8
Academia

The health of the public during the twenty-first century can be assured only through the cooperation and collaboration of many individuals in diverse institutional settings, each of which has important contributions to make to this important and challenging endeavor. Among the recommendations in The Future of Public Health (IOM, 1988), several focused on needed improvements in academia regarding the education of public health professionals. The report called for the following changes:

  • Creating new linkages among public health schools and programs and public health agencies at the federal, state, and local levels;

  • Developing new relationships within universities between public health schools and programs and other professional schools and departments;

  • Formulating more extensive approaches to education that encompass the full scope of public health practice;

  • Strengthening the knowledge base in the areas of international health and the health of minority groups;

  • Conducting a wide range of research that includes basic and applied research, as well as research on program evaluation and implementation; and

  • Developing new training opportunities for professionals who are already practicing in public health.

There has been progress in most of these areas. For example, collaborations and partnerships are receiving increased emphasis, practice-based



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The Future of the Public’s Health in the 21st Century 8 Academia The health of the public during the twenty-first century can be assured only through the cooperation and collaboration of many individuals in diverse institutional settings, each of which has important contributions to make to this important and challenging endeavor. Among the recommendations in The Future of Public Health (IOM, 1988), several focused on needed improvements in academia regarding the education of public health professionals. The report called for the following changes: Creating new linkages among public health schools and programs and public health agencies at the federal, state, and local levels; Developing new relationships within universities between public health schools and programs and other professional schools and departments; Formulating more extensive approaches to education that encompass the full scope of public health practice; Strengthening the knowledge base in the areas of international health and the health of minority groups; Conducting a wide range of research that includes basic and applied research, as well as research on program evaluation and implementation; and Developing new training opportunities for professionals who are already practicing in public health. There has been progress in most of these areas. For example, collaborations and partnerships are receiving increased emphasis, practice-based

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The Future of the Public’s Health in the 21st Century research efforts are expanding, and certificate programs and distance-learning programs aimed at providing lifelong learning to practicing public health workers have grown. Much more can be achieved, but these improvements are dependent on a critical analysis of the functions of academia, an examination of academia’s potential contributions to the public health system, and a discussion of recommendations made to enhance academia’s capacity to make these contributions. Academia performs three important functions within the public health system. These are to (1) educate and train public health workers; (2) conduct basic and applied research in disciplines pertinent to public health; and (3) engage in community, public, and professional service. Of course, academia is not the only institution that provides education, research, and service. Federal, state, and local public health agencies, for example, provide training to public health workers. Public health agencies and the Centers for Disease Control and Prevention (CDC) conduct community-based research. Federal and state health agencies collect and disseminate valuable, credible information and statistics for the nation through vehicles such as the National Health Interview Survey, the Vital Statistics system, and the publication Morbidity and Mortality Weekly Report. The Public Health Faculty/Agency Forum, convened by CDC and the Health Resources and Services Administration (HRSA), illustrates one way in which nonacademic institutions convene and foster cooperation and coordination between academia and public health agencies in support of community health. Although numerous federal, state, and local agencies make important contributions through education and training, information dissemination, collaborative activities, and research, these functions are central to the mission of academia. These functions are not, however, mutually exclusive. For example, service learning (defined as a method by which students learn through active participation in organized service experiences that meet actual community needs [Rhoads and Howard, 1998]) can be classified under the education and training function as well as the service function. Community-based participatory research is another example. Although it is clearly classified under the research function of academia, this approach to research is also a component of the service function because it is conducted in a collaborative fashion with the community and addresses problems identified as important by the community. The emphasis of this chapter is on how academia fulfills its responsibilities for assuring the health of the public through education (and training), research, and service. For the purposes of this discussion, “academia” refers to all units within community and 4-year colleges and universities that contribute to assuring the health of the population.

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The Future of the Public’s Health in the 21st Century EDUCATION AND TRAINING The “most distinctive role of public health education lies in the preparation of public health professionals” (Fineberg et al., 1994). Because of the critical role of education in preparing public health professionals to function effectively, the Institute of Medicine (IOM) convened the Committee on Educating Public Health Professionals for the 21st Century that, concurrent with the work of the Committee on Assuring the Health of the Public in the 21st Century, has conducted an in-depth examination of the future needs of public health professional education and developed a framework and recommendations for how, over the next 5 to 10 years, education, training, and research in programs and schools of public health can be strengthened to prepare future public health professionals to improve population health. Given the in-depth examination and analysis of public health education that was undertaken by the IOM Committee on Educating Public Health Professionals for the 21st Century, the present report will not go into detail about the future of public health education but, rather, will briefly describe the kinds of degree and professional development programs available, discusses the current workforce and its training needs, identifies problems and barriers to providing public health education, and makes recommendations for maximizing academia’s contributions to the education of the current and future public health workforce. People who work as professionals in the public health system receive their education and training in a wide range of disciplines and in diverse academic settings, including schools of public health, medicine, nursing, dentistry, social work, allied health professions, pharmacy, law, public administration, veterinary medicine, engineering, environmental sciences, biology, microbiology, and journalism. The master of public health (MPH) is the basic professional degree traditionally earned by public health workers, but many college graduates who work in public health are educated in other health professions. For example, nurses make up about 10.9 percent of the total public health workforce, whereas physicians comprise about 1.3 percent (HRSA, 2000a). The doctor of public health (DrPH) is offered for advanced training in public health leadership. Individuals with academic degrees (e.g., a master of science or doctorate) in the public health disciplines such as epidemiology, biostatistics, environmental health, health services and administration, nutrition, and the social and behavioral sciences also may be found in the larger state and local public health agencies and in the health care delivery system. The 32 accredited schools of public health, along with the 45 accredited MPH programs, supply the bulk of public health graduates. The Association of Schools of Public Health (ASPH), the organization that represents accredited schools of public health, reports that in 1998–1999, the 29

