|Year : 2008 | Volume
| Issue : 2 | Page : 236
On the Journal's 20th Anniversary: The Beginnings of Education for Health
HG Schmidt1, P Vluggen2
1 Erasmus University, Rotterdam, The Netherlands
2 The Network: Towards Unity for Health, The Netherlands
|Date of Web Publication||12-Jan-2013|
H G Schmidt
Burgemeester Oudlaan 50, Building M, 3000 DR Rotterdam
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Schmidt H G, Vluggen P. On the Journal's 20th Anniversary: The Beginnings of Education for Health. Educ Health 2008;21:236
This year marks exactly twenty years since "Education for Health0" was established. The journal initially carried a different name, "Annals of Community-Oriented Education," which expressed its original purpose: to record developments in this field of education. It was published just once a year.
In the years preceding 1988, the World Health Organization and American foundations, notably the Rockefeller Foundation, called upon the health professions education community to reorient its teaching goals towards primary care and have students spend more curricular time in primary care settings. It was generally felt that the training of health personnel fell seriously short in responding to the urgent health needs that graduates were supposed to address. These were the years following the Alma Ata Declaration of 1978 in which governments committed themselves to provide "Health for all by the year 2000," and the call for change fit well with this strategy. One should remember that in the seventies and preceding decades, medical students were trained almost exclusively in tertiary-care hospitals, and often in the academic variant of such hospitals. Kerr White once noted that these students were exposed to less than one percent of the variation in health problems as they presented themselves in the population-at-large and that these atypical patients presented only the most serious diseases, often in a late stage of development (White, Williams & Greenberg, 1961). Medical care as practiced in those hospitals, therefore, was hardly representative of the real health needs of the communities in which graduates were supposed to serve. In only a few schools were rotations in primary care settings part of the curriculum. Medical training in developing countries suffered an additional shortcoming. Since most of their teachers were trained in the West, curricula tended to reflect the objectives of the English medical schools in which they were trained rather than being relevant to local health problems back home. The principal medical school in the Sudan, for instance, ran a curriculum akin to that of Cambridge, with an emphasis on degenerative diseases such as cancer and cardiovascular problems and short on contagious diseases and diseases of poverty.
Time for change
The first important steps in curriculum change were taken by Tamas Fülöp, Director of the Division of Health Manpower Development at WHO, and Fred Katz, his collaborator. In 1978, the year of Alma Ata, they brought together educational leaders from about fifteen medical schools to think out a strategy to change existing curricular practices. This meeting, in Kingston, Jamaica, led to the establishment of the Network of Community-Oriented Educational Institutions for Health Sciences. Its secretariat was established at Maastricht University in the Netherlands, a country thought to be sufficiently neutral in those cold war times to be an acceptable place for such an international organization. At this secretariat, first Wynand Wijnen, and, somewhat later, Jacobus Greep, set out to change medical schools worldwide. Ine Kuppen and Henk Schmidt supported them, and later Pauline Vluggen did also. In the first years, the focus was principally on organizing workshops and conferences all over the world, intended to disseminate ideas and help schools in adapting their curricula to the new requirements. From those years we remember, among others, workshops on community-oriented education in Wad Medani, the Sudan, Harare, Zimbabwe, and Maastricht, the Netherlands. We organized conferences in Bellagio, Italy, Havana, Cuba, Ismailia, Egypt, and Pattaya, Thailand. These workshops and conferences, although often eye-openers for those attending, fell short in disseminating new ideas about community-oriented practices among a wider audience. A publication strategy was necessary. Ine Kuppen established the still popular Newsletter, and books on the topic were produced (Katz & Fülöp, 1980; World Health Organization Study Group, 1987; Schmidt, Lipkin, De Vries, & Greep, 1989; Nooman, Schmidt, & Ezzat, 1990). In addition, Tonja Mol established a clearing house for information about curriculum renewal. Those interested could order papers, sent by mail from Maastricht (those were the days before the internet, remember?). Nevertheless, it soon became obvious that a regular scientific outlet was needed as well.
The establishment of the "Annals of Community-Oriented Education."
