Schools of Public Health--their Doing and Undoing

The heretofore untold story of Abraham Flexner's role in the establishment of the first endowed schools of public health (Johns Hopkins and Harvard) provides an unusual window through which to view the historic struggle of public health doctors to resolve their identity problem. They have become a profession, nominally a part of and yet fundamentally different from that of the physician in patient care. Nonetheless, the primary qualification for leadership in public health still is considered an M.D. degree rather than a Dr.P.H. or some equivalent. The author analyzes the characteristic inability of public health leaders to support their grand visions in times critical for decision, and calls on the modern community health educator, planner, and organizer to face the explicit question that all but a few of his public health forebears have sidestepped: Is public health a brance of medicine? Are education and training for clinical medicine desirable preparation for a career in public health, or does this simply doom one essential profession to remain subordinate to another?