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The Future of the Public’s Health in the 21st Century accredited schools of public health graduated 5,568 students. Of all degree recipients, 89.9 percent received a master’s degree (61.5 percent received an MPH degree) and 10.1 percent received doctoral degrees (of these, 6.7 percent received a doctor of philosophy [PhD] degree and 2 percent received a DrPH degree) (ASPH, 2000). It is estimated that accredited graduate programs in community health and preventive medicine and in community health education graduate an additional 700 to 800 master’s degree students each year (Davis and Dandoy, 2001). Many of these graduate programs in public health are represented by the Association of Teachers of Preventive Medicine. Additionally, in 1997–1998 there were 9,947 master’s graduates of programs of public administration and public affairs, many of whom emphasized health policy and management and public health in their training (National Association of Schools of Public Affairs and Administration, 1998). The Association of University Programs in Health Administration reports that in 2000 there were 1,778 graduates who received master’s degrees (in health administration); some (an unknown number) of them received the MPH and master of science degrees (Association of University Programs in Health Administration, 2000). Many public health workers also receive undergraduate training from 4-year institutions that offer programs in the environmental sciences or in health education and health promotion. These programs can offer valuable continuing education to health workers by providing current scientific information in many specialized areas. Those who graduate with training in public health are only a small part of the public health workforce. Although it is unclear exactly how many public health workers there are in the United States today, it is estimated that about 450,000 people are employed in salaried positions in public health and that an additional 2.85 million people volunteer their services (HRSA, 2000a). This is probably an undercount because, according to HRSA, states reporting the number of workers within their jurisdictions almost never include information about public health workers found in nongovernmental and community partner agencies. Additionally, limited information is obtained regarding the numbers of volunteers and salaried staff in voluntary agencies. Kennedy and colleagues (1999), in an 18-month study of the Texas public health workforce, counted nearly 17,700 professional public health workers in that state. Only one-third of the professional public health workforce identified in that study was employed in official public health agencies, and only an estimated 7 percent had formal education in public health. Nationally, it is estimated that about 80 percent of public health workers lack basic training in public health (CDC, 2001a). Furthermore, only 22 percent of chief executives of local health departments have graduate degrees in public health (Turnock, 2001).

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The Future of the Public’s Health in the 21st Century Public Health Education and Training Basic public health training has changed over the years. Early public health efforts in the United States were directed toward improving sanitation and ensuring the safety of the food and water supply, controlling infectious diseases, and providing immunizations to children. Thus, in the early 1900s, the public health workforce was trained primarily in medicine, nursing, and the biological sciences (Brandt and Gardner, 2000; Garrett, 2000; Mullan, 2000). Basic public health training now requires an approach that incorporates understanding of the following: Health problems must be examined in the context of defined populations; Many problems of public health are deeply rooted in the behavior of individuals and in their social context; Public health problems of the twenty-first century are rooted in the technologies of economic development; and Public health problems continue to require the engagement of the body politic, in the form of government participation, for their solution (Fineberg et al., 1994). Additionally, changing demographics in the United States and the importance of community engagement in problem solving contribute to the need for a more broadly trained and diverse workforce. Involvement in global health issues also argues for increased attention to workforce diversity, but achieving such diversity in the workforce is a major challenge for governmental public health agencies and other public health entities because of the inadequate number of students and faculty from ethnic minority groups. Without high school and undergraduate degree programs in public health, there is little exposure of potential minority candidates to public health as a career option. A related issue is the lack of ethnic minority faculty in programs and schools of public health. Public health agencies, schools and programs of public health, professional organizations, and other components of the public health system need to devote major efforts to identify and facilitate, through funding and other mechanisms, approaches to increase cultural diversity, as well as to enhance awareness of global health issues among public health faculty, students, and staff. For example, many schools of public health have established programs that provide students with practical experiences working abroad, offer short-term international internships as well as fellowship programs related to global health, and engage in international research collaboration on major global health issues. Recent efforts directed toward achieving the goal of a broadly trained

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The Future of the Public’s Health in the 21st Century workforce have focused on identifying basic competencies in public health and developing curricula that teach the information and skills necessary to meet those competencies. A number of different organizations have tackled this task. For example, the Pew Health Professions Commission (O’Neil, 1998) has developed a set of 21 competencies for successful practice that apply to physicians, nurses, and allied health professionals. The Council on Linkages Between Academia and Public Health Practice has developed a set of core competencies for public health professionals that apply to three job categories: frontline staff, senior-level staff, and supervisory management staff (Council on Linkages, 2001). The ASPH has endorsed the core competencies developed by the Council on Linkages and plans to develop additional and complementary competencies for MPH students. Furthermore, the CDC Office of Workforce Policy and Planning (CDC, 2001b) has developed a table of competency sets (see Appendix E), differentiated into the categories of Core-basic public health (addresses the essential services of public health); New topical areas (emergency response, genomics, law, informatics); Functional areas (leadership, management, supervisory, secretarial); Discipline-specific areas (professional, technical, entry-level students); and Other topical areas (e.g., maternal and child health, environmental health, health communication, sexually transmitted diseases). The preparation of students and workers to engage in effective public health practice requires not only a definition of competencies but also an educational approach that encompasses a necessarily broad range of skills and information. Integrated approaches to education and training are crucial. Integrated Interdisciplinary Learning One example of an effort to promote an integrated approach to education is the Medicine/Public Health Initiative, a national consortium created in 1994 under the joint leadership of the American Medical Association and the American Public Health Association and involved in efforts to improve the working relationship and bridge the gap between medical and public health practitioners. The initiative has the following seven primary goals: To engage the community and change existing thinking to focus on improving the health of the community.

