Can public health and medicine partner in the public interest?

The dominant issues for health and health care today can be effectively engaged only if public health and medicine work together as better partners. Yet historical, professional, organizational, operational, and financial barriers exist to closer relationships. Fostering the necessary collaboration will require changes for both public health and medicine in leadership styles, professional education, practice incentives, accountability measures, and financing structures.     

How can systems engineering inform the methods of programme evaluation in health professions education?

Context

We evaluate programmes in health professions education (HPE ) to determine their effectiveness and value. Programme evaluation has evolved from use of reductionist frameworks to those addressing the complex interactions between programme factors. Researchers in HPE have recently suggested a ‘holistic programme evaluation’ aiming to better describe and understand the implications of ‘emergent processes and outcomes’.

Framework

We propose a programme evaluation framework informed by principles and tools from systems engineering. Systems engineers conceptualise complexity and emergent elements in unique ways that may complement and extend contemporary programme evaluations in HPE . We demonstrate how the abstract decomposition space (ADS ), an engineering knowledge elicitation tool, provides the foundation for a systems engineering informed programme evaluation designed to capture both planned and emergent programme elements.

Methods

We translate the ADS tool to use education‐oriented language, and describe how evaluators can use it to create a programme‐specific ADS through iterative refinement. We provide a conceptualisation of emergent elements and an equation that evaluators can use to identify the emergent elements in their programme. Using our framework, evaluators can analyse programmes not as isolated units with planned processes and planned outcomes, but as unfolding, complex interactive systems that will exhibit emergent processes and emergent outcomes. Subsequent analysis of these emergent elements will inform the evaluator as they seek to optimise and improve the programme.

Conclusion

Our proposed systems engineering informed programme evaluation framework provides principles and tools for analysing the implications of planned and emergent elements, as well as their potential interactions. We acknowledge that our framework is preliminary and will require application and constant refinement. We suggest that our framework will also advance our understanding of the construct of ‘emergence’ in HPE research.

     

Putting the public back into public health. Part II. How can public health be accountable to the public?

The practice of public health involves the application of evidence to improving population health, and should be accountable to the public. Accountability to the public can be considered either at the individual doctor-patient interface or through population-level policy making. The public, at both patient and population levels, should join the professionals at each stage of the 'population health evidence cycle'-in asking for, collecting, understanding and using evidence. A greater appreciation of the non-professional, public perspective would represent a substantial commitment to transforming our understanding and needs for different kinds of evidence required to improve the health of the population.     

Grand challenges of public health: How can health information systems support facing them?

Objectives

Achieving Universal Health Coverage (UHC) and establishing robust Civil Registration and Vital Statistics (CRVS) systems are two urgent priorities and grand challenges of global health, especially in Low and Middle Income Countries (LMICs). It is argued that addressing both these priorities requires strong supportive Health Information Systems (HIS), which to date have been elusive to develop.

Reducing social inequalities in health: public health, community health or health promotion?

While the Consortium on 'Community Health Promotion' is suggesting a definition of this new concept to qualify health practices, this article questions the relevance of introducing such a concept since no one has yet succeeded in really differentiating the three existing processes: public health, community health, and health promotion. Based on a literature review and an analysis of the range of practices, these three concepts can be distinguished in terms of their processes and their goals. Public health and community health share a common objective, to improve the health of the population. In order to achieve this objective, public health uses a technocratic process whereas community health uses a participatory one. Health promotion, on the other hand, aims to reduce social inequalities in health through an empowerment process. However, this is only a theoretical definition since, in practice, health promotion professionals tend to easily forget this objective. Three arguments should incite health promoters to become the leading voices in the fight against social inequalities in health. The first two arguments are based on the ineffectiveness of the approaches that characterize public health and community health, which focus on the health system and health education, to reduce social inequalities in health. The third argument in favour of health promotion is more political in nature because there is not sufficient evidence of its effectiveness since the work in this area is relatively recent. Those responsible for health promotion must engage in planning to reduce social inequalities in health and must ensure they have the means to assess the effectiveness of any actions taken.     

Service role of schools of public health: in between research and education?

This paper is meant to serve as a basis for discussion regarding the service or external role of schools of public health (SPHs). A number of countries in Eastern Europe are developing and establishing their own SPHs, at the same time trying to come to terms with the development of the public health function, its organisation, and its core activities in their respective countries. Although the position and the role of a school of public health cannot be seen outside the context in which it is functioning, including it's institutional setting, a thorough analysis of this context would be beyond the scope of this paper. The paper therefore concentrates on the roles of a school of public health, specifically the service role, and will seek to define that role. Further, the paper will look at how this role has been translated into the mission and policies of the SPH and how this role is operationalised. Finally, points for consideration and actions to be taken are suggested when defining the service role of a SPH.     

How do directors of public health perceive leadership?

This study examines how directors of public health (DsPH) perceive effective leadership. Kelly's repertory grid technique is used. A total of 13 out of a possible 14 DsPH in one NHS region of England were interviewed. Qualitative and quantitative analysis were carried out. The findings show that male DsPH (n = 8) rate their leadership ability more highly than do female DsPH (n = 5). Qualitative analysis produced a number of categories of constructs, some of which are perceived to be indicative of effective leadership, these being "working for others", "personal attributes", "vision and innovation" and "courage and integrity" Some categories appear to be applicable only to the UK (or to public health) and not to the existing dominant US models of leadership. In general, DsPH perceptions of effective leadership converge with current theories; most specifically the UK-based theories. This study therefore refutes any simple extrapolation of US theories of leadership to UK health organisations.     

The three domains of public health: an internationally relevant basis for public health education?

By focusing on the Masters of Public Health course, this study took a pragmatic approach to exploring the interface between public health education and public health practice. The commonly utilized 'three domains of practice' framework could provide a robust and explicit link between educational provision and practice for public health. This model provides the workforce, the university, the students and the potential funders of the course with an easily comprehensible framework for understanding how the modules of an MSc can support the development of competency within the context of practice.