COMMENTARY
Anticipating Change, Sparking Innovation: Framing the Future As the 100th anniversary of the 1915 Welch-Rose report approaches, the Association of Schools and Programs of Public Health (ASPPH) has been pursuing two initiatives to spark innovation in academic partnerships for enhancing population health: (1) Framing the Future: The Second 100 Years of Education for Public Health and (2) Reconnecting Public Health and Care Delivery to Improve the Health of Populations. We describe how ASPPHmember schools and programs accredited by the Council on Education for Public Health, along with their extraordinarily diverse array of partners, are working to improve education that better prepares health professionals to meet 21st-century population health needs. (Am J Public Health. 2015;105: S46–S49. doi:10.2105/AJPH. 2014.302379)
Donna J. Petersen, ScD, MHS, CPH, John R. Finnegan Jr, PhD, and Harrison C. Spencer, MD, MPH, CPH
SINCE THE 1915 WELCH–ROSE report called for a new professional training program in the emerging field of organized public health, the field has struggled to secure its identity among the various clinical and nonclinical professions that contribute to population health.1---3 Al Sommer famously penned in 1995 that “public health is a goal, not a profession.”4(p657) He reflected both the importance and the enormity of the task and the great diversity of people who contribute to improvements in health through myriad institutional structures, organizations, and systems. Although Welch--Rose clearly articulated the need for “professionals” trained in public health, it equivocated on the degree to which public health should belong to a cadre of specially trained professionals. Recent opportunities, including the 2010 Patient Protection and Affordable Care Act,5 are inspiring academic public health to encourage systems capable of navigating rapid changes in education and health care to ensure population health. As the 100th anniversary of the Welch-Rose report approaches, the Association of Schools and Programs of Public Health (ASPPH) has been pursuing two initiatives to spark innovation in academic partnerships for enhancing the public’s health: Framing the Future: (1) The Second 100 Years of Education for Public Health Task Force (Framing the Future or task force) and (2) Reconnecting Public Health and Care Delivery to Improve the Health of Populations.
S46 | Commentary | Peer Reviewed | Petersen et al.
FRAMING THE FUTURE In summer 2011, the Education Committee of the Association of Schools of Public Health (now ASPPH) was faced with a confluence of exciting new initiatives.6 The Undergraduate Public Health Learning Outcomes Model had just been released. Growing pressure to develop guidelines for baccalaureate degrees in public health competed with the need to revisit and revise the Master of Public Health (MPH) core competencies developed in 2006.7 Innovations in the academic sector presented opportunities to rethink how education in public health is delivered. The rapidly changing health care landscape and policymakers’ demands for increased accountability in higher education and for health care and services that respond more efficiently and effectively to population health needs provided new opportunities to reconsider public health content in other health professional training, as well as consider integrating public health and the social determinants of health into fields and disciplines beyond the clinical arena. The committee created a special task force to take an “empty room approach” to exploring these issues and assembled a broadly representative group of stakeholders. The task force has 56 members from academia, governmental public health, other health professions, employers of public health professionals, foundations, the Council on Education for Public Health, and educational organizations including the Association of American Colleges and Universities and the League for
Innovation in the Community College. The task force conducts its work through subcommittees, inclusive of six expert panels and one advisory board (Figure 1). To propel maximum stakeholder engagement in innovative thinking, the task force developed a multidimensional approach. ASPPH created a Web site providing an easy-to-access platform for task force members and others. A blog posed provocative questions to stimulate discussion around critical issues considered by the task force. Those interested were encouraged to host town hall meetings to explore the latest thinking on the next 100 years of education in public health, of which 20 have occurred to date. Members submitted abstracts for presentations at partners’ conferences, and the chair conducted open discussions at every ASPPH major meeting as well as in-person task force meetings and conference calls. A 33-member Blue Ribbon Public Health Employers’ Advisory Board provided guidance to the task force on 21st-century workforce needs across the health system and how educational innovations can promote readiness.8 It was clear from the beginning that establishing the task force aligned fully with major change trends already evident. Following the initial creation of schools of public health at the time of the Welch---Rose report (circa World War I), new schools of public health emerged slowly and almost exclusively at the graduate level for much of the 20th century. A few schools offered undergraduate degrees, all offered the MPH,
American Journal of Public Health | Supplement 1, 2015, Vol 105, No. S1
COMMENTARY
Undergraduate Public Health Education Expert Panel (2011–2012)
MPH Expert Panel (2012–2014)
Community Colleges and Public Health Expert Panel (2012–2014)
Task Force empaneled (2011–present)
DrPH Expert Panel (2014)
Blue Ribbon Public Health Employers’ Advisory Board (2013–present)
Workforce Development Expert Panel (2014–present)
Population Health in All Professions Expert Panel (2014–present)
Note. ASPPH = Association of Schools and Programs of Public Health; DrPH = Doctor of Public Health; MPH = Master of Public Health
FIGURE 1—Expert panels and advisory board for The Framing the Future: The Second 100 Years of Education for Public Health Task Force.
some offered other master’s degrees, most offered the Doctor of Philosophy (PhD), and some offered the Doctor of Public Health (DrPH). Despite the creation of a mechanism for academic accreditation in 1945,9 it took more than 60 years after the 1915 Welch---Rose report before the number of accredited schools reached 20. It took another 20 years to reach 30 accredited schools. Beginning in the late 1990s, however, growth began to accelerate. In the next decade, another 10 accredited schools emerged, and in the following three years, another 10. Accredited programs experienced a similar growth trajectory. It took 30 years for the first 26 accredited programs to appear and less than half that time to accredit another 76 (Christine M. Plepys, MS, e-mail communication, May 2014). Although this was extraordinary growth, it was mostly limited to an increase in the number of schools and programs and did not extend to educational innovations.