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The Future of the Public’s Health in the 21st Century To change the educational process so that public health and medicine can enhance their understanding of each other’s practices. To create joint research efforts by developing a common research agenda for public health and medicine by using the threefold approach of relaying advantages of joint research, using preventive medicine certification and training as a form of integrated learning, and supporting the funding of research that links medicine and public health. To devise a shared view of health and illness so that public health and medicine can use a common conceptual framework of health and illness. To work together in health care provision and integrate health promotion and prevention into clinical health care delivery systems. To jointly develop health care assessment measures such as quality, effectiveness, and outcome evaluations. To translate Initiative ideas into action. The Initiative’s work led to the development of a program that funded 19 collaborative projects around the country (Phillips, 2000). The Agency for Health Care Policy and Research also funded three projects aiming to enhance cooperation between the medical and public health communities in the context of community-based health programs (AHCPR, 1997). Preventive medicine certification and training is another example of integrated interdisciplinary learning. In preventive medicine training, the primary emphasis is on disease prevention and health promotion. There are currently 6,091 certified preventive medicine specialists in the United States, but the proportion of these specialists among all U.S. physicians is on the decline. The decline has been greatest among those training in public health, with the primary reason for the decline being inadequate funding (Lane, 2000). In addition, it is critical for public health education to cross traditional boundaries and link more effectively with the educational programs for other health professionals. In 1998, the Josiah Macy, Jr., Foundation sponsored a conference entitled Education for More Synergistic Practice of Medicine and Public Health (Hager, 1999). The goal of the conference was to develop recommendations on how public health practitioners and physicians can be trained to collaborate with one another. During the conference, Lasker (1999) emphasized the importance of public health education for medical students, whereas Lumpkin (1999) discussed what to teach students of public health about medical practice. He pointed out that because of the changes in the issues facing public health, enrolling students no longer come primarily from the medical or nursing profession. This, in turn, means that those students do not have a working knowledge of the biomedical basis of medical treatment or of the medical treatment system. To gain needed exposure to the academic disciplines and the actual practices of their counterparts, medical students must become acquainted

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The Future of the Public’s Health in the 21st Century with epidemiology, biostatistics, public health policy, the elements of prevention, and other essentials of public health, whereas students of public health require familiarization with the workings of the health care delivery system, the pharmacological and therapeutic treatment of disease, and techniques of dealing with individual patients (Hagar, 1999). Nursing education is another area for integrated interdisciplinary learning, such as linkages with education in public health. Although schools of nursing require course work in community and public health nursing at the bachelor’s level, there is a great deal of variation in the content of these programs. In 2001, there were 85 schools of nursing that offered master’s degrees in community health and/or public health nursing (Berlin, 2002). Model curricula incorporating public health content into bachelor’s nursing curricula are lacking; an insufficient number of nursing faculty are prepared in public health; and access to public health agencies for population-based clinical experience is often a problem, as is access to continuing education in population-based public health and public health nursing. For additional information about preparing nurses to enter the public health workforce, refer to Who Will Keep the Public Healthy? (IOM, 2003). Unfortunately, efforts to integrate teaching across schools and departments face several institutional barriers. First, most schools and colleges are departmentalized, with the resources provided for teaching distributed among the departments. Departmental priorities lie with ensuring that courses for majors and service courses are taught within the department’s discipline. Faculty who teach departmental, discipline-based courses are provided with both monetary support for teaching such courses and recognition by their departmental colleagues for contributing to the department’s teaching load. At present, either integrated interdisciplinary courses must receive funding from sources outside the various departments involved, or each department supporting the disciplines involved in integrated interdisciplinary courses must agree to contribute faculty teaching time to the teaching efforts. Even when such agreements among departments can be reached, faculty are still reluctant to participate because the development and teaching of integrated interdisciplinary courses usually require more time than that required to teach a course in one’s own discipline. This additional time is usually not recognized in either commensurate pay or teaching credit. A second disincentive for faculty participation in integrated interdisciplinary educational approaches relates to promotion and salary review. Faculty teaching integrated interdisciplinary courses may be penalized during promotion and salary merit review because their departmental colleagues know little of their interdisciplinary teaching activities or do not value such activities as highly as they value contributions to the department’s

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The Future of the Public’s Health in the 21st Century curriculum. Because integrated interdisciplinary teaching is important to the preparation of a well-trained workforce that is capable of addressing today’s broad array of public health issues, academic institutions must ensure that funds are available for integrated interdisciplinary teaching activities and must provide incentives in their reward structures for faculty participating in such activities. The emerging focus of a broad education based on competencies, both basic and discipline specific, is important. However, the need for public health students to understand medical practice and for physicians to understand public health practice, including the ethical and legal foundations of public health, must be kept in mind. The committee endorses the findings of the Macy Foundation conference—that there must be greater synergy between education for medicine and education for public health—and extends that endorsement of synergy to education in other clinical health science professions. Therefore, the committee recommends that academic institutions increase integrated interdisciplinary learning opportunities for students in public health and other related health science professions. Such efforts should include not only multidisciplinary education but also interdisciplinary education and appropriate incentives for faculty to undertake such activities. Additional discussion of the need to increase collaboration and education between public health and other health professions can be found in the report Who Will Keep the Public Healthy?, developed by the IOM Committee on Educating Public Health Professionals for the 21st Century (IOM, 2003). Public health workers should be trained in a set of core public health competencies and should have opportunities for practical experience; and additional education and training must be tailored to and depend on the experiences, activities, and functions of particular groups. For example, current MPH students have training needs that differ from those of past graduates of such programs who have been practicing for many years in a public health agency. The training needs of public health nurses differ in critical ways from the training needs of health educators, administrators, and environmental professionals. Identification of these specific training needs requires assessment and evaluation. Solloway and colleagues (1997) reported on a study funded by HRSA to assess state agency-based health workforce capacity and examine state training and educational needs in five states: Illinois, Maryland, Missouri, Oregon, and Rhode Island. The authors report that most state public health workers have no formal education or training in the field of public health, lack a good understanding of the goals and mission of public health, and do not have a full understanding of the activities carried out by public health

