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EUROPEAN PUBLIC HEALTH REFERENCE FRAMEWORK (EPHRF)
Started in 2006, ASPHER’s European Programme on Public Health Core Competences has involved more than hundred European public health teachers, scientists and practitioners in the development of lists of competences for public health professionals. In the first round, all ASPHER member schools were invited to contribute to six workgroups, which lead to the first list of competences (1). Thereafter, European ministries of health were invited to participate, among other things in a conference at Aarhus University in April 2008, where, in the end, 27 European countries were represented, by decision makers and by teachers and scientists. At the same time the first two in a series of national practitioner-teacher workshops were performed, in Slovenia and Scotland, respectively (2). This all led to the second, enlarged list of competences (3), which was presented in October 2008 at a second European conference in Paris, as part of France’s EU Presidency that year.
Box 1 The main structure of ASPHER’s European list of public health generic core competences.
- Methods in public health – quantitative and qualitative methods
- Population health and its social and economic determinants
- Population health and its material – physical, radiological, chemical and biological – environmental determinants
- Heath policy; economics; organisational theory and management
- Health promotion: heath education, health protection and disease prevention
ASPHER’s workgroup on competences represented four parts of Europe, intended to make easier the implementation of the lists in various population health and health systems frameworks. ‘Master classes’ were organised with high-level decision makers. The lists were further developed to crystalize concepts and terms and to avoid overlaps – and to demonstrate the whole spectrum of competences expected in the public heath professional at large (4) as well as the shorter list for master of public health (MPH) education (5). This 3rdedition (2011) (4, 5, 6) was printed, sent to all ministries of health in Europe, and finally, in September 2012, was endorsed by all European WHO member states to form the basis for public health education, as expressed in WHO’s European Action Plan for Strengthening Public Heath Capacities and Services (7, p. 18):
"National governments should make efforts to ensure that the core competences for public health, recently revised by the Association of Schools of Public Health in the European Region (ASPHER), are being taken into account in national and subnational educational and training programmes for the public health workforce".
The wider process related to the development of the competences lists has been described in reference (6), and a review of broader perspectives related to the development and use of lists of competences has been analysed and commented in reference (8). Moreover, as the lists are intended to play crucial roles in the development of the European public health workforce, as aimed at in WHO Europe’s Health 2020 Strategy, ASPHER has also commented on the wider policy aspects of the future development of the European public health workforce and systems of public health services, including the crucial role of lists of competences (9).
The fundamental chain: Challenges in population health < > Interventions to improve population health - EPHOs < > Competences (the ‘C-E-C Chain’ (10)) - forms the basis for the analysis and illustration of the role of defined competences and their related performances in public health (10) and, furthermore:
- Not only defines the generalist professional in comprehensive public health (11), but also makes possible:
- The identification of the components of public health to be taken care of by various health professionals – doctors, nurses, midwives, dentists, other – and:
- By persons outside the health sector, e.g., decision makers, teachers, architects, policemen.
Accordingly, the 4th edition of the list was published in 2016 in together with mapping of the theoretical connection of competences to action, as indicated by WHO Europe’s Essential Public Health Operations (EPHOs) (7,12). In parallel an IT born tool is under development in the repository. The tool includes competences and EPHOs offered by ASPHER members departments and schools of public health and is intended to form the basis for individual career planning as well as systems planning (10,13). Moreover, considering the competences and EPHOs profiles offered by the departments and schools of public health (14), working together in networks in order to be able to cover the comprehensive public health curriculum at the relevant quality level offers itself as a straightforward possibility (15).
The Council of ASPHER’s EPHRF is accountable for the development of the list of competences and for the IT tool as well as the development of plans for implementation of the list. Moreover, it is of course a crucial challenge to keep the list updated continuously, so that, at any time over the years, it will represent the best of our knowledge and practice in the comprehensiveness of the public health discipline. The list shall form a solid academic basis of building stones for public health education and training and thus for the development of a sufficient and competent public health workforce and a public health profession in European countries (7,11). Moreover, it also offers itself as a knowledge basis for the development of other, more specific lists, e.g., employer-oriented lists.
Box 2 Editions of ASPHER’s European List of Public Health Core Competences for the Public Health Professional.
2008 1st Edition Based on contributions from about 100 teachers and scientists.
2008 2nd Edition With contributions from European conferences and practitioner-teacher workshops.
2011 3rd Edition Concepts crystallized. Endorsed by WHO Europe member states (2012).
2016 4th Edition With mapping of the competences-EPHOs relationship.
2018 5th Edition Contributions from advisory expert groups within epidemiology and biostatistics; sociology; health economics; leadership; nutrition; infectious disease control.
Accordingly, since 2015, groups of international experts have been organised within parts of the list’s themes, and the 5th edition published May and November 2018 (16, 17) includes adjustments suggested by advisory experts within epidemiology and biostatistics; sociology; health economics; leadership; nutrition; infectious disease control. September 2018, the 5th edition was commented by its Editorial Committee in the European Journal Public Health - "Meeting the population health challenge: What should you know, and what should you be able to do?" (18).
As also described in reference (6), the programme would not have been possible without the support of colleagues all over Europe as well as public health associations, such as, WHO Europe, EUPHA, EuroHealthNet, PHA, EHMA. During 2013-16 ASPHER participated in chairing WHO’s working group on EPHO 7, the development of a sufficient and competent public health workforce in European countries. – Since its start in 2006 the programmes has been chaired by Professor Anders Foldspang, Aarhus University, now Past President of ASPHER. It was during 2008-2012 co-chaired by Dr. Christopher Birt, Liverpool University, then member of ASPHER’s executive board. Since 2008, the administrative part of the programme has been managed by ASPHER’s Director, Robert Otok, who is also member of the EPHRF Council and main editor of the IT born tool.