A similar increase occurred among undergraduate public health programs. After identifying more than 100 such programs— many in liberal arts colleges—the ASPPH formed the Undergraduate Public Health Education Expert Panel in 2012. Invited members were charged with pinpointing the critical issues in undergraduate public health education. The panel then worked to produce “The Recommended Critical Component Elements of an Undergraduate Major in Public Health,”10 a report that the Council on Education for Public Health adopted in its entirety as part of its inaugural criteria for the accreditation of stand-alone baccalaureate programs. As of summer 2014, 12 such programs are in applicant status and currently preparing self-studies (Laura Rasar King, MPH, oral communication, August 2014). This was an early and important innovation of the larger process in rationalizing the components of baccalaureate education in public health and its
Supplement 1, 2015, Vol 105, No. S1 | American Journal of Public Health
distinctive purpose and content as compared with graduate-level learning. The task force convened a second expert panel exploring the role of two-year colleges in education for public health. This activity aligned well with the national rising interest in the role of two-year colleges eager to support those students transferring to the new 4-year programs in public health. Beyond designing models for two-year associate of arts transfer degrees, the group explored the development of standalone associate of science degrees in public health and considered the essential role two-year colleges could play in workforce development, a persistent need in a field still dominated by those not trained in public health. The League for Innovation in the Community College staffed this panel; its report was completed in fall 2014. The first phase of the project produced a series of Foundation and Consensus Statements11 in 2013 that reflected
what public health and community colleges could do together. The second phase produced “prototype curricular models” designed for associate’s degrees and academic certificate programs in community colleges. Discussion around nextgeneration transformation of the MPH centered on changes in the field of public health, workforce needs, and changing educational technologies. The Patient Protection and Affordable Care Act accelerated changes in health care, including new emphases on prevention and health promotion, outcomes metrics, values-based payments, electronic health records, and patient-centered care.5 Combined with a greater emphasis on population health, the nation continues to move toward a conceptualization of a health system truly focused on health improvement for all, from the clinical setting to the community. Reaching this goal requires a new relation between public health and health care delivery as well as reenvisioning interprofessional education of health care professionals beyond high-performing clinical teams alone. How will public health engage in, collaborate with, and affect this new environment? Technological innovations are also changing where and when health care can and should be delivered, challenging us to rethink our approach to teaching and modes of learning. These two revolutions in health care and higher education provided an immense opportunity for public health and led to the formation of four more expert panels focusing on (1) the MPH degree, (2) the DrPH degree, (3) the integration of population health across all professions, and (4) workforce development. In light of other health professions moving to the doctorate as
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COMMENTARY
the terminal degree, the MPH Expert Panel deliberated on the value of the MPH and determined that it was “here to stay.” Several visionary recommendations from the expert panel included the emphasis on an integrated common core rooted in professional practice (and not in the traditional five core disciplines); the liberation of graduate programs from the requirement that they offer the MPH in the five core disciplines toward encouraging the creation of concentrations more reflective of the strengths of the institutions and the needs of the communities each serves; and the clear emphasis on preparing professionals with a definitive area of expertise.12(p373)
Thus, the MPH is now clearly distinguished as a specialty degree but with greater emphasis on shared professional content across specialty areas. The conversations taking place in town halls, at conferences, and with employers and thought leaders consistently emphasized that greater attention be paid to the knowledge, skills, and values underlying public health practice in the new century and that more active, integrated, and student-centered approaches to learning are needed. At the same time, the need for individuals with depth of knowledge and breadth of skills was equally apparent. The expert panel handled this challenge by reflecting on both design elements and critical content of the MPH degree. This shift in thinking about the MPH and learning approaches is intended to stimulate creative strategies and experimentation in schools and programs across the United States. Schools such as the Mailman School of Public Health at Columbia University (the host of the symposium that led to this special issue) have successfully implemented a redesigned MPH program with a fully integrated core curriculum.13 The School of Public
Health at Loma Linda University has eliminated its traditional discipline-specific departmental structure and reorganized around three academic centers. Other examples can be found in these pages, and the innovations will continue. The MPH degree report issued in January 2014 supersedes the prior MPH core competencies developed in 2006,7 whereas the DrPH Expert Panel is building on the DrPH core competencies from 200914 and more clearly defining the role of DrPH degree holders as transformative practitioners and leaders who parlay evidence-based findings in health systems that are increasingly focused on population health approaches to improving health outcomes at lower health care costs. This report was also finalized in fall 2014. The late-breaking Population Health in All Professions Expert Panel formed in light of the growing recognition that improving health outcomes will require increased attention to population health in the education and practice of all professions. The panel’s goal is to propose a framework for professional education addressing population health in the preparation of professionals in health fields and other disciplines. In recognizing that what is true for the health professions is equally appropriate for other professions that affect the public’s health, such as architecture and urban planning, law, public administration, civil engineering, economics, business, and international affairs, the opportunity for cross-training is nearly limitless. This panel’s report is anticipated during winter 2015. A recently formed expert panel in conjunction with the Association of State and Territorial Health Officials will examine the opportunities for and roles and responsibilities of academic public
S48 | Commentary | Peer Reviewed | Petersen et al.
