Competencies Required of Public Health Professionals and Leaders Presentation at OHI/Braun SPH

1. 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

2. 2000 1500 1000 500 1970 1980 1990 2000 2010 Is There a Population Health Problem in Russia? All Cause Mortality Rates 990102 +SDR all causes, all ages, per 100000 Russian Federation EU(15-prior 1.05.2004) average CSEC(15) average CIS(12) average Nordic(5) average

3. Is There a Population Societal Problem in Russia? Human Development Index 998008 UNDP Human Development Index (HDI) 0.95 0.9 Israel Poland 0.85 Russian Federation United Kingdom 0.8 0.75 1970 1980 1990 2000 2010

4. 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.

5. 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

6. 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

7. 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

8. 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

9. 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

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

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

12. Structure and Stakeholders for SPHs University Academy Faculty International Academic Partners Funding Agencies Other Local Academic Institutions Ministry of Health School of Public Health Other health institutions Other Ministries Local governments Faculty Students NGOs

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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, 1-392 • 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 Write to: Tedt@hadassah.org.il

24. Thank you!