Box 3 The members of the Council of ASPHER’s European Public Health Reference Framework
Roza Adany, Professor, Head of the Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Hungary; President of the Hungarian Training and Research Institutions. Christopher A. Birt, Honorary Clinical Senior Lecturer, Department of Public Health and Policy, University of Liverpool, Liverpool, UK. Vesna Bjegovic-Mikanovic, Professor, Head of the Centre-School of Public Health, University of Belgrade, Serbia; President of the Managerial Board of the National Institute of Public Health «Batut». Katarzyna Czabanowska, ASPHER President 2017-18, Associate Professor, Department of International Health, Faculty of Health, Medicine and Life Sciences, Maastricht University, The Netherlands; Director of the Leadership for European Public Health Continuing Professional Development Programme. Anders Foldspang, Past President of ASPHER, Professor, Department of Public Health, Aarhus University, Aarhus, Denmark. Soeren Kjergaard, Professor, Past Head of the Department of Public Health, Aarhus University, Aarhus, Denmark. Jørn Olsen, Professor, Section of Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark. Robert Otok, Director, ASPHER, Brussels, Belgium. Mala Rao, Professor, Senior Clinical Fellow, Department of Primary Care and Public Health, Imperial College London, UK. Rodolfo Saracci, Professor, International Agency for Cancer Research, Lyon, France. Carmen Varela, Senior Expert, European Centre for Disease Prevention and Control, Stockholm, Sweden. Miroslaw Wysocki, Professor, Director of the National Institute of Public Health – NIH, Warsaw, Poland.
- Foldspang A (Ed.). Provisional Lists of Public Health Core Competencies. European Public Health Core Competencies Programme (EPHCC) for Public Health Education. Phase 1. ASPHER Series No. 2. Brussels: ASPHER, 2007.
- Whittaker PJ, Pegorie M, Read D, Birt C, Foldspang A. Do academic competences relate to ‘real public health practice’? A report from two exploratory workshops. Eur J Public Health 2010;20:8-9. Link
- Foldspang A (Ed.). Provisional lists of public health core competencies. European Public Heath Core Competencies Programme (EPHCC) for Public Health Education. Phase 2. ASPHER Series No. 4. Brussels: ASPHER, 2008.
- Birt C, Foldspang A. European Core Competences for Public Health Professionals (ECCPHP). ASPHER’s European Public Health Core Competences Programme. ASPHER Publication No. 5. Brussels: ASPHER, 2011. Link
- Birt C, Foldspang A. European Core Competences for MPH Education (ECCMPHE). ASPHER’s European Public Health Core Competences Programme. ASPHER Publication No. 6. Brussels: ASPHER, 2011. Link
- Birt C, Foldspang A. Philosophy, Process, and Vision. ASPHER’s European Public Health Core Competences Programme. ASPHER Publication No. 7. Brussels: ASPHER, 2011. Link
- Action Plan for Strengthening Public Health Capacities and Services. Copenhagen: WHO Regional Office for Europe, 2012. Link
- Birt C, Foldspang A. The Developing Role of Systems of Competences in Public Health Education and Practice. Public Health Rev 2011;33:134-47. Link
- Foldspang A, Otok R. ASPHER’s position paper concerning: The new European policy for health – Health 2020 (Draft 2), and The European Action Plan for Strengthening Public Health Capacities and Services (17.02.2012). Brussels: ASPHER, 2012. Link
- Foldspang A, Otok R, Czabanowska K, Bjegovic-Mikanovic V. Developing the Public Health Workforce in Europe. The European Public Health Reference Framework (EPHRF): It’s Council and Online Repository. Concept and Policy Brief. Brussels: ASPHER, 2014. Link
- Foldspang A. Towards a Public Health Profession: The Roles of Essential Public Health Operations (EPHOs) and Lists of Competences. Invited editorial. Eur J Public Health, 2015;25:361-2. Link
- Foldspang A. From Potential to Action. Public Health Core Competences for Essential Public Health Operations. A Manual. Vol. I, II, III. Brussels: ASPHER, 2016. Link
- Foldspang A, Otok R. Competences based individual career and workforce planning in public health. Eurohealth 2016;22:21-6. Link
- Otok R, Foldspang A. Main competences and skills to perform Essential Public Health Operations, offered by Schools of Public Health in four European countries: a short pilot report. Int J Public Health 2016;61:633-9. Link
- Otok R, Czabinowska K, Foldspang A. Public health educational comprehensiveness: The strategic rationale in establishing networks among schools of public health. Scand J Public Health 2017:45:720.22. Link
- Foldspang A, Birt CA, Otok R (Eds.). ASPHER’s European List of Core Competences for the Public Health Professional. 5th Edition. Brussels: ASPHER, 2018. Link
- Foldspang A, Birt CA, Otok R (Eds.). ASPHER’s European List of Core Competences for the Public Health Professional. Scand J Public Health 2018:46:Issue_23 Suppl pp. 1-52. Freely available at http://journals.sagepub.com/home/sjp.
- Birt CA, Foldspang A, Otok R. Meeting the population health challenge: what should you know, and what should you be able to do? Eur J Public Health 2018;28:789-90. Link