health institutions in workforce development in the traditional public sector. This is an important component of education in public health, one anticipated in the Welch---Rose report1,2 and a frequent subject of town hall meetings and task force deliberations. The full task force continues to engage in lively discussions around other emerging opportunities that it anticipates in the near future. From expanded views of learning spaces and competencybased credentialing to kindergarten through 12th-grade education, dual enrollment, and new forms of certification, we expect a continued acceleration of the changes first signaled by the growth in the number of schools and programs. The Framing the Future task force provides the means for deep discussions around these issues as we continue to seek the best ways to shape improvements in population health. As promised, task force products have been released immediately so that they can be considered and implemented as quickly as possible. As a final nod to the innovative spirit of its work, the task force will not issue a traditional report. Rather, the products of the task force that are already available online will be assembled as dynamic Web-based content designed to encourage continuing dialogue and the addition of continuing innovations. Each of the reports noted earlier and a space for ongoing dialogue via social media will be on the ASPPH Web site (www.aspph.org/ educate) by early 2015.
RECONNECTING PUBLIC HEALTH AND CARE DELIVERY As a founding member of the Interprofessional Education Collaborative, composed of the
organizations that represent higher education in allopathic medicine, dentistry, nursing, osteopathic medicine, pharmacy, and public health, the ASPPH contributed to the creation of core competencies for interprofessional collaborative practice that guide curricula development in all health professions.15 In May 2014, ASPPH and the Interprofessional Education Collaborative, with support from the National Center for Interprofessional Practice and Education,16 hosted the Reconnecting Public Health and Care Delivery to Improve the Health of Populations thought leaders conference. This, the first of a series of planned events, was intended to meet the long-range goal to achieve improved population health through integrating health professional education, public health practice, and care delivery in an evolving health care system. A background concept paper set the stage for the conference, describing the increasing momentum from all sectors of health to transform care delivery into an outcomesfocused system that improves population health; provides value-added services across the continuum of care; directly engages individuals, families, and communities in achieving health; and that simultaneously reduces per-capita cost (Frank B. Cerra, MD, unpublished paper, May 2014).
Although the macrolevel system (organizational capabilities of entities such as academic institutions, public health organizations, and health system agencies) is described as evolving successfully in connecting public health to care delivery, the problem statement in the paper points to the lack of productive interaction and integration at the micro level (individual proficiencies of health professions students, public health
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agency practitioners, and individual care providers) and at the meso level (team performance). Because this conference occurred too recently to have produced output, the ASPPH and Interprofessional Education Collaborative will work with the National Center for Interprofessional Practice and Education to follow up and synthesize the thought leaders’ suggestions at the conference regarding creating a new health system—one that values disease prevention and population health promotion, provides incentives for systems leaders and providers to manage and optimize population health data and strategies that use evidence-based mechanisms and methods, and demands interprofessional collaboration and training. Next steps include setting priorities for action, identifying the implications of change, and defining the pathways for the interface changes to occur. We sincerely hope that the conversations occurring through the Framing the Future and Reconnecting Public Health and Care Delivery efforts continue to spark wildly creative ideas and that collectively we continue to anticipate change, advance knowledge, and assist in public health academe’s role in building a cadre of well-prepared, inspired, and collaborationminded public health and health care professionals for a healthier world. j
About the Authors Donna J. Petersen is with the Framing the Future Task Force, the Association of Schools and Programs of Public Health, and the University of South Florida, Tampa. John R. Finnegan is with the Association of Schools and Programs of Public Health and the School of Public Health, University of Minnesota, Minneapolis. Harrison C. Spencer is with the Association of Schools and Programs of
Public Health and the Interprofessional Education Collaborative, Washington, DC. Correspondence should be sent to Donna J. Petersen, ScD, MHS, CPH, Dean, College of Public Health, University of South Florida, 13201 Bruce B Downs Blvd, MDC 056, Tampa, FL 33612 (e-mail: dpeters@health. usf.edu). Reprints can be ordered at http://www.ajph.org by clicking the “Reprints” link. This article was accepted October 1, 2014.
Contributors D. J. Petersen and J. R. Finnegan developed the first draft of the article. All authors contributed additional material, comments, and revisions in producing the final, consensus article.
