Appendix C
Organizational Input



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Who Will Keep the Public Healthy?: Educating Public Health Professionals for the 21st Century Appendix C Organizational Input

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Who Will Keep the Public Healthy?: Educating Public Health Professionals for the 21st Century ASPH Answers for the IOM Study on Educating Public Health Professionals for the 21st Century 1. Why would your organization or the members of your organization consider hiring someone with a public health education? (a) The Association of Schools of Public Health (ASPH) has a mission to: strengthen, coordinate, and promote the education, research, and service activities of the 31 accredited schools of public health. In 2000, the then 28 member schools launched almost 6,000 masters and doctoral graduates into the workforce. Current association policy calls for graduates from an ASPH member school to fill key staff management positions. This policy ensures that the ASPH staff leadership are familiar with schools of public health and are well-versed in the core areas of public health; and, (b) Graduate schools of public health are exceptionally interdisciplinary institutions that hire and promote faculty and staff who represent fields ranging from anthropology to zoology. Core doctoral training in public health, however, is required for most faculty positions. Individuals who have been academically prepared in other fields, nonetheless, often have a masters-level degree in public health. 2. What is the minimum knowledge you or your organization’s members expect from someone with a public health education? ASPH and its members consider the master of public health (M.P.H.) degree the basic professional public health degree. The M.P.H. is the most commonly awarded degree at schools of public health (accounting for 63 percent of degrees awarded in 1999–2000). Other masters-level degrees that are conferred in schools of public health (e.g., M.S., M.H.A./M.H.S.A., and M.S.P.H.) are valued as comparable professional degrees to the M.P.H. While graduates of schools of public health practice in every imaginable industry and setting in a field that becomes increasingly more complex and inter- and multi-disciplinary every year, there remain five core areas of knowledge that schools of public health must make available to masters and doctoral students: biostatistics, epidemiology, environmental health sciences, health services administration, and social and behavioral sciences. Individual schools may make other coursework mandatory, at their discretion. For example, the Biological Basis for Public

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Who Will Keep the Public Healthy?: Educating Public Health Professionals for the 21st Century Health, Community Health Sciences, and Health Law are three required courses at different ASPH member schools. More and more, schools of public health are tailoring flexible programs to assure that curricula continually evolve to meet new and emerging needs in research and practice. For example, residential and distance learning opportunities are commonly found at both degree and non-degree levels, including: management science, leadership for community health improvement, and emergency preparedness. 3. What do you or your organization’s members view as the most important areas for education for public health professionals? The challenge for schools of public health (SPH) is that our graduates are employed in an increasingly broad variety of settings and venues. There is no longer such a thing as a “classic” student in an SPH, as in years past when the average student was a clinician in professional practice who sought an M.P.H. in order to work in a health department or similar setting. We know that very few students today go to work in state and local health agencies and, in the absence of accurate data that would track where our graduates go to work, SPH need to train emerging health professionals to practice in every imaginable worksite. Moreover, the standard academic research focus, once the sole clear-cut purpose of SPH located in research universities, while still the bedrock of academic public health, is making room for investigative approaches that incorporate perspectives from other disciplines and pedagogies, as well as from communities themselves. Over the last two and a half years, the ASPH Education Committee has been discussing and refining a draft conceptual framework of the key perspectives, skills, and settings in which M.P.H. students should become competent upon graduation from an ASPH member school. The original framework that is currently under discussion, while not discarding the five core knowledge areas mentioned above, presents a crosscutting schema for graduate public health education. This process is still underway and is anticipated to result in a consensus around the core areas of competence during the spring of 2002. 4. What do you or your organization’s members see as the strengths and challenges facing public health education today? The ASPH Strategic Planning Committee recently identified the key strategic considerations that define the current external and internal environments for the association. This process produced a list of organizational strengths and weaknesses and a list of environmental opportunities

