Transformative Education
for Health Professionals

China embraces One Health for One World

China embraces One Health for One World

A recent issue of the Lancet highlighted the complexity of China’s health professional education system. As Li Bin, minister of the newly formed National Health and Family Planning Commission (NHFPC), reaffirmed that health professionals are the key driving force of health-care reform, investment in quality training becomes vital to the future of the country with more than 1.3 billion people.

The national policy announced by the Chinese government in 1998 led to the dramatic administrative reform that merged many of the formerly independent health professional institutions into universities under the Ministry of Education. The capacity of graduates increased. Skill-mix also became more balanced after a prominent increase in nursing staff.

With strong motivation, a new round of health sector reform was announced in 2009. The concept of Healthy China 2020 was proposed with an aim to establish universal coverage that provides “safe, effective, convenient, and affordable basic health services” to all urban and rural residents. Primary care and public health programs are the priority for public financing. It was reported that the central government funding for public health reached 3 billion USD in 2009.

Public health training in China is mostly undergraduate education or 5 years after high school, enrolling around 7000 students per year. Master and doctoral degrees in public health are very limited, with only 1500 and 400 students per year respectively. Many graduates secure jobs in provincial Centers for Disease Control and Prevention (CDC) and governmental health inspection units. There is a pressing need for more public health professionals. Moreover, current curriculum is outdated and reform has been static, failing to equip students a full range of competencies. There have been numerous calls for more international exchange and partnership to bring in global perspectives.

One Health – a timely and relevant topic for Guangdong, China

Guangdong is located at South China Sea coast with a population of more than 106 million. The province made it to the international news headlines in March 2003, when the World Health Organization alerted its outbreak of severe acute respiratory syndrome (SARS) which soon became a global epidemic.  Investigators traced the outbreak to contacts with civets in live-animal markets. These local cuisines are traded under overcrowding conditions and mixing of various animal species, explaining the inter- and cross-species infections. Research later showed horseshoe bats might be natural reservoir hosts of the SARS-related coronavirus.

A similar story is told about Ebola virus disease. Since its discovery in 1976, some of its numerous outbreaks in Africa have been associated with non-human primates and fruit bats. Consumption of bush meat is a significant risk factor of wildlife-to-human infection that is followed by extensive human-to-human transmissions.

In fact, emerging and re-emerging infectious diseases events are dominated by zoonoses with wildlife origins. They are significantly correlated with socio-economic, environmental and ecological factors. The element of surprise often meets an unprepared health system. The result is usually dreadful, if not tragic. 

A masked palm civet caged for sale in a Guangzhou wild-animal food market in 2006  (Photo by Animals Asia Foundation, Hong Kong) 

Bats are abundant, diverse, and geographically widespread.  Some species have been identified as reservoir hosts of emerging viruses. The above shows a Chinese rufous horseshoe bat. (Photo from Internet)

Human beings do not exist in a biological vacuum. Our health is interdependent with that of the planetary biodiversity as well as the realm of the inanimate. Climate change and urbanization together with exponential growth in trading and tourism have brought new dynamics to infectious diseases. The challenges in food safety, infectious disease control, antimicrobial resistance and environmental pollution have become more complicated than ever. No single discipline can tackle these issues solely.

One Health can be described as “the collaborative effort of multiple disciplines – working locally, nationally, and globally – to attain optimal health for people, animals and our environment”. The term is new but the concept has a long history in the field of medicine. The world is recognizing its importance and the wisdom behind. For Guangdong, this is an opportunity that must be seized.

Leading change, building momentum

The International Symposium for One Health Research recently held in Guangzhou marked an important step forward. Made possible by the vision of Prof. Jiahai Lu, Prof. Yuantao Hao and Prof. Gregory Gray, the event was co-organized by Sun Yat-sen University (SYSU), South China Agricultural University (SCAU), Academy of Military Medical Sciences, and Duke University. It was graced with prestigious guest speakers from countries including China, Mongolia, Kazakhstan, Vietnam, Thailand, Romania, the USA and Australia.

Overcoming language barrier is possible, as demonstrated by this bilingual symposium with English-Chinese simultaneous interpretation. Over 300 scholars and students attended. The organizing committee left no chance for anything to reduce their enthusiasm. Even the PowerPoint presentations were translated before the event.

Students are the cornerstone for bringing One Health into China. Prof. Lu has been encouraging them by sharing related literatures and creating dialogues. Students from SYSU and SCAU were involved in organizing the symposium, which further engaged them in the field. The symposium also included a student research competition. It received more than 15 submissions with a variety of topics. The poster presentations were judged by an international group of experts. This allowed young researchers to exchange experience and to expand their professional network.

The event concluded with the grand opening of One Health Research Center of SYSU. Being the first one in China, the center is dedicated to driving the agenda in Asia. It takes time, but the country is all geared up for the journey.

Prof. Nanshan Zhong discussing the strategy of prevention and control of emerging infectious diseases in Guangdong. The province endured SARS, H1N1, H7N9, and more recently a severe outbreak of Dengue.

Over 50 students from SYSU School of Public Health and SCAU School of Veterinary Medicine volunteered in the event. Their hard work was rewarded with knowledge, new friends and inspirations.

One Health approach in the context of Transformative Education

The world begins to understand that a One Health research approach is clearly the most rational, cost effective and appealing approach to manage the risks facing environmental, animal and human health. But how to make changes happen?

Prof. Martyn Jeggo impressed the audience during the symposium with 3 interlinked priorities:

Re-organize. Independent entities should be created in form of departments, divisions, agencies or ministries that are empowered to lead. They are to ensure quality and relevance of research, putting evidence into policies that live up to the spirit of One Health.

Educate. Human and veterinary health professionals should be taught with relevant knowledge and skills, so they could communicate and work collaboratively. Accredited undergraduate and postgraduate programs may incentivize the students. The role of social scientists and environmentalists should be strengthened. Policy makers should be educated through highlighting the success of One Health approach.

Reallocate resource. Investments in One Health make perfect economic sense. Benefits are possible through sharing health resources between the medical and veterinary sectors, controlling zoonosis and preventing pandemics, as well as generating insights and adding value to health research and development.

Evidence-based recommendations and good practices to implement reform have been articulated in WHO Guidelines on Transforming and Scaling up Health Professional Education and Training. Multidisciplinary collaboration from higher level is being called for. From the recent ISOHR, political commitment of Guangdong government is evident. It can be anticipated that the initiative will be a game-changer for education in the country, bringing up very tangible targets to achieve. A new course is on its way as China continues to join the global community not just for quantity, but also better quality and relevance of health workforce to face future challenges that arise within our One World. 

 

Yao Xia, MPH student in SYSU. Graduated from Geo-information and Engineering Geology in 2013, he discovered his interest in public health and its relationship with the environment. He joined the organizing committee of ISOHR with the enthusiasm to drive One Health research in China.

Yanshan Zhu, undergraduate student in SYSU majoring in preventive medicine. She would like to develop her enthusiasm in scientific research during her senior year, which is also the reason why she participated in  the organizing committee of ISOHR. She was mainly responsible for secretarial work and volunteer management.