History of the Public Health Institute of Semmelweis Medical University, Budapest

The science of public health of the XVIIIth century named politia medica together with medicina forensis became an independent obligatory subject in 1793 at the Medical Faculty of the Hungarian Royal University of Science. The independent Public Health Institute of the Medical Faculty was established in 1874. The first professor of public health was József Fodor who attained international reputation during his professorship. He organized training for school physicians and health teachers first in Europe and he organized courses for medical officers and for military doctors. He held courses for law-, engineer- and architect-students. He promoted all fields of the public health. His research on the bactericide effect of serum places him among the founders of immunology. Fodor's successors at the Chair of Public Health were Leó Liebermann whose research activities included physico-chemistry, biochemistry, microbiology and social hygiene; Gusztáv Rigler who focused on the epidemiology of communicable diseases, on the health effects of spa treatment and mineral waters. The next famous professor was Gyula Darányi. His scientific field was public health bacteriology and public health chemistry. They were followed by József Melly and László Dabis (Scheff). After the Second World War fundamental changes took place in the life of the university. The Faculty of Medicine was separated from the University of Science on February 1, 1951 and became an independent university under the control of the Ministry of Health. In 1953 the Institute of Public Health was cut into two separate institutes: Institute of Public Health and Institute for the Organization of Health Service. The Institute of Public Health was transformed to Institute of Public Health and Epidemiology in 1973. The Institute for the Organization of Health Service was transformed into Institute of Social Medicine and History of Medicine in 1985 and later into Institute of History of Medicine and Social Medicine in 1991. The Institute of Public Health and Epidemiology and The Institute of History of Medicine and Social Medicine were reunited as Institute of Public Health in 1997. The Institute teaches public health to medical, dental and pharmacy students in Hungarian, in English and in German.     

Occupational health care system and its effectiveness in Lithuania

The Ministry of Labor and Social Affairs in collaboration with the Ministry of Health Care carries out the activities aimed at solving occupational health and safety problems in Lithuania. Occupational health care system in Lithuania consists of three levels: 1) primary occupational health centers in the industry; 2) general practitioners taking care of employees' health; and 3) the State Labor Inspectorate. The second level includes regional occupational medicine centers that are located in the three major cities of Lithuania: Vilnius, Kaunas and Klaipeda. Hygiene investigations of workplaces and prophylaxis of occupational diseases are performed by regional Public Health Center Departments of Occupational Medicine. The third level is provided by the Lithuanian Center of Occupational Medicine in Vilnius and the State Commission of Medical and Social Examination. The complicated cases of occupational diseases are treated in specialized departments of the University clinics. The real situation of work safety is not good. About 600 cases of occupational diseases and over 2500 accidents, including 60 fatal causalities are registered annually.     

Survey of how public health doctors in the United Kingdom and Republic of Ireland investigate the effects of long-term exposure to point sources of chemicals

Public health departments may need to investigate the health effects of long term exposures to chemicals from sources such as landfill sites and factories. Public health consultants responsible for communicable disease and environmental health and directors of public health in all health authorities and health boards in the United Kingdom and the Republic of Ireland were surveyed on behalf of a Faculty of Public Health Medicine guideline development group. The survey achieved a response rate of over 80%. Most public health doctors had investigated the health effects of long term exposure to chemicals, but many found it difficult to conduct effective and appropriate investigations in the face of community and political pressure. Most doctors acknowledged that they were responsible for investigating these problems, but wanted more epidemiological support, training, and guidance.     

Strategic orientation of public health in transition: an overview of South Eastern Europe

Two recent developments have redirected the course of Public Health in Europe - the Public Health Mandate of the European Commission and the conceptualization of a New Public Health. For the transition, countries in South Eastern Europe, particularly Serbia, provide support to essential public health reforms in four areas: strategic management, public health information, public health legislation, and public health training and research. The roles of the Dubrovnik Pledge (2001) and the Stability Pact, which has international support, have been central.     

