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美国大学公共卫生专业

 

前言:

在美国,公共卫生事实上是每届总统后选人着重强调的三大问题之一(除此以外,还包括经济和国际关系),特别是在“9•11”事件和炭疽袭击后,美国的公共卫生系统更是得到全面的提升与完善,在世界范围内可以说首屈一指。奥巴马总统上台后承诺将把布什总统削减的经费重新投入卫生保健系统。而中国自从 “SARS”以后,公共卫生也成为各大医学院最热门的专业之一。故此,学习和就业前景我认为应当是非常乐观。事实上,很多 在国内修读公共卫生专业和其他医学,生物,化学等专业的同学也已经将美国TOP20的公共卫生学院作为自己深造的目标。在本篇文章中,简要的从该专业从申请到毕业工作谈一下公共卫生专业的前景。

 

一、公共卫生是什么?

1.    公共卫生的定义 

健康的认识:世界卫生组织在组织法里明确指出:“健康不仅是没有疾病或不虚弱,而且是身体的、健康的健康和社会适应的完美状态。”
公共卫生是通过组织社区资源,为公众提供疾病预防和促进健康的一门管理学,它使用预防医学、健康促进、环境卫生、社会科学等技术和手段。公共卫生体系由国际公共卫生组织、国家公共卫生组织、地方公共卫生组织和社区公共卫生组织组成。

 

What is Public Health?

Public Health is the science of protecting and improving the health of communities through education, promotion of healthy lifestyles, and research for disease and injury prevention. Public health professionals analyze the effect on health of genetics, personal choice and the environment in order to develop programs that protect the health of your family and community.

 

HSPH的分类:

EnvironmentalHealth
• Biostatistics
• BehavioralScience/Health Education
• Epidemiology
• HealthServices Administration/Management
• Maternal andChild Health
• Nutrition
• International/GlobalHealth
• PublicHealth Laboratory Practice
• Public HealthPolicy
• Public HealthPractice
Overall, public health is concerned with protecting the health of entire populations. These populations can be as small as a local neighborhood, or as big as an entire country.

 

公共卫生涉及的学科知识:

• 流行病学 Epidemiology
• 预防医学 Preventive Medicine
• 生物统计 Biostatistics
• 环境卫生 Environmental Health
• 职业卫生 Occupational Health
• 卫生政策 Health Policies
• 医学管理 Medical Management
• 组织与机构

 

1. 按组织划分

1. 国际公共卫生组织。通过参加组织、加入协约与公约等形式,指导、监督、协调各个国家与地区的公共卫生工作。如世界卫生组织、绿色和平和世界自然基金会等等。
2. 国家或地区(及地方)公共卫生组织。作为政府行政管理机构,代表政府提供公共卫生服务,共同发挥支柱作用。如卫生部门(U.S. Department of Health and Human Services,分支机构如CDC-Center for Disease Control)、劳工与保障部门(U.S. Department of Labor)、国土与环境部门和规划与发展部门等。 

2. 按职能与职责划分 1. 卫生保健提供者。如医院、社区健康服务中心、精神卫生组织、实验(检验)中心、护理院,主要提供预防、诊断、康复和护理服务。
2. 公共安全组织。如警察局、消防队、医疗急救中心,预防处理紧急伤害和公共卫生事件。
3. 环境保护、劳动保护和食品安全机构。作为执法部门,监督和保障安全的生存环境、保障人群健康。
4. 文化、教育、体育机构。为社区提供促进健康的精神环境和物质环境。
5. 民政、慈善组织。为弱势人群包括失能人士、低收入人士和独居及高龄人士提供政策与物质支持。

3. 按人群划分 1. 儿童疾病与死亡
2. 孕产妇疾病与死亡
3. 老年人生活质量

4. 按健康问题划分 1. 传染病:SARS、禽流感、流感、疯牛症、艾滋病 登革热
2. 慢性非传染性疾病:肿瘤、糖尿病、高血压
3. 意外伤害:车祸
4. 不良健康行为:吸烟、饮酒 吸毒 不安全的性行为
5. 精神及心理卫生:忧郁症 
 

