Education for health: case studies of two multidisciplinary MPH/MSc public health programmes in the UK

Amidst the winds of change that are blowing across the UK public health (PH) landscape in relation to the essential abilities and national standards that are required for the 'art and science' of PH, the preparation for a new cadre of 'PH professionals' is already underway. Several postgraduate masters programmes in public health (MPH) have taken on board the challenge of addressing the requisite sets of skills and expertise as a guide to their content and delivery. Although there are recommendations regarding teaching PH to undergraduate medical students, little consensus seems to exist on teaching postgraduate PH to non-medically qualified professionals, health managers and administrators. Employing a case study approach, this article analyses the methods used, philosophies and processes, structure and organization, outcomes to date, and lessons learnt from MPH programmes implemented at two institutions in the UK. The programmes have been initiated recently, and have had the opportunity to take on board the recent national guidelines about training standards. The findings indicate that preparatory work of the programmes, and the challenges and strengths in meeting the recent policy developments in PH training are pertinent points. The MPH programmes highlight key issues in interprofessional education and its purpose, its process and its outcomes in relation to multidisciplinary specialist practice. These programmes provide a variety of models for others wishing to develop or restructure their postgraduate PH teaching programmes. The finalization of the national standards for specialist practice in PH in the UK is encouraged, along with clearer working definitions of the domains of expertise required. Collectively, attention to these measures can ensure that the processes which teaching programmes embrace to refine their content and delivery will equip tomorrow's professionals with PH knowledge and skills.     

Mapping the public health workforce I: a tool for classifying the public health workforce

We aimed to develop a tool to identify members of the public health workforce and classify them using categories developed for the Chief Medical Officer's project to strengthen the public health function. The tool was developed to gain a picture of London's public health workforce, and needed to be reliable and easy to use in many settings inside and outside the health service. We needed to be able to classify posts from brief information without interrogation of postholders, so that the entire workforces of large organisations could be classified from information provided by only a few key informants. Key questions and decision rules were defined by presenting interviewees in public health with brief information on nine jobs and discussing with them the process by which they determined whether each post was in the public health workforce, and if so, in which category. The questions and decision rules were refined into a classification tool which was presented as a flow diagram and a questionnaire. Application of the tool revealed that it was understood by key informants and resulted in classifications which were accepted by the researchers. The tool has now been applied extensively in London and yielded useful results. Many other applications in public health workforce planning and development are anticipated.     

Making the case for a 'fifth wave' in public health

This paper will argue that the UK has seen several phases of public health improvement since the Industrial Revolution, and that each of these can be linked to major shifts in thinking about the nature of society and health itself. The authors are not, however, attempting to delineate firm sequences of events (or imply causality) as this would require a level of analysis of the relationship between economy, society and culture which is beyond the scope of this paper. Rather, it is suggested that each phase of health improvement can be thought of in metaphorical terms as a 'wave'. The first wave is associated with great public works and other developments arising from social responses to the profound disruptions which followed the Industrial Revolution. The second wave saw the emergence of medicine as science. The third wave involved the redesign of our social institutions during the 20th Century and gave birth to the welfare state. The fourth wave has been dominated by efforts to combat disease risk factors and the emergence of systems thinking. Although a trough of public health activity continues from each wave, none exerts the same impact as when it first emerged. This paper will discuss the complex challenges of obesity, inequality and loss of wellbeing, together with the broader problems of exponential growth in population, money creation and energy usage. As exponential growth is unsustainable on a finite planet, inevitable change looms. Taken together, these analyses suggest that a fifth wave of public health development is now needed; one which will need to differ radically from its forerunners. The authors invite others to join them in envisioning its nature and in furthering the debate about future public health.     

Building global alliances for public health nutrition training

The purpose of this paper is to present a review of opportunities and challenges for future progress in building intercountry, regional, and global alliances for public health nutrition training. Drawing on experiences from developing, implementing, and evaluating public health nutrition training in Australasia, Europe, and the Middle East, suggestions are provided for building a network of global training activities. Opportunities are described in areas such as standardization of course competencies and registration schemes, resource sharing, student and trainer exchange programs, and professional development. Challenges are identified and options presented for building global alliances in public health nutrition training into the future.     

