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Education and training[edit]

Education and training of public health professionals is available throughout the world in Medical Schools, Veterinary Schools, Schools of Nursing, Schools of Public Health, and Schools of Public Affairs. The training typically requires a university degree with a focus on core disciplines of biostatistics, epidemiology, health services administration, health policy, health education, behavioral science and environmental health.[35][36] The National Commission for Health Education Credentialing (NCHEC) offers a national certification, Certified Health Education Specialist, C.H.E.S., for those who meet the eligibility requirements.

Schools of public health[edit]

In the United States, the Welch-Rose Report of 1915[37] has been viewed as the basis for the critical movement in the history of the institutional schism between public health and medicine because it led to the establishment of schools of public health supported by the Rockefeller Foundation.[38] The report was authored by William Welch, founding dean of the Johns Hopkins Bloomberg School of Public Health, and Wycliffe Rose of the Rockefeller Foundation. The report focused more on research than practical education.[38][39] Some have blamed the Rockefeller Foundation's 1916 decision to support the establishment of schools of public health for creating the schism between public health and medicine and legitimizing the rift between medicine's laboratory investigation of the mechanisms of disease and public health's nonclinical concern with environmental and social influences on health and wellness.[38][40]

Even though schools of public health had already been established in Canada, Europe and North Africa, the United States had still maintained the traditional system of housing faculties of public health within their medical institutions. A $25,000 donation from businessman Samuel Zemurray instituted the School of Public Health and Tropical Medicine at Tulane University in 1912 conferring its first doctor of public health degree in 1914.[41][42] The Johns Hopkins School of Hygiene and Public Health became the an independent, degree-granting institution for research and training in public health, and the largest public health training facility in the United States,[43][44][45][46] when it was founded in 1916. By 1922, schools of public health were established at Columbia, Harvard and Yale on the Hopkins model. By 1999 there were twenty nine schools of public health in the US, enrolling around fifteen thousand students.[35][38]

Over the years, the types of students and training provided have also changed. In the beginning, students who enrolled in public health schools typically had already obtained a medical degree; public health school training was largely a second degree for medical professionals. However, in 1978, 69% of American students enrolled in public health schools had only a bachelor's degree.[35]

Degrees in public health[edit]

Schools of public health offer a variety of degrees which generally fall into two categories: professional or academic.[47] The two major postgraduate degrees are the Master of Public Health (M.P.H.) or the Master of Science in Public Health (MSPH). Doctoral studies in this field include Doctor of Public Health (DrPH) and Doctor of Philosophy (Ph.D.) in a subspeciality of greater Public Health disciplines. DrPH is regarded as a professional leadership degree and Ph.D. as more of an academic degree.

Professional degrees are oriented towards practice in public health settings. The Master of Public Health, Doctor of Public Health, Doctor of Health Science (DHSc) and the Master of Health Care Administration are examples of degrees which are geared towards people who want careers as practitioners of public health in health departments, managed care and community-based organizations, hospitals and consulting firms among others. Master of Public Health degrees broadly fall into two categories, those that put more emphasis on an understanding of epidemiology and statistics as the scientific basis of public health practice and those that include a more eclectic range of methodologies. A Master of Science of Public Health is similar to an MPH but is considered an academic degree (as opposed to a professional degree) and places more emphasis on quantitative methods and research. The same distinction can be made between the DrPH and the DHSc. The DrPH is considered a professional degree and the DHSc is an academic degree.[citation needed]

Academic degrees are more oriented towards those with interests in the scientific basis of public health and preventive medicine who wish to pursue careers in research, university teaching in graduate programs, policy analysis and development, and other high-level public health positions. Examples of academic degrees are the Master of Science, Doctor of Philosophy, Doctor of Science (ScD), and Doctor of Health Science (DHSc). The doctoral programs are distinct from the MPH and other professional programs by the addition of advanced coursework and the nature and scope of a dissertation research project.

In the United States, the Association of Schools of Public Health[48] represents Council on Education for Public Health (CEPH) accredited schools of public health.[49] Delta Omega is the honor society for graduate studies in public health. The society was founded in 1924 at the Johns Hopkins School of Hygiene and Public Health. Currently, there are approximately 68 chapters throughout the United States and Puerto Rico.[50]

Public health programs[edit]

Today,[when?] most governments recognize the importance of public health programs in reducing the incidence of disease, disability, and the effects of aging and other physical and mental health conditions, although public health generally receives significantly less government funding compared with medicine.[51] In recent years,[when?] public health programs providing vaccinations have made strides in promoting health, including the eradication of smallpox, a disease that plagued humanity for thousands of years.

Three former directors of the Global Smallpox Eradication Programme read the news that smallpox had been globally eradicated, 1980

The World Health Organization (WHO) identifies core functions of public health programs including:[52]

  • providing leadership on matters critical to health and engaging in partnerships where joint action is needed;
  • shaping a research agenda and stimulating the generation, translation and dissemination of valuable knowledge;
  • setting norms and standards and promoting and monitoring their implementation;
  • articulating ethical and evidence-based policy options;
  • monitoring the health situation and assessing health trends.

