NATIONAL PUBLIC HEALTH PRIORITIES AND EDUCATIONAL NEEDS

1
NATIONAL PUBLIC HEALTH PRIORITIES AND EDUCATIONAL
NEEDS

• Linas Šumskas MD, PhD
• Assoc. Professor
• Faculty of Public Health
• of Kaunas University of Medicine
• Kyiv, July 1, 2004

2
Public Health is

• The science and art
• of preventing disease,
• prolonging life and
• promoting health through organized efforts of
  society
• Acheson Report, 1988

3
Public Health 1 cauld be defined as

• multidisciplinary
• population-based
• action oriented
• community targeted
• democracy-based

4
Public Health 2 cauld be defined as

• Those activities of government
• agencies or community groups not
• normally done by the private sector
• that improve the health status of
• the community or of individuals in
• the community.
• BJ Cassens,1992
• Preventive Medicine and Public Health

5
Public Health 2

• Second definition emphasize
• Priority of state regulation
• Concept from the top level
• Small priority in private health services

6
FROM CORE PH FUNCTIONS TO CORE TEACHING CURRICULUM

• Core PH Functions
• Core System Competencies
• Core Individual
• Competencies
• Core Teaching
• Curriculum

7
ESSENTIAL PH FUNCTIONS/SERVICES

• Terminology
• Essential/core PH functions/services
• are fundamental
• in defining PH and meeting PH goals
• Essential Core
• Functions Services

8
COMPETENCIES

• Competency
• The ability to perform an integrative task
• Knowledge, skills and abilities of organisation
  or system members

9
Competency Based Educational Planning

• Competency TASK

Knowledge
Attitude
Skills
10
COMPETENCIES

• Terminology
• Competencies being fundamental
• in defining PH and
  meeting
• PH goals
• Essential Core
• Functions Services

11
CORE PH FUNCTIONS

• United States
• England
• Canada
• Australia
• WHO
• WHO Western Pacific Region
• Pan American PH Organisation
• Serbia

12
Core Functions of PH (Institute of Medicine,
USA, 1988)

• Assessment/monitoring of the health of
  communities and populations
• Policy development in collaboration with
  community and government leaders
• Assurance appropriate and cost-effective health
  promotion and disease prevention services

13
CORE PUBLIC HEALH FUNCTIONS Public Health
Function Steering Committee, USA, 1994

14
ESSENTIAL PUBLIC HEALTH FUNCTIONS (PH Functions
Steering Committee, USA, 1994)

• Assessment
• Monitor health status to identify community
  health problems
• Diagnose, investigate health problems, health
  hazards in the community
• Policy development
• Inform, educate, empower people about health
  issues
• Mobilize community partnerships to identify and
  solve health problems
• Develop policies and plans that support
  individual and community health efforts
• Asurance
• Enforce laws, regulations that protect health,
  ensure safety
• Link people to needed personal health services
  and assure the provision of health care
• Assure a competent public health and personal
  health care workforce
• Evaluate effectiveness, accessibility, quality of
  personal and population-based health services
• Serving All Functions
• Research for new insights, innovative solutions
  to health problems

15
CORE PH FUNCTIONSEngland, 2002

1. Health surveylance, monitoring and analysis
   (outbreaks, epidemics, risks)
2. Establishing, designing, managing health
   promotion programs.
3. Enabling and empowering communities, , citizens
   to promote health and reduce inequalities.
4. Creating , sustaining cross-governmental and
   inter-sectorial partnership to improve health,
   reduce inequalities.
5. Ensuring compliance with regulations and lows to
   protect and promote health
6. Developing and maintening a well educated
   multidisciplinary public health workforce
7. Ensuring effective performance of NHS services in
   inproving health, preventing disease, reducing
   inequalities
8. Research, development, evaluation and innovation
9. Quality assurance for public health functions

16
CORE PH FUNCTIONSWHO, 2002

1. Prevention, surveylance and control of
   communicable and non-communicable disease
2. Monitoring the health situation
3. Health promotion
4. Occupational health
5. Protecting environmental
6. Public health legislation and regulation
7. Public health management
8. Specific public health services
9. Personal health care for vulnerable and risk
   populations

