FROM PUBLIC HEALTH FUNCTIONS TO COMPETENCIES AND CORE CURRICULUM OF TEACHING

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FROM PUBLIC HEALTH FUNCTIONS TO COMPETENCIES AND
CORE CURRICULUM OF TEACHING

• Linas umskas MD PhD
• Associate Professor
• Faculty of Public Health
• of Kaunas University of Medicine
• Kaunas, Lithuania,
• February 26, 2007

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Public Health is

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

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Public Health 1 cauld be defined as

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

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Public Health 2 cauld be defined as

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

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Public Health 2

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

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MISSION OF THE SPH / UNIVERSITY
Teaching prepare the new generation of health
professionals and update PH competencies for in
service staff aiming for better assessment of
health problems, formulating objectives,
strategies and implementing programs Research
promote academic and applied knowledge in area of
population based research and health services
research Policy assist local, regional,
national authorities and non governmental
agencies in analysis and policy needed to improve
the health status of population and high risk
groups
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FROM CORE PH FUNCTIONS TO CORE COMPETENCIES AND
CORE TEACHING CURRICULUMTHREE COMPONENTS

• 1. Core PH Functions
• 2. Core System Competencies
• Core Individual
• Competencies
• 3. Core Teaching
• Curriculum

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FUNCTIONS AND COMPETENCIES

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

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CORE PH FUNCTIONS

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

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CORE PH FUNCTIONSWHO, 2002

• Prevention, surveillance and control of
  communicable and non-communicable disease
• Monitoring the health situation
• Health promotion
• Occupational health
• Protecting environmental
• Public health legislation and regulation
• Public health management
• Specific public health services
• Personal health care for vulnerable and risk
  populations

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CORE PH FUNCTIONSEngland, 2002

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

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CORE PH FUNCTIONSAustralia, 2002

• Assess, analyze and communicate population health
  needs, expectations
• Prevent and control communicable and
  non-communicable disease, injuries through risk
  factor reduction, education, screening,
  immunization
• Promote healthy lifestyles and behaviors through
  action with individuals families, communities and
  wider society
• Promote, develop and support healthy public
  policy including legislation, regulation and
  fiscal measures
• Plan, found manage and evaluate health gain and
  capacity building programs designed to achieve
  measurable improvements in health status and to
  strengthen skills, competencies, systems and
  infrastructure
• Strengthen communities and build social capital
  through consultation, participation and
  empowerment
• Promote, develop, support and initiate actions
  which ensure safe and healthy environment
• Promote, develop and support growth and
  development through all life stages
• Promote, develop and support actions to improve
  the health status of Aboriginal and Torres Strait
  Islander people and other vulnerable groups

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

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

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CORE PH FUNCTIONS Serbia, 2003

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

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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

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CORE FUNCTIONS OF PH (Institute of Medicine,
USA, 1988 John Hopkins SPH, 1995)

• Assessment and monitoring
• Policy/Program Development
• Assurance
• Communication

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

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

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

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FROM CORE PH FUNCTIONS TO CORE TEACHING CURRICULUM

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

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COMPETENCIES

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

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COMPETENCY BASED EDUCATIONAL PLANNING

• Competency TASK

Knowledge
Attitude
Skills
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CORE COMPETENCIES FOR PH PROFESSIONALS(Council
on Linkages, USA, 2001)

• Analytic/Assessment Skills
• Policy Development/Program Planning Skills
• Communication Skills
• Cultural Competency Skills
• Community Dimensions of Practice Skills
• Basic Public Health Sciences Skills
• Financial Planning and Management Skills
• Leadership and Systems Thinking Skills

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CORE COMPETENCIES FOR PH PROFESSIONALS(Council
on Linkages, USA, 2001)

• 1. Analytical/Assessment skills
• Defines a problem
• Determines appropriate uses and limitations of
  both quantitative and qualitative data
• Selects and defines variables relevant to defined
  public health problems
• Identifies relevant and appropriate data and
  information sources
• Evaluates the integrity and comparability of data
  and identifies gaps in data sources
• Applies ethical principles to the collection,
  maintenance, use, and dissemination of data and
  information
• Partners with communities to attach meaning to
  collected quantitative and qualitative data
• Makes relevant inferences from quantitative and
  qualitative data
• Obtains and interprets information regarding
  risks and benefits to the community
• Applies data collection processes, information
  technology applications, and computer systems
  storage/retrieval strategies
• Recognizes how the data illuminates ethical,
  political, scientific, economic, and overall
  public health issues

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CORE COMPETENCIES FOR PH PROFESSIONALS(Council
on Linkages, USA, 2001)

• 2. Policy Development/Program Planning Skills
• Collects, summarizes, and interprets information
  relevant to an issue
• States policy options and writes clear and
  concise policy statements
• Identifies, interprets, and implements public
  health laws, regulations, and policies related to
  specific programs
• Articulates the health, fiscal, administrative,
  legal, social, and political implications of each
  policy option
• States the feasibility and expected outcomes of
  each policy option
• Utilizes current techniques in decision analysis
  and health planning
• Decides on the appropriate course of action
• Develops a plan to implement policy, including
  goals, outcome and process objectives, and
  implementation steps
• Translates policy into organizational plans,
  structures, and programs
• Prepares and implements emergency response plans
  
• Develops mechanisms to monitor and evaluate
  programs for their effectiveness and quality

