Competencies Required of Public Health Professionals and Leaders Presentation at OHI/Braun SPH Summer School, Moscow July 2004 TH Tulchinsky MD MPH, Braun School of Public Health, Jerusalem

Is There a Population Health Problem in Russia? All Cause Mortality Rates Russian Federation EU(15-prior ) average CSEC(15) average CIS(12) average Nordic(5) average SDR all causes, all ages, per

Is There a Population Societal Problem in Russia? Human Development Index Israel Poland Russian Federation United Kingdom UNDP Human Development Index (HDI)

Role of PH Professional To understand and report on the scale of the health situation and to raise public and political awareness To interpret patterns of health and morbidity e.g smoking, alcohol, social dislocation To advise on what should be done, drawing on best available evidence of effectiveness of interventions from different settings e.g. folic acid, community vs. hospital care To monitor the impact of new policies, adapting them for changing circumstances McKee M. Foreword. Proceedings Conference on Developing New SPHs. Public Health Reviews, 2002;30.

Competencies Needed by Public Health Leaders Analyze health of population and risk groups Define priorities Develop planning to address the problems Make the case for action Mobilize resources needed Supervise implementation Monitor and report results Modify and sustain Study and publish reports

Interest and Capacity for Analysis, Research and Advocacy Identification of problems amenable to prevention e.g. cervical cancer, birth defects (PKU, HDN, CH, NTDs, Downs and Rubella syndromes) Awareness/access to “gold standards” Critical analysis e.g. effectiveness of screening for breast cancer, osteoporosis, Ca prostate Make the issues known to decision makers, the media, the public e.g. food fortification Fight for change when lethargy and inertia dominate e.g. food fortification Resist the “zombies” i.e. old dead stories that keep coming back e.g. immunization and autism

Understand Social Determinants of Disease and Outcomes Lifestyle issues e.g. smoking, diet, exercise Societal issues e.g. unemployment, family income Complex mechanisms e.g. transition and self image Widening social and regional inequities Crucial roles of education, pensions, social policy, political economics, health policy Partnerships to deal with complexity Analysis and monitoring What can the health system do to alleviate the negative results of individual and societal states? From Boback and Normand, Kiev conference, 2004

Political and Societal Context Shift toward market economy Reduced job and societal security Administrative decentralization (vs decapitation) Undervaluing of health e.g. health expenditures as % GDP under 3% in Russia vs. 7-9 % in industrial countries Reduced role of the state Switch from Semashko to Bismarckian models Stress on individual responsibility Role of the hospital oriented health system vs. shift to community oriented system

In the “Culture of Public Health” Ethical basis e.g pikuah nefesh Philosophical approach e.g. societal responsibility Traditions and history Evolving concepts e.g. from hygiene to NPH Problems solved e.g. water borne disease New challenges e.g HIV, chronic diseases, diabetes What works and what doesn’t Medical and population approach models Formal training - a learned culture with specific competencies

Key Roles of Schools of Public Health Training and education education Research and Analysis Analysis Service and Advocacy Advocacy

SPH and MPH Graduates Interactions Professional Needs Training/Education Science of Learning experiences Advocacy and Interventions Information Presentation Management Legislation MPH Graduate Schools of Public Health Research & Technology development Technical cooperation Direct community action Source: Varavikova EA. Proceedings of International Conference Survival and Success Analysis Prioritisation Strategy Implement Provision of service Resource allocation

Structure and Stakeholders for SPHs School of Public Health School of Public Health Ministry of Health Ministry LocalgovernmentsLocalgovernments NGOsNGOs Other Local Academic Institutions Other Local Academic Institutions UniversityAcademyFacultyUniversityAcademyFaculty FundingAgenciesFundingAgencies FacultyFaculty StudentsStudents Other health institutions institutions OtherMinistriesOtherMinistries International Academic PartnersInternational Partners

Objectives of SPHs Centers of excellence – training, research, service International standards and participation Academic independence i.e. not a function of state Attractive to students and stakeholders Sustainability Culture of quality Acceptance by graduates and faculty Accountability and reward - not by hours but program and results Internal and external peer review

Potential Contribution of Schools of Public Health  Train people (skills and competencies) to:  Analyze health system and PH problems  Develop evidence-based policies  Assist governments in re-alignment of health priorities  Work with public and private sector  Research and develop tools to deal with new issues, e.g. globalization, communications technology, internet  Continuous professional and public education  Develop policy, programs, models and actions driven by national and community needs (e.g. poverty and inequity reduction)  Create a demand for professionalism in public health

Clientele for Public Health Training and Education Undergraduate training Public health students e.g. BSc in PH Medical and nursing students Students of social sciences, biology, law etc. Students of public health management and administration Postgraduate training MPH students Students of management and administration in PH Public health residents training, e.g. occupational health Research training -MSc and PhD training Professional continuing education

Graduates: Skills and Values Values /dedication/ethics Commitment Knowledge and positive attitude Ideology Flexibility Ability to take risk and make decisions Networking and team building Staying power

Professional Continuing Education Short-term training courses in Public health management and financing Environmental health Health promotion and education Epidemiology and research methods Health economics Health ethics and law Strategic planning and health targets

Role of Research in SPHs  Set standards of evidence from past and current international experience  Identify avoidable morbidity/mortality in individual and population health  Identify individual and societal risk factors  Explore ways to prevent disease and promote health  Find the ways of improving primary prevention and delivery of health services (efficiency, effectiveness, evidence-based)  Promote quality in management in health systems

Research in SPHs Publications in local and international peer reviewed scientific journals Develop culture of peer review and a self- critical attitude (Research Forum) for students and faculty Disseminate findings to those who can benefit If in national language, abstract in English invites comment and criticism from a wider audience If funding of a SPH is tied to teaching hours, need to provide incentives and time for active research to be valued and rewarded

Service in Public Health Participation in the legislative and policy process Support, advise, and counsel PH practitioners, governments, and the public at large Work at local, national, and international level on public health practice, policy, services and their development, Initiate debate and advocacy based on their scientific knowledge, judgement, and values Zwanikken PAC. Service role of SPHs. Public Health Reviews;30:133-41

Participation in International Public Health Networks and Collaboration International standards Training – local and abroad Research – local, bilateral, multi-lateral Exchange of students and teachers Continuity and support Academic – faculty development Professional organizations Graduates – alumni organizations

Conclusion High mortality and morbidity from preventable diseases cannot be addressed without training large numbers of public health professionals Need for schools of public health in former Soviet countries, and in developing countries Evolution of Social Hygiene to a “New Public Health” Needs time, resources, international support, and adaptation from successful experience to local circumstances

Published As: Tulchinsky TH, Epstein L, Norman C [eds]. Proceedings of the International Conference on Developing New Schools of Public Health. Public Health Reviews, 2003; 30, Write to: Keynote addresses OSI/ASPHER PEER review Mission and structure of SPHs Student expectations, selection, and assessment Curriculum Service and research roles Resources for a SPH Working Groups Background resource material by Braun Faculty

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