The Swiss Health Literacy Survey: development and psychometric properties of a multidimensional instrument to assess competencies for health

Background Growing recognition of the role of citizens and patients in health and health care has placed a spotlight on health literacy and patient education. Objective To identify specific competencies for health in definitions of health literacy and patient‐centred concepts and empirically test their dimensionality in the general population. Methods A thorough review of the literature on health literacy, self‐management, patient empowerment, patient education and shared decision making revealed considerable conceptual overlap as competencies for health and identified a corpus of 30 generic competencies for health. A questionnaire containing 127 items covering the 30 competencies was fielded as a telephone interview in German, French and Italian among 1255 respondents randomly selected from the resident population in Switzerland. Findings Analyses with the software MPlus to model items with mixed response categories showed that the items do not load onto a single factor. Multifactorial models with good fit could be erected for each of five dimensions defined a priori and their corresponding competencies: information and knowledge (four competencies, 17 items), general cognitive skills (four competencies, 17 items), social roles (two competencies, seven items), medical management (four competencies, 27 items) and healthy lifestyle (two competencies, six items). Multiple indicators and multiple causes models identified problematic differential item functioning for only six items belonging to two competencies. Conclusions The psychometric analyses of this instrument support broader conceptualization of health literacy not as a single competence but rather as a package of competencies for health.     

公共卫生人才全球化视野的内涵与培养

随着中国在国际舞台上的重要性不断提高,培养具有全球化视野的公共卫生人才成为关键问题。全球化视野包括对全球政治、经济、社会发展的深入理解,对全球卫生问题的历史、现状与发展趋势的掌握,对公共卫生全球治理与公共卫生专业本身关系的理解和感悟,在多元文化环境中对多元价值的理解、适应和自我发展,以及通过外交谈判手段获得问题解决方案的能力和向全球卫生治理提供中国案例的能力。培养这些能力,既需要打造理论与实践相结合的师资队伍,选择适宜人才进行后备队伍培养和教育,也需要提供多种多样的实践与培训,如到国外留学、到国际组织或者跨国机构任职、参与中国政府对外援助项目等。     

Epidemic forecasts as a tool for public health: interpretation and (re)calibration

Objective: Recent studies have used Bayesian methods to predict timing of influenza epidemics many weeks in advance, but there is no documented evaluation of how such forecasts might support the day‐to‐day operations of public health staff. Methods: During the 2015 influenza season in Melbourne, Australia, weekly forecasts were presented at Health Department surveillance unit meetings, where they were evaluated and updated in light of expert opinion to improve their accuracy and usefulness. Results: Predictive capacity of the model was substantially limited by delays in reporting and processing arising from an unprecedented number of notifications, disproportionate to seasonal intensity. Adjustment of the predictive algorithm to account for these delays and increased reporting propensity improved both current situational awareness and forecasting accuracy. Conclusions: Collaborative engagement with public health practitioners in model development improved understanding of the context and limitations of emerging surveillance data. Incorporation of these insights in a quantitative model resulted in more robust estimates of disease activity for public health use. Implications for public health: In addition to predicting future disease trends, forecasting methods can quantify the impact of delays in data availability and variable reporting practice on the accuracy of current epidemic assessment. Such evidence supports investment in systems capacity.     

公共卫生硕士(MPH)质量保证体系初探

目的卫生人力资源不足凸显了高层次公共卫生教育的必要性,公共卫生硕士(MPH)教育是提高公共卫生人才能力的重要方面。本研究旨在探讨复旦大学MPH项目对毕业生职业生涯和所学能力的影响。方法对2006—2013年复旦大学毕业的公共卫生硕士研究生进行网上问卷调查,了解MPH学习所获对其职业生涯及公共卫生工作能力的影响。结果毕业生报告的MPH项目对毕业后公共卫生专业胜任力提高的贡献度在74.7%~96.5%之间,在全部23条公共卫生专业胜任力中有9条超过90%的毕业生认为在MPH阶段的学习对自己应用这些能力有一定或较大的帮助,还有49.5%的毕业生认为自己领导水平因此提高,33%认为个人报酬因此增加。结论本研究表明,MPH项目有助于提高毕业生的执业能力,促进公共卫生领导力的建设,同时自我认同度也获得了提升。MPH教育项目对毕业生在跨学科和实践方面的能力发展仍有改善空间。     

Moving from intersection to integration: public health law research and public health systems and services research

