Who Will Keep the Public Healthy? Educating Public Health Professionals for the 21st Century (2003) / Chapter Skim
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3. The Future of Public Health Education
3. The Future of Public Health Education
Pages 61-107
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From page 61... ...
Such an approach requires a well-educated interdisciplinary cadre of public health professionals who focus on population health and understand the multiple determinants that affect health. A cadre of professionals who also understand that successful interventions require understanding not only of the effects of biology and behavior, but also the social, environmental, and economic contexts within which populations exist.
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From page 62... ...
However, the committee believes that public health professionals will be better prepared to address the major health problems and challenges facing society if they achieve competency in the following eight content areas: informatics, genomics, communication, cultural competence, community-based participatory research, global health, policy and law, and public health ethics. These eight areas are now and will continue to be significant to public health and public health education in programs and schools of public health for some time to come.
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From page 63... ...
Public health informatics involves more than automating existing activities; it enables the redesign of systems using approaches that were previously impractical or not even contemplated. Public health informatics has immense potential not only to improve current public health practice, but to transform present-day capacity.
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From page 64... ...
A critical challenge for public health informatics is to educate the public health workforce in computing and communication technology applicable to public health activities. Some level of informatics training for both new and existing public health workers is essential.
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From page 65... ...
and other efforts to develop core competencies in PHI. CDC has established the Public Health Informatics Competencies Working Group to develop core competencies in public health informatics within the broader context of the Global and National Implementation Plan for Public Health Workforce Development with an initial focus on developing informatics competencies for the existing U.S.
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From page 66... ...
has sponsored conferences on public health informatics and distance learning that focused on how people and technology can work together to positively impact public health practice. The User Liaison Program (ULP)
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From page 67... ...
A number of centers are currently providing public health professionals with connections to online resources and the opportunities to learn technology-based skills that can be applied in their work setting. The critical challenge of educating the public health workforce in computing and communication technology applicable to public health activities will require collaborative action involving those working in the field; professional associations; local, state, and federal government agencies; library and information service providers; and programs and schools of public health.
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From page 68... ...
Public health professionals of the 21st century must learn about public health informatics and understand how this science contributes to the core functions of assessment, policy development, and assurance activities. Public health professionals must be prepared to understand and use these new information technologies to most effectively work to improve the health of the public.
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From page 69... ...
With the arrival of the era in which we will have the ability to understand gene-environment interactions comes not only the era of genomic medicine, but of genomics-based public health. Understanding genomics, therefore, is essential for an effective public health workforce.
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From page 70... ...
Two groups have provided valuable considerations of "core competencies" in genomics and genetics that help pinpoint what this might mean in terms of public health education. The National Coalition for Health Professional Education in Genetics, a coalition of more than 120 health professional organizations, has promulgated a set of competencies in genetics and genomics (Jenkins et al., 2001~.
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From page 71... ...
Few, if any, public health education programs have developed comprehensive curricula in genomics. Genomics is not only new, but also changing as rapidly as any area of bioscience.
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From page 72... ...
Because few in the current public health workforce have the level of understanding of genomics that is required today, major continuing education efforts must be undertaken to ready practicing public heath professionals to use genomics effectively. Public health education programs and schools must provide their students with a framework for understanding the importance of genomics to public health and with the ability to apply genomics to basic public health sciences.
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From page 73... ...
Public Health Communication Defined As a form of health communication, public health communication involves a translation process that begins with the basic science of what is known about a health topic. From the science, public health professionals derive messages about attitudes and behaviors the public should adopt, together with policies that organizations and government should enact to support population health.
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From page 74... ...
Strategies to Facilitate Public Health Communication Public health professionals should plan risk communication to include strategies for coping with risk rather than just information about risk. Communicating these guidelines together with information about a risk will enable the public to have a sense of confidence and control, contributing to perceived self-efficacy in abilities and skills to adapt to a situation (Bandura, 1986~.
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From page 75... ...
These values sometimes conflict with efforts to avoid distorting public health information and contribute to the general public's perceptions that private information will be made public as a result of interaction with the public health system. Barriers to Overcome in Public Health Communication The public's cooperation with public health goals includes disclosing personal information in medical and public health settings, contributing to the collection of data for disease registries, allocating resources to health and health care needs, and recognizing gaps in policy and health law.
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From page 76... ...
