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Graduate programs in public health
Editorials and Commentary
Graduate Programs in Public Health Major Contributions Today; Tomorrow We’ve Got To Get Organized Daniel S. Blumenthal, MD, MPH, Patricia Rodney, PhD, MPH
P
ublic health as a profession is less than a century old; the Johns Hopkins University School of Public Health and Hygiene, the first school of public health, was established in 1918. The first “programs” in public health— degree-granting courses of study located outside of schools of public health—were established in the 1930s. By 1936, however, only 10 schools or programs in public health existed.1 Today, however, a prospective graduate student in public health can apply to his or her choice of 36 schools of public health, 48 accredited public health programs, or an unknown number of non-accredited public health programs. Some of the programs are housed in medical schools and some in various other academic units of universities or even in a health department. The ability to pursue a graduate degree in public health in such a variety of academic settings is one of the things that makes public health a unique profession. This diversity of settings for the pursuit of a graduate degree has many benefits. What do the programs that are not located in schools of public health offer that make them valuable? In this issue of the Americn Journal of Preventive Medicine, Davis and her colleagues from the Association of Teachers of Preventive Medicine (ATPM) present the results of a survey that help answer that question.2 One benefit is the expanded opportunity to study for a graduate degree that is represented by programs in public health. Davis et al.2 noted that 14 programs are located in states without a school of public health. However, even within states that do have a school, programs provide important additional geographic access. For instance, Florida’s school of public health, at the University of South Florida in Tampa, is some distance from population centers in north Florida and the Miami area. However, students in north Florida are served by Masters of Public Health (MPH) programs at the University of Florida in Gainesville and Florida A&M University in Tallahassee; those in the southeastFrom the Department of Community Health and Preventive Medicine (Blumenthal), and MPH Program (Rodney), Morehouse School of Medicine, Atlanta, Georgia Address correspondence to: Daniel S. Blumenthal, MD, MPH, Professor and Chair, Department of Community Health and Preventive Medicine, Associate Dean for Community Programs, Morehouse School of Medicine, 720 Westview Drive SW, Atlanta GA 30310. E-mail: [email protected].
Am J Prev Med 2003;24(4) Published by Elsevier Inc.
ern part of the state, by programs at the University of Miami and Nova Southeastern University. The ability to attend a program near home is particularly important to working students; the ATPM survey reported that nearly half of students in MPH programs were employed in full-time jobs while attending school and another 17% were working part-time. Another important characteristic of graduate public health programs is their potential to reduce the medicine–public health divide. Numerous authors have recently noted that the public is not being served well by the growing distance between the disciplines of public health and medicine.3– 6 This distance will not be diminished if the leadership at medical schools does not expose medical students to public health issues either in the medical curriculum or otherwise. The opportunity for dual MD (Doctor of Medicine)/MPH or DO (Doctor of Osteopathy)/MPH degrees exists for students at the 35 medical schools whose university includes a school of public health (although the relationship between the two schools is often more remote than one might desire). Students at another 19 medical and osteopathic schools have the opportunity to pursue a joint MD/MPH degree because of the presence of an MPH program at their school. For those who opt not to pursue the second degree, at least the opportunity exists to interact with public health students and faculty, and perhaps to take public health courses; this opportunity may be enhanced because of the co-location of both the MD and MPH programs in the same school. Of special importance is the role of graduate public health programs in increasing the number of minorities in the workforce. The problems addressed by public health agencies— health status disparities, the health problems of the poor and underserved—are overwhelmingly problems that affect minority populations. A well-trained minority public health workforce is needed to find solutions to these problems at the community level. There are a limited number of trained minority public health professionals in the workforce, but the public health programs are important contributors to enlarging this number. At the time of the ATPM survey (1998 –1999), 894 minority students were enrolled in graduate public health programs (276 Asians, 157 Hispanics, 16 Native Americans,
0749-3797/03/$–see front matter doi:10.1016/S0749-3797(03)00014-X
371
and 445 African Americans), not including the 400 students on whom racial/ethnic data were unavailable. Of special importance in this regard are the six graduate public health programs located in historically black colleges and universities (HBCUs): Morehouse School of Medicine, Florida A&M University, Meharry Medical College, Morgan State (Maryland) University, Jackson State (Mississippi) University, and Fort Valley State (Georgia) University. These programs are either accredited or in the accreditation process, and are needed to help address the health disparities and inequities that plague African-American communities and other communities of color. Without these programs, many minority students would not pursue graduate degrees in public health because, for many African-American young people, a predominantly black school offers a better learning environment in which to pursue their education. Graduate public health programs have the advantages of small class sizes, mentoring programs, flexible formats, and accommodation of mature, employed students. However, in many ways, they are among public health’s best-kept secrets. Their diversity and independence may make them difficult to locate for potential students searching for a suitable course of study, or for public health professionals attempting to survey the field. No database offers a complete accounting of all the U.S. programs. Over 55 programs are members of ATPM’s Council of Graduate Programs, but some are not. MPH Programs in Community Health Education are represented by a separate organization, the Council of Accredited MPH Programs, which has 13 members. Many programs are accredited or in applicant or pre-accreditation status with the Council on Education for Public Health (CEPH), but others are not. Using a variety of sources, Davis et al.2 constructed an initial sample frame of 112 programs at 96 institutions, but eventually narrowed this to a sample of 48 potential respondents, of which 45 had some status with CEPH. This sort of search-and-eliminate process would not have been necessary had the authors been surveying schools of public health or medicine or graduate programs in, say, nursing or social work.
