The control of communicable disease, the essence of traditional public health,
is not the same as the internal medicine subspecialty of infectious disease
treatment. This subspecialty is concerned with the treatment of individual
patients infected with viral and bacterial organisms, and the training is
oriented to individual patients, not the community. In contrast, disease control
is concerned with the prevention of the spread of diseases in the community
rather than the treatment of individual patients.
Disease control was the core of public health until the last polio epidemics in
the 1950s. With the development of antibiotics and effective immunizations,
the public lost its fear of communicable diseases, undermining public support
for disease control in the general populace and in schools of public health.
Since the 1960s, public health has become a broad umbrella, encompassing
every cause from nuclear war to controlling cholesterol levels. This loss of
focus has weakened the disease control programs in most health departments.
The diminished support for disease control is exacerbated by the burden of
indigent medical care. Although indigent medical care is a critical community
service, it is so expensive and demanding that it saps the resources of the
much smaller preventive programs.