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In: The Graduate Education of Foreign Physicians in Public Health and Preventive Medicine. The Role of United States Teaching Institutions, edited by Wendy W. Steele and Sally F. Oesterling. Philadelphia, Pennsylvania, Educational Commission for Foreign Medical Graduates, . 29-31.This presentation focuses on the changing role of US schools of public health over the past 60 years and covers predictions and trends of future changes. Foreign physician graduates of US schools of public health were not only responsible for founding the WHO, but have also served in positions such as director-general of WHO. Since World War II there has been an increase in foreign students trained in US schools of public health. Between 1965 and 1981 the number of foreign students increased from approximately 250 to about 700/year, and by 1983 the foreign student enrollment in US schools of public health had reached almost 1200. Most of the increase comes from heavily populated countries in Asia and in Africa. India was the country of origin for an average of 24 public health students in the US during 1967-68, but this number declined to 16 by 1977-78 and 1981. Nigeria significantly increased the number of trainees sent to the US from 5 students in 1967-68 to 54 in 1981. Although the total enrollment of foreign students has more than tripled since the 1960s, the % of foreign students in US schools of public health has dropped from over 20% in the early 1960s to about 13% in 1983. A review of all Johns Hopkins medical graduates shows that 75% of over 700 foreign medical graduate students live in their countries of origin, and only 14% live in the US. In general, the number of students from each country reflects that country's need. Assuming adequate levels of financing, US schools of public health should assist in the development of a sufficient number of schools of public health in their countries to meet those countries' needs for public health professionals.
In: The Graduate Education of Foreign Physicians in Public Health and Preventive Medicine. The Role of United States Teaching Institutions, edited by Wendy W. Steele and Sally F. Oesterling. Philadelphia, Pennsylvania, Educational Commission for Foreign Medical Graduates, . 15-8.At a time when there is a growing interdependency among nations with regard to trade, resources and security, there is an increasing provincialism in the US. In such a climate it is difficult to generate support for international programs. Involvement on the part of medical schools has waned almost to the point of nonparticipation in international medical affairs, largely because of constraints on training and residency programs. Academic health centers have not been supported as a matter of policy. Leadership in international health in other parts of the world, diminished involvement in international health, current priorities and programs and a future prospectus are discussed. The WHO seems an unlikely source for necessary leadership in helping define future directions for education or new strategies in preventive medicine and public health in the developing world. Institutions in Europe have deteriorated and participation and leadership from them are unlikely. Few people today are interested in clinical tropical medicine. Another reason for waning academic activity in international health relates to the paucity of interest on the part of foundations. An important initiative was the development about 5 or 6 years ago of the WHO Tropical Disease Research Program. It now has a budget of about US $25 million and has attracted additional money from the US and from other countries. A gamut of prospects has resulted including a maria vaccine, a leprosy vaccine, a new drug for malaria. In the developing countries, there is a much larger base of basic competence than existed only 10 or 20 years ago, but these health workers need support if health goals are to be attained. Schools of public health should be as much professional schools as schools of medicine, and the practice of public health should be engaged in. The US Centers for Disease Control (CDC), in its global Epidemic Intelligence Service (EIS) program in Thailand and in Indonesia has pioneered admirable new approaches in practical training. Provision must be made for sufficient faculty to permit both professional practice and education in any school that offers public health education. The US has a vital and unique role to play in public health and preventive medicine.
Assignment Children. 1984; (65-68):49-54.The resolutions of the American Academy of Pediatrics, the International Pediatric Association, the League of Red Cross and Red Crescent Societies, and the International Confederation of Midwives in support of the Child Survival and Development Revolution (CSDR) proposed by UNICEF, stress that the major causes of infant and child morbidity and mortality are preventable and remediable through low-cost, highly effective health technologies. In particulat, the use of charts to monitor growth, promotion of oral rehydration therapy, protection of breastfeeding and universal immunization, have created opportunities for significant improvements in infant and child health, worldwide. The American Academy of Pediatrics urges pediatricians from all countries to support the objectives of program like UNICEF's in their practices and through their public role. The International Pediatrics Association sees the large scale application of these effective health technologies in the context of primary health care, employing, in particular, methods of mass communication and social organization and commits itself to partnership in the effort to reduce childhood mortality and morbidity; and resolves to work at all levels with UNICEF to bring about a CSDR. The League of Red Cross and Red Crescent Societies encourages ma ximum use of all basic child health measures through its information and health learning programs. The International Confederation of Midwives calls upon midwives all over the world to ensure that newborn babies have the oopportunity to be put to the breast, that special efforts are made in hospitals to prevent sick or premature babies being deprived of their mothers' milk, that national governments be properly informed about the need to promote breastfeeding. The International Confederation of Midwives also fully supports UNICEF to promote breastfeeding and endorses UNICEF's GOBI strategy.