医学VS公共卫生(来自HSPH哈佛卫生学院)
传统医学专业 公共卫生专业

•    Primary focus on individual
•    Personal service ethic, in the context of social responsibilities
•    Emphasis on disease diagnosis, treatment, and care for the individual patient
•    Medical paradigm places predominant emphasis on medical care
•    Uniform system for certifying specialists beyond professional medical degree
•    Lines of specialization organized, for example, by:
o organ system (cardiology, neurology)
o patient group (obstetrics, pediatrics)
o etiology and pathophysiology (infectious disease, oncology)
o technical skill (radiology, surgery)
•    Biological sciences central, stimulated by needs of patients; research moves between laboratory and bedside
•    Numerical sciences increasing in prominence, though still a relatively minor part of training
•    Social sciences tend to be an elective part of medical education •         Primary focus on population
•         Public service ethic, as an extension of concerns for the individual
•         Emphasis on disease prevention and health promotion for the whole community
•         Public health paradigm employs a spectrum of interventions aimed at the environment, human behavior and lifestyle, and medical care
•         Variable certification of specialists beyond professional public health degree
•         Lines of specialization organized, for example, by:
o    analytical method (epidemiology, toxicology)
o    setting and population (occupational health, international health)
o    substantive health problem (environmental health, nutrition)
•         Biological sciences central, stimulated by major threats to the health of populations; research moves between laboratory and field
•         Numerical sciences an essential feature of analysis and training
•         Social sciences an integral part of public health education

 

一、 公共卫生院系设置介绍

 

在美国, 并不是所有的大学都有公共卫生学院或者相关专业,特别是独立的公共卫生学院,往往在一个州中仅有1到2个大学具备较大的完整的院系设立。而正是这1到2个大学的公共卫生学院承担了与本州卫生部门共同进行的疾病预防﹑健康教育﹑环境卫生等一系列重大事件的规划与执行。一般来说,独立的公共卫生学院有以下分系:卫生统计学(Biostatistics)﹑流行病学(Epidemiology)社区与健康教育学(Community And Health Education)﹑卫生政策与管理学(Health Policies And Administrations)﹑环境与职业病卫生学(Environmental And Occupational Health)。

 

以Harvard School of Public Health为例,其下设的方向和学位包括有:

 

Department of Biostatistics
SM (42.5-credit, 60-credit, and 80-credit programs), PhD
Department of Environmental Health
Exposure, epidemiology, and risk: SM (42.5-credit and 80-credit programs, including 80-credit program in industrial hygiene), SD
Molecular and integrative physiological sciences: SD, PhD (through the Division of Biological Sciences)
Occupational health (including programs with Simmons College): MOH, SM (42.5-credit and 80-credit programs), SD, DPH
Department of Epidemiology
SM (42.5-credit and 80-credit programs), SD, DPH
Department of Genetics and Complex Diseases
PhD (through the Division of Biological Sciences)
Department of Global Health and Population
SM (80-credit program), SD, DPH
Department of Health Policy and Management
SM (42.5-credit and 80-credit programs), SD
Health care management (part-time, nonresidential): SM (42.5-credit program)
Health policy: PhD (through university program)
Department of Immunology and Infectious Diseases
SD, PhD (through the Division of Biological Sciences)
Department of Nutrition
Nutritional epidemiology, public health nutrition: SD, DPH
PhD (through the Division of Biological Sciences)
Department of Society, Human Development, and Health (including joint programs with Simmons College)
SM (42.5-credit and 80-credit programs), SD, DPH
Health communication: SM (80-credit program), SD, DPH
Maternal and child health: SM (42.5-credit and 80-credit programs), SD, DPH
Master of Public Health Program
Clinical effectiveness, family and community health, health care management and policy, international health, law and public health, occupational and environmental health, quantitative methods: MPH
Combined MD-MPH
Joint JD-MPH (for Harvard law students only)
Definition of Terms
DPH   Doctor of public health
MOH   Master of occupational health
MPH   Master of public health
PhD   Doctor of philosophy
SD   Doctor of science
SM   Master of science 

 

二、公共卫生教育

 

申请的要求:

1.   从HSPH和JHSPH的申请要求上,我们可以发现,这些公共卫生学院对申请的要求,1)至少需要具备本科学历;
2.   就是不同的学院、专业方向和学位,对申请者都有某一个和数个方面的特殊要求
3.   学分越少的Program,对申请人的要求越苛刻。

The Departments of Biostatistics and Epidemiology will review applicants holding a minimum of a bachelor's degree for the master of science 80 credit or the doctoral program (PhD or SD, respectively).
The Departments of Environmental Health; Global Health and Population (formerly Population and International Health);Health Policy and Management; Nutrition; and Society, Human Development, and Health may consider applicants with a minimum of a bachelor's degree, however, most successful candidates have some relevant work experience.
Degree Name    Prerequisite Degree Requirements 
Master of Science 80 credit SM Requires prior bachelor's degree or non-US equivalent. Some departments prefer work experienceŒ. See departmental websites for more specific information. The 80-credit master of science is offered in Biostatistics; Environmental Health; Epidemiology; Global Health and Population (formerly Population and International Health); Health Policy and Management; and Society, Human Development, and Health.

