Public Health Education in India and China: History, Opportunities, and Challenges

By Bangdiwala, Shrikant I.; Tucker, Joseph D. et al. | Public Health Reviews; Rennes, January 1, 2011 | Go to article overview

Public Health Education in India and China: History, Opportunities, and Challenges


Bangdiwala, Shrikant I., Tucker, Joseph D., Zodpey, Sanjay, Griffiths, Sian M., Li, Li-Ming, Reddy, K. Srinath, Cohen, Myron S., Gross, Miriam, Sharma, Kavya, Tang, Jin-Ling, Public Health Reviews; Rennes


INTRODUCTION

This issue of Public Health Reviews on the theme of "Education in Public Health" aims to provide a broad scope analysis of the history, current status and challenges for future development of educational and accreditation systems for the public health workforce needed in the coming decades. China and India are the most populous countries in the world and are rapidly developing emerging global economic and political powers. Based on the Human Development Index of the World Bank (Table 1), both have been developing rapidly since 1980, with China outpacing India, and currently higher than the global average. An understanding of public health education history and current efforts in these two important countries may shed some light on how public health education can be prioritized in other developing nations.

Public health in the 21st century faces challenges on three fronts. First, there is an increasing recognition of the growing economic and social impact of chronic diseases on an ageing population. Changing demographics and increased longevity in developing countries have increased the numbers of those at risk for chronic diseases, thereby necessitating health systems to evolve in order to meet this new challenge. China has almost nine years higher life expectancy at birth than India (Table 2). Second, although there is an acknowledgement that the delivery of quality health services depends on the availability of a robust and efficient workforce which embodies the principles of primary health care, there is increasing concern about limited human resources and "brain drain", workforce migration from developing to developed countries. Third, the increasingly strapped budgets of public health sectors increase the importance of cost-effective interventions and implementation research. The rising costs of basic public health interventions mean that value and costs must be more explicitly accounted into planning and models.

Regarding public health education specifically, the current expenditure on education as a percent of GDP is only 2.3 percent in China and 3.2 percent in India (Table 2). Expenditure on health as a percent of GDP is also quite small, 1.9 percent in China and 1.1 percent in India (Table 2). Existing systems and models must be modernized and optimized to modern standards of public health education in the United States, Europe and elsewhere. Strengthening health systems through structural changes and improving human resources can help address the challenges facing public health education in the 21st century.

This article first examines the Chinese and then the Indian contexts. In each case, we review the history of public health teaching, current challenges, and potential opportunities for reform and improvement of public health education.

PUBLIC HEALTH EDUCATION IN CHINA

The importance of public health and public health education reaches back to ancient China. The Yellow Emperor's Classic of Internal Medicine stated, "The superior physician helps before the early budding of the disease. The inferior physician begins to help when the disease has already developed."1 The twentieth century saw remarkable developments in Chinese public health education, including some unique systems merging clinical and public health implementation (health demonstration projects, barefoot doctors) that have drawn global attention. The transformation of the cooperative medical system alongside the phasing out of the barefoot doctor system has ushered in a new period of more dedicated public health education, training, and scholarship.

History of Public Health Education in China

Prior to 1949, there were limited formalized public health systems or public health education structures. The central government established a Sanitary Department in 1905,2 but many public health functions were implemented by police and other interdisciplinary groups. Municipality public health administrations followed German models that designated health work, often compulsory quarantine, as the domain of the police. …

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