Education Of Public Health Professionals Research Articles

Education and training in public health: is there progress in the European region?

The Association of Schools of Public Health in the European Region (ASPHER) is confronted with challenges to improve education for public health professionals. In this article, we attempt to answer the question: Did ASPHER members improve their organization and programmes to enable their graduates to acquire the competences to tackle the diverse areas of public health defined in the Ten Essential Public Health Operations (EPHOs)? ASPHER run two surveys among its membership: In 2011, 66 Schools and Departments of Public Health (SDPHs) took part (82.5%), while in 2015-16, 78 SDPHs (81.3%). The performance of graduates was estimated using a Likert scale. In 2015-16, the SDPHs delivered 169 academic programmes (2.2 on average per SDPH). Among the SDPHs participating in both surveys, significant differences could not be determined, neither for the organization (except increasingly using social media) nor for teaching areas. The performance of graduates did not show significant differences except for the deterioration of EPHO-8 ('assuring sustainable organizational structures and financing'). However, the qualitative data revealed progressive dynamics regarding innovations in the organizational set-up, digitalization, teaching/training, introduction of new modules and research. The results generated do not allow us to state that the innovative elements introduced after the first survey in 2011 have had a clear impact reflected in the second survey carried out in 2015-16, but perhaps this is due to the need for a broader follow-up in order to objectify the potential consequences derived from the boost generated by the changes introduced.

Statistical methods used in the public health literature and implications for training of public health professionals.

Statistical literacy and knowledge is needed to read and understand the public health literature. The purpose of this study was to quantify basic and advanced statistical methods used in public health research. We randomly sampled 216 published articles from seven top tier general public health journals. Studies were reviewed by two readers and a standardized data collection form completed for each article. Data were analyzed with descriptive statistics and frequency distributions. Results were summarized for statistical methods used in the literature, including descriptive and inferential statistics, modeling, advanced statistical techniques, and statistical software used. Approximately 81.9% of articles reported an observational study design and 93.1% of articles were substantively focused. Descriptive statistics in table or graphical form were reported in more than 95% of the articles, and statistical inference reported in more than 76% of the studies reviewed. These results reveal the types of statistical methods currently used in the public health literature. Although this study did not obtain information on what should be taught, information on statistical methods being used is useful for curriculum development in graduate health sciences education, as well as making informed decisions about continuing education for public health professionals.

Cultivating Hygiene as a Science: The Welch-Rose Report's Influence at Johns Hopkins and Beyond.

In 1915, William Henry Welch and Wickliffe Rose submitted a report to the Rockefeller Foundation that became the template for public health professional education in the United States and abroad. Based on the Welch-Rose Report's recommendations, the Foundation awarded a grant to Johns Hopkins University in 1916 to establish the first independent graduate school of public health, with Welch serving as the founding dean. The Welch-Rose Report and, by extension, the Johns Hopkins School of Hygiene and Public Health established and transmitted a new model of scientific training that wove the laboratory mindset together with the methods of public health administration and epidemiologic fieldwork. During the School's first quarter-century, faculty and alumni were remarkably active in frontline public health problem-solving, as well as launching public health agencies and schools of all types and sizes. The most lasting contribution of the Welch-Rose Report and the Johns Hopkins School of Hygiene and Public Health, now the Johns Hopkins Bloomberg School of Public Health, has been to "cultivate the science of hygiene" to bring about exponential growth in the evidence base for public health. The schools that have adopted the Johns Hopkins model of public health education worldwide have produced professionals who have worked to achieve wide-ranging reforms dedicated to preserving life, protecting health, and preventing injury across populations and continents.

