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TitleWho Will Keep the Public Healthy?
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LanguageEnglish
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Kristine Gebbie, Linda Rosenstock,
and Lyla M. Hernandez, Editors

Committee on Educating Public Health Professionals
for the 21st Century

Board on Health Promotion and Disease Prevention

INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS
Washington, D.C.
www.nap.edu

Who Will Keep
the Public Healthy?

Educating Public Health Professionals
for the 21st Century

Page 160

143PUBLIC HEALTH EDUCATION IN OTHER PROGRAMS AND SCHOOLS

cannot succeed as a niche speciality. Creating the conditions in which
Americans can be healthy requires the informed collaboration of plan-
ners, executives, and lawyers. Indeed, there are many professions whose
practitioners play an important role in health, and whose trainees are
appropriate candidates for health training.

Law plays essential roles in public health. As a tool for regulation, it
provides incentives for healthy behavior and deters insalubrious activi-
ties (Gostin, 2000). It structures and limits public health activities (Burris,
1994; Gostin et al., 1999). Laws and regulations provide public health with
various powers under certain conditions, ranging from the authority to
quarantine individuals through civil and criminal enforcement when nec-
essary to protec the health of citizens. More fundamentally, an ecological
view of health reveals the role of law in structuring social determinants of
health, in mediating their effects, and as a tool of Òstructural interventionÓ
at the level of policy (Blankenship, 2000; Burris et al., 2002).

Public health is marginal or entirely missing as a component of the
curriculum at most of the countryÕs nearly 200 law schools (Goodman et
al., 2002). Without training in public health, it is not surprising that law-
yers in practiceÑ as advocates, legislators, executives, and judgesÑ have
difficulties unraveling complex health issues. As Parmet and Robbins
observe, Òthinking like a lawyerÓ does not currently include adopting a
public health perspective. Cases are brought, decisions are made, and
statutes are drafted with a profound effect upon the public health, yet
with little appreciation of what that means. Thus, the U.S. Supreme Court
in Bragdon v. Abbott seemed confused about what it means for the Centers
for Disease Control and Prevention to be unable to prove that seven den-
tal workers who were HIV-positive had not been exposed at work. The
dissent went further, suggesting that risks can be assessed without con-
sidering denominators. Likewise, the Supreme Court rejected state regu-
lation of tobacco marketing, failing in a fundamental way to comprehend
that public health is not a matter of individual choice (Parmet and
Robbins, 2002).

Renewed appreciation of the importance of socio-economic factors in
public health points to business as a neglected but crucial actor in public
health (Woodward and Kawachi, 2000). From the availability of HIV/
AIDS drugs (James, 1998) to the prevalence of fast-food outlets (Nestle
and Jacobson, 2000), the conditions of health reflect decisions by national
and international concerns. Business decision-makers, moreover, are com-
munity leaders. Their partnership is recognized as essential in developing
and implementing collective health strategies (Williams et al., 1991;
Sumartojo, 2000). Setting aside the question of regulation, the importance
of business to health suggests the value of training future business leaders
about the health consequences of their decisions. Like other activities,
business can be informed by ethical considerations (Danis and Sepinwall,

Page 161

144 WHO WILL KEEP THE PUBLIC HEALTHY?

2002), which, in turn, depend upon a grasp of the underlying facts about
how economic factors influence health. However, the practice of public
health can benefit from better understanding and use of business man-
agement techniques (Guarino, 1997).

Urban planningÑ including zoning, design, sanitary regulations and
construction standardsÑ was one of the most pressing preoccupations of
19th century public health (Duffy, 1990; Novak, 1996). During the 20th
century, the health aspects of planning grew less pressing, and the focus
of the profession turned elsewhere. While the proposition that planning
matters to health would not be disputed in the urban planning profession,
health concerns remain on the periphery of training and practice. Yet as
new research continues to show, the physical environment matters to
health (Cohen et al., 2000), and planning can be a tool of interventionÑ or
a means through which social inequalities produce health inequalities
(Bullard and Johnson, 2000; Maantay, 2001).

The committee believes that public health is an essential part of the
training of citizens, and that it is immediately pertinent to a number of
professions. Specialized interdisciplinary training programs, such as those
offering joint J.D. and M.P.H. degrees or joint M.P.H. and M.U.P. (masters
of urban planning) degrees can create specialists and are important. Our
view, however, is that more is needed. Public health literacy, entailing a
recognition and basic understanding of how health is shaped by the social
and physical environment, is an appropriate and worthy social goal. Fur-
ther, education directed at improving health literacy at the undergradu-
ate level could also serve to introduce persons to possible careers in pub-
lic health. The committee recommends that all undergraduates should
have access to education in public health.

