Topic outline

  • General

    Foundations of Public Health - open for public access

    This course is designed to provide an overview of what is Public Health and some of its main components. It is particularly directed at those with an interest in health problems in developing countries. You will find that we emphasise the importance of creating and applying an evidence base to finding solutions to the health problems facing populations. 

    While this is a stand-alone course and available to all, we also see it as a pre-requisite for those who wish to enrol in further studies with Peoples-uni, which can lead to a Master of Public Health degree. Working through this module will give you an idea of the structure and type of content you will find as a student. [You might also like to look at some not-for-credit freely available courses on our Open Online Courses site.]

    Introduction to Public Health.

    The challenges for Public Health are eloquently described in 'Disease Control Priorities in Developing Countries': "Between 1950 and 1990, life expectancy in developing countries increased from forty to sixty-three years with a concomitant rise in the incidence of the non-communicable diseases of adults and the elderly. Yet there remains a huge unfinished agenda for dealing with under-nutrition and the communicable childhood diseases. Four critical challenges face developing countries today: high levels and rapid growth of non-communicable diseases; the unchecked HIV/AIDS pandemic; the possibility of a successor to the influenza pandemic of 1918; and the persistence of high but preventable levels of diseases such as malaria, tuberculosis, diarrhoea, and pneumonia for which malnutrition is a critical risk factor." (Note: this quote is from the 2nd edition, DCP2 - DCP3 will update many of the chapters)

    Meeting these challenges to the health of the population is the task of Public Health. This course, Foundations of Public Health, is designed to set the scene for those who want to learn more about how to improve the health of their populations.

    Navigating the demonstration module.

    In this demonstration module, you will find 7 main sessions. Each will include a set of resources and readings, as well as links to further resources for you to access and read yourself. Each session of a regular module includes a Discussion forum for you to discuss with fellow students and tutors to see if you have grasped the main points. You would also be expected to provide references in your contributions. Although we have included a discussion in each section of this demonstration module, we have set it so that no-one can enroll in the discussions as they are not moderated, and we ask you to reflect rather than post to a forum. Regular Peoples-uni modules also include quiz questions and the key resources placed in zip files for those with limited Internet access. Regular courses also have assignments!

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    • Session 1

      What is Public Health

      This session aims to help you develop an in-depth understanding of the role and relevance of Public Health today. You should be able to::

      • identify the definition and roles of Public Health which are relevant to your own setting and
      • discuss how examples of successful examples of Public Health approaches to disease control might be applied in your setting

      There are many definitions of Public Health, and we will see a number of them during this introductory module, but here is something to start with:

      The role of public health
      is to ‘contribute to the health of the public through assessment of health and health needs, policy formulation, and assurance of the availability of services’. (Institute of Medicine (1988) The future of public health. Institute of Medicine, Washington, DC.)

      'Public health is about improving and protecting the health of groups of people, rather than about treating individual patients.' - from the UK Faculty of Public Health.

      Other than the definitions given above, here is another one: "Use of theory, experience and evidence derived through the population sciences, to improve the health of the population in a way that best meets the implicit and explicit needs of the community (the public)" - this definition is designed to help Public Health practitioners interpret their role (and thus their educational requirements) (Heller et al Public Health 2003:117;62-5). As we will see in the various Topics in this module, the area is challenging as practitioners require many skills - all required to understand and improve the health of the population.

      The population is the focus of Public Health, and this resource from the Public Health Agency of Canada provides an excellent summary of What is the population health approach, which can be found on the site you have just looked at from the Public Health Agency of Canada, defines the key elements of the population health approach - 1. Focus on the health of populations; 2. Address the determinants of health and their interactions; 3. Base decisions on evidence; 4. Increase upstream investments; 5. Apply multiple strategies; 6. Collaborate across sectors and levels; 7. Employ mechanisms for public involvement; 8. Demonstrate accountability for health outcomes.