Public Health Communication Competence Public health professionals require different communication skills to interact with various publics, including co-workers, elected officials and policymakers, health care providers, media, and lay citizens, all comprising the public health professionals' sphere of influence. At a macro level, public health professionals should be able to state the case for public health programs and activities, which often requires knowledge of the history of public health promotion and research efforts associated with a topic, an audience, and one's own agency and area.
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From page 77... ...
Media advocacy acknowledges this relationship and strives to strategically plan for and use news to educate and involve community members with important issues (Wallack and Dorfman, 2001~. Public health communication requires skills to use mass media strategically in combination with community organizing to advance public health policies through media advocacy, targeting policymakers, organizations, and/or legislative bodies.
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From page 78... ...
CULTURAL COMPETENCE Globalization, changing demographics, and disparities in health care have brought renewed attention to cultural competence skills and information in public health education and training. The term cultural competence has been so heavily overworked that it is often perceived and responded to as an empty cliche or ideology (Vega and Lopez, 2001~.
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From page 79... ...
This is accomplished by a systematic exposure to a knowledge base that, combined with practice methods, provides an additional dimension to public health education. The knowledge base includes specificity about inter-ethnic and intra-ethnic health indices, sociocultural aspects of health and help seeking, assessment techniques adapted to community cultural diversity, improving communication of health prevention and promotion, and medical care information, cultural translation and mobilization strategies for communities and their institutions, and methodologies to improve the delivery of public health interventions and to evaluate their effectiveness (Lee, 1988; Gold, 1992; Mo, 1992; Alcalay et al., 1993; Vega and VanOss-Marin, 1997; House and Williams, 2000; Kaplan et al., 2000; Schulz et al., 2001~.
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From page 80... ...
The Council on Linkages Between Academia and Public Health Practice has developed eight competency domains for public health professionals, one of which is cultural competency. The committee believes that this core competency as explicated by the council is important and forms a focus for education of culturally competent public health professionals.
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From page 81... ...
In particular, cross-cultural competence requires the public health professional to combine the perspective of a group that is the focus of study or practice with the science that informs public health research and practice. To do so means that professional training should
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From page 82... ...
Training should focus on ways in which methods can be adapted in partnership with crosscultural groups and still retain scientific validity. Cultural competence skills and knowledge are applicable to dual priorities in public health education, global health, and U.S.
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From page 83... ...
This is compounded by a dearth of tenured faculty that have direct experience with public health practice in minority communities. Some faculty may even be attitudinally resistant or substantively unprepared to address the renovation of curricula to achieve greater cultural competence among their students.
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From page 84... ...
Cultural competency should be supported as an essential element in teaching, research, and practice. COMMUNITY-BASED PARTICIPATORY RESEARCH Public health research has contributed greatly to improvements in population- and individual-level health.
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From page 85... ...
The NIH National Institute of Environmental Health Sciences defines community-based participatory research as a methodology that promotes active community involvement in the processes that shape research and intervention strategies, as well as in the conduct of research studies (NIH, 2002~. A Rationale for CBPR and Practice Green and Mercer (2001)
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From page 86... ...
The lessons learned about community engagement from these complex community trials were reinforced during the last decade by the emergence of social ecology principles for informing public health interventions (Shine, 1996; Green and Kreuter, 1999~. Social ecology is the application of multiple and linked intervention strategies across multiple social levels the individual, family, social network, service organizations, community groups, and policy bodies (Goodman, 2000a; McLeroy et al., 1988~.
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From page 87... ...
Green, Centers for Disease Control and Prevention, September 13, 2002) , and the tune 2002 issue of Health Education ~ Behavior, the most widely cited journal in the Health Education field, devoted an entire special issue to the topic (Schulz et al., 2002~.
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From page 88... ...
, or factors that contribute to "how society shapes the health of people" (Berkman and Kawachi, 2000~. The SDOH perspective shares many characteristics with social ecology principles in that both take a population perspective, highlight social context in understanding individual behavior, and operate on multiple social levels.
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From page 89... ...
Preliminary findings indicate that communities that are most successful in producing desired community health and social outcomes tend to have important capacities in leadership, a strong set of values and principles, organizing abilities, and strategic community actions. A1though these findings remain preliminary, they reinforce the prominent role that community-based participatory research and practice should be accorded in public health.
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From page 90... ...
First, course work on community engagement concepts should be integrated into the M.P.H.
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From page 91... ...
The implications for programs and schools of public health concerning training for CBPR and practice are that multiple methods are important given the complexities of community health factors. The researcher, evaluator, and practitioner should be trained to tailor strategies to the specific questions and concerns of a community project.
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From page 92... ...
