Background

In 1988 the Institute of Medicine (IOM) released its now infamous report, The Future of Public Health, in which the Committee said that the public health system has fallen into disarray. The Committee made a number of recommendations, including that “firm practice links” be established between schools of public health and public health agencies. Additionally, the authors recommended that,

Schools of public health should provide students an opportunity to learn the entire scope of public health practice, including environmental, educational, and personal health approaches to the solution of public health problems; the basic epidemiological and biostatistical techniques for analysis of those problems; and the political and management skills needed for leadership in public health. ¹

Out of these recommendations, the Public Health Faculty/Agency Forum was established in 1989. This Forum laid the groundwork for the work of the Council on Linkages Between Academia and Public Health Practice (the Council), including releasing the Universal Competencies, a set of skills, knowledge, and attitudes necessary for the broad practice of public health. These competencies were revised and updated and on April 11, 2001, after extensive public comment, the Council adopted the Core Competencies for Public Health Professionals (Core Competencies).

In 2003, the IOM released a new study, Who Will Keep the Public Healthy? Educating Public Health Professionals for the 21 st Century which was aimed at, among other things, determining what progress had been made since The Future of Public Health was published. The Committee that authored the study expanded on the five core areas of public health (i.e., epidemiology, biostatistics, environmental health, health services administration, and social and behavioral sciences) by adding eight content areas which “are now and will continue to be significant to public health and public health education.”² The eight areas are: informatics, genomics, communication, cultural competence, community-based participatory research, global health, policy and law, and public health ethics. The Committee recommended that for each of these eight areas, competencies be identified.

Who Will Keep the Public Healthy? also highlighted the ecological model of public health, which it defined as “a model of health that emphasizes the linkages and relationships among multiple factors (or determinants) affecting health.”³ The IOM Committee stressed that public health professionals should understand the ecological model and be able to “look beyond biological risk factors that affect health and seek to also understand the impact on health of environmental, social, and behavioral factors.” The Committee endorsed the idea that education should be competency-based and supported the competency domains identified by the Council. However, in addition to these competencies, the Committee recommended that schools of public health teach the ecological approach and emphasized the influence that schools have on all health professional education and practice.⁴

In a brief discussion of the competency domains identified by the Council, the authors of Who Will Keep the Public Healthy? stressed that greater emphasis should be placed on the specific areas of communication, policy, and cultural competence, while keeping in mind the importance of incorporating the ecological model.⁵

Top

What This Means for the Core Competencies Workgroup

As the Council looks to update and refine the Core Competencies, Workgroup members should take into account the recommendations made by the authors of Who Will Keep the Public Healthy? regarding the incorporation of the ecological model. Just as there is a need for schools and programs in public health to teach the ecological model, there is a need for public health professionals to understand and apply the model to their work.

With these reports in mind, one of the tasks of the Core Competencies Workgroup is to integrate the ecological model into existing competencies and, where proper, incorporate additional competencies which will ensure that the model is understood and applied effectively.