摘要：In the 21st century, we face enormous public health challenges that differ fundamentally from those of the last century, because these challenges involve widespread societal change and complexity. To address these challenges, public health professionals need to be able to place their work in a larger social context, understand local and global perspectives on a deeper level, and effectively engage a wide variety of stakeholders. To confer these skills, we need to change the way we train our students. We present two examples of low-cost innovative approaches to teaching public health that promote active engagement with individuals across a wide range of backgrounds and fields and that train students to be effective agents for change. For public health to succeed in the 21st century, we need to create fundamentally new approaches compared with those pursued in the 20th century. Some of the greatest global successes (e.g., small pox eradication, soon to be followed by polio, hopefully) were massive efforts that required immense ingenuity, commitment, courage, and effectiveness, but these efforts still did not involve much social change. For instance, the technology of immunization has not changed how people work, how much they earn, or where and how they live. Areas in which we had remarkable, but partial, success in the 20th century included addressing motor vehicle accidents and tobacco-related deaths. Public health succeeded in dramatically reducing illness, injury, and death in high-income countries, saving millions of lives. At the same time, the globalization of the economy facilitated dramatic increases in tobacco use and poor quality diets in low- and middle-income countries; the latter situation resulted in a marked rise in the rates of obesity and diabetes, although malnutrition is still widespread. When we look to the greatest population health challenges of the 21st century, whether addressing tobacco globally or addressing climate change, there will be no simple solutions. Reducing the extent of risk and preventing the massive amount of morbidity and mortality associated with social, economic, and environmental risks require addressing social factors both globally and locally. We need to train public health leaders by providing students with the opportunity to: (1) develop the skills needed to successfully address problems that require societal change to solve, and (2) address social, economic, and environmental problems as part of a global community. We need to help all public health students develop these skills, including students in resource-constrained environments. We describe two examples of approaches taken while training students and public health practitioners to address climate change, a problem that the World Health Organization highlights as one of the greatest threats to health that requires deep societal responses on a global scale. 1 We purposely selected two examples of approaches, one local and one global, that can be applied in public health schools and programs around the world and do not require substantial financial resources. A primary innovation of the approach in both of these examples was that the format and content of the trainings were driven by local public health needs identified by our partners, and the courses were then designed using a collaborative, consultative process. In addition, the courses were unusual in that they provided our students with opportunities to engage directly with important stakeholder groups and to learn how they approach challenging, multidisciplinary problems. Although many high profile innovations in teaching in recent years focused on using technology, often in an asynchronous mode, to deliver training to large numbers of students and professionals, both of the examples discussed herein illustrate the important benefits of promoting direct interactions in relatively small group settings. We discuss why synchronous engagement was critical to learning and cross-fertilization between groups in each of these examples and how low cost-technological solutions could be used for synchronous engagement between institutions in different countries.