372
Moreover, the study findings may not be representative of a number of programs that were not included in the ATPM sample. At least 70 institutions are on CEPH’s “early warning” list—programs that are “under development, in early operational stages, and considering accreditation.”7 Unfortunately, the disorganization in the “community” of public health graduate programs weakens its collective power to negotiate access to policymakers and, thus, to influence policy that affects public health education. The disorganization also diminishes our knowledge of the growing public health workforce and makes it difficult for employers to evaluate the quality of education and skill levels of their applicants. What is needed is both a representative organization to which all of the programs will belong and incentives (as exist in the case of other professional graduate-degree programs) that will move all programs to seek accreditation. The proliferation of graduate public health programs at a variety of institutions of higher education represents a strength, because it significantly increases the number of young (and older) people who are able to obtain a public health graduate education. The lack of organization among these programs is a weakness— one that needs to be urgently corrected.
References 1. Gebbie K, Rosenstock L, Hernandez LM, eds. Who will keep the public healthy? Educating public health professionals for the 21stCentury. Washington DC: National Academies Press, 2002, 40:194 1. 2. Davis MV, Dandoy S, Greaves WW. Graduate programs: What is their contribution to the training of the public health workforce? Am J Prev Med 2003;24:361– 6. 3. Lasker R, Committee on Medicine and Public Health. Medicine and public health: the power of collaboration. New York: New York Academy of Medicine, 1997. 4. Reiser SJ. Topics for our times: The Medicine/Public Health Initiative. Am J Pub Health 1997;87:1098 –9. 5. Brandt AM, Gardner M. Antagonism and accommodation: interpreting the relationship between public health and medicine in the United States during the 20th century. Am J Pub Health 2000;90:707–15. 6. Haber M, ed. Education for more synergistic practice of medicine and public health. New York: The Josiah Macy Foundation, 1999. 7. Evans PP. An Accreditation Perspective on the Future of Professional Public Health Preparation. Presentation to the Institute of Medicine Committee on Educating Public Health Professionals for the 21st Century, Irvine CA, March 13, 2002.
American Journal of Preventive Medicine, Volume 24, Number 4
Graduate Programs in Public Health Major Contributions Today; Tomorrow We’ve Got To Get Organized Daniel S. Blumenthal, MD, MPH, Patricia Rodney, PhD, MPH
P
ublic health as a profession is less than a century old; the Johns Hopkins University School of Public Health and Hygiene, the first school of public health, was established in 1918. The first “programs” in public health— degree-granting courses of study located outside of schools of public health—were established in the 1930s. By 1936, however, only 10 schools or programs in public health existed.1 Today, however, a prospective graduate student in public health can apply to his or her choice of 36 schools of public health, 48 accredited public health programs, or an unknown number of non-accredited public health programs. Some of the programs are housed in medical schools and some in various other academic units of universities or even in a health department. The ability to pursue a graduate degree in public health in such a variety of academic settings is one of the things that makes public health a unique profession. This diversity of settings for the pursuit of a graduate degree has many benefits. What do the programs that are not located in schools of public health offer that make them valuable? In this issue of the Americn Journal of Preventive Medicine, Davis and her colleagues from the Association of Teachers of Preventive Medicine (ATPM) present the results of a survey that help answer that question.2 One benefit is the expanded opportunity to study for a graduate degree that is represented by programs in public health. Davis et al.2 noted that 14 programs are located in states without a school of public health. However, even within states that do have a school, programs provide important additional geographic access. For instance, Florida’s school of public health, at the University of South Florida in Tampa, is some distance from population centers in north Florida and the Miami area. However, students in north Florida are served by Masters of Public Health (MPH) programs at the University of Florida in Gainesville and Florida A&M University in Tallahassee; those in the southeastFrom the Department of Community Health and Preventive Medicine (Blumenthal), and MPH Program (Rodney), Morehouse School of Medicine, Atlanta, Georgia Address correspondence to: Daniel S. Blumenthal, MD, MPH, Professor and Chair, Department of Community Health and Preventive Medicine, Associate Dean for Community Programs, Morehouse School of Medicine, 720 Westview Drive SW, Atlanta GA 30310. E-mail: [email protected].
