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by Kerstin Sell on behalf of the Network
A wave of transformative energy has been building up in Germany’s Public Health community over the past years. After the 2015 Leopoldina report powerfully presented the necessity for reform in Germany’s Public Health institutions and academic landscape, along with the country’s politics and policies, the actors in the Public Health community have joined forces to work towards a new Public Health strategy for Germany. The conference Zukunftsforum Public Health (Future Forum PH) has been critical in facilitating community networking, interdisciplinary exchange of perspectives and preparing a road map for the strategy development.
At the second Zukunftsforum Public Health in December 2017, early career public health professionals, students, and researchers sought to find a medium to connect with each other, network, discuss and work on common interests. This led to the formation of the German Network of Young
Professionals in Public Health which we would like to introduce here.
Initially, the network consisted of an informal mailing list that anyone who self-defined as a young person with an interest in Public Health could join after review by the moderators. News about the network was shared by word of mouth, but as the network became more formalised, new members were informed about its existence through publications and the visibility of public engagement of the network.
In addition to the email exchange, regular conference calls were established, a network statute was adopted, a corporate design and a homepage were launched, and a coordinating committee was elected. Within the first months of the network’s existence we published an article about our perspectives as young professionals on Public Health in Germany with a focus on necessary reforms in Public Health education and training (Akçay et al. 2018). Careers in Public Health have been an ongoing topic in the network as the urgency to reform Public Health education in Germany has become very clear through the exchange of the network members’ experiences.
At the third Zukunftsforum conference in January of 2019, participation of young professionals and students had increased remarkably. A network meeting was organised for the day following the conference to enable reflection about our role as Young Professionals in Public Health at the conference and within the German Public Health landscape. The network meeting also offered the opportunity to continue brainstorming and discussing the Zukunftsforum’s main topic: the new Public Health strategy for Germany. From the brainstorming process we were able to derive recommendations for the strategy development from our perspective, which we subsequently published on our homepage. An executive summary of this paper has been accepted for publication recently.
While our network is growing and facilitating exchange, cooperation and a platform for discussion among young professionals in Public Health in Germany, it is also still evolving and diversifying. We hope to be able to report on further interesting projects and initiatives in another EuroNet Newsletter in the future.
As our homepage is in German, please feel free to contact the speakers of the network email@example.com for more information.
Akçay et al., Public Health in Germany from the Perspective of Young Professionals. Gesundheitswesen 2019; 81(03): 176-181. DOI: 10.1055/a-0795-3477. (Article in German)
by Erica De Vita and Filippo Quattrone,
PH residents University of Pisa, Italy
The 2019 edition of the Deans’ & Directors’ Retreat organized by the European Association of Public Health (ASPHER) was held in Erice (Sicily, Italy), from 26th to 29th of May.
The congress dealt with educational issue in some of the most relevant topics in public health such as vaccinology, digital health, climate change and workforce development.
A parallel session of the congress was dedicated to Italian schools of public health.
It was a unique occasion for Directors and Residents from all over Italy to discuss together about the status of public health education in Italy.
Erica De Vita and Filippo Quattrone, two members of SItI residents` committee (EuroNet MRPH member), had the opportunity to illustrate the expectations of residents and to propose some solutions
In particular five expectations were highlighted:
- Recognize that the status quo of public health education is unsatisfactory.
- Act for quality standards and homogeneity among all schools of public health.
- Promote collaboration among schools on public health education.
- Adopt innovative technologies and methods in public health
- Involve actively residents in their own education.
In addition, two improvements were proposed:
1) to write, with the contribution of all Italian school, a national core curriculum based on ASPHER list of core competencies for the public health professional.
2) to develop a e-learning portal where sharing courses among different schools. The proposals found the approval of the presents and the session closed with the institution of a working group, composed by directors and residents’ representatives, to promote the improvement of public health education in Italy.
by: Dott. Stefano Greco, MD. Resident in Hygiene and Preventive Medicine at the University of L’Aquila, Co-ordinator of the Consulta SItI’s working group of Emergency Management and Disaster medicine; Dott. Francesco Rosiello, MD; Dott. Antonio Vinci, MD. Resident in Hygiene and Preventive Medicine at Università di Tor Vergata; Dott. Mario Muselli, MD. Resident in Hygiene and Preventive Medicine at University of L’Aquila
Following the institution of the working group on Emergency Management and Disasters Medicine within the Italian Advisory Body of Medical Residents in Hygiene, Preventive Medicine and Public Health ( Consulta SItI), an official body of the Italian Society of Hygiene, Preventive Medicine and Public Health (Società Italiana di Igiene, Medicina Preventiva e Sanità Pubblica, SItI), a survey on preparedness, knowledge demand and professional interest on disaster medicine among residents in public health has been conducted. 96 out of about 500 interns answered the survey.
