READING B

PREVIEW

Public health，when working well，is invisible.However，when a public health system is chronically underfunded，understaffed，undertrained，and undersupported，the consequences are immense and visible.The pandemic of emerging infectious diseases has made our nation more aware than ever the important role public health plays in surveillance and screening to contain outbreaks，and the distribution of vaccines and other essential resources to control them.Although public health education in general is expanding，it is doing so at a slower pace than many other health science disciplines.The multidisciplinary and multisectoral nature of public health may pose a challenge to organizing public health education.Currently，most clinical physicians in China do not receive public health training，and most public health professionals responsible for disease control are not equipped with sufficient clinical skills.Existing undergraduate and graduate curricula for the preventive medicine may unintentionally widen the gap between public health and clinical medicine.It is urgently needed to strengthen preventive medicine curriculum in training programs for clinical medical students in the new era.

Questions for Discussion

Q1：How to bridge the gaps between clinical medicine and public health for disease control in China？

Q2：Why do graduates of top preventive medicine programs show little interest in working at CDCs？

Text B　Public Health and Preventive Medicine Education in China：Things to Consider

Defining Public Health

Public health has evolved，so has the definition of public health.Common to most definitions is a sense of the general public interest，a focus on the broader determinants of health，and a desire to improve the health of the entire population.Earlier definitions also made explicit reference to the administration of health-care services.The plethora of definitions suggests the need for a short and succinct definition of public health that is both broad in scope and of wide appeal.In fact，public health evolved from a narrowly disease-centered to a broader population-based，multidisciplinary and multisectoral discipline that is "collective action for sustained improvement of the health of all people".It requires contributions from various disciplines：sociologists，economists，politicians，environmentalists，epidemiologists，statisticians，clinicians，etc.

Public Health and Preventive Medicine in China

The difference between preventive medicine and public health has not been well recognized in most countries，including China.From the 1950s to the 1970s，China's model of public health education was imported from the former Soviet Union，with an emphasis on sanitation and hygiene.During this era，many medical universities and colleges established departments of hygiene，or as it was later called，preventive medicine.Public health education mainly consisted of five core disciplines：food and nutrition，environmental health，occupational health，radiation health，and school health.Beginning in the 1980s，departments of preventive medicine began to establish schools of public health.New disciplines based on western models were also established，including epidemiology，health statistics，social medicine，and health policy and management.

Based on the technical developments in epidemiology in the middle of the last century，public health has been dominated by the quantitative sciences at the expense of other public health sciences.Preventive medicine is often treated as a specialty of medicine，and therefore has clinical training as its foundation，with additional training in public health.According to its educational curriculum，China does treat preventive medicine as a specialty of medicine.Most undergraduate preventive medicine programs in China require five years of predominantly clinical and basic science training：four years of basic health science and curative medicine，and one year of public health （e.g.epidemiology，biostatistics，occupational health，environmental health，etc.）.Afterwards，the students received their medical degrees.

Disease Control System Reforms Potentially Widen the Gap between Public Health and Clinical Medicine

In 2002，the outbreak and spread of SARS drew great attention to the field of public health and the prevention of infectious disease.China established the Chinese Center for Disease Control and Prevention （CDC）in 2002，and divided each Hygiene and Anti-Epidemic Stations（HAES）at various levels into two separate units：the local CDC and the Health Inspection Unit （HIU）.The HIU is the law enforcement unit that ensures various activities，such as food production，comply with national health standards.Meanwhile，many universities or medical schools established Schools of Public Health.Consequently，preventive medicine has become synonymous with public health in China，and the two terms are used interchangeably.

Drastic change of regulations on the eligibility of medical practitioners unintentionally distanced preventive medicine from clinical medicine and potentially widened the gap between public health and clinical medicine.The Law on Licensed Doctors of the People's Republic of China implemented in 1999，which stipulated the qualification of health professionals working in the field of clinical medicine，disease prevention，and health promotion.A supplemental regulation on the eligibility for national medical professional exams further reiterated that only graduates with a clinical medicine degree were eligible to take the medical board examination and engage in clinical medicine after fifteen years （2014）.It profoundly affected preventive medicine graduates'career development.Since then，preventive medicine graduates have not been able to practice clinical medicine.Nor could they practice in the division of infectious diseases at hospitals where they previously sought employment.Preventive medicine graduates cannot practice curative medicine，which generates a disconnection between the curriculum and the practice.

