The Developing Role of Systems of Competences in Public Health Education and Practice

In recent decades there have been attempts in many professions to define the competences of their practitioners. Over the last quarter century attempts have been made to apply this to public health; initiatives in several countries have been devised to meet the perceived needs of public health education and training (e.g., the United States), of public health practice (e.g., the United Kingdom), etc. The achievements and some of the failings of US and UK initiatives are reviewed. Since 2006 The Association of Schools of Public Health in the European Region (ASPHER) has been working on a system of public health competences suited and adapted to the needs of both public health education and training, and practice. After much work and several stages of development, a third series of competence lists (for public health practitioners generally, for MPH-related education, and for employment purposes) will soon be published. ASPHER believes that for sustainability of a competences project, the competences proposed must be seen as relevant by all public health practitioners and stakeholders, including those engaged in education and training, service work, and public health research. Accordingly, all these stakeholders need to be involved in the preparation of lists of competences. Sustainability will also require an ongoing system and structure for permanent review of existing public health competences, and of the need for definition of new ones. Possible directions towards the achievement of this are indicated. A generally accepted system of core competences could contribute most to the establishment of a clearly identifiable public health profession across Europe, equipped to address current and future health needs of its peoples. All three experiences described share similar challenges, and on a continuing basis these will of necessity need to be addressed in the future: the assessment of whether competences have been achieved or not; the evaluation of whether lists of competences are genuinely appropriate both to population health challenges and to the development and management of systems of intervention as experienced in practice; identification of appropriate means to take account of geographical, regional and national disparities within one common competence system.