The Annals was established with two goals in mind. The first was to publish empirical studies on curricular innovation. The second goal was, however, no less important: to provide young educators, in particular those from developing countries, with a forum to practice the skill of scientific writing. These two objectives were stated in the first editorial as follows:
"Community-oriented education can be characterized as an approach to teaching and learning that derives its objectives from an empirical analysis of the major health hazards in a given population. This approach deviates from more conventional approaches to curriculum development in that it does not take as its point of departure the traditional 'core content' of health professions education, or is dominated by the internal structure of its contributing disciplines, but looks at the future tasks of health professionals. The question is asked: "Which kinds of skills, what kind of knowledge should a physician, a nurse or a midwife possess in order to have a measurable impact on the health condition of the people he or she serves?" Community-oriented education can thus be considered a response of academic institutions to the observation that the present training of health workers seems to have only little effect on the improvement of health of the general population … As witnessed by the number of reports at meetings dedicated to the subject, th(is) assumption has challenged many investigators to test (its) truth. The results of these studies are however, not disseminated to an extent warranted by the importance of the subject. It is in response to this observation that the "Annals of Community-Oriented Education" are published … As has been stated in the Publication Policy, the editors in particular welcome contributions from young investigators who are new to the field. Rather than to judge the quality of a manuscript submitted, the Editorial Board sees as its primary objective to help less experienced authors improving their contributions, provided its subject is interesting to a broader audience and the study carried out is methodologically sound (Annals of Community-Oriented Education, 1988, pp. 1-2)."
Helping young educators develop the skills of clear, unambiguous science writing proved to be a quite daunting task. The first Editor remembers spending many nights providing detailed comments to the authors of the articles to be published in the first issue. In fact, in some cases articles were entirely rewritten by the Editor and by some members of the first Editorial Board. (This first Editorial Board consisted of Ola Alausa, Bayero University, Nigeria, Henk van Berkel, Maastricht University, The Netherlands, Charles Engel, Wellcome Foundation, England, Tamas Fülöp, World Health Organization, Switzerland, Arthur Kaufman, University of New Mexico, United States, Ron McCauley, McMaster University, Canada, and Zohair Nooman, Suez Canal University, Egypt.)
In particular, Charles Engel, a British educator who had been involved in establishing the first Australian community-based school in Newcastle, NSW, proved invaluable in this respect. So invaluable, that he was soon asked to take over the role of Editor. Under his stewardship, it was decided to broaden the base of potential contributors by renaming the journal "Education for Health." In addition, we choose to distribute it through a commercial publisher rather than through the Network itself.
[Additional file 1]
The first issue of the Annals contained a series of articles that modelled the kinds of subjects that were to be published in the years to come. In addition, the issue demonstrated that it was indeed possible to encourage authors from developing countries to submit papers. Papers came from Nigeria, Egypt, Bahrain, the Netherlands, and the Philippines.
Education for Health thrives; it has reached its primary objectives. Educators from Africa, Asia and Latin America now participate fully in the competition to get their articles published in this journal or in other journals in the field. A science of community-based and community-oriented education has emerged. We now know much more about the potential and the pitfalls of this kind of education than we did twenty years ago. Most importantly, we now know, thanks to the numerous researchers who shared their data with their readers in this journal, that community-oriented education cannot be the medicine for all ailments of health care delivery relevant to the primary health needs of communities. Educating health professionals the right way is not enough. Much more is needed, not in the least suitable health policies in the country involved, reasonable living conditions for health professionals, and adequate salaries. However, community-oriented education has also been demonstrated to instil in generations of graduates an attitude of curiosity and respect for people that need their help. That is no small accomplishment.
Henk Schmidt, [email protected]
Pauline Vluggen, [email protected]
Founding Editors of the "Annals of Community-Oriented Education," precursor of Education for Health.
Katz, F. M. & Fülöp, T. (Eds.). (1980). Personnels de santé: quelques exemples de programmes de formation (Personnel for health care, case studies of educational programmes). Genève: Organisation Mondiale de la Santé.
Nooman, Z., Schmidt, H. G., & Ezzat, E. (Eds.). (1990). Innovation in medical education, an evaluation of its present status. New York, NY: Springer Publishing.
Schmidt, H. G., Lipkin, M., De Vries, M., & Greep, J. (Eds.). (1989). New directions for medical education. New York, NY: Springer Verlag.
White, K. L., Williams T. F., & Greenberg, B. G. (1961). The ecology of medical care. The New England Journal of Medicine; 265:885-892.
World Health Organization Study Group. (1987). Community-based education of health personnel. Geneva, Switzerland: World Health Organization.