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The Future of the Public’s Health in the 21st Century workers outside their own units or departments. They identified educational and training needs in eight areas: Information systems and computer skills Technical writing and presentation skills Research and policy development skills Management and administrative skills Grantsmanship Public relations Transition skills Leadership skills The study also found that states need federal support to obtain technical assistance for the acquisition and use of new technologies for distance-based or remote-site learning, ongoing financial support, and symbolic support demonstrating that training and education are valued and are priorities. Another study conducted by Reder and colleagues (1999) assessed the training needs of public health professionals in Washington State. They found that communication was the area in which public health professionals require the most training, with the four most highly rated topics being interpersonal communication, cross-cultural and cross-age communication, electronic communication, and participatory teaching and training skills. The educational and training needs of the current public health workforce are enormous and multifaceted. Academia has an essential and unique role to play in ensuring that broad-based educational and training opportunities are available on a regional basis. All accredited MPH programs, school based or otherwise, are required to provide some continuing education; however, what is offered varies widely depending on the available resources and expertise. With the advent of new and expanding information technologies, the opportunity for schools and programs to provide education and training to a broader audience via distance learning is increasing rapidly. The means for achieving this are discussed further in the chapter on the governmental public health infrastructure (Chapter 3). Although academia can play a leadership role in the coordination of various educational and training opportunities for the public health workforce, it cannot meet all of these needs. In some cases, practitioners in the field can best provide in-service training. Funding of Public Health Professional Education and Training A current lack of funding is a major problem in providing training and education for both students seeking degrees and those already in the public

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The Future of the Public’s Health in the 21st Century health workforce. According to Gebbie (1999), the primary barrier to workforce development is the “incredibly weak” budget allocated for training. This has not always been the case, however. Over the past five decades, the major sources of funds for the training of students in public health were HRSA and CDC. Table 8–1 provides a chronology of legislation authorizing funds for health professional training in public health between 1956 and 1976 (DHHS, 1980). In 1976, Congress passed the Health Professions Educational Assistance Act (P.L. 94–484). This act provided for a number of programs in health professions education, including Extensions of existing public health traineeships. Grants to accredited schools of public health for student traineeships. A separate program of grants to public or nonprofit private educational entities (excluding schools of public health) that offered an accredited program in health administration, hospital administration, or health policy analysis and planning. Funding to public or nonprofit private educational entities (excluding schools of public health) for graduate programs in health administration. Grants to assist accredited schools of public health and other public or nonprofit educational entities with accredited graduate programs in health administration, health planning, or health policy analysis and planning in meeting costs of special projects to develop new programs or expand existing ones in the same four public health disciplines mentioned above. A requirement for the Secretary of Health and Human Services, in coordination with the National Center for Health Statistics, to continuously develop and disseminate statistics and other information on the supply of and need for different types of public and community health personnel. Between 1980 and 1987, spending by the Bureau of Health Professions (which is part of HRSA in the Department of Health and Human Services [DHHS]) for education in all health professions declined yearly, from a high of $411,469,000 in 1980 to $189,353,000 in 1987. General-purpose traineeship grants to schools of public health went from $6,842,000 in 1980 to $2,958,000 in 1987. Curriculum development grants, funded at $7,456,000 in 1980, were not funded at all in 1981 and 1982; but the funding recovered slowly in 1983, with funding at $1,740,000, and increased in 1984 to $2,856,000 and reached $9,787,000 in 1987. Grants for graduate programs in health administration were

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The Future of the Public’s Health in the 21st Century immediately include agreement on a mission statement with goals and objectives, clarification of roles and relationships, definition of a decision-making process, development of an organizational structure, the frequency and length of meetings, and the benefits for each member of the coalition (Feighery and Rogers, 1990). The benefits of successful collaborative efforts and partnerships are many. Collaborations can reduce disparity in access to information, resources, and skills; increase public health’s understanding of community needs and assets; and lead to the development of a process for continual improvement in public policy and health systems (Berkowitz, 2000). Additional benefits include the freedom to become involved in new issues without bearing sole responsibility for managing or developing those issues; developing widespread public support for issues, actions, or unmet needs; developing a critical mass for action; minimizing duplication of effort and services; mobilizing a broad array of talents, resources, and approaches to problem solving; providing a mechanism for recruiting participants with diverse backgrounds and beliefs; and having flexibility in providing an opportunity to exploit new resources in changing situations (Butterfoss et al., 1993; Green et al., 2001). Centers and Institutes Academia engages in service to the community in many ways. One approach to service is through various centers and institutes. For example, in 2002 the University of Washington’s Center for Ecogenetics and Environmental Health conducted a town meeting to engage in discussions with the community on racial disparity, poverty, and pollution. Activities brought together researchers, legislators, and community members to discuss the health risks of pesticides to agricultural workers and their families, contamination of seafood by marine toxins and chemical pollutants, hazardous waste sites, culturally appropriate research strategies, and links between indoor and outdoor air pollution and asthma. These discussions led to a number of projects designed to address community-identified concerns and needs. The three newly funded CDC Centers for Genomics and Public Health, located at the University of Michigan, University of North Carolina, and University of Washington, are another mechanism through which service to the community can be provided. Each center will develop a regional hub of expertise for the use of genetic information to improve health and prevent disease. In addition to contributing to the knowledge base on genomics and public health and providing training for the public health workforce, the centers are to provide technical assistance to regional, state, and local public health organizations. “With this collaborative approach, CDC hopes to

