working with other public health professionals to address population issues such as health promotion and disease prevention, chronic and infectious diseases, safe food and water supplies, sanitation, and environmental exposures. Second, the committee envisions a future in which sufficient numbers of well-trained public health physicians are available to provide the scientific and clinical input along with the leadership and management necessary for linking and coordinating the efforts of the many participants of a strong public health system, as described in The Future of the Public’s Health (IOM, 2003). Third, in the face of public health emergencies, the committee envisions a future in which there will be sufficient numbers of professionals trained in public health, including physicians, to plan for and prevent these emergencies and to respond to them. Such emergencies would include disasters such as hurricanes, bioterrorism, and emerging or reemerging infections such as pandemic influenza or mumps.

This report explores the many pathways by which physicians may enter careers in public health. The committee also identified three levels of physician involvement with public health: all physicians, physicians with limited roles in public health, and physicians with careers in public health. For each of these levels the report describes the knowledge and the skills that these physicians need for effective public health action. The report also describes various approaches to preparing physicians for careers in public health, including preventive medicine programs, schools and programs of public health, the Epidemic Intelligence Service program, certificate programs, distance learning, leadership networks, and continuing education programs.

The public health system envisioned in the 2003 IOM report The Future of the Public’s Health includes governmental public health agencies at the core working with the health care delivery system, public health and health sciences academia, communities, businesses and employers, and the media. According to that report, governmental public health agencies form the backbone of the public health system and the actions that it takes. Without sufficient numbers of well-trained physicians in this backbone, the entire public health system is weakened.

Estimates of the current number of public health physicians range from 1,400 (American Medical Association) to 22,000 (Bureau of Labor Statistics); however, the methods used to derive all estimates have major flaws, including the lack of a consistent definition of a public health physician. Both because of the difficulty of estimating the broader number of public health physicians and because of the importance and centrality of the backbone to ensuring the public’s health, the central focus of this report is physicians in governmental agencies. The committee’s opinion, based on the calculations described in Chapter 2, is that as many as 10,000



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