      The goal of Public Health is to improve the health of populations, and this chapter from the online Disease Control Priorities in Developing Countries has an excellent chapter on improving the health of populations: lessons from experience. (Note: this chapter is from the 2nd edition - DCP3 will update many of the chapters)

      Primary Health Care has been a strong 'relative' of Public Health, in fact a key component of improvements in Public health will be improvements in primary health care. This is recognised by the World Health Organisation, whose 2008 World Health Report is called 'Primary Health Care -now more than ever'. You can see the overview of the report here.

      Further:
      Going 'back' one stage, we might also want to think about what is 'health' - here are a series of audio lectures from the Johns Hopkins School of Public Health (whose Open CourseWare series are freely available through the Internet and which we use consistently in Peoples-uni modules). We suggest you might want to listen to the first lecture, where part A defines health (feel free to browse the other lectures if you wish). 

    • Session 2

      The need for an evidence base - Evidence based Public Health.

      This session aims to help you apply knowledge and understanding to the methods of obtaining evidence that underpin Public Health. You should be able to:

      • develop an understanding of the 'population approach' and the main methods of measuring the health of a population
      • assess the ways in which interventions can be introduced to reduce the burden of illness
      • discuss the barriers to the introduction of an evidence base to the practice of Public Health

      We are probably all familiar with the notion of 'Evidence-Based Medicine', EBM, the term having been expanded to Evidence-Based Practice to go beyond clinical practice. An evidence base for Public Health is as important as it is for individual patient care in clinical practice - in fact probably more so since a Public Health policy may affect many thousands of individuals. One of the main differences is that it is much easier to design and undertake a randomised controlled drug trial amongst patients (in fact EBM has been termed Pharmaceutical Based Medicine as so much of EBM deals with pharmaceutical agents), than it is to design high quality research into population-based interventions and collect evidence. Here are some links to resources which discuss this issue in some detail.

      Need for Evidence Based Practice
      From Evidence-based Medicine to Evidence-Based Public Health
      The Public Health Information and Data Tutorial from the Public Health Partners is an excellent overview of the relationship between Evidence Based Medicine and Evidence Based Pubic Health, and the importance of the topic.

      Evidence Based Policymaking (EBP)

      (From UK Overseas Development Institutue: Evidence Based Policymaking: Lessons from the UK for developing countries)

      "The idea of using evidence to inform policy is not a new idea......

      Why does it matter for developing countries?

      This matters even more for developing countries. Better utilization of evidence in policy and practice can help save lives, reduce poverty and improve development performance. For example, the Government of Tanzania has used the results of household disease surveys to inform health service reforms that helped reduce infant mortality by 40 per cent. However, the HIV/AIDS crisis has deepened in some countries because governments have ignored the evidence of what causes the disease and how to prevent it spreading. In developing countries, the challenges of evidence-based policy are significantly greater that in the North. Social and political environments are more difficult. Capacity is much more limited and resources are scarcer."

      Evidence based Public Health - presentation from the Epidemiology Supercourse. This presentation, one of those from the vast array available from the Epidemiology Supercourse, contrasts the evidence requirements of clinical and Public Health practice, and gives some examples relating to cesarean section.


      The population approach.
      As you will see in other parts of this module, and more clearly in other modules from the Peoples-uni, there is a real science in the study and application of evidence to populations. Here, we just give a flavour.

      Measuring the burden of illness on the population

      There are a number of ways of measuring the impact of illness on a population, and the Global Burden of Disease measure as described on the WHO web site gives details of one important method.

      Population based interventions are well described by the Public Health Agency of Canada on their web site. This is from part of it:

      "Prevention of health problems (e.g., disease, injury) occurs at three levels:

      • Primary prevention involves activities aimed at reducing factors leading to health problems.

      • Secondary prevention activities involve early detection of and intervention in the potential development or occurrence of a health problem.

      • Tertiary prevention is focused on treatment of a health problem to lessen its effects and to prevent further deterioration and recurrence.

      Because injury, chronic illness, infectious diseases, acute trauma and other health problems can significantly impact the population, population based prevention strategies are warranted. Prevention activities occur primarily in the health care, public health and primary care systems.

      Since the factors leading to health problems are complex and include for example behavioural, socio-economic, cultural and other influences, the population health approach provides a framework for developing prevention strategies where all the determinants of health and their interactions are considered."

