News Report / Profile
Interview with Professor José Pereira Miguel - Director of the Institute of Preventive Medicine
The Editorial team of the Faculty of Medicine of the University of Lisbon interviewed the Director of the Institute of Preventive Medicine, Professor José Pereira Miguel, who told us about this Institute and all those working there, and about the work currently underway and plans for the future.
" For my part, I see professional life as a relay race: we run our leg to the best of our ability, we pass on the baton in good condition, and the race moves on ... hopefully, with brilliance and success" J.P.M.
Newsletter: Dear Professor Pereira Miguel, the Newsletter has been disclosing the Faculty to its readers so that they can know more about it. Accordingly, we would like you to tell us about the origins of the Institute of Preventive Medicine, its founding year, directors, main events, and historic landmarks that you see fit to highlight.
Professor Pereira Miguel: The history of our teaching dates back to the late nineteenth century and to a subject of the Medical-Surgical School of Lisbon called Forensic Medicine and Hygiene. Hygiene was linked to Forensic Medicine, as it was felt that many aspects of public health were under the scope of health legislation. At that time, Ricardo Jorge took refuge in Lisbon. He was persecuted and mistreated in Porto as a result of action he had taken to fight off an outbreak of bubonic plague. He was already a major figure in the field of public health. Accordingly, the School offered him the Hygiene Chair, by splitting the former subject into two.
The situation remained unchanged until the 1911 Reform, whose centenary we are now celebrating. This reform, alongside the creation of the Faculty of Medicine of Lisbon, set up a chair in Hygiene and a course in Epidemiology, also the responsibility of Professor Ricardo Jorge.
There were several education reforms throughout the twentieth century, and this curriculum area was successively named Hygiene and Epidemiology, Social Medicine and Hygiene, and later on, after the 25 April 1974 revolution, Community Medicine. However, Preventive Medicine is the latest official designation. As a result of this development, the Institute of Preventive Medicine (IMP) was created as structural unit of the Faculty of Medicine of Lisbon.
This diversity of names was, of course, the result of various scientific and political contexts. Nevertheless, it should be noted that what has characterized our field is the approach to health issues primarily from a population perspective and in terms of health promotion and disease prevention.
Going back to the IMP, it was initially directed by Professor Fernando da Costa Leal. He was succeeded by Professor Artur Torres Pereira, who, years earlier, had been the Professor of Hygiene and Social Medicine. Later, already as associate professor, I was entrusted the direction of the Institute.
Newsletter: How would you describe the evolution in terms of teaching?
Professor Pereira Miguel: Although each one of us had distinct scientific training and pedagogical approaches, there was considerable continuity in the academic work that was done, both in terms of core topics and values and principles transmitted. This was achieved despite the necessary adaptation to different curricular reforms. In this respect, the main innovation was the gradual presence of Preventive Medicine from year 1 to the last year of medical school, which, through compulsory or optional subjects, enabled the continued study of population health and prevention.
This is how new areas such as Epidemiology, Environmental and Occupational Health, General and Family Medicine and, ultimately, Public Health, emerged in recent years. A longitudinal teaching axis was gradually formed, trying to prepare future physicians for a practice in which prevention plays an increasingly important role.
Among the most significant developments, one was undoubtedly the introduction of General and Family Medicine as an academic discipline by Professor Artur Torres Pereira, about 20 years ago. This subject aims to give students a special preparation in terms of medical practice in the community, centred in individuals and their families, and taking into account the whole social context. This requires specific skills at the level of health promotion, prevention and treatment.
However, one can never emphasize enough the importance of all other subjects in the preparation of a physician. Epidemiology is an absolutely fundamental science to the practice of Preventive Medicine and Public Health, because it allows us to measure health/disease, identify risk factors and their causes, and evaluate interventions. We have always insisted both on the teaching of basic epidemiology and on its applications, particularly to clinical practice (Clinical Epidemiology). Public Health has been taught for two years based on its core functions, which all doctors should be familiar with, and for which the contribution of clinical epidemiology is essential.
Environmental and Occupational Health are also two very important areas of Preventive Medicine, increasingly on the agenda. For this reason, the general physical environment and working conditions see it as a major health determinant. Health Economics, which is increasingly important due to the need to manage resources that are always scarce, has also been taught as an optional area. In future, we hope to extend these training opportunities to nutrition and international health (better known today as "global health").
I made a point of referring first to our contribution to the bachelor degree in medicine, currently an Integrated Master Degree. However, the work done in other FMUL bachelor degrees cannot be forgotten, such as Nutrition, Microbiology, and Health Sciences. We have guaranteed, or still guarantee, curriculum areas in all those degrees, in the fields I have mentioned earlier.
