The Lancet commissions by scientific advances, with no rigorous standards of examples, including several in the Arabian countries and education and practice based on modern foundations. south Asia, show the capacity of public health academic After developments in western Europe, the first institutions to respond to diverse and rapidly changing about the public generation of 20th century reforms in North America local requirements(panel 2) ndation of India see were sparked by such reports as Flexner(1910), In parallel with the increasing engagement of national w-phfLorg/ which launched modern health sciences into classrooms reforms began after World War 2 both in industrialised ro mores althseehttp://www dentistry, respectively(panel 1). These reforms, which were independence from colonialism. 7 School and university bracuniversitynet/&S/sph/ usually sequencing education in the biomedical sciences followed by training in clinical and public health practice, Panel 2: Adaptation of public health education and research to local priorities were joined by similar efforts in other regions. Curricular reform was linked to institutional transformation- Several public health institutes have developed over recent decades in response to very university bases, academic hospitals linked to universities, diverse local contexts. We present inovations in three regions: Arabian countries, closure of low.-quality proprietary schools, and the bringing Mexico, and south Asia. gether of research and education. The goals were to Institute of Community and Public Health, Birzeit University, occupied Palestinian n dvance scientifically based professionalism with high territory, is one of three independent schoolsof public health linked to leading technical and ethical standards American philanthropy, led by the Rockefeller of Alexandria in Egypt is a large institution founded in 1956; and the Faculty of Health Foundation, the Carnegie Foundation for the Advancement Sciences, American University of Beirut(AUB), Lebanon, was established as separate from and other similar organisations, promoted AUB's medical school in 1954 and achieved accreditation of its graduate public health these educational reforms by financing the establishment programme from the US Council on Education for Public Health in 2006. All were of dozens of new schools of medicine and public health uniquely shaped by national contexts, ranging from a strong state in Egypt to civil the USA and elsewhere. 2 years after the publication of conflict in Lebanon, to absent state structures in the occupied Palestinian territory. All his original report, which focused on the USA and Canada ive adopted different approaches to public health: application of evidence-based Flexner"extended his study of medical education to the interventions to improve health-care delivery and environmental health in Egypt: German Empire, Austria, France, England, and Scotland. xpansion of multisectoral developmental public health practice in Lebanon; and focus on infuence went beyond nations in social determinants of health necessitating actions inside and outside the health sector in The so-called flexner model was translated into action through the establishment of new medical schools, the e occupied Palestinian territory earliest and most prominent being the Peking Union National Institute of Public Health of Mexico(NIPH), "founded in 1987, responded to Medical College founded in China by the Rockefeller rapid national economic and social change, striving to balance excellence in its research Foundation and implemented by its China Medical Board and educational mission with relevance to decision making through proactive translation in1917635 of knowledge into evidence for policy and practice. The Institute widely disseminated a In public health, the earlier experiences at the London conceptual base around the essential attributes of public health; developed educational School of Tropical Medicine, Tulane University, and the programmes across diverse areas of concentration; implemented a wide range of Harvard-MIT School for Health Officers were affected by innovative educational approaches, from short courses to doctoral programmes; and the Welch-Rose report, "which paved the way for a major developed sound evidence that supported the design, implementation, and evaluation of growth in new schools starting with the Johns Hopkins the ongoing health reform initiative for universal coverage. The success of the NIPH School of Hygiene and Public Health(1916), the Harvard underscores the crucial importance of national and international networking to School of Public Health(1922), the School of Public thstand local difficulties by sharing of experiences to build a strong health-research Health of Mexico(1922), a renewed London School of system that is able to tackle a vast array of local and global health challenges. Hygiene and Tropical Medicine(1924), and the University The Public Health Foundation of India is a unique private-public partnership to energise of Toronto School of Public Health(1927). The Welch. public health by bringing together pooled resources from the Indian Government and Rose model was also exported through Rockefellers private philanthropy to address Indias priority health challenges. The Foundation is funding of 35 new schools of public health overseas, as crafting partnerships with four state governments to create eight training institutes of amplified by the School of Public Health of Mexico, public health in the country. The BRACUniversity's School of Public Health, named which was established in 1922 as part of the Federal after UNICEF's visionary leader James P Grant, was launched by the worlds largest This mass-scale export and adoption had mixed non-governmental organisation and offers an innovative 12-month curriculum for outcomes, with useful results in some countries but also basic public health skills in the context of rural health action, followed by the remaining evere misfits in others. In 1987, the pioneering Mexican 6 months of thematic and research training. These two public health initiatives in south school underwent major reform when it merged with the Asia were based on the legacy of British colonialism, which focused exclusively on medical Centre for Public Health Research and the Centre for rather than public health schools. Importantly, both these schools are developing new Infectious disease research to form the National institute urricula shaped to national and global priorities, and neither is adopting wholesale the of Public Health--one of the leading institutions of its Welch-Rose model of public health education type in the developing world. Many other innovative ww.thelancet.comThe Lancet Commissions www.thelancet.com 13 by scientific advances, with no rigorous standards of education and practice based on modern foundations. After developments in western Europe, the first generation of 20th century reforms in North America were sparked by such reports as Flexner (1910),13 