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Holiday homework

In Europe and on the other side of the Atlantic there is fierce debate about the education system and its performance. Do primary and secondary schools provide equality of opportunity or do they, on the contrary, increase the gaps that exist between groups of society right from birth? How can children’s scholastic achievements be improved? Should there be smaller classes? Should there be greater emphasis on information technology? More sport? Longer holidays? Fewer holidays? A 5-day or a 4-day week? More schooling? Or less? In France, school doctors (trained by the EHESP) have been involved in discussions for a long time. But what methodology is applied? What courses are currently available on the subject?

Karl Alexander, sociologist at Johns Hopkins University, studied the progress of 650 children from first grade (6 years old) to 5th grade (10 years old) in state schools in Baltimore. He published the results of his research in 2001 in an article in Education Evaluation and Policy Analysis (abstract in English only, free on-line). He studied the marks obtained in achievement tests for mathematics and reading (California Achievement Test). The results of the study by Alexander et al. showed, first of all, that there were no differences depending on socioeconomic factors in the progress measured in the children’s learning over the school year during the 5 years at primary school. However, progress in mathematics and reading during the summer holidays (between June and September) differed significantly between children from affluent backgrounds and children from middle classes or more disadvantaged backgrounds. At the start of the school year, the scores of children from rich families increased on average by 10 to 15 points from June to September, for each year of primary school, whereas progress by children from middle classes increased at a slower rate (2 points) and progress by children from poorer classes during their holidays was flat.

In the USA at any rate, it is not school which affects equality of opportunity at school, but rather the holidays! What do children from affluent backgrounds do during their holidays which distinguishes them from the poorer children? They go to summer camp with organised lessons, they are overseen and encouraged by their parents (as in France with the standard holiday work books for when they come in from the beach), and if they get bored on their own at home they will probably have more books and magazines to hand than poorer children who will probably more often be in front of the television. Poor children in Baltimore stop learning when schools close. As schools are closed far longer in Baltimore (and in the rest of the USA and Europe) than in Korea or Japan (180 school days in Baltimore as against 220 in Korea and 243 in Japan), it is not surprising that people find it impossible to climb up the social ladder in the USA and that, in the highly competitive world of North America, the best places in colleges are taken by young people from the affluent classes and by foreigners from Asia.

As stated by Malcolm Gladwell, who quotes the work of Alexander in his book, Outliers, it is not a question of focusing on the size of classes and the amount of computer equipment in schools in order to give opportunities to the more disadvantaged classes of society but rather of looking at the periods during which these children are not at school to offer them the same access to knowledge as their contemporaries in the affluent classes of society.

Given the known effect of social determinants on health, ensuring equality of opportunity for children right from primary school must be a priority in democratic societies. This will perhaps, at least in the USA, be through increasing the amount of schooling (or more schooling during holidays), before considering better equipped schools, even though these are not mutually exclusive.

When will similar studies be carried out in France?

In the meantime, children everywhere, open your holiday homework books!

For public health in Europe

A new scientific review, Public Health Reviews, is being launched on Internet. The review is dedicated to public health, articles are in English and access is free on-line and unrestricted. A collection of articles on paper on particular themes will also be published twice a year. Volume 1 covering the first half of 2010 (340 pages) will be available soon, price €49 inclusive of VAT from Presses de l’EHESP, Rennes, or from ASPHER (Association des écoles de santé publique européennes – Association of European public health schools) in Brussels.

Was yet another review really necessary in a world where we are wilting under a surfeit of information? Well, surprising as it may seem, it is not really true that we have too much information in the public health field. The only other review is the Annual Review of Public Health and it has the strongest impact factor (7.9) of scientific reviews dealing with public health. It is published once a year, one volume has about 500 pages and is used as a reference work by many professionals who often keep it close at hand in their libraries. However, more than 90% of the authors of articles published are North American. Some will say that this is the harsh reality of scientific competition, others will be surprised by this high percentage when the health models most often cited, on both sides of the Atlantic, as being the most effective in the world tend to be European.

We did not want to produce a review that was 90% European. We did, however, want the review to present a more balanced picture of each side of the Atlantic. The 27-strong editorial committee, therefore, includes 15 Europeans (including 3 French, one of whom is the editor in chief), and, of the first 18 articles, 9 are by Europeans, 8 by North-Americans and one by the Australian, Robin Warren, who was awarded the Nobel Prize for Medicine in 2005.