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Who Will Keep the Public Healthy?: Educating Public Health Professionals for the 21st Century and threats as they relate to ASPH. Excerpted below are the points relative to graduate public health education: Strengths There is a large pool of talented faculty at schools of public health who can lead the education of emerging public health professionals as well as the training of public health practitioners Federal agencies have recognized schools of public health as educational institutions that provide valuable research and teaching M.P.H. is a shared, well-recognized “product” The 31 schools of public health represent a vast resource for public health education, representing an array of institutions with a diverse portfolio of degrees and activities The trend towards competency-based education and performance standards Changes in the healthcare industry, such as the trend towards managed care and the increasing focus on population health Weaknesses Cost of graduate public health education, plus low starting remuneration for many fields Tensions exist between academic and practice activities Signature doctoral degree (Dr.P.H.) has low status and no clear definition Environmental opportunities Increased prominence of public health following the World Trade Center disaster and the use of anthrax as a bioterrorist weapon Recognition of the need to support public health infrastructure Growing government and foundation support for health-related research Federal commitment to reducing health disparities Increasing public emphasis on disease prevention and health promotion Application of public health methods to key issues in medical care Development of coalitions to advocate for major increases in funding Training and credentialing of the public health workforce Application of new technologies, including the World Wide Web, which has broadened access to graduate public health education and increased research possibilities

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Who Will Keep the Public Healthy?: Educating Public Health Professionals for the 21st Century Potential for new partnership with medical and other schools Expanding job market for SPH graduates Globalization Marketing potential of accreditation Response to growth of the aging population Environmental threats Weak public understanding of, and support for, “public health” No respect for value of academic public health Lack of faculty diversity, which may hinder the recruitment and retention of underrepresented minority faculty and students Adverse government policies and funding priorities Reductions in federal funding for public health education and practice The difficulty in staying current with the increasingly rapid pace of change 5. What, in your opinion, are changes that might occur in the next 10 years that will call for new skills/knowledge to be added to public health professional training? As far as graduate public health education is concerned, a number of changes are influencing the way that the 31 accredited schools of public health educate graduates: (a) Diversity of Practice Setting Each year brings new opportunities for public health practice and concomitant new titles and scopes of work for graduates of schools of public health. The diversity of duties for which public health professionals have primary or partial responsibility has yet to be accurately enumerated. As SPH gain more understanding of where our graduates practice, analyze job trajectories, and consider implications for graduate public health education as well as needs for lifelong learning, we will continue to refine the way we prepare students for successful practice in the “real world.” (b) Demographic Changes in Student Bodies The classic student in a school of public health used to be a white, clinically trained doctor or nurse who pursued a M.P.H. in order to practice at the level of a health department or other similar setting. Students of public health today are increasingly younger, with less work experience,

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Who Will Keep the Public Healthy?: Educating Public Health Professionals for the 21st Century and more varied in the academic disciplines and the perspectives they bring to the profession. Students who seek current training in public health are also more diverse regarding ethnicity, race, age, and culture. While men used to outnumber women in SPH, today women represent over two-thirds of matriculates. Many students seek a part-time or other flexible educational experience. The challenge in this area results from maintaining a balance in trying to attract students into SPHs who have some prior public health experience while succeeding in tapping into the talents of younger, inexperienced students and shaping them into effective public health professionals. (c) More Interdisciplinary and Interpersonal Context for Public Health Work Public health professionals joining the work force today interact even more closely than those in years past with health sciences professionals and others whose primary goals may seem distal to public health. Colleagues in fields as varied as the transportation or building industries, or the prison or welfare systems, increasingly focus on (or can be encouraged to consider) the health and safety of their constituencies and the general public. Professionals in these fields may be experiencing changes in their areas of work as rapid and pervasive as in the core public health areas. Honing interpersonal skills and employing team approaches to decision making and problem solving have taken on a whole new meaning for public health professionals. Public health professionals must now also work in partnership with communities of all types (including mobilizing the “communities” of business, government, science, media, etc.) as well as serve communities that experience the greatest burden of disease. They must focus their efforts on community-wide results, and do so without constituencies of grateful individual patients to laud and support their work. They must account for the powerful influence within communities of cultural and normative values. Further, public health practice has expanded to include virtually every sector of society, from agriculture to zoology, and it pervades people’s lives in ways that few individuals thoroughly appreciate. Public health work is ubiquitous, and one may encounter large numbers of professionals with graduate public health training in community-based organizations, not-for-profit agencies, business, the insurance industry, foundations, high-tech operations, and every imaginable venue for providing conventional and alternative prevention services. In response to this reality, applied learning opportunities, such as internships, fellowships, and interdisciplinary team projects, have become more available in schools of public health.

