Hope of prevention training in South Asia

Editor—The theme issue on Health in South Asia in April addressed problems and hopes for health but neglected prevention. South Asia has a quarter of the world's population. The optimal means to improve health is public health, which means that new public health workers need to be recruited and educated. The global 25 year increase in life expectancy is almost all due to prevention, not clinical medicine. In South Asia, Sri Lanka shows the importance of public health and prevention with impressive achievements at low cost.1

In South Asia the epidemiological transition has resulted in a twin disease burden. Cardiovascular disease is a potent cause of death, with only 0.1% of $2.9 billion being allocated to it in 2003.2

The neglect is apparent in training: around 200 medical schools produce 7000 graduates annually but there are only 23 public health centres and no schools of public health in South Asia (www.sasnet.lu.se/university.html). Clinicians outnumber preventionists by 10-20 times. Public health has been neglected. Some of the resources targeted at clinical training should be re-allocated to public health.

Public health is considered to be a second rate profession, which results in most resources being allocated to clinical medicine. To change this inexpensively, public health education in medical students can be improved by using an internet based supercourse (www.pitt.edu/∼super1). It can enrich medical curriculums with over 1800 PowerPoint prevention lectures. A mission of the 15 500 faculty (900 from South Asia) is to connect people working in prevention worldwide and provide better teaching material.3 4 A proposed model of a school of public health in Pakistan on the website can be used as a template (www.pitt.edu/∼super1/lecture/lec11921/index.htm).

Brick and mortar schools such as Harvard are needed for high end training. World class schools can be built in developing countries for a fraction of the cost of a hospital or medical school.5 Such schools should be accredited to become world class.

The costs would be small, but the impact on health, immense.