Richard M. Fairbanks School of Public Health—Indianapolis (Workforce Development Expert Panel, cochair); Terry Dwelle, State Health Officer, North Dakota Department of Health (Workforce Development Expert Panel, cochair); and David J. Fine, President, Catholic Health Initiatives Institute for Research and Innovation (Blue Ribbon Public Health Employers’ Advisory Board, chair). Also deserving of thanks for their leadership and oversight of the initiative are the following Association of Schools and Programs of Public Health board of directors’ members: Michael Klag, Dean, Johns Hopkins Bloomberg School of Public Health (immediate past chair and board governance committee, chair); and Gary Raskob, Dean and Regents Professor, University of Oklahoma Health Sciences Center College of Public Health (chair-elect).
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11. Community Colleges and Public Health Project. Interim Report. November 2013. Available at: http://www.league. org/league/projects/ccph/files/ InterimReport_PrintFriendlyVersion.pdf. Accessed on June 12, 2014. 12. Petersen DJ, Weist EM. Framing the future by mastering the new public health. J Public Health Manag Pract. 2014;20 (4):371---374. 13. Begg MD, Galez S, Bayer R, Walker JR, Fried LP. MPH education for the 21st century: design of Columbia University’s new public health curriculum. Am J Public Health. 2014;104(1):30---36.
References
14. Calhoun JG, McElligott JE, Weist EM, Raczynski JM. Core competencies for doctoral education in public health. Am J Public Health. 2012;102(1):22---29.
1. Welch WH, Rose W. Institute of Hygiene. New York, NY: Rockefeller Foundation, General Education Board; 1915.
15. National Center for Interprofessional Practice and Education Web site. Available at: https://nexusipe.org. Accessed on June 12, 2014.
2. Fee E. The Welch-Rose Report: Blueprint for Public Health Education in America. 1992. Available at: http://www. deltaomega.org/documents/WelchRose. pdf. Accessed on June 12, 2014.
16. Interprofessional Education Collaborative Expert Panel. Core Competencies for Interprofessional Collaborative Practice. Washington, DC: Interprofessional Education Collaborative; 2011. Available at: https://ipecollaborative.org/uploads/ IPEC-Core-Competencies.pdf. Accessed on June 12, 2014.
Acknowledgments The Association of Schools and Programs of Public Health received support from the Centers for Disease Control and Prevention for the Undergraduate Public Health Education Expert Panel of the Framing the Future Task Force. The authors wish to acknowledge the Framing the Future Task Force members for their support and guidance on this initiative since 2011. In particular, the following individuals deserve thanks for their dedication in leading most of the task force activities and for their work in producing consensus reports: Randy Wykoff, Dean, East Tennessee State University College of Public Health (Undergraduate Public Health Education Expert Panel, chair); Robert Meenan, Dean, Boston University School of Public Health (MPH Expert Panel, chair); Richard Riegelman, Professor and Founding Dean, George Washington University Milken Institute School of Public Health (Community Colleges and Public Health Expert Panel, cochair); Cynthia Wilson, Vice President, Learning and Research, League for Innovation in the Community College (Community Colleges and Public Health Expert Panel, cochair); James Raczynski, Founding Dean and Professor, University of Arkansas for Medical Sciences Fay W. Boozman College of Public Health (DrPH Expert Panel, chair); Ruth Gaare Bernheim, Chair, Department of Public Health Sciences, University of Virginia School of Medicine (Population Health in All Professions Expert Panel, chair); David Goff, Dean and Professor, Colorado School of Public Health: University of Colorado, Colorado State University, University of Northern Colorado (Population Health in All Professions Expert Panel, subgroup leader); Howard Frumkin, Dean, University of Washington School of Public Health (Population Health in All Professions Expert Panel, subgroup leader); Paul Halverson, Founding Dean, Indiana University
elements of an undergraduate major in public health. Public Health Rep. 2013;128(5):421---424.