17
CORE PH FUNCTIONSWHO Western Pacific Region,
2002

1. Health situation monitoring and analysis
2. Epidemiological surveylance/ disease prevention
   and control
3. Development of policies and planning of PH
4. Strategic management of health systems and
   services for population health gains
5. Regulation and enforcement to protect PH
6. Human resources development and planning in PH
7. Health promotion, social participation and
   empowerment
8. Ensuring the quality of personal and
   population-based health services
9. Research, development of innovative PH solutions

18
CORE PH FUNCTIONSPan American PH Organisation,
PAHO, 2002

1. Monitoring, evaluation, analysis of health status
2. PH surveylance, research, control of risks and
   threats to PH
3. Health promotion
4. Social participation in health
5. Development of policies, institutional capacity
   for regulations and enforcement in PH definition
6. Strenghtening institutional capacity for planning
   and management in PH
7. Valuation and promotion of equitytyable access to
   health services
8. Human resource development and training in PH
9. Quality assurance in personal and population
   based services
10. Research in PH
11. Reduction of impact of emergencies on the health

19
CORE PH FUNCTIONS Advisory Committee on
Population Health, ACPH, Canada, 2001

• Population health assessment
• Health surveillance
• Health promotion
• Disease and injury prevention
• Health protection

20
CORE PH FUNCTIONSAustralia 2002

1. Assess, anlyze and communicate population health
   needs, expectations
2. Prevent and control communicable and
   non-communicable disease, injuries through risk
   factor reduction, education, screening,
   imunisation
3. Promote healthy lifestyles and behaviours through
   action with individuals families, communities
   and wider society
4. Promote, develop and support heakthy public
   policy including legislation, regulation and
   fiscal measures
5. Plan, found manage and evaluate health gain and
   capacity building programs designed to achieve
   measurable improvemnets in health status and to
   strenghten skills, competencies, systems and
   infrastructure
6. Strenghten communitoes and build social capital
   through consultation, participation and
   empowerment
7. Promote, develop, support and initiate actions
   which ensure safe and healthy environment
8. Promote, develop and support growth and
   development through all life stages
9. Promote, develop and support actions to improve
   the health status of Aboriginal and Torres Strait
   Islander people and other vulnerable groups

21
CORE PH FUNCTIONS Serbia, 2003

• Health Promotion
• Disease prevention
• Health protection
• Surveylance
• Population health assessment
• Intersectorial collaboration

22
Six Core Competencies of PH Professionals(PH
Faculty/Agency Forum, USA)

• Analytical skills
• Communication skills
• Policy/program development skills
• Cultural skills
• Basic Public Health Science Skills
• Management, financial planning skills

23
Core Competencies of PH Professionals(PH
Faculty/Agency Forum, USA)

• Analytical skills
• Define PH program
• Determine apropriate use of data, statistical
  methods for problem identifivcation and solution
• Select and define variables relevant to PH
  problems
• Evaluate the data, their quality and gaps
• Understand how data illuminate ethical, political
  economical sides of PH issues
• Make relevant inferences from data

24
Core Competencies of PH Professionals(PH
Faculty/Agency Forum, USA)

• Communication skills
• Communicate effectively writing and orally
• Present accurately demographic, statistical,
  program, scientific information for professionals
  and lay audience
• Solicit inputs from individuals and organisations
• Advocate for PH programs and resources
• Leadand participate in groups to address specific
  issues
• Use media to communicate important public health
  information
• Make relevant inferences from data

25
Core Competencies of PH Professionals(PH
Faculty/Agency Forum, USA)

• Policy Development/Program Planning Skills
• Collect and sumarize data relevant to the issue
• State policy options
• Agriculture health, fiscal, administrative,
  legal, social and political implementations of
  each policy option
• Write a clear and concise policy statements
• Develop the plan to implement the policy (goals,
  outcomes, process objectives and implementation
  steps)
• Translate policy into organisational plans,
  structures, programs
• Identify PH laws, regulations, policies related
  to specific programs
• Develop mechanisms to monitor, evaluate programs
  for their effectiveness and quality