Fundamental Challenges on Human Resources for Disease Control in China

The fundamental challenge for the CDCs is the lack of qualified personnel with both clinical and public health training.Existing undergraduate preventive medicine programs only provide students with one to two years of clinical training，which is not sufficient for them to acquire adequate clinical experience to tackle communicable and non-communicable diseases at the individual and community levels.Furthermore，education for public health students in China lags behind due to outdated curricula and teaching materials，excessive focus on teaching biomedical sciences，insufficient or low-quality practical training in the public health sector.Most students choose to start work immediately after graduation，with only a minority deciding to pursue further studies.Although public health education in general is expanding，it is doing so at a slower pace than many other health science disciplines.At one of the most competitive universities in China，the number of doctorate students admitted into public health and preventive medicine programs increased by only 5.3% from 2008 to 2011，which was substantially lower than the average 14.1% increase across all disciplines at universities.

The number of master graduates working at the CDCs is significantly lower than the number employed in hospitals.Nearly 35% of the graduates are doing administrative or logistical work unrelated to their specializations.Moreover，a large number of the graduates are employed by provincial-or municipal-level institutions，which results in the relatively low educational level in rudimentary CDCs.Many students are often persuaded or assigned to study public health.According to a nationwide survey of 1197 undergraduate public health students，those who chose to study public health as their first preference only accounted for 26.9% of the entire surveyed students，which starkly contrasts against the preferences for students who chose to study medicine （75.0%）.With a large proportion of students dissatisfied with their major，these students are more likely to find a job that is not related to health sciences.The survey also found that about one in five public health students were unwilling to find a job in public health after graduation.

Salary is one of the most important factors for job seekers.Along with healthcare reform，the income of hospital medical staff has increased.Nevertheless，due to the nature of the public institutions，CDCs pay relatively low salaries based on standard and performance.Graduates may earn more in hospitals，colleges，and enterprises than in the CDCs or other public healthrelated institutions，which may be one of the reasons that prevent them from working in disease prevention-related institutions.The initial salary of the master's graduates varied across administrative levels.The study showed that only 30.9% of graduates earned more than CNY 6，000 per month.Due to this reason，the satisfaction rate and work ethic of CDC staff inevitably suffer.

Strengthen Preventive Medicine for Disease Control in China

It is imperative to reform preventive medicine training to strengthen the links between public health and clinical medicine.Firstly，the curriculum of clinical medicine for undergraduate preventive medicine programs should be strengthened.Undergraduate programs in preventive medicine should have clinical training similar to that of clinical medicine to ensure that preventive medicine undergraduates receive adequate training in clinical medicine.The government should enhance residency training programs on preventive medicine and rectify the eligibility regulation to allow preventive medicine graduates to obtain a certificate to practice clinical medicine in the field where public health interventions play a significant role in reducing the disease burden，such as infectious diseases，non-communicable diseases，injuries，and maternal and child health.

Secondly，the training programs should incorporate more diverse curricula on public health.The core course should include basic knowledge in these areas：epidemiology，biostatistics，health policy，management，and economics （health services administration）；social and behavioral sciences （medical sociology，health education，health promotion，behavior change）；and environmental health.These are internationally recognized as the five core areas of public health，which are consistent with the three domains of public health practice，and with curriculum proposed by the Associations of School of Public Health in the USA and Europe.The training programs should also provide more intensive clinical training to meet the increasing demand for interdisciplinary skills in disease control.

Finally，it is critical to provide clinical settings for preventive medicine physicians to sharpen their clinical skills for disease control.Hospital beds should be allocated for public health physicians to manage inpatients as well and to implement the responsibilities and requirements of public health physicians for patient management.In brief，public health physicians are required to participate in the whole process of patient reception，diagnosis and treatment，operation，medical record writing and follow-up.In the process of clinical practice，public health physicians should attend clinical lectures，teaching rounds and case analysis according to the training plans；so that they could systematically master the clinical knowledge and applications，and achieve certain professional ability to deal with clinical affairs.

Conclusion

The multidisciplinary and multisectoral nature of public health may pose a challenge to organizing public health education.Existing undergraduate and graduate curricula for preventive medicine may unintentionally widen the gap between public health and clinical medicine.Enhancing clinical skills，amending the Law on Licensed Doctors of the People's Republic of China，and expanding the public health curriculum for preventive medicine graduates can better equip professionals to address both global and national health challenges.

