Shaping public health education around the world to address health challenges in the coming decades

Schools of public health and related training institutions are increasing in number.¹ This month’s Bulletin theme issue provides a platform to address important issues in public health education.²

How well-equipped are graduates to understand, advocate and catalyse the change towards better health? Can they design better and more equitable health systems, provide clinical- or population-based services that reach out and meet different sub-populations’ needs, including those who are marginalized, neglected or socially excluded? Can they push the boundaries of what contributes to and shapes differential population health outcomes, and work together to negotiate pro-health policies across sectors and interest groups at global and district levels? Can they bring public health values^3,4 to profit-driven international management consulting firms?

Public health graduates are influenced by their schools and institutions, yet it is the conditions of practice that will enable graduates to perform. Just as students shop around for programmes that will advance their careers most, employers recruit staff who are most likely to contribute to their organization’s goals. In this dynamic context, schools of public health have the responsibility to attract and equip diverse students, including health workers, so that they can be better public health professionals. These include ministry of health staff who want to document how well their health system performs and how better to implement national policies, and a range of others whose daily work impacts in some way on public health. How schools manage responsibilities, opportunities and demands in different national contexts and national health systems and how they increase their meaningful links to regional or global networks are therefore critical to a school’s relevance, quality and competitiveness.

The global nature of health raises many challenges and opportunities for public health training themes and new information tools. The phenomenon of placing global health within the sphere of foreign policy has catalyzed new partnerships and training programmes to equip graduates with health diplomacy skills. Ilona Kickbusch et al. report on innovative programmes that link foreign policy to health as a collaborative learning exercise. Increasing the reach and relevance of vast Internet resources addressing health can yield multiple gains in terms of quality review and capacity-building networks; this theme is addressed by Richard Heller et al.

Increasing the numbers of public health professionals in Africa is an urgent priority and is a challenge for the African region and the international community given the multiple forces that shape the flows, competencies and career paths of professionals. Carel IJsselmuiden et al. document characteristics of postgraduate public health training programmes in 22 African countries. Kebogile Mokwena et al. discuss innovative approaches used by South Africa’s National School of Public Health, such as its online learning methods, to increase the school’s impact on graduates to address health issues relevant in Africa.

Currently, public health education programmes are densely concentrated in high-income countries. Not only do these schools continue to train large numbers of students from low- and middle-income countries, but they also promote innovations and partnerships in their national contexts that document what is possible, given that schools, associations of schools and public health institutes around the world share some similar challenges. Fiona Sim et al. describe strategies used in England since the 1990s to transform the public health workforce dominated by medical professionals to a much wider mix of professionals who can address and improve population health. Within the Swiss national context of rising health costs and increasing inequalities, Ursula Ackermann-Liebrich et al. discuss a 10-year effort to bring together Swiss schools of public health across different cantons, language groups and areas of expertise, such as health economics or surveillance methods, to better equip students to make a difference in the organization of health services throughout the country.

In the Bulletin’s public health classic, Elizabeth Fee and Liping Bu provide a retrospective look at the different models of public health education and the creation of schools of public health in the early decades of the 20th century, drawing on the Welch-Rose Report of 1915 presented to the Rockefeller Foundation.⁵

We hope the lively round table discussion with deans and directors of schools of public health will provide a forum for debate and show the diverse ways schools in many different settings are shaping training, research and practice to reach an appropriate balance between the science and art of public health.

This theme issue is intended to stimulate more schools and related programmes and associations to submit evaluated innovations, practices and tools that drive public health education, including student-led research, towards improving population health and health equity. We look forward to additional contributions from students, faculty, deans, civil society and professional organizations to be published during 2008 as part of the Bulletin’s commemoration of WHO’s 60th anniversary. ■