    
Master of Science 60 credit  SM Requires prior bachelor's degree or non-US equivalent in one of the mathematical sciences or an allied field (for example, biology, psychology, or economics)?. The 60-credit master of science is offered in Biostatistics.

    
Master of Science 42.5 credit SM Please see departmental websites for specific prerequisite degree requirements. For most departments, applicants must hold a prior doctoral degree. The Department of Environmental Health will review applicants with a master’s degree in a related discipline or significant professional experience?. The Department of Society, Human Development, and Health will review applicants with a prior related graduate degree and experience in the public health field. The 42.5-credit master of science is also offered in Biostatistics, Epidemiology, and Health Policy and Management.

    
Master of Public Health
MPH
Requires prior doctoral degree- for example MD, DO, DDS (or their non-US equivalents), PhD, SD, JD, or other health-related doctoral degrees. MD and DO students may apply to enroll between third and fourth year in medical school. Also eligible to apply are those with a master's degree in a health-related field (for example, MSN, MSW, MBA) and three years of relevant experience. The law and public health concentration requires a prior JD or non-US equivalent degree?. Law students already holding a relevant advanced degree may also be considered. Students who may have been accepted to Harvard Law School may apply to a joint JD/MPH program.

    
Master of Occupational Health MOH  Requires prior medical degree. The master of occupational health is offered through the Department of Environmental Health.

    
Doctor of Science SD Bachelor's degree or non-US equivalent except for the Departments of Health Policy and Management (requires prior medical degree) and Immunology and Infectious Diseases (requires prior clinical degree). The SD is also offered in Environmental Health; Epidemiology; Global Health and Population (formerly Population and International Health); Nutrition; and Society, Human Development, and Health.

    
Doctor of Public Health DPH Applicants must have, or be in progress toward, an MPH degree, in addition, candidates must hold an advanced degree in a basic public health discipline similar to the requirements for the master of public health (42.5 credit) program listed above?. The DPH is offered by Environmental Health; Epidemiology; Global Health and Population (formerly Population and International Health); Nutrition; and Society, Human Development, and Health.

    
Doctor of Philosophy PhD All PhD programs are offered under the aegis of the Harvard Graduate School of Arts and Sciences‘.

 

专业的不同侧重:从两个不同专业Degree Planners侧重的能力解读

Epidemiology Environmental Epidemiology
•       Demonstrate basic skills in core public health sciences of epidemiology and biostatistics.
•       Develop comprehensive knowledge of the role of epidemiology as a basic science for public health and clinical medicine to provide a quantitative approach to addressing public health and clinical problems.
•       Interpret descriptive epidemiologic results in order to develop hypotheses of possible risk factors for a disease.
•       Critically evaluate public health and medical literature through knowledge gained of the basic principles and methods of epidemiology, including disease (outcome) measures, measures of association, study design options, bias, confounding, and effect measure modification.
•       Apply quantitative skills to analyze and synthesize epidemiologic data related to public health issues.
•       Develop quantitative skills needed to analyze and synthesize epidemiologic data.
•       Apply knowledge of the physiology and pathophysiology of human disease to epidemiologic studies.
•       Develop the skills to interpret the methods for disease screening.
•       Develop substantive knowledge of the epidemiology of infectious and chronic disease and apply this knowledge to public health issues.
•       Design an epidemiologic investigation (Master’s Thesis) resulting in a publishable manuscript or grant application.
  •     Demonstrate competence with the 5 core disciplines for the professional SM degree program (listed in the MPH Curriculum Guide).
•     Characterize contaminant sources and mechanisms of environmental transport.
•     Identify, model, measure, evaluate and interpret the human contact with environmental contaminants that constitutes exposure, and develop strategies to control environmental hazards, allergens, and pathogens.
•     Investigate health effects by applying appropriate statistical and epidemiological concepts and techniques to the relationships between environmental hazards and health outcomes.
•     Employ risk assessment and management strategies to minimize adverse outcomes.
•     Communicate effectively with individuals and communities regarding risk associated with environmental hazards.
 
