In 1915, the Welch-Rose Report became the template for public health professional education in the United States.
The report established a public health education model that combined the laboratory mindset with the methods of public health administration and epidemiologic fieldwork. Rather than focus on diagnosing and treating a single individual, public health professionals are concerned with threats to the health of populations — as small as a handful of individuals or as large as a continent of people. Subfields of public health include environmental health, community health, behavioral health, health economics, public policy, mental health, and occupational safety and health.
Today, public health professionals find careers in a broad range of industries. They can be found in clinical settings or wellness and prevention programs acting as administrators, managers, researchers, policy leaders, and community outreach coordinators.
To recognize the 100th anniversary of the Welch-Rose Report, the Association of Schools and Programs of Public Health (ASPPH), which is the accrediting body for schools of public health, began re-examining the design of academic public health programs and developing a revised curriculum that reflects the changing roles of public health professionals.
As these graduates enter a variety of fields that include healthcare, consulting, and pharmaceuticals, they need to possess a variety of skills, such as collaboration and strategic thinking. The changing demographics of U.S. communities also create an increased need for public health students to understand the health challenges of underrepresented and underserved populations, the factors that contribute to health disparities, and strategies for reducing health inequities.
ASPPH’s Framing the Future Initiative kicked off in 2011 with an effort to produce a framework that would transform public health education, says Donna J. Petersen, ScD, dean of the College of Public Health at the University of South Florida, chair of the Framing the Future Task Force, and chair of the ASPPH Board of Directors.
The most significant change is the elimination of traditional core stand-alone courses and the integration of multiple core concepts into courses that better reflect the real world, says Petersen. She explains that previously, students would take a biostatistics class one semester and an epidemiology class another semester and never see how the lessons learned in each might come together to form a health policy.
At Boston University (BU), the transformation of the public health curriculum reflects the changing demographics of students as well as the variety of settings in which they will work, says Lisa M. Sullivan, PhD, associate dean for education in the BU School of Public Health. Not only are students planning to work in the healthcare or pharmaceutical industries rather than traditional public health settings, such as local and state health departments or federal agencies like the National Institutes of Health, but they often are not waiting to pursue a master’s degree after gaining work experience, she says.
“We have a lot more students coming into our master’s program directly from their undergraduate studies,” says Sullivan. “We do not have an undergraduate public health program, so most of them hold degrees in related fields but have not been exposed to public-health-specific courses.”
[Above: Lisa Sullivan leads a public health class at Boston University.]
This presents a challenge because courses must be designed to bring these students up to speed while still teaching new information to those who may have worked in the public health field before entering the master’s program, says Sullivan. “We also learned from our employer surveys that students were not prepared to think strategically and did not possess the soft skills that employers want — collaboration, teamwork, communication, and leadership,” she explains.
BU’s redesigned curriculum, which launched in fall 2016 for the master’s program, eliminated the six traditional stand-alone core courses that included biostatistics and epidemiology and created four integrated courses that combine related knowledge and skills. For example, Quantitative Methods for Public Health teaches biostatistics but demonstrates how this knowledge is used in correlation with epidemiology and environmental health to design programs or develop policy.
“It is a challenge for faculty who were accustomed to teaching one course,” says Sullivan. “I taught biostatistics and have had to change the way I teach the core course, but it is exciting, and we work together as a team to support each other.” She also points out that the redesigned curriculum is the result of faculty work groups providing input throughout the five years prior to its implementation. The process of discussion, compromise, and consensus, she says, was integral to its successful launch.
Once students have completed the core curriculum, they can choose specialties that are also interdisciplinary and focus on specific skills such as project management, community assessment, and health communications. The final step in the program is a practicum that now requires a minimum of 240 hours of hands-on experience working in a public health setting versus the previous minimum of 112 hours.
Sullivan points out that although students typically exceeded the minimum number of hours, faculty believed that requiring more hours for the practicum would expose students to additional opportunities to interact with diverse people and situations.
Because many students do not have professional experience and because of feedback from employers, BU’s public health program added another innovative course: a career prep class that provides information and tools to help students interview for and get that first job, as well as information on how to build a career.
University of Pittsburgh
At the University of Pittsburgh (Pitt) Graduate School of Public Health, curriculum changes as a result of ASPPH’s Framing the Future Initiative have focused on adding to the base of scientific courses and knowledge in the master’s program. This has included offering classes that give students the opportunity to integrate the knowledge gained in all courses into one semester-long project or case study, says Eleanor Feingold, PhD, senior associate dean and associate dean for education. “We added a new community and public health course that is case-based,” she says.
In this class, students are presented with a problem that must be solved — for example, designing a food bank for a specific community. They must evaluate demographics, assess needs, write grants, develop communications plans, and identify staffing or volunteer needs. “Instead of only writing a paper describing what they would do, they must produce deliverables such as strategic plans and grant applications,” Feingold says.
“We also redesigned the capstone course … to require production of all elements of the development of a public health program from beginning to end, including items such as budgets, human resource plans, communications strategies, and tactical plans,” she adds.
Additionally, cultural competence and population differences are incorporated throughout all of Pitt’s new and existing public health courses. Capstone assignments are based on cases in which there are cultural or socioeconomic differences in populations; these require final products geared to each population represented in the case, explains Feingold. For example, one part of the project would be a communication plan that identifies specific messages and methods to reach the different populations served.
“A case may include a population that is 50 percent Hispanic and 50 percent African American, and the student is expected to take language, cultural, educational, and economic differences into account when addressing the assignment,” says Feingold. Because access to care — as a result of financial or logistical issues, such as transportation — can cause healthcare disparities, acknowledging and recommending solutions to these issues is also critical.
Cultural differences in public health, however, are not always related solely to the client population, Feingold says. “A case might also include a situation with a boss who is of a different culture or gender,” she explains, “and the student must determine the most effective way to work with the individual as policies or public health programs are proposed.”
At this time, both BU and Pitt have focused on changes to their master’s degree curricula, as neither school offers an undergraduate degree in public health. However, both institutions report that they are constantly evaluating their programs.
“Changing the curriculum is a challenge, but it is the right thing to do,” says Sullivan. “I remind people that this is a work in progress.”●
Sheryl S. Jackson is a contributing writer for INSIGHT Into Diversity.