International effort fosters a new approach to public health training in Russia

Since an initial visit to St. Petersburg in 1997 to explore collaborative work on HIV prevention, Michael H. Merson, M.D., dean of public health at Yale, has made five trips across the Atlantic to support efforts to stem the AIDS epidemic in Russia. In October and January he traveled again to St. Petersburg on a different mission. Yale is helping to launch the first master of public health training program in Russia, to be based at Saint-Petersburg State University.

“It is really a recognition that there needs to be a strengthening of the public health work force to deal with HIV and other infectious and chronic diseases in Russia,” Merson said on his return from a planning trip to St. Petersburg in October. “There is very little in the way of public health programs focusing on prevention in Russia.”

According to Merson, public health has followed a different model in Russia than in other developed nations, including the United States. In Russia, public health practitioners are trained in medical schools as health administrators and managers. As the country faces an ever-increasing array of health problems, there is an urgent need for people trained in prevention programs and in epidemiology, the social and behavioral sciences, and public health.

“We have several epidemics,” said Andrei P. Kozlov, Ph.D., founder and director of the Biomedical Institute in St. Petersburg, and one of the partners in the initiative. “We have AIDS. We have TB. We have injection drug use. We have sexually transmitted diseases.” He says life expectancy in Russia, currently 59 years, has dropped 20 percent in the past decade due to increased deaths from chronic disease. Those ailments include cardiovascular disease, diabetes, cancer and obesity.

The public health program envisioned in St. Petersburg would join experts from a variety of disciplines in a common goal. It would also run up against a longstanding belief in Russia that physicians must handle all aspects of health care. “Here people expect that if you are involved in anything having to do with health, you have to have medical training,” said Svetlana Palamodova, M.P.H. ’02, who returned to St. Petersburg last year after completing her graduate work at Yale. “They don’t realize that for a lot of jobs you don’t necessarily need to have a medical background, for example in social work, health administration or prevention work.”

Since her return to Russia, Palamodova has been working on a study of tuberculosis. Because of her fluency in English and Russian and her knowledge of Yale, she has helped organize the new public health program.

The program would be the first to bring together Russian faculty from different departments to educate students in social and behavioral sciences and global health. “We have started to create a more open society. We are looking for new models,” said Igor A. Gorlinsky, Ph.D., dean of the faculty of biology and soil sciences at Saint-Petersburg and head of the university’s institutional review board. Gorlinsky will head the new program. “We have to start multidisciplinary programs and projects. The most suitable place is a classical university with multidisciplinary potentials.” The program will draw people from 12 faculties in the social and basic sciences to teach courses in biostatistics, epidemiology, environmental health sciences, health services administration and management, social and behavioral sciences, bioethics and global health. “These programs are very complex, and we need to involve people from psychology and other departments and specialties,” Gorlinsky said.

Will it be difficult to build a new program from the ground up? Kozlov sees no major obstacles. “Many faculty members are already trained for this project,” he said. “I see some technical problems. Who will teach epidemiology? Should we train this person at Yale? Maybe we should bring a teacher from Yale?”

Funding is expected from the Russian Ministry of Education, but other funds will be needed to cover the estimated $2 million cost of training faculty in the United States and providing computing facilities, reference books and journals.

Gorlinsky expects that it will take another year or two to set up the program and another two years for the first public health class to complete its studies. Details of the collaboration were agreed upon at a three-day workshop in January attended by Russian deans from many faculties at the university and representatives from Yale, Johns Hopkins, Emory, the University of Alabama, the State University of New York, the University of Illinois in Chicago, the University of North Carolina, three schools in Europe, various institutions in Russia and The Open Society Institute.

“This initiative is very important,” Kozlov said. “[Saint-Petersburg] will set up a model for the whole country and through its associations with Russian universities will promote it in the whole country.”