What is lacking is convincing the politicians about the need for the frameworks and to respect the agreements reached under the frameworks.
Most of the frameworks I have seen tend to neglect the need to measure overall assumptions that the interventions will work. Several principles have been suggested for the framework with the idea that the principles should be multipliers. The need for political skills, imagination, initiative, and courage to face the different issues cannot be ignored. Other interviewees highlighted multifaceted proposals to build consensus among all interlocutors at the national and international levels as well as with the WHO.
Interlocution with governments which would include academic-institutional leaderships, representatives of scientific societies, leaders of organized social movements interested in health, parliamentarians, associative instances of health managers in Brazil we have the Municipal and State Heath Secretaries Councils and international health representations Pan American Health Organization PAHO , WHO.
WHO and the public health community need to coalesce and synthesize the various jargons: social determinants for health, environmental and other determinants for health, Health in All Policies, intersectoral action for health, multi-sectoral action for health, and so on. The consultation aimed to provoke a valuable discussion on how to adapt public health to its new role in the global context with a special focus on the next generation of global public health leaders.
Today public health professionals face a number of profound and complex challenges. The recognition of multiple determinants of health, from the socioeconomic to environmental, across multiple levels, from the national to individual levels, is important. Solutions should be prioritized that involve different sectors and actors, such as multidisciplinary researchers from different academic backgrounds, institutional decision-makers, representatives of civil society, and the private sector New skills are required to negotiate the interface between varied groups with different interests, legitimacy, and power.
Creativity and commitment should underpin the new generation of global public health professionals willing to take the initiative to lead global changes for the next decades Important changes are necessary to prepare the public health workforce for its future role. First, the public health profession itself has not yet been acknowledged nor legitimized.
The public health workforce consists of different professionals; efforts to shape and legalize this profession so that it can be part of the elite of regulated professions are made at the regional level Second, public health education has not yet recognized that the socioeconomic, political, environmental, and commercial changes impacting public health require specific and adapted teaching and training to address these contexts.
Meeting these challenges implies profound changes in terms of education and training.
An interesting example is provided by the pioneering experience of Brazil, in their Health Government Schools program, intra- and intergovernmental training of professionals that aims to provide the skills necessary to tackle public health challenges with a multisectoral approach Higher academic institutions are searching for appropriate strategies in competence-based education, which will increase the global attractiveness of their academic programs and courses for continuous professional development.
Such educational reform will be a long and difficult process that demands leadership and requires effort in changing perspectives and work styles and creating good relationships between all potential stakeholders New developments in public health training, including flexible academic programs and lifespan learning with a focus on employability and accreditation, are key to better preparing future professionals in global public health Moreover, since public health faces more and more global opportunities and challenges, higher education institutions worldwide have to look beyond national boundaries and participate in networks for education, training, research, development, and practice Concrete ideas about how to equip the new generation of public health professionals with the necessary political sensitivity and awareness, as well as a serious rethinking of the education curriculum, are necessary.
It should provide the skills to understand and interact with the commercial industry as well as to address lifestyles and behaviors, to cite a few. The curriculum should be harmonized; although such harmonization does not currently exist at the global level, some activities are ongoing at the regional level. However, the set-up of a global collaborative approach to public health education in a short time frame remains crucial Updated and reliable data are not always available, especially in certain programmatic areas of public health or in developing countries.
This point was largely debated during the consultation. Improved statistical and computational methods have allowed optimized use of the data, and enhanced health care applications have been developed Despite the potential positive effects on public health, for the most part only multinational health care companies have had the access and the resources to exploit these data sets Several criticisms have been raised, underscoring the risk that big data will not be used as a public good, but only for informing commercial decisions.
In this context, effective and accountable private—private partnership are of primary importance. Health is a political choice, and it is always made within the context of competing interests The need for genuine political engagement has been stressed in this consultation. Looking at health through the lens of political determinants means analyzing how different power dynamics, institutions, processes, interests, and ideological positions affect health within different political systems and cultures and at different levels of governance.
Politicization of health occurs at all levels of governance, and in an increasingly globalized context it occurs within governments, between governments, within global institutions, and in the private sector and civil society. Health has become an integral feature within processes of globalization related to trade, commerce, foreign policy, and security 37 , while gaining greater prominence in national affairs due to the increased recognition of the economic rationale for investing in health.
Philanthropic and business interests are deeply linked to global public health. The work of the WHO has also become more and more interconnected with the activities of PPPs, merging the commercial mandates of industries with the WHO's engagement with health as a human right.
Despite the undeniable conflict of interest, only this kind of partnership currently has the financial and human resources to sustain effective global health interventions In this context, a compulsory consultation of public health professionals for certain policies should be guaranteed.
Recognizing that health has always been political in nature, there is now the need for a clear affirmation that the lack of engagement with the field of public health in political processes needs to change. This is important for ensuring that health outcomes are considered across all policy decisions, both nationally and beyond national jurisdictions. The adoption of a public health impact assessment is an important example that improves accountability in relation to political decisions impacting health.