Newsletter: You have told us about undergraduate education only. In terms of postgraduate studies, what do you highlight in the work of IMP?
Professor Pereira Miguel: Over the years, we have carried out many specific activities, such as courses, seminars, lectures, etc., and invited national and international lecturers. However, the most systematic and sustained activities have been conducted in the Faculty’s various master degrees. The oldest were the masters in School Health and Health Management. Over the past years, our major effort has focused on the masters in Epidemiology (we are currently preparing the 5th edition) and Health Communication (now preparing the 3rd edition).
In the future, we would like to go further and develop an inter-faculty PhD in the field of Epidemiology/Preventive Medicine/Public Health. We have already started negotiations with our potential partners in other faculties, but the model is not yet fully established. We would also like to carry out more postgraduate training activities in the various scientific fields mentioned above, which are the ones we know more about.
Newsletter: Are there other fields of activity of IMP that you would like to mention?
Professor Pereira Miguel: In the context of teaching, I must refer to our participation in several other disciplines that request our cooperation. Without being exhaustive, I can mention History of Medicine, Ethics, Introduction to Medicine, Integrated Master in Medicine, and also several other modules and master courses.
In addition to teaching and as part of our mission, we also conduct research and provide services to the community. Of course, the resources we have at our disposal to do research are perhaps fewer than those to teach. In any case, over the years we still managed to set up a research unit recognized by the Foundation for Science and Technology. We have a few research strands, contracted researchers and scientific resources in the fields of Preventive Medicine and Public Health. The most relevant research areas are environmental epidemiological surveillance, occupational health, cardiovascular prevention, migrant health, nutrition, and issues related to health impact assessment, among others. The IMP has received several doctoral students, MA students and medical students who do their research with us.
With regard to providing services to the community, although we have developed several activities over the years, the most significant contribution has been the epidemiological surveillance of municipal waste stations (in São João da Talha/Lisbon and in Meia Serra/Madeira). We have been monitoring the populations exposed to the emissions of these industrial structures for several years, in order to identify possible effects on their health at an early stage.
It is perhaps worth adding that all these activities are supported by small units set up in the IMP with several members of staff, and I cannot fail to point out the major contribution of many independent lecturers and research students.
Finally it is equally important to mention our Documentation Centre. We are proud to have gathered a considerable bibliographic collection over the years, dedicated to the topics we nurture and which is fully computerized and accessible to all with an interest in those topics.
Newsletter: Has the management of an Institute with these characteristics been easy or problematic? Have there been conditioning factors worth talking about?
Professor Pereira Miguel: Well, this question could lead to a long conversation. Any structural unit of the Faculty is influenced by the way the latter is managed and by available resources. All this occurs in the context of a particular organization of Public Administration, which does not always make it easy for us...
I personally believe that anything that encourages greater participation in decision-making, greater rigour, transparency and dialogue, and more resources for teaching and research are potential factors for success. In the past, among other difficulties, we had no proper facilities. Nowadays, we are in the Egas Moniz Building, so we cannot complain.
The Association for Research and Development of the Faculty of Medicine (AIDFM) has been a very important facilitating factor over the years, for which reason it is only fair to speak highly of it.
However, the most important factor has been "people". Lecturers, assistants, independent lecturers, researchers, and administrative staff have all contributed significantly to the fulfilment of IMP’s mission
Newsletter: You have already mentioned some possible future developments of IMP. Are there any others that should be referred to, especially in the context of the Lisbon Academic Medical Centre and the institutions that comprise it?
Professor Pereira Miguel: We see all these collaborations as highly desirable, for which reason we have made several suggestions and attempts over the years. The latest, which was enshrined in the actual statutes of CAML, is the possibility that it will have units of primary health care. Should this happen, this would be a huge step forward for an ever more adequate preparation of physicians, and for the advancement of General and Family Medicine in the Faculty.
Another very important aspect is collaboration abroad. In our scientific areas, and in addition to cooperation with similar institutions and entities with converging objectives, the practice of various roles in the health system and internationalization is indispensable. Many employees of IMP have held prominent positions, both at home and internationally. This has been very important for our teaching and research. It has ensured constant updating and the integration of the most important topics in our academic activity. We also received interns, especially from Portuguese-speaking countries.
