Advancing the science of understanding and improving the health of the population.

In this special issue of the Wisconsin Medical Journal, we celebrate 50 years of the Department of Population Health Sciences at the University of Wisconsin School of Medicine and Public Health (SMPH). This anniversary could not come at a more momentous time in the context of the transformation of the former UW Medical School into an integrated school of medicine and public health. In several past issues of the Journal, Robert Golden, MD, Dean of the SMPH, has described how fundamental and extensive this innovative transformation truly is for the school.1 This 50th anniversary also occurs alongside important and evolving worldwide shifts in public health and health care policy. Today, for example, the United States is confronting the challenge of a major overhaul of its health care system; obesity and type 2 diabetes are becoming global pandemics, occurring even in countries where people suffer from malnutrition; and as was all too clear this past spring, when almost no country proved immune to swine flu, emerging infections do not respect national boundaries. The international aspects of health and disease are becoming much more mainstream in the public discussion and decision-making. As reflected in the accompanying overview article,2 much has happened within the department and its parent institution in these past 5 decades. Founded in 1959 as the Department of Preventive Medicine, the department has evolved over the years to include significant academic programs in epidemiology, health services research, and health policy. This evolution culminated in 2001 with the department’s name change to the Department of Population Health Sciences. Some have asked, “What was the problem with the previous name?” Of course, there is nothing wrong with preventive medicine. Quite the contrary. We recognize that preventive medicine is a key— albeit often neglected—aspect of health care and a paramount goal for public health. But the term did not accurately reflect the true scope of the faculty’s research and educational activities. Preventive medicine usually refers to activities of health care professionals aimed at preventing diseases—or disease consequences—in individuals. Even if the department’s research and educational activities often have a preventive flavor, our work is not restricted to prevention and certainly is not limited to clinical preventive approaches in individual patients. Let’s look at the example of the patient who arrives in an emergency department with a heart attack. The medical model will put a cardiologist, a nurse intensivist, and other health care professionals in charge of that person’s care to try to keep the patient alive and well. To improve the patient’s chances of avoiding another heart attack, secondary prevention strategies such as lipid lowering therapy and an exercise program might be initiated. Ideally, however, primary prevention activities would have been implemented in order to keep that heart attack from occurring in the first place. That would be the job of preventive cardiologists, family physicians, and nurse practitioners advising individuals in their clinics to improve their diets and quit smoking to improve their cardiovascular fitness. But research and experience show that the reach and effectiveness of these clinical approaches to prevention is sometimes limited. They do not cover the uninsured, the less educated, or the less motivated individuals in our society; and even those who receive this care might have a hard time following through with the recommended lifestyle changes. Quitting smoking might be nearly impossible for a nicotine-addicted individual who does not live or work in a smokefree environment; a healthy diet might not be affordable for individuals of limited economic means or who live in areas with low-quality grocery stores; and increasing physical activity will be harder for Doctor Nieto is Chair of the Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health.