Permanent education in health: a review

OBJECTIVETo undertake a meta-synthesis of the literature on the main concepts and practices related to permanent education in health.METHODSA bibliographical search was conducted for original articles in the PubMed, Web of Science, LILACS, IBECS and SciELO databases, using the following search terms: “public health professional education”, “permanent education”, “continuing education”, “permanent education health”. Of the 590 articles identified, after applying inclusion and exclusion criteria, 48 were selected for further analysis, grouped according to the criteria of key elements, and then underwent meta-synthesis.RESULTSThe 48 original publications were classified according to four thematic units of key elements: 1) concepts, 2) strategies and difficulties, 3) public policies and 4) educational institutions. Three main conceptions of permanent education in health were found: problem-focused and team work, directly related to continuing education and education that takes place throughout life. The main strategies for executing permanent education in health are discussion, maintaining an open space for permanent education, and permanent education clusters. The most limiting factor is mainly related to directly or indirect management. Another highlight is the requirement for implementation and maintenance of public policies, and the availability of financial and human resources. The educational institutions need to combine education and service aiming to form critical-reflexive graduates.CONCLUSIONSThe coordination between health and education is based as much on the actions of health services as on management and educational institutions. Thus, it becomes a challenge to implement the teaching-learning processes that are supported by critical-reflexive actions. It is necessary to carry out proposals for permanent education in health involving the participation of health professionals, teachers and educational institutions.

Qualification of management and attention processes in the city of Caaporã, state of Paraíba, Brazil: mentoring reports on permanent education in health

ABSTRACT: The aim of this paper was to report the training on Permanent Education in Health (PEH) of Family’s Health Teams (FHT) from the Muncipality of Caapora, State of Paraiba. The problems identified involved the difficulties to access health services, fragility of the link with the community, and lack of educational and preventive actions. The proposed interventions encom-pass redirection of access strategies, integration between ESF and the community, and redistri-bution of tasks among FHT members. Results show the elimination of queue for care service, strengthening of the link with the community, and introduction of preventive measures in the FHT. The PEH in Caapora contributed to modify the management and health care practices. KEYWORDS: Primary Health Care; Public Health Professional Education; Professional Practice. 1 Pos-Graduando em Clinica Odontologica pela Universidade Estadual de Campinas (Unicamp) – Campinas (SP), Brasil. Tutor de Aprendizagem, Curso de Formacao de Facilitadores de Educacao Permanente em Saude.

Public Health as a Distinct Profession

This article reviews the elements consistent with the definition of a "profession" in the contemporary United States and argues that public health should be considered a distinct profession, recognizing that it has a unique knowledge base and career paths independent of any other occupation or profession. The Welch-Rose Report of 1915 prescribed education for public health professionals and assumed that, although at first the majority of students would be drawn from other professions, such as medicine, nursing, and sanitary engineering, public health was on its way to becoming "a new profession." Nearly a century later, the field of public health has evolved dramatically in the direction predicted. It clearly meets the criteria for being a "profession" in that it has (1) a distinct body of knowledge, (2) an educational credential offered by schools and programs accredited by a specialized accrediting body, (3) career paths that include autonomous practice, and (4) a separate credential, Certified in Public Health (CPH), indicative of self-regulation based on the newly launched examination of the National Board of Public Health Examiners. Barriers remain that challenge independent professional status, including the breadth of the field, more than one accrediting body, wide variation in graduate school curricula, and the newness of the CPH. Nonetheless, the benefits of recognizing public health as a distinct profession are considerable, particularly to the practice and policy communities. These include independence in practice, the ability to recruit the next generation, increased influence on health policy, and infrastructure based on a workforce of strong capacity and leadership capabilities.

Analysis of the Literature Pertaining to the Education of Public Health Professionals

A well-educated workforce is essential to the infrastructure of a public health system (1). At a time when global focus on public health is increasing, a severe shortage of public health professionals is projected (2). A strong educational framework is thus imperative to ensure the capacity and capability of the worldwide public health workforce for the future. The education of those who work in public health is spread across disciplines, subject-specific training programs and types of academic institutions. In the 2011 report on the Health Professionals for a New Century, Frenk and Chen comment that, compared to medicine and nursing, public health has done the least to examine what and how it teaches (3). This does not bode well for meeting the demands of the public health workforce for the future. The purpose of the study reported here is to analyze the state of pedagogy pertaining to the education of the public health workforce as evidenced by published literature. The focus is on “professionals,” defined as those who have formal education, are self-governing, and can work independently.