National security and the health of people: human needs and the allocation of scarce resources

Gellhorn, a professor at the Harvard School of Public Health, delivered this paper as the opening address to the Eighth International Conference on the Social Sciences and Medicine, held in Scotland in August 1983. He discusses the impact of the international arms race on public health and economic development, particularly in Third World nations. His paper is followed by commentaries by Christine K. Cassel of the University of Oregon Department of Medicine; Margot Jefferys, emeritus professor of medical sociology at the University of London; F.M. Mburu of the University of Nairobi Department of Community Health; Peter J.M. McEwan, a professor of social sciences in Scotland; Vicente Navarro of the Johns Hopkins University School of Hygiene and Public Health; Harmon L. Smith of the Duke University Divinity School; and Philip Wood, of the University of Manchester ARC Epidemiology Research Unit.     

The impact of globalization on public health: implications for the UK Faculty of Public Health Medicine

BACKGROUND: There has been substantial discussion of globalization in the scholarly and popular press yet limited attention so far among public health professionals. This is so despite the many potential impacts of globalization on public health. Defining public health broadly, as focused on the collective health of populations requiring a range of intersectoral activities, globalization can be seen to have particular relevance. Globalization, in turn, can be defined as a process that is changing the nature of human interaction across a wide range of spheres and along at least three dimensions. Understanding public health and globalization in these ways suggests the urgent need for research to better understand the linkages between the two, and effective policy responses by a range of public health institutions, including the UK Faculty of Public Health Medicine. METHODS: The paper is based on a review of secondary literature on globalization that led to the development of a conceptual framework for understanding potential impacts on the determinants of health and public health. The paper then discusses major areas of public health in relation to these potential impacts. It concludes with recommendations on how the UK Faculty of Public Health Medicine might contribute to addressing these impacts through its various activities. RESULTS: Although there is growing attention to the importance of globalization to public health, there has been limited research and policy development in the United Kingdom. The UK Faculty of Public Health Medicine needs to play an active role in bringing relevant issues to the attention of policy makers, and encourage its members to take up research, teaching and policy initiatives. CONCLUSIONS: The potential impacts of globalization support a broader understanding and practice of public health that embraces a wide range of health determinants.     

Evaluation of a primary health care program for the poor

This paper examines the success in implementing a major program involving a partnership between public and private providers to deliver primary health care services to the poor. In 1985, the 69th Texas Legislature passed the Primary Health Care Services Act, authorizing the Texas Department of Health to contract for or directly provide primary health care services in those parts of the state that are medically underserved and have large numbers of people in poverty. This paper evaluates the potential impact of the projects with respect to access and cost. The study revealed that the basic concept of allowing local public and private providers to develop projects reflecting their community's unique needs and resources was successful. The approach lead to a wide variety of different types of projects, but the basic goals and activities of the projects are consistent with the legislation. The evaluation identified three major program areas that could be improved: (1) patient monitoring and follow-up to ensure the accessibility of the priority primary care services, (2) the need for the development of projects in other high need areas of the state, and (3) greater efficiency in service delivery.Charles E. Begley, Ph.D. is an Assistant Professor at the School of Public Health, The University of Texas Health Science Center at Houston, P.O. Box 20186, Houston, Texas 77225.Lu Ann Aday, Ph.D. is an Associate Professor at the School of Public Health, The University of Texas Health Science Center at Houston.Roy McCandless is a Faculty Associate, Center for Health Policy Studies, School of Public Health, The University of Texas Health Science Center at Houston.The research on which this paper is based was supported by the Bureau of Dental and Chronic Disease Prevention, Texas Department of Health. The authors wish to acknowledge the substantial contributions of Margaret Frank, M.H.S. and Kiyoko Parrish, M.P.H., Faculty Associates with the Center for Health Policy Studies, in the development and conduct of this research.     

