Master of Public Health Global Health Concentration Competencies: Preparing Culturally Skilled Practitioners to Serve Internationally, Nationally, and Locally

Global health is valued as an applied multidisciplinary field that provides opportunities for faculty, students, and trainees to work together with international and interprofessional partners on developing creative solutions to major global challenges.¹ Over the past decade, many universities have launched initiatives to support global health engagement by students and scholars in public health, medicine, nursing, the arts and sciences, and other areas of study.² Each discipline engaged in global health education brings its own lens to the work, including public health.

During the 2018–2019 academic year, about one in six Master of Public Health (MPH) programs accredited by the Council on Education for Public Health (CEPH) offered a concentration in global health. The program descriptions and current competencies of the 30 CEPH-accredited MPH programs offering general global health concentrations provide insight about how these programs are defining the scope of global public health practice. Some of the programs focus specifically on low-income countries and vulnerable populations such as refugees, but most have a broader perspective that explores the ways that globalization processes are changing the threats to health in populations around the world.

Most global health MPH programs emphasize their application of a social justice or health equity lens to public health, and one of the ways they operationalize that perspective is by developing the cultural knowledge, awareness, attitudes, and aptitudes to work effectively in diverse practice settings. The typical MPH concentration in global health is seeking to prepare culturally competent practitioners who have the proficiencies to address health disparities at any scale—internationally, nationally, or locally. Students are being equipped to work not only for intergovernmental agencies, multinational organizations, and multilateral partnerships but also for local health departments, nonprofit social service groups, and health care providers.

The current competencies for global health MPH concentrations reflect the knowledge and skills that are perceived to be most critical for professionals who will be working with multicultural, interprofessional teams to address the complex sets of factors that contribute to generating, exacerbating, and perpetuating health disparities. These exceptional attributes of global public health education are also apparent in the recommended competencies for MPH concentrations in global health that were released by the Association of Schools and Programs of Public Health (ASPPH) in July 2018 (see the box on page 1190).³ The ASPPH recommendations complement the 11 domains for interprofessional global health practice developed by the Consortium of Universities for Global Health^4,5 and the proficiency areas for global health education identified by other groups.⁶ However, the ASPPH recommendations are unique in their singular focus on global health education for MPH students.

Association of Schools and Programs of Public Health Recommended Competencies for Master of Public Health Concentrations in Global Health.

1 Analyze the roles, relationships, and resources of the entities influencing global health.

2 Apply ethical approaches in global health research and practice.

3 Apply monitoring and evaluation techniques to global health programs, policies, and outcomes.

4 Propose sustainable and evidence-based multisectoral interventions, considering the social determinants of health specific to the local area.

5 Design sustainable workforce development strategies for resource-limited settings.

6 Display critical self-reflection, cultural humility, and ongoing learning in global health.

Source. Association of Schools and Programs of Public Health.³

The six ASPPH global health competencies build on the 12 foundational knowledge areas and the 22 MPH foundational competencies required for all CEPH-accredited programs.⁷ Most of the ASPPH competencies call for the ability to apply general MPH knowledge and competencies in global health contexts. Competency 1 enhances foundational competencies pertaining to health care systems in national and international settings by requiring comprehension of the roles and relationships of the various entities involved in global health. Competency 3 extends foundational competencies pertaining to planning and management by applying monitoring and evaluation skills in global health practice contexts. Competency 5 builds on foundational competencies related to public health policy and leadership by engaging with public health workforce capacity building in disadvantaged countries and communities.

Mastering these concentration competencies requires a nuanced understanding of global health principles. For example, Competency 4 requires MPH students to “propose sustainable and evidence-based multi-sectoral interventions, considering the social determinants of health specific to the local area.”³ There are at least two critical underlying knowledge areas students must master before they can plan appropriate interventions: an understanding of the major causes of morbidity and mortality in countries with different income levels and an awareness of the variety of social, political, economic, environmental, biological, behavioral, and other determinants of health that contribute to the global burden of disease. While these themes align with several of the MPH foundational knowledge areas, the foundational requirements do not mandate that public health fundamentals be explored in diverse and international settings. Before global health concentrators can design complex interventions, they must understand how health and risk profiles are different in high-, middle-, and low-income countries and in various subpopulations within countries.

To work effectively with diverse populations, public health practitioners need to develop a variety of critical thinking and communication skills beyond those included among the MPH foundational competencies. Two of the ASPPH recommended competencies for global health address soft skills and the affective domain. Competency 2 calls for MPH students pursuing global health concentrations to develop skills in applied ethics. Competency 6 aims for students to display self-reflection, cultural humility, and a commitment to lifelong learning. Although all MPH students are expected to demonstrate some level of cultural awareness, global health students are expected to develop and apply cultural knowledge and skills at a higher level.

The ASPPH recommendations can be voluntarily adopted or adapted for use by MPH programs, and it is likely that many of these domains will be incorporated into future revisions of concentration competencies and curricula. However, most global health MPH programs’ existing concentration competencies already feature many of the elements of the ASPPH recommendations. The most popular current competencies include ones related to health systems and organizations, the social and environmental determinants of health, the global burden of disease, and various aspects of health equity, human rights, ethics, and culture. These are complemented by concentration competencies focused on program management, collaboration and partnerships, and leadership in diverse communities and workplaces.

Although the definition and scope of global health as an interdisciplinary field of study and practice are still evolving, there are some clear trends in how MPH programs approach education for global public health practice. Global health is not just about health in low-income countries, even though the field has a special emphasis on the health of disadvantaged communities. Global health is about understanding and responding to shared transnational human health and environmental quality concerns that affect interconnected people and populations in countries across the income spectrum. MPH concentrations in global health prepare students with foundational global health knowledge and the ethical and cultural skills required for effective public health practice around the world and close to home.