Framing the Future: The Second 100 Years of Education for Public Health

Framing the Future: Provocative Questions

Welcome to the blog for "Framing the Future: The Second Hundred Years of Education for Public Health." We are setting a bold course to reassess, reconsider and reframe public health education for the current century. We need everyone's input to make sure we are as thoughtful, comprehensive and innovative as we can be. We will be posting a series of "provocative questions" designed to elicit input from a wide audience. As we are taking an "empty room" approach to this task, we begin with the first such question and encourage you to be free-thinking and forward-focused in your response. Any and all comments welcome! Stay tuned for new questions every couple of weeks. And thank you in advance for actively engaging in this exciting process.

Q1: What do you believe should be the essential elements of a newly designed public health education system in the 21st century United States?

Progress! Bachelor’s Degrees: the “What”

Greetings! You haven't heard from me in a while but that's because we've been busy, appearing at various conferences, tracking your comments and questions and engaging in intense discussions at our task force meetings. Today, I'm happy to announce the release of the first draft of a set of "critical component elements" for undergraduate degrees in public health. Thanks to Dean Randy Wykoff (East Tennessee State University) and our expert panel, we generated and then whittled down a list of potential critical component elements in record time. Dean Wykoff's insight and foresight enabled this expert panel to focus exclusively on the relevant and appropriate content for undergraduate degrees, the "what", and to not get embroiled in unnecessary discussions of the "how" or the "who".

Said more simply, the critical component elements are just that - critical content that should be expressed, emphasized and integrated into undergraduate degrees in public health for students interested in entering the workforce and/or pursuing further graduate or professional studies in whatever structure, format or model makes sense for the particular institution offering the degree. Undergraduate education is enjoying an important metamorphosis and the expert panel was hopeful that innovative learning approaches would be incorporated in existing or new public health degree programs in two and four year colleges and universities. Remember that most of the growth in undergraduate public health degrees is in institutions of higher education that do NOT have schools or programs of public health. Having said that, these critical component elements are intended to inform the design of undergraduate public health degree programs at any institution, whether two year or four year, with or without an existing public health presence.

The critical component elements address basic content elements (the physical and social sciences, arts and humanities and quantitative reasoning) and basic skill areas (communications and information literacy); core public health content elements (an overview of public health, the role and importance of data, identifying and addressing community health challenges, human health, determinants of health, project management, health care systems and structures, health policy, law and economics and health communication; and capstone and field experiences.

We are soliciting comments from the widest possible audience until Tuesday May 29. Please take a moment to consider the critical component elements and share your thoughts with us. You may access them at http://www.asph.org/FramingtheFuture and send your comments to AUGPHelements@asph.org. Keep in mind that how we frame undergraduate public health education will necessarily shape how we reframe graduate and professional education in public health.

Keep those comments coming!

We'll post another provocative question next week.

Donna

 

The Gretzky Approach to Framing the Work of the Task Force (by Robert Meenan)

On Behalf of Robert Meenan, Dean, Chair, Sociomedical Sciences, and Professor, Health Policy & Management, Boston University School of Public Health:

"I will not be able to attend the Task Force meeting, so I will take this opportunity to put in my two cents.

I think the Task Force should approach its work using what is typically characterized as the Gretzky approach. Gretzky was a great hockey player because he had the foresight to go where the puck was going to be, not by going to where it was. And perhaps more importantly, not by going to where he wanted it to be. If the Task Force uses a Gretzky approach it will focus on where academic health is going to be, not on where it is and, most critically, not primarily on where we want it to be or where we hope it will be.

My sense of where public health will be in 25 years involves some fundamental changes:

• Public health will increasingly be seen as population health. It will entail a broader definition of the field that incorporates traditional public health while also incorporating an increasingly broad array of activities that overlap with traditional public health.
• Academic public (population) health will become less and less focused on the MPH degree and more and more focused on bachelor’s degrees and doctoral degrees. That has been the trend in many disciplines (nursing, PT) and it more closely matches the approach in most arts and sciences disciplines. The demand for bachelor’s graduates will grow for financial and other reasons, and the demand for doctoral graduates will grow as doctoral preparation becomes a requirement for leadership and management positions. The MPH may well revert to its original purpose – a supplemental degree in population health for physicians and other clinicians.
• Population health will increasingly focus on approaches to health that are based on systems thinking, facilitated by increasingly powerful computer and data analysis capacities. The field will need to become more numerically sophisticated and will need to train graduates in the use of sophisticated computational and modeling approaches. Systems thinking will be population health’s contribution to interprofessional education.

