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New Approach to Community
Medicine Draws on Social Sciences
By Pat Keefe
The career of an internationally known research psychologist appointed head of the Department of Community Medicine and Health Care is an illustration of where the department is going, as the 21st century gets into full swing.
"We're trying to establish Community Medicine as a first-rate teaching and research department that represents a new public health approach to disease prevention and health promotion," says Thomas F. Babor, professor and head of the Department of Community Medicine and holder of the Physicians Health Services Chair in Community Medicine and Public Health.
"In this country, the major causes of illness now have changed dramatically since the 19th century, when infectious and communicable diseases prevailed," Babor says. "We are concerned with disease determinants that our medical schools and health care systems are not prepared to deal with - environmental factors such as air pollution and poverty, as well as behavioral factors, such as overeating, lack of exercise and the use and abuse of alcohol, tobacco and other drugs.
"To deal with the health of the population," he says, "you need a knowledge base and training capabilities that focus on environmental and behavioral determinants as much as on biological mechanisms.
Babor began his career in disease prevention and health promotion, the main areas of public health inquiry, from an academic base in alcohol and addiction research.
Addiction research was a relatively new area of study when Babor earned his doctorate in social psychology at the University of Arizona in 1971. He did post-doctoral work at McLean Hospital's Alcohol and Drug Abuse Research Center in Belmont, Mass., then won a Research Scientist Development award from the National Institute on Alcohol Abuse and Alcoholism, which allowed him to conduct research on alcoholism in France.
He also earned a master's in public health degree in psychiatric epidemiology from the Harvard School of Public Health, before accepting a faculty position in the Health Center's Department of Psychiatry in 1982.
At the Health Center, he focused his research on addictions, with particular emphasis on alcohol. He became the scientific director for the Alcohol Research Center and the principal investigator of the Project MATCH, the largest clinical trial of alcoholism treatment ever conducted. He also served as regional editor for the international journal Addiction.
The field of alcohol and addiction research offers parallels for the field of community medicine at large.
"In the past 25 years, we've made tremendous advances in our understanding of addictive behavior," Babor says. "We've made progress in studying the genetics of addiction, basic biological mechanisms, and treatment interventions, and in our knowledge of the limits of preventive measures."
Researchers and experts have often been unable to translate their new insights into alcohol and addiction into effective policies that could limit or prevent drug abuse or other addictive disorders. Yet there have been positive social forces at work to lessen some of the public health burden of substance abuse: nicotine addiction has been greatly reduced by a combination of health policies, public information, attitude changes, and behavioral economics, in the form of sharply increased cigarette taxes. Similarly, in the area of problem drinking, social movements like Mothers Against Drunk Driving have used advocacy and legislation to reduce traffic fatalities and underage drinking, all through sound prevention policies.
For instance, new statistical technologies have allowed Community Medicine faculty like Dr. Martin Kulldorff to distinguish incipient epidemics from standard mortality trends, using complex geographic models. Epidemiology - the study of the incidence, distribution and control of disease in a population - has also aided researchers and clinicians in preventing and treating outbreaks.
New research approaches in community medicine include an emphasis on the social sciences; these have made tremendous contributions to the understanding of health behavior and disease prevention, Babor says.
The new public health concepts that have emerged, he says, provide a way of looking at the health of the nation and the health care system in order to address two basic questions: how to deal with the major causes of illness most effectively, and how to prevent people from becoming ill in the first place?