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Who Will Keep the Public Healthy?: Educating Public Health Professionals for the 21st Century (d) Changing Fundamentals of Practice The concepts, principles, and methods underlying the work of public health have evolved dramatically in recent decades, and this rapid development shows no sign of stopping. Interest in the social and behavioral sciences and epidemiology, in particular, is expanding as a result of research advances and improvements in methodologies, including the genomic, molecular, and biological sciences. This acceleration in basic scientific discoveries also speeds up the need for their continuous translation through public health disciplines into safe, practical, accessible benefits for all. The legal, ethical, and social issues attending new findings are profound. Deciding how to harness new knowledge in ways that protect, preserve, and promote what is strong and productive in social, cultural, and moral terms requires full public participation and discourse. Ensuring community involvement in decision-making—the hallmark of the public health process—is becoming an even more important, sensitive, and complex endeavor. Cultural competency has been identified as a critical skill for all public health practitioners, particularly as the United States evolves towards a more diverse society. The worldwide impact of new communication technologies and computer-based tools transforming information exchange in all its aspects brings great promise for improving the health of the public. With these technologies, however, has come the limitless potential for disseminating misinformation and an unfortunate capacity to extol the popular rather than the accurate, especially as it relates to heath. Attending the exponential growth in the availability of information is the need for people to sort it out, to be more analytical in their use of it, and apply it more effectively in problem solving. Using information that is related to clinical treatment and prevention services is especially challenging given system-wide change. The communication revolution and recent advances in science have been accompanied by new ways of financing, organizing, and delivering health services at a pitch not realized since the advent of Medicare and Medicaid. Public health professionals in administration and financing also need to play key roles in informing policy that ensures coverage and access for all. (e) The Evolution to Competency-Based Education The proliferation of competency statements, the existing variation in core requirements across the schools, and, most especially, the changes occurring in the field have prompted the deans of the 31 accredited graduate schools of public health, as mentioned before, to revisit the issue of master’s level public health competence. A current aim of the ongoing ASPH competency development project is to ensure that

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Who Will Keep the Public Healthy?: Educating Public Health Professionals for the 21st Century M.P.H. graduates are prepared to meet the challenges of practice in the new century. The ASPH Education Committee, as charged by the deans and supported by the membership, is attempting first to recognize the significant changes in the composition and expectations of our students, the demands of employers for more well-rounded students, the scrutiny of the public regarding the benefits of higher education, the challenges that science provokes, and the needs of communities to be served, and, in light of that recognition, to recommend areas of core competence that should be achieved by the M.P.H. curriculum. The need to effectively measure academic public health performance is exigent and a long-standing vacuum in whole-person, population based funding in research that prevents disease and disability has distressed the health of academia. Performance measurement systems, which measure public health practice as defined by the Essential Public Health Services, aim to provide information to advocate for public health at state and local levels, shape policy decisions, and target resources to ultimately improve the health of the public. Performance measures represent one movement that resounds in many schools of public health that will lead to improvements in training, curricula, and research; enhance accountability and highlight best practices; as well as increase the science base for practice-based research, teaching, and service in SPHs. (f) Credentialing the Public Health Workforce As weaknesses in the public health infrastructure have become more obvious, the need to certify and credential the public workforce has grown. The American Public Health Association (APHA) and ASPH have been exploring options for credentialing the workforce with the practice community and plan to collaborate with key practice organizations in developing a system for credentialing public health workers. It is expected that the emerging credential for public health will contribute towards professionalization of the workforce, increase the visibility of public health practice, and assisting in assuring that public health meets the needs of the nation. 02/28/02

