Bulletin of the World Health Organization

The pull of public health studies

Public health has burgeoned over the past 100 years, from the study of tropical diseases in the 19th century to national public health systems after World War One and, more recently, to include international public health. Education has kept up with these trends, and today there are hundreds of schools around the world, many flourishing in developing countries.

“Public health is an excellent mix of health and social issues,” says Abebual Zerihun Demilew, an Ethiopian student who just graduated from the James P Grant School of Public Health in Dhaka, Bangladesh, which is run by the world’s largest development nongovernmental organization, BRAC (formerly the Bangladesh Rural Advancement Committee).

The James P Grant School is one of a new breed of public health institutions based in a developing country. It offers courses relevant to Bangladesh as well as international public health issues, and attracts students from both developing and developed countries.

Abebual Zerihun Demilew, an Ethiopian graduate of the James P Grant School of Public Health, accompanies a research programme manager from the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), on a field trip to rural Bangladesh to assess hygiene and sanitation practice during flooding. Both the public health school and the centre are based in the capital, Dhaka.
Abebual Zerihun Demilew, an Ethiopian graduate of the James P Grant School of Public Health, accompanies a research programme manager from the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), on a field trip to rural Bangladesh to assess hygiene and sanitation practice during flooding. Both the public health school and the centre are based in the capital, Dhaka.

“The main drive for students to come to this school is that the course is given in partnership with internationally prestigious schools, including Johns Hopkins, Harvard and so on,” Zerihun says, adding: “We are 25 students, 12 from Bangladesh and 13 from all over the world. Six of those are medical doctors.” Their countries of origin include Afghanistan, Ethiopia, India, Kenya, Myanmar, Nepal, Pakistan, Uganda, the United Republic of Tanzania, Singapore and the United States of America (USA). Students on Zerihun’s course are also attracted by the real-life experience of fieldwork.

Public health schools have existed since the late 1890s. The first two, the Liverpool and London schools of hygiene and tropical medicine, were founded in the United Kingdom in 1898 and 1899, respectively. They studied diseases brought home by sailors returning from far-flung shores and the health risks that administrators, merchants and soldiers faced in the British empire’s colonies and trading stations.

During the first part of the 20th century, public health schools tended to be in rich, industrialized countries and focus on national health systems.

The last few decades have witnessed a shift. Today there are schools, like the Bangladesh school, in developing countries such as China, Benin, Brazil, the Democratic Republic of the Congo, Ghana, India, Kazakhstan and Thailand, to name but a few, covering international public health issues and local concerns.

Some schools provide both degrees and training in diverse disciplines for specific professionals while others have a purely academic focus.

Courses range from one to seven years, require varying amounts of fieldwork and cater to professionals, who are already working in public health, and recent graduates. Depending on the school, a student can opt to study full-time, part-time and by correspondence, online; earn anything from a master’s degree in public health (MPH) to a doctorate; or take a short course and receive a certificate in a particular subject.

In the USA, for example, accredited public health schools generally offer five core disciplines, according to the American Association of Public Health Schools, the umbrella organization: biostatistics, epidemiology, health services administration, health education/behavioural science and environmental health. Schools in the USA and elsewhere also offer courses in international health, maternal and child health, nutrition, public health programme management and biomedical laboratory science.

There are as many instruction methods as there are schools. The University of Pretoria’s School of Health Systems and Public Health offers a self-directed learning programme including epidemiology; health policy and management; environmental and occupational health; disease control; health research ethics and health promotion. Although there are structured classes, the school encourages independent learning.

“We strongly believe that all our graduate students are self-directed learners,” according to the Pretoria school’s MPH course description. “For this reason, the MPH programme is very flexible in time and content. The programme is focused on enabling students to learn what is important, in light of previous education and a vision of their own future in the health system.” The goal is to create a “learning environment for students, not a teaching format for the school”.

Because schools are so diverse, there are many things to consider when choosing a programme besides the cost and length of time.

Many public health schools in developed countries are affiliated to or collaborate with others in developing nations, offering exchange programmes and the opportunity to do joint projects or fieldwork in the affiliated school. Professors and lecturers also move between schools. A student who can’t get a place or afford to study at a specific school may be able to attend one that is connected with that institution.

Public health careers run the gamut from working in community clinics to consulting for private companies to serving at the top of a country’s public health sector, as health minister, according to public health school web sites.

Some schools assure their graduates a job after they complete their studies. For example, all the students at Kazakhstan’s School of Public Health are from that country and most go on to work in its public health offices and clinics as determined by the Kazakhstan Ministry of Health. Graduates of the School of Public Health at Beijing University can expect to find a job mainly in preventive medicine and related fields in China itself, though some alumni work abroad.

Many of the world’s public health schools give classes in English language or have special programmes in English for foreign students. The University of Debrecen’s School of Public Health in Hungary, for instance, offers an international health programme in English. Pretoria requires a good command of English, as do many other schools, while those in Algeria, Benin and Lebanon require a good command of French.

Pretoria conducts all its graduate courses in English and offers language programmes to help students, as proficiency in English is a requirement to enrol in the school’s MPH programme.

Programmes vary, too, on their prerequisites. Debrecen’s applicants are required to pass tests in biology, physics and chemistry, though the requirement can be waived for students with degrees in biology and related subjects. ■

Research and report by Theresa Braine

“The main drive for students to come to this school is that the course is given in partnership with internationally prestigious schools, including Johns Hopkins, Harvard and so on.”
Abebual Zerihun Demilew, an Ethiopian student who just graduated from the James P Grant School of Public Health in Dhaka, Bangladesh.