World Health. 1984 Jul; 3-5.In 1977 the World Health Organization (WHO) began a peaceful revolution in international public health by asking a group of experts which drugs were really necessary to take care of most health problems. The conclusion was that about 200 drugs and vaccines could be considered essential in good medical practice. Most of them were of proven efficacy, with well-known therapeutic properties, and most were no longer protected by patent rights and could be mass produced at a reasonable cost to patients. The Model List of Essential Drugs, although revised twice since 1977, has needed only minor adjustments and is still limited to about 220 essential drugs and vaccines. More than 80 countries in the 3rd world have adapted the model list to their requirements. Country experience demonstrates that using a limited number of essential drugs poses no threat to public health. In response to problems of drug supply and drug use in developing countries, country application of the philosophy of essential drugs has become the centerpiece of a global program designed to make sure that a limited number of essential drugs of good quality are available at prices that poorer patients can afford. A strategy, drawn up toward the end of the 1970s and which eventually became the Action Program on Essential Drugs and Vaccines, addresses the complexity of the world of pharmaceutical products and their utilization. It focuses on essential drug availability in primary health care. If a limited number of essential drugs cannot be delivered on a regular basis to rural areas and the poorer sections of cities, the whole strategy of health for all by the year 2000 will face a partial or even total failure. The Action Program on Essential Drugs and Vaccines is becoming a worldwide effort, with many partners involved. Countries decide for themselves on the pharmaceutical policy they want to follow. Many have chosen an essential drug policy and some have accelerated their programs with external technical and financial collaboration. Physicians and other health workers who prescribe, and dispensing pharmacists, are obvious partners for the Action Program. New information and training must be provided for students of medicine, pharmacy, and pharmacology before an improvement in the fine art of prescribing medicine can be expected. Patients, supported by better information and follow-up, should also accept more responsibility for their own use of drugs.
Jama. 1984 Jan 27; 251(4):502-4.To gain more information about the magnitude and specifics of current involvement of US physicians in international health, the Johns Hopkins University Department of International Health (JHU/DIH) and the National Council for International Health (NCIH) surveyed 1257 organizations. An estimated 8700 US health professionals are currently engaged in international health work, with physicians comprising 22% and nurses 23% of this total. 0.32% of all US doctors and 0.12% of US nurses are working overseas. 46% have longterm placements, 20% are on short-term (1 year or less) assignments, and 33% are volunteers. Almost 1/3 of the physicians are involved in public health activities, compared with only 1% of physicians working in the US. The majority are involved in clinical practice. Survey results indicate that there are 241 budgeted vacancies for physicians in international health, 128 of which are for volunteers. A substudy reviewed the working history of the 66 1962-71 graduates from JHU/DIH to determine the attrition rate of physicians working in the field of international health. 9 graduates were pursuing lifetime careers in international work, 12 chose not to enter the field, 28 spent 5 or fewer years in the field, and 18 followed a mixed pattern of both international and national work. The current survey indicates that the number of health professionals working overseas has increased 63% since 1969, when a similar survey was conducted. Although government agencies have decreased in importance as employers of US health professionals working overseas, private voluntary organizations, corporations, and universities have increased in importance. Church-related organizations have remained the largest single employer. The large number of physicians serving overseas in short-term assignments suggests a need for short, self-instructional orientation courses. Longer, more intensive training programs are needed for longterm personnel. Recent data indicate there are too few fully prepared US health professionals for the job openings in existence.