Avaliação da conduta de profilaxia antirrábica indicada para pessoas envolvidas em agravos com cães e gatos no município de Jaboticabal, SP, no período de 2000 a 2006

The present study aimed to evaluate rabies post-exposure prophylaxis (PEP) in humans in the municipality of Jaboticabal, São Paulo from 2000 through 2006. A descriptive and retrospective study was conducted by collecting data available in patient records. Vaccination costs were also calculated; 2,493 patients injured by animals received PEP, totaling R$ 179,105.14 and 7,108 doses; 2,184 (71.5%) out of the total reports were caused by dogs and cats clinically healthy at the moment of the attack. These animals remained sound throughout the 10-day observation period. The observation was conducted by the victim or by the owner. Considering animal observation and the epidemiological status of rabies in the municipality, all of these patients could have been dismissed from PEP treatment. Instead, only 464 were dismissed, meaning that 1,720 patients were unnecessarily vaccinated. An estimated 4,590 doses and R$114,420.81 could have been saved. In comparison with rates of other municipalities of the State of São Paulo and with the national mean, the number of PEP in Jaboticabal is very high and it became evident that management evaluated neither the health status of the animal nor the epidemiological status of the area for rabies. Permanent awareness and education of public health professionals with respect to rabies epidemiology and the need to perform correct observation of the aggressors are recommended. It is essential that medical and veterinary services be integrated to provide better assessment of cases and safer decisions on the institution of PEP.

Community as Classroom

Traditional models for public health professional education tend to be didactic, with brief, discrete practica appended. National reports of both practitioners and academicians have called for more competency-driven, interdisciplinary-focused, community-based, service-oriented, and experientially-guided learning for students across the curriculum. East Tennessee State University began its own curricular revisioning in health professions education nearly 2 decades ago with a grant from the W.K. Kellogg Foundation, emphasizing competencies development through community-based learning in community-academic partnerships. This article describes 3 examples that grew from that initiative. In the first example, students in multiple classes delivered a longitudinal community-based employee wellness intervention for a rural county school district. BS public health students conducted needs assessments and prepared health education materials; MPH students conducted health assessments and worked with school wellness councils to deliver client-centered interventions; DrPH students supervised the project and provided feedback to the schools using participatory methods. In the second example, MPH students in a social-behavioral foundations course used experiential learning to investigate the region's elevated cancer mortality ranking. Following meetings with multiple community groups, students employed theoretical constructs to frame regional beliefs about cancer and presented findings to community leaders. One outcome was a 5-year community-based participatory research study of cancer in rural Appalachia. In the third example, MPH students in a health-consulting course assessed local African Americans' awareness of the university's health and education programs and perceptions of their community health issues. Students learned consultation methods by assisting at multiple regional African American community meetings to discover issues and interest that resulted in the organization of a regional African American health coalition, multiple community health interventions, and the region's first health disparities summit. Lessons learned are presented which identify key elements of success and factors that influence adoption of community-based teaching and learning in public health.

Education of Veterinary Medical and Other Public Health Providers: Linking Interventions with Health Outcomes

A systematic literature review was performed to summarize the nature, implementation, outcomes, and long-term impacts of previously instituted interventions and programs aimed at educating veterinary public health providers. A logic model was developed to direct the literature search strategy, provide a framework for evaluating the relationship between veterinary public health professional education and their associated population health outcomes, and guide future training development and recommendations for the education of veterinary health professionals. Our literature review indicates that there is a relative lack of published literature that connects veterinary public health educational interventions to population health outcomes. Reasons for the lack of evidence to connect educational programs and population health outcomes include the evaluation of outcomes on a short-term rather than intermediate- or long-term basis, a lack of experimental studies, and infrequent grounding in population health or educational theory. Future intervention recommendations as suggested in the reviewed articles are also summarized.