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The Future of the Public’s Health in the 21st Century . . . demonstrate—through real examples—the translation of gene discoveries into disease prevention and improved health” (CDC, 2001d). Of primary importance in providing service to the working public health community is the Public Health Leadership Institute. The institute was developed as a collaborative effort of CDC and the Western Consortium for Public Health to provide leadership training for senior public health officers in state and local health departments. The University of North Carolina now coordinates its efforts. Each year a cohort of senior public health officials is selected to participate in a 12-month program that includes self-study, teleconferences, electronic seminars, action-learning projects, and an intensive on-campus week. The curriculum is centered around four modules concerning the challenges to public health: the study of the future, leadership and vision, communication and information, and political and social change (Scutchfield et al., 1995). The institute has spawned the development and growth of regional leadership training efforts aimed at increasing the leadership skills of public health practitioners at various levels of the system. Other approaches to service include the summer institutes and courses discussed above in the section Education and Training. These institutes and courses provide education and training to state and local health departments and other members of the community. Academia’s contributions to service also can be seen in the work of the Centers for Public Health Preparedness funded by CDC. There are academic centers, specialty centers, and local exemplar centers (see Table 8–3). Academic centers aim to increase individual preparedness at the front line by linking schools of public health, state and local public health agencies, and other academic and community health partners. Specialty centers focus on a topic, professional discipline, core public health competency, practice setting, or application of learning technology. Local exemplar centers develop advanced applications at the community level in three areas: integrated communications and information systems, advanced operational readiness assessment, and comprehensive training and evaluation. Table 8– 3 lists the centers in existence as of the writing of this report. The centers work in collaboration with partners across their regions to assure a well-trained and prepared public health workforce, informed health care providers, and an alert citizenry to protect against terrorism. In September 2000, CDC, the Association of Schools of Public Health, state and local public health agencies, and other academic communities entered into a partnership to begin development of a national system of Centers for Public Health Preparedness (DHHS, 2002). Service learning (also discussed above in the section Education and Training) is another way in which academic institutions engage in community service. Academic service-learning organizations and activities are growing and include the following: (1) service-learning centers on college

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The Future of the Public’s Health in the 21st Century TABLE 8–3 Centers for Public Health Preparedness Type Location Academic centers University of Illinois at Chicago School of Public Health University of North Carolina, Chapel Hill, School of Public Health University of Washington School of Public Health and Community Medicine Columbia University Mailman School of Public Health University of Iowa College of Public Health University of South Florida College of Public Health St. Louis University School of Public Health Specialty centers Dartmouth College Medical School Interactive Media Laboratory Saint Louis University School of Public Health The Johns Hopkins University Bloomberg School of Public Health and the Georgetown University Law Center University of Findlay (Ohio) National Center of Excellence for Environmental Management Local exemplar centers DeKalb County Health Department Denver Public Health Monroe County Health Department campuses across the United States that support and facilitate student and faculty work in communities; (2) the National Service-Learning Exchange, which provides training and technical assistance to service-learning programs; (3) campus compact (a national organization of more than 750 college and university presidents), which offers workshops, tool kits, and publications aimed at encouraging student and faculty involvement in community and public service; (4) research opportunities and studies; and (5) a planned National Center for Service-Learning Research (Howard, 2001). Barriers and Solutions There are barriers to establishing successful collaborations and partnerships. Clark (1999) outlined four barriers or gaps: Communication—a lack of a shared language and emphases; Access—little access to skilled public health faculty by some practitioners and communities; Credibility—practitioner skepticism of academic understanding and vice versa; and

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The Future of the Public’s Health in the 21st Century Expectations—the failure of what it takes to operate in the real world to meet academic standards of scientific rigor. Other investigators include as barriers perceived threats to a sense of autonomy, disagreement about community needs, conflicts over funding decisions, a lack of consensus about membership criteria or coalition structure, failure to include relevant constituencies, and a lack of leadership (Feighery and Rogers, 1990; Kreuter et al., 2000). A continuing barrier to scholarly service and one of great concern relates to faculty rewards, promotion, and tenure. Public health practice activities are not generally valued or rewarded by most academic institutions. Israel and colleagues (2001) write that multiple means are needed to provide evidence and recognition of the scholarship of public health practice. They list a number of matters that must be addressed to overcome this barrier. For example, peer-reviewed journals must recognize difficult methodological issues associated with conducting community-based participatory research and should be willing to publish such articles. Universities need to expand their evaluation of reputable journals. Because faculty members may assist communities in preparing grant proposals, these activities should be recognized and valued by academic institutions. Similarly, training activities for and technical assistance to community partners should be given credit toward tenure and promotion. Practice Scholarship Efforts are in progress to overcome the institutional lack of recognition of public health practice and service as scholarly endeavors. Maurana and colleagues (2000) report on two evidence-based models for documenting and assessing community scholarship activities. The first model, the Points of Distinction Project, is part of the Outreach Committee of Michigan State University. This model identified quantitative and qualitative indicators of success for four dimensions of quality outreach. The service must have significance, in that the issues addressed are of importance and value to project goals. The context of the service is crucial, in that it should have a close fit with the environment, use appropriate expertise and methods, have a substantial degree of collaboration, and use resources sufficiently and creatively. The scholarship of the service should demonstrate appropriate application, generation, and use of knowledge. Lastly, the service should be able to demonstrate that it has influence on issues, institutions, and individuals. The second model is the Competency-Based Model of Alverno College in Milwaukee, Wisconsin. This model divides scholarly activity into four competencies, each of which specifies skills, activities, and requirements