In particular, public health surveillance programs can:[53]

  • serve as an early warning system for impending public health emergencies;
  • document the impact of an intervention, or track progress towards specified goals; and
  • monitor and clarify the epidemiology of health problems, allow priorities to be set, and inform health policy and strategies.
  • diagnose, investigate, and monitor health problems and health hazards of the community

Public health surveillance has led to the identification and prioritization of many public health issues facing the world today, including HIV/AIDS, diabetes, waterborne diseases, zoonotic diseases, and antibiotic resistance leading to the reemergence of infectious diseases such as tuberculosis. Antibiotic resistance, also known as drug resistance, was the theme of World Health Day 2011. Although the prioritization of pressing public health issues is important, Laurie Garrett argues that there are following consequences.[54] When foreign aid is funneled into disease-specific programs, the importance of public health in general is disregarded. This public health problem of stovepiping is thought to create a lack of funds to combat other existing diseases in a given country.

For example, the WHO reports that at least 220 million people worldwide suffer from diabetes. Its incidence is increasing rapidly, and it is projected that the number of diabetes deaths will double by the year 2030.[55] In a June 2010 editorial in the medical journal The Lancet, the authors opined that "The fact that type 2 diabetes, a largely preventable disorder, has reached epidemic proportion is a public health humiliation."[56] The risk of type 2 diabetes is closely linked with the growing problem of obesity. The WHO’s latest[when?] estimates highlighted that globally approximately 1.5 billion adults were overweight in 2008, and nearly 43 million children under the age of five were overweight in 2010.[57] The United States is the leading country with 30.6% of its population being obese. Mexico follows behind with 24.2% and the United Kingdom with 23%. Once considered a problem in high-income countries, it is now on the rise in low-income countries, especially in urban settings. Many public health programs are increasingly dedicating attention and resources to the issue of obesity, with objectives to address the underlying causes including healthy diet and physical exercise.

Some programs and policies associated with public health promotion and prevention can be controversial. One such example is programs focusing on the prevention of HIV transmission through safe sex campaigns and needle-exchange programmes. Another is the control of tobacco smoking. Changing smoking behavior requires long-term strategies, unlike the fight against communicable diseases, which usually takes a shorter period for effects to be observed. Many nations have implemented major initiatives to cut smoking, such as increased taxation and bans on smoking in some or all public places. Proponents[who?] argue by presenting evidence that smoking is one of the major killers, and that therefore governments have a duty to reduce the death rate, both through limiting passive (second-hand) smoking and by providing fewer opportunities for people to smoke. Opponents[who?] say that this undermines individual freedom and personal responsibility, and worry that the state may be emboldened to remove more and more choice in the name of better population health overall.

Simultaneously, while communicable diseases have historically ranged uppermost as a global health priority, non-communicable diseases and the underlying behavior-related risk factors have been at the bottom. This is changing however, as illustrated by the United Nations hosting its first General Assembly Special Summit on the issue of non-communicable diseases in September 2011.[58]

Many health problems are due to maladaptive personal behaviors. From an evolutionary psychology perspective, over consumption of novel substances that are harmful is due to the activation of an evolved reward system for substances such as drugs, tobacco, alcohol, refined salt, fat, and carbohydrates. New technologies such as modern transportation also cause reduced physical activity. Research has found that behavior is more effectively changed by taking evolutionary motivations into consideration instead of only presenting information about health effects. Thus, the increased use of soap and hand-washing to prevent diarrhea is much more effectively promoted if its lack of use is associated with the emotion of disgust. Disgust is an evolved system for avoiding contact with substances that spread infectious diseases. Examples might include films that show how fecal matter contaminates food. The marketing industry has long known the importance of associating products with high status and attractiveness to others. Conversely, it has been argued that emphasizing the harmful and undesirable effects of tobacco smoking on other persons and imposing smoking bans in public places have been particularly effective in reducing tobacco smoking.[59]

Applications in health care[edit]

As well as seeking to improve population health through the implementation of specific population-level interventions, public health contributes to medical care by identifying and assessing population needs for health care services, including:[60][61][62][63]

  • Assessing current services and evaluating whether they are meeting the objectives of the health care system
  • Ascertaining requirements as expressed by health professionals, the public and other stakeholders
  • Identifying the most appropriate interventions
  • Considering the effect on resources for proposed interventions and assessing their cost-effectiveness
  • Supporting decision making in health care and planning health services including any necessary changes.
  • Informing, educating, and empowering people about health issues

Implementing effective improvement strategies[edit]

To improve public health, one important strategy is to promote modern medicine and scientific neutrality to drive the public health policy and campaign, which is recommended by Armanda Solorzana, through a case study of the Rockefeller Foundation's hookworm campaign in Mexico in the 1920s. Soloranza argues that public health policy can't concern only politics or economics. Political concerns can lead government officials to hide the real numbers of people affected by disease in their regions, such as upcoming elections. Therefore, scientific neutrality in making public health policy is critical; it can ensure treatment needs are met regardless of political and economic conditions.[64]

The history of public health care clearly shows the global effort to improve health care for all.[citation needed] However, in modern-day medicine, real, measurable change has not been clearly seen, and critics argue that this lack of improvement is due to ineffective methods that are being implemented. As argued by Paul E. Farmer, structural interventions could possibly have a large impact, and yet there are numerous problems as to why this strategy has yet to be incorporated into the health system. One of the main reasons that he suggests could be the fact that physicians are not properly trained to carry out structural interventions, meaning that the ground level health care professionals cannot implement these improvements. While structural interventions can not be the only area for improvement, the lack of coordination between socioeconomic factors and health care for the poor could be counterproductive, and end up causing greater inequity between the health care services received by the rich and by the poor. Unless health care is no longer treated as a commodity, global public health can ultimately not be achieved.[citation needed] This being the case, without changing the way in which health care is delivered to those who have less access to it, the universal goal of public health care cannot be achieved.[65]

See also[edit]

References




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