The Oldest Old: Missed Public Health Opportunities

The fastest growing segment of our population is the “oldest old,” usually defined as those 85 years and older. In 2005, this group numbered more than 5 million persons, or about 1.7% of the US population, a 40% increase since 1990. Because the oldest old carry a greater burden of disease and disability, they account for a substantial proportion of health care spending, with total annual per capita health care costs of $25691. A higher proportion of health care spending in this population is partially attributable to long-term services—most notably, nursing home care. As our population ages, substantial concerns have been expressed regarding the future ability of the health care system to provide needed care. Much of this analysis, however, has failed to consider the potential impact of public health strategies to promote health and reduce disability among the old and very old in our population. There is promising evidence that rates of disability and functional dependence among older persons have been decreasing over the last 2 decades, and continue to fall. In this issue of the Journal, Murabito et al. provide data from the Framingham study to show a significant decline in disability among community-dwelling elders from the 1970s to the 1990s. Unfortunately, there are important missed public health opportunities to improve the health and function of older populations. Vaccination for influenza is provided to less than 75% of older persons, and even fewer (60%) have ever received a pneumococcal vaccine. Promotion of healthy behaviors is also crucial. The Type II Diabetes Prevention Trial demonstrated that older persons were able to follow diet and exercise regimens, and that these behavior changes resulted in significant success in prevention of type II diabetes. However, despite the fact that physical activity is associated with important health outcomes at all ages, physical activity declines with age. Only 1 in 5 persons aged 45–64 years engages in vigorous physical activity, and this drops to about 1 in 20 for those over the age of 75 years. To achieve the potential of improved health among the oldest old, as a society we would do well to work together to (1) change public perceptions regarding the benefits of promoting health among older persons, (2) encourage elders to engage in healthier behaviors, (3) improve the practices of health providers, (4) stimulate health departments and service agencies to provide health promotion services, and (5) include public health and aging in education of public health professionals. Despite the importance of improving health behaviors across the life span to achieve optimal health and function in old age, a recent survey of schools of public health reported that fewer than 6% of students participated in a public health and aging course. Moreover, the majority of schools lack a comprehensive and integrated curriculum that adequately addresses health issues in the aging. We have the opportunity to do better for our older population and for ourselves as we age. My 93-year-old grandmother illustrated this perfectly. As she showed us around her senior housing, she pointed out the congregate meals site that she visited on Tuesdays and Thursdays. When I asked if she enjoyed the meals, she pulled herself up to her full 4 feet, 10 inches to indignantly declare that she did not go to eat, but to “help serve the old people.”

Epidemiology core competencies for Master of Public Health students.

Competency-based education for public health professionals has been recommended by the Institute of Medicine. The Association of Schools of Public Health has developed a set of academic core competencies that it recommends that all Master of Public Health (MPH) students should possess prior to graduation. This article discusses the processes and reasoning used by the workgroup that prepared the epidemiology subset of MPH core competencies that appear in the association's 2006 report. These academic core competencies are complementary to but distinct from the specialist competencies that students should develop in their major field. The authors emphasize the importance of ongoing refinement of the core competency model with participation from both public health academics and public health practitioners.

Integrating information literacy into the education of public health professionals: roles for librarians and the library.

The paper reviews the core competencies for public health professionals presented in the Institute of Medicine's (IOM's) report, Who Will Keep the Public Healthy: Educating Public Health Professionals for the 21st Century; describes improving information literacy (IL) as a mechanism for integrating the core competencies in public health education; and showcases IL as an opportunity for solidifying partnerships between academic librarians and public health educators. The IOM competencies, along with explicit examples of library support from a literature review of current IL trends in the health sciences, are analyzed. Librarians can play a fundamental role in implementing the IOM's core competencies in shaping public health education for the twenty-first century. A partnership between public health educators and librarians through a transdisciplinary approach is recommended. IL skills and competencies integrated into public health curricula through a collaborative partnership between public health educators and librarians can help integrate the IOM's core competencies and improve public health education.

