TRAINING FOR PUBLIC HEALTH

Preparation for a career in public health usually requires formal training at the graduate level, typically resulting in a Master of Public Health (M.P.H.) degree. Career options for a person with an M.P.H. are varied, and there are many types of organizations that employ public health professionals. Historically, these have included mainly federal, state, and local health departments, but contemporary public health practice has broadened to include many other employment settings, such as community-based organizations, health care facilities, insurance agencies, foundations, voluntary health agencies, and various business and industry settings.

All of these career options, regardless of employer, share an emphasis on populations rather than on individual clients or patients, and a broadly shared mission to promote health and prevent disease and disability. Major public health job titles, for example, include epidemiologists, biostatisticians, health-services administrators, health policy analysts, environmental health scientists, industrial hygienists, occupational health and safety specialists, biomedical and laboratory technicians, health educators, evaluation researchers, and health-services researchers. In addition, many people combine clinical training with public health training for jobs such as preventive medicine physicians, public health nurses, and public health nutritionists.

The M.P.H. degree is the most recognized professional degree in public health, although other degree titles are occasionally used. The M.P.H. degree usually takes between one and two years of full-time study, with the shorter course of study limited to individuals who enter with a prior professional degree, such as medicine or dentistry, or who have many years of public health work experience. The longer course of study is typical for students who enter the M.P.H. program directly from a baccalaureate program and without work experience.

The M.P.H. degree usually requires a set of public health core courses, a set of courses that provide skill development in a specialty area, a practicum or internship, and a final integrative project or experience. The public health core—the knowledge considered essential for all public health professionals regardless of their job titles—provides basic competencies in biostatistics, epidemiology, health-services administration, environmental health, and the social and behavioral sciences. The specialty courses build in-depth skills in one of these areas or in other recognized areas of public health practice, such as maternal and child health, international health, and public health nutrition. The particular specialties that a school or program offers beyond the public health core depends in large part on available faculty expertise. A practice experience, usually carried out in an agency setting, gives the student an opportunity to apply skills and knowledge learned in the coursework. A final integrative assignment, such as a thesis or a major essay, allows the student to demonstrate that he or she has mastered the content and is ready for practice. With some minor variations across schools and specialty areas, these four components are common to nearly all M.P.H. degree programs.

There are undergraduate training programs in selected areas of public health practice, such as community health education, health administration, and environmental health. Only a few undergraduate programs are offered in schools of public health, but many are available in baccalaureate-and master's-level colleges and universities. Although baccalaureate training is sometimes acceptable for entry-level public health positions, leadership positions usually require at least a masters degree. Doctoral training—leading to the Doctor of Public Health (D.P.H.) degree, which is the primary professional doctorate in public health, or to the Doctor of Philosophy (Ph.D.) degree, which is a highly specialized research degree—is offered in all U.S. schools of public health and in some of the larger programs outside schools of public health.

Public health, as a recognized profession, emerged in the early and mid-1800s with the onset of the Industrial Revolution. In response to the debilitating social and environmental conditions associated with the Industrial Revolution, public health emerged as a field of practice devoted to reducing disease and maintaining the health of the population. Drawing on the talents of physicians, nurses, engineers, chemists, lawyers, and statisticians, early public health efforts sought to solve community health problems. With the breakthrough of bacteriology in the late 1800s, public health became a science-based field, and the need for formal training was firmly established. However, it was not until the early part of the 1900s that a consensus emerged about a specific body of knowledge needed to achieve the goals of public health.

Elizabeth Fee, a noted public health historian and the author of The History of Education in Public Health: Health that Mocks the Doctors Rules, recounts the development of the public health profession as part of a "deliberate plan and strategy," not a haphazard, incremental set of events. She points to a conference in 1914 in the offices of the General Education Board of the Rockefeller Foundation as a "critical event in shaping the future structure of the public health profession." This meeting, which involved university leaders, early public health practitioners, and foundation representatives, set about "defining the necessary knowledge base for public health practice and designing the educational system needed to train a new profession." The Welch-Rose Report of 1915, written by two participants at that conference, would become the major reference document for the early design of schools of public health.