3. Evashwick CJ, Begun JW, Finnegan JR. Public health as a distinct profession: has it arrived? J Public Health Manag Pract. 2013;19(5):412---419. 4. Sommer A. W(h)ither public health? Public Health Rep. 1995;110(6):657---661. 5. Patient Protection and Affordable Care Act, 42 USC §18001 et seq (2010). 6. Petersen DJ, Albertine S, Plepys CM, Calhoun JG. Developing an educated citizenry: the undergraduate public health learning outcomes project. Public Health Rep. 2013;128(5):425---430. 7. Calhoun JG, Ramiah R, Weist EM, Shortell SM. Development of a core competency model for the master of public health degree. Am J Public Health. 2008;98:1598---1607. 8. Association of Schools and Programs of Public Health. Public Health Trends and Redesigned Education: Blue Ribbon Public Health Employers’ Advisory Board: Summary of Interviews. September 6, 2013. Available at: http://publichealth.uic.edu/ media/uicedu/sph/downloads/pdfs/ hpa/BlueRibbonPublicHealthEmployers AdvisoryBoard_Report2013.pdf. Accessed on June 12, 2014. 9. Council on Education for Public Health. History. Available at: http://ceph. org/about/history. Accessed on June 12, 2014. 10. Wykoff R, Petersen D, Weist EM. The recommended critical component
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Anticipating Change, Sparking Innovation: Framing the Future As the 100th anniversary of the 1915 Welch-Rose report approaches, the Association of Schools and Programs of Public Health (ASPPH) has been pursuing two initiatives to spark innovation in academic partnerships for enhancing population health: (1) Framing the Future: The Second 100 Years of Education for Public Health and (2) Reconnecting Public Health and Care Delivery to Improve the Health of Populations. We describe how ASPPHmember schools and programs accredited by the Council on Education for Public Health, along with their extraordinarily diverse array of partners, are working to improve education that better prepares health professionals to meet 21st-century population health needs. (Am J Public Health. 2015;105: S46–S49. doi:10.2105/AJPH. 2014.302379)
Donna J. Petersen, ScD, MHS, CPH, John R. Finnegan Jr, PhD, and Harrison C. Spencer, MD, MPH, CPH
SINCE THE 1915 WELCH–ROSE report called for a new professional training program in the emerging field of organized public health, the field has struggled to secure its identity among the various clinical and nonclinical professions that contribute to population health.1---3 Al Sommer famously penned in 1995 that “public health is a goal, not a profession.”4(p657) He reflected both the importance and the enormity of the task and the great diversity of people who contribute to improvements in health through myriad institutional structures, organizations, and systems. Although Welch--Rose clearly articulated the need for “professionals” trained in public health, it equivocated on the degree to which public health should belong to a cadre of specially trained professionals. Recent opportunities, including the 2010 Patient Protection and Affordable Care Act,5 are inspiring academic public health to encourage systems capable of navigating rapid changes in education and health care to ensure population health. As the 100th anniversary of the Welch-Rose report approaches, the Association of Schools and Programs of Public Health (ASPPH) has been pursuing two initiatives to spark innovation in academic partnerships for enhancing the public’s health: Framing the Future: (1) The Second 100 Years of Education for Public Health Task Force (Framing the Future or task force) and (2) Reconnecting Public Health and Care Delivery to Improve the Health of Populations.
S46 | Commentary | Peer Reviewed | Petersen et al.
FRAMING THE FUTURE In summer 2011, the Education Committee of the Association of Schools of Public Health (now ASPPH) was faced with a confluence of exciting new initiatives.6 The Undergraduate Public Health Learning Outcomes Model had just been released. Growing pressure to develop guidelines for baccalaureate degrees in public health competed with the need to revisit and revise the Master of Public Health (MPH) core competencies developed in 2006.7 Innovations in the academic sector presented opportunities to rethink how education in public health is delivered. The rapidly changing health care landscape and policymakers’ demands for increased accountability in higher education and for health care and services that respond more efficiently and effectively to population health needs provided new opportunities to reconsider public health content in other health professional training, as well as consider integrating public health and the social determinants of health into fields and disciplines beyond the clinical arena. The committee created a special task force to take an “empty room approach” to exploring these issues and assembled a broadly representative group of stakeholders. The task force has 56 members from academia, governmental public health, other health professions, employers of public health professionals, foundations, the Council on Education for Public Health, and educational organizations including the Association of American Colleges and Universities and the League for
Innovation in the Community College. The task force conducts its work through subcommittees, inclusive of six expert panels and one advisory board (Figure 1). To propel maximum stakeholder engagement in innovative thinking, the task force developed a multidimensional approach. ASPPH created a Web site providing an easy-to-access platform for task force members and others. A blog posed provocative questions to stimulate discussion around critical issues considered by the task force. Those interested were encouraged to host town hall meetings to explore the latest thinking on the next 100 years of education in public health, of which 20 have occurred to date. Members submitted abstracts for presentations at partners’ conferences, and the chair conducted open discussions at every ASPPH major meeting as well as in-person task force meetings and conference calls. A 33-member Blue Ribbon Public Health Employers’ Advisory Board provided guidance to the task force on 21st-century workforce needs across the health system and how educational innovations can promote readiness.8 It was clear from the beginning that establishing the task force aligned fully with major change trends already evident. Following the initial creation of schools of public health at the time of the Welch---Rose report (circa World War I), new schools of public health emerged slowly and almost exclusively at the graduate level for much of the 20th century. A few schools offered undergraduate degrees, all offered the MPH,
American Journal of Public Health | Supplement 1, 2015, Vol 105, No. S1
COMMENTARY
Undergraduate Public Health Education Expert Panel (2011–2012)
MPH Expert Panel (2012–2014)
Community Colleges and Public Health Expert Panel (2012–2014)
Task Force empaneled (2011–present)
DrPH Expert Panel (2014)
Blue Ribbon Public Health Employers’ Advisory Board (2013–present)
Workforce Development Expert Panel (2014–present)
Population Health in All Professions Expert Panel (2014–present)
Note. ASPPH = Association of Schools and Programs of Public Health; DrPH = Doctor of Public Health; MPH = Master of Public Health
FIGURE 1—Expert panels and advisory board for The Framing the Future: The Second 100 Years of Education for Public Health Task Force.
some offered other master’s degrees, most offered the Doctor of Philosophy (PhD), and some offered the Doctor of Public Health (DrPH). Despite the creation of a mechanism for academic accreditation in 1945,9 it took more than 60 years after the 1915 Welch---Rose report before the number of accredited schools reached 20. It took another 20 years to reach 30 accredited schools. Beginning in the late 1990s, however, growth began to accelerate. In the next decade, another 10 accredited schools emerged, and in the following three years, another 10. Accredited programs experienced a similar growth trajectory. It took 30 years for the first 26 accredited programs to appear and less than half that time to accredit another 76 (Christine M. Plepys, MS, e-mail communication, May 2014). Although this was extraordinary growth, it was mostly limited to an increase in the number of schools and programs and did not extend to educational innovations.