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Who Will Keep the Public Healthy?: Educating Public Health Professionals for the 21st Century Association of State and Territorial Health Officials Answers for the IOM Study on Educating Public Health Professionals for the 21st Century 1. Why would your organization or the members of your organization consider hiring someone with a public health education? The Association of State and Territorial Health Officials (ASTHO) is the national non-profit organization representing the state and territorial public health agencies of the United States, the U.S. Territories, and the District of Columbia. ASTHO’s members, the chief health officials of these jurisdictions, are dedicated to formulating and influencing sound public health policy, and to assuring excellence in state-based public health practice. A stable and effective public health infrastructure, including sufficient numbers of appropriately trained health professionals distributed to provide appropriate public health services to all populations, is essential to ensure development of sound public health policy and excellence in public health practice. A public health education experience can provide persons who propose to engage in the practice of public health with valuable skills and perspectives critical to a full appreciation of their discipline. Individuals with these critical skills and perspectives are sought because they are likely to be successful in advancing the mission and goals of a public health agency. 2. What is the minimum knowledge you or your organization’s members expect from someone with a public health education? ASTHO supports the use of the three core functions—assessment, assurance, and policy development—as previously described by the Institute of Medicine, and the 10 essential services to improve the practice of public health. ASTHO and its members also acknowledge that it is unlikely that all of our nation’s state and local health departments will be fully staffed by persons with a master’s degree in public health. With the richness of the various disciplines that comprise the public health workforce, it is important to consider the concept of a public health education in its broadest construct and not limited to graduate

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Who Will Keep the Public Healthy?: Educating Public Health Professionals for the 21st Century academic programs. It is more productive at this time to consider the concept of levels or stages of minimum knowledge in public health, linked to progressively broader and more complex competencies. If considered in this manner, the core competencies for public health professionals published by The Council on Linkages Between Academia and Public Health Practice are one example of how the minimum knowledge base can be described. For example, to improve the overall practice of public health ASTHO supports the use of assessment, planning and evaluation; information for health status monitoring and improvement; Healthy People 2010 objectives with their leading health indicators and community health status profiles; bioterrorism and emergency preparedness; health data, health data systems; and the capacity of the state and local public health information infrastructure to appropriately measure population health status. Individual members of the public health workforce should be well trained in the specific skills of their discipline; they should have opportunities for ongoing learning; and they should have the skills required to be effective team members in our evolving health care system. 3. What do you or your organization’s members view as the most important areas for educating public health professionals? Within the construct of levels or stages of public health knowledge and competencies, there is a need to establish realistic competency expectations for each level/stage of “public health education.” Such a model encompasses the skills, knowledge, and attitudes necessary for health professionals without a formal public health degree working in a public health practice setting at one end of the continuum (i.e., professional education in a related field such as medicine, nursing, or social work) to those with advanced degrees in public health working in either practice or academic settings (i.e., doctoral education in public health) at the other end of the continuum. The levels or stages of public health education also must consider the competencies that need to be transmitted via continuing education methods for the current public health workforce (both with and without advanced degrees in public health) as well as the competencies of newly prepared public health practitioners graduating from public health graduate programs. While discipline specific competencies remain necessary for specialized roles within public health, promoting the use of the three core functions and the 10 essential services to improve the practice of public health is the keystone upon which all educational plans must be built. Academic public health programs must focus their attention on preparing their graduates for employment in public health practice settings. This has to involve on-going collaboration with the practice community as curricula are developed.

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Who Will Keep the Public Healthy?: Educating Public Health Professionals for the 21st Century It is critically important that ways be found to build upon the existing public health infrastructure by measuring and continuously improving capacity, resources, skills, partnerships, and activities promoting a national public health performance standards program. This necessitates the availability of a network of appropriate training programs for the continuing education of the existing public health workforce as well as the availability of appropriate educational programs for the preparation of those newly entering the field of public health. Coordination and collaboration with the HRSA Public Health Training Centers and the CDC Centers for Public Health Preparedness is essential. The current geographic disparities in educational opportunities must be addressed in the process and ways to promote the equitable distribution of professionals prepared to practice in public health setting must be found. 4. What do you or your organization’s members see as the strengths and challenges facing public health education today? Compared to earlier eras, public health education today has been strengthened by the development of greater rigor in the underlying academic disciplines, accompanied by considerable expansion of the research (theory) basis of public health practice. Federal agencies such as HRSA, CDC, and NIH have provided important support for this development. In addition, important recent efforts such as the Public Health Workforce Development Collaborative and the Council on Linkages Between Academia and Public Health Practice have improved the coordination between most of the critical entities involved in public health workforce development. The key challenge facing public health education today is reconciliation of the academic environment in which most public health education takes place with the practice environment for which students are destined. Academic public health institutions and their faculty have a strong and entirely appropriate interest in research; the financial environment of American academic institutions reinforces that focus. All too often, the result of this focus is delivery of public health education that better addresses academic and research issues than the realities of public health practice. Public health education is challenged, as a number of health professions are challenged, to deliver an educational program that is simultaneously academically rigorous and practice oriented. Further, there remains a need to maximize investments in public health workforce training resources and endeavors and to ensure that those in need of training have access to appropriate and high quality offerings. Again, the workforce development efforts in the states as well as the HRSA and CDC Centers and the state/regional/national leadership institutes must be part of the public health training system. The distribution of well-trained and

