Tervishoiut

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Competencies Required of Public Health
Professionals and Leaders Presentation at
OHI/Braun SPH Summer School, Moscow July 2004
TH Tulchinsky MD MPH, Braun School of Public
Health, Jerusalem
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Is There a Population Health Problem in Russia?
All Cause Mortality Rates
990102 SDR all causes, all ages, per 100000
Russian Federation
EU(15-prior 1.05.2004) average
CSEC(15) average
CIS(12) average
Nordic(5) average
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Is There a Population Societal Problem in Russia?
Human Development Index
998008 UNDP Human Development Index (HDI)
0.95
0.9
Israel
Poland
0.85
Russian Federation
United Kingdom
0.8
0.75
1970
1980
1990
2000
2010
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Role of PH Professional

• To understand and report on the scale of the
  health situation and to raise public and
  political awareness
• To interpret patterns of health and morbidity e.g
  smoking, alcohol, social dislocation
• To advise on what should be done, drawing on best
  available evidence of effectiveness of
  interventions from different settings e.g. folic
  acid, community vs. hospital care
• To monitor the impact of new policies, adapting
  them for changing circumstances

McKee M. Foreword. Proceedings Conference on
Developing New SPHs. Public Health Reviews,
200230.
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Competencies Needed by Public Health Leaders

• Analyze health of population and risk groups
• Define priorities
• Develop planning to address the problems
• Make the case for action
• Mobilize resources needed
• Supervise implementation
• Monitor and report results
• Modify and sustain
• Study and publish reports

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Interest and Capacity for Analysis, Research and
Advocacy

• Identification of problems amenable to prevention
  e.g. cervical cancer, birth defects (PKU, HDN,
  CH, NTDs, Downs and Rubella syndromes)
• Awareness/access to gold standards
• Critical analysis e.g. effectiveness of screening
  for breast cancer, osteoporosis, Ca prostate
• Make the issues known to decision makers, the
  media, the public e.g. food fortification
• Fight for change when lethargy and inertia
  dominate e.g. food fortification
• Resist the zombies i.e. old dead stories that
  keep coming back e.g. immunization and autism

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Understand Social Determinants of Disease and
Outcomes

• Lifestyle issues e.g. smoking, diet, exercise
• Societal issues e.g. unemployment, family income
• Complex mechanisms e.g. transition and self image
• Widening social and regional inequities
• Crucial roles of education, pensions, social
  policy, political economics, health policy
• Partnerships to deal with complexity
• Analysis and monitoring
• What can the health system do to alleviate the
  negative results of individual and societal
  states?

From Boback and Normand, Kiev conference, 2004
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Political and Societal Context

• Shift toward market economy
• Reduced job and societal security
• Administrative decentralization (vs decapitation)
• Undervaluing of health e.g. health expenditures
  as GDP under 3 in Russia vs. 7-9 in
  industrial countries
• Reduced role of the state
• Switch from Semashko to Bismarckian models
• Stress on individual responsibility
• Role of the hospital oriented health system vs.
  shift to community oriented system

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In the Culture of Public Health

• Ethical basis e.g pikuah nefesh
• Philosophical approach e.g. societal
  responsibility
• Traditions and history
• Evolving concepts e.g. from hygiene to NPH
• Problems solved e.g. water borne disease
• New challenges e.g HIV, chronic diseases,
  diabetes
• What works and what doesnt
• Medical and population approach models
• Formal training - a learned culture with specific
  competencies

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Key Roles of Schools of Public Health
Training and education
Research and Analysis
Service and Advocacy
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SPH and MPH Graduates Interactions
MPH Graduate
Schools of Public Health
Training/Education Science of Learning
experiences
Management Legislation
Professional Needs
Information Presentation
Research Technology development
Advocacy and Interventions
Analysis Prioritisation Strategy
Implement Provision of service Resource
allocation
Technical cooperation
Survival and Success
Direct community action
Source Varavikova EA. Proceedings of
International Conference
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Structure and Stakeholders for SPHs
University Academy Faculty
International Academic Partners
Funding Agencies
Other Local Academic Institutions
Ministry of Health
School of Public Health
Other health institutions
Other Ministries
Local governments
Faculty
NGOs
Students
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Objectives of SPHs