A similar increase occurred among undergraduate public health programs. After identifying more than 100 such programs— many in liberal arts colleges—the ASPPH formed the Undergraduate Public Health Education Expert Panel in 2012. Invited members were charged with pinpointing the critical issues in undergraduate public health education. The panel then worked to produce “The Recommended Critical Component Elements of an Undergraduate Major in Public Health,”10 a report that the Council on Education for Public Health adopted in its entirety as part of its inaugural criteria for the accreditation of stand-alone baccalaureate programs. As of summer 2014, 12 such programs are in applicant status and currently preparing self-studies (Laura Rasar King, MPH, oral communication, August 2014). This was an early and important innovation of the larger process in rationalizing the components of baccalaureate education in public health and its
Supplement 1, 2015, Vol 105, No. S1 | American Journal of Public Health
distinctive purpose and content as compared with graduate-level learning. The task force convened a second expert panel exploring the role of two-year colleges in education for public health. This activity aligned well with the national rising interest in the role of two-year colleges eager to support those students transferring to the new 4-year programs in public health. Beyond designing models for two-year associate of arts transfer degrees, the group explored the development of standalone associate of science degrees in public health and considered the essential role two-year colleges could play in workforce development, a persistent need in a field still dominated by those not trained in public health. The League for Innovation in the Community College staffed this panel; its report was completed in fall 2014. The first phase of the project produced a series of Foundation and Consensus Statements11 in 2013 that reflected
what public health and community colleges could do together. The second phase produced “prototype curricular models” designed for associate’s degrees and academic certificate programs in community colleges. Discussion around nextgeneration transformation of the MPH centered on changes in the field of public health, workforce needs, and changing educational technologies. The Patient Protection and Affordable Care Act accelerated changes in health care, including new emphases on prevention and health promotion, outcomes metrics, values-based payments, electronic health records, and patient-centered care.5 Combined with a greater emphasis on population health, the nation continues to move toward a conceptualization of a health system truly focused on health improvement for all, from the clinical setting to the community. Reaching this goal requires a new relation between public health and health care delivery as well as reenvisioning interprofessional education of health care professionals beyond high-performing clinical teams alone. How will public health engage in, collaborate with, and affect this new environment? Technological innovations are also changing where and when health care can and should be delivered, challenging us to rethink our approach to teaching and modes of learning. These two revolutions in health care and higher education provided an immense opportunity for public health and led to the formation of four more expert panels focusing on (1) the MPH degree, (2) the DrPH degree, (3) the integration of population health across all professions, and (4) workforce development. In light of other health professions moving to the doctorate as
Petersen et al. | Peer Reviewed | Commentary | S47
COMMENTARY
the terminal degree, the MPH Expert Panel deliberated on the value of the MPH and determined that it was “here to stay.” Several visionary recommendations from the expert panel included the emphasis on an integrated common core rooted in professional practice (and not in the traditional five core disciplines); the liberation of graduate programs from the requirement that they offer the MPH in the five core disciplines toward encouraging the creation of concentrations more reflective of the strengths of the institutions and the needs of the communities each serves; and the clear emphasis on preparing professionals with a definitive area of expertise.12(p373)
Thus, the MPH is now clearly distinguished as a specialty degree but with greater emphasis on shared professional content across specialty areas. The conversations taking place in town halls, at conferences, and with employers and thought leaders consistently emphasized that greater attention be paid to the knowledge, skills, and values underlying public health practice in the new century and that more active, integrated, and student-centered approaches to learning are needed. At the same time, the need for individuals with depth of knowledge and breadth of skills was equally apparent. The expert panel handled this challenge by reflecting on both design elements and critical content of the MPH degree. This shift in thinking about the MPH and learning approaches is intended to stimulate creative strategies and experimentation in schools and programs across the United States. Schools such as the Mailman School of Public Health at Columbia University (the host of the symposium that led to this special issue) have successfully implemented a redesigned MPH program with a fully integrated core curriculum.13 The School of Public
Health at Loma Linda University has eliminated its traditional discipline-specific departmental structure and reorganized around three academic centers. Other examples can be found in these pages, and the innovations will continue. The MPH degree report issued in January 2014 supersedes the prior MPH core competencies developed in 2006,7 whereas the DrPH Expert Panel is building on the DrPH core competencies from 200914 and more clearly defining the role of DrPH degree holders as transformative practitioners and leaders who parlay evidence-based findings in health systems that are increasingly focused on population health approaches to improving health outcomes at lower health care costs. This report was also finalized in fall 2014. The late-breaking Population Health in All Professions Expert Panel formed in light of the growing recognition that improving health outcomes will require increased attention to population health in the education and practice of all professions. The panel’s goal is to propose a framework for professional education addressing population health in the preparation of professionals in health fields and other disciplines. In recognizing that what is true for the health professions is equally appropriate for other professions that affect the public’s health, such as architecture and urban planning, law, public administration, civil engineering, economics, business, and international affairs, the opportunity for cross-training is nearly limitless. This panel’s report is anticipated during winter 2015. A recently formed expert panel in conjunction with the Association of State and Territorial Health Officials will examine the opportunities for and roles and responsibilities of academic public
S48 | Commentary | Peer Reviewed | Petersen et al.