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Who Will Keep the Public Healthy?: Educating Public Health Professionals for the 21st Century Centers for Disease Control Answers for the IOM Study on Educating Public Health Professionals for the 21st Century INTRODUCTION The Centers for Disease Control and Prevention has a 50-year tradition of providing and supporting education and training for public health professionals. We applaud the work of the Institute of Medicine Committee on Educating Public Health Professionals for the 21st century and appreciate the opportunity to comment on the questions you posed for consideration. QUESTIONS: 1. Why would your organization or the members of your organization consider hiring someone with a public health education? Public health education (IOM) context: “We’re trying to be fairly inclusive when talking about public health education but we will be focusing on CEPH accredited schools of public health and accredited M.P.H. programs.” L. Hernandez (IOM) CDC Response: The mission of the CDC is to promote health and quality of life by preventing and controlling disease, injury, and disability. The accomplishment of the mission is predicated on the following agency strengths: prevention strategies based on sound scientific knowledge, leadership and technologic capabilities of state and local health organizations and integration of those capabilities with private health organizations, trained public health workers and leaders, ability to serve a diverse population with a diverse workforce. Trained public health workers are a fundamental capacity for our organization. As an employer, CDC seeks ways to enhance the skills of its employees through its Corporate University and other opportunities for advance studies in public health. For additional information about the Cor-

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Who Will Keep the Public Healthy?: Educating Public Health Professionals for the 21st Century porate University, contact Sylvia Bell or Carol Higbee, Human Resources Management Office at 770-488-1856. Dale Indergaard at 770-488-1756 can provide specific statistics on fellowships, internships, and job descriptions. 2. What is the minimum knowledge you or your organization’s members expect from someone with a public health education? For individual with M.P.H. or equivalent from a CEPH accredited program, the agency would anticipate minimum knowledge in:* Biostatistics — collection, storage, retrieval, analysis and interpretation of health data; design and analysis of health-related surveys and experiments; and concepts and practice of statistical data analysis. Epidemiology — distributions and determinants of disease, disabilities and death in human populations; the characteristics and dynamics of human populations; and the natural history of disease and the biologic basis of health. Environmental health sciences — environmental factors including biological, physical, and chemical factors that affect the health of a community. Health services administration — planning, organization, administration, management, evaluation, and policy analysis of health programs. Social and behavioral sciences — concepts and methods of social and behavioral sciences relevant to the identification and the solution of public health problems. 3. What do you or your organization’s members see as the most important areas for educating public health professionals? In the CDC/ATSDR Strategic Plan for Public Health Workforce Development (1999), developed in collaboration with a broad range of academic and practice community partners, task force members articulated three curriculum levels required for the public health workforce: basic, cross-cutting, and discipline-specific (technical/categorical). Basic or “Public Health 101” —provides an overview of public health, history, core values, functions, essential services, and other content as required by local area need, organizational focus, and individual role/responsibility. Cross-cutting—designed to develop core competency skills from basic through intermediate and advanced as required by role/responsibility and career path; The recently published Council on Linkages document “Core Competencies for Public Health Professionals” (April 2001) provides detailed *   From CEPH program accreditation standards.

