Public health education in Europe and the Nordic Countries: Status and perspectives

Abstract

The challenges that public health education has to meet are represented in two systems – the population’s health, and artificial systems aimed at improving population health, both from a longitudinal perspective – history, present state, and future development. Population health varies considerably across European countries, as do living conditions, healthcare and social security systems, and environmental systems. In terms of disease burden, the major ‘‘old rascals’’ are still cardiovascular disease and cancer, with the addition of traffic injuries, musculoskeletal diseases, mental disorders, and suicide. Although still active on the scene, many classic infectious diseases no longer seem to pose major problems as concerns life expectancy and burden of disease. Moreover, new infectious population threats have emerged, including still more or less hidden HIV and AIDS spread. Major persistent population health determinants are related to poor living conditions in general, and they show considerable social inequality; poor social adjustment of immigrant and other population groups outside the national or local mainstream culture; violence and other health-damaging behaviour such as smoking, excess alcohol consumption and substance abuse, and unprotected sexual intercourse; stressful workplace environment and pollution of the physical environment. The list could easily be extended. Even if there are heavy contrasts between European regions in terms of both health and health determinants, the nature of the components of the overall picture seems rather similar. This also applies to the Nordic countries. The structure, resources and functioning of the health systems also vary considerably between countries and between regions, and the health systems have been subject to reform in many European countries, with the aim of catching up with population needs, expectations and demands; with scarce resources, underproduction and emigration of health staff; with firmly established old traditions and institutional inertia; with poorly developed sectors of health science, including public health science and, thus, with a burden of inherited practices in health promotion, disease prevention, cure, healthcare and social care and rehabilitation, unsupported or poorly supported by rational scientific evidence. Also in the affluent Nordic countries with their developed welfare systems, public health systems are relatively weak as compared to the curative sectors in terms of programmes, organizational structures, professional staffing, and other resources. Population demands for curative interventions keep increasing, creating problems such as overuse of pharmaceuticals and waiting lists even for simple services, e.g. visits to general practitioners and hernia surgery. In public health, interactions between practice, research and training seem very far from being developed to a degree that could make them comparable to parallel interactions in the curative sector. Also in the Nordic countries, investment in research on health promotion and disease prevention is very much smaller than investment in curative interventions and curative science – in spite of the fact that the major health determinants are those mentioned above, and that much more evidence for