Models of public health education: choices for the future?

"II. THE SITUATION AND THE NEEDS IN AMERICA In this country we are woefully lacking both in laboratories of hygiene and in opportunities for training in public health work. Three or four medical schools have hygienic laboratories, but none is complete, and adequately equipped and supported. Still other schools attempt something in the way of instruction in this subject, but it is all inadequate and unsatisfactory. The need for supplying these deficiencies is at present the most urgent one in medical education and in public health work, and is recognized on all sides. The cry comes loudest from public health officials, social workers and others interested in public health administration, national, state, municipal and rural, who realize the lack of trained leaders and trained workers in all grades of the service. Here with the rapidly growing appreciation of efficient public health organization new and promising careers of useful service are opening from those who are qualified by ability, character and training. Scarcely less important is it for medical students and physicians who engage in practice to be well grounded in the principles of hygiene and of preventive medicine. Furthermore the advancement of knowledge in this field, the cultivation of hygiene as a science, is one of the great needs of this country and should be a fundamental aim of an institute of hygiene." For the full text of the paper by WH Welch and W Rose (1), please see: http://archive.rockefeller.edu/ Global public health in the beginning of the 21st century has been threatened by SARS, avian influenza, wars and bioterrorism, to name but a few dangers. To deal effectively with new as well as existing public health challenges would seem to require an international army of qualified public health workers, as well as an educated public mobilized to deal with health hazards. A retrospective look at the different models of public health education and the creation of schools of public health in the early decades of the 20th century may help us to consider the choices and options for the future of global public health education. Here we examine the creation of schools of public health in three locations: China, the United States of America and the former Yugoslavia. In 1913, the Rockefeller Foundation sponsored a conference on the need for public health education in the United States. Foundation officials were convinced that a new profession of public health was needed. It would be allied to medicine but also distinct, with its own identity and educational institutions. The result of deliberations between public health leaders and foundation officials was the Welch-Rose Report of 1915, which laid out the need for adequately trained public health workers and envisioned an "institute of hygiene" for the United States. (1) The term "hygiene" was used to indicate the scientific basis of public health, as taught in the German institutes of hygiene, rather than the British term "public health", which suggested a greater focus on administration. The remarkable design of an institute of hygiene, as detailed in the Welch-Rose Report, lay in the fact that it would be allied with, but independent of, a medical school in a university setting, and also independent of the structure of state public health services. Hence, the United States created a structure of public health education different from that of the United Kingdom or continental Europe. (2) The aims of the institute of hygiene were to train public health leaders and advance the knowledge of the sciences of hygiene, such as bacteriology, immunology, parasitology, physiology and epidemiology. Finding a balance between researching these scientific fields and teaching the more practical aspects of public health would be a source of ongoing tension within schools of public health. (3) This tension, embedded within the Welch-Rose Report, reflected the different preferences of the plan's two architects: William Henry Welch favoured scientific research, whereas Wickliffe Rose wanted an emphasis on public health practice. …