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Who Will Keep the Public Healthy?: Educating Public Health Professionals for the 21st Century descriptions of cross-cutting competencies needed to assure that public health agencies have a workforce prepared to deliver essential public health services. The eight domains listed include: analytic assessment skills, basic public health sciences, cultural competency, communication skills, community dimensions of practice, financial planning and management skills, leadership and systems thinking, and policy/program planning. (Additional information is available at http://www.TrainingFinder.org/competencies.) Specific emerging needs include: informatics, genomics, public health systems, behavioral/social sciences, health/risk communications, bioterrorism/emergency/disaster preparedness, injury prevention and control, environmental health, evaluation, and ethics. Experience in state or local public health provides a context for policy and practice and is an important component of public health education. 4. What do you or your organization’s members see as the strengths and challenges facing public health education today? Strengths Increase in CEPH accredited schools of public health, graduate programs in community health, and graduate programs in community health/preventive medicine; Increased access to learning through distance education and certificate programs (meeting needs of adult learners); Increased recognition of the importance of public health by general public and political leaders. Challenges Accredited programs are not always accessible; Expanding the pipeline into public health, enhancing learning opportunities and workforce diversity; Lack of partnership with the practice community in training/education development, implementation and evaluation; Growth of non-CEPH accredited programs; graduates enter workforce with various levels of preparation in basic public health science; Balancing research and education and service mission (rewarding faculty for practice-focused activities); No consistent approach to enumeration of the public health workforce; forecasting personnel needs or related training requirements is limited;

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Who Will Keep the Public Healthy?: Educating Public Health Professionals for the 21st Century National consensus on basic and cross-cutting competencies does not yet exist; An integrated delivery system for life-long learning does not exist; Inadequate incentives for participation in training and continuing education; Financing of workforce training and continuing education is hampered by the absence of a coherent policy framework and strategies for funding these activities. Additional Comments The public health workforce is multidisciplinary. Individuals enter the field of practice from a broad range of undergraduate and graduate preparation programs. Entry to practice for specific clinical areas such as medicine, nursing, dentistry, etc., is licensed. There is no systematic approach to assure ongoing competency in public health practice through certification, credentialing, or a systematic approach to life long learning opportunities for front line public health professionals. The CDC/ATSDR Strategic Plan for Public Health Workforce Development and complementary Global and National Implementation Plan for Public Health Workforce Development proposes a flexible three-tiered framework for addressing this complex issue. Expert panel members envisioned a framework with agreement on three levels of certification: basic, discipline-specific and integrator/leader. basic or orientation level would be available for every public health practitioner completing a “core” practice-focused curriculum (awareness level learning experience); discipline-specific certification would result from strengthening public health competencies within existing certification systems (i.e., medical specialty boards; other licensing bodies); integrator/leader level would address the unique competencies required of public health system leaders. Incentives (individual or organizational) should function synergistically within the public health system to enhance capacity to perform essential services and ultimately impact health outcomes. Therefore, the consequences of any incentive system(s) must be carefully considered and strategies developed to reinforce positive effects and ameliorate unintended negative effects. 5. What, in your opinion, are the changes that might occur in the next 10 years that will call for new skills/knowledge to be added to public health professional training?

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Who Will Keep the Public Healthy?: Educating Public Health Professionals for the 21st Century advances in understanding of the human genome may transform medical practice and in turn significantly change public health practice (e.g., treatments for chronic diseases, birth defects, vaccines, environment and health . . .); changing demographics—focus on geriatrics and enriched understanding of cultural dimension of health; global health issues; increased understanding of environmental influences on health; occupational and environmental health; informatics and information technology—adaptation and use of a broad range of technology in public health practice; emerging infections/drug resistance; availability of incentives to pursue life long learning; learning technologies will change the way professional education is obtained (advance distance learning); advances in neuroscience—mental health; health and spirituality—mind/body connection; alternative/complementary medicine; stress and health.

