Monday, 25 April 2016

First half century of the Association of Schools of Public Health in the European Region

Jeffrey Levett
The National School of Public Health, Athens, Greece.

This year, the Association of Schools of Public Health in the European Region (ASPHER) reaches 50 years [1966-2016] and is engaged in celebration. Its significant achievements on the European stage will appear in the Anniversary Book and tell much of its exciting story (1). The official ceremony will take place in Athens, Greece 25-27 May 2016 with an opening event in the Acropolis Museum. The celebration is hosted by the Hellenic School, an institution finally launched in 1929, following heroic efforts of Greek pioneers in malaria and after a bizarre pandemic of dengue fever and a little known, unique and short-lived revolution in public health, which hiccoughed its way into history (2-5). One powerful driving force was Ludwik Rajchman of the League of Nations who described the health situation in Greece as being “worse than in Brazil”.

ASPHER’s contemporary vision is expressed in its 2020 strategy, enunciated into five specific strategic objectives that reflect educational quality, research capacity and global governance. These are pivotal to present and future population health challenges and have been elaborated in a spirit of collaboration and solidarity and in concert with the international community. One fundamental goal is the continued improvement of competency training of the European workforce. Appropriately trained public health practitioners are an effective link to crisis intervention such as in the current refugee crisis. ASPHER is a natural link and think tank for Europe and can provide insights into paths towards solution for the current and horrendous set of European problems.

In 1992, with the support of WHO-EURO [Jo Asval, M. Barberro] and the European Commission, DGV [David Hunter, Jos Draijer], a turbulent General Assembly was hosted by the Hellenic School. It received support from the Rockefeller and Goulandri Foundations and from Hellenic Ministries of Health, Education and Culture [Melina Mecouri]. In Athens, i) a Balkan Forum for Public Health was conducted and facilitated Eastern European Schools to become a greater force within ASPHER thus fulfilling the aim of its first Secretary-General, Teodor Gjurgjevic, Zagreb [1968] who travelled unsuccessfully to Moscow, to encourage membership; ii) ASPHER outlined its response to Article 154 of the Maastricht Treaty, and; iii) an award named for Andrija Stampar got underway, which this year goes to Richard Horton, editor of The Lancet (6).

Public health is a paradoxical entity spurned when things go well, called back by society when things fall apart. It is an essential function of society; an organized and systematic concoction for dealing with unpleasant surprises. It is an invigorating interdisciplinary cocktail, which like women’s domestic work, does not fit well into the economist’s equations of development or into business or market models.

Public health is an anti-hero, not unlike Don Quixote who tilted at windmills and Hucklebury Finn who knew hell awaited him, after he helped the escape from slavery. Like Huck and the Don, Public Health has a nobility of spirit and purpose, wanting to right wrongs. Like a woman spurned, it can take disastrous revenge when rejected by the community or by the state. Think of Ebola [Africa]; lead in Flint [USA].

Social sensitivity to deprivation and the organization of public health in response to dismal outcomes from environmental miasma are both constructs and products of the Enlightenment (7). Its thinkers aimed to improve living conditions of the population impacted by the Industrial Revolution and urbanization. They embraced such powerful thoughts as: “there but for the grace of god go I, do onto others as you would have them do onto you and that the reduction of mortality had an economic value to society”. Nevertheless, the danger still exists that the ship of state is operating with an insufficient ratio of lifeboats to passengers while avoidable death climbs (8).

ASPHER’s homunculus-logo depicts both heart and brain, thus echoing the ancient maxim of “healthy in body, healthy in mind”, for the individual, the community and the body politic. Perhaps we should listen more to female voices; Hygiene, daughter of Asclepius, goddess symbol of public health; Peitho goddess of persuasion. Linguistically, public health suggests political tension and ideological divisions. It is a strange couplet from which the polar “public-private” surfaces. Etymologically, Idiocy-idiot derives from the Greek word private and health lacks importance until lost.

At this time of humanitarian crisis in Europe, ASPHER calls for greater tolerance of diversity; color, creed, opinion nurtured within cultures of peace and science and within a framework of equality. Public health policy must be equal in complexity to the current problem space; refugee waves, austerity measures, terrorism. It must demonstrate flexibility in approach and draw upon alternative but convergent conceptualizations as either in terms of reducing vulnerability or in terms of resilience building. As we step into the future we may be faced by health indicator decline and health determinant disasters.

ASPHER’s 50 year legacy must be seen as a vital contributor to socio-economic progress, a bulwark against health damage and a pillar for our common European future. We say that investing in Schools of Public Health is a good thing! Schools of Public health do make a difference (9)!

No better gift can come from the political world than greater recognition of Schools and Institutions of Public Health in tandem with the ascendancy of public health up the political agenda.

From Athens, ASPHER’s thoughts and concerns go out to all victims of abominable terrorist attacks, those suffering the consequences of austerity and to the plight of being a refugee. We must resist the dastardly and merciless acts of terrorism and mount a more effective response to population deprivation and environmental dangers and not permit them to derail Europe.

With pride we draw attention to our appealing Association ASPHER as it reaches a half century, while simultaneously, appealing to the European world of politics to make more room for public health.

1. Foldspang A, Müller-Nordhorn J, Bjegovic-Mikanovic V, Otok R (Eds.). Fifty years of professional public health workforce development. ASPHER’s 50th Anniversary Book. Brussels: Association of Schools of Public Health in the European Region, 2016 [in press].
2. Mandyla M, Tsiamis C, Kousounis A, Petridou E. Pioneers in the anti-malaria battle in Greece (1900-1930). Gesnerus 2011;68:180-97.
3. Levett J. The Athens School: Lighthouse of Greek Public Health. (Greek only).
4. Giannuli D. Repeated Disappointment: the Rockefeller Foundation and the reform of the Greek Public Health System, 1929-1940. Bull Hist Med 1988;72:47-72.
5. Scientific Foundations of Public Health Policy in Europe. Editors: Laaser U, de Leeuw E, Stock C. Juventa Verlag Weinheim and Munchen; 1995.
6. ASPHER. Welcome to Athens.,4,20.html
7. Levett J. Disaster press: Public Health Enlightenment, Greece: From the Athens to the Hellenic National School of Public Health. Sunday, 20 November 2011. (accessed: April 21, 2016).
8. Levett J. Disaster press: Blunders without Apology, Mistakes and their Excuses. Thursday, 31 March 2016. (accessed: April 21, 2016).
9. de Leeuw E. European schools of public health in state of flux. Lancet 1995;345:1158-60.
From South Eastern European Journal of Public Health

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