Context: For three decades, experts have been stressing the importance of law to the effective operation of public health systems. Most recently, in a 2011 report, the Institute of Medicine recommended a review of state and local public health laws to ensure appropriate authority for public health agencies; adequate access to legal counsel for public health agencies; evaluations of the health effects and costs associated with legislation, regulations, and policies; and enhancement of research methods to assess the strength of evidence regarding the health effects of public policies. These recommendations, and the continued interest in law as a determinant of health system performance, speak to the need for integrating the emerging fields of Public Health Law Research (PHLR) and Public Health Systems and Services Research (PHSSR). Methods: Expert commentary. Findings: This article sets out a unified framework for the two fields and a shared research agenda built around three broad inquiries: (1) the structural role of law in shaping the organization, powers, prerogatives, duties, and limitations of public health agencies and thereby their functioning and ultimately their impact on public health (“infrastructure”); (2) the mechanisms through which public health system characteristics influence the implementation of interventional public health laws (“implementation”); and (3) the individual and system characteristics that influence the ability of public health systems and their community partners to develop and secure enactment of legal initiatives to advance public health (“innovation”). Research to date has laid a foundation of evidence, but progress requires better and more accessible data, a new generation of researchers comfortable in both law and health research, and more rigorous methods. Conclusions: The routine integration of law as a salient factor in broader PHSSR studies of public health system functioning and health outcomes will enhance the usefulness of research in supporting practice and the long‐term improvement of system performance.     

Critical appraisal for public health: a new checklist

OBJECTIVES: There have been a number of attempts to develop critical appraisal tools, but few have had a public health focus. This paper describes a new checklist with public health aspects. STUDY DESIGN: Review of previous appraisal instruments and pilot test of new checklist. METHODS: Criteria of particular reference to public health practice were added to well-established appraisal criteria. The checklist was piloted with 21 public health professionals, research staff or postgraduate students. RESULTS: The checklist is organized using the 'ask', 'collect', 'understand' and 'use' categories of the Population Health Evidence Cycle. Readers are asked to assess validity, completeness and transferability of the data as they relate to: the study question; key aspects of the methodology; possible public health implications of the key results; and the implications for implementation in their own public health practice. Of the 21 public health professionals that piloted the checklist, 20 said that they found the checklist useful and 18 would use it or recommend it in the future. Participants were prepared to commit to the majority of the questions, and there was good agreement with a consensus of 'correct' answers. CONCLUSIONS: The public health critical appraisal checklist adds public health aspects that were missing from previous critical appraisal tools.     

医患双主体视角下南京地区公众健康教育的现状调查与问题分析

目的 通过现状调查了解健康中国进程以来江苏南京地区公众健康教育实施的问题和不足,为我国公众健康教育可持续发展提供积极的路径参考。方法 2020年8月至2021年6月,选取南京地区5所三甲医院,采用整群随机抽样方法,针对医患双主体人群,开展公众健康教育相关问题调查,并对调查数据进行统计分析。结果 在内容上,医患双方在涉医的公众伦理、心理、法律教育评价上呈现统计学差异(P＜0.05); 在方式上,医患在公众健康教育媒介选择上具有统计学差异(P＜0.05),医方更希望采用群体教育方式(=19.003,P＜0.001),患方更希望采取个性化教育方式(=136.196,P=0.001); 在责任上,医患对公众健康教育的责任主体评价存在差异(网络媒体=63.863,P＜0.001; 医院及医护人员=46.197,P＜0.001); 在重要性评价上,医方的概念认知水平高于患方(Z=-3.815,Z=-3.530,P＜0.001),不同学历患者在公众健康教育认知上呈现统计学差异(高中b=-0.010,大专b=-0,201,本科b=0,硕士b=0.002,博士b=0.234,P＜0.05)。结论 明确公众健康教育中的政府主导与多方合力,强化医学专业人员公众健康教育的意识和能力,提升医学教育中公众健康内容的针对性和有效性,充分利用新旧媒介的复合传播功能推进技术升级,从而形成医院、大学、政府、社会多方参与的公众健康教育发展模式。     

A review of UK housing policy: ideology and public health

OBJECTIVES: The aim of this paper is to review UK public health policy, with a specific reference to housing as a key health determinant, since its inception in the Victorian era to contemporary times. REVIEW: This paper reviews the role of social and private housing policy in the development of the UK public health movement, tracing its initial medical routes through to the current socio-economic model of public health. The paper establishes five distinct ideologically and philosophically driven eras, placing public health and housing within liberal (Victorian era), state interventionist (post World War 1; post World War 2), neoliberal (post 1979) and "Third Way" (post 1997) models, showing the political perspective of policy interventions and overviewing their impact on public health. The paper particularly focuses on the contemporary model of public health since the Acheson Report, and how its recommendations have found their way into policy, also the impact on housing practice. CONCLUSIONS: Public health is closely related to political ideology, whether driven by the State, individual or partnership arrangements. The current political system, the Third Way, seeks to promote a sustainable "social contract" between citizens and the State, public, private and voluntary organizations in delivering community-based change in areas where health inequalities can be most progressively and successfully addressed.     