HYPERTENSION 2020: CONFRONTING TOMORROW'S PROBLEM TODAY

1. In developed countries, the major burden of disease is due to chronic diseases, such as heart disease and stroke. In contrast, the major burden of disease among people in developing countries has been due largely to diseases caused by malnutrition, poor sanitation and infection. In recent years, with increasing economic and demographic development, there has been a shift in developing countries from diseases caused by poverty towards chronic, non-communicable, lifestyle-related diseases. The rapid emergence of these chronic diseases has not occurred with a similarly rapid decline in infectious diseases. Therefore, these developing countries are experiencing high rates of both infectious and chronic diseases. 2. The increase in chronic diseases in developing countries has been brought about by the increasing prevalence of risk factors, such as increased alcohol consumption, smoking, obesity, physical inactivity and low fruit and vegetable intake. In parallel with this, there is also increased evidence of high blood pressure and high cholesterol levels. 3. The preventive strategies required to reverse this trend for these emerging diseases include the education of public health professionals, the introduction of surveillance activities to monitor changes in risk factors, the introduction of health promotion, the development of prevention research and improved advocacy for disease prevention programmes. Experience from other countries provides evidence that prevention programmes can work. The global challenge is to ensure that implementation of such programmes in the world's developing nations does not come too late.

Towards a new generation of simulation models in public health education

This article sets the scene for the development of an educational simulation software package based on multimedia, decision support systems, risk estimates, project outcomes and evaluation. It begins by looking at the history and current use of educational software and its application to the education of public health professionals. Then, it previews accompanying technological advances that were essential precursors to the facilities now available and reviews learning theories relevant to the development of problem solving simulation models. Possible candidates for providing more effective educational solutions, such as decision support systems, modelling and simulation software are reviewed and the design of a new generation, fully integrated simulation model is discussed.

Ethics content in community health nursing textbooks.

Nurses learn ethics content and ethical decision-making strategies through textbooks, basic curricula, continuing education, and professional experience. The author describes an ethics content analysis of community health nursing textbooks, offers suggestions for the improvement of ethics content for textbooks, and raises awareness of the need for more emphasis on public health ethics in nursing and public health professional education.

AIDS and Human Rights: Where Do We Go from Here?

Through the insights provided by the connection between health and human rights explicit efforts to promote and protect human rights have been added to the list of traditional useful public health approaches. Two major challenges arise out of these interconnection: forms and mechanisms of human rights action are inappropriate to public health workers; neither health-related institutions nor human rights organizations may provide sufficient moral and logistic support for health/human rights-based action. From the viewpoint of human rights organizations health-related issues such as HIV/AIDS constitute a special challenge. To initiate action towards HIV/AIDS based on the health and human rights connection 4 steps are proposed: 1) connections between human rights and HIV/AIDS and other health issues must be established and reinforced; 2) training and continuing education of public health professionals must be strengthened; 3) forms of research capable of identifying and verifying linkages between human rights and health must be developed; 4) work on human rights requires a willingness to deal with values. Work in these areas can expand and advance a health and human rights agenda for HIV/AIDS prevention control and care.

Computer communication for international collaboration in education in public health. The TEMPUS Consortium for a New Public Health in Hungary.

Computer conferencing using the Canadian system CoSy is presented, and three related projects are discussed. 1. An extramural university course in epidemiology and medical statistics was taught using CoSy. Computer conferencing can be a useful vehicle for distance education, enabling health professionals to attend "classes" independent of geographical and time constraints. The subjects taught are well suited to this medium. 2. Internet was used to establish a small network of public health researchers and teachers. Participants are from Canada, Hungary, Israel, Norway, and Australia. Networks of this type not only facilitate international collaboration within public health, they also enable international collaborative research and teaching projects that would have been too cumbersome and time consuming to initiate and conduct without this communication facility. 3. "Development of Medical Education for a New Public Health in Hungary," a project funded by the European Community's TEMPUS program, is established with a view to developing the undergraduate and graduate education of public health professionals. It is a joint program between the five Hungarian medical schools and ten universities in the G24 countries. The TEMPUS listserver functions as an important vehicle for communication within this project.

An assessment of the client-centered planning approach in continuing education for public health professionals.

This paper reviews the concept of client-centered planning as an approach to program development for continuing education in public health. Client-centered planning is aimed at the identification of individual practitioner needs and the development of educational interventions tailored to improve competency in selected areas. This paper presents the essential elements of client-centered planning and examines findings from continuing education programs in public health conducted by the Center for Continuing Education of Public Health Professionals at the University of Michigan. The Center model is presented as one approach to program planning. As such, protocols for needs assessment, program planning, implementation and evaluation developed according to client-centered theory serve as a baseline for improved program planning for use by instructors and agencies.