Dear Editor, Thank you for publishing the timely article Medical educationand training: responding to community needs' by Rabbani et al. [1]. The article examined the experienceof developing a medical curriculum that addresses the health needs of the community at large. It wasfound that mode of training depended in the overall objectives of the programs, the clients and the setting.A conclusion was that training must focus on the communities at the grass root level or community basedorganizations. A problem related to this important issue is that there exists a discrepancy between thegoals of society and the individual. It could be argued that the discrepancy is related to among otherthings different time preferences for the individual and the society [2]. The study of time preferencesis central in understanding health education and subsequent outcomes. The principle of discounting hasbeen applied within economics and recently also within health. Discounting is based on a time preferencewhich assumes that individuals prefer to forego a part of the benefits if they accrue now, rather thanfully in the uncertain future [3]. Individual's with a high positive discount rate value the presentmore and are more willing to engage in activities damaging to health without thinking of future healthstate, whereas those individuals with negative discount rates value the present health state less, andare willing to incur short-term costs to accrue future benefits. In societal health models future healthcosts and benefits are generally devalued at a rate of approximately 3-5% annually, whereas individualdiscount rates are much higher in the range of 50 to 100% [4]. The difficulty of improving future healthis well-known. Health programs have been initiated by society with the goal that these education andtraining projects would give changes in health-related behaviors. However, subsequent evaluations havefound [5,6] that reported effects often are temporary. Therefore, it could be argued that the discrepancybetween goals for future health of the individuals and implicit public policy is not appropriate andnot in the public interest. The inherent conflict between individual and societal interests requiresthat behaviors are consistent enough with normative principles to justify them at the societal level.A possible solution to diminish the discrepancy between the individual and society has been suggestedusing various framing effects in health messages [7]. Framing health messages as large important losseswith long delays could induce lower discount rates. Similarly, presenting the message as a series ofoutcomes rather than one single outcome could lower discount rates. The strategy of using framing effectsmight increase the long-term impact of education and training reaching the goal of a good health bothat an individual and societal level. Sincerelly, Monica Ortendahl MD, PhD, Malma Backe 3 H, 756 47 Uppsala,Sweden, e-mail: [email protected] References: 1. Rabbani F, Shaikh BT, Mahmood Q et al: Medicaleducation and training: responding to community needs. Med Sci Monit, 2005; 11(10): SR21-SR25 2. GaniatsTG: Prevention, policy, and paradox: What is the value of future health? Am J Prev Med, 1997;13: 12-173. Chapman GB: Your money or your health: Time preferences and trading money for health. Med Decis Making,2001; 22: 410-16 4. Gyrd-Hansen D, Sogaard J: Discounting life-years: whither time preference? HealthEcon, 1998;7: 121-27 5. Glasgow R, Boles S, Lichtenstein E et al: Adoption, reach, and implementationof a novel smoking control program: analysis of a public utility-research organization partnership. NicotineTob Res, 2004; 6: 269-74 6. Dasinger LK, Shane PA, Martinovich Z: Assessing the effectiveness of community-basedsubstance abuse treatment for adolescents. J Psychoactive Drugs, 2004; 36: 27-33 7. Ortendahl M, FriesJF: Framing health messages based on anomalies in time preference. Med Sci Monit, 2005; 11(8): RA253-RA256.

Keywords: Community Health Services, Education, Medical, Health Services Needs and Demand