 
三、 各个分支的申请特色与前景分析

Pfizer Guide to Careers in Public Health
Click on the following links to learn more about careers in the public health desciplines.
Health Policy and Management
Academic Policy Advisor
Legislative Policy Advisor
Management Policy Advisor
Epidemiology
State Epidemiologist
Research Epidemiologist
Pharmacoepidemiologist
Behavioral Science and Health Education
Behavior Scientist
Health Educator
Mental Health Researcher
Health Communications
Communications Specialist
Journalist
Occupational Safety and Health
Corporate Medical Director
Environmental Health Sciences
State Environmentalist
Federal Environmentalist
International and Global Health
Reproductive Health Specialist
International HIV Specialist
Tropical Disease Specialist
Public Health Preparedness and Function
State Epidemiologist
Laboratory Director
Public Health Lawyer
Oral Health
Public Health Dentist
Family Health
Local Health Officer
Nurse Educator
Nutritionist
Applying your Degree to Public Health Practice 
Academic Nurse Leader
Topics in Public Health 
Public Health Preparedness
International and Global Health
Health and Behavior
Career Prospects 
The Importance of Partnership in the Public Health System
Practicing Public Health in the Private Sector
Practicing Public Health in a Managed Care Setting
Looking Forward

1.   卫生保健提供者。如医院、社区健康服务中心、精神卫生组织、实验(检验)中心、护理院,主要提供预防、诊断、康复和护理服务。
2.   公共安全组织。如警察局、消防队、医疗急救中心,预防处理紧急伤害和公共卫生事件。
3.   环境保护、劳动保护和食品安全机构。作为执法部门,监督和保障安全的生存环境、保障人群健康。
4.   文化、教育、体育机构。为社区提供促进健康的精神环境和物质环境。
5.   民政、慈善组织、NGO。为弱势人群包括失能人士、低收入人士和独居及高龄人士提供政策与物质支持。
6.   大型企业的员工健康支持,健康保险公司

政府部门:

?   Agency for Health Care Research and Quality (AHRQ)
?   Centers for Disease Control and Prevention (CDC)
?   Food and Drug Administration (FDA)
?   Health Resources and Services Administration (HRSA)
?   Maternal and Child Health Bureau, HRSA (MCHB)
?   Office of Disease Prevention and Health Promotion (ODPHP/HHS)
?   Public Health Functions / HP 2010
?   Substance Abuse and Mental Health Services Administration (SAMHSA)
?   U.S. Department of Agriculture (USDA)
?   US Department of Health & Human Services (HHS)
?   US Agency for International Development (USAID)
?   Federal Government Salary Table for the DC-MD-PA-VA-WV areas
 
1. 卫生统计学(Biostatistics):

是近几年的大热学科,除开医学学生,不少数学和统计等理科的同学也纷纷申请。这个专业在美国前景非常之好,可以说就业面广,包括医药公司﹑政府卫生部门和高校都需要此专业人才,技术性强,很少能被其他专业人才所取代,毕业后平均年收入也比其他卫生类专业更高。卫生统计学的申请者不一定需要医学背景,但往往学校会要求在本科或研究生阶段有一定的高等数学和统计学课程。

2. 流行病学(Epidemiology):和卫生统计学科有很大的交叉,都需要能熟练的运用统计学软件和原理,但对于疾病本身关注相对较多,毕业后大多也在各级别卫生部门从事相关工作,如艾滋病防治,心脏病的防治项目等。申请时更看重申请人的医学背景,被录取者多来自公卫本专业﹑临床﹑药学﹑护理﹑基础医学等专业,对于国际学生更是看中医学相关背景。

3. 社区与健康教育学(Community And Health Education):是所有公卫专业中最看重英语能力的,所以其GRE和IBT要求也最高,因为毕业后所开展的工作多以社区为基础,强调与人群沟通能力。其工作范围也相对较广,渗透在几乎卫生事业各级别各类型工作中。申请人如果要申请此方向,英语口语能力和过往实际的公共卫生相关工作经验尤为重要。

4. 卫生政策与管理学(Health Policies And Administrations):是公卫专业所有专业里最偏向管理学和政治学的科目,甚至有部分课程来自MBA和法律专业。毕业生多在不同部门扮演卫生政策的制定者或法律援助群体,也有很多在健康保险和其他健康相关产品行业里工作。此专业对申请人的写作能力以及工作或实习经验较为看重,国际学生申请此专业较统计学和流行病学相对较难,因为需要申请人了解美国的政府构架和法律规范。

