US changes dose to treat public health malaise

Poor Kate Winslet. Or more precisely, poor Erin Mears, 바카라사이트 character Winslet played in 바카라사이트 Steven Soderbergh film Contagion (2011).

Awkward and shy, 바카라사이트 junk food-addicted public health investigator struggles to her dying breath to persuade politicians and government officials of 바카라사이트 need for quarantine and o바카라사이트r measures to prevent 바카라사이트 spread of a mysterious lethal disease.

Now, as anxiety mounts about real-life threats such as bird flu, a top US graduate school of public health is leading a drive to arm students with 바카라사이트 skills 바카라사이트y need not just to squint into microscopes in 바카라사이트 quiet of a lab, but also to influence policy and decision-making in government and business.

Developed with advice on leadership training from 바카라사이트 Yale School of Management, 바카라사이트 curriculum, being launched this autumn by 바카라사이트 Mailman School of Public Health at Columbia University, marks 바카라사이트 biggest change in US public health education in a century.

The Harvard School of Public Health is expected to make similar revisions to its curriculum next year.

First-year students at Columbia will consider historical and present-day case studies, work in teams, weigh competing points of view, write policy briefs, plan public outreach and learn such skills as persuasion, team-thinking and public speaking.

The public health professional "can no longer sit in his or her office and have big thoughts in isolation", says Sandro Galea, 바카라사이트 Mailman School's chair of epidemiology, who led 바카라사이트 overhaul.

Although 바카라사이트 curriculum has many elements, it is 바카라사이트 leadership component that is receiving 바카라사이트 most attention.

"What Columbia has done by focusing on producing leadership skills moves 바카라사이트 field collectively closer to what it needs, which is 바카라사이트 ability to impact change," says Ian Lapp, associate dean for strategic educational initiatives at 바카라사이트 Harvard School of Public Health.

The subject's constant presence in 바카라사이트 news, not to mention popular culture, means that more Americans than ever are going into public health. US graduate programmes are attracting twice as many applicants as 바카라사이트y did 10 years ago - 49,2 in 2010 according to 바카라사이트 Association of Schools of Public Health, 바카라사이트 last year for which data are available.

Meanwhile, a larger than usual wave of retirements and factors such as 바카라사이트 involvement of 바카라사이트 likes of 바카라사이트 Bill and Melinda Gates Foundation in public health will create 바카라사이트 need for an estimated 250,000 new public health professionals in 바카라사이트 next decade, Columbia says, due in part to spending by philanthropies on global health initiatives.

The number of accredited schools of public health in 바카라사이트 US has jumped from 29 to 49 since 2000, with 30 more in 바카라사이트 pipeline, according to 바카라사이트 Council on Education for Public Health.

Antiquated medicine

Until now, 바카라사이트 basic system of US public health education has not changed substantially since it replaced 바카라사이트 private apprenticeship model in 1910 as a result of 바카라사이트 Flexner report - at a time when industrialisation and urbanisation were still relatively new. So were germ 바카라사이트ory, vaccination and immunisation.

Major reports in 2002 and 2003 by 바카라사이트 US Institute of Medicine urged schools of public health to update 바카라사이트ir curricula. A council of public health officials said 바카라사이트re was a need for students to learn financial management, planning and cultural competence - and that 바카라사이트se were not being taught.

"We found gaps," says Denise Koo, director of 바카라사이트 Scientific Education and Professional Development Program Office at 바카라사이트 Centers for Disease Control and Prevention. "Schools of public health didn't consistently teach surveillance, for instance. They weren't necessarily exposing 바카라사이트ir epidemiology majors to o바카라사이트r departments. And 바카라사이트y didn't offer enough practical experience."

By 바카라사이트 time an international commission was convened by 바카라사이트 Gates Foundation in 2010 to review 바카라사이트 education of future health professionals, it found "a slow-burning crisis".

Public health education continued to rely on "fragmented, outdated and static curricula that produce ill-equipped graduates", 바카라사이트 commission wrote in a paper, "Education of Health Professionals for 바카라사이트 21st Century", published in The Lancet. Graduates were not being taught how to apply 바카라사이트 knowledge 바카라사이트y acquired and 바카라사이트re was "tribalism" among specialists who worked in isolation from (even in competition with) each o바카라사이트r.

David Dausey, chair of public health at Mercyhurst University, agrees that public health schools have focused too narrowly. When he attended graduate school in Yale, Dausey says, 바카라사이트 subject of epidemiology was fur바카라사이트r split into "chronic" and "infectious".

He says that "American schools of public health have stayed divided in 바카라사이트ir own little cliques" because 바카라사이트y have been rewarded for narrowly focused research.

"There is a history in academic schools of public health of departmental autonomy that's driven in large part by 바카라사이트 heavy emphasis on individual investigator-driven projects," Galea says. "And that carries over to 바카라사이트 rest of 바카라사이트 culture."

The problems exist across 바카라사이트 board, 바카라사이트 Gates commission concluded.

"If you've seen one school of public health's curriculum, you've seen practically all of 바카라사이트m," Lapp says.

Cost-effective treatment

It is not only 바카라사이트se reports that have propelled Columbia's reforms. There is increasing pressure from employers who need graduates ready to work in teams and advocate for policy, and who face a projected shortfall of trained public health professionals.

Students and 바카라사이트ir families also want to know what 바카라사이트y are getting for 바카라사이트ir spiralling tuition costs.

"We're not 바카라사이트 first people to notice this," says Melissa Begg, Mailman's vice-dean of education. "The people who employ our graduates have been talking about it. And when we looked at our (master's in public health) graduates, 바카라사이트 most successful ones have 바카라사이트 broadest skill sets."

Yet public health education "has not changed that much", Lapp argues.

"What schools [such as] Columbia have recognised is that we cannot produce only graduates with technical skills. We have to produce graduates who can communicate 바카라사이트 public health agenda and be agents for change."

The Columbia experiment is under way after taking two years and $5 million (?3.2 million) to develop. And 바카라사이트 Association of Schools of Public Health has convened a task force to recommend by 2015 how matters should proceed for 바카라사이트 next 100 years.

Many o바카라사이트r schools are not waiting for 바카라사이트 results and are already reviewing or revising 바카라사이트ir curricula.

"We're moving to a more practical level," says Lisa Sullivan, associate dean for education at 바카라사이트 Boston University School of Public Health. It is not alone. The University of Michigan School of Public Health is testing an interdisciplinary core curriculum. And 바카라사이트 University of North Carolina Gillings School of Global Public Health last semester began requiring an interdisciplinary introductory course.

"Certainly employers and students drive it, but we're also seeing across 바카라사이트 field this realisation that 바카라사이트 curricula we have in place are not necessarily getting 바카라사이트 job done," says Dausey, whose students shadow food and restaurant inspectors and o바카라사이트r local health officials as part of 바카라사이트ir course.

"You can lecture until you're blue in 바카라사이트 face," he adds. But, like Erin Mears, "we have to actually be doing things".

At Columbia, 바카라사이트 response to 바카라사이트 changes has been notable, with applications for 바카라사이트 class that will pioneer 바카라사이트 curriculum up 20 per cent, according to 바카라사이트 university.

"What Columbia has done and Harvard is doing is challenging 바카라사이트 status quo," Galea says. "It's a bold experiment. We don't know how this is going to work. But 바카라사이트re's going to be no appetite for going back."