el Ansari W, Russell J, Spence W, Ryder E, Chambers C
Department of Public and Community Health, School of Health and Social Care, Oxford Brookes University, Heritage Gate, Sandringham House, Sandy Lane West, Oxford OX4 6LB, UK.
Public Health. 2003 Mar;117(2):77-87. doi: 10.1016/S0033-3506(02)00020-3.
Health policy in the UK is going through significant changes. At the heart of the transformation is a dedicated focus on public health. The new primary-care-based health system will not only be premised on a specialist public health workforce, but also on broader based public-health-oriented health professionals. Within primary care, widening the foundation of health professionals with public health competencies suggests that higher education bodies will need to adapt their curricula to an approach that highlights population-based health principles, preventive philosophy, and public health concepts and methods. The first part of this paper describes the mapping of the public health content of healthcare curricula at one university in England, based on the 10 public health standard areas of competencies of the Faculty of Public Health Medicine. The second part examines, through the findings of a strengths, weaknesses, opportunities, threats (SWOT) analysis, the factors that advocates for a public-health-oriented educational strategy must examine before embarking on the instigation and development of public health concepts in the healthcare curricula. The aspects that necessitate consideration include strengths such as the prevailing policy, market forces, commitment, and motivation to the effort, and the availability of resources, information and external contacts. Features such as political drive and advocacy, interest in the education debate, collaborative links through joint working and partnerships, and ongoing internal reforms and restructuring could all act as opportunities. However, resistance and anxiety are to be expected, the operationalization of the effort and empowerment of those leading it need to be thought about, and issues of control and interests are critical. The presence of conflicting priorities and competition or the lack of vision and directives, or uncertainty about change, could act as threats and barriers to the effort. If shifting the 'traditional' healthcare curricula to a more 'innovative' public-health-oriented one is to be a success, administrators of educational change will need to take into account a 'melange' of factors and stakeholders involved in a gradual and incremental process.
英国的卫生政策正在经历重大变革。变革的核心是对公共卫生的专门关注。新的以初级保健为基础的卫生系统不仅将以专业的公共卫生劳动力为前提，还将以更广泛的面向公共卫生的卫生专业人员为基础。在初级保健领域，扩大具有公共卫生能力的卫生专业人员基础意味着高等教育机构需要调整其课程，以突出基于人群的健康原则、预防理念以及公共卫生概念和方法。本文第一部分描述了基于公共卫生医学系的10个公共卫生标准能力领域，对英格兰一所大学医疗保健课程中的公共卫生内容进行的梳理。第二部分通过优势、劣势、机会、威胁（SWOT）分析的结果，审视倡导以公共卫生为导向的教育战略的人士在着手在医疗保健课程中倡导和发展公共卫生概念之前必须考虑的因素。需要考虑的方面包括优势，如现行政策、市场力量、对这项工作的承诺和动力，以及资源、信息和外部联系的可用性。诸如政治推动力和倡导、对教育辩论的兴趣、通过联合工作和伙伴关系建立的合作联系，以及持续的内部改革和重组等特征都可能成为机会。然而，预计会有阻力和焦虑，需要考虑这项工作的实施以及赋予领导者权力的问题，而且控制和利益问题至关重要。相互冲突的优先事项和竞争的存在，或者缺乏愿景和指令，或者对变革的不确定性，都可能成为这项工作的威胁和障碍。如果要成功地将“传统 ”医疗保健课程转变为更 “创新 ”的以公共卫生为导向的课程，教育变革的管理者将需要考虑在一个渐进的过程中涉及的各种因素和利益相关者的 “混合体”。