Am J Prev Med 2003;24(4) Published by Elsevier Inc.
ern part of the state, by programs at the University of Miami and Nova Southeastern University. The ability to attend a program near home is particularly important to working students; the ATPM survey reported that nearly half of students in MPH programs were employed in full-time jobs while attending school and another 17% were working part-time. Another important characteristic of graduate public health programs is their potential to reduce the medicine–public health divide. Numerous authors have recently noted that the public is not being served well by the growing distance between the disciplines of public health and medicine.3– 6 This distance will not be diminished if the leadership at medical schools does not expose medical students to public health issues either in the medical curriculum or otherwise. The opportunity for dual MD (Doctor of Medicine)/MPH or DO (Doctor of Osteopathy)/MPH degrees exists for students at the 35 medical schools whose university includes a school of public health (although the relationship between the two schools is often more remote than one might desire). Students at another 19 medical and osteopathic schools have the opportunity to pursue a joint MD/MPH degree because of the presence of an MPH program at their school. For those who opt not to pursue the second degree, at least the opportunity exists to interact with public health students and faculty, and perhaps to take public health courses; this opportunity may be enhanced because of the co-location of both the MD and MPH programs in the same school. Of special importance is the role of graduate public health programs in increasing the number of minorities in the workforce. The problems addressed by public health agencies— health status disparities, the health problems of the poor and underserved—are overwhelmingly problems that affect minority populations. A well-trained minority public health workforce is needed to find solutions to these problems at the community level. There are a limited number of trained minority public health professionals in the workforce, but the public health programs are important contributors to enlarging this number. At the time of the ATPM survey (1998 –1999), 894 minority students were enrolled in graduate public health programs (276 Asians, 157 Hispanics, 16 Native Americans,
0749-3797/03/$–see front matter doi:10.1016/S0749-3797(03)00014-X
371
and 445 African Americans), not including the 400 students on whom racial/ethnic data were unavailable. Of special importance in this regard are the six graduate public health programs located in historically black colleges and universities (HBCUs): Morehouse School of Medicine, Florida A&M University, Meharry Medical College, Morgan State (Maryland) University, Jackson State (Mississippi) University, and Fort Valley State (Georgia) University. These programs are either accredited or in the accreditation process, and are needed to help address the health disparities and inequities that plague African-American communities and other communities of color. Without these programs, many minority students would not pursue graduate degrees in public health because, for many African-American young people, a predominantly black school offers a better learning environment in which to pursue their education. Graduate public health programs have the advantages of small class sizes, mentoring programs, flexible formats, and accommodation of mature, employed students. However, in many ways, they are among public health’s best-kept secrets. Their diversity and independence may make them difficult to locate for potential students searching for a suitable course of study, or for public health professionals attempting to survey the field. No database offers a complete accounting of all the U.S. programs. Over 55 programs are members of ATPM’s Council of Graduate Programs, but some are not. MPH Programs in Community Health Education are represented by a separate organization, the Council of Accredited MPH Programs, which has 13 members. Many programs are accredited or in applicant or pre-accreditation status with the Council on Education for Public Health (CEPH), but others are not. Using a variety of sources, Davis et al.2 constructed an initial sample frame of 112 programs at 96 institutions, but eventually narrowed this to a sample of 48 potential respondents, of which 45 had some status with CEPH. This sort of search-and-eliminate process would not have been necessary had the authors been surveying schools of public health or medicine or graduate programs in, say, nursing or social work.
372
Moreover, the study findings may not be representative of a number of programs that were not included in the ATPM sample. At least 70 institutions are on CEPH’s “early warning” list—programs that are “under development, in early operational stages, and considering accreditation.”7 Unfortunately, the disorganization in the “community” of public health graduate programs weakens its collective power to negotiate access to policymakers and, thus, to influence policy that affects public health education. The disorganization also diminishes our knowledge of the growing public health workforce and makes it difficult for employers to evaluate the quality of education and skill levels of their applicants. What is needed is both a representative organization to which all of the programs will belong and incentives (as exist in the case of other professional graduate-degree programs) that will move all programs to seek accreditation. The proliferation of graduate public health programs at a variety of institutions of higher education represents a strength, because it significantly increases the number of young (and older) people who are able to obtain a public health graduate education. The lack of organization among these programs is a weakness— one that needs to be urgently corrected.
References 1. Gebbie K, Rosenstock L, Hernandez LM, eds. Who will keep the public healthy? Educating public health professionals for the 21stCentury. Washington DC: National Academies Press, 2002, 40:194 1. 2. Davis MV, Dandoy S, Greaves WW. Graduate programs: What is their contribution to the training of the public health workforce? Am J Prev Med 2003;24:361– 6. 3. Lasker R, Committee on Medicine and Public Health. Medicine and public health: the power of collaboration. New York: New York Academy of Medicine, 1997. 4. Reiser SJ. Topics for our times: The Medicine/Public Health Initiative. Am J Pub Health 1997;87:1098 –9. 5. Brandt AM, Gardner M. Antagonism and accommodation: interpreting the relationship between public health and medicine in the United States during the 20th century. Am J Pub Health 2000;90:707–15. 6. Haber M, ed. Education for more synergistic practice of medicine and public health. New York: The Josiah Macy Foundation, 1999. 7. Evans PP. An Accreditation Perspective on the Future of Professional Public Health Preparation. Presentation to the Institute of Medicine Committee on Educating Public Health Professionals for the 21st Century, Irvine CA, March 13, 2002.
American Journal of Preventive Medicine, Volume 24, Number 4