Development of a Master of Public Health programme in Tirana, Albania

In 2001, two Albanian institutions, the Department of Public Health, Faculty of Medicine, University of Tirana and the National Institute of Public Health obtained membership to the Association of Schools of Public Health for the European Region (ASPHER). Since 2000, these two institutions have been members of the Public Health for South Eastern Europe (PH-SEE) network. Furthermore, in the fall of 2001, the Open Society Institute (OSI) and ASPHER launched a project that culminated in the establishment of a School of Public Health (SPH) and the commencement of the first Master of Public Health (MPH) programme in Tirana. The MPH programme began in December 2005 and enrolled 32 students from different backgrounds. A suitable start for the development of the MPH programme was the implementation of key modules developed by the European MPH programme. In addition, specific modules reflecting the needs of Albania were designed according to the preferences and the heterogeneous lecturing faculty involved in public health training. International guest lecturers delivered other modules, with ASPHER and the PH-SEE network offering an excellent solution for complementary modules in different public health disciplines. However, the newly established SPH in Albania should now strive for other postgraduate teaching programmes, undergraduate programmes, and especially service training and continuing education.     

National survey of working life in public health after 'Shifting the Balance of Power': results of first survey

OBJECTIVES: 'Shifting the Balance of Power' restructured public health in England by abolishing district health authorities and relocating public health in primary care trusts (PCTs). Concern at the time was focused on whether there would be adequate human and other resources available to achieve the expanded public health agenda. A survey was conducted to explore these issues. DESIGN: Postal questionnaire survey of a random sample of members and fellows of the Faculty of Public Health Medicine (FPHM; now Faculty of Public Health). METHODS: Around 8 months after April 2002, a postal questionnaire survey was sent out to members/fellows and honorary members/fellows of the FPHM. Questions asked about current job status, perception of adequacy of resources and networks, opportunities and challenges, perception of 'job strain', anxiety and depression. RESULTS: The response rate was 229/357 (64%). Respondents from PCTs responded that resources were barely adequate or totally inadequate to deliver the public health agenda (83%); public health networks were said to be adequate by 32% and inadequate by 68%. The PCT respondents were significantly more anxious and depressed than respondents from universities and other organizations, and 28% reported high workloads and low discretion ('job strain'). CONCLUSIONS: Eight months after the re-organization of specialist public health in England, there was a substantial impact on individuals working in PCTs. Financial and human resources were perceived as lacking, and levels of anxiety, depression and 'job strain' were high. Future restructuring after 'Choosing Health' must resolve major issues in capacity and capability.     

In-country and community-based postgraduate family practice training for Micronesian physicians--the Palau AHEC: a collaborative effort

The U.S. Institute of Medicine in its 1998 review of the health care systems among the U.S.-Associated Pacific Islands (USAPI) identified promotion of primary health care (PHC) and training of the regional health workforce including postgraduate training for physicians as priorities. With the support of the health leadership of the USAPI and the Republic of Palau, the John A. Burns School of Medicine (JABSOM) of the University of Hawaii captured U.S. federal Area Health Education Center (AHEC) funds to implement a postgraduate program to train Family Practitioners - physician specialists in primary care for the region. The Palau AHEC has evolved into ajoint activity of JABSOM, the University of Auckland Faculty of Medicine and Health Sciences (UAFMHS), the School of Public Health & Primary Care--Fiji School of Medicine, and Palau Community College to provide Diploma-level training in Family Practice and Community Health for Micronesian physicians.     

Information needs and uses of the public health workforce--Washington, 1997-1998

Substantial efforts have been made to ensure that state and local public health agencies have the information technology and training needed for public health communications, information access, and data exchange. Numerous public health-related data and information resources are available on the World-Wide Web (e.g., MEDLINE, MMWR, CDC Prevention Guidelines Database, and Emerging Infectious Diseases); however, little systematic work has been done to understand the information needs of the public health workforce. To identify these needs and patterns of use and to set priorities for developing new online public health information resources, the University of Washington School of Public Health and Community Medicine (UW SPHCM) and the Washington State Department of Health (WSDoH) held structured and facilitated discussions with segments of the local public health workforce in Washington during 1997-1998. This report summarizes the results of those discussions, which indicate that different segments of the public health workforce have different information needs.     

