School of Public Health,The Chinese University of Hong Kong

Sian Griffiths, Josette Sin-yee Chor, Janice Yue, Fowie Ng

Multidisciplinary integration and public health training: Moving towards

undergraduate public health education

What I will cover

• The challenges for PH

• Educational recommendations

• CUHK BScPH : why we have started it and what we hope to achieve

Current challenges for Public Health

• Responding to emerging threats – Infectious disease – Environmental hazards– Obesogenic societies– Ageing populations

• Systems reform and synthesizing public health and primary care approaches

Recommendations• Basic and ongoing training in infection control, fundamental

epidemiology and public health principles for all healthcare workers

• HA should rapidly address the skills shortages in clinical infectious diseases and critical care medicine

• The Government should give a policy commitment to public health training and ensure that priority is accorded in the allocation of resources

• The Government should consider establishing a Hong Kong field epidemiology training programme as a means of rapidly establishing a cadre of specially trained infectious disease epidemiologists

• Public health training collaborations with Mainland China should be explored

Report by SARS Expert Committee, 2003

CDCs in China

Primary care

• Decades of experience tell us that primary health care is the best route to universal access, the best way to ensure sustainable improvements in health outcomes, and the best guarantee that access to care will be fair.

– M Chan, 2007

Integration of Personal and Community Healthcare

• Better alignment of a public-health approach with personal health services will achieve a better balance, but the balance since Alma-Ata has tilted towards personal health care at the expense of population health

• It is time to integrate personal health care and public health, and organise primary care on the principle of care for individuals in the context of an identified population over time. The future of primary care, and health care in general, will depend on how effectively primary practices achieve this community-oriented primary care approach and contribute to equity and social cohesion

van Weel 2008 Lancet

Primary Care in the Health System: UK• Local health services are managed by Primary Care Trusts(PCTs)

responsible for populations of about 170,000 people. PCTs are run by Boards of local professional & lay people. They have three main functions:

– Improving the health of the community, by assessing health needs, planning, tackling health inequalities, forming partnerships

– Developing primary care services, including medical, dental, pharmaceutical & optical services

– Commissioning care for their populations, in partnership with primary care ‘gatekeepers’, creating competition among NHS hospitals and private providers to win contracts to provide care for their populations

Darzi Review: Key Points

• Create an NHS that helps people to stay healthy– Our efforts must be focused on six key goals:

• Tackling obesity• Reducing alcohol harm• Treating drug addiction• Reducing smoking rates• Improving sexual health• Improving mental health

Public Health and Primary Care

Public health approach

Personal health

Public health services

Primary care services

Secondary care services

Tertiary care services

Who Is a Public Health Professional?

• A public health professional is a person educated in public health or a related discipline who is employed to improve health through a population focus.

The Health Map. Barton & Grant 2006Based on a public health concept by Whitehead & Dahlgren. The Lancet 1991

Waste management professionals, Farmers, Gardeners, Landscape Designers Architects, Traffic engineers,

Spatial planners, Electricians, Plumbers, Builders Restaurant owners,

Caterers, Transport planners, Teachers, Business owners/Employers, Engineers, Scientists

Employers, Businessmen, Bankers

Religious leaders, Local Leaders, School teachers

Doctors, Nurses, Pharmacists, Carers, Social Workers

Political and Global Leaders, Scientists, Business Leaders, Civil Servants

A sample of workforces with the potential to influence determinants of health

Public Health Team

• Multidisciplinary team

• Engage people with various interests and talents– Epidemiologist and biostatistics (mathematical modeling)

– Health educators (communication, program planning and teaching skills)

– Behavioral scientists (psychology)

– Environmental and occupational health specialists, infectious diseases (science skills)

– Health administrators (business administration, organization)

– Health policy analyst (law and ethics)

– Clinicians (primary health care nurses/ doctors)

Competency Escalator

Design Policies

Design/Guide/plan strategies

Make decisions based on interpretations of data

Give technical inputs/confirm diagnosis/analyze data/interpret data

Facilitate Process/Plan further steps/collection of data

Collect samples/perform basic tests/supply necessary remedy

Identify & confirm the info/report

Observe, Identify and report

Observation

Policy Makers /Strategic Public Health Leaders and Academics

Early/Middle level academicians/ NGOs/Early/Middle Level Administrators

Technical Specialists / Public health nurses

Auxiliary Nurse Midwife/Health Inspector

Community workers

Trained lay workers

Community Self Help Groups

Schools of Public Health Recommendation for Access to Life-Long Learning

• Schools of public health should fulfill their responsibility for assuring access to life-long learning opportunities for several disparate groups including:

– public health professionals– other members of the public health workforce– other health professionals who participate in public health

activities

Training• Who can specialise?

