ROUND TABLE DISCUSSION
Barry R Bloom1
Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
Public health schools are critical to the development of knowledge and information about the health of populations and countries. As the economist Dean Jamison stated: "Knowledge about disease prevention, good surveillance for infectious diseases, the lessons from intervention research, sharing of health data, and the development of new products such as vaccines - all are public goods." In terms of providing new knowledge in public health and compelling evidence to affect policy in meaningful ways, schools of public health should, in my view, seek to contribute in each of four areas:
- research: defined as the generation of new knowledge and providing scientific evidence for decision-making at the individual or societal levels;
- training: not only of doctoral and master's degree students, practitioners and researchers, but of political leaders and public officials at national and local levels;
- communication: providing skills to inform leaders, the media and the public about health risks and prevention and health promotion best practices;
- practice: as an integral component of training; taking knowledge from the laboratory and population research into communities that inform about cultural contexts, disparities, needs and barriers, to have a real impact on the public's health.
A dilemma faced by all schools of public health is the balance between our responsibility to create new knowledge and transmit that knowledge to a future generation, and the need to apply existing knowledge to improve the health of populations now. In the United States of America (USA), we struggle to define what it is that students should know, from broad disciplines like epidemiology, biostatistics and health management, to new categories of competencies, such as informatics, communications, cultural competency, global health, policy and law, and ethics.1
My view is simpler: it is that in contrast to most graduate or postgraduate programmes organized around disciplines, professions, skills or sectors, our overarching aim in public health is to train our students to solve problems affecting the public's health. Our vision at Harvard is to encompass a continuum of scientific disciplines and programmes, from fundamental science to application locally and globally, in order to address most effectively the big problems in public health. To do so, we place great emphasis on multidisciplinary and interdepartmental approaches to problems and education. Education should not stop with satisfying the disciplinary or credentialing requirements. BRAC has brilliantly immersed the students directly in the health problems in villages. We are revising our curriculum to include, in addition to a practicum experience in the community, more case-based learning and analytical thinking. In both schools, the aim is to provide our students with the best skills in solving problems in public health.
What is the knowledge that is important? I believe there are three kinds: "public knowledge" accessible to everyone, as in published scientific literature; "contextual knowledge", namely how to apply public knowledge in a particular place or health context; and "tacit knowledge", the knowledge that cannot be taught but is learned by example, that breaks down barriers of culture or training, and is transformational in the lives of people.2 These are the great challenges, as I see them, in public health education.
References
1. Gebby K, Rosenstock L, Hernandez LM, eds. Who will keep the nation healthy: educating public health professionals for the 21st century. Board on Health Promotion and Disease Prevention. Washington, DC: The National Academies Press; 2003.
2. Bloom, BR, Michaud, CM, LaMontagne, JR, Simonson. Priorities for global research and development of interventions: overview and synthesis. In: Jamison DT, Mosley WH, Measham AR, Bobadilla JL, eds. Disease control priorities for developing countries, 2nd ed. New York: Oxford University Press; 2006: pp. 103-18.
1 Correspondence to Barry R Bloom (e-mail: bbloom@hsph.harvard.edu).