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The Future of the Public’s Health in the 21st Century that faculty must master for promotion. These skills include being able to teach effectively, work responsibly in the college community, develop and pursue a research agenda, and serve the wider community. The model proposed by Maurana and colleagues (2000) defines community scholarship as “the products that result from active, systematic engagement of academics with communities for such purposes as addressing a community-identified need, studying community problems and issues, and engaging in the development of programs that improve health.” They offer standards and criteria for assessment of this scholarship. Criteria evaluate goals, preparation, methods, results presentation, and reflective critique. The model also describes four types of community scholarship products: Resources, such as how-to manuals, technical assistance, and tools and strategies to assess community strengths and assets or concerns; Program outcomes, such as improved community health outcomes, increased community leadership and funding for health, and integration of students and residents into community-based efforts or creative education; Dissemination, such as presentations, journal articles, and leadership at the national, state, and community levels; and Other products, such as new or strengthened partnerships and coalitions and program development grants. In Demonstrating Excellence, ASPH (1999:9) discusses the issue of service as scholarship: Service is relevant as scholarship if it requires the use of professional knowledge, or general knowledge that results from one’s role as a faculty member. This knowledge is applied as consultant, professional expert, or technical advisor to the university community, the public health practice community, or professional practice organizations. The dimension of scholarship distinguishes practice-based service from a form of service known traditionally as the general responsibilities of citizenship. To meet the requirements of scholarship as defined by ASPH, academic service must be provided through community-based participatory research, service learning or the work of the Prevention Research Centers, Centers for Genomics and Public Health, and Centers for Public Health Preparedness. Such activities to improve the health of the community not only fulfills academia’s obligation of service but also expands the knowledge base and contributes to improvements in the health of the public. The value of these contributions is great and should be acknowledged by academic institutions in their promotion and tenure policies. For these reasons, the committee recommends that academic institu

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The Future of the Public’s Health in the 21st Century tions develop criteria for recognizing and rewarding faculty scholarship related to service activities that strengthen public health practice. CONCLUDING OBSERVATIONS Academia, as one component of the public health system, provides important contributions to the health of the public in three ways: educating and training public health workers; conducting research in disciplines pertinent to public health; and engaging in community, public, and professional service. Numerous activities have been undertaken to educate and train the current and future public health workforce through methods such as classroom-based instruction, distance-learning programs, and training and leadership institutes. Stagnant and shrinking resources allocated to public health training are, however, impeding the ability of academic institutions to address today’s new and emerging health problems. If it is true that the public health workforce is at the heart of the nation’s ability to respond to new challenges such as emerging infections and preparedness against terrorist attacks, then that public health workforce must be adequately educated and trained to successfully face those challenges. This cannot be accomplished without making the training and education of public health workers the number one priority as demonstrated through adequate funding. Academia has made major contributions to prolonging life and increasing the quality of life through research. Basic research has provided the knowledge necessary to develop precious vaccines that protect against debilitating and deadly diseases, whereas research on the determinants of health has demonstrated the importance of social and behavioral factors to health. However, comparatively few resources have been devoted to supporting prevention research, community-based research, or the translation of research findings into practice. Such resources must be found and allocated if academia is to continue to have a major impact on the health of communities. With the collaboration and partnership of academia, scholarly service has the potential to make great strides in engaging the community in improving its own health. However, without a restructuring of the reward system within universities and colleges, this most promising approach to change encounters barriers that are difficult to surmount. Improvement of the public’s health faces great challenges. Academia is committed to working in partnership with other components of the public health system to meet these challenges. Yet, to be successful, the role of academia must be valued, and funding must be available to develop the programs and approaches needed for education and training, research, and service to improve the public’s health.

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The Future of the Public’s Health in the 21st Century REFERENCES AHCPR (Agency for Health Care Policy and Research). 1997. AHCPR funds project to foster collaboration between medicine and public health. In Research Activities Newsletter, No. 202. AHCPR Publication 97–0024. Rockville, MD: AHCPR. ASPH (Association of Schools of Public Health). 1999. Demonstrating Excellence. Washington, DC: ASPH. Available online at http://www.asph.org/uploads/demon.pdf. Accessed March 17, 2002. ASPH. 2000. 1999 Annual Data Report: Applications, New Enrollments & Students, and Fall 1999 Graduates, 1998–99 with Trends, 1989–1999. Washington, DC: ASPH. Association of University Programs in Health Administration. 2000. Health Services Administration Education Director of Programs 2001–2002. Washington, DC: Association of University Programs in Health Administration. Baker EL, Melton RJ, Stange PV, Fields ML, Koplan JP, Guerra FA, Satcher D. 1994. Health reform and the health of the public: forging community health partnerships. Journal of the American Medical Association 272(160):1276–1282. Berkowitz B. 2000. Collaboration for health improvement: models for state, community, and academic partnerships. Journal of Public Health Management and Practice 6(1):67–72. Berlin L. 2002. Special tabulation from the American Association of Colleges of Nursing 2001–2002 database. Washington, DC: American Association of Colleges of Nursing. Bialek, R. 2000. Building the science base for public health practice. Journal of Public Health Management and Practice 6(5):51–58. Brandt AM, Gardner M. 2000. Antagonism and accommodation: interpreting the relationship between public health and medicine in the United States during the 20th century. American Journal of Public Health 90(5):707–715. Brownson RC, Simoes EJ. 1999. Measuring the impact of prevention research on public health practice. American Journal of Preventive Medicine 16(3 Suppl.):72–79. Butterfoss FD, Goodman RM, Wandersman A. 1993. Community coalitions for prevention and health promotion. Health Education Research: Theory & Practice 8(3):315–330. Cannon MM, Umble KE, Steckler A, Shay S. 2001. “We’re living what we’re learning”: student perspectives in distance learning degree and certificate programs in public health. Journal of Public Health Management and Practice 7(1):49–59. Cauley K, Canfield A, Clasen C, Dobbins J, Hemphill S, Jaballas E, Walbroehl G. 2001. Service learning: integrating student learning and community service. Education for Health 14(2):173–181. CDC (Centers for Disease Control and Prevention). 2000. Proceedings from the Public Health Workforce Development Expert Panel Workshop, November 1–2, 2000, Calloway Gardens, GA. Atlanta, GA: CDC. CDC. 2001a. A Global Life-Long Learning System: Building a Stronger Frontline Against Health Threats. A Global and National Implementation Plan for Public Health Workforce Development. Revision date: January 5, 2001. Atlanta, GA: CDC. CDC. 2001b. A collection of competency sets of public health-related occupations and professions. Available online at www.phppo.cdc.gov/workforce. Accessed August 30, 2001. CDC. 2001c. What is PHTN? The history. Available online at http://www.phppo.cdc.gov/phtn/history.asp. Accessed October 31, 2002. CDC. 2001d. Centers for Disease Control and Prevention (CDC) Awards Funds for Genetics Programs. CDC National Center for Environmental Health (NCEH) news release, October 18, 2001. Available online at www.cdc.gov/genomics/activities/fund2001.htm. Accessed October 31, 2002.

