Editorial: Education for a Public Health Workforce in Europe and Globally

The State of Public Health Education and Science During and After the Fall of the Soviet Union: Achievements, Remaining Challenges, and Future Priorities

Objectives

In the post–COVID-19 world, when the adequacy of public health workforce education is being critically re-evaluated, this study undertakes a historical analysis of how the educational and scientific field of public health developed during and after the fall of the Soviet Union in 1991. The study intends to historically contextualize public health education and science development in former Soviet Republics. It attempts to document achievements after gaining independence and identify remaining challenges that need to be addressed for advancing public health science and education in Former Soviet Union countries to better prepare them for future pandemics and address current health challenges of the nations.

Methods

The study used a mixed-methods review approach combining both a literature review, information collection from the school's websites, and secondary analysis of the quantitative data available about scientific outputs—peer-reviewed articles.

Results

During communist rule and after the fall of the Soviet Union, the main historical events seem to have shaped the public health field of former Soviet countries, which also determined its eventual evolution. The international efforts post-1991 were instrumental in shifting medically oriented conceptualization of public health toward Western approaches, albeit with variable progress. Also, while scientific output has been growing from 1996 to 2019, sub-regional differences remain prominent.

Conclusion

The region seems to have matured enough that it might be time to start and facilitate regional cooperation of public health schools to advance the field of public health and research. Regional and country variabilities feature prominently in the volume and quality of scientific output and call for the immediate attention of national governments and international partners.

Establishing undergraduate public health education: process, challenges, and achievements in a case study in Israel

BACKGROUND

In this paper, we describe the development process of the first undergraduate public health baccalaureate program, in the Ashkelon Academic College in Israel. Expansion of degree-granting colleges in Israel is part of the democratization of higher education providing access to and increasing educational opportunities for groups underrepresented in universities. The main objectives of the program at Ashkelon Academic College have been to open accessible and affordable career opportunities for current workers in the health system and for new entries to health careers for academic advancement in a peripheral and relatively poor region of the country.

CASE PRESENTATION

The program focuses on well-established and literature-based learning goals of public health education but also includes basic medical sciences, incorporation of arts and sciences into public health, development of critical thinking and quantitative skills, experiential field learning, and integrative learning for facing global health challenges. The curricula of the program is composed of seven modules including introductory courses, methodology courses, health organization courses, epidemiology courses, courses related to core content of public health, elective courses and practicum. The first class will graduate in 2017; this will allow for final approval of the Council of Higher Education of Israel and possible revision of curriculum. A second BA program is now seeking approval in Israel and cooperation with post-graduate schools of public health is developing.

CONCLUSIONS

Our program is in keeping with trends in Europe and the USA to broaden public health education, to reduce inequality of career opportunity, to expand the workforce, and to promote public health.

Integrating ethics in public health education: the process of developing case studies

The study of ethics in public health became a societal imperative following the horrors of pre World War II eugenics, the Holocaust, and the Tuskegee Experiment (and more recent similar travesties). International responses led to: the Nuremberg Doctors' Trials, the Universal Declaration of Human Rights (1948), and the Convention on Prevention and Punishment of the Crime of Genocide (CCPCG, 1948), which includes sanctions against incitement to genocide. The Declaration of Geneva (1948) set forth the physician's dedication to the humanitarian goals of medicine, a declaration especially important in view of the medical crimes which had just been committed in Nazi Germany. This led to a modern revision of the Hippocratic Oath in the form of the Declaration of Helsinki (1964) for medical research ethical standards, which has been renewed periodically and adopted worldwide to ensure ethical research practices. Public health ethics differs from traditional biomedical ethics in many respects, specifically in its emphasis on societal considerations of prevention, equity, and population-level issues. Health care systems are increasingly faced with the need to integrate clinical medicine with public health and health policy. As health systems and public health evolve, the ethical issues in health care also bridge the gap between the separation of bioethics and public health ethics in the past. These complexities calls for the inclusion of ethics in public health education curricula and competencies across the many professions in public health, in the policy arena, as well as educational engagement with the public and the lay communities and other stakeholders.

Human Resources for Health

A health system is an expensive knowledge-based industry made up of professionals, paraprofessionals, and administrative and support personnel. Human resources to provide and manage public health and clinical services are crucial to developing and sustaining national and global health systems. High-income countries are replete with highly trained and motivated personnel, but face issues such as increasing costs of care for aging populations and using new categories of health workers. Low-income countries face severe human resource shortages as training programs are underdeveloped. Health workforce issues include urban–rural differentiation, promoting standards and quality of care, specialization versus primary care, tensions between public and private health systems, and integrating new health professions. Migration of health professionals from low-income to high-income countries hampers the buildup of a critical mass of leaders, providers, and teachers to expand the capacity of health systems. Strategic policies are crucial to this field.

Education and training of public health professionals in the European Region: variation and convergence

OBJECTIVES

To assess the exit competences of public health graduates across a diverse European landscape.

METHODS

The target population comprised 80 full institutional members of the Association of Schools of Public Health in the European Region with a participation rate 82.5 %. The web-based questionnaire covered institutional profiles and the ranking of exit competences for master of public health programmes, grouped according to WHO Essential Public Health Operations.

RESULTS

European schools and departments usually are small units, funded from tax money. A total of 130 programmes have been indicated, together releasing 3,035 graduates in the last year before the survey. All competence groups showed high reliability and high internal consistency (α > 0.75, p < 0.01). The best teaching output has been assessed for health promotion, followed by disease prevention and identification of health hazards in the community, the least in emergency preparedness.

CONCLUSIONS

Given the fragmentation of the institutional infrastructure, the harmonisation of programme content and thinking is impressive. However, the educational capacity in the European Region is far from being sufficient if compared to aspired US levels.