health institutions in workforce development in the traditional public sector. This is an important component of education in public health, one anticipated in the Welch---Rose report1,2 and a frequent subject of town hall meetings and task force deliberations. The full task force continues to engage in lively discussions around other emerging opportunities that it anticipates in the near future. From expanded views of learning spaces and competencybased credentialing to kindergarten through 12th-grade education, dual enrollment, and new forms of certification, we expect a continued acceleration of the changes first signaled by the growth in the number of schools and programs. The Framing the Future task force provides the means for deep discussions around these issues as we continue to seek the best ways to shape improvements in population health. As promised, task force products have been released immediately so that they can be considered and implemented as quickly as possible. As a final nod to the innovative spirit of its work, the task force will not issue a traditional report. Rather, the products of the task force that are already available online will be assembled as dynamic Web-based content designed to encourage continuing dialogue and the addition of continuing innovations. Each of the reports noted earlier and a space for ongoing dialogue via social media will be on the ASPPH Web site (www.aspph.org/ educate) by early 2015.
RECONNECTING PUBLIC HEALTH AND CARE DELIVERY As a founding member of the Interprofessional Education Collaborative, composed of the
organizations that represent higher education in allopathic medicine, dentistry, nursing, osteopathic medicine, pharmacy, and public health, the ASPPH contributed to the creation of core competencies for interprofessional collaborative practice that guide curricula development in all health professions.15 In May 2014, ASPPH and the Interprofessional Education Collaborative, with support from the National Center for Interprofessional Practice and Education,16 hosted the Reconnecting Public Health and Care Delivery to Improve the Health of Populations thought leaders conference. This, the first of a series of planned events, was intended to meet the long-range goal to achieve improved population health through integrating health professional education, public health practice, and care delivery in an evolving health care system. A background concept paper set the stage for the conference, describing the increasing momentum from all sectors of health to transform care delivery into an outcomesfocused system that improves population health; provides value-added services across the continuum of care; directly engages individuals, families, and communities in achieving health; and that simultaneously reduces per-capita cost (Frank B. Cerra, MD, unpublished paper, May 2014).
Although the macrolevel system (organizational capabilities of entities such as academic institutions, public health organizations, and health system agencies) is described as evolving successfully in connecting public health to care delivery, the problem statement in the paper points to the lack of productive interaction and integration at the micro level (individual proficiencies of health professions students, public health
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agency practitioners, and individual care providers) and at the meso level (team performance). Because this conference occurred too recently to have produced output, the ASPPH and Interprofessional Education Collaborative will work with the National Center for Interprofessional Practice and Education to follow up and synthesize the thought leaders’ suggestions at the conference regarding creating a new health system—one that values disease prevention and population health promotion, provides incentives for systems leaders and providers to manage and optimize population health data and strategies that use evidence-based mechanisms and methods, and demands interprofessional collaboration and training. Next steps include setting priorities for action, identifying the implications of change, and defining the pathways for the interface changes to occur. We sincerely hope that the conversations occurring through the Framing the Future and Reconnecting Public Health and Care Delivery efforts continue to spark wildly creative ideas and that collectively we continue to anticipate change, advance knowledge, and assist in public health academe’s role in building a cadre of well-prepared, inspired, and collaborationminded public health and health care professionals for a healthier world. j
About the Authors Donna J. Petersen is with the Framing the Future Task Force, the Association of Schools and Programs of Public Health, and the University of South Florida, Tampa. John R. Finnegan is with the Association of Schools and Programs of Public Health and the School of Public Health, University of Minnesota, Minneapolis. Harrison C. Spencer is with the Association of Schools and Programs of
Public Health and the Interprofessional Education Collaborative, Washington, DC. Correspondence should be sent to Donna J. Petersen, ScD, MHS, CPH, Dean, College of Public Health, University of South Florida, 13201 Bruce B Downs Blvd, MDC 056, Tampa, FL 33612 (e-mail: dpeters@health. usf.edu). Reprints can be ordered at http://www.ajph.org by clicking the “Reprints” link. This article was accepted October 1, 2014.
Contributors D. J. Petersen and J. R. Finnegan developed the first draft of the article. All authors contributed additional material, comments, and revisions in producing the final, consensus article.
