Mission and Values Statement for ASPHER Ted Tulchinsky MD MPH Braun SPH Jerusalem, Israel Presentation at Deans and Directors Meeting ASPHER, 25 May 2007

Mission of ASPHER Vision - a better (healthier, more equitable) world Mission – Education, training, advocacy, service Values – Ethics of public and individual health Goals – –Promote PH workforce development –Organized programs of post graduate education –In keeping with Bologna Declaration –To strengthen PH in Europe and globally –In academic centers of excellence –Education, teaching, research, service, advocacy

Background Statement of Mission beyond representing members Important for members and potential members Important for project development and funding Important for legislators, politicians, public servants, media, visibility Needed for new SPHs as guidelines Helps to define objectives and set standards Help define the “culture” of public health

Why is a Statement of Mission Needed by ASPHER: The Case for Action Europe is diverse in health and socio economic status. Inequalities between and within countries Challenges to the basic European consensus of social solidarity. ASPHER has key role in promoting high quality professional education for public health including professional and technical levels to achieve the goals of high levels of health for all in a new Europe. ASPHER also has a role in promoting public health policies. Values and ethics of PH based on lessons learned from successes of PH, recognizing tragic misapplications of concepts of social hygiene in the 20th century. The New Public Health is an important concept for the post Soviet countries. The “Old Public Health” is still strong in service and educational systems. The Bologna Process is a vital step in a new direction. A wider definition of public health and its content, competencies and values are also vital to that process. New SPHs need ASPHER guidelines, statements of purpose and basic values..

What is Public Health? " Public health is the Science and Art of (1) preventing disease, (2) prolonging life, and (3) promoting health and efficiency through organized community effort for (a) the sanitation of the environment, (b) the control of communicable infections, (c) the education of the individual in personal hygiene, (d) the organization of medical and nursing services for the early diagnosis and preventive treatment of disease, and (e) the development of social machinery to ensure everyone a standard of living adequate for the maintenance of health, so organizing these benefits so as to enable every citizen to enjoy his birthright of health and longevity." C.E.A. Winslow, 1920

What is a Public Health System? " A network of public, private, and voluntary entities that contribute to the health and well-being of a community.” WHO World Health Report 2004

Why Ethics is a Basic Value for ASPHER? Great achievements of PH in 19 th and 20 th centuries But PH has been corrupted with extreme unethical behavior in the 20 th century Eugenics movement and its downstream effects of organized mass murder Unethical “medical” experimentation in concentration camps by Nazis and Japanese Army in WW II Holocaust justified by racist eugenics, isolation methods Nuremberg Doctors Trial Tuskegee experiment in United States Conflict between individual and community interests in PH Many current ethical issues such as folic acid fortification of flour, euthenasia, fluoridation of community water supplies, genetic engineered foods, selection of funding priorities and others.

What is the New Public Health? Includes all possible activities useful and effective in promoting health and in the prevention, treatment, rehabilitation of diseases for the individual, community, population as a whole. Provides standards relevant to any country whether developed or developing, but application depends on the health problems and economic status of each country, or regions in a country. Wide range of interventions in the physical and social environment, health behavior, and biomedical methods along with health care organization and financing. Links traditional hallmarks of public health, such as sanitation, communicable disease control, maternal and child health and epidemiology, with clinical services, health systems management, and health promotion. Recognizes that health of the individual and the community are directly and indirectly affected by social and economic factors. An under­standing of these concepts is essential to the design of effective health care interventions to prevent the occurrence of diseases or their complications. Takes into account the realities of resource allocation, economic factors, and priorities in health policy. Resources for health care are limited, and choices must be made as to the balance of programs and services provided, with cost constraint and substitution of one type service for another. Both society and the individual have rights and responsibilities in promoting and maintaining health through direct services, healthy environmental and community health promotion. Social advocacy is part of this yet, public health is also the art of the possible. We can’t solve all poverty and injustice, but can improve survival and quality of life, step by step. Define measurable targets of improved health for individual and community. Addresses social and physical environment, and personal services for individual health needs. It brings together community-oriented with personal individual-oriented care. WHO A Discussion Paper, Geneva, WHO, 1995.

