Some items on global public health and training for health professionals

What's Next for Disease Eradication?
It has been more than 30 years since the eradication of smallpox - a disease responsible for as many as 2 million deaths a year and many more disfigured. In August approximately 260 of the scientists and public health leaders responsible for this success met in Rio de Janeiro to celebrate. That success 30 years ago bolstered thoughts about eradication of other such diseases responsible for such pain and suffering. Among the targets were polio, guinea worm disease, lymphatic filariasis, measles, river blindness, and malaria. Regretfully, the success with smallpox has not been repeated. Science magazine summarizes some of the issues raised at a meeting in Frankfort, Germany. At this meeting public health experts tried “to try to chart a new path for disease eradication in the 21st century.” Read the full Science article – “What’s Next for Disease Eradication?”

An Interactive Map of U.S. Global Initiatives

The Center for Global Development’s - Rethinking U.S. Foreign Assistance blog has provided access to a terrific interactive tool that allows users to see where four of the current development initiatives operate. These include: Feed the Future, the Global Health Initiative, the Millennium Challenge Corporation, and the United States President’s Emergency Plan for AIDS Relief (PEPFAR). Casey Dunning, in her blog entry “U.S. Development Initiatives: Where in the World Are They?” reports “President Obama’s recent policy directive on U.S. global development called for an increased 'focus of resources, policy tools, and engagement in support of select countries.' But the question as to where this 'enhanced engagement' might occur still remains.”

Infant and Child Feeding - How are we doing?

In 2003 the World Health Organization and UNICEF jointly developed Global Strategy for Infant and Young Child Feeding to “revitalize world attention to the impact that feeding practices have on the nutritional status, growth and development, health, and thus the very survival of infants and young children.” This strategy was the result of a two-year effort designed to alleviate the burden of disease borne by children and to contribute to a reduction in poverty and was guided by two underlying principles: 1) the strategy should be grounded on the best available evidence; and, 2) wherever possible the strategy should result from a truly participatory process. However, a report released in December suggests that 42 million infants out of 78 million born are sub-optimally fed. This report, “The State of Breastfeeding in 33 Countries: 2010, Tracking Infant and Young Child Feeding Policies and Programmes Worldwide” is based on assessments conducted by the World Breastfeeding Trands Initiative (WBTi). WBTi’s press release accompanying this report states “that policies and programmes are lagging behind in all the 10 areas of action highlighted in the W.H.O. ’s Global Strategy for Infant and Young Child Feeding, especially in relation to support to women when they need it most.”

Defining Global Public Health

In 2010 Dean Linda Fried (Mailman School of Public Health) and six colleagues published a comment in Lancet entitled “Global health is public health” partly in response to an earlier viewpoint piece by Professor Jeffrey Koplan and colleagues – Towards a common definition of global health.” I highly recommend both of these articles but I was particularly struck by the seven key tenets of global public health as outlines in Fried and colleagues (page 536). And among these seven, the one that rings clearest for me was “Dedication to better health for all, with particular attention to the needs of the most vulnerable populations, and a basic commitment to health as a human right.” This for me has always been at the core of my understanding of public health’s mission. The need to provide the best state-of-the-art practice in public health at the population level, with the two underlying principles – social justice and equity. The challenge for me has always been how to we effectively train practitioners to this end. The best definition of education I ever heard (and cannot remember its source), is “Education is what’s left over after we forget everything we’ve been taught.”

Educating Health Professionals In The 21st Century

In that light, I am impressed with a Lancet Commissions Report released a couple of months ago. Just as Flexner, Welch-Rose, and Goldmark prepared reports a century ago that transformed education for physicians, public health practitioners, and nurses, this new report re-examines the training of health professionals for the 21^st century. This Lancet Commission report is authored by Professor Julio Frenk, Dean of Harvard School of Public Health, Dr. Lincoln Chen, China Medical Board, and colleagues. A press release, dated Nov. 29, 2010 summarizes the ten suggested reforms found in this landmark report. The full report is available from Lancet. In their executive summary Frenk, Chen and colleagues introduce us to the notion of third-generation reforms in health professions education with this challenge:

“All health professionals in all countries should be educated to mobilise knowledge and to engage in critical reasoning and ethical conduct so that they are competent to participate in patient and population-centered health systems as members of locally responsive and globally connected teams. The ultimate purpose is to assure universal coverage of the high- quality comprehensive services that are essential to advance opportunity for health equity within and between countries” (page 6).

The authors go on to identify the principle barriers and recommendations to help overcome those barriers. I highly recommend this report.