Fortnightly Review: Tropical medicine for the 21st century

Abstract

The specialty of tropical medicine originated from the needs of the colonial era and is removed from many of the health care requirements of tropical countries today. Tropical medicine concentrates on parasitic diseases of warm climates, although other infections and diseases related to poverty rather than climate dominate medicine in developing countries challenged by population pressure, civil strife, and migration. In the new century, tropical medicine would best be absorbed into the specialty of infectious diseases, which should incorporate parasitic diseases, travel medicine, and sexually transmitted diseases. Pressing questions for health care and research in developing countries concern the provision of appropriate services for problems such as HIV/AIDS, tuberculosis, sexually transmitted diseases, and injuries. The question of how to provide appropriate clinical care in resource poor settings for the major causes of morbidity and premature mortality has been neglected by donors, academic institutions, and traditional tropical medicine. Tropical medicine arose from the needs of the colonial era, when infectious diseases such as typhoid were common in all countries, but diseases associated with tropical climates posed special problems for the European colonists. Today, our northern perspective of tropical medicine remains dominated by unfamiliar parasitic and other exotic diseases.1 In reality, however, medicine in the tropics now concerns the health problems--mainly infectious diseases--of societies that are poor and also have warm climates. Nonclinical tropical medicine, sometimes referred to as international health, most often falls within the disciplines of public health and epidemiology. The specialties in northern industrialised countries most closely allied to tropical medicine are infectious diseases and (especially because of its role in HIV and AIDS care) genitourinary medicine. In the United Kingdom, the specialty of infectious diseases has been little developed, but genitourinary medicine is strong. In other European countries genitourinary medicine does not exist as a distinct entity …