It is beyond both our charge and our capacity to make specific recom-
mendations about how to incorporate health into diverse curricula. Doubt-
less the usual challenges to curricular change will ariseÑ faculty flexibil-
ity, scarce resources of time, and student interest. The committee does,
however, stress the importance and recommend the integration of a
more accurate and ecologically oriented view of health into primary,
secondary, and post-secondary education in the United States.

This chapter has emphasized the importance of public health educa-
tion in graduate programs of public health and in other schools and insti-
tutions of learning. The following chapter examines the role of local, state,
and federal agencies in educating public health professionals.

Page 320

303INDEX

Strategic Plan for Public Health Workforce
Development, 159, 212, 214

Student bodies, demographic changes in,
203-204

Students. See also Nursing student clinical
training; Public health students;
Recommendations for medical
students; Undergraduate students

support from federal public health
agencies, 160-161

Substance Abuse and Mental Health
Services Administration (SAMHSA),
22, 157

Successful Models of Community-Based
Participatory Research, 87

Supervised practice opportunities, for
public health education, expansion
of, 11, 113

Support for students, from federal public
health agencies, 160-161

Support functions, competency in, 269-270
Survey responses, identifying challenges

and opportunities, 58-60

T

Teaching
community-based organizations to

work with schools of public health
in, 16, 197

schools of public health to reward
faculty based on excellence in, 16,
127

Teaching Cultural Competence in Health Care,
79

Technical competencies, research and
evaluation, 91-92

Technicians, 263
Technology development. See also

Communication
in federal public health agencies, 161

Texas A&M University, x, 54
Topical area competency sets, 267-268, 277

community-based health, 277
cultural diversity, 277
emergency response, 267-268
genomics, 268
law, 268
maternal and child health, 277
STDs and HIV, 277

Toxicology, courses in, 187

Training and education, in local health
departments, 146-147

Transdisciplinary research, 11-12, 117-120,
128

schools of public health to collaborate
with other academic units in, 16,
126, 194-195

schools of public health to implement
reforms based on, 12, 120

Tulane University, x, 54
School of Public Health and Tropical

Medicine, 55
Twentieth century, education of public

health professionals in, 222-261
Twenty-first century, future role of schools

of public health in educating public
health professionals for, 108-127

U

Undergraduate students, to have access to
public health education, 20, 141, 144,
195-196

Unequal Treatment: Confronting Racial and
Ethnic Disparities in Health Care, x

United States health care system, schools of
public health to lead public policy
discussions about its future, 13, 121,
194

United States public health education, 3
history and current status of, 41-60

United States Public Health Service, 43, 47,
227, 236, 241, 245, 253

United States Supreme Court, 143
University of Alabama, Birmingham, x, 54
University of Albany (SUNY), x, 54
University of California, Berkeley, x, 54,

134-135
University of California, Los Angeles, x, 54

School of Public Health, 83
University of California, San Francisco, 18,

134-135
University of Colorado, 140
University of Illinois, 140
University of Iowa, x, 54
University of Massachusetts, x, 54
University of Medicine and Dentistry of

New Jersey, x, 54
University of Michigan, x, 54
University of Minnesota, x, 54
University of North Carolina, Chapel Hill,

x, 54

Page 321

304 INDEX

University of Oklahoma, x, 54
University of Pittsburgh, x, 54
University of South Carolina, x, 54
University of Southern California, 135
University of Texas, Houston, x, 54
University of Washington, x, 48, 54

Northwest Center for Public Health
Practice, 124

School of Public Health and
Community Medicine, 56

University of Wyoming, 140
Urban planning field, 144
User Liaison Program (ULP), 66

V

Veterans Administration, 242
Volunteers, 14, 264

organizations of, 30

W

Wahl, Patricia W., v, 288
Wald, Lillian, 137

War on Poverty, 47
War years, public health education during,

234-235
Water quality, courses in, 187
Welch, William Henry, 228-229
West Nile virus, 112
Williams, Huntington, 231
Winslow, Charles-Edward A., 227, 240
Wolman, Abel, 249
Women, Infants, and Children (WIC)

program, 88
Workforce development

continuum of assessment activity, 154-
155

local, state, and federal health agencies
to assess needs in public health, 23,
163

World Health Organization, 31
World Trade Center, terrorist attack on, 63

Y

Yale University, x, 45, 54

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