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Victor M. Cardenas, MD, PhD, MPH

V. M. Cardenas is with the University of Texas School of Public Health, El Paso Regional Campus.

Correspondence: Requests for reprints should be sent to Victor M. Cardenas, MD, PhD, MPH, 1100 North Stanton Avenue, Suite 110F, El Paso, TX 79902 (e-mail: vcardenas{at}sph.uth.tmc.edu).

My opinions may not necessarily reflect those of the Training Programs in Epidemiology and Public Health Interventions Network (TEPHINET), as I am no longer director of this nongovernmental organization. However, our paper showed that noncommunicable diseases (NCDs), mental health, and injuries were topics of 3.5%, 1.5%, and 5.8%, respectively, of the TEPHINET trainee papers presented during the late 1990s,¹ small fractions that, indeed, eloquently speak for the need of broadening TEPHINET’s scope. Nonetheless, among those projects there are many examples of contributions on NCDs, including a community-based smoking-prevention intervention initiated by religious leaders in Thailand, the assessment of smoke-out days in the Philippines, smoking prevalence surveys in Hungary and Germany, and the validation of face-to-face and telephone behavioral risk factor surveys in Colombia. Some obstacles and possible aids to broaden the scope of these training programs include the following:

1. The mission of some of the institutions hosting the training programs, which were often created with the sole purpose of academic research on infectious disease, may be rather limited. In part as an outcome of the establishment of TEPHINET programs, many host institutions have rapidly incorporated applied research and public health surveillance into their mission, and have strengthened their links with public health services and programs.
   
2. Administrative barriers to funding trainee positions in NCD or injury prevention programs often exist. NCD programs could play a more active role as stakeholders in TEPHINET programs as current or future employers of graduates, following the examples of other units (i.e., epidemiology, immunization, food- and waterborne diseases, tuberculosis, HIV/STD programs) within different countries’ ministries of health.
   
3. Surveillance of NCDs or injuries often does not provide practical training opportunities like those offered through the systematic investigation of outbreaks of infectious diseases. The design, systematic analysis, and evaluation of behavioral risk factor surveillance systems and data as outlined in the World Health Organization’s STEPwise strategy⁴ might provide some of these long-awaited training opportunities in NCDs.
   

Given the role that TEPHINET programs play in global public health surveillance and response, I think they have a unique opportunity and moral obligation to contribute to improving public health by addressing infectious disease. Broadening the focus of field epidemiology and public health training will benefit from such firm grounding on infectious disease surveillance and response.

References

1. Cardenas VM, Roces MC, Wattanasri S, Martinez-Navarro F, Tshimanga M, Al-Hamdan N, Jara J. Improving global public health leadership through training in epidemiology and public health: the experience of TEPHINET. Am J Public Health. 2002;92:196–197.[Free Full Text]

2. Swaddiwudhipong W, Chaovakiratipong C, Nguntra P, Khumklam P, Silarug N. Influence of religious leaders on smoking cessation in a rural population—Thailand, 1991. MMWR Morb Mortal Wkly Rep. 1993;42(19):367–369.[Medline]

3. Trujillo LG, Soto FJ, Arroyave MC, et al. Encuesta de factores de riesgo de enfermedades crónicas en el departamento de Caldas, diciembre de 1997. Informe Quincenal Epidemiológico Nacional. 1997;2(24):342–349.

4. World Health Organization. WHO global NCD risk factor surveillance. Available at: http://www.who.int/mipfiles/1967/WHOGlobalNCDRiskFactorSurveillance.pdf. Accessed August 21, 2002.

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