Greetings to each and every member of the SPH community. The New Year is now well underway, and public health issues, as always, loom large, from the local to the global scales. Two of the most prominent stories in recent weeks have been the contamination of drinking water in Flint, Michigan, by lead, and the eruption and rapid spread of Zika virus through much of Latin America. These two challenges bookend the field of public health. Lead toxicity causes chronic effects, especially on the nervous system, while Zika virus causes a short-term illness. Lead toxicity is well understood; Zika virus appears to be associated with both microcephaly and Guillain-Barre syndrome, although the evidence is incomplete and we have much to learn. Both conditions interact with social determinants of health such as poverty, and with environmental risk factors. In both cases public health agencies, working with health care providers and other agencies and organizations, need to mount rapid, diligent responses to protect affected populations—a standard that seems, shamefully, was not met in Flint.
Never has public health been more salient!
In this Dean’s Dispatch, I’d like to address three items: diversity; our MPH curriculum; and letting you know some of what I’m up to.
Diversity
I’ve been thinking a lot about diversity, equity, and inclusiveness lately. Our common book this year, Michelle Alexander’s The New Jim Crow: Mass Incarceration in the Age of Colorblindness, paints a searing picture of racism in the United States; it is one of the most important books I’ve read in a long time. As 2015 drew to a close, and we reflected on the year that was ending, some of the most gut-wrenching events were the shootings of unarmed young men by police—with blacks being victimized at more than twice the rate of whites. In January, Martin Luther King Day served as a reminder of our nation’s ongoing struggle for racial justice. And the news is full of examples of racial disparities in health, from the drinking water lead exposure in predominantly black Flint, MI, to an extraordinary outbreak of tuberculosis in predominantly black Marion, Alabama, fueled by poverty, a history of limited health care access, and a legacy of mistrust of public health agencies.
Here at UW, the Race and Equity Initiative is focusing attention and energy on supporting diversity across campus. UW’s six Health Science schools are collaborating through the Center for Equity, Diversity & Inclusion, to advance these goals across the health sciences. The Board of Deans and Chancellors is about to begin a professional development initiative to focus on leading for equity, inclusion, and access; I’ll be actively involved with that effort. Within the School of Public Health, diversity and inclusion are core values, and our Diversity Committee, including faculty, staff, and students, has led a range of efforts, focusing on curriculum, climate, and the recruitment and retention of diverse faculty, staff, and students. I’m proud that the committee was awarded the Health Sciences SPH 2016 MLK Jr Award for its efforts.
But we have much more to do. We need to press forward on all these programmatic fronts. We also need to work on ourselves at a more personal level, exploring unconscious assumptions, being self-critical and self-correcting when necessary, listening respectfully to people who differ from us, and valuing and celebrating those differences. This effort will be among my highest priorities for the coming year.
The MPH curriculum
The MPH is the most widely recognized professional degree for those in public health. Our School has long been recognized for the quality of our MPH, especially for its methodological rigor. That said, in our Strategic Plan we identified an updating of our MPH curriculum as a priority. Some of the factors that drove this decision included:
- Hearing from our community partners, such as health departments, that our graduates were well trained methodologically, but were not always equipped with essential skills such as communication, coalition-building, budgeting, and project management.
- A shift in national expectations, and accreditation requirements, toward competency-based MPH curricula.
- The rise of problem-based learning and of innovative teaching technologies.
- The recognition that some essential topics, such as public health history and ethics, were not systematically included in our curriculum.
We’ve made real progress toward updating our MPH curriculum, but we’re not finished. What’s taking so long? In my view, we’ve encountered several barriers:
- The MPH is expected to meet two quite distinct goals: train those who wish to develop research skills, and train those who plan careers in public health practice. This is a lot to ask of a single, two-year curriculum!
- Reflecting that spectrum, some faculty in our School emphasize the need for methodological rigor, while other faculty are more focused on practice skills. We haven’t fully come together around a shared vision.
- There’s a more prosaic reason. Our faculty are extraordinarily busy, and few have much time to devote to the substantial demands of curriculum redesign.