Even if this assessment is not a new instrument, it is a crucial one for improving population health, since it calls for different sectors to work together, combines several issues of relevance, and synthesizes them for purposes of decision making However, public health remains marginalized by many governments Challenging this marginalization needs to be a central focus of public health professionals. Rhetoric, not action, has characterized approaches to health, with priorities often being given to economic and commercial interests.
The Lancet and the University of Oslo's Commission on Global Governance for Health have highlighted the central importance of political determinants on health, analyzing the political origins of health inequity as well as the power disparities and dynamics across a range of policy sectors defining the global political determinants of health as the product of the global political interaction across all sectors that affect health Politics, both nationally and internationally, throughout and prior to the recent Ebola outbreak in West Africa provide further illustration of how political determinants shape outbreaks and outbreak responses 40 , Through this study, a number of milestones in public health that could be used as examples as well as innovative solutions have been highlighted to put public health in the global spotlight.
Such milestones include building on successes like the Framework Convention on Tobacco Control 42 , or participating in fora allowing continuous and constructive discussions with stakeholders from different fields, as well as taking advantage of intermediate regional or international structures. Examples include the regular health conferences sponsored by the WHO Healthy Regions Program, between all relevant stakeholders and chaired by ministers of health, based on the North Rhine-Westphalia model 43 , and the Brazilian Municipal and State Health Secretaries Councils, which gather academic institutional leaders, representatives of scientific societies, leaders of organized social movements interested in health, parliamentarians, and top-level health managers, as well as international health representatives from the WHO or PAHO Although very interesting reflections and examples have been provided, interviewees have not always proposed groundbreaking solutions that encompass a comprehensive and intersectoral vision of global health in its broader and complex world context, instead focusing mainly on their areas of expertise.
Public health today needs a new integrated vision of the different dots with an integrated analysis of the leverage points and available resources to achieve common goals and to add public health input into political decision-making processes. Many questions remain to be addressed. On the one hand, the question of whether today we need public health professionals trained to work with other sectors or whether we should provide basic training in public health to any professional is still under debate.
How can public health schools guarantee appropriate education and training? Is the model of an independent school of public health with an updated program the solution? Or would we do better to have courses of public health within all other faculties and governments? Shall we focus education on pre- or post-graduate students? On the other hand, the global public health leadership needs to respond to today's complex context. Who should lead global public health in the future? How do we engage multinational companies and philanthrocapitalism for global public health?
Important frameworks have and will characterize the story and progress of global public health. Over the last 15 years the Millennium Development Goals MDGs have represented a mission and a movement to target public health efforts and investments, leading to important achievements. Beyond the MDGs, in-depth discussions and consultations have been organized to define the development framework after At the Sustainable Development Summit, UN member states adopted the Agenda for Sustainable Development, which includes a set of 17 Sustainable Development Goals to eliminate poverty, combat inequality and injustice, and tackle climate change At the global level, the WFPHA together with the WHO has embarked on an initiative to stimulate a debate around the global public health concept and the creation of a flexible framework for advocacy.
Remarkable suggestions and models from countries where public health has a strong voice and is integrated into government policies and initiatives should be carefully taken into consideration. However, we feel that a more comprehensive and integrated vision of global health in its complexity, shared among all stakeholders involved in decision-making processes, is still missing. This shared vision of global public health represents the first step in innovating public health at the global level and should lead to a serious rethinking of education curricula to allow the next generation to engage with political contexts for structuring public health action.
Niranjan Casinader – Research Output — Monash University
Global leaders are essential to realize this change, with the final aim to provide a healthy, sustainable, and stable society. We thank all who participated in the consultation or advised us on the design of the study: Dr. Krech of the WHO, for his advice on the study conception and design and general supervision; the high-level stakeholders taking part in the consultation for their valuable input; the WFPHA leadership for its support; L.
Bourquin and J. Zhao for the teleconference coordination. The authors have not received any funding or benefits from industry or elsewhere to conduct this study. ML participated in the conception and design of the study; acquisition, analysis, and interpretation of data; and manuscript drafting. CJ contributed to the manuscript drafting and data interpretation. BB participated in the conception and design of the study, drafted the manuscript, and supervised the whole project.
Design A qualitative study was undertaken. Results Stakeholders underscored that global public health today should tackle the political, commercial, economic, social, and environmental determinants of health and social inequalities. Conclusions The study highlighted some of the main public health challenges currently under debate in the global arena, providing interesting ideas. Keywords: global health today, politics, global health education, global public health leaders. Introduction The integration and interactions between numerous cultural, economic, social, environmental, governmental, and political processes are characteristic of our complex globalized world.
Methods The study started in Table 1 Main needs in global public health themes and citations. Open in a separate window. Table 2 Main challenges in global public health themes and citations. Almost always trade trumps health The application of the HiAP approach embraces inclusive decision-making processes, formulation of effective policies to achieve measurable and sustainable goals with a special focus on tackling inequalities , transparency, accountability, and support for research and innovation. Great achievements in public health in the past were not driven by public health professionals … Public health should be driven by politicians and I hope soon leadership of countries will not only be based on economic prosperity for the citizens but the healthy living for the population In this context, leadership in public health should reflect the penetration of public health into all sectors of the government and society.
