MPH Education for the 21st Century: Motivation, Rationale, and Key Principles for the New Columbia Public Health Curriculum

摘要

Public health is at a watershed moment. The world’s health needs are changing, and complex problems require interdisciplinary approaches and systems-based solutions. Our longer lives and changing environments necessitate life-course and structural approaches to prevention. This argues strongly for public health graduate education that adequately prepares trainees to tackle emerging challenges and to lead now and in the future. Nearly a century of scholarship and scientific advances may offer a blueprint for training the next generation of public health leaders. We articulate a case for change; discuss some of the foundational principles that should guide public health education; and discuss what such a change might look like building on prior scholarship, on the examples set by other disciplines, and on our own experience. We are in many ways in a period of remarkable global change, driven by large-scale macrosocial forces that, for the first time in human history, are altering the core conditions of daily living and the health needs of populations within single generations. We briefly, by way of illustration, highlight 4 of these forces—globalization, urbanization, population aging, and health disparities—that point to the types of challenges that a new, integrated problem-based curriculum must be designed to prepare graduates to address. First, the world is globalizing at a dramatic pace. Globalization, the increasing interconnectedness of ideas, behaviors, resources, and human capital across the globe, is increasingly shaping all aspects of human interaction and knowledge exchange. 1,2 At the most visible level, infectious disease outbreaks, fueled by transcontinental travel, are no longer confined to 1 country or continent. Less visibly, global epidemics of obesity are fueled by widespread adoption of unhealthy dietary practices and the growing availability of nutritionally poor, calorie-dense foods, coupled with less physical activity. 3,4 Conversely, a globalizing world creates opportunities for innovative, effective interventions that can promote the public’s health, from the ability to develop global governance around shared threats to individual-based solutions. An example of the latter: novel use of communications technologies have been shown to be effective means of communicating health messages. 5 For example, cellular telephones have been shown to have positive effects on sexual health, because they can be used to quickly communicate risk reduction messages. 6 Young people are the most likely age group to contract sexually transmitted infections and the largest demographic group among cellular telephone users, giving cellular telephones an important potential role in sexual health education. Young people also may be more likely to communicate and follow up with physicians through the privacy of their own cellular telephones instead of a family landline. Globalization then magnifies the scale and scope of public health’s remit, presenting previously unthinkable challenges and introducing yet unforeseen opportunities, and highlighting the complex knowledge base and diverse toolkit we need to impart to public health graduates who will be working in a globalized world. Second, increasingly, urbanization poses a unique challenge to public health research and practice. Urbanization is a sentinel human demographic shift during the past 2 centuries. For the first time in human history, more than half of the world’s population is now living in urban areas, with the most rapid urbanization happening in, and most urban residents living in, low- and middle-income countries. 7,8 By 2030, 60% of the world’s population will live in cities. Urban living affects all aspects of the human experience, influencing how we behave, think, interact, eat, and live. 9 Nearly a decade ago, world leaders and mayors at the World Urban Forum in 2004 warned that “rapid urbanization was one of the greatest challenges facing humanity in the new millennium . ” 10 Migration in many countries results in massive movement of the world’s populations into cities annually, occasioning new challenges to urban planning and strains on aging urban infrastructures. It has also resulted in the separation of family members in many regions, attracting young and middle-aged adults to urban environments and leaving the very young and very old in rural areas. However, as with globalization, urbanization presents opportunities for public health action. Effective health departments in large urban areas have been responsible for the implementation of large-scale environmental modifications that influence the health of millions living in densely populated urban areas. 11–13 The concentration of vulnerable populations in cities affords an opportunity to provide services that can meet the needs of these groups. Interconnectedness of urban populations provides opportunities for behavioral interventions at a truly large scale, illustrating the need for