We always dream about a more robust, more competent and intervening IMP. Competition with other scientific fields, both basic and clinical fields, has always been ubiquitous, and it will always be. It is critical for survival, but also for scientific progress. If we believe there is a place for Preventive Medicine and Public Health in the Faculties of Medicine, the obligation to fight for excellence falls very much upon all of us. For my part, I see professional life as a relay race: we run our leg to the best of our ability, we pass on the baton in good condition, and the race moves on ... hopefully, with brilliance and success
" For my part, I see professional life as a relay race: we run our leg to the best of our ability, we pass on the baton in good condition, and the race moves on ... hopefully, with brilliance and success" J.P.M.
Newsletter: Dear Professor Pereira Miguel, the Newsletter has been disclosing the Faculty to its readers so that they can know more about it. Accordingly, we would like you to tell us about the origins of the Institute of Preventive Medicine, its founding year, directors, main events, and historic landmarks that you see fit to highlight.
Professor Pereira Miguel: The history of our teaching dates back to the late nineteenth century and to a subject of the Medical-Surgical School of Lisbon called Forensic Medicine and Hygiene. Hygiene was linked to Forensic Medicine, as it was felt that many aspects of public health were under the scope of health legislation. At that time, Ricardo Jorge took refuge in Lisbon. He was persecuted and mistreated in Porto as a result of action he had taken to fight off an outbreak of bubonic plague. He was already a major figure in the field of public health. Accordingly, the School offered him the Hygiene Chair, by splitting the former subject into two.
The situation remained unchanged until the 1911 Reform, whose centenary we are now celebrating. This reform, alongside the creation of the Faculty of Medicine of Lisbon, set up a chair in Hygiene and a course in Epidemiology, also the responsibility of Professor Ricardo Jorge.
There were several education reforms throughout the twentieth century, and this curriculum area was successively named Hygiene and Epidemiology, Social Medicine and Hygiene, and later on, after the 25 April 1974 revolution, Community Medicine. However, Preventive Medicine is the latest official designation. As a result of this development, the Institute of Preventive Medicine (IMP) was created as structural unit of the Faculty of Medicine of Lisbon.
This diversity of names was, of course, the result of various scientific and political contexts. Nevertheless, it should be noted that what has characterized our field is the approach to health issues primarily from a population perspective and in terms of health promotion and disease prevention.
Going back to the IMP, it was initially directed by Professor Fernando da Costa Leal. He was succeeded by Professor Artur Torres Pereira, who, years earlier, had been the Professor of Hygiene and Social Medicine. Later, already as associate professor, I was entrusted the direction of the Institute.
Newsletter: How would you describe the evolution in terms of teaching?
Professor Pereira Miguel: Although each one of us had distinct scientific training and pedagogical approaches, there was considerable continuity in the academic work that was done, both in terms of core topics and values and principles transmitted. This was achieved despite the necessary adaptation to different curricular reforms. In this respect, the main innovation was the gradual presence of Preventive Medicine from year 1 to the last year of medical school, which, through compulsory or optional subjects, enabled the continued study of population health and prevention.
This is how new areas such as Epidemiology, Environmental and Occupational Health, General and Family Medicine and, ultimately, Public Health, emerged in recent years. A longitudinal teaching axis was gradually formed, trying to prepare future physicians for a practice in which prevention plays an increasingly important role.
Among the most significant developments, one was undoubtedly the introduction of General and Family Medicine as an academic discipline by Professor Artur Torres Pereira, about 20 years ago. This subject aims to give students a special preparation in terms of medical practice in the community, centred in individuals and their families, and taking into account the whole social context. This requires specific skills at the level of health promotion, prevention and treatment.
However, one can never emphasize enough the importance of all other subjects in the preparation of a physician. Epidemiology is an absolutely fundamental science to the practice of Preventive Medicine and Public Health, because it allows us to measure health/disease, identify risk factors and their causes, and evaluate interventions. We have always insisted both on the teaching of basic epidemiology and on its applications, particularly to clinical practice (Clinical Epidemiology). Public Health has been taught for two years based on its core functions, which all doctors should be familiar with, and for which the contribution of clinical epidemiology is essential.
Environmental and Occupational Health are also two very important areas of Preventive Medicine, increasingly on the agenda. For this reason, the general physical environment and working conditions see it as a major health determinant. Health Economics, which is increasingly important due to the need to manage resources that are always scarce, has also been taught as an optional area. In future, we hope to extend these training opportunities to nutrition and international health (better known today as "global health").
I made a point of referring first to our contribution to the bachelor degree in medicine, currently an Integrated Master Degree. However, the work done in other FMUL bachelor degrees cannot be forgotten, such as Nutrition, Microbiology, and Health Sciences. We have guaranteed, or still guarantee, curriculum areas in all those degrees, in the fields I have mentioned earlier.
Newsletter: You have told us about undergraduate education only. In terms of postgraduate studies, what do you highlight in the work of IMP?