Formally organized and independent schools of public health emerged in this nation shortly afterwards, largely modeled after the Johns Hopkins University School of Hygiene and Public Health, which was the first of several schools of public health to be endowed by the Rockefeller Foundation. In the 1920s, Johns Hopkins, Yale, Columbia, and Harvard all established schools of public health. In the following decade, the Universities of Michigan, Minnesota, North Carolina, and California at Berkeley established full-fledged schools. However, a variety of other public health training programs emerged in other institutions of higher education, where offerings included short intensive courses, certificates, diplomas, or multiyear degree programs.

At about this same time, the American Public Health Association, then and now the major professional public health organization in the United States, launched a series of activities intended to standardize the formal training that was needed for public health practice. In 1946, the APHA established a formal accreditation process to publicly recognize those universities that met these standards. This action responded in part to the urgings of the Association of Schools of Public Health, a new organization established by the leading schools of public health, and in part to recommendations of the U.S. Surgeon General. The Surgeon General sought from APHA an authoritative list of educational institutions where post-World War II funds for public health training could best be invested. Ten schools of public health were initially accredited, one of them a Canadian institution.

By 1974 the APHA sought to transfer the accreditation responsibility to a new independent group, and in collaboration with the Association of Schools of Public Health, incorporated the Council on Education for Public Health (CEPH). In addition to schools of public health, CEPH began in the late 1970s to accredit graduate community health education programs and graduate community health/preventive medicine programs. These programs are usually smaller and more narrow in the scope of offerings than a school of public health, but they, too, prepare public health

Table 1

practitioners at the master's level, usually awarding the M.P.H.

Schools of public health are usually independent schools or colleges, organizationally similar to other professional schools, such as law, medicine, and engineering schools. In contrast, public health programs usually are located within some other organizational unit, such as schools of medicine, allied health, education, health, physical education, recreation and dance, public administration and policy, human ecology, pharmacy, or health and human services. Both schools and programs are located almost exclusively in the nation's large research universities. They are often a part of an academic health center, which serves as an umbrella organizational structure for schools of the health professions and medical care facilities that may be owned or operated by the university. The health professions schools typically include medicine, dentistry, nursing, pharmacy, veterinary medicine, allied health, and public health. The alignment of the health professions training programs in an academic health center facilitates communication and collaboration across disciplines, a hallmark of education in public health.

The most notable difference in the public health professional preparation landscape now and when CEPH was established in 1974 is the sheer number of institutions of higher education offering graduate training in public health. While there were 10 accredited schools in 1946 and 18 accredited schools in 1974, by October 2000, CEPH had accredited 72 schools and programs. These included 29 schools, 13 community health education programs, and 30 community health/preventive medicine programs. A list of accredited schools and programs is presented in Table 1 and an updated list is available through CEPH's web site (http://www.ceph.org).

The growth in public health training capacity during the past pales in comparison to the growth that appears to be on the immediate horizon. In 2000, projections based on the number of institutions that were formal applicants for accreditation or in some stage of planning and development, and that expect to seek CEPH accreditation in the future, indicated that the number of schools and programs accredited between 1974 and 1999 was likely to more than double between 2000 and 2010.

In addition to the great expansion in the number and type of institutions providing public health training, many innovations have occurred in public health training. Among these are: (1) collaborative organizations in which two or more universities jointly sponsor and operate a single, geographically dispersed M.P.H. program or school;(2) the rapid development and deployment of nontraditional, technology-based ways of delivering education, especially through interactive video and web-based distance learning options; (3) the emergence of new public health specializations in areas such as public health genetics, clinical investigations, and informatics; and (4) new and nontraditional partnerships among multiple universities and among public health practice agencies to deliver training opportunities for the public health workforce.

Patricia P. Evans

(see also: American Public Health Association; Association of Schools of Public Health; Careers in Public Health; Council on Education for Public Health; Public Health Practice Program Office )

Bibliography

Fee, E., and Acheson, R. M. (1991). A History of Education in Public Health: Health that Mocks the Doctor's Rules. New York: Oxford University Press.

National Association of County and City Health Officials (1996). Exploring Public Health Career Paths: An Overview of Public Health Career Opportunities. Washington, DC: Author.

National Health Council (1998). 270 Ways to Put Your Talent to Work in the Health Field. Washington, DC: Author.