      Public health interventions are defined by Rychetnik and Frommer as "organised activities intended to promote or protect health or prevent ill health in communities or populations, and are often directed at determinants of health (or ill health). They are distinguished from clinical interventions, which are intended to prevent or treat ill health in individuals. Public health interventions may include the following (singly or in combinations):

      • government policy at local, state or national level

      • legislation and regulation

      • organisational development (including organisational policy)

      • community development

      • education (which could have a variety of intended outcomes from behaviour change in communities to professional skill development)

      • engineering and technical developments (such as clean-water supply systems)

      • service development and delivery

      • communication (including social marketing)."

      The population approach to prevention is well described in the World Health Report for 2002. http://www.who.int/whr/2002/chapter5/en/index2.html

      Another part of the World Health Report summarises the population approach nicely - partly reproduced below:

      Population-wide strategies for prevention: from the World Health Report

      "It makes little sense to expect individuals to behave differently from their peers; it is more appropriate to seek a general change in behavioural norms and in the circumstances which facilitate their adoption." -- Geoffrey Rose, 1992.

      The distribution and determinants of risks in a population have major implications for strategies of prevention. Geoffrey Rose observed, like others before and since, that for the vast majority of diseases "nature presents us with a process or continuum, not a dichotomy". Risk typically increases across the spectrum of a risk factor. Use of dichotomous labels such as "hypertensive" and "normotensive" are therefore not a description of the natural order, but rather an operational convenience. Following this line of thought, it becomes obvious that the "deviant minority" (e.g. hypertensives) who are considered to be at high risk are only part of a risk continuum, rather than a distinct group. This leads to one of the most fundamental axioms in preventive medicine: "a large number of people exposed to a small risk may generate many more cases than a small number exposed to high risk". Rose pointed out that wherever this axiom applies, a preventive strategy focusing on high-risk individuals will deal only with the margin of the problem and will not have any impact on the large proportion of disease occurring in the large proportion of people who are at moderate risk. For example, people with slightly raised blood pressure suffer more cardiovascular events than the hypertensive minority. While a high-risk approach may appear more appropriate to the individuals and their physicians, it can only have a limited effect at a population level. It does not alter the underlying causes of illness, relies on having adequate power to predict future disease, and requires continued and expensive screening for new high-risk individuals.

      In contrast, population-based strategies that seek to shift the whole distribution of risk factors have the potential to control population incidence. Such strategies aim to make healthy behaviours and reduced exposures into social norms and thus lower the risk in the entire population. The potential gains are extensive, but the challenges are great as well -- a preventive measure that brings large benefits to the community appears to offer little to each participating individual. This may adversely affect motivation of the population at large (known as the "prevention paradox").

    • Session 3

      Public Health systems, structures, and major global initiatives to improve Public Health


      This session aims to develop an understanding of the way that various countries establish systems to protect and promote the health of the public, and critically evaluate the potential and the limitations of current initiatives to improve global health

      • develop an in-depth understanding of the evolution of Public Health agencies, organisations, and systems, and the role of the World Health Organisation and various global funds.
      • develop a critical appraisal of the limitations of aid as a method of improving global health

      Health systems and structures
      Please look at the presentation, Structural and Functional Foundations  of Public  Health, at the  end of this section, where you will see a description of the functions of health systems for Public Health

      The World Health Organisation has a whole stream dedicated to health systems and you can browse the various parts here. It is apparent that systems change is required to improve the health of populations. WHO identified 6 building blocks to strengthen health systems:
      Service delivery
      Good health services are those which deliver effective, safe, quality personal and non-personal health interventions to those that need them, when and where needed, with minimum waste of resources.
      Health workforce
      A well-performing health workforce is one that works in ways that are responsive, fair and efficient to achieve the best health outcomes possible, given available resources and circumstances (i.e. there are sufficient staff, fairly distributed; they are competent, responsive and productive).
      Health information system
      A well-functioning health information system is one that ensures the production, analysis, dissemination and use of reliable and timely information on health determinants, health system performance and health status.
      Medical products, vaccines and technologies
      A well-functioning health system ensures equitable access to essential medical products, vaccines and technologies of assured quality, safety, efficacy and cost-effectiveness, and their scientifically sound and cost-effective use.
      Health systems financing
      A good health financing system raises adequate funds for health, in ways that ensure people can use needed services, and are protected from financial catastrophe or impoverishment associated with having to pay for them. It provides incentives for providers and users to be efficient.
      Leadership and governance
      Leadership and governance involves ensuring strategic policy frameworks exist and are combined with effective oversight, coalition-building, regulation, attention to system-design and accountability.

