Antagonism and accommodation: Interpreting the relationship between public health and medicine in the United States during the 20th century

Throughout the course of the 20th century, many observers have noted important tensions and antiphaties between public health and medicine. At the same time, reformers have often called for better engagement and collaboration between the 2 fields. This article examines the history of the relationship between medicine and public health to examine how they developed as separated and often conflicting professions. The historical character of this relationship can be understood only in the context of institutional development in professional education, the rise of the biomedical model of disease, and the epidemiologic transition from infectious disease to the predominance of systemic chronic diseases. Many problems in the contemporary burden of diseases pose opportunity for effective collaborations between population-based and clinical interventions. A stronger alliance between public health and medicine through accommodation to a reductionist biomedicine, however, threatens to subvert public health's historical commitment to understanding and addressing the social roots of disease.