建设高水平公共卫生学院，培养高层次公共卫生人才

高水平公共卫生学院建设的落脚点始终在于人才培养,要把培养什么人、怎么培养人、为谁培养人作为根本问题,对标世界一流高校,建设一流学科,培育一流人才,产出一流成果。要注重学科交叉融合,注重新发突发传染病和突发公共卫生事件应急处置的理论教学和实践训练,注重医疗机构和公共卫生机构融合,全链条培养公共卫生人才。     

To integrate or deintegrate?: Fitting public health into New Zealand's reforming health system

The relationship between public health and clinical medicinehas been the subject of international debate. In New Zealandsuccessive restructurings of the health sector have seen significantchanges in this relationship and the status of public health.The paper traces these changes over a decade of public sectorrestructuring (1984–1993) and shows how public healthpolicy and the purchasing and delivery of public health serviceshave been subject to integration, deintegration and reintegrationwith clinical and treatment services. Some advantages flowedfrom integrating policy, purchasing and delivery, includinga comprehensive approach to tackling problems through nationalhealth goals and targets. On the other hand, there is evidencethat public health was financially disadvantaged by this association.A separate public health structure, set up in 1992 and led byan independent Public Health Commission, brought some benefits.These included a specific budget and a high profile for publichealth. It also created tensions between competing policy agencies,a fragmented purchasing system for public health and exposedpublic health to political interference. This led to the abolitionof the Commission in 1995 and the reintegration of policy makingat the national level and purchasing at the regional level.At the end of 1996 a new coalition government formally abandonedthe commercial elements of its predecessor's health reforms.The new policy requires the main providers of hospital and relatedservices, which continue to include public health, to focuson health gains for their defined populations. With the integrationof policy and purchasing this should lead to the promotion ofbetter integration at the service delivery level.     

Public health in practice: the three domains of public health

This paper outlines a conceptual model for public health practice by proposing the three domains as a framework to organize and to deliver public health programmes. The model builds on the recognition that public health is everybody's business and therefore, needs a common definitional base. Different levels of skill and a wide range of contributions are needed if public health programmes are to make the most impact. The different domains of practice help to construct a basis for understanding the necessary elements of the public health system and their interactions. Using teenage pregnancy as a case study of a public health programme highlights the characteristics of the model. It demonstrates not only the importance of the role of directors of public health in taking a population-based overview, but also the need for multi-sectoral, multidisciplinary working. The relevance of the public health approach not only to primary care but also to the hospital-based sector becomes apparent, as does its relevance to communities, voluntary sector and local government. Integration of the three domains, a common definition and the framework for the public health system will support effective delivery of health improvement.     

加强政府公共财政对公共卫生事业投入的针对性和有效性

我国作为世界最大的发展中国家，根本的特征是人口多、底子薄，发展不平衡，政府对公共卫生事业发展的投入不可能参照发达国家的水平和标准，但要提高和改变现有财政投入的比率和方向，加强投入的针对性和有效性。     

公共卫生和公共卫生突发事件

该文从理论角度阐述什么是现代公共卫生观念 ,公共卫生应在公共卫生突发事件处理中发挥什么作用和怎样发挥作用 ,希望对确定我国现代公共卫生理论体系有所启发     

以胜任力为导向的公共卫生硕士校外实践培养体系的构建探索

目的 探索构建以胜任力为导向的公共卫生硕士（MPH）校外实践培养体系。方法 通过文献检索,分析国内外MPH专业学位培养模式,以胜任力为导向创新设计一个全面的、可行的MPH校外实践培养体系。结果 中山大学-广州市CDC高水平公共卫生人才培养示范基地针对实践时长2年以上的MPH探索构建了“4+N+综合评价”的实践体系,“4”代表基于实践的教学、专业实践、公共卫生项目管理参与和科研训练,分别培养MPH“公共卫生科学”“操作与实践”“人群健康管理”“卓越技能”能力。“N”代表拓展实践,培养MPH“综合能力与职业精神”能力,以综合评价来评估培养效果。结论 本研究构建以胜任力为导向的MPH“4+N+综合评价”校外实践体系,培养新时期社会需求的高层次应用型公共卫生人才。