      YouTube presentation. You might also be interested to see this short video: Join the Revolution: Systems Thinking to transform Thailand's health system.



      Global Health Initiatives
      Gobal Health Initiatives are described by WHO as: An emerging and global trend in health is a focus on partnerships - alongside public-private partnerships there are also a number global health initiatives. Such initiatives are thought to be one of the benefits of globalization. Global initiatives are typically programmes targeted at specific diseases and are supposed to bring additional resources to health efforts. Three major global health initiatives were launched between 1998 and 2000:

      • Roll Back Malaria. A global strategy to reduce deaths from malaria by increasing access to prompt and effective treatment (including protective intermittent therapy for pregnant women) and prevention tools (including insecticide-treated bed nets); by facilitating rapid response to malaria outbreaks; and by developing new products for the prevention and treatment of malaria.

      • Stop TB. A global strategy to stop the spread of TB around the world. One of its objectives is to promote implementation of the directly observed therapy short-course strategy (DOTS).

      • Global Alliance for Vaccines and Immunization. A global effort to strengthen childhood immunization programmes and bring a new generation of recently licensed vaccines into use in developing countries. These include vaccines against hepatitis B, childhood meningitis, yellow fever and respiratory infections, which are the leading cause of death in children under age five.

      Probably the most well known global initiatives are the Millennium Development Goals. These do need study, and are fully discussed in a number of modules in the Peoples-uni. This web site is a gateway to information about the MDGs. You can track the progress towards meeting the MDGs in general and in your own country through this web site. As the timescale for MDGs has expired, they are followed by Sustainable Development Goals.

      From the WHO site: Global Health Initiatives (GHIs) have been successful in dramatically raising the level of resources for health, in part because of their selective focus on specific diseases, products or populations. However, in a vicious circle, weak health systems have constrained the delivery capacity of the GHIs while the selective approach of the GHIs has also, in some cases, had the unintentional effect of further eroding the capacity of health systems. This dilemma has prompted a heightened commitment from all stakeholders to broader health systems strengthening and to better integrating the efforts of GHIs and health systems, and has stimulated the idea of Maximising positive synergies between health systems snd Global Health Initiatives - details of this report can be seen through the web site linked above.

      Globalisation and health.
      It is worth thinking about the role of globalisation, and this paper to which we provide a link adds an interesting perspective: Globalization and social determinants of health: Promoting health equity in global governance (part 3 of 3) Ron Labonte and Ted Schrecker. Globalization and Health 2007, 3:7

      This article is the third in a three-part review of research on globalization and the social determinants of health (SDH). In the first article of the series, we identified and defended an economically oriented definition of globalization and addressed a number of important conceptual and metholodogical issues. In the second article, we identified and described seven key clusters of pathways relevant to globalization's influence on SDH. This discussion provided the basis for the premise from which we begin this article: interventions to reduce health inequities by way of SDH are inextricably linked with social protection, economic management and development strategy.

      Reflecting this insight, and against the background of the Millennium Development Goals (MDGs), we focus on the asymmetrical distribution of gains, losses and power that is characteristic of globalization in its current form and identify a number of areas for innovation on the part of the international community: making more resources available for health systems, as part of the more general task of expanding and improving development assistance; expanding debt relief and taking poverty reduction more seriously; reforming the international trade regime; considering the implications of health as a human right; and protecting the policy space available to national governments to address social determinants of health, notably with respect to the hypermobility of financial capital. We conclude by suggesting that responses to globalization's effects on social determinants of health can be classified with reference to two contrasting visions of the future, reflecting quite distinct values.

