REINVENTING PUBLIC HEALTH: Shaping the Future of Public Health Education
Lu Ann Aday, Ph.D. Lorne D. Bain Distinguished Professor Emerita in Public Health and Medicine University of Texas School of Public Health
OVERVIEW Background Key Elements for Transforming Public Health Public Health Practice Public Health Education
BACKGROUND
BOOK
Book: Aday, L. A. (Ed.). (2005). Reinventing Public Health: Policies and Practices for a Healthy Nation. San Francisco: Jossey-Bass/Wiley. Thesis: To effectively improve population health and reduce health disparities, policymaking in a variety of policy domains must take into account the fundamental social, economic, and ecological determinants of health.
INSTITUTE OF MEDICINE REPORTS
Institute of Medicine. Committee for the Study of the Future of Public Health. (1988). The future of public health. Washington, DC: The National Academies Press. Institute of Medicine. Committee on Assuring the Health of the Public in the 21st Century. (2003a). The future of the public's health in the 21st century. Washington, DC: The National Academies Press.
Institute of Medicine. Committee on Educating Public Health Professionals for the 21st Century. (2003b). Who will keep the public healthy? Educating public health professionals for the 21st century. Washington, DC: The National Academies Press.
FIELD OF PUBLIC HEALTH (Institute of Medicine, 1988)
“What we, as a society, do collectively to assure the conditions in which people can be healthy”
PUBLIC HEATH PROFESSIONAL (Institute of Medicine, 2003b)
“A public health professional is a person educated in public health or a related discipline who is employed to improve health through a population focus.”
PUBLIC HEALTH REVOLUTIONS
REVOLUTION FOCUS INTERVENTIONS
1ST
(late 18th & early 19th century)
Physical Environment: Public sanitation and quarantine
Individual Behavior: High-risk behavior and lifestyle
Public health laws and regulations
2nd
(1974-Lalonde Report in Canada)
Individual behavioral change interventions
3rd
(1986-Ottawa Charter)
Macro Social and Economic Trends and Environment: Fundamental determinants of health
Social and economic policies
KEY ELEMENTS FOR TRANSFORMING PUBLIC HEALTH
KEY ELEMENTS FOR TRANSFORMING PUBLIC HEALTH
Transdisciplinary (in contrast to disciplinary, multidisciplinary, or interdisciplinary) research base Population health-centered Grounded in the fundamental social and economic determinants of health Participatory and inclusive Intersectoral in design
KEY ELEMENT: Transdisciplinary research base
Note: D1, D2, D3, and D4 refer to different disciplines.
KEY ELEMENT: Population health-centered
Population health is defined as “the health outcomes of a group of individuals, including the distribution of such outcomes within the group”.
“The field of population health includes health outcomes, patterns of health determinants and interventions that link these two” (Kindig, 2007; Kindig and Stoddart, 2003).
KEY ELEMENT: Grounded in the fundamental social and economic determinants of health
“essential resources that serve to enhance the prospects of health and well-being at a variety of levels” (Link and Phelan, 1995)
– Natural capital—environmental resources – Human capital—education – Material capital—occupation, employment, and income – Social and cultural capital—social support and community empowerment
KEY ELEMENT: Participatory and inclusive
↔
Coalitions
GOVERNMENT
COMMUNITY
↔
MARKET
Advisory boards
Communities Public-private Socially of practice partnerships responsive corporate management
KEY ELEMENT: Intersectoral in design
SECTORS
Social and economic Business Education Government Nongovernmental Other Public health practice
SELECTED INTERVENTIONS
Sustainable development Human development Economic development
Community development Media, academia, others
Assessment Policy development Assurance
Health care system
Financing Availability Organization
PUBLIC HEALTH PRACTICE
POPULATION HEALTH-CENTERED PUBLIC HEALTH PRACTICE: Assessment Function
Essential Services Monitor health status to identify community health problems. Diagnose and investigate health problems and hazards in the community. Current Practice Develop and employ disease surveillance systems. Conduct disease outbreak investigations in the community. Population Health Centered Practice Develop and employ population health information systems. Apply ecosocial models to identify the fundamental determinants of population health in the community.
