Rethinking the Role of Medicine

Stephen R Leeder

The Menzies Centre for Health Policy

The University of Sydney

The Gadugil people of the Eora nation

The Medical Foundation – 50 years

…an early desire to do Medicine

Insulin

“Sorry, no By-Pass” – RNSH 1970

The Genome

Neuroscience

Nanotechnology

Stem Cells

Organ Regeneration

Not this Possibly this

…leagues under the sea

PUBLIC HEALTH

MEDICINE

DOCTORING

Doctoring

The foundational ethic: to relieve suffering and to save life (Faunce)

Lots of professionals can do bits of doctoring The workforce crisis: it’s time to sort out who

does what bits of doctoring (Gorman).

PUBLIC HEALTH

MEDICINE

DOCTORING

Medicine

Hi-tech enterprise, market-driven Most advances depend on people other than

medical doctors Expensive.

PUBLIC HEALTH

MEDICINE

DOCTORING

Public Health and Prevention

Two courses of action – addressing individuals or addressing the population

The features of population-based approaches “What is the cause of lung cancer in a population

where everyone smokes?” Individual versus population-based susceptibility Both hi-risk individual and population-based

approaches are needed to achieve health gain.

The Future

The rise and rise of hi-tech medicine The question of equity The gains, and losses of exponential growth

in productivity.

Edward Jenner and Smallpox

Alma Ata – Health for All

The Eight Millennium Development Goals

The Challenge

Accepting the great advances in medicine Defining who will do what doctoring Developing an understanding of public health Recruiting beyond government – from academia,

business and civil society Seeking a public health ethic Identifying lots of heroes!