1、PS 素材The Tufts DrPh program is based on a framework that reflects the competencies required by a leader in public health. The curriculum, which is flexible to the interests and background of the student, is designed to give the student the advanced skills necessary to synthesize and apply scientific
2、, biomedical, and public health knowledge and research to improve the health of populations. required and elective coursesA wide variety of elective courses are available within the Public Health Program and through other graduate and professional schools at Tufts University.One of the distinctions
3、between a traditional PhD and the DrPH program is the focus on public health practice. a qualified public health practitioner/mentor. This practicum will provide the student with a structured opportunity to master competencies needed to support their future careers as public health leaders.mastery o
4、f these competencies may be achieved through several apprenticeships. A student will be admitted to candidacy 1.T he careers outlined in this book represent a small window into the enormous world of public health, where wonderful opportunities abound.2. the aphorism that serendipity favors the prepa
5、red mind. In fact, a theme that recurs in many of the chapters in this guide is how important it is to be prepared to face the multiple challenges of our field. A second recurring theme is that the education of the past is but a preparation for the present and a forecast to the future, which is anot
6、her way of saying that a career in public health is a career of lifetime learning.1. 穆罕穆德.尤努斯 1） 1974 年 孟加拉国经历大规模的饥荒，几十万人都饿死了，我觉得很难过，因为我在教室里讲授美妙的经济学理论，告诉他们精彩的解决办法，但是走出教室你就会看到饿死的人们，就在你眼前。我发现，面对可怕的问题，你的理论压根起不了作用。2）他告诉学生，要用一种如虫子般的眼光而不是鸟类的眼光看待世界。因为鸟是从高空观察世界，离世界太高，可能无法看清每一件事物，从而你开始想象，从而你会基于想象去做出决定，而不是基于事
7、实。3）由于用大学教授的身份担保，尤努斯拿到了 200 美元的贷款，他的同事觉得一个教授做这种事有失身份，但是他对此毫不在乎，我不在乎他们是否喜欢，不在乎这是否是一个教授应该做的。4）在孟加拉某些贫苦地区，妇女几乎完全没有社会地位。在很多案例里，妇女们拿着手里的第一笔30 或 35 美元的贷款时，双手一直在颤抖，不知所措， 无法相信自己手里能有这么一笔巨款，更无法相信有人能这么相信她，眼泪夺眶而出。于是，她会努力工作来保证这种信任不会改变，她们尝到了被人尊重和信赖的滋味。这笔贷款的意义绝不止一笔钱，它能释放人的正能量，能释放她从未意识到的潜力，就像是一种自我实现。5）大饥荒开始时，我的抱负非常
8、实际，如果我能帮助一个人，我就是很幸运的，哪怕只有一天的时间，我一直努力去帮助我眼前的每一个人。我并没有打算去干一番大事业，虽然现在看来今天的目标非常大，但在当时，真的是非常小的事。6）格莱珉银行（1977 年创办至今）的十六条村约：直白、实际7）社会型企业 V.S.慈善机构8）2006 年他来到中国，准备开展小额贷款的项目。他说：我从不觉得任何一个国家是陌生的。 我觉得人都是一样的，当你去到农村，看见那些贫苦妇女，就她们的需求而言，我们是有共同语言的。她们的抱怨和我在其他地方听到的一样。9）从乡村银行诞生之日，质疑之声就一直伴随左右。希拉里：什么是最好的人生方向：要充分认识自己和相信自己，要
9、亲听自己的心声，要做自己的事，做哪些充实他们的社会生活和职业生涯的事。也许从此会经历变化，人生道路会改变，但我觉得追求自己觉得重要的事业是最好的生活方式。castle 第四集 23 集中女儿在准备毕业演讲时跟爸爸说：I am so scared. About what? Moving on. 是的，转变专业的 scare，放弃未来的安稳及高收入，不是个容易的决定，但是我有想去做的事，listen to my inner voice，rather than other factors that might drive me away from my destination.a universal
10、 truth: no matter we want or not, everything eventually ends.As much as Ive looked forward to this day, ive always disliked endings.The last of summer, the last chapter of a great book,parting away with closed friends. But endings are ineveitable. Leaves fall. You close the book. You say goodbye. To
11、day is one of those for us. Today we say oodbye to everything we were familiar, everything that was comfortable.We are moving on.Both nationally and globally, infant mortality is a key measure of population health. The infant mortality rate, the rate at which babies less than one year of age die, ha
12、s continued to steadily decline in the US over the past several decades; most recent national data from 2010 shows 6.15 deaths per 1,000 live births. Despite overall progress, racial disparities in infant mortality persist and preventable infant deaths continue to occur. Public health agencies inclu
13、ding CDC/ATSDR, health care providers, and communities of all ethnic groups must partner to further reduce the infant mortality rate in the United States. This joint approach should address the social, behavioral, and health risk factors that affect birth outcomes.Clearly, global health is a work in
14、 progress. While substantial headway hasbeen made against many of the most widespread and intractable healthproblems communicable and infectious diseases like plague and influenza,substance abuse, environmental health, mental illness they are still verymuch part of the global landscape.The good news
15、 is that organizations and individuals working across politicaland geographic boundaries have scored some remarkable successes. Forexample, immunization programs have reduced and in some cases eliminatedthe presence of polio and other childhood diseases worldwide; by 1980, theWorld Health Organizati
16、on (WHO) had succeeded in eradicating smallpox.But as old problems are solved, new ones emerge and spread across borders,driven by behavioral or demographic changes, natural disasters, war andbioterrorism. Smallpox and other ancient diseases may have been banished, but in their place comes a new wav
17、e of universal scourges HIV/AIDS,epidemic tuberculosis, food-borne diseases, and man-made environmentalhorrors such as acid rain and global warming. They affect the world ingeneral, but reserve the bulk of their malevolence for developing nations.For example, malaria is on the increase in tropical c