Here are my thoughts about the education ladder in population health:

• Bachelor-level education: The Task Force should consider a recommendation that all accredited schools of public health must offer bachelor’s degrees in public health. Public health education is expanding rapidly down to the bachelor’s level. If schools of public health do not “own” that expansion then the field will be irrevocably split between graduate education and undergraduate education. This will be a challenge to many schools because they are decidedly “graduate schools”. But if schools continue to concern themselves solely with graduate education and research, which is what many faculty and administrators would prefer, then academic public health will become increasingly isolated from the front lines of the field.

• Masters-level education; The Task Force should recommend fundamental changes in the requirements for the MPH curriculum. The current curriculum and requirements have been in place for decades. It is time to redefine and restructure our requirements so that they more closely match what will be expected of graduates. The requirements related to systems approaches, computation and modeling need to be strengthened. A critical challenge will be to redefine requirements rather than simply increasing requirements. This should be done by assuming that students entering MPH programs will no longer be neophytes but will have taken a substantial proportion of current MPH content as undergraduates.

• Doctoral education: I believe the Task Force should endorse a strengthening and expansion of DrPH programs. In its quest for university status, academic public health has emphasized PhD education. This has had the perverse but predictable effect of downplaying the fact that public health is a discipline that can be taught and learned at the doctoral level. It’s as if Schools of Medicine gave many more PhD than MD degrees. Doctoral degrees are increasing the required level of education for leadership and management positions. If public health wants to train leaders and managers, it needs to produce more DrPH graduates.

I am very concerned that the Task Force not define the content of public health education primarily or even largely in relation to public health practice and public health departments. Graduates with public health degrees are increasingly entering a broad array of career paths, and academic public health must prepare its graduates to pursue careers across that broad range.

The Task Force should recommend that the subsequent version of a Welch-Rose type report should take place in 50 years rather than 100 years. Change moves far too rapidly these days to wait that long.

Finally, I recommend that the Task Force should produce a blue print for lasting peace in the Middle East.

Good luck!

Bob Meenan"

Framing the Future: Provocative Question #3

We're getting some great comments in response to our questions and postings!  The more input we get, the better it will be for all of us (and you can and should feel free to respond to any of the posted questions or to comment on the responses).  Last week's question was on Interprofessional Education so this week we thought we would continue on that theme, with a different twist.

Q3:  Thinking about other professions and  how professionals are educated (be it in engineering, business, law, etc., or other health professions) what do you believe is the appropriate entry degree for the public health profession?  How about the appropriate terminal degree?

 

The MCATs and Interprofessional Education

This week the Association of American Medical Colleges (AAMC) officially approved changes in the Medical College Admission Test (MCAT). The changes not only represent an advance in preparation of pre-medical students but should have an important impact on interprofessional education.

Beginning in the spring of 2015 the MCAT will include a component on behavioral and social sciences that is parallel to its components on the natural and on the biological sciences. In addition, a new framework called Scientific Inquiry and Reasoning Skills (SIRS) will incorporate basic elements of research methods and statistics as well as evidence-based thinking. While these changes are specifically designed for preparation for the MCAT exam, they make sense for and are likely to be adopted by a wide range of clinical health professions.

The rapid growth that is occurring in undergraduate public health education provides an opportunity for public health to attract a large number of pre-health professional students to individual courses as well as public health minors and majors. Course work in epidemiology and biostatistics as well as in the social and behavioral sciences provide an opportunity for future clinicians to develop a population health perspective as well as gain specific knowledge and skills.

The times are changing and undergraduate public health is now on the national and student agendas. Students who will take the MCATs in the spring of 2015 are already or will soon be undergraduate students. Therefore the time is right to build on the momentum of interprofessional education and engage undergraduates with course work in health behavior and research methods and statistics through undergraduate course work in public health.

Undergraduate public health education can play a key role in preparing students for the health professions. Hopefully, it will also make them more receptive to the population perspective as they pursue clinical training and clinical practice.

