Independence Mechanisms in Health Education/Promotion and Public Health Departments: A Narrative Review

A Synthesis of Global Evidence on Philosophical, Professional, and Competency-Based Justifications for Structural Separation

Abstract

As administrators try to restructure in the name of efficiency, the organizational structure of public-health schools is increasingly challenged. A recurrent question is whether Public Health (PH) and Health Education and Health Promotion (HEandHP) should remain distinct academic disciplines or be merged or absorbed into more public health fields. Drawing on philosophical foundations, professional associations, competence frameworks, staff requirements and documented organizational results, this narrative review summarizes the global evidence for (a) the independence of HE and PH as separate units, (b) the independence of PH as a separate unit and (c) the structural separation of the two units.  The five areas in which we have reviewed the evidence are the WHO Essential Public Health Functions (EPHF), professional associations and certification, competence frameworks, philosophical bases and documented risks of departmental mergers. Peer reviewed publications from 2010 to 2026 as well as official reports from the WHO, CEPH, ASPHER, SOPHE, IUHP and NCHEC were also sources of information. The organizational structure of the Iranian schools of public health is discussed qualitatively as an illustrative national context. Instead of relying on a specific, independently verified institutional data set, this debate is based on the general prevalence of classic departments reported in the Iranian literature on higher education in the field of medicine. There were five converging findings. First, HE, HV, and PH are based on different philosophical traditions. Secondly, the various branches maintain separate professional associations and certificates. Thirdly, each is based on a different competence framework (the 22 CEPOL core competences versus the eight NCHEC core competences). Fourth, the WHO's 12 European PHD Units need a diverse and specialized staff, which is best trained in the different departments. Fifth, there are significant risks associated with documented departmental mergers and proposals for restructuring. These risks include loss of professional identity, weakened specialized competencies and resistance from stakeholders, which sometimes delayed or partly modified proposed mergers, but did not always reverse them. The five traditional departments, including HE and HE, remain the dominant organizational model in the Iranian medical science university system, while new areas (e.g. G. Health policy and health information technology are still relatively under-represented in the official department structures. The evidence is in favour of keeping the PH and HE&HP separate. The merging of these departments could compromise the capacity of the workforce, professional identity and the development of specialized skills. Instead of structural mergers, cross-disciplinary cooperation should be pursued through research centres, joint programmers and networks of expertise.