18、ountries because evenone degree of global warming allows mosquitoes to breed in areas theycould never have previously inhabited.During the past three decades, attention has focused on micronutritional issues the roles ofvitamins and minerals and how they can be delivered to nutrition-poorpopulations
19、. Iodine deficiency in particular was a major cause of preventablemental retardation in millions of children in developing nations. But teamsof scientists, health workers, policymakers and others working in closecollaboration devised effective ways to introduce iodine into childrens diets.Admittedly
20、, not all global health problems have responded so readily.Many international agencies and organizations are working to improveglobal health. Paramount among these is the World Health Organization,created in 1948 for the purpose of guaranteeing “the attainment by all peo-ple of the highest possible
21、level of health.” WHOs mission has translatedinto direct interventions and assistance whenever and wherever they arenecessary, as evidenced most recently by its participation in fighting theoutbreak of Ebola virus in Gabon in 2001. The United Nations ChildrensFund (UNICEF), meanwhile, has done an ou
22、tstanding job of focusing onthe health problems of the worlds children. In the early 1980s, UNICEFlaunched its “GOBI” initiative. “GOBI” stands for growth monitoring, oralrehydration, breastfeeding and immunizations; the agency boldly assertedthat these four simple interventions could dramatically r
23、educe the death tollof children worldwide. And they have been proven correct, time and again.In a real sense, the terms “public health” and “global health” have becomeinterchangeable. “In a world where nations and economies are increasinglyinterdependent, ill health in any population affects all peo
24、ples, rich andpoor,” notes the Institute of Medicine.As WHO director-general Dr. GroHarlem Brundtland elegantly reminds us, the rampant spread of infectiousdiseases such as AIDS, malaria and the West Nile virus give evidence that“in a globalized world, we all swim in a single microbial sea.”The simp
25、le fact is that global action against health risks in one country canhelp protect all people in all countries. That is the essence of global healthin the 21st century. In a world of easy travel and vanishingtrade restrictions, it is in the interests of developed countries to assist theirdeveloping n
26、eighbors. It isnt a simple matter of altruism or noblesseoblige but, rather, an understanding that the problems of one communitythreaten the whole world.Six billion people share a small and increasingly fragile planet, confrontedby global health problems that may seem overwhelming. But they are alls
27、olvable problems. Global health professionals will be an integral part of thesolution.Health and Behavior1. After years of seeing this model usedin a wealth of different settings andprograms, I soon realized it wasgaining momentum in public healthpractice. Public health professionalscan modify our m
28、odel and othermodels of care in any way that works for them. After all, by effectingchange early in populations, it is possible to prevent poor health on a muchbroader scale. For example, our model was used statewide in a Californiapublic health campaign that targeted smokers in the pre-contemplatio
29、nstage. The results of the campaign were excellent, because the public healthprofessionals running the campaign had tailored it for their target popula-tion. The plan implementers didnt ask people in the pre-contemplationstage to set a quitting date in the next month. Instead, messages helpedthem ap
30、preciate the benefits of behavioral change, including the benefits toloved ones of not having to breathe second-hand smoke.2. 成就感 Despite the sad circumstances that led to my entry into the field of psychology, my career has had a remarkably positive impact on my life. It has had apositive impact on
31、 many of my patients, and through others who apply myprinciples, it has led to a broadening of public health models.【 To know thatan idea you conceived and implemented has affected peoples behavior in away that helps them live healthier and perhaps longer lives is extremelysatisfying and to see your
32、 lifes work implemented all over world, andwith such great success, is truly an honor.】Director of the Cancer Prevention Research Center and Professor of Psychology at the University.He has served as a consultant to the American Cancer Society, the Centers for Disease Control and Prevention, managed
33、 care organizations, theNational Health Service of Great Britain, major corporations and numerousuniversities and research centers.The current public health climate is exhilarating in part because its challengespresent so many fresh opportunities. Many of these challenges arose in theimmediate after
