Researching and teaching Public Health The View from
Researching and teaching Public Health The View from Europe Professor Bettina Borisch, MD, MPH, FRCPath Institute of Global Health University of Geneva, Switzerland Executive Director, World Federation of Public Health Associations Borisch-CAPHIA-2017 1
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Views from Europe Views from Britain Borisch-CAPHIA-2017 3
“European” puzzle Borisch-CAPHIA-2017 4
Public Health traditions in Europe • Anglo-saxon: • • John Graunt 1662 John Snow 1854, William Beveridge 1942 Archibald Cochrane, 1972 • Continental: • • Karl Freiherr vom Stein, Karl-August von Hardenberg 1807 Ignaz Philipp Semmelweiss 1847 Rudolf Virchow 1848 Otto von Bismarck 1883 Borisch-CAPHIA-2017 5
Public Health Teaching and Learning in a Changing University Environment • Changes in Education • Changes in Public Health • Change does just happen • Ontological restlessness • Need to close the gap between what we want and what is • Ontological need to security, need for order Borisch-CAPHIA-2017 6
Changes in Education Technically boosted changes societal 1. 2. 3. 4. 5. 6. Borisch-CAPHIA-2017 big hierarchies Lifelong learning global is the scale changed the rules “correct answer” “smart failure” 7
Changes that affect Public Health • Today more people have access to a mobile phone than a toilet. • Today, people are living longer, with more access to education and health care, less chronic disease, and lower infant and maternal mortality. • Continued rapid growth in emerging markets will give rise to an unprecedented expansion of the global middle class • It will trigger an explosion in demand for housing, consumer durables, and cars Borisch-CAPHIA-2017 8
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ASPHER Association of Schools of Public Health in the European Region J. Müller-Nordhorn, Kasia Czabanowska Borisch-CAPHIA-2017 11
Founded in 1966 Represented in 41 countries 94 institutional full members ASPHER Main Goal: Strengthening the role of public health by improving the education and training of PH professionals for both practice and research. ASPHER Mission: to promote education, research and services in PH, in order to foster a creative and dynamic academic infrastructure for PH workforce development. Borisch-CAPHIA-2017 http: //2011. aspher. org/ 12
Searching for interfaces and synergies: … from Core PH Functions to Core Competences, Teaching Curricula and PH Performance EFFICIENT AND ACCOUNTABLE PERFORMANCE COMPETENCE BASED EDUCATION AND TRANING CORE PUBLIC HEALTH COMPETENCES CORE PUBLIC HEALTH FUNCTIONS (OPERATIONS) Borisch-CAPHIA-2017 13
Australia, 2000 Public Health Core Functions 1. Assess, analyse & communicate population health needs & community expectations 2. Prevent & control communicable & noncommunicable diseases & injuries through risk factor reduction, education, screening, immunisation & other interventions 3. Promote & support healthy lifestyles & behaviours through action with individuals, families, communities & wider society 4. Promote, develop & support healthy public policy, including legislation, regulation & fiscal measures 5. Plan, fund, manage & evaluate health gain & capacity building programmes designed to achieve measurable improvements in health status, & to strengthen skills, competencies, systems & infrastructure 6. Strengthen communities & build social capital through consultation, participation & empowerment 7. Promote, develop, support & initiate actions which ensure safe & healthy environments 8. Promote, develop & support healthy growth & development throughout all life stages 9. Promote, develop & support actions to improve the health status of Aboriginal & Torres Strait Islander people & other vulnerable groups Borisch-CAPHIA-2017 14
WFPHA Survey, 2012 Borisch-CAPHIA-2017 15
The application of essential public health functions – linking education and performance: An ASPHER survey ASPHER Working Group on Innovation and Good Practice in Public Health Education WG IGP Borisch-CAPHIA-2017 16
The survey was the core ASPHER consultation and is designed to serve the following purposes: • To build a comprehensive database for the Schools of Public Health in the European Region; • To enable ASPHER to contribute efficiently to the worldwide discussion on harmonising essential public health functions, core competencies, and performance standards; • To evaluate the competencies of public health professionals in order to guide their training and to identify required expertise for public health professionals in the 21 st century. Borisch-CAPHIA-2017 17
Mapping the survey population • • ASPHER Members – 82 Other SPHs in Europe Mo. Hs, and Mo. E EUPHA Members • Full members – 42 • Associate Institutional members – 13 • Associate International NGO members – 8 • Associate Individual members – 6 • EPHA Members • Full members – 10 • Associate members – 10 • IUPHE • Trustee members from Europe – 7 • IANPHI • Members from Europe – 27 Borisch-CAPHIA-2017 18