      The limitations of international development assistance.

      A debate has arisen about the benefit of aid to reduce poverty and improve global health. Sachs argues that the solution to many of the global health problems in low-income settings is to increase the level of aid, but there are opposing views about the long-term benefit of such aid. These are nicely encapsulated in this editorial in the British Medical Journal, which summarises as follows: "Scrap development aid as we know it and give the money to independent pro-poor aid organisations." Lets give the last word on this to Sachs - even though it is not in a peer reviewed article! "Nine million children die each year of extreme poverty and disease conditions which are almost all preventable or treatable or both. Impoverished countries, with impoverished governments, can't solve these problems on their own. Yet with help they can. The Global Fund to Fight AIDS, TB, and Malaria, and the Global Alliance on Vaccines and Immunizations are both saving lives by the millions, and at remarkably low cost."

    • Session 4

      Health promotion and health protection

      This session aims to discuss the roles of health promotion and health protection. You should be able to:

      • develop an understanding of how theory underpins the practice of health promotion

      Health promotion and health protection

      In many countries, the practice of Public Health is divided into two parts - health promotion and health protection. In the UK, health protection has come to be taken to relate to communicable diseases, disaster management and emergency planning, and threats to the population from issues such as bioterrorism. The history of health promotion is lengthy and complex. The paper for which we provide an abstract, and a link to the full text, is an important contribution, which indicates that as for many aspects of clinical and Public Health practice, an evidence base is much needed! Here it applies to the theoretical underpinnings of the approach to health promotion.

      The Ottawa Charter for Health Promotion encourages the use of multiple strategies by identifying five action areas for health promotion practice. These five action areas are:

        1. Building healthy public policy

        2. Create supportive environments

        3. Strengthen community action

        4. Developing personal skills

        5. Re-orienting health services

      Health promoters have worked on these five action areas through the use of multiple, complementary strategies. Some of the key strategies include:

      Key strategies

      • Health communication

        • Use of communication techniques and technologies to positively influence individuals, populations and organizations for promoting conditions conducive to human and environmental health

      • Health education

      • Constructed opportunities for learning involving communication to improve health literacy, including improving knowledge and life skills to improve individual and community health

      • Self help/mutual aid

        • A process by which people who share common experiences, situations or problems can offer each other support

      • Organizational change

        • Working within settings for health, such as schools, worksites, universities, to create supportive environments that enable healthier choices

      • Community development and mobilization

        • Collective efforts by communities directed toward increasing community control over determinants of health

      • Advocacy

        • A combination of individual and social actions to gain political commitment or support for a particular health goal or program

      • Policy development

        • the process of developing legislation and regulatory measures that protect the health of communities and make it easier for individuals to make healthy choices

      Theories of health behaviour
      To understand how people can be supported to improve their health it’s important to have a basic understanding of the different theories about health behaviour. These theories can be used to develop Public Health interventions. This paper, which comes from one of the journals in the BioMed Central series, which are freely available online, "A review of health behaviour theories: how useful are these for developing interventions to promote long-term medication adherence for TB and HIV/AIDS?" reviews health behaviour theories and shows if they have been applied in practice. It is a very important paper to read. The abstract is reproduced here.
      "BACKGROUND: Suboptimal treatment adherence remains a barrier to the control of many infectious diseases, including tuberculosis and HIV/AIDS, which contribute significantly to the global disease burden. However, few of the many interventions developed to address this issue explicitly draw on theories of health behaviour. Such theories could contribute to the design of more effective interventions to promote treatment adherence and to improving assessments of the transferability of these interventions across different health issues and settings. METHODS: This paper reviews behaviour change theories applicable to long-term treatment adherence; assesses the evidence for their effectiveness in predicting behaviour change; and examines the implications of these findings for developing strategies to improve TB and HIV/AIDS medication adherence. We searched a number of electronic databases for theories of behaviour change. Eleven theories were examined. RESULTS: Little empirical evidence was located on the effectiveness of these theories in promoting adherence. However, several models have the potential to both improve understanding of adherence behaviours and contribute to the design of more effective interventions to promote adherence to TB and HIV/AIDS medication. CONCLUSION: Further research and analysis is needed urgently to determine which models might best improve adherence to long-term treatment regimens."