How should we move forward? In my view, as we contemplate curriculum change, we need to be intensely student-centered. This means providing students what they need to launch successful public health careers. That, in turn, means that we must understand those needs—which means understanding the evolving public health landscape. That’s not easy; our faculty are most expert with regard to academic roles such as research, but most of our MPH students are not bound for academic careers.
Of the many recent publications that shed light on this challenge, I’ll mention two. One is “Health Professionals for a New Century”, the 2010 report of the Global Commission on the Education of Health Professionals for the 21st Century. This report argued that health professional education, including in public health, has not kept pace with evolving challenges, because of “fragmented, outdated, and static curricula that produce ill-equipped graduates.” Among the specific problems cited were “systematic mismatch of competencies to patient and population needs; poor teamwork;…narrow technical focus without broader contextual understanding;…and weak leadership to improve health system performance.” The Commission’s vision was anchored not in academic disciplines but in what the world needs: “all health professionals in all countries should be educated to mobilize knowledge and to engage in critical reasoning and ethical conduct so that they are competent to participate in patient- and population-centered health systems as members of locally responsive and globally connected teams.” The ultimate purpose of this training, the Commission went on, is “to assure universal coverage of the high-quality comprehensive services that are essential to advance opportunity for health equity….”
A more recent publication, “Aspirations and Strategies for Public Health,” by Sandro Galea and George Annas (JAMA, 2016), focuses not on the entire range of health professions, but just on public health. The authors argue that public health has lost sight of its “aspirational, population-health, purpose-driven mission.” The major public health challenges of our era, including chronic illnesses, an aging society, and persistent health disparities, require “solutions at the interstices of social, political, cultural, and economic domains.” The traditional core public health functions, then, are too narrow; the role of public health must “shift…from acting alone to engaging as a coordinator and motivator of various, sometimes unusual partners in sectors not directly responsible for health,” including “tak[ing] a leadership role in reducing inequities.”
These are bold visions for the future of public health. The professionals who will implement them in coming years need training that goes well beyond the traditional public health curriculum. We need not—we must not—sacrifice our longstanding excellence in methodological training. But we must be fearless, open-minded, and creative as we look at our MPH curriculum, and update it as necessary, to assure that we are preparing our students for what they will be called on to do.
Annette Fitzpatrick, our new Assistant Dean for Graduate Public Health, will be working closely with the Faculty Council, the Curriculum and Educational Policy Committee, the Departments, our student organizations, and other key members of the School community, to help move us forward. I look forward to robust discussion, and to emerging with the very best MPH curriculum anywhere.
Where’s Howie?
Joanne and I took a week-long holiday on Hawaii’s Big Island in early January. We stayed south of Kona—the epicenter, as it turned out, of the very active dengue fever outbreak now underway. We used more DEET than I’d like to say! Unfortunately, the outbreak has continued, reaching 250 confirmed cases since late October. The mayor of the Big Island declared a state of emergency this week.
I have several trips during February and March. In early February I visited Boston, for a one-day meeting of the Steering Committee of the Planetary Health Alliance, a new Rockefeller Foundation-funded project based at Harvard. Later this month, I’ll join other public health deans in Washington, DC, for our annual legislative day, visiting members of Congress to discuss academic public health goals with them. In early March, I’ll attend a meeting at Johns Hopkins Bloomberg School of Public Health, as part of an advisory committee assessing CDC’s Climate and Health program. And later in March, I’ll attend the ASPPH annual meeting in Washington, DC, followed by a meeting of the Wellcome Trust “Our Planet, Our Health” committee in London. Other than those trips, I’ll be here…and looking forward to seeing you!
A final note of thanks—first, to the students and staff who planned today’s wonderful study break in South Campus Center, where many of our students gathered to relax, mingle, and commune with service animals (really!). I was delighted to be there. Second, thanks to all who contributed to my five-year review. I view these reviews as a great privilege, and I know the collective feedback from across the SPH community will help me learn, grow, and do my job better.
With warm regards,
Howie
Howard Frumkin, M.D., Dr.P.H.
Dean, School of Public Health