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Who Will Keep the Public Healthy?: Educating Public Health Professionals for the 21st Century National Association of County and City Health Officials Answers for the IOM Study on Educating Public Health Professionals for the 21st Century 1. Why would your organization or the members of your organization consider hiring someone with a public health education? The work of NACCHO is directed at improving and supporting the practice of public health at the local level. A candidate for hiring that brings either local experience or a good grasp of public health as obtained through a course of education/training is fairly well prepared to begin contributing to NACCHO’s work. Without that, we must spend time and effort training new hires. 2. What is the minimum knowledge you or your organization’s members expect from someone with a public health education? We rarely hire someone with a PH education who doesn’t have an M.P.H. We expect someone with an M.P.H. to have a broad grasp of public health principles, history, and understanding of the general programs and methods used in the field, and a good grasp of the terminology. We have hired staff with M.P.A.s, M.B.A.s, Ph.D.s, and other advanced degrees outside public health and have had good luck with most. They do, however, require a little more time up front with orientation and vocabulary building. I also need to add here that someone with an average to very good public health education is NOT fully prepared for practice, and is not fully prepared to work at NACCHO. Nearly all lack exposure to community dynamics and the varying challenges that practitioners experience daily. Experience, even if through on-the-job exposure, is absolutely essential. We try to rotate all of our staff through local health departments for a substantial exposure. 3. What do you or your organization’s members view as the most important areas for educating public health professionals? More and more we are hearing that public health professionals need more training in leadership, management, community organization, communications, and trans-disciplinary orientation (e.g., orientation to city planning, law enforcement, etc.) While a good grounding in the basic public health sciences is important for some staff in a public health organ-

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Who Will Keep the Public Healthy?: Educating Public Health Professionals for the 21st Century ization (e.g., biostat, epidemiology), local health officials indicate that more if not all staff need expertise in the other five areas mentioned. 4. What do you or your organization’s members see as the strengths and challenges facing public health education today? The strengths are that there are alternatives (schools and programs), and that they are fairly widely available. Many offer midcareer courses of study. The challenges seem to be significant and daunting: while some gains have been made, there continues to be a disconnect between public health academia and practice. Most M.P.H. students (estimated at 80 percent by ASPH) do not pursue a career in public health. Most schools and programs appear to have little interest in addressing the training needs of public health practitioners (outside of a course of study leading to a degree). There is little connection between the course of study and practical experience opportunities in most schools, and most schools do NOT utilize the practice expertise of practitioners in shared teaching arrangements. Few academicians venture out into practice to learn from and contribute to practice. Research conducted by schools of public health is seldom practice oriented, and where it is, there is often very poor translation to and connection between practice research findings and practice. 5. What, in your opinion, are changes that might occur in the next 10 years that will call for new skills/knowledge to be added to public health professional training? Infrastructure is being built at the state and local level as an outcome of bioterrorism and resultant funding. The growing staff component of tomorrow’s health departments will require short courses in the public health sciences, as well as training in a variety of areas. As mentioned above, schools of public health have a very poor track record of addressing such needs, and often aren’t even qualified to address practice needs. I believe schools should begin moving capacity to address this building need. Several strategies should be considered, including: including local and state public health practitioners as part of faculty; conducting research regarding where current public health professionals have been trained, where they obtain on-going professional training, where they would like to get training, barriers to training and education, etc.; granting access to libraries and other resources of the schools for public health practitioners in the area;

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Who Will Keep the Public Healthy?: Educating Public Health Professionals for the 21st Century pursuing “practical” research in state and local public health settings; increasing responsibility/focus on continuing education for public health professionals; engaging public health faculty in undergraduate training of professions which work with or are hired by public health agencies, such as nursing, environmental health; developing stronger linkages during training between academic work and field practice.

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Who Will Keep the Public Healthy?: Educating Public Health Professionals for the 21st Century Public Health Foundation Answers for the IOM Study on Educating Public Health Professionals for the 21st Century 1. Why would your organization or the members of your organization consider hiring someone with a public health education? While we do not limit our hiring to individuals with a public health degree, the M.P.H. is very attractive to the Public Health Foundation (PHF). We strongly desire well-rounded individuals with knowledge and skills in the basic sciences of public health and research methods. In addition, we value individuals who have practical experience in public health practice and have developed expertise as effective communicators, conveners, and consensus builders. The ideal for us is an individual educated in public health with practical experience and training received in a public health practice setting. 2. What is the minimum knowledge you or your organization’s members expect from someone with a public health education? Our organization looks for people with knowledge and skills in each of the eight domains of the core competencies for public health professionals (adopted by the Council on Linkages Between Academia and Public Health Practice in April 2001). While we do not expect individuals to have skills for each of the competencies (there are over 60), we do expect individuals to have knowledge and skills in each of the eight competency domains. Unfortunately, our expectations often go unmet. 3. What do you or your organization’s members view as the most important areas for educating public health professionals? Education occurs in many ways and in many settings. For this question, we focus on graduate-level education and continuing education of the current workforce. While graduate-level education typically provides an individual with an excellent understanding of the theories of public health, often times a comprehensive orientation to public health practice does not occur. In addition, much of the graduate-level training is increasingly moving towards specialization. This is resulting in fewer graduates with a well-rounded education. To round out one’s education and provide a greater