      Additional resource.
      You may also be interested to look through this online resource about health promotion from the Ontario Health Promotion Resource System.

    • Session 5

      Disease causation

      Disease causation (epidemiology research methods)
      This session aims to
      develop an understanding of the ways of assessing disease causation through epidemiological research methods. You should be able to:

      • apply knowledge and understanding of the major methods of measuring disease causation through epidemiology research

      First - some key epidemiological terms.

      Please look at the presentation Descriptive Epidemiology for Public Health Professionals, at the end of this section, to learn about how to measure disease and some basic terms

      First, it is important to be familiar with some very basic principles of measuring how common is the health problem?

      Simple measures of the frequency of disease and its risk factors.

      The following indicators can be used to compare the health states of populations:

      Prevalence and Incidence data: Prevalence is the number of people with a particular disease or risk factor at one point in time, or over a specified period of time. Incidence describes the number of new cases of a disease (or risk factors) arising over a specified period of time. Thus prevalence includes all cases of that disease, both new and existing, in a particular population – and the identification of the population at risk (the denominator) is of key importance. These indicators are measures of morbidity (the burden of disease). For some very clear and simple descriptions of the key measures including Prevalence and Incidence, see this chapter Quantifying Disease in Populations in 'Epidemiology for the uninitiated' - particularily chapter 2.


      Epidemiology as a basis for Public Health

      The way of measuring the causes of disease depends on epidemiology, which many people agree is the fundamental discipline of Public Health. However, as this quote from the relevant Topic in the Introduction to Epidemiology module makes clear, more evidence than just available from epidemiologic research is required:
      "In epidemiology, causality is defined as: “The relating of causes to the effects they produce. Most of epidemiology concerns causality… It must be emphasized, however, that epidemiologic evidence by itself is insufficient to establish causality, although it can provide powerful circumstantial evidence.” (from John M Last (ed.), A Dictionary of Epidemiology, 3rd ed, Oxford University Press, 1995.)"

      An excellent presentation by Songer in the Epidemiology Supercourse discusses the role of epidemiology in ascribing causation really well - look out for the Bradford Hill criteria in the presentation.

      Two resources you will find of relevance and interest are from the Johns Hopkins school of Public Health whose Open Courseware lectures provide a very useful set of resources including this one on Epidemiology and Biostatistics within the the paradigm of Public Health by Sukon and colleagues, and the Epidemiology Supercourse, by Raj Bhopal. There is also a very clear and interesting presentation on the history and basic concepts of epidemiology, from the Geneva Foundation for Medical Education, on whose web site you can find a number of other detailed presentations about epidemiology methods and other issues.

      An excellent primer is now a little dated, but stands the test of time as providing a basis for epidemiological methods - Epidemiology for the Unitiated by Cogon, Rose and Barker. Here is part of the first section on What is Epidemiology:

      "Epidemiology is the study of how often diseases occur in different groups of people and why. Epidemiological information is used to plan and evaluate strategies to prevent illness and as a guide to the management of patients in whom disease has already developed.

      Like the clinical findings and pathology, the epidemiology of a disease is an integral part of its basic description. The subject has its special techniques of data collection and interpretation, and its necessary jargon for technical terms....

      All findings must relate to a defined population

      A key feature of epidemiology is the measurement of disease outcomes in relation to a population at risk. The population at risk is the group of people, healthy or sick, who would be counted as cases if they had the disease being studied. For example......"

    • Session 6

      Social foundations of health and disease

      This session aims to illustrate some of the social determinants of health. You should be able to:

      • develop an understanding of the role of social factors in the development of ill health and the major approaches to reducing their influence

      Social foundations of health and disease

      It has been known for many years that there is a social dimension to the burden of illness. Both within and between populations, social factors play a large part in behaviour putting people and populations at risk as well as in access to health care and prevention. Inequalities and inequity in health have become one of the most important aspects of Public Health today. Some of the resources here speak to this issue.

      Please look at the file, Poverty and the social foundations of health, at the end of this section - it provides a clear introduction to to this issue, with an international context.