The general profile of European schools and departments of public health from 36 ASPHER member countries In Europe and even nationally, significant diversity can be observed with different degrees in public health and high variation of curricular content, duration of study, number of students (including international ones), and recognition with respect to national accreditation. The typical European School or Department of Public Health is relatively small, at least if compared to American institutions. The median number of FTEs is only 20 FTE-lecturers (excluding 4 implausibly high numbers). Therefore the need for cooperation with other faculties or institutes is high. More than 4/5 of the SDPHs contract lecturers from the outside of SDPHs; however, half of the lecturers also lecture elsewhere. Borisch-CAPHIA-2017 Time dynamics of the establishment of the European schools and departments of public health (SDPH) 19
Current and desired level of EPHOs performance as determined by employers in comparison to the estimate of the training output by SDPHs EPHO 1. Surveillance of diseases and assessment of the population’s health EPHO 2. Identification of priority health problems and health hazards in the community EPHO 10. Health-related research EPHO 9. Core communication for public health EPHO 3. Preparedness and planning for public health emergences EPHO 8. Core governance, financing and quality assurance for public health EPHO 4. Health protection operations (environmental, occupational, food safety and others) EPHO 7. Assuring a competent public health and personal health care workforce EPHO 5. Disease prevention EPHO 6. Health promotion Current Desired Borisch-CAPHIA-2017 The rays in the spider web indicate the ranks of the 5 point Likert Scale SPH's Output 20
ASPHER survey(2013): in summary • High agreement on the estimates of what kind and level of knowledge and skills the SDPHs provide to equip their graduates for their professional careers. • Epidemiology and management are the main topics • The determination of the desired performance by employers for most EPHOs (6/10) is almost congruent with the estimated output of SDPHs. • However, the current performance of employed public health professionals is considered to be lower than desired, leaving a gap between desired and current performance Borisch-CAPHIA-2017 21
An example: • Agency for Public Health Education Accreditation in the European Region Education Research Practice Borisch-CAPHIA-2017 http: //www. aphea. net www. aspher. org 22
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Future orientation of PH – challenges I • Industrialisation and technology impact on ecological sytems of future generations • Lack of future conditions for health, instead: immediate risk and short -term benefits • Evidence base is ill-suited; RCTs will not identify the result of complex interventions Borisch-CAPHIA-2017 24
Future orientation of PH – challenges II • Equity, human rights and political empowerment • Inter-generational equity • Trans-national, global aspects of health • Integrating the complexity and non-linearity of PH problems • New approaches based on understanding linkages, relationships and interactions Borisch-CAPHIA-2017 25
Future orientation of PH – opportunities/challenges • Define common priorities for collective action for the next 15 years (UN The World we Want/SDGs) • transportability or translatability of local health solutions into global contexts • tensions between cosmopolitan public-health policies and individual states’ political agendas • importance of environment and place-based approaches to global health governance • Political process: End of the autocraties and hierarchical patronage machines, populism • Societal process: worldwide conversation Borisch-CAPHIA-2017 26
Ways “out” • Systems science • System philosophy • Avoid the silo thinking • Integrate the regional members • get the global interconnectivity into the picture: “all in one boat” Borisch-CAPHIA-2017 27
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WFPHA recent “product” Borisch-CAPHIA-2017 29
Global Charter for the Public’s Health Borisch-CAPHIA-2017 30
Global Charter for the Public’s Health • Core Services: • Promotion, Prevention, Protection, (Partnership, Participation) • Enabler Functions: • Governance • Information, Education • Capacity, Leadership • Advocacy Borisch-CAPHIA-2017 31
ASPHER (K Czabanowska) and WFPHA • Try to collaborate around the COP 2017 , started by WHO EU in Copenhagen: • Integrate the Global Charter for the Public’s Health into curricula of SPH • Already present: leadership programs • Advocacy courses to follow • …. governance and the political determinants. . Borisch-CAPHIA-2017 32
Mark Twain • College is a place where a professor’s lecture notes go straight to the students’ lecture notes, without passing through the brains of either. Borisch-CAPHIA-2017 33
Thank you for your attention Borisch-CAPHIA-2017 Rope of solidarity – Zermatt - 2011 34
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