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In: White KL, Bullock PJ, ed. The health of populations: a report of two Rockefeller Foundation conferences, March and May 1979. New York, Rockefeller Foundation, Sept. 1980. 183-9.Reviews the interrelationships among epidemiology, medical education, and the planning, organization, and provision of health services. Epidemiology can be defined as the application of the scientific method and of biostatistical reasoning to the problems of health and disease in communities. Clinical epidemiology is of value in resolving problems arising from misallocation of manpower, facilities, technology, and service; adoption of unevaluated or inappropriate forms of medical intervention; overemphasis on laboratory and clinical medicine; and inadequate education and training in population-based medicine. Several reasons for the usual lack of success in teaching an epidemiological perspective have been identified. Some epidemiologists have recently made efforts to integrate the teaching of epidemiology with clinical medicine, and it is widely agreed that epidemiology and biostatistics should be included at all stages of the medical curriculum. Epidemiological scrutiny continues to be useful in elucidating the causes and risk factors of communicable and chronic disease, as well as iatrogenic disease and occupational health hazards. The importance of lifestyle and the interplay of behavioral, cultural, and economic factors with production of disease are attracting increasing attention. Increased use of epidemiological skills at all levels of medical care management and service will assist in rational allocation of health resources in developing countries, and possibly help them to resist overemphasis on advanced medical technology. Foundations can play an important role by supporting development of a consortium of clinical epidemiology units in both developing and developed countries.
In: White KL, Bullock PJ, ed. The health of populations: a report of two Rockefeller Foundation conferences, March and May 1979. New York, Rockefeller Foundation, Sept. 1980. 139-44.The background, planning process, and structure of the McMaster University-Sierra Leone project are described and its progress after 1 year of operation is assessed. It was agreed that the University of Sierra Leone would establish a Department of Community Health in Freetown and would not develop a medical school, while the Ministry of Health would develop a paramedical training school. The Ministry of Health's mandatory 2-year training program for physicians educated abroad would have cooperative links with the Department of Community Health. A senior coordinating committee directly responsible to the president of Sierra Leone would be responsible for subsequent project planning. Establishment of an eduational base in the Department of Community Health is intended to develop expertise in clinical epidemiology, biostatistics, and related areas. Community-based continuing education programs for potential users of the new disciplines at district and chiefdom levels are planned. Considerable progress has been made in the first year, but some anticipated problems have arisen and some necessary local support has wavered. Experience with this project suggests that the size of external aid must be related to the potential for change rather than the health need; factors limiting potential for change may include government commitment, priority for health care, political stability, economic conditions, and societal acceptance. Planning should be flexible and iterative, and should consider recurring costs as well as initial development costs. Initial involvement at the community and village level is essential.