Academic medicine: time for reinvention

Editor—Bhutta's editorial highlights well the poor state of health systems and public health, and subsequent poor population health, in developing countries.¹ The opportunity offered by BMJ's campaign to revive academic medicine,² or more inclusively academic health care, needs to be captured, debated, and built on, particularly in developing countries, where this problem is greatest.

The key to taking this debate further would be to bring to public health sciences in developing countries the rigour and respect that is necessary to improve health systems and the health of populations. In India, for example, substantial talent is increasingly being tapped internationally, and systems have not been developed there to optimally use this talent for long term societal development. Thus India has brilliant basic scientists and clinicians but a poorly developed public health research and teaching system that lacks originality and substance and prevents fundamental improvements in population health. Currently, no coherent agenda exists for original and relevant research in the core disciplines of public health or in major visible public health problems.^3-5 Without substantial original research, teaching in public health is not surprisingly bland and theoretical.

Without a cultural shift the development of research and teaching in public health sciences in India and many other developing countries will continue to fall far short of the requirement to improve population health. However, this shift will not come through hope alone or romanticising such ideas. The improvement in public health sciences will come about only if these sciences and their application earn respect through providing the substance that they are capable of.