Richard M. Fairbanks School of Public Health—Indianapolis (Workforce Development Expert Panel, cochair); Terry Dwelle, State Health Officer, North Dakota Department of Health (Workforce Development Expert Panel, cochair); and David J. Fine, President, Catholic Health Initiatives Institute for Research and Innovation (Blue Ribbon Public Health Employers’ Advisory Board, chair). Also deserving of thanks for their leadership and oversight of the initiative are the following Association of Schools and Programs of Public Health board of directors’ members: Michael Klag, Dean, Johns Hopkins Bloomberg School of Public Health (immediate past chair and board governance committee, chair); and Gary Raskob, Dean and Regents Professor, University of Oklahoma Health Sciences Center College of Public Health (chair-elect).
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11. Community Colleges and Public Health Project. Interim Report. November 2013. Available at: http://www.league. org/league/projects/ccph/files/ InterimReport_PrintFriendlyVersion.pdf. Accessed on June 12, 2014. 12. Petersen DJ, Weist EM. Framing the future by mastering the new public health. J Public Health Manag Pract. 2014;20 (4):371---374. 13. Begg MD, Galez S, Bayer R, Walker JR, Fried LP. MPH education for the 21st century: design of Columbia University’s new public health curriculum. Am J Public Health. 2014;104(1):30---36.
References
14. Calhoun JG, McElligott JE, Weist EM, Raczynski JM. Core competencies for doctoral education in public health. Am J Public Health. 2012;102(1):22---29.
1. Welch WH, Rose W. Institute of Hygiene. New York, NY: Rockefeller Foundation, General Education Board; 1915.
15. National Center for Interprofessional Practice and Education Web site. Available at: https://nexusipe.org. Accessed on June 12, 2014.
2. Fee E. The Welch-Rose Report: Blueprint for Public Health Education in America. 1992. Available at: http://www. deltaomega.org/documents/WelchRose. pdf. Accessed on June 12, 2014.
16. Interprofessional Education Collaborative Expert Panel. Core Competencies for Interprofessional Collaborative Practice. Washington, DC: Interprofessional Education Collaborative; 2011. Available at: https://ipecollaborative.org/uploads/ IPEC-Core-Competencies.pdf. Accessed on June 12, 2014.
Acknowledgments The Association of Schools and Programs of Public Health received support from the Centers for Disease Control and Prevention for the Undergraduate Public Health Education Expert Panel of the Framing the Future Task Force. The authors wish to acknowledge the Framing the Future Task Force members for their support and guidance on this initiative since 2011. In particular, the following individuals deserve thanks for their dedication in leading most of the task force activities and for their work in producing consensus reports: Randy Wykoff, Dean, East Tennessee State University College of Public Health (Undergraduate Public Health Education Expert Panel, chair); Robert Meenan, Dean, Boston University School of Public Health (MPH Expert Panel, chair); Richard Riegelman, Professor and Founding Dean, George Washington University Milken Institute School of Public Health (Community Colleges and Public Health Expert Panel, cochair); Cynthia Wilson, Vice President, Learning and Research, League for Innovation in the Community College (Community Colleges and Public Health Expert Panel, cochair); James Raczynski, Founding Dean and Professor, University of Arkansas for Medical Sciences Fay W. Boozman College of Public Health (DrPH Expert Panel, chair); Ruth Gaare Bernheim, Chair, Department of Public Health Sciences, University of Virginia School of Medicine (Population Health in All Professions Expert Panel, chair); David Goff, Dean and Professor, Colorado School of Public Health: University of Colorado, Colorado State University, University of Northern Colorado (Population Health in All Professions Expert Panel, subgroup leader); Howard Frumkin, Dean, University of Washington School of Public Health (Population Health in All Professions Expert Panel, subgroup leader); Paul Halverson, Founding Dean, Indiana University
elements of an undergraduate major in public health. Public Health Rep. 2013;128(5):421---424.
3. Evashwick CJ, Begun JW, Finnegan JR. Public health as a distinct profession: has it arrived? J Public Health Manag Pract. 2013;19(5):412---419. 4. Sommer A. W(h)ither public health? Public Health Rep. 1995;110(6):657---661. 5. Patient Protection and Affordable Care Act, 42 USC §18001 et seq (2010). 6. Petersen DJ, Albertine S, Plepys CM, Calhoun JG. Developing an educated citizenry: the undergraduate public health learning outcomes project. Public Health Rep. 2013;128(5):425---430. 7. Calhoun JG, Ramiah R, Weist EM, Shortell SM. Development of a core competency model for the master of public health degree. Am J Public Health. 2008;98:1598---1607. 8. Association of Schools and Programs of Public Health. Public Health Trends and Redesigned Education: Blue Ribbon Public Health Employers’ Advisory Board: Summary of Interviews. September 6, 2013. Available at: http://publichealth.uic.edu/ media/uicedu/sph/downloads/pdfs/ hpa/BlueRibbonPublicHealthEmployers AdvisoryBoard_Report2013.pdf. Accessed on June 12, 2014. 9. Council on Education for Public Health. History. Available at: http://ceph. org/about/history. Accessed on June 12, 2014. 10. Wykoff R, Petersen D, Weist EM. The recommended critical component
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