another or to work across disciplinary boundaries. “They have a job to do,” he said, and “they need to pool whatever skills and talents they have to accomplish their goal. They must work across disciplinary boundaries and at many levels.

“We in the health field have a difficult time behaving in a similar way,” Dr. Syme observed. Influenced by the traditions of academia, professionals are organized by discipline, and they tend to stick to their own kind. “There is not as much interdisciplinary interaction as might be expected or hoped for,” he said, “and our students of course note this and eventually emulate it in their own lives.”

The way we fund research and training programs perpetuates, even encourages, this tradition, Dr. Syme said. “We will not, in my view, begin to deal with this problem until we are able to offer financial incentives to the university to bridge disciplinary perspectives.”

But there are already some steps in the right direction, he noted. The counterpart of National Institutes of Health (NIH) in Canada, called the National Institutes of Health Research, not only “contains institutes on heart disease and cancer and arthritis but has also established new institutes that cross disease lines, such as the Institute of Population Health, Institute on Gender, and Institute of Aboriginal Health. . . . And the funding for these institutes is, importantly, determined by the degree to which each institute collaborates with the other institutes.”

In a similar spirit, “the Robert Wood Johnson Foundation is currently soliciting proposals from universities to train a generation of population health scholars,” Dr. Syme noted. “The emphasis in this program would be on the degree to which universities can develop truly interdisciplinary programs directed toward community health issues.”

He acknowledged as well the MacArthur Foundation Network groups and referred to “other beginning initiatives, at both government and foundation levels, that think in terms of community and environmental prevention programs. But all of these efforts are at the very early stages, and funding is still quite limited.”

Dr. Syme reminded his audience that “as the population of the United States continues to grow, and to age, the burden of providing appropriate medical care will grow exponentially.” Given that our medical care system is already strained, unless we “take more seriously the issue of prevention, and especially community-based prevention programs, . . . it is fair to say we ain’t seen nuthin’ yet.”

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