OCR for page 358
The Future of the Public’s Health in the 21st Century CDC and Agency for Toxic Substance and Disease Registry (ATSDR). 1999. Strategic Plan for Public Health Workforce Development: Toward a Life-Long Learning System for Public Health Practitioners. Atlanta, GA: CDC. Citrin T. 2001. Enhancing public health research and learning through community-academic partnerships: the Michigan experience. Public Health Reports 116:74–78. Clark, NM. 1999. Community/practice/academic partnerships in public health. American Journal of Preventive Medicine 16(3 Suppl.):18–19 Council on Linkages. 2001. Core Competencies for Public Health Professionals. Washington, DC: Public Health Foundation. Davis MV, Dandoy S. 2001. Survey of Graduate Programs in Public Health and Preventive Medicine and Community Health Education. Washington, DC: Association of Teachers of Preventive Medicine and the Council on Education for Public Health. DHHS (Department of Health and Human Services). 1980. Chronology of Health Professions Legislation: 1956–1979. Washington, DC: Office of Program Development, Bureau of Health Professions, Health Resources Administration. DHHS. 1988. Bureau of Health Professions: Selected Summary Data on Fiscal Years 1980–87 Awards. ODAM Report 3–88. Washington, DC: Office of Data Analysis and Management, Bureau of Health Professions, Health Resources and Services Administration. DHHS. 2002. HHS announces new funding for academic centers. Press release, February 6. Available online at www.hhs.gov/news. Accessed March 2, 2002. Doll L, Berkelman R, Rosenfield A, Baker E. 2001. Extramural prevention research at the Centers for Disease Control and Prevention. Public Health Reports 116(Suppl. 1):10– 19. Feighery E, Rogers T. 1990. Building and Maintaining Effective Coalitions, 2nd ed. Palo Alto, CA: Stanford Health Promotion Resource Center. Fineberg HV, Green GM, Ware JH, Anderson BL. 1994. Changing public health training needs: professional education and the paradigm of public health. Annual Review of Public Health 15:237–257. Garrett L. 2000. Betrayal of Trust: The Collapse of Global Public Health. New York: Hyperion. Gebbie KM. 1999. The public health workforce: key to public health infrastructure. American Journal of Public Health 89(5):660–661. Green LW, Mercer SL. 2001. Can public health researchers and agencies reconcile the push from funding bodies and the pull from communities? American Journal of Public Health 91(12):1926–1929. Green L, Daniel M, Novick L. 2001. Partnerships and coalitions for community based research. Public Health Reports 116(Suppl. 1):20–30. Hager, M. 1999. Education for More Synergistic Practice of Medicine and Public Health. New York: Josiah Macy, Jr., Foundation. Howard J (Ed.). 2001. Service-Learning Course Design Workbook. Ann Arbor, MI: OCSL Press. HRSA (Health Resources and Services Administration). 2000a. The public health workforce: enumeration 2000. Prepared for HRSA by Kristine Gebbie, Center for Health Policy, Columbia University School of Nursing, December. Washington, DC: HRSA. HRSA. 2000b. Public health training centers. Available online at http://bhpr.hrsa.gov/publichealth/phtc.htm. Accessed October 31, 2002. IOM (Institute of Medicine). 1988. The Future of Public Health. Washington, DC: National Academy Press. IOM. 1997a. Linking Research and Public Health Practice: A Review of CDC’s Program of Centers for Research and Demonstration of Health Promotion and Disease. Washington, DC: National Academy Press.