Ten Great Achievements of Public Health in the US in the 20 th Century 1.Vaccination 2.Motor vehicle safety 3.Safer workplaces 4.Decline in deaths from coronary heart disease, strokes 5.Safer and healthier foods 6.Healthier mothers and babies 7.Family planning 8.Fluoridation of drinking water 9.Recognition of tobacco as a health hazard 10.Control of infectious disease MMWR 1999

Bologna Agreement, 1999 A system of easily readable and comparable degrees shall be introduced, supported by the implementation of the Diploma Supplement. Higher education course systems shall be based on two consecutive cycles: - undergraduate cycle, lasting three years, to qualify students for employment, - graduate cycle shall lead to Master's and/or doctorate degrees. In order to ensure student mobility through the transferability of their achievements, a credit system similar to ECTS shall be launched; credits shall also be obtainable in non-HE contexts such as life-long learning. Student mobility and free movement shall be promoted. European co-operation in quality assurance shall be established. The European dimension shall be promoted in public health education through curricula, inter-institutional co-operation and mobility schemes for students, teachers, practitioners and researchers.

Vision and Goals of PH Vision: Healthy people in healthy communities, with social solidarity and equity. Goals: Prevent epidemics and the spread of disease Protect against environmental hazards Prevent injuries Promote and encourage healthy behaviors Respond to disasters and assist communities in recovery Assure health status Identify community problems

Vision Healthy people and communities living in peace, social solidarity, equity, with protection of human rights.

Values High standards of public health workforce education in terms of technical, academic and professional preparation and education, in keeping with the spirit and intent of the Bologna Agreement. Protection of human rights in health, in keeping with the historic ethical principles based on the Sanctity of Human Life, the Nuremberg Trials, the Universal Declaration of Human Rights and the Helsinki Accords. International, national and community rights to high standards of public health. Highest standards of public health practice, using evidence based on science and good public health practices as practiced in leading countries, and as promoted by recognized international and national professional bodies.

Mission I To promote national and international efforts to improve educational standards, and accreditation systems so as to assure a competent public health and personal health care workforce with adequate professional and economic working conditions. To participate in collaborative efforts of international, regional, national and community partnerships to identify, diagnose, investigate and solve individual and community health threats. To promote universal assurance of equity in health, with provision to meet the needs of groups at special disadvantage or health risk. To promote national and international efforts in systematic monitoring of the health status of nations and communities, through improved population-based health information systems, including inter-linkage between multiple data sets to identify health problems at the international, regional, national and local community levels. To promote and advocate policies, plans and funding systems for adequate financial and political support needed for improvement and equity in individual, community, national and international health, through collaboration to inform, educate, and assist policy makers, health providers, and populations about health issues related to individual and community health risks and potential solutions.

Mission II To promote policies and management of health resources so as to provide efficient, effective and equitable care needed for personal and community health services, and to assure the provision of health care to groups at special disadvantage or health risk. To promote legislation, regulation and enforcement of these, so as to promote and protect health and to ensure safety. To promote development and reform of organizational systems, policies, economic analysis and management of health resources, so as to provide efficient, effective and equitable care needed for personal and community health services within national health and public health systems. To promote research and conduct evaluation of the effectiveness, accessibility, quality and equity of personal and population-based health services. To promote high professional and ethical standards of evidence-based public health in keeping with international evidence, experience and practice.

Principles/Standards for Education of PH Workforce Multidisciplinary including medical doctors, nurses, sociologists, lawyers, engineers, veterinarians and other disciplines professional and technical Professional education should include university training at the undergraduate, masters and PhD levels as in Bologna Agreement. Educational centers for public health should be located within multi- disciplinary or medical degree granting universities, institutes, academies. If in medical faculties, there should be a high degree of independence for administration, standards, student enrolment criteria, curriculum and financial autonomy. BSc and MPH degrees should be recognized as necessary qualifications for appointment and advancement in policy and management positions in the health sector, including private and governmental and NGOs Technical level training should be developed in community college or equivalent educational institution. Governments should recognize educational achievements in n national and internationally recognized universities for purposes of appointment, advancement and salary benefits for leadership in health sector. Accreditation systems within countries in the educational sector. International accreditation systems.

Core Disciplines Biostatistics Environmental health sciences Epidemiology Health Policy management Social and behavioral sciences Cross Disciplines Communication and informatics Diversity and culture Professionalism Program planning Public health biology Systems thinking Ethics Law Core and Cross Disciplines

Conclusions ASPHER has a role in promoting education, training, advocacy and research in PH Within ethical concepts M and V statement needed to define our role and its standards. Part of the process of management of any organization Basis for discussions of competencies, standards and roles for new and existing SPHs