Health personnel training in the Nicaraguan health system

The "Unified National Health System" of Nicaragua was established in 1979, in an attempt to transform some of Latin America's worst health indices. This system, based on the stated principles of planning, regionalization, public participation, and primary care, has prioritized the development of health professions training programs appropriate to its special needs and principles. Public Health and Epidemiology training was inaugurated in 1982. A new campus of the School of Medicine was opened in 1981, increasing the number of medical students by a factor of five. Formal residency training (never before available within the country) in primary care specialties has been established. Training for allied health personnel has been formalized in several fields, with the establishment of the Polytechnical Institute of Health. The rapid increase in number and size of training programs has created a tremendous need for educational resources both human and material. This article reviews the status of health personnel training in Nicaragua today, the integration of these programs into planning for the health system, and problems arising from their rapid appearance.     

Development and implementation of a public health workforce training needs assessment survey in North Carolina

Assessing the training needs of local public health workers is an important step toward providing appropriate training programs in emergency preparedness and core public health competencies. The North Carolina Public Health Workforce Training Needs Assessment survey was implemented through the collaboration of several organizations, including the North Carolina Center for Public Health Preparedness at the North Carolina Institute for Public Health, the outreach and service unit of the University of North Carolina School of Public Health, the Office of Public Health Preparedness and Response in the North Carolina Division of Public Health Epidemiology Section, and local health departments across the state.     

Team Epi-Aid: graduate student assistance with urgent public health response

Team Epi-Aid provides graduate students with practical public health experience through participation in outbreak investigations and other applied projects with state and local health departments in North Carolina. It is an initiative of the North Carolina Center for Public Health Preparedness in the North Carolina Institute for Public Health at the University of North Carolina School of Public Health. The program allows state and local health departments access to volunteers and technical expertise from the university when they need assistance. It requires close collaboration with state and county health departments. Team Epi-Aid provides the opportunity for integrated learning with students and faculty within the departments of the School of Public Health, and through recent expansion, within the schools of Medicine and Pharmacy. Orientations are conducted each semester and formal training is provided as needed. Team Epi-Aid has been popular, with 58 active student participants contributing 1,465 hours of service during the initiative's first 21 months.     

The Faculty of Public Health in Sofia: activities and experiences in setting New Public Health as a national priority

The article outlines the development and recent national and international activities of the Faculty of Public Health, Medical University - Sofia (FPH, MU - Sofia). It has a leading position in public health education and research in Bulgaria and plays a key role in the introduction of the New Public Health approach to Bulgarian health system and policy. A general aim of the FPH is to build up a well-trained capacity of public health specialists and thus strengthen human recourses in the public health sphere in the country. A major objective of the FPH is to create a new generation of healthcare managers ready for the challenges of the dynamic European market of health services. During its 5-year history, the FPH has been an extremely active player on the regional and international public health stage as well as on a national level. The main priority of the FPH for the future is to guarantee public health education in harmony within the south eastern Europe (SEE) region as well as with European standards. It also strives to provide methodological support to health politicians and decision makers in Bulgaria in order to establish a socially orientated, equitable, effective and high-quality healthcare system.     

The role and approaches of the European schools of public health in improving public health managerial skills of the human resources from developing countries: Challenges into the years 2000

This paper, based on a 1996 Association of Schools of Public Health in the European Region (ASPHER) Conference working group, reviews and promotes the importance of the role and approaches of the European Schools of Public Health (SPH), particularly non-tropical Schools, in improving public health managerial skills of the human resources from developing countries. Following up on the main findings of a “Symposium on Training and Continuing Education” (1995 European Conference on Tropical Medicine), the paper points to innovative approaches to overcome the limitations of training. It recommends an interdisciplinary approach to training development adapted to each country specific needs. More attention needs to be paid by European Schools of Public Health to be the catalysts with the appropriate curricula development and selection of tools, backing up the local Developing Countries training Institutes. The latter need to be in turn the driving engines and play a central role for such efforts.     

