Community medicine: success or failure?

The development of university-based community-medicine programs represents one of the most fundamental reforms in medical education in recent times. These programs have attempted to train and motivate students to undertake research and innovations in health service and health-care systems, and to provide service to those in need. Since community medicine is based upon the collective needs of population groups, its relevance, value and effectiveness as a teaching, research and service device in the United States must be seriously questioned unless the prevailing system of individualized care is fundamentally changed to one of collective and regionalized organization. Moreover, working with small population groups, university programs do not provide a large enough epidemiologic base to serve as models for this reform. In developing countries community medicine has proved to be ineffective when isolated from broader socioeconomic development, and should, as now constituted, be abandoned as an independent undertaking.