      WHO commission on the social determinants of health.
      A major report was published in 2008 to try to define the social determinants of health, in particular as they lead to inequalities in health outcomes. This is a very long report, but you might want to search through it. The three overarching recommendations are as follows:

      1. Improve daily living conditions.

      Improve the well-being of girls and women and the circumstances in which their children are born, put major emphasis on early child development and education for girls and boys, improve living and working conditions and create social protection policy supportive of all, and create conditions for a flourishing older life. Policies to achieve these goals will involve civil society, governments, and global institutions.

      2.Tackle the inequitable distribution of power,money and resources.

      In order to address health inequities, and inequitable conditions of daily living, it is necessary to address inequities – such as those between men and women – in the way society is organized. This requires a strong public sector that is committed, capable, and adequately financed. To achieve that requires more than strengthened government – it requires strengthened governance: legitimacy, space, and support for civil society, for an accountable private sector, and for people across society to agree public interests and reinvest in the value of collective action. In a globalized world, the need for governance dedicated to equity applies equally from the community level to global institutionsand Assess the Impact of Action

      3. Measure and understand the problem and assess the impact of action.

      Acknowledging that there is a problem, and ensuring that health inequity is measured – within countries and globally – is a vital platform for action. National governments and international organizations, supported by WHO, should set up national and global health equity surveillance systems for routine monitoring of health inequity and the social determinants of health and should evaluate the health equity impact of policy and action. Creating the organizational space and capacity to act effectively on health inequity requires investment in training of policy-makers and health practitioners and public understanding of social determinants of health. It also requires a stronger focus on social determinants in public health research.

    • Session 7

      Developing workforce capacity in Public Health

      This session aims to discuss how the development of knowledge and skills, such as through online courses from the Peoples-uni, can contribute to developing workforce capacity in Public Health, and can contribute to individual career development and improving the health of the population. You should be able to:

      • discuss the issues of workforce needs in Public Health in your setting and the potential for e-learning to help build capacity

      Human resource development

      A massive need for human resource development has been identified for low-income settings,  in relation to the Public Health workforce requirements. Please look at the presentation Workforce Issues in Public Health at the end of this section.

      The journal Human Resources for Health is freely available online, and has a number of excellent papers (you can see the RSS feed at the top right hand of this module with new papers identified as they come online) - you might also like to see the paper on the Peoples-uni published in that journal.

      The Global Health Workforce Alliance has been established - here is the introduction from its web site: "Health workers are the heart and soul of health systems. And yet, the world is faced with a chronic shortage - an estimated 4.2 million health workers are needed to bridge the gap, with 1.5 million needed in Africa alone. The critical shortage is recognized as one of the most fundamental constraints to achieving progress on health and reaching health and development goals.

      The Global Health Workforce Alliance (GHWA) was created in 2006 as a common platform for action to address the crisis. The Alliance is a partnership of national governments, civil society, international agencies, finance institutions, researchers, educators and professional associations dedicated to identifying, implementing and advocating for solutions."


      As an example, the Peoples-uni provides Public Health Capacity building through online education.

      The overall goal and objectives of learning through the Peoples-uni are as follows:

      The goal

      To contribute to improvements in the health of populations in low- to middle-income countries by building Public Health capacity via e-learning


      Objectives

      1. Provide Public Health education for those working in low- to middle-income countries who would otherwise not be able to access such education, via Internet based e-learning
      2. Utilise a 'social model' of capacity building, with volunteer academic and support staff and Open Educational Resources available through the Internet, using a collaborative approach and modern Information and Communication Technology

      3. Offer education at the 'train the trainers' level, equivalent to that of a Masters degree, for those with prior educational and occupational experience

      4. The education will meet identified competences which help with the evidence based practice of Public Health and be action oriented, to assist in tackling major health problems facing the populations in which the students work

      5. Create an educational portfolio leading to the award of Certificate, Diploma and Master of Public Health

      6. Work with the graduates of the educational programme, and other relevent partner organisations, in teaching, research, implementation of evidence based health policy and advocacy to improve the health of their populations.