POPULATION HEALTH-CENTERED PUBLIC HEALTH PRACTICE: Policy Development Function
Essential Services
Inform, educate and empower people about health issues.
Current Practice
Inform, educate, and empower individuals and communities to promote their health and well-being.
Population Health Centered Practice
Inform, educate, and empower various sectors (business, education, community orgs., media, academia, government, public health, health care) to promote population health. Build intersectoral public health system to address population health problems. Formulate and strengthen population health-centered public policy.
Mobilize community partnerships and action to identify and solve health problems. Develop policies and plans that support individual and community health efforts.
Build local, statewide, or national partnerships to address public health problems. Formulate and strengthen public health and health care policy.
POPULATION HEALTH-CENTERED PUBLIC HEALTH PRACTICE: Assurance Function
Essential Services
Enforce laws and regulations that protect health and ensure safety.
Current Practice
Regulate environmental and occupational hazards and disaster preparedness.
Population Health Centered Practice
Design model legislation to promote population health-centered programs within and across sectors.
Link people to needed personal health care services and assure the provision of health care when otherwise unavailable. Assure a competent public health and personal and population-based health workforce. Evaluate effectiveness, accessibility and quality of personal and populationbased health services.
Organize and manage the delivery of “safety net” health care services in the community.
Collaborate to develop and finance an integrated continuum of primary prevention, treatment, and long-term care programs and services in the community. Train public health, planning, and development professionals in the population health approach. Evaluate public health and intersectoral initiatives in terms of their population health impact.
Train and evaluate public health professionals in terms of core public health competencies. Evaluate public health agencies and communities in terms of model and performance-based standards.
POPULATION HEALTH-CENTERED PUBLIC HEALTH PRACTICE: Serving All Functions
Essential Services Current Practice Population Health Centered Practice
Research for new insights and innovative solutions to health problems.
Design and conduct multidisciplinary and interdisciplinary research to address public health issues.
Design and conduct transdisciplinary research to address fundamental determinants of population health.
PUBLIC HEALTH EDUCATION
NEW AREAS OF STUDY (Institute of Medicine, 2003b)
CONTENT
Ethics* Genomics* Global Health* Policy and Law*
METHODS
Communication* Community-Based Participatory Research* Cultural Competence* Informatics*
* Addressed to some extent in ASPH MPH Core Interdisciplinary Competency Areas.
SPECTRUM OF PRACTICE-BASED TEACHING STRUCTURES (ASPH, 2004)
PROGRESSIVE Progressive, permissive, learner-driven, practically oriented education Semistructured education that recognizes subjectivity of learning TRADITIONAL Traditional, structured education; competencydriven and normative education
MODEL PUBLIC HEALTH UNIVERSITY FOR THE 21ST CENTURY
DIMENSION
Vision
Values Planning
DESCRIPTION
Population health-centered
Guided by core public health principles Grounded in an understanding of the past and the potential for the future of the public health field Centered on learning throughout all levels of the institution Balanced and motivated by high standards of excellence
Leadership Scholarship
REFERENCES
Aday, L. A. (Ed.). (2005). Reinventing public health: Policies and practices for a healthy nation. San Francisco: Jossey-Bass/Wiley.
Association of Schools of Public Health. Council of Public Health Practice Coordinators. (2004). Demonstrating excellence in practice-based teaching for public health. Washington, DC: ASPH.
Institute of Medicine. Committee for the Study of the Future of Public Health. (1988). The future of public health. Washington, DC: The National Academies Press.
Institute of Medicine. Committee on Assuring the Health of the Public in the 21st Century. (2003a). The future of the public's health in the 21st century. Washington, DC: The National Academies Press. Institute of Medicine. Committee on Educating Public Health Professionals for the 21st Century. (2003b). Who will keep the public healthy? Educating public health professionals for the 21st century. Washington, DC: The National Academies Press. Kindig, D. (2007). Understanding population health terminology. The Milbank Quarterly, 85, 139-161.
Kindig, D., and Stoddart, G. (2003). What is population health? American Journal of Public Health, 93, 380-383.
Link, B. G., and Phelan, J. (1995). Social conditions as fundamental causes of disease. Journal of Health and Social Behavior (Special Issue), 80-94.