Welch-Rose (1915),14 Goldmark (1923),15 and Gies (1926),16 which launched modern health sciences into classrooms and laboratories in medicine, public health, nursing, and dentistry, respectively (panel 1). These reforms, which were usually sequencing education in the biomedical sciences followed by training in clinical and public health practice, were joined by similar efforts in other regions. Curricular reform was linked to institutional transformation— university bases, academic hospitals linked to universities, closure of low-quality proprietary schools, and the bringing together of research and education. The goals were to advance scientifically based professionalism with high technical and ethical standards. American philanthropy, led by the Rockefeller Foundation, the Carnegie Foundation for the Advancement of Teaching, and other similar organisations, promoted these educational reforms by financing the establishment of dozens of new schools of medicine and public health in the USA and elsewhere.64 2 years after the publication of his original report, which focused on the USA and Canada, Flexner63 extended his study of medical education to the German Empire, Austria, France, England, and Scotland. But the influence went beyond nations in western Europe. The so-called Flexner model was translated into action through the establishment of new medical schools, the earliest and most prominent being the Peking Union Medical College founded in China by the Rockefeller Foundation and implemented by its China Medical Board in 1917.63,65 In public health, the earlier experiences at the London School of Tropical Medicine, Tulane University,66 and the Harvard-MIT School for Health Officers were affected by the Welch-Rose report,14 which paved the way for a major growth in new schools starting with the Johns Hopkins School of Hygiene and Public Health (1916), the Harvard School of Public Health (1922), the School of Public Health of Mexico (1922), a renewed London School of Hygiene and Tropical Medicine (1924), and the University of Toronto School of Public Health (1927). The Welch￾Rose model was also exported through Rockefeller’s funding of 35 new schools of public health overseas, as exemplified by the School of Public Health of Mexico, which was established in 1922 as part of the Federal Department of Health. This mass-scale export and adoption had mixed outcomes, with useful results in some countries but also severe misfits in others. In 1987, the pioneering Mexican school underwent major reform when it merged with the Centre for Public Health Research and the Centre for Infectious Disease Research to form the National Institute of Public Health—one of the leading institutions of its type in the developing world.67 Many other innovative examples, including several in the Arabian countries and south Asia, show the capacity of public health academic institutions to respond to diverse and rapidly changing local requirements (panel 2). In parallel with the increasing engagement of national governments in health affairs, a second generation of reforms began after World War 2 both in industrialised and in developing nations, many of which had just gained independence from colonialism.71 School and university Panel 2: Adaptation of public health education and research to local priorities Several public health institutes have developed over recent decades in response to very diverse local contexts. We present innovations in three regions: Arabian countries, Mexico, and south Asia. Institute of Community and Public Health, Birzeit University, occupied Palestinian territory, is one of three independent schools of public health linked to leading universities in the Arab region; the High Institute of Public Health (HIPH) at the University of Alexandria in Egypt is a large institution founded in 1956; and the Faculty of Health Sciences, American University of Beirut (AUB), Lebanon, was established as separate from AUB’s medical school in 1954 and achieved accreditation of its graduate public health programme from the US Council on Education for Public Health in 2006. All were uniquely shaped by national contexts, ranging from a strong state in Egypt to civil conflict in Lebanon, to absent state structures in the occupied Palestinian territory. All have adopted different approaches to public health: application of evidence-based interventions to improve health-care delivery and environmental health in Egypt; expansion of multisectoral developmental public health practice in Lebanon; and focus on social determinants of health necessitating actions inside and outside the health sector in the occupied Palestinian territory.68 National Institute of Public Health of Mexico (NIPH),69 founded in 1987, responded to rapid national economic and social change, striving to balance excellence in its research and educational mission with relevance to decision making through proactive translation of knowledge into evidence for policy and practice. The Institute widely disseminated a conceptual base around the essential attributes of public health; developed educational programmes across diverse areas of concentration; implemented a wide range of innovative educational approaches, from short courses to doctoral programmes; and developed sound evidence that supported the design, implementation, and evaluation of the ongoing health reform initiative for universal coverage. The success of the NIPH underscores the crucial importance of national and international networking to withstand local difficulties by sharing of experiences to build a strong health-research system that is able to tackle a vast array of local and global health challenges. The Public Health Foundation of India is a unique private–public partnership to energise public health by bringing together pooled resources from the Indian Government and private philanthropy to address India’s priority health challenges. The Foundation is crafting partnerships with four state governments to create eight training institutes of public health in the country.70 The BRAC University’s School of Public Health, named after UNICEF’s visionary leader James P Grant, was launched by the world’s largest non-governmental organisation and offers an innovative 12-month curriculum for masters in public health that begins with 6 months on its Savar rural campus acquiring basic public health skills in the context of rural health action, followed by the remaining 6 months of thematic and research training. These two public health initiatives in south Asia were based on the legacy of British colonialism, which focused exclusively on medical rather than public health schools. Importantly, both these schools are developing new curricula shaped to national and global priorities, and neither is adopting wholesale the Welch-Rose model of public health education. For more about the Public Health Foundation of India see http://www.phfi.org/ For more about BRAC University’s School of Public Health see http://www. bracuniversity.net/I&S/sph/