– The higher specialist training programme in public health is open to both qualified medical doctors and those from other public health disciplines.

• How long does specialist training take? – The typical training programme for specialising in public health is normally

five years full time. This usually includes undertaking either one year full time, or two years part time to complete an academic course to provide the essential knowledge for the discipline

UK: Areas of Specialist Practice

• Surveillance and assessment of the population’s health and well-being (including managing, analysing and interpreting information, knowledge and statistics)

• Promoting and protecting the population’s health and well-being  

• Developing quality and risk management within an evaluative culture 

• Collaborative working for health

• Developing health programmes and services and reducing inequalities

• Policy and strategy development and implementation

• Working with and for communities

• Strategic leadership for health

• Research and development

• Ethically managing self, people and resources (including education and continuing professional development)

Medical Schools—Recommendation

• The committee strongly recommends that

– all medical students receive basic public health training in the population-based prevention approaches to health

– serious efforts be undertaken by academic health centers to provide joint classes and clinical training in public health and medicine

Tomorrow’s Doctor － General Medical Council (UK,1993)

• Recommendations on undergraduate medical education– The theme of Public Health Medicine should figure

prominently in the curriculum, encompassing health promotion and illness prevention, assessment and targeting of population needs, and awareness of environmental and social factors in disease

– Public health was relevant to many parts of the curriculum and should not be compartmentalized within a public health course

Other Schools Recommendation

• All undergraduates should have access to education in public health.

Be the One to Make Be the One to Make

a a DifferenceDifference

Future Careers for Public Health Graduates

Three Domains of Public Health

Competency-Based Curriculum Design

BSc in Public Health Process Model

Public Health Jobs at Entry-level - Examples

• Government (Health Departments)– Management trainees, hospital administrator– Research scientist– Executive officer – Project assistant/ project co-ordinator/ project officer

• Non-Governmental Organisations– Program coordinators of community projects– Health educators in community health centers– Health education teachers in schools– Development and education officer– Research and development officer

Support from Senior officials

Professor Liming Li

Vice President of Chinese Academy of Medical Sciences (CAMS)/ Peking Union Medical College (PUMC);

Chairman of the Ministry of Education Steering Committee for Education in Preventive Medicine, China

“I would like to congratulate to The Chinese University of Hong Kong for its exciting launching of the BSc in Public Health, which is a great news to Hong Kong and the Asia region. It is generally recognised that public health in a country symbolizes its development and civilization, as well as the protection of population health and quality of life. Government commitment and law enforcement are just as important as high quality professions who are ready to serve. The BSc in Public Health is a timely product of economic and health globalization. Undoubtedly, it will have a great influence on health protection and promotion in Hong Kong.”

Dr York Chow, SBS, JP

Secretary for Food and Health, HKSAR Government

“Hong Kong prides herself on her public healthcare infrastructure of international standard, and public health education at the tertiary education level plays a key role in sustaining this leading edge. The School of Public Health of The Chinese University of Hong Kong has long demonstrated her unfailing dedication in providing comprehensive education, nurturing talents and carrying out research of high quality. The new Bachelor of Science in Public Health Programme of the School will further enhance competencies in various important areas of public health in Hong Kong including health protection, community healthcare and health services. Its advent would mark another important step towards improving public health in Hong Kong.”

Mr Stephen Leung

Country Manger of Pfizer Corporation Hong Kong Ltd.;

Chairman of the School of Pharmacy Advisory Board, The Chinese University of Hong Kong

“Congratulations to The Chinese University of Hong Kong for launching the new Bachelor of Science in Public Health, another new horizon for CUHK’s public health portfolio offering. Health is wealth. Investment in health is an investment in human capital. To maintain Hong Kong’s admirable healthcare statistics and economic prosperity, we need to pay attention not only to sick-care but also to health-care. Having a good public health system is the key for our future success and our gift to the next generation. With experienced faculty experts offering global perspectives, we are confident that this new programme will add enormous value to Hong Kong by developing our future professionals in this important discipline of Public Health.”

Dr Homer Tso

Immediate Past Chairman of Hong Kong Council on Smoking and Health

“Public Health is the “science and art of preventing disease, prolonging life, and promoting health through organised efforts of society”. It ahs roots in antiquity from the beginning of human civilization and is now an important concept representing a complete physical, mental and social well-being of mankind. I wish to extend my congratulations to The Chinese University of Hong Kong on the development of such a far sighted undergraduate course, which will provide a broad and sound foundation for those who are dedicated to devote themselves to becoming professionals in Public Health. In the longer run, we hope people from all walks of our community benefiting when issues such as AIDS prevention and anti-smoking are managed in the hands of well=trained professionals.”

Thank you!

Website:http://www.sph.cuhk.edu.hk

Email address:info_sph@cuhk.edu.hk