From the answers it can be affirmed that, despite growing attention on the matter (especially due to the numerous nefarious events that afflicted Italy in the last 10 years), a very small number of Schools of Specialization dedicate time of resources on the thematic.
Italy, during the last 10 years, was afflicted by 5 earthquakes of medium-high intensity (Richter >3) and several floods and\or unseasonal meteorological hazards. These events sum up to anthropic disasters of national relevance, such as the collapse of Morandi Bridge in Genua, interrupting a fundamental traffic road not only for the city and the hinterland, but for the entire national road movements of people and goods.
Materials and Methods
After a first meeting (in person) on the creation of the working group, several online meetings were indicted via skype in order to design a questionnaire to be delivered on all Italian’s Public Health (Hygiene) residents.
The final questionnaire consisted of 12 Items, based on a 6-steps increasing scale (0-5), yes/no answers and open ones. It was host on Google module and diffused to all Schools, whose interns had ample time to answer to (one month).
96 out of 500 interns answered the questionnaire, from 26 out of 35 schools. Overall compliance was of 19,2% for interns and 74,2 for schools.
The answers, shown in figure 2, were as follow: 79% declared they never attended any activity on emergency management in public health; 93.8% is not satisfied by the space reserved to the thematic in their School; 75% declared to be interested in the thematic (scale score >= 4); 80% declared they never attend to any course on the matter and 86% that their university did not have any Master active on the thematic.
As per sources of information, 58,9% declared they look for information on courses and congresses, with a strong interest on workshops, simulations, and formative events.
Last but not the least, 81,3% declared absence of a sharing policy for confrontation and experiences exchange among Schools from clinical areas.
Strengths and Limitations
Unfortunately, number of respondent residents was only a fraction of the total resident number, most likely those who already had a keen interest in the matter. This could have lead to a selection bias, at least on the interns’ interest section; it must be noted, however, that this has no repercussions on the study section regarding presence of specific courses or masters, since this does not depend from the number of participants.
Also this did not influence the statistics covering information sources either, since those who have no interest are not expected to have a source of information at all.
An analysis of answers shows that there is high interest on the matter by Italian residents, but unfortunately such interest is not always met by the courses held in the respective Specialization Schools. Henceforth, the authors believe it is opportune to allow an enrichment of the formative portfolio of Italian interns, and that this should be reported in all opportune environments, in order to answer to the formative demand hereby emerged.
The survey was conducted by Dr. Stefano Greco, MD, resident from L’Aquila University and co-ordinator of the Consulta SItI’s Emergency Management and Disaster medicine working group. All the members of the Working Group actively helped Stefano to realize this project.
by Giulia Gherardi, MD
PH resident University of Bologna, Italy
“Challenges and realistic Solutions to Migrant Health Burden in Europe” has taken place in Amsterdam 12 July 2019. Amsterdam Public Health-Global Health Section within the Amsterdam UMC (University Medical Centers)
has organized this symposium. The seminary started at 9:30 AM in a stunning Mennonite Church in Singel Street and ended at 6:00 PM with a celebration for the recent “full Professor title” of Professor Charles Agyemang.
In the morning three keynote lectures has been presented by leading scholars in the field of ethnicity, health and migration, including Prof. Raj Bhopal (University of Edinburgh), Prof. Allan Krasnik (university of Copenhagen) and Prof. Karien Stronks (Amsterdam UMC, University of Amsterdam).
The first presentation has dealt with risk factors, both genetic and environmental, for diabetes type 2 among South Asian population living in Amsterdam. The result imputed, as a major risk factor, the lifestyle and the particular way of cooking at very high temperature that concentrate trans-fat acids. On the other hand, the second and the third
lectures have been broader, addressing the important role of inequalities and social determinants on migrants’ health.
They strengthened the need of improvement cultural competence of health services as well as the creation of target programs for selected population.
After the lunch, PhD students of UMC presented some thriving researches about the burden of chronic non-communicable diseases among migrant population. Some of them has been extremely specific (metabolism and molecular pattern) and mostly based on the South Asian community, which is the more representative in the city of Amsterdam.
In the end, a Round Table Discussion has been carried out with the keynote speakers. This dynamic interaction pointed out that we need a system thinking with inclusive intervention designs with community engagement and stakeholder participation in order to develop achievable and realistic solution to this issue. Professor Agyemang’ celebration has probably been the best part. To honor also is Ghanaian origin he presented a wide interesting lecture “Healthy Migrants, Healthy Society” about migration and all its aspects.
Personally, this attendance has been a pleasure. Especially noticing that UMC really cares, allocates resources and promotes research in migrants’ health, as it is seriously considered an important public health issue.
by Rachael Marsh
Public Health resident, Bristol, UK
“We can only pray that our sick planetary patient might be placed on a road to recovery – failure to write the prescription, however, might leave us contemplating the death certificate instead”. Prince of Wales 2015, Royal Society in London.