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Who Will Keep the Public Healthy?: Educating Public Health Professionals for the 21st Century orientation to practice, graduate-level education should include: 1) greater use of case studies; 2) involvement of students in applied research activities; 3) exercises on writing to non-academic audiences for identified purposes; 4) training on finding information and determining its quality; and 5) a greater focus on qualitative analysis. As in virtually all professions, continuing education also is essential in public health. Many in the current workforce, while extremely skilled in many technical areas, lack a basic understanding of public health concepts, frameworks, and principles, such as the Essential Public Health Services and Healthy People 2010. In addition, continuing education is needed in areas such as: 1) understanding, using, and managing information technology; 2) applied research methods; and 3) finding, understanding, and using the scientific evidence in public health. 4. What do you or your organization’s members see as the strengths and challenges facing public health education today? In schools of public health, there are more practice opportunities today than possibly at any time in the past. This is a major strength of public health education today. In addition, there are more schools of public health and enrollees, resulting in more well-educated graduates in public health. For the current workforce, there also are hundreds of distance learning courses available as well as on-site continuing education opportunities. One of the greatest challenges facing public health practice education are market forces. Too few graduates of schools of public health end up working in public health practice settings, especially the more traditional state and local health agency settings. Because of this reality, schools may not tailor their curriculum to the needs of governmental public health. For this to change, agencies need to be willing to hire, and appropriately pay, graduates of schools of public health. Otherwise, schools may continue to move away from providing appropriate education for individuals desiring to work in public health agency settings. In addition, Federal support for teaching in public health has become virtually nonexistent. These funds are vital for supporting faculty training and developing much-needed case study materials. Other market forces, such as continued emphasis by funding agencies on basic science research (with little emphasis on public health systems research), results in faculty focusing their research energies on non-practice questions. If students are to develop a greater understanding of applied research techniques and develop an appreciation for evidence-based approaches to public health practice, funding of this type of research is essential. Another challenge facing public health education is that there are too few courses designed to build knowledge and skills in many of the core

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Who Will Keep the Public Healthy?: Educating Public Health Professionals for the 21st Century public health competencies. For example, there are few courses addressing cultural competence needs and approaches for working with stakeholders. There are many challenges also facing continuing education for the current public health workforce. While hundreds of distance learning courses have been developed and are available to all public health professionals, there are few, if any, standards to enable a potential student to distinguish a quality course from one of lesser quality. Even when quality courses are identified, often times the employer does not permit time off to take the course or provide the funds necessary for enrolling in the course. Finally, while distance learning and on-site continuing education exist, the most appropriate technologies and adult learning techniques are not fully utilized by the public health profession. 5. What, in your opinion, are changes that might occur in the next 10 years that will call for new skills/knowledge to be added to public health professional training? The greatest challenge is to meet the current identified needs that have gone unmet for well over a decade already. For many years, experts in public health practice and academia have identified training needs in areas such as: 1) cultural competence; 2) the basics of public health practice; 3) managing contracts; 4) managing information and technology; and 5) accountability and performance management. Needs in these areas are likely to increase throughout this decade and beyond. To more completely understand the current and future education and training needs of the public health workforce, a comprehensive assessment using the core competencies for public health professionals could be conducted that identifies gaps and priority training needs. Other new skill/knowledge needs are likely to be in the areas of genomics, how to identify and use the growing body of scientific evidence that can guide the practice of public health, and strategies for integrating the aging population into public health programs.