Professor Pereira Miguel: Over the years, we have carried out many specific activities, such as courses, seminars, lectures, etc., and invited national and international lecturers. However, the most systematic and sustained activities have been conducted in the Faculty’s various master degrees. The oldest were the masters in School Health and Health Management. Over the past years, our major effort has focused on the masters in Epidemiology (we are currently preparing the 5th edition) and Health Communication (now preparing the 3rd edition).
In the future, we would like to go further and develop an inter-faculty PhD in the field of Epidemiology/Preventive Medicine/Public Health. We have already started negotiations with our potential partners in other faculties, but the model is not yet fully established. We would also like to carry out more postgraduate training activities in the various scientific fields mentioned above, which are the ones we know more about.
Newsletter: Are there other fields of activity of IMP that you would like to mention?
Professor Pereira Miguel: In the context of teaching, I must refer to our participation in several other disciplines that request our cooperation. Without being exhaustive, I can mention History of Medicine, Ethics, Introduction to Medicine, Integrated Master in Medicine, and also several other modules and master courses.
In addition to teaching and as part of our mission, we also conduct research and provide services to the community. Of course, the resources we have at our disposal to do research are perhaps fewer than those to teach. In any case, over the years we still managed to set up a research unit recognized by the Foundation for Science and Technology. We have a few research strands, contracted researchers and scientific resources in the fields of Preventive Medicine and Public Health. The most relevant research areas are environmental epidemiological surveillance, occupational health, cardiovascular prevention, migrant health, nutrition, and issues related to health impact assessment, among others. The IMP has received several doctoral students, MA students and medical students who do their research with us.
With regard to providing services to the community, although we have developed several activities over the years, the most significant contribution has been the epidemiological surveillance of municipal waste stations (in São João da Talha/Lisbon and in Meia Serra/Madeira). We have been monitoring the populations exposed to the emissions of these industrial structures for several years, in order to identify possible effects on their health at an early stage.
It is perhaps worth adding that all these activities are supported by small units set up in the IMP with several members of staff, and I cannot fail to point out the major contribution of many independent lecturers and research students.
Finally it is equally important to mention our Documentation Centre. We are proud to have gathered a considerable bibliographic collection over the years, dedicated to the topics we nurture and which is fully computerized and accessible to all with an interest in those topics.
Newsletter: Has the management of an Institute with these characteristics been easy or problematic? Have there been conditioning factors worth talking about?
Professor Pereira Miguel: Well, this question could lead to a long conversation. Any structural unit of the Faculty is influenced by the way the latter is managed and by available resources. All this occurs in the context of a particular organization of Public Administration, which does not always make it easy for us...
I personally believe that anything that encourages greater participation in decision-making, greater rigour, transparency and dialogue, and more resources for teaching and research are potential factors for success. In the past, among other difficulties, we had no proper facilities. Nowadays, we are in the Egas Moniz Building, so we cannot complain.
The Association for Research and Development of the Faculty of Medicine (AIDFM) has been a very important facilitating factor over the years, for which reason it is only fair to speak highly of it.
However, the most important factor has been "people". Lecturers, assistants, independent lecturers, researchers, and administrative staff have all contributed significantly to the fulfilment of IMP’s mission
Newsletter: You have already mentioned some possible future developments of IMP. Are there any others that should be referred to, especially in the context of the Lisbon Academic Medical Centre and the institutions that comprise it?
Professor Pereira Miguel: We see all these collaborations as highly desirable, for which reason we have made several suggestions and attempts over the years. The latest, which was enshrined in the actual statutes of CAML, is the possibility that it will have units of primary health care. Should this happen, this would be a huge step forward for an ever more adequate preparation of physicians, and for the advancement of General and Family Medicine in the Faculty.
Another very important aspect is collaboration abroad. In our scientific areas, and in addition to cooperation with similar institutions and entities with converging objectives, the practice of various roles in the health system and internationalization is indispensable. Many employees of IMP have held prominent positions, both at home and internationally. This has been very important for our teaching and research. It has ensured constant updating and the integration of the most important topics in our academic activity. We also received interns, especially from Portuguese-speaking countries.
We always dream about a more robust, more competent and intervening IMP. Competition with other scientific fields, both basic and clinical fields, has always been ubiquitous, and it will always be. It is critical for survival, but also for scientific progress. If we believe there is a place for Preventive Medicine and Public Health in the Faculties of Medicine, the obligation to fight for excellence falls very much upon all of us. For my part, I see professional life as a relay race: we run our leg to the best of our ability, we pass on the baton in good condition, and the race moves on ... hopefully, with brilliance and success