OCR for page 358
The Future of the Public’s Health in the 21st Century IOM. 1997b. Improving Health in the Community: A Role for Performance Monitoring. Washington, DC: National Academy Press. IOM. 2000. Promoting Health: Intervention Strategies from Social and Behavioral Research. Washington, DC: National Academy Press. IOM. 2001. Health and Behavior: The Interplay of Biological, Behavioral, and Societal Influences. Washington, DC: National Academy Press. IOM. 2002. The National Clinical Research Enterprise: Draft Discussion Paper of the Clinical Research Roundtable. Washington, DC: National Academy Press. IOM. 2003. Who Will Keep the Public Healthy? Educating Public Health Professionals. Washington, DC: National Academy Press. Israel BA, Schulz AJ, Parker EA, Becker AB. 1998. Review of community-based research: assessing partnership approaches to improve public health. Annual Review of Public Health 19:173–202. Israel BA, Schulz AJ, Parker EA, Becker AB. 2001. Community-based participatory research: policy recommendations for promoting a partnership approach in health research. Education for Health 14(2):182–197. Kegler MC, Steckler A, McLeroy K, Malek SH. 1998. Factors that contribute to effective community health promotion coalitions: a study of 10 project ASSIST coalitions in North Carolina. Health Education & Behavior 25(3):338–353. Kennedy VC, Spears WD, Loe HD, Jr., Moore FI. 1999. Public health workforce information: a state-level study. Journal of Public Health Management Practice 5(3):10–19. Kreuter MW, Lezin NA, Young LA. 2000. Evaluating community-based collaborative mechanisms: implications for practitioners. Health Promotion Practice 1(1):49–63. Lane DS. 2000. A threat to the public health workforce: evidence from trends in preventive medicine certification and training. American Journal of Preventive Medicine 18(1):87– 96. Lantz PM, Viruell-Fuentes E., Israel BA, Softley D, Guzman R. 2001. Can communities and academia work together on public health research? Evaluation results from a community-based participatory research partnership in Detroit. Journal of Urban Health: Bulletin of the New York Academy of Medicine 78(3): 495-507. Lasker RD. 1999. What to teach medical students about public health for synergistic practice, pp. 148–158. In Hager M (Ed.). Education for More Synergistic Practice of Medicine and Public Health. New York: Josiah Macy, Jr., Foundation. Lasker RD. 2000. Promoting Collaborations that Improve Health. Prepared for Discussion at Community-Campus Partnerships for Health’s 4th Annual Conference. New York: The New York Academy of Medicine Division of Public Health Lumpkin J. 1999. What to teach students of public health about medical practice. In Hager M (Ed.). Education for More Synergistic Practice of Medicine and Public Health. New York: Josiah Macy, Jr., Foundation. Maurana C, Wolff M, Beck BJ, Simpson DE. 2000. Working with Communities: Moving from Service to Scholarship in the Health Professions. Prepared for Discussion at Community-Campus Partnerships for Health’s 4th Annual Conference. San Francisco, CA: Community-Campus Partnerships for Health. McGinnis JM, Foege WH. 1993. Actual causes of death in the United States. Journal of the American Medical Association 170(18):2207–2211. Mullan F. 2000. Public health then and now. American Journal of Public Health 90(5):702– 706. National Association of Schools of Public Affairs and Administration. 1998. Survey of Enrollment and Degrees—Academic Year 1997–1998. Washington, DC: National Association of Schools of Public Affairs and Administration.

OCR for page 358
The Future of the Public’s Health in the 21st Century Nelson JC, Rashid H, Galvin VG, Essien JDK, Levine LM. 1999. Public/private partners: key factors in creating a strategic alliance for community health. American Journal of Preventive Medicine 16(3 Suppl.):94–102. NIH (National Institutes of Health). 2002a. Centers for Children’s Environmental Health and Disease Prevention Research. Division of Extramural Research and Training (DERT) website. Available online at www.niehs.nih.gov/dert/. Accessed October 31, 2002. NIH. 2002b. Current research. Prevention Research Branch, National Institute for Child Health and Human Development (NICFD), NIH. Available online at www.nichd.nih.gov/about/despr/prbrsh.htm. Accessed October 31, 2002. O’Neil EH, Pew Health Professions Commission. 1998. Recreating Health Professional Practice for a New Century. San Francisco, CA: Pew Health Professions Commission. Phillips DF. 2000. Medicine–public health collaboration tested. Journal of the American Medical Association 283(4):465–467. Porter M, Monard K. 2001. Ayni in the global village: building relationships of reciprocity through international service-learning. Michigan Journal of Community Service Learning Fall5–17. Reder S, Gale JL, Taylor J. 1999. Using a dual method needs assessment to evaluate the training needs of public health professionals. Journal of Public Health Management and Practice 5(6):62–69. Rhoads R, Howard J (Eds.). 1998. Academic Service Learning: A Pedagogy of Action and Reflection. San Francisco, CA: Josey-Bass Publishers. Riegelman R, Persily NA. 2001. Health information systems and health communications: narrowband and broadband technologies as core public health competencies. American Journal of Public Health 91(8):1179–1195. Roussos ST, Fawcett SB. 2000. A review of collaborative partnerships as a strategy for improving community health. Annual Review of Public Health 21:369–402. Sattin RW. 2001. The Prevention Research Initiative and the peer review process at CDC. Public Health Reports 116(Suppl. 1):254–256. Scrimshaw SC, White L, Koplan J. 2001. The meaning and value of prevention research. Public Health Reports 116(Suppl. 1):4–9. Scutchfield FD, Spain C, Pointer DD, Hafey JM. 1995. The Public Health Leadership Institute: leadership training for state and local health officers. Journal of Public Health Policy 16(3):304–323. Seifer S, Krauer P. 2001. Toward a policy agenda for community-campus partnerships. Education for Health 14(2):156–162. Solloway M, Haack M, Evans L. 1997. Assessing the Training and Education Needs of the Public Health Workforce in Five States. Washington, DC: Center for Health Policy Research, Workforce Study Group, The George Washington University Medical Center. Spencer HC. 2000. Testimony before the IOM Committee on Assuring the Health of the Public in the 21st Century. Washington, DC: Institute of Medicine. Sullivan TJ. 2001. Methods of Social Research. Fort Worth, TX: Harcourt Brace and Co. Turnock BJ. 2001. Public Health: What It Is and How It Works. Gaithersburg, MD: Aspen Publishers, Inc. Valente TW. 2002. Evaluating Health Promotion Programs. New York: Oxford University Press.

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