Public health at a crossroads: assessing teaching on economic globalization as a social determinant of health

Abstract

This article examines how public health faculty prepare students to respond to economic globalization, and more broadly considers the response of public health academics to structural challenges that fall within the realm of global economics, politics, and policy. At this moment, public health is at a crossroads of formalizing its education through graduate competencies and certifications. This research undertook in-depth interviews with public health faculty from across the US to explore how students are prepared to critically consider root causes and respond to political and economic trends shaping health. These interviews reveal a general dearth of attention to globalization, as well as several factors shaping public health academic knowledge production. These include the deep influence and shortcomings of funding resources; a general lack of critical perspective in public health; and both methodological and faculty competence deficiencies. Interviewees also discuss political influences and conflicting student demands, as well the strength of public health as an interdisciplinary profession and potential opportunities for improving public health's responsiveness. Interestingly, while there was near unanimity regarding public health's role and obligation to advocate for change on these issues, there was also uncertainty about how to appropriately model and teach advocacy skills, and tension over public health's role in politics and policy. While public health has a rich history of addressing structural and political factors shaping health, this research reveals an ongoing need to define public health's role in contemporary politics and policy, and in advocating for change at the global policy level.

Keywords:

• globalization
• public health education
• politics and policy

Notes

Notes

1. A public health program offers a general Master of Public Health (MPH) degree, while SPHs offer, at minimum, the MPH degree in five specialized areas of public health, as well as a doctoral degree in three specialized areas (CEPH n.d.).

2. The Ecological Model of Health was defined in interviews as a model highlighting various levels of determinants of health, from the most proximal (biological and behavioral) to the broadest structural level (including economic, social, cultural, and environmental factors).

3. Economic globalization was defined in interviews as the increasing ‘integration of national economies into the international economy through trade, direct foreign investment, capital flows and the flow of workers’, which has been governed over recent decades by organizations like the World Bank, International Monetary Fund and the World Trade Organization, plus trade agreements like NAFTA and CAFTA (Bhagwati 2004, p. 1).

4. Neoliberalism was defined in interviews as encompassing the tenets of privatization, downsizing of government spending, deregulation of business and investment sectors, and the liberalization (or opening) of national markets to international trade (England and Ward 2007).

5. The concept of a public health ‘profession’ is amorphous and difficult to define. When asked in interviews, I delineated it as including professionals who have received at least master's level training in public health. This is consistent with but narrower than the IOM's (2003a, p. 4) definition which includes, ‘a person educated in public health or a related discipline who is employed to improve health through a population focus’.