Framing the Future: Provocative Question #2

One of the exciting trends in health professions education is the growing interest in Interprofessional Education.  As part of this movement, many health professions schools (e.g. medicine, veterinary medicine, nursing, dentistry, pharmacy, etc.) are seeking to infuse more public health content into their curricula.  How do you believe the public health community should respond to or capitalize on this interest?  What role should we play in shaping or providing this content?  What opportunities (or threats) do you perceive in this arena?

We look forward to your comments!

 

Provocative Question #1A

The conversation has started!  and we would like to hear from more of you.  The first question was a big one so to help you perhaps focus your thoughts, I offer the following refinement:

Thinking about public health education in the US, what one element do you believe is critical to the preparation of public health professionals for the next decade?  The one thing we must not lose sight of as we seek to redefine and redesign public health education?

Let us know your thoughts!

How to Furnish the Empty Room?

The very idea that we should try to envision collectively an optimal system of education for public health in the 21^st Century is a benchmark of the field’s growing maturity as a profession.  It has been almost 165 years since the idea of public health began to emerge as a reaction to the social and political upheaval of the Industrial Revolution, at least if you date it from the European Revolutions of 1848.  In the century past, we identified bodies of knowledge that could be standardized, transformed into curricula and taught.  We created public health collegiate units in universities to be the agents of professional and academic growth beginning on the eve of World War I.  We’ve developed credentials, accreditation and certification as key factors in professionalizing public health.  We have produced and placed public health professionals in a large and diverse if fragmented health system that has nevertheless been successful in improving population and community health in so many ways.  But some 100 years after Welch-Rose, what should we do in this century? 

When I discuss 21^st Century public health with people unfamiliar with the field, I use five descriptors:

• Collaborative
• Interdisciplinary
• Inter-professional
• Global
• Digital

I have found it useful to describe public health by characteristics of how it does its work rather than by an exhaustive (and exhausting) list of what it does.  The what changes with the social and political circumstances of health needs.  I find somewhat more stability in the how because it often reflects choices about means to achieve public health ends in ways that embody core public health values.

To begin with, public health is about all those conditions that enhance or detract from our collective self-actualization as humans (see Maslow). It is about human achievement, development and progress.  The conditions that converge to detract from collective human achievement are the “wicked challenges” that we face everyday.  Beyond the wicked challenges lie all those convergent factors that make for CQI in the human condition and take us to some new level of excellence and achievement.

Collaborative means leadership, teams, and building the capacity to engage all sectors of communities and societies in goal and outcomes-driven commitment and action.  It is about strategies of abundance (rather than scarcity) to leverage and amplify our strengths (like social capital) and counterbalance our weaknesses in pursuit of prevention and health promotion.  The Baldridge framework comes to mind.

Interdisciplinary is about the need to approach wicked challenges and human enhancement from multiple perspectives. If it’s about understanding or achieving change, then it’s about different causal pathways by which we believe change occurs within the individual, the group, the community or society at large.  See the SEM Model for greater depth.  As H.L. Mencken famously remarked, “For every complex problem, there is a single solution that is simple, neat, and wrong.”

Inter-professional is about breaking down the walls between health professions and healthcare and public health sectors that currently drive us to snatch defeat from the jaws of victory when it comes to community and population health.  This is about changing the way we educate all health professionals, and our expectations for all organizations’ and social institutions’ accountability for health outcomes.

Global and Digital are about critical factors that make this century and others to follow different. Fundamentally, they are about increasingly interlinked and interdependent systems of biology, environment, economy, and networks of changing social relations that span the planet.  They are also about the speed of interaction and change, and the depth and breadth of information and knowledge generation and diffusion.  While these terms encompass forces that may compound the complexity of wicked challenges, they also present astonishing opportunities for progress and achievement.

So, this is my initial take on what kind of “furniture” I would like to see in the metaphorical “empty room” we seek to design and fill. It surely won’t be my last and I look forward to hearing what you want to put there.  JRF

Welcome!

The purpose of the Association of Schools of Public Health (ASPH)-convened Framing Task Force blog is to promote communication among the many individuals and organizations vested in public health education and practice. As the task force aims to reconsider the role of public health education 100 years after the Welch-Rose Report and to develop a new vision for public health education in the future, we need to hear from you.