• Centers of excellence training, research,
  service
• International standards and participation
• Academic independence i.e. not a function of
  state
• Attractive to students and stakeholders
• Sustainability
• Culture of quality
• Acceptance by graduates and faculty
• Accountability and reward - not by hours but
  program and results
• Internal and external peer review

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Potential Contribution of Schools of Public
Health

• Train people (skills and competencies) to
• Analyze health system and PH problems
• Develop evidence-based policies
• Assist governments in re-alignment of health
  priorities
• Work with public and private sector
• Research and develop tools to deal with new
  issues, e.g. globalization, communications
  technology, internet
• Continuous professional and public education
• Develop policy, programs, models and actions
  driven by national and community needs (e.g.
  poverty and inequity reduction)
• Create a demand for professionalism in public
  health

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Clientele for Public Health Training and
Education

• Undergraduate training
• Public health students e.g. BSc in PH
• Medical and nursing students
• Students of social sciences, biology, law etc.
• Students of public health management and
  administration
• Postgraduate training
• MPH students
• Students of management and administration in PH
• Public health residents training, e.g.
  occupational health
• Research training -MSc and PhD training
• Professional continuing education

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Graduates Skills and Values

• Values /dedication/ethics
• Commitment
• Knowledge and positive attitude
• Ideology
• Flexibility
• Ability to take risk and make decisions
• Networking and team building
• Staying power

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Professional Continuing Education

• Short-term training courses in
• Public health management and financing
• Environmental health
• Health promotion and education
• Epidemiology and research methods
• Health economics
• Health ethics and law
• Strategic planning and health targets

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Role of Research in SPHs

• Set standards of evidence from past and current
  international experience
• Identify avoidable morbidity/mortality in
  individual and population health
• Identify individual and societal risk factors
• Explore ways to prevent disease and promote
  health
• Find the ways of improving primary prevention and
  delivery of health services (efficiency,
  effectiveness, evidence-based)
• Promote quality in management in health systems

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Research in SPHs

• Publications in local and international peer
  reviewed scientific journals
• Develop culture of peer review and a
  self-critical attitude (Research Forum) for
  students and faculty
• Disseminate findings to those who can benefit
• If in national language, abstract in English
  invites comment and criticism from a wider
  audience
• If funding of a SPH is tied to teaching hours,
  need to provide incentives and time for active
  research to be valued and rewarded

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Service in Public Health

• Participation in the legislative and policy
  process
• Support, advise, and counsel PH practitioners,
  governments, and the public at large
• Work at local, national, and international level
  on public health practice, policy, services and
  their development,
• Initiate debate and advocacy based on their
  scientific knowledge, judgement, and values

Zwanikken PAC. Service role of SPHs. Public
Health Reviews30133-41
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Participation in International Public Health
Networks and Collaboration

• International standards
• Training local and abroad
• Research local, bilateral, multi-lateral
• Exchange of students and teachers
• Continuity and support
• Academic faculty development
• Professional organizations
• Graduates alumni organizations

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Conclusion

• High mortality and morbidity from preventable
  diseases cannot be addressed without training
  large numbers of public health professionals
• Need for schools of public health in former
  Soviet countries, and in developing countries
• Evolution of Social Hygiene to a New Public
  Health
• Needs time, resources, international support, and
  adaptation from successful experience to local
  circumstances

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Published As Tulchinsky TH, Epstein L, Norman C
eds. Proceedings of the International
Conference on Developing New Schools of Public
Health. Public Health Reviews, 2003 30, 1-392

• Keynote addresses
• OSI/ASPHER PEER review
• Mission and structure of SPHs
• Student expectations, selection, and assessment
• Curriculum
• Service and research roles
• Resources for a SPH
• Working Groups
• Background resource material by Braun Faculty

Write to Tedt_at_hadassah.org.il
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Thank you!