34、math of the terrorist attacks of 2001. Since then, the publichas been troubled by the emergence of bioterrorist weapons, and publichealth issues have been thrust into the limelight. When legislators used thewords “public health infrastructure” when they talked to the press aboutthe solutions to our
35、nations lack of preparedness, many of this volumescontributors knew an important corner had been turned. 3. The workforce is an essential perhaps the most essential part of anyinfrastructure dependent on people. When considering what it will take toprovide a workforce that delivers on the promises f
36、or the decade ahead,several matters become clear. First, as the population ages, public healthservices will expand and as they do, so will the number of jobs at all levels.Competitive salaries will be needed to keep public health careers on a levelplaying field with other occupations. Second, we nee
37、d well-trained peoplewith strong skills to fill those positions as they develop. Health professionals,including nurses, social workers, nutritionists, administrators, educators,pharmacists and physicians, should exhibit competencies not always providedby schools of public health. To this end, there
38、is a movement afoot to consider developing separatepublic health credentials, parallel to what we see in our educational system.For example, someone wishing to teach biology can have a PhD in biologybut still not be allowed in the classroom without a teachers certificate. Thesame holds true in publi
39、c health as well; an MD might not be well preparedfor the public health challenges ahead. As you have read in Dr. Gebbieschapter, a separate credentialing mechanism is being considered, designed toensure that anyone who practices in public health demonstrates professionalcompetence not only in his o
40、r her specialty, but also in the core essentials ofpublic health.A natural conceptual leap from credentialing for public health professionalsis accreditation of community health agencies. The “National Public HealthSystem Performance Standards,” which were designed to evaluate the waycommunities dep
41、loy essential health services, have actually provided com-munities with a great opportunity for self-assessment. Might a nationalgroup such as the Joint Commission of Accreditation of Health CareOrganizations (JCAHO) tweak these same standards to accredit communities,provided these communities demon
42、strate, through application of the publichealth system standards, that they are adequately protecting the health ofthe people?Unacceptable disparities in health status among underserved subgroups ofour population persist. For the infrastructure to work at maximum effective-ness to serve us all, and
43、particularly to help us all address and overcomedisparities, we need to capitalize on the potential for diversity in this profes-sion. The positive lessons learned in the divisive 60s and 70s are that theworkforce is stronger for its differences. Still, in this profession, many culturaland ethnic gr
44、oups are underrepresented. We must make a strong effort torecruit a culturally balanced workforce to create an effective public healthsystem. This principle especially applies to leadership positions. Leadership inthe public health community must be developed from a large and culturallymixed pool of
45、 potential supervisors and directors, and that means involvingand mentoring, in the integral workings of every facet of the profession, anyqualified and promising people who request such assistance.Two initiatives should be mentioned that I believe give us a preview ofthings to come in public health
46、. The first, Public Health Grand Rounds, is ademonstration project jointly sponsored by the CDC and the University ofNorth Carolina School of Public Health. In Public Health Grand Rounds,the “patient” is the community and the “condition” is a public health issueconfronting the community, such as an
47、epidemic, higher percentage of low-birth weight newborns or prevalent drug abuse.1The Grand Rounds teamvisits communities where a public health situation has occurred, interviewsWith a surveillance system properly tuned, a response system properlyprepared and a support system regularly refreshed, we
48、 can face these chal-lenges. These and other tools to address these situations will be available toyou as never before. But in all our excitement about the future, let us notforget the enormous progress of preventive medicine over the past 50 years,which makes it possible for someone like myself a g
49、uy in his 60s toanticipate another 20 years of productive public health work. This opportu-nity for me and for a healthier America exists as a result of the insights, leadership and resources of my contemporaries. But its up to the nextgeneration, those of you who are currently working toward degrees, to nowstep up to the helm. Im personally looking forward to seeing you there.Hugh Tilson, MD, DrPH is Clinical Professsor of Epidemiology and HealthPolicy at the School of Public Health at the University of North Carolina,描述职业的用语 Dr. Tilson（本段作者）