5. 环境与职业病卫生学(Environmental And Occupational Health): 这是全世界范围内的热门学科,在美国也如此,美国的环境与职业病卫生学贯穿于水质﹑空气﹑土壤﹑基础设施建设和制造产业中的卫生规范与管理,每年政府也会大力投入大量的人力和物力资源。可谓说此专业是很多美国本土学生也致力申请的方向,而申请者也不需要强调医学背景,其竞争激烈,前景光明,对国际学生也并非有太高的语言门槛。

 

三、学位设置

各个大学的公共卫生学院学位设置大致相同,它们包括,MPH(Master Of Public Health)﹑MSPH(Master Of Science Public Health)﹑PHD﹑MHA(Master Of Healthcare Administration)。MPH和MSPH的区别在于前者多培养学生的实际工作能力,后者多培养学生的科研能力并可以进一步深造Ph.D学位。 MHA学位强调学生作为管理者的能力,如人力资源管理,市场策划等,是所有专业中最接近MBA的一种。PHD专业是为高校﹑研究机构﹑政府部门培养的科研人才,一般奖学金非常丰富,毕业后留美机会较大。
四、申请人需做的准备
公共卫生是热门学科,竞争非常激烈。GRE和IBT考试肯定是必不可少的,TOP20的公共卫生学院一般要求GRE1200以上,IBT100分以上(Speaking 20)。同时学院希望申请有一定的医学相关背景,尤其针对国际学生,如没有医学相关学位,申请者可以积极参与国内的公共卫生项目,如疾病的宣传教育课题,这样可一定程度上弥补背景的不足。在申请过程中,PS(Personal Statement)和CV显得尤为重要,学院希望申请人有对卫生保健事业的强烈兴趣和责任感,这往往从对自己未来的计划和对过去背景的总结介绍中得知。公共卫生的研究生阶段奖学金甚少,因为这也是当前全美国的热门学科,而排名靠前的公共卫院一年的学费和生活费大约在3万5到5万美金左右。PHD阶段奖学金会相对多一些,但是竞争也是比较残酷。
从我个人角度来说,公共卫生作为当前世界重要的议题,无论在中国和美国都具有相当好的发展前景,在最近北美经济走势不佳的情况下,仍然是非常热门和容易找工作的学科。有此志向的同学可以提早为自己的将来做详细的规划,准备好自己的申请。
 
下面附《全美2009年公共卫生研究生专业前25位排名》)
 

 
美国各大学公共卫生专业的排名(研究生专业,数据来源U.S. News 2009)  

学校名称   得分(总分为5)
1 Johns Hopkins University
Baltimore, MD   Score 4.9
2 Harvard University
Boston, MA   Score 4.7
2 University of North Carolina--Chapel Hill
Chapel Hill, NC   Score 4.7
4 University of Washington
Seattle, WA   Score 4.5
5 University of Michigan--Ann Arbor
Ann Arbor, MI   Score 4.4
6 Columbia University
New York, NY   Score 4.1
7 Emory University
Atlanta, GA   Score 4.0
8 University of California--Berkeley
Berkeley, CA   Score 3.9
8 University of California--Los Angeles
Los Angeles, CA   Score 3.9
10 University of Minnesota--Twin Cities
Minneapolis, MN   Score 3.8
11 University of Pittsburgh
Pittsburgh, PA   Score 3.6
12 University of Texas--Houston Health Sciences Center
Houston, TX   Score 3.4
13 Boston University
Boston, MA   Score 3.3
13 Tulane University
New Orleans, LA   Score 3.3
15 University of Illinois--Chicago
Chicago, IL   Score 3.2
16 University of Alabama--Birmingham
Birmingham, AL   Score 3.1
16 Yale University
New Haven, CT   Score 3.1
18 University of Iowa
Iowa City, IA   Score 3.0
19 George Washington University
Washington, DC   Score 2.9
20 University of South Florida
Tampa, FL   Score 2.8
21 Ohio State University
Columbus, OH   Score 2.7
21 St. Louis University
St. Louis, MO   Score 2.7
21 University of Arizona (Zuckerman)
Tucson, AZ   Score 2.7
24 Texas A&M University System Health Sciences Center
College Station, TX   Score 2.5
24 University of South Carolina
Columbia, SC

 

 

 

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