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Trends and challenges in preventive medicine in European Union countries. Comment on the state in Croatia.

Throughout history, major contributions to population health have come from the initiatives of public health and community-based activities, such as improvements in food supplies and nutrition, sanitary and general living conditions, vaccinations and smoking cessation campaigns. However, the importance of these public measures has not always been corectly verified by the medical establishment, traditionally focused on curing ill individuals. Public health care services have been considered as being too close to social measures and politics and lacking in experimental, scientific methods. In contrast, clinical medicine has been established early on as a branch of science, being oriented towards both, searching for pathogenetic causes of diseases and the scientifically-based treatment (1). Public health has become more scientifically based during the later part of the 19th and the first part of the 20th century, due to the efforts of Robert Koch and Louis Paster. During that time, huge advances in understanding the nature of infectious diseases and their ways of spreading and prevention have been achieved. Dramatic success in the eradication of many dangerous infectious diseases through vaccination and the definition of microbial agents as biological causes of infectious diseases has initiated the strong biological orientation in epidemiology and other public health settings (2, 3). This has led to the development of experimental research methodologies with focus placed on statistical issues. Many characteristics of modern epidemiology and other public health settings, viewed as a part of science, have their roots in this »golden era«. Analysts agree that these characteristics can be described as an expansion of statistical methods for the measurement of the occurence of diseases in the population. However, by using conventional methods of analysis, diseases are excluded from their natural social and historical context (1). Nevertheless, this was the time of the industrial revolution in western countries which uncovered the importance of socioeconomic factors as implicated in disease onset and the distribution pattern. Ideas on social medicine and public health in historical terms appear in two directions. The first one is conviction that social, environmental and economic condition influence health. The second one is that for the solution of health problems, for improvement of health, prevention and control of diseases collective actions are needed. For those collective actions, the main responsibility should take public authorities. Public health as defined by CEA Winslow in 1920 started in 19th century (4). Since that time the modern ideas of public health began to be implemented in everyday practice in countries of South Eastern European Region (SEE) which were under different influence, either from the West or East. Slovenia, Croatia and Bosnia and Herzegovina were mostly linked to Western Europe, and Serbia and Montenegro, Bulgaria, Macedonia, Romania, and Moldova were mostly linked to Russia and Soviet Union. That fact had, and even now has, the consequences for the development of public health, organization of health services and health care in this region (5). The most prominent public health person in the SEE region in the second part of the 19th century and beginning of the 20th century was Milan Jovanovi};-Batut (1847–1940) born in Srijemska Mitrovica, Vojvodina (Serbia). He was the public health educator, writer, teacher and health reformer. His work has great impact on the development of public health in the region. His student and successor was Andrija [tampar (1888-1958), born in the village Drenovac (Croatia), on the border of the then Austro-Hungarian Monarchy. Very early in his life he was exposed to poverty, inequality and injustice of life of rural people. Among other scientists who influenced [tampar by their outlook, special attention should be made of the biologist Ernst Haeckel and Alfred Grotjahn. Social influences to health [tampar experienced and undertaken interventions very intense in countries of former Yugoslavia and China during 30-ties of the last century (5).

preventive medicine ; the past ; the present ; the future ; European Union ; Croatia

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