26
Core Competencies of PH Professionals(PH
Faculty/Agency Forum, USA)

• Cultural skills
• Understand forces for cultural diversity
• Interact sensitively, effectively and
  professionally with persons from diverse
  cultural, socioeconomical, educational,
  professional backgrounds, with persons of all
  ages and preferences
• Identify the role of cultural and behavioral
  factors in determining disease, in disease
  prevention, health promoting behaviour, and
  service organisation , delivery
• Develop and adapt approaches to problems that
  take into account cultural diffrences

27
Core Competencies of PH Professionals(PH
Faculty/Agency Forum, USA)

• Basic PH Science Skills
• Define, assess and understand health status of
  population, determinants of health and illness,
  factors contributing to health promotion and
  disease prevention, factors influencing the use
  of health services
• Understand research methods in all basic PH
  sciences
• Apply the basic PH sciences (behavioral and
  social sciences, biostatistics, , epidemiology,
  environmental PH, prevention of chronic disease
  and injury)
• Understand the historical development and
  structure of state, local and national public
  agencies

28
Core Competencies of PH Professionals(PH
Faculty/Agency Forum, USA)

• Financial Planning and Management Skills
• Develop and present budget
• Mange programs with budgetary constrains
• Develop strategies for determining budget
  priorities
• Monitor program performance
• Prepare proposals for funding from external
  sources
• Apply basic human relation skills to the
  management of organizations, resolution of
  conflicts
• Manage personnel
• Understand the theory of the organizational
  structure and its relation to organizational
  practice

29
FIVE LONG RECOGNIZED CLASSICAL CORE AREAS OF PH
1. Biostatistics 2. Epidemiology 3. Social and
behavioral sciences 4. Environmental sciences 5.
Health services management
30
CORE CURRICULUM (ASPH, USA, Roemer M., 1999)

• Basic tools of social analysis
• Health and disease of population
• Promotion of health and disease prevention
• Health care systems and their management

31
RELEVANT FIELDS OF PH TEACHING (ASPHER
Criteria, 2001)

• Tools for measurement of health of population
• Main determinants of health in individuals and
  populations
• 3. Intervention to change health
• 4. Health policy, advocacy from national to
  global levels

32
RELEVANT FIELDS OF PH TEACHING (ASPHER
Criteria, 2001)

• 1. Tools for measurement of health of population
• describtive and etiological epidemiology,
• epidemiological, statistics techniquesfor
  assesing interventions
• istruments for measuring health, disease,
  quality of life
• 2. Main determinants of health of individuals
  and populations
• environmental and occupational factors
• socio-economic factors
• lifestyle, behavior
• genetic factors

33
RELEVANT FIELDS OF PH TEACHING (ASPHER
Criteria, 2001)

• 3. Intervention to change health
• environmental monitoring of physical
  environmental
• health promotion at population level
• personal health promotion, behavioural change
• provision of health services

34
RELEVANT FIELDS OF PH TEACHING (ASPHER
Criteria, 2001)

• 4. Health policy, advocacy, from national to
  global levels
• health policy structures
• structures of public health services
• health service finance and organisation
• evaluation of policy and programmes

35
Core Areas and Scope of European Master in
European Public Health (EMEPH) Teaching
Program(ASPHER, 1999)
1. PH in Europe 2. Health policy and
management 3. Epidemiology and biostatistics 4.
Health promotion/health education and social
sciences 5. Environment and health
36
EIGHT FUTURE" AREAS IN PH TRAINING (Committee
on Educating PH Professionals for 21st century,
Institute of Medicine, USA, 2003)
1. Informatics 2. Genomics 3. Communication 4.
Cultural competence 5. Community based
participatory research 6. Global health 7. Policy
and law 8. Public health ethics
37
EIGHT FUTURE" AREAS IN PH TRAINING (Committee
on Educating PH Professionals for 21st century,
Institute of Medicine, USA, 2003)

• Recommendations
• Competencies be identified
• Each area included into PH training
• Continuing development of knowledge
• Opportunity for specialisation be offered

38
CONCLUSIONS

• Essental PH functions in the country be defined
• 2. Core curriculum of SPH should be based on
• a) core PH functions (country
  specific)
• b) core competencies (country
  specific)