Passar bra ihop
Use the data to discuss possible mutually beneficial goals Leadership should be able to communicate with government and society that public health is a sustainable, cost-effective means to better living even in complex environments and should be able to build a social movement for public health. New public health professional skills Health workers are a public good and their training should be tuned to the current social-health reality and adequate to the world of work where they will act. Fields of action Stakeholders underscore that public health professionals should cover different roles at different levels.
Roles and fields of action of public health professionals. Global health framework Some of the interviewees supported the idea of a framework of instruments or of common structures for negotiation and collaboration to influence governments. Most of the frameworks I have seen tend to neglect the need to measure overall assumptions that the interventions will work Several principles have been suggested for the framework with the idea that the principles should be multipliers.
Interlocution with governments which would include academic-institutional leaderships, representatives of scientific societies, leaders of organized social movements interested in health, parliamentarians, associative instances of health managers in Brazil we have the Municipal and State Heath Secretaries Councils and international health representations Pan American Health Organization PAHO , WHO WHO and the public health community need to coalesce and synthesize the various jargons: social determinants for health, environmental and other determinants for health, Health in All Policies, intersectoral action for health, multi-sectoral action for health, and so on.
Discussion The consultation aimed to provoke a valuable discussion on how to adapt public health to its new role in the global context with a special focus on the next generation of global public health leaders. Acknowledgements We thank all who participated in the consultation or advised us on the design of the study: Dr. Conflict of interest and funding The authors have not received any funding or benefits from industry or elsewhere to conduct this study. Annex I Survey questions: Given the important changes and developments over the last 15 years, where do you see the most important challenges for public health today?
In light of increasingly complex health negotiations and in order to address the determinants of health, which skills are required by new public health professionals? As there is agreement that in many programmatic areas of public health there are good data available, which should be the fields of action of public health? If we want to safeguard health in the global arena, how can we act more proactively and how can we better understand the agendas in other sectors? How can the concerted decision-making process be implemented?
How far should public health people be involved in the implementation of the agreed-upon policies? How to address the challenges of the rapidly changing environment, the administrative imperatives and leverages? In light of the significant advocacy role that public health professionals play, do you think that a common framework of instruments to influence governments would allow more effective negotiations?
Which set of principles should be included in the framework? Authors' contributions ML participated in the conception and design of the study; acquisition, analysis, and interpretation of data; and manuscript drafting. References 1. Rennen W, Martens P. The globalisation timeline. Integr Assess. Ampuja M.
Second international handbook on globalisation, education and policy research. Springer, Netherlands: Springer; Trade, foreign policy, diplomacy and health. Keynote address. Sixty-fifth world health assembly; 21—26 May ; Geneva. Chan Margaret. Director-General of the World Health Organization. Kickbusch I. Tackling the political determinants of global health. Kickbusch I, Behrendt T. Implementing a Health vision: governance for health in the 21st century. Making it happen. Chan M. Citation from: Implementing a Health vision: governance for health in the 21st century. The health impacts of globalization: a conceptual framework.
Global Health. A game change in global health. Public Health Rev. Birn A-E. Bosworth D. The cultural contradictions of philanthrocapitalism. World Economic Forum. Maximizing healthy life years: investments that pay off. G20 monitor- Investment, inclusiveness, implementation, and health governance. Sidney, Australia: Lowy institute for international policy; We have a dedicated site for Germany. This handbook presents a global overview of developments in education and policy change during the last decade. It provides an accessible, practical and comparative source of current research that examines the intersecting and diverse discourses of this important issue.
Divided into two parts, the handbook first examines globalisation and education policy reforms, including coverage of main trends as well as specific policy issues such as gender, equity, minorities and human rights. Next, the handbook offers a comparative perspective that evaluates the ambivalent and problematic relationship between globalisation, the state and education reforms globally. It features coverage on curricula issues and education reforms in schools around the world as well as the curriculum in the global culture.
Now more than ever there is a need to understand and analyse both the intended and the unintended effects of globalisation on economic competitiveness, educational systems, the state and relevant policy changes--all as they affect individuals, the higher education sector, schools, policy-makers and powerful corporate organisations across the globe. By examining some of the major education policy issues, particularly in the light of recent shifts in education and policy research, this handbook offers readers a comprehensive picture of the impact of globalisation on education policy and reforms.
It will serve as a vital sourcebook of ideas for researchers, practitioners and policy makers in education. He specializes in globalisation and education policy reforms, social justice, history education, and values education.
Global public health today: connecting the dots
He has written and edited 28 books and over book chapters and articles in the areas of globalisation and education policy, higher education, and curriculum reforms. Recent publications include: Zajda, J Globalisation and Neo-liberalism as Educational Policy in Australia. Turner Eds. The Russian Revolution. Ryan Eds.
Phillips Ed. Thousand Oaks: Sage; Zajda, J.