Practice-based teaching for health policy action and advocacy

The Institute of Medicine has issued numerous reports calling for the public health workforce to be adept in policy-making, communication, science translation, and other advocacy skills. Public health competencies include advocacy capabilities, but few public health graduate institutions provide systematic training for translating public health science into policy action. Specialized health-advocacy training is needed to provide future leaders with policy-making knowledge and skills in generating public support, policy-maker communications, and policy campaign operations that could lead to improvements in the outcomes of public health initiatives. Advocacy training should draw on nonprofit and government practitioners who have a range of advocacy experiences and skills. This article describes a potential model curriculum for introductory health-advocacy theory and skills based on the course, Health Advocacy, a winner of the Delta Omega Innovative Public Health Curriculum Award, at Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland.     

Powerful connections for public health: the National Library of Medicine and the National Network of Libraries of Medicine.

As incorporated in Healthy People 2010 objectives, data and information systems and a skilled workforce are 2 of the critical components of the public health infrastructure. The National Library of Medicine (NLM) and the National Network of Libraries of Medicine (NN/LM) are important resources for improving Internet access and providing related training to the public health workforce and to those in training for public health careers. The NLM and the NN/LM have joined forces with the Centers for Disease Control and Prevention, the Health Resources and Services Administration, the Association of State and Territorial Health Officials, the National Association of County and City Health Officials, and the Public Health Foundation. The goal of this collaboration is to improve electronic resources useful in public health practice and increase awareness of them, to train public health professionals to use electronic information services, and to help public health agencies obtain the equipment and Internet connections needed to use these services effectively. The databases, outreach programs, and connection grants available to public health professionals from the NLM, and the training and ongoing support available from the NN/LM for accessing these programs and services, are described.     

Evaluation of a medical teaching programme in public health in Laos

Specialised medical training is progressively being established in Laos at the request of the Ministry of Health. A medical teaching programme in public health has been organised by the Cooperation Committee with Laos (CCL) in collaboration with the National Institute for Public Health (INSP) and has been taking place since 1997 within the framework of Franco-Laos cooperation. At the end of the validation of the second promotion of senior medical management staff (2002-2004) and of the presentation of the first Masters in Public Health in Laos, an evaluation of this training programme was carried out with the aim of completely transferring the project over to the hands of the Laotians. The study consisted of a before and after comparison of the training's procedural criteria and a longitudinal prospective survey over the last seven months of the programme. The results of the evaluation show that the development of the training conforms to the initial project and that the knowledge acquired in public health methodology by the 12 students is satisfactory. The use of the French language was revealed as being a difficult challenge to overcome for most of the students. Moreover, the partners in Laos had a difficult time playing their role in certain organisational and educational aspects of the training programme. It would be desirable, within the perspective of establishing a Masters of Public Health in Laotian, to establish a partnership between the National Institute of Public Health (INSP) and the Faculty of Medical Sciences (FSM) to work together on the organisation of the training programme. Foreign assistance remains necessary to provide essential financial and educational support.     

Building bridges between schools of public health and public health practice.

A 1988 Institute of Medicine report, The Future of Public Health, characterized the current public health system as fragmented, particularly with regard to relationships between public health agencies and academic institutions. As one response to the report, the Health Resources and Services Administration established the Center for the Development of Public Health Practice at the University of Illinois to advance linkages between schools of public health and public health agencies. Surveys of schools of public health and of state health agencies were conducted in 1992 to collect baseline data on the practice links between the two. Responses reveal that there is a substantial amount of informal collaboration between them. Formalization of collaborative activities between schools and agencies is beginning to occur and is expected to expand owing to increased focus on public health practice at schools of public health.