The very idea that we should try to envision collectively an optimal system of education for public health in the 21st Century is a benchmark of the field’s growing maturity as a profession. It has been almost 165 years since the idea of public health began to emerge as a reaction to the social and political upheaval of the Industrial Revolution, at least if you date it from the European Revolutions of 1848. In the century past, we identified bodies of knowledge that could be standardized, transformed into curricula and taught. We created public health collegiate units in universities to be the agents of professional and academic growth beginning on the eve of World War I. We’ve developed credentials, accreditation and certification as key factors in professionalizing public health. We have produced and placed public health professionals in a large and diverse if fragmented health system that has nevertheless been successful in improving population and community health in so many ways. But some 100 years after Welch-Rose, what should we do in this century?
When I discuss 21st Century public health with people unfamiliar with the field, I use five descriptors:
- Collaborative
- Interdisciplinary
- Inter-professional
- Global
- Digital
I have found it useful to describe public health by characteristics of how it does its work rather than by an exhaustive (and exhausting) list of what it does. The what changes with the social and political circumstances of health needs. I find somewhat more stability in the how because it often reflects choices about means to achieve public health ends in ways that embody core public health values.
To begin with, public health is about all those conditions that enhance or detract from our collective self-actualization as humans (see Maslow). It is about human achievement, development and progress. The conditions that converge to detract from collective human achievement are the “wicked challenges” that we face everyday. Beyond the wicked challenges lie all those convergent factors that make for CQI in the human condition and take us to some new level of excellence and achievement.
Collaborative means leadership, teams, and building the capacity to engage all sectors of communities and societies in goal and outcomes-driven commitment and action. It is about strategies of abundance (rather than scarcity) to leverage and amplify our strengths (like social capital) and counterbalance our weaknesses in pursuit of prevention and health promotion. The Baldridge framework comes to mind.
Interdisciplinary is about the need to approach wicked challenges and human enhancement from multiple perspectives. If it’s about understanding or achieving change, then it’s about different causal pathways by which we believe change occurs within the individual, the group, the community or society at large. See the SEM Model for greater depth. As H.L. Mencken famously remarked, “For every complex problem, there is a single solution that is simple, neat, and wrong.”
Inter-professional is about breaking down the walls between health professions and healthcare and public health sectors that currently drive us to snatch defeat from the jaws of victory when it comes to community and population health. This is about changing the way we educate all health professionals, and our expectations for all organizations’ and social institutions’ accountability for health outcomes.
Global and Digital are about critical factors that make this century and others to follow different. Fundamentally, they are about increasingly interlinked and interdependent systems of biology, environment, economy, and networks of changing social relations that span the planet. They are also about the speed of interaction and change, and the depth and breadth of information and knowledge generation and diffusion. While these terms encompass forces that may compound the complexity of wicked challenges, they also present astonishing opportunities for progress and achievement.
So, this is my initial take on what kind of “furniture” I would like to see in the metaphorical “empty room” we seek to design and fill. It surely won’t be my last and I look forward to hearing what you want to put there. JRF
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