Our Planet is Critically Sick
If we were to consider our Planet as a patient, as health professionals, we would be seriously concerned about their health and would quickly diagnose that ‘Patient Planet’ was critically sick. A rapid assessment of the Planet’s health
would find an escalating fever, with difficulties breathing, a faltering circulation, with metabolic acidosis and a toxic status, failing liver and kidney functions, a pale, blotchy skin indicating signs of shock, with a rapidly declining mental state.
Human systems can be seen as a microcosm of the Earth’s living biosphere, although there are significant differences in scale and functioning of some of these systems, in terms of appreciating the seriousness of the Earth’s failing eco-systems, it is helpful to consider the analogies of the Planet’s health with that of a human, as below:
“Fever – escalating temperature – 1°C now, rapidly rising to 3-4°C by 2100 and 3-10°C by 2200 (a temperature rise of 3-4°C is considered a medical emergency and risks fatally in humans).
Respiratory System – escalating carbon emissions with CO2 at 411ppm; air pollution dangerously high with 91% of places exceeding WHO guidelines; wildfires and continued loss of global forests.
Circulatory system – oceans 30% increased acidity having absorbed 50% of postindustrial carbon emissions and 90% of the excess heat (equivalent to 36°C when released back to the atmosphere); pollution with toxins and plastics; freshwater scarcity.
Organs (liver and kidneys) – an annual 3% loss of swamp and marsh lands that protect coasts, detoxify and regenerate.
Skin – increasing desertification, mudslides, and depleted agricultural land.
Mental Health – biodiversity loss at 60% for mammals, birds, fish and reptiles since 1970, nearing the threshold for a sixth mass extinction at 75% loss.”
Source. IPCC (2018); WHO (2016); NASA (2019); FAO (2019); WMO (2019); Living Planet Report (2018); IUCN (2016); Drawdown (2017); Lewis and Maslin (2018); Kumar and Clark (2016).
Diagnosis and prognosis – will ‘Patient Planet’ die?
As physicians, we would diagnose an escalating fever with a critical risk of multiple organ failure and send ‘Patient Planet’ straight to Critical Care. Not knowing what else to do, we could declare the situation as chronic, terminal, and just take steps to make the patient as comfortable as possible until the end came. However, we stand at a critical moment in the history of our Planet. Over the next decade, we are the generation that holds the responsibility to reverse the epidemic explosion of carbon emissions and urgently stabilise the risks from runaway climate change.
Management – how can we save ‘Patient Planet’?
Just like for a sick patient, by taking a Critical Care Response approach as below, we can halt and potentially reverse the harm done so far.
Resuscitation: declare a Climate Emergency.
We already have mechanisms like the WHO Emergency Response Framework in place, and given the critical state of the Planet’s Health, this should warrant an urgent assessment, which based upon risks and severity of global impacts, should be placed at Grade 3, triggering a multi-sector, global emergency response (WHO, 2017). We can draw lessons from handling other emergencies like Ebola, which led to rapid mobilisation of resources, strategic co-ordination and action at speed and scale.
Stabilization: homeostasis/ re-stabilization of systems requires a rapid reduction of carbon emissions over the next decade, including actively sequestering carbon to lower the driver of increasing temperatures. Stabilisation
of ocean temperatures and acidity may also be required.
Treatment: depending upon the successful resuscitation and stabilisation, ‘Patient Planet’ would be able to leave the critical care unit, with a longer-term treatment plan, including an initial recovery period, during which time
toxins and plastics would be removed to allow healing.
Recovery: to enhance the recovery of ecosystems
• Air – rapid investment in clean energy and transport systems
• Water – restore healthy ocean and coastal environments, enhance naturebased solutions for clean water and
• Food – reduce food waste and excess consumption, enhance plant based healthy foods and clean cooking
Rehabilitation: additionally, a preventive approach would be taken, including building climate resilience/ emergency preparedness (flood management, drought response, etc). Development of planetary health indicators to
act as an Early Warning Score enabling detection of high-risk symptoms, and corresponding early intervention.
Promotion: promote sustainable development with a focus on actions that primarily benefit the health of the Planet, whilst maximising cobenefits for humans, including: continuing work towards the Sustainable Development Goals (SDGs, 2015) and actions such as; reduced food waste, plant rich diets, family planning, educating girls, clean cookstoves, renewable energy, housing insulation, recycling, forest protection, water saving, walkable cities, and
cycling infrastructure (Drawdown, 2017).
The UN recently declared that we have to reduce global carbon emissions by 45% by 2030, in order to keep to within safe limits (1.5°C), with a target of zero emissions by 2050. This requires urgent, large-scale action with an estimated annual investment of 2.5% of global GDP (IPCC 2018).
Please share this analogy widely to help save ‘Patient Planet’. Concept adapted from work by Dr Joanna Nurse
(Strategic Advisor to InterAction Council).