Words and Expressions

explicit 明确的

Parents and teachers can help children by providing explicit instruction regarding the mind as a learning machine.

succinct 简明的

The book gives an admirably succinct account of the technology and its history.

sanitation 环境卫生；卫生设备和系统

Many illnesses are the result of inadequate sanitation.

hygiene 卫生

The government has introduced some tough new laws on food hygiene.

quantitative 定量性的；量化的

The organizers of the experiment concluded that far fewer students were achieving at high levels on critical thinking than they were doing for written communication or quantitative literacy.

synonymous 同义的；等同于……的

Wealth is not necessarily synonymous with happiness.

regulation 章程；规章制度

The European Union has proposed new regulations to control the hours worked by its employees.

eligibility 资格

The government has altered the rules governing eligibility for unemployment benefit.

unintentionally 无意中

They had unintentionally provided wrong information.

stipulate 规定；明确要求

Some jurisdictions permit individuals to waive their right to contest a hearing and instead stipulate to civil commitment.

tackle 解决

The first reason to tackle these problems is to save children's lives.

excessive 过度的

Democracy is incompatible with excessive，bureaucratic regimentation of social life.

substantially 大量地，可观地

Salaries and associated costs have risen substantially.

administrative 管理的；行政的

I spend a lot of my time on administrative duties.

logistical 后勤的

She described the distribution of food and medical supplies as a logistical nightmare.

rudimentary 初级的；基本的

They were given only rudimentary training in the job.

inevitably 不可避免地

The result will inevitably fuel speculation about the Prime Minister's future.

imperative 重要紧急的；迫切的

It is imperative to continue the treatment for at least two months.

residency 高级专科住院医生实习期

On Improving the Capability of Standardized Training Residency in Internal Intensive Medicine.

incorporate 合并；包含

When we acquire new information，the brain automatically tries to incorporate it within existing information by forming associations.

interdisciplinary 多学科的；跨学科的

Australian Chinese study is a kind of interdisciplinary research on Chinese problems.

physician 医师；（尤指）内科医生

I'm a practicing physician trying to help people here and now.

detrimental 有害的；不利的

Poor eating habits are detrimental to health.

Language Points

bridge the gap 消除隔阂；弥合差距

to have qualities of two different groups or things

His work bridges the gap between popular fiction and serious literature.

notifiable infectious diseases 法定传染病

Currently，41 infectious diseases are notifiable in China，classified as Class A，Class B and Class C according to their epidemic levels and potential population threats.Class A and Class B（total 30 diseases）represent categories of diseases with high risk of outbreaks or that are likely to result in rapid spread once an outbreak occurs.Mortality and morbidity related to group A and B diseases are reported and published by the National Health Commission of the People's Republic of China on a monthly basis.Class C diseases are less infectious and，when outbreaks occur，are epidemiologically less severe.They are required to be reported only when outbreaks occur.

We performed a descriptive study of notifiable infectious diseases among foreigners reported from 2004 to 2017 in China using data from the Chinese National Notifiable Infectious Disease Reporting System （NNIDRIS）.

pose a challenge to 给……带来挑战

Polio poses a particular challenge to countries with unstable politics and weak health systems.

undergraduate 大学本科生

a student who is studying for their first degree at a college or university

postgraduate 研究生

a student who has already received one degree and is studying at a university for a more advanced degree

We thank our colleagues，collaborators，postgraduate and undergraduate students who have contributed to，motivated and inspired our research activities in this field.

Center for Disease Control and Prevention （CDC）疾病预防控制中心

Chinese Center for Disease Control and Prevention （briefly as China CDC）is a governmental and national-level technical organization specialized on disease control and prevention and public health.Its mission is to create a safe and healthy environment，maintain social stability，ensure national security and promote the health of people through prevention and control of disease，injury and disability.Devoted itself to disease control and prevention，it sticks to relying on scientific research and values talent as a fundamental element.

CDC conducts critical science and provides health information that protects our nation against expensive and dangerous health threats，and responds when these arise.

EXERCISES

Task 1：Vocabulary Application

Fill in the blanks with the words given below.Change the form where necessary.

1.As a result of the ___________ disease pandemic，commercial hand ___________products have become scarce and World Health Organization （WHO）alcohol-based hand rub formulations containing ethanol or isopropanol are being produced for hospitals worldwide.

2.In Germany，___________ skin diseases have topped the annual list of suspected workrelated diseases for years.

3.With the evolution of digital media，areas such as public health are adding new platforms to ___________ traditional systems of epidemiological ___________.

4.In the first decades of the 21st century，a major transition is underway in documentation of patient-related data in clinical settings with the rapid acceleration of the adoption of electronic___________ .

5.To determine which methods best prepare psychiatry residents for the ___________exam，and ultimately for practice，to facilitate appropriate ___________ program ___________changes.

Task 2：Writing

The Lancet is collecting ideas from preventive medicine students about public health. For this part，you are allowed to write a letter to the Editor of the Lancet to express your views on the importance of public health system reform.You should write at least 150 words but no more than 300 words.

Task 3：Oral Presentation

Debate involves an individual or a team of students working to effectively convince a judge that their side of a resolution or topic is，as a general principle，more valid.Students in debate come to thoroughly understand both sides of an issue，having researched each extensively，and learn to think critically about every argument that could be made on each side.

For this part，please hold a debate with the topic "Is it necessary for clinicians to receive public health training？".

（邹华春）