particularly to physicians…

It is true that physicians as a whole give assent to the principles of preventive medicine. They endorse the health movement…they practice those methods of routine in their professional work which are calculated in a measure to limit the spread of disease…

It is as individuals that they fail. And they fail because they still take the narrow individualistic view of their work. They get the patient so close to their eyes that they cannot see the public. They consider their trade and fail to recognize their profession. How many of them, for example, find it convenient to fail to report cases of infectious disease? How many connive at violation of quarantine? How many give weak support to public officials in health matters? I may be wrong in the impression that the number guilty of all these offenses is large. But I am not wrong in the observation that far too few physicians are accurately informed on matters of public health. Far too few are leaders of public sentiment. Far too few even make serious effort to educate their own patients in their public duties…

You may point to the important accomplishments in sanitation and public hygiene, and claim the credit for the medical profession. I grant the importance of the achievements and acknowledge in large measure the justice of the claim. These accomplishments, however, involved for the most part, the control of matter and natural forces – what has aptly been termed the "non-human environment." They were largely engineering problems such as waterworks, filtration plants, sewers, and garbage incinerators. Or they involved control of lower forms of life such as mosquitoes, ticks and rats. The things that are to be done are vastly more difficult because they involve the human animal. Every step from now on must begin with a limitation of individual freedom and individual rights to property…Only by the painfully slow process of education can the altruistic motive gain ascendancy, an only as such ascendancy is gained will control of the preventable diseases by realized.

In this tremendous but not superhuman task of education the doctors must take the lead. And in proportion as they realize the task and work on it with all their strength, privately and collectively, with their patients as individuals and with the public at large, only thus will they realize the fullness of the term ‘Doctor" which means primarily one who teaches.