First, an array of research methods courses, both qualitative and quantitative should be part of training, particularly at the doctoral level. Second, the courses should focus not only on the acquisition of technical skills in design, data collection, and analysis but also on developing creative problem solving skills in contouring designs to fit with community input and social ecology principles (that is, multiple interventions at multiple social levels)
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From page 93... ...
There is a growing need to address issues that impact global health, such as the increasing income differentials between and among countries that foster poverty-associated conditions for poor health; the variance in environmental and occupational health and safety standards that contributes to hazardous production facilities and dangerous working conditions; global environmental changes leading to such things as depletion of freshwater supplies and the loss of arable lands; and the re-emergence of infectious diseases (IOM, 1997; McMichael and Beaglehole, 2000~. Poverty and ill health have long been associated, and the number of poor and marginalized people is increasing (Macfarlane et al., 2000~.
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From page 94... ...
According to Kickbusch and Buse (2001) , "A 300 percent increase in the real TABLE 3-2 Factors Contributing to Disease Reemergence and Examples of Associated Infections Contributing Factors Associated Infectious Diseases Human demographics and behavior Technology and industry Economic development and land use International travel and commerce Microbial adaptation and change Breakdown of public health measures Dengue/dengue hemorrhagic fever, sexually transmitted diseases, giardiasis Toxic shock syndrome, nosocomial (hospital acquired)
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From page 95... ...
Education in policy analysis and, in particular, in policy methods, needs to be strengthened and systematically provided to all students, consistent with the inclusion of policy development as a core competency for public health professionals (Council on Linkages, 2001~.
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From page 96... ...
Successful community public health work at the policy level typically requires political collaboration with stakeholders (Freudenberg and Golub, 1987~. Public health professionals in the community can be more effective if they can understand the dynamics of community politics, identify and work with stakeholders, identify legal and policy structures currently influencing community health and efficacy, and motivate and educate stakeholders and officials.
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From page 97... ...
the recurring themes of thefield and the dilemmas faced in everyday public health practice; and (ivJ the role of advocacy to achieve the goal of safer and healthier populations (Gostin, 20021.
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From page 98... ...
A statement of public health practice ethics has only recently been produced, and very little attention is paid to public health ethics in educational programs. Few schools of public health have trained ethicists on faculty, despite the fact that 22 of the 25 responding schools of public health report teaching ethics.
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From page 99... ...
have described the scope of issues in public health ethics as encompassing four general categories: health promotion and disease prevention, risk reduction, epidemiological and other public health research, and structural and socioeconomic disparities. They further identify different types of ethical analysis: professional ethics, applied ethics, advocacy ethics, and critical ethics, and they encourage all schools of public health to promote the teaching of ethics.
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From page 100... ...
With a population perspective, public health institutions think in terms of healthy populations and communities as well as healthy individuals. The health of a community includes the quality of interactions among community members (consider, for example, the prevention of violence)
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From page 101... ...
An important part of public health ethics is sorting through ethical issues in a group setting. The combination of a population perspective and institutional action presents a particular ethical danger to public health.
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From page 102... ...
that address the relationship between public health institutions and the populations they serve. Other codes of ethics for epidemiology and health education provide additional information more specific to these practices (located on the Web, respectively, at www.acepidemiology.org/policystmts/EthicsGuide.htm and www.sophe.org/~.
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From page 103... ...
"Ethical analysis can further understanding in every area of public health practice" (Levin, 2002) , and it is essential that programs and schools of public health incorporate the teaching of ethics.
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From page 104... ...
For the teaching of ethics to be credible and vital to students, ethical education must include a practical component, most likely in the field, and schools and programs of public health education must personify a high ethical standard. Law is another emerging area for public health scholarship, and while ethics and law are often discussed as related fields, each deserves attention in its own right.
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From page 105... ...
SUMMARY Each of the eight content areas discussed in this chapter is important for the future of public health and public health education. Understanding and being able to apply information and computer science technology to public health practice and learning (i.e., public health informatics)
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From page 106... ...
The committee emphasizes that it is important that public health education not "freeze" with the focus as identified in this report. Rather, the committee believes that the progress made in understanding and incorporating these eight important areas into public health practice, education, and research will enable us, in the future, to identify other new and emerging areas that must be addressed.
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From page 107... ...
Chapter 4 discusses the role of schools of public health in educating public health professionals, while Chapter 5 discusses the roles of other schools and programs. Chapter 6 focuses on the state, local, and federal public health agencies.
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