From Revolution to Evolution: 90 Years of ESPM

Springing from the turmoil of revolution, the School of Public Health of Mexico (ESPM) is a pioneering institution that deals with an array of public health challenges. Starting as a hygiene and sanitation training center, it has evolved into one of the leading academic and research schools of public health in the developing world. Since its foundation in 1922, the first of its kind in Latin America and the second in the Americas, after the School of Hygiene and Public Health at Johns Hopkins University, the ESPM has undergone several structural changes to respond to public health issues, as well as to the national health organizational restructuring and health education reforms.

The ESPM was established in response to the need for a health and sanitation workforce during the complex health and social situation faced during the armed movements of the Mexican Revolution in 1910. Within the same period, international health education reforms were triggered by the Flexner and Welch-Rose reports and the philanthropic participation of the Rockefeller foundation. This entity established training centers to combat infectious epidemics and also constituted a key element for ESPM’s foundation. In 1943, the school became the Ministry of Health’s welfare- training center for medical doctors, nurses and sanitation personnel. During its first two decades of existence, ESPM adopted a more social perspective, providing technical campaigns teaching skills that promoted disease

“The ESPM, now part of the

INSP, has been key to improving

Mexico’s public health

programs and public policy by

generating scientific evidence

to orient strategic decisions”

prevention. From 1945 to 1982, the school faced important challenges resulting from complex international socio- political contexts. World War II, the Cold War and different armed and student movements in Latin America caused the school to respond to foreign interests, mostly from the US, to build a continental shield against the Axis countries (Germany, Italy and Japan) and the Soviet Union. US aid from Health for the Americas provided an opportunity to enrich public health officers’ academic and scientific backgrounds in Latin America.

Efforts to cement a scientific foundation into health professionals’ education, as indicated by the Flexner report, started to flourish with academic programs, partnerships with the Infectious and Tropical Disease Institute, and student exchanges with counterparts in the US such as Harvard and Johns Hopkins. Financial support from the US Office of the Coordinator of Inter-American Affairs helped Latin American students train at ESPM. Mexico, alongside other countries in the region, founded the Latin-American Association of Schools of Public Health to incorporate a continental scope for public health practice. This close collaboration, alongside ideology discussions, provided the vision for modernizing public health practice by reaching a balance between academic, research and service components.

During the ‘70s, there was a break in public health’s modernization process because of outdated academic programs. This was the result of lost formal links with international research and academic institutions and the reorientation of policy and health infrastructure development. This trend changed in the '80s through the vision of highly qualified officials returning from postgraduate studies at renowned international public health schools, bringing new ideas for modernization.

A major reform occurred with the creation of the National Institute of Public Health (INSP) in 1987, through the fusion of ESPM, the Center of Public Health Research (CISP) and the Infectious Disease Research Center (CISEI). Additional reform made INSP legally independent from the Ministry of Health, which allowed the institute to plan more strategically to address emerging public health challenges. Structurally, INSP has embodied different decision-making organisms that allow it to adapt to different needs and challenges and make it accountable for its decisions. After the creation of the INSP, research consolidation, graduate training and continuing education programs were envisioned. A clear goal was set to transform the newly formed INSP into a highly academic and scientifically

qualified institution. It was intended to address burdens on the health system and other emerging public health threats following a deep analysis of the academic offering to identify its needs and flaws. This process also included changes in the pedagogical model, incorporating the use of information technology and communications, and the professionalization of teaching.

Currently, the INSP offers more than 30 professional and research-focused degree programs. These include an M.Sc. in Health Systems Quality, a Ph.D. in Public Health, a Ph.D. in Public Health Sciences, Nutrition and Environmental Health, a residency program in Preventive Medicine, as well as certification programs. Their M.Sc. in Public Health covers 10 focus areas, and the M.Sc. of Health Sciences straddles eight areas of concentration. The institute offers diverse educational formats beyond the standard school timetable and format, such as executive programs on weekends and an intensive online program.

In the last 10 years, the continuing education program has allowed the Institute to strengthen the public health workforce by training over 60,000 professionals. The development of MOOCs (Massive Online Open Courses), has been fundamental to update the in-service workforce

facing epidemiological emergencies such as influenza in 2009, followed by cholera and zika. More than 250,000 health workers have been trained in this format. To guarantee high academic standards and continuing improvements, the INSP has been credited by the National Council for Science and Technology in 1994 and by the US Council for Education in Public Health in 2006. This makes it the first institution with this accreditation outside the US.

The ESPM, now part of the INSP, has been key to improving Mexico’s public health programs and public policy by generating scientific evidence to orient strategic decisions. As well as developing the workforce’s expertise through a wide range of degrees and continuing education programs, many of the school’s courses are implemented in partnership with the Ministry of Health and state-level health departments. Evidence from national health surveys conducted by the INSP from 1996 to 2012, has provided insight into different health and development challenges, from infant iron-deficiency and non communicable diseases to the need to promote a health reform initiative to create universal coverage. This evidence, along with program evaluations, has provided essential information for decision making in the implementation of social programs in the country.