Skip Navigation Links
Centers for Disease Control and Prevention
 CDC Home Search Health Topics A-Z

Preventing Chronic Disease: Public Health Research, Practice and Policy

View Current Issue
Issue Archive
Archivo de números en español








Emerging Infectious Diseases Journal
MMWR


 Home 

Volume 4: No. 3, July 2007

EDITORIAL
Revisiting the Social Contract: Physicians as Community Health Promoters


TABLE OF CONTENTS


Print this article Print this article
E-mail this article E-mail this article:



Send feedback to editors Send feedback to editors
Download this article as a PDF Download this article as a PDF (343K)

You will need Adobe Acrobat Reader to view PDF files.


Navigate This Article
Author Information
References


Margaret Gadon, MD, MPH

Suggested citation for this article: Gadon M. Revisiting the social contract: physicians as community health promoters. Prev Chronic Dis [serial online] 2007 Jul [date cited]. Available from: http://www.cdc.gov/pcd/issues/2007/
jul/06_0195.htm
.

The Shaw family is a typical U.S. family whose members live in a suburb of a small midwestern city. Mr and Mrs Shaw have three school-aged children, work full time, and earn a combined income of $75,000. They commute to work and drive an additional seven hours per week for errands and social and school events. On average, they eat out twice each week, and on a third night Mrs Shaw picks up some prepared food from the supermarket for dinner. Both adults work out at the local health club on weekends. Mr and Mrs Shaw, who are in their early 40s, are both overweight but have no other overt medical problems. One of the children has moderate asthma that is kept under control with the support of the school nurse. They visit their physicians regularly and attempt to follow all health advice. Physicians for the Shaw family have provided its members with detailed information on maintaining optimum health and changing unhealthy behaviors.

Are these physicians doing all they can to promote the health of the Shaw family? Traditionalists would most likely say yes. However, proponents of a greater professional role for physicians would not agree. They believe that the role of physicians extends further, to include a commitment to exert their influence on the many social, economic, and environmental factors that cause disease. This social contract between physicians and patients has been well described and justified by various leaders in medicine (1-7). In their 2004 paper, “Physician–Citizens — Public Roles and Professional Obligations,” Gruen et al argue that social accountability is inherent to the profession of physician (7). They propose a model of physician responsibility that correlates the expected level of engagement in socioeconomic domains with the degree to which these factors adversely affect individual health (7).

Justifiably, physicians continue to be viewed as credible leaders within their communities. This privileged position provides them with the power to leverage public opinion in domains other than the strictly medical. Clear evidence exists that a physician’s recommendation to stop smoking cigarettes is one of the most effective factors in promoting smoking cessation (8). Such efforts in the areas of injury prevention, environmental health, and nutrition that extend to a broader societal level are likely to be equally effective.

Physicians can promote health outside the traditional medical venue in multiple ways. One strategy is for physicians to work with local business networks to ensure that healthful foods are available throughout the community. Another is to appeal directly to municipal authorities for community recreational facilities such as parks and walking trails. Physicians can also promote community health by participating in local school programs designed to prevent obesity and school violence and by encouraging local, state, and national professional societies to advocate for legislative and policy changes to improve physical and social conditions that adversely affect people’s health.

In this issue of Preventing Chronic Disease, Navarro et al discuss the recommendations of a national panel of experts to guide future activities related to community health at the Centers for Disease Control and Prevention’s National Center for Chronic Disease Prevention and Health Promotion (9). The eight recommendations described in the report cover policy change, workforce issues, surveillance activities, and increased federal resources dedicated to community health promotion. Physicians working in concert with the public health system have the potential to develop collaborations that will enhance the health of their patients and that of the communities in which they live.

Yet how can we expect overburdened physicians to incorporate these added responsibilities into their daily practices of medicine? A first step could be a reassessment of their current system of practice and possible redesign of their offices to provide care more efficiently, equally, and effectively. Physicians might also work with their local medical societies and public health departments to identify public health and community resources that can complement and reinforce patient care. They can encourage patients to use these resources. Ultimately, working in partnership with community organizations could allow physicians to maintain continuity of care without overtaxing their office practices. As quality of care becomes increasingly incentivized, physicians can turn to community partnering as a means of achieving both optimum quality of care and healthier lifestyles for their patients. For the Shaw family, this could mean the difference between being at risk for and free from disease.

Back to top

Author Information

Margaret Gadon, MD, MPH, Director, Health Disparities, American Medical Association, Professional Standards, 515 N State St, Chicago, IL 60610. Telephone: 312-464-5228. E-mail: margaret.gadon@ama-assn.org.

Back to top

References

  1. Medical Professionalism Project. Medical professionalism in the new millennium: a physician charter. Ann Intern Med 2002;136(3):243-6.
  2. Stevens RA. Public roles for the medical profession in the United States: beyond theories of decline and fall. Millbank Q 2001;79(3):327-53, III.
  3. Geraghty KE, Wynia MK. Advocacy and community: the social roles of physicians in the last 1000 years. Part I. MedGenMed 2000;2(4):E29.
  4. Geraghty KE, Wynia MK. Advocacy and community: the social roles of physicians in the last 1000 years. Part II. MedGenMed 2000 Nov 6;:E28.
  5. Geraghty KE, Wynia MK. Advocacy and community: the social roles of physicians in the last 1000 years. Part III. MedGenMed 2000 Nov 13;:E27.
  6. Rothman DJ. Medical professionalism--focusing on the real issues. N Engl J Med 2000;342(17):1284-6.
  7. Gruen RL, Pearson SD, Brennan TA. Physician–citizens — public roles and professional obligations. JAMA 2004;291(1):94-8.
  8. Kattapong VJ, Locher TL, Secker-Walker RH, Bell TA. Tobacco-cessation patient counseling: American College of Preventive Medicine practice policy statement. Am J Prev Med 1998;15(2):160-2.
  9. Navarro AM, Voetsch K, Liburd LC, Giles HW, Collins J. Charting the future of community health promotion: recommendations from the National Expert Panel on Community Health Promotion. Prev Chronic Dis [serial online] 2007 Jul.

Back to top

*URLs for nonfederal organizations are provided solely as a service to our users. URLs do not constitute an endorsement of any organization by CDC or the federal government, and none should be inferred. CDC is not responsible for the content of Web pages found at these URLs.

 




 



The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.


 Home 

Privacy Policy | Accessibility

CDC Home | Search | Health Topics A-Z

This page last reviewed March 22, 2013

Centers for Disease Control and Prevention
National Center for Chronic Disease Prevention and Health Promotion
 HHS logoUnited States Department of
Health and Human Services