We wanted the review to be free for authors and readers alike, as public health professionals do not always benefit from the subscriptions to publications that universities usually provide for their research and teaching personnel. We wanted a free review financed by public funds only, on similar lines to the Emerging Infectious Diseases, a review financed by the Centers for Disease Control in Atlanta. The first four issues of the review are being funded by the EHESP and ASPHER. We will then, together, enthusiastically seek support from European organisations as we believe that European public health needs initiatives such as Public Health Reviews. We will do our utmost to ensure that these initiatives continue to give an independent, unbiased view of the major issues at stake, now and in the future, in the sensitive field of public health policies. The next volume to be published on the website between September and December 2010 will be on aging. The third volume in 2011 will cover cardio-vascular diseases, which are a major scourge of modern society. The fourth volume to be published in 2011 will be a comparison of public health education in various countries.

Reading five Public Health Reviews articles a day keeps the doctor away!

Fête de l’Ecole or Fête des Elèves?

The academic year has come to an end and the EHESP has recently introduced the tradition of celebrating the completion of studies and awarding diplomas to all students, regardless of their status in the school (public servants, Masters, PhDs),… even if their course was completed several months beforehand. In some American universities this is referred to as the Commencement Ceremony, as, for students, the end of the academic year marks the start of their new career. This applies in particular to the EHESP whose students are destined for the top jobs in the health systems in the countries where they will be working. In a culture that is perhaps more French, we call this the “Fête de l’Ecole”, probably because the event is focussed, perhaps rather too closely, on ourselves, the permanent staff at the EHESP who are still there when the students have left and the new intake has not yet arrived.

This does not prevent me from wishing the best of luck to all our students who will be leaving for new horizons after 7 July 2010, the day of our Fête and the presentation of the diplomas. These students decided to make a change in their lives, for some a radical change, by applying for a course at the EHESP to qualify them for a job that will transform their lives as well as the lives of those under their leadership. Others wished to deepen their knowledge or increase their skills after years of professional experience by taking a Master, an Executive Master or one of the many other diplomas available at the EHESP. We will find out why they took the decision in the next few weeks by interviewing a few of the students who have graduated (nearly 1,000 in 2009) and, with their permission, posting these brief interviews on our website.

According to Malcolm Gladwell, quoted by John Gibbon, instructor for continuing studies for managers at Stanford, in his blog, in English, most people agree that there are three qualities that work has to have if it is to be satisfying: “autonomy, complexity, and a connection between effort and reward. … Work that fulfils those three criteria is meaningful. Being a teacher is meaningful. Being a physician is meaningful. So is being an entrepreneur.” He takes as examples Jewish immigrants arriving in New York, creating the world’s largest ready-to-wear clothing industry in the 1890s, and the careers of the Beatles and Bill Gates nearly one hundred years later. In all three, you find the three elements of job satisfaction, often combined with great personal commitment and hard work, strongly rewarded, not necessarily by a high level of personal income (the New York rag trade reinvested all its profits in equipment for the business), but they were their own bosses, with considerable decision-making latitude that occupational stress specialists recognise as a major prevention factor. The complexity of the problems they had to face only fuelled the passion with which they resolved them.

Howard Gardner, psychologist at the Harvard Graduate School of Education, suggests that there are three questions you can ask about your job to evaluate your GoodWork level:

1) Does it fit your values?

2) Does it evoke excellence; are you highly competent and effective at what you do?

3) Does it bring you that subjective barometer of engagement, joy?

His advice for anyone who is at a crossroads in his career and thinking about a new job is “Decide what you really like to do and what you would like to spend your life doing. That’s more important [in his eyes] than deciding what particular job to hold, because the employment landscape is changing radically and quickly.” Finally he adds, “If you have any choice over where to work, when you’re considering a job, go there and talk to people. Ask yourself, ‘Is this the kind of place where I can see myself in others?’ You might make five times more money at one place, but does it reflect who you are and who you want to be? Are my colleagues people I’d admire or people I’d prefer to avoid?

This is the I advice I would give to my students and our readers who are asking these questions – as each one of us does at some stage in our careers – and particularly those who in the coming weeks and months will have to face the job market, and I congratulate them. It is also useful advice for our public service students who have chosen or will choose jobs according to a certain number of criteria that are specific to them and who do not leave things completely to chance. Be as mobile, be as flexible, be as dynamic as you can be! These are my three recommendations, in addition to those of specialist colleagues quoted above. Some people see the world as a trial to which they have to adapt. Others see the world as being malleable. Surely the progress of man is in the image of the latter: if you have the opportunity to choose your life, take the plunge, the world needs you to shape it!