Competencies Required of Public Competencies Required of Public Health Professionals and LeadersHealth Professionals and Leaders

Presentation at OHI/Braun SPHSummer School, Moscow July 2004

TH Tulchinsky MD MPH, Braun School of Public Health,

Jerusalem

Is There a Population Health Problem in Is There a Population Health Problem in Russia? All Cause Mortality RatesRussia? All Cause Mortality Rates

500

1000

1500

2000

1970 1980 1990 2000 2010

Russian FederationEU(15-prior 1.05.2004) averageCSEC(15) averageCIS(12) averageNordic(5) average

990102 +SDR all causes, all ages, per 100000

Is There a Population Societal Problem in Is There a Population Societal Problem in Russia? Human Development IndexRussia? Human Development Index

0.75

0.8

0.85

0.9

0.95

1970 1980 1990 2000 2010

IsraelPoland

Russian FederationUnited Kingdom

998008 UNDP Human Development Index (HDI)

Role of PH ProfessionalRole 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 DevelopingNew SPHs. Public Health Reviews, 2002;30.

Competencies Needed by Public Health Competencies Needed by Public Health LeadersLeaders

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

Interest and Capacity for Analysis, Research Interest and Capacity for Analysis, Research and Advocacyand 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

Understand Social Determinants of Disease Understand Social Determinants of Disease and Outcomesand 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

Political and Societal ContextPolitical 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

In the “Culture of Public Health”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 doesn’t Medical and population approach models Formal training - a learned culture with specific

competencies

Key Roles of Key Roles of Schools of Public HealthSchools of Public Health

Training and Training and educationeducation

Training and Training and educationeducation

ResearchResearch and andAnalysisAnalysis

ResearchResearch and andAnalysisAnalysis

ServiceService and andAdvocacyAdvocacy

ServiceService and andAdvocacyAdvocacy

SPH and MPH Graduates Interactions SPH and MPH Graduates Interactions

Professional Needs

Training/Education

Science of Learning experiences

Advocacy and

Interventions

Information

Presentation

ManagementLegislation

MPH Graduate Schools of Public Health

Research & Technology development

Technical cooperation

Direct community action

Source: Varavikova EA. Proceedings of International Conference

Survival and

Success

AnalysisPrioritisationStrategy ImplementProvision of serviceResource allocation

Structure and Stakeholders for SPHsStructure and Stakeholders for SPHs

School of School of Public HealthPublic Health

School of School of Public HealthPublic Health

Ministry Ministry of Healthof Health

Ministry Ministry of Healthof Health

Local Local governmentsgovernments

Local Local governmentsgovernments NGOsNGOsNGOsNGOs

Other Other LocalLocalAAcademic cademic IInstitutionsnstitutions

Other Other LocalLocalAAcademic cademic IInstitutionsnstitutions

UniversityUniversityAcademyAcademyFacultyFaculty

UniversityUniversityAcademyAcademyFacultyFaculty

Funding Funding AgenciesAgencies

Funding Funding AgenciesAgencies

FacultyFacultyFacultyFacultyStudentsStudentsStudentsStudents

Other health Other health institutionsinstitutions

Other health Other health institutionsinstitutions

Other Other MinistriesMinistries

Other Other MinistriesMinistries

InternationalInternational AAcademic cademic PartnersPartners

InternationalInternational AAcademic cademic PartnersPartners

Objectives of SPHsObjectives 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

Potential Contribution of Potential Contribution of Schools of Public HealthSchools 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

Clientele for Public Health Training and Clientele for Public Health Training and Education 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

Graduates: Skills and ValuesGraduates: 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

Professional Continuing EducationProfessional 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

Role of Research in SPHsRole 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

Research in SPHsResearch 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

Service in Public HealthService 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 Reviews;30:133-41

Participation in International Public Participation in International Public Health Networks and CollaborationHealth 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

ConclusionConclusion 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

Published As: Published As: Tulchinsky TH, Epstein L, Norman C Tulchinsky TH, Epstein L, Norman C [eds]. Proceedings of the International Conference on [eds]. Proceedings of the International Conference on

Developing New Schools of Public Health. Public Health Developing New Schools of Public Health. Public Health Reviews, 2003; 30, 1-392Reviews, 2003; 30, 1-392

Write to: Write to: Tedt@hadassah.org.il

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

Thank you!Thank you!