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CORE COMPETENCIES FOR PH PROFESSIONALS(Council
on Linkages, USA, 2001)

• 3. Communication skills
• Communicates effectively both in writing and
  orally, or in other ways
• Solicits input from individuals and
  organizations
• Advocates for public health programs and
  resources
• Leads and participates in groups to address
  specific issues
• Uses the media, advanced technologies, and
  community networks to communicate information
• Effectively presents accurate demographic,
  statistical, programmatic, and scientific
  information for professional and lay audiences
• Attitudes
• Listens to others in an unbiased manner,
  respects points of view of others, and promotes
  the expression of diverse opinions and
  perspectives

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CORE COMPETENCIES FOR PH PROFESSIONALS(Council
on Linkages, USA, 2001)

• 4. Cultural competency skills
• Utilizes appropriate methods for interacting
  sensitively, effectively, and professionally with
  persons from diverse cultural, socioeconomic,
  educational, racial, ethnic and professional
  backgrounds, and persons of all ages and
  lifestyle preferences
• Identifies the role of cultural, social, and
  behavioral factors in determining the delivery of
  public health services
• Develops and adapts approaches to problems that
  take into account cultural differences
• Attitudes
• Understands the dynamic forces contributing to
  cultural diversity
• Understands the importance of a diverse public
  health workforce

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CORE COMPETENCIES FOR PH PROFESSIONALS(Council
on Linkages, USA, 2001)

• 5. Community dimensions of practice skills
• Establishes and maintains linkages with key
  stakeholders
• Utilizes leadership, team building, negotiation,
  and conflict resolution skills to build community
  partnerships
• Collaborates with community partners to promote
  the health of the population
• Identifies how public and private organizations
  operate within a community
• Accomplishes effective community engagements
• Identifies community assets and available
  resources
• Develops, implements, and evaluates a community
  public health assessment
• Describes the role of government in the delivery
  of community health services

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CORE COMPETENCIES FOR PH PROFESSIONALS(Council
on Linkages, USA, 2001)

• 6. Basic public health science skills
• Identifies the individual's and organization's
  responsibilities within the context of the
  Essential Public Health Services and core
  functions
• Defines, assesses, and understands the health
  status of populations, determinants of health and
  illness, factors contributing to health promotion
  and disease prevention, and factors influencing
  the use of health services
• Understands the historical development,
  structure, and interaction of public health and
  health care systems
• Identifies and applies basic research methods
  used in public health
• Applies the basic public health sciences
  including behavioral and social sciences,
  biostatistics, epidemiology, environmental public
  health, and prevention of chronic and infectious
  diseases and injuries
• Identifies and retrieves current relevant
  scientific evidence
• Identifies the limitations of research and the
  importance of observations and interrelationships
  
• Attitudes
• Develops a lifelong commitment to rigorous
  critical thinking

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CORE COMPETENCIES OF PH PROFESSIONALS (Council
on Linkages, USA, 2001)

• 7. Financial Planning and Management Skills
• Develops and presents a budget
• Manages programs within budget constraints
• Applies budget processes
• Develops strategies for determining budget
  priorities
• Monitors program performance
• Prepares proposals for funding from external
  sources
• Applies basic human relations skills to the
  management of organizations, motivation of
  personnel, and resolution of conflicts
• Manages information systems for collection,
  retrieval, and use of data for decision-making
• Negotiates and develops contracts and other
  documents for the provision of population-based
  services
• Conducts cost-effectiveness, cost-benefit, and
  cost-utility analyses

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CORE COMPETENCIES OF PH PROFESSIONALS (Council
on Linkages, USA, 2001)

• 8. Leadership and systems thinking skills
• Creates a culture of ethical standards within
  organizations and communities
• Helps create key values and shared vision and
  uses these principles to guide action
• Identifies internal and external issues that may
  impact delivery of essential public health
  services (i.e., strategic planning)
• Facilitates collaboration with internal and
  external groups to ensure participation of key
  stakeholders
• Promotes team and organizational learning
• Contributes to development, implementation, and
  monitoring of organizational performance
  standards
• Uses the legal and political system to effect
  change
• Applies theory of organizational structures to
  professional practice

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FROM CORE PH FUNCTIONS TO CORE TEACHING CURRICULUM

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

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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.

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RELEVANT FIELDS OF PH TEACHING (ASPHER
Criteria, 2001)

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

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CORE CURRICULUM Five Long Recognized Classical
Core Areas of PH
1. Biostatistics 2. Epidemiology 3. Social and
behavioral sciences 4. Environmental sciences 5.
Health services management
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CORE CURRICULUM Six Areas of Knowledge Considered
as Basic to Public Health(Tulchinsky T., 2000)
1. Biostatistics 2. Epidemiology 3.
Organization of public health services 4.
Environmental health sciences 5. Health services
administration 6. Social and behavioral sciences
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CORE CURRICULUM 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
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CORE CURRICULUM 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
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CORE CURRICULUM Committee on Educating PH
Professionals for 21st century, Institute of
Medicine, USA, 2003

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

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CONCLUSIONS

• PH functions and core competencies of PH
  professionals should be discussed and defined by
  EU countries
• MOCCA curriculum with integrated mobility abroad
  should be based on
• essential services/functions provided by PH
  institutions
• core competencies for PH professionals who are
  conducting these services in the country