The Integration of Core Public Health Education into Undergraduate Curricula

Although people are continually exposed to public health information through multiple media outlets, there is a critical need to educate the public to understand complex public health issues and generate informed opinions on topics such as health care reform and infectious disease pandemics. Although the discipline of public health has been established in graduate education, its incorporation into undergraduate curricula has received little consideration. In 2003, the Institute of Medicine (IOM) report, Who Will Keep the Public Healthy? Educating Public Health Professionals for the 21st Century recommended that “all undergraduates should have access to education in public health.”¹ Moving beyond this call for “access,” the authors challenged educators to integrate core public health instruction into all US college and university curricula and to view undergraduate public health education not as a professional credential but as part of the preparation of an educated individual.¹ 

This drive for integration stems from the IOM’s view that undergraduate public health education is more than a professional credential; it is a credential of an educated individual regardless of career path. Recently, the Association of American Colleges and Universities developed a framework that addressed the concept of a liberal education. This framework, Liberal Education and America’s Promise (LEAP), recommends that an education that intentionally fosters, across multiple fields of study, wide-ranging knowledge of science, cultures, and society; high level intellectual and practical skills; an active commitment to personal and social responsibility; and the demonstrated ability to apply learning to complex problems and challenges ² is necessary.

The LEAP framework seeks to build a structure of interrelated learning goals that will produce an educated citizenry. The introduction of core public health education at an undergraduate level aligns with the LEAP goals of integrative and interdisciplinary baccalaureate preparation.³

During a 2006 conference sponsored by the Association for Prevention Teaching and Research (APTR) and the Association of Schools of Public Health, general principles and recommendations were created to address the recommendations put forth by the 2003 IOM report⁴:

• Core curricula in public health should be available to students at all undergraduate institutions.
• Core curricula may include introductory coursework in public health, epidemiology, and global health, as well as integrative interdisciplinary approaches.
• Local public health practitioners should participate in teaching undergraduate courses.

As a result of the recommendations put forth during the conference and with the support of the Centers for Disease Control and Prevention (CDC)–APTR, a Faculty Development Program and an Undergraduate Public Health Curriculum Guide have been developed and are being disseminated.⁵

Integration of public health education into undergraduate learning will result in an educated individual. Graduates will have the skills to critically examine public health issues within their respective occupation and place of residence, will appreciate the importance of public health interventions, and will have the ability to digest public health messages presented in the media. In addition, having future professionals equipped with basic public health knowledge would encourage financial and political support for public health interventions.

An example of a university that has incorporated public health education into the undergraduate curricula is New York University (NYU). In 2006, through the APTR, the CDC offered NYU a grant to support integration of public health classes into its undergraduate curriculum. NYU offered 2 core public health courses, Public Health 101 and Epidemiology 101, for undergraduates in the liberal arts. The objectives of these courses were to introduce the interdisciplinary nature of the field of public health and some of the ethical issues involved in epidemiological and public health research. University records indicated that more than 17 different academic departments were represented within both courses, and a diverse group of juniors and seniors complete the courses. The overall approval and interest in the courses confirmed the need of public health courses at the undergraduate level.⁶

To increase access to public health education and prepare people to digest public health messages and interventions, the American Public Health Association (APHA) should adopt policy to support efforts to increase undergraduate public health education. In these efforts, APHA should continually collaborate with the public health community, governmental agencies, nonprofit organizations, and business groups to ensure continued and coordinated efforts to bring core public health education to an undergraduate level.

As APHA works to build on its policy priorities and combine the expertise of the sections within APHA, a call to action should be upheld to actively support efforts to link its members and affiliates with local colleges and universities seeking to teach undergraduate public health courses and concepts. This work dovetails with the publication of The Educated Citizen and Public Health Initiative,⁷ which aims to fulfill the IOM’s recommendation that “all undergraduates should have access to education in public health”¹ to ensure that Americans are capable of responding to our nation’s public health problems in both professional and lay roles. Support of undergraduate education may open the pipeline of public health professionals and increase the public health workforce to meet future needs.

Acknowledging APHA’s policy action related to specific aspects of workforce development and the support of the workforce, this movement must be complemented by the support of undergraduate public health education.

Currently, APHA policies call for improved recruitment and retention of public health nurses,⁸ expansion of the maternal and child health workforce,⁹ a strengthened public health workforce as a guiding principle for the public health response to terrorism and emergencies,¹⁰ targeted recruitment and retention of Hispanics to be leaders in their field,¹¹ and adequate funding for graduate training programs for public health professionals by governmental entities.¹² Although it is recognized that bachelor programs for public health majors exist within the United States, this policy solely focuses on the incorporation of undergraduate public health education into a liberal arts curriculum. Because this movement is currently being discussed within other associations such as the APTR, the Association of Schools of Public Health, the Council of Colleges of Arts and Sciences, and the Association of American Colleges and Universities, minimal scientific-based, peer-reviewed literature has been published on the study of the integration of public health education in undergraduate curricula.

Therefore, the APHA recommends that

1. Universities and colleges incorporate undergraduate public health education into general liberal arts curricula to include core introductory public health courses such as public health, epidemiology, and global health. All core courses should include cultural competency as a component.
2. Universities and colleges work with partners in public health and arts and sciences educational associations to bolster the number of professors with adequate teaching and practical experience that can provide high-quality, effective public health education at the undergraduate level.
3. Universities and colleges identify and promote opportunities to increase the quantity of public health education received by undergraduates.
4. Schools of public health and applied public health training programs provide outreach to respective undergraduate student bodies.
5. Universities and colleges partner with public health and arts and sciences educational associations to educate their members on the role of undergraduate public education in creating an educated individual and provide scientific evidence to support the integration of public health education in undergraduate curricula.

References

1. Gebbie K, Rosenstock L, Hernandez LM. Who Will Keep the Public Healthy? Educating Public Health Professions for the 21st Century. Washington, DC: National Academy Press, 2003; page 144.
2. Association of American Colleges and Universities. College Learning for the New Global Century. Washington, DC: Association of American Colleges and Universities, 2007; page 4.
3. Albertine S. Undergraduate public health preparing engaged citizens as future health professionals. Am J Prev Med. 2008;35:253–257.
4. Centers for Disease Control and Prevention. Notice to readers: recommendations for public health curriculum–Consensus Conference on Undergraduate Public Health Education. November 2006. MMWR. 2007;56:1085–1086. Available at: www.cdc.gov/mmwr/preview/mmwrhtml/mm5641a5.htm. Accessed December 19, 2009.
5. Riegelman R. Undergraduate public health education. Am J Prev Med. 2008;35258–261.
6. Bass SB, Guttmacher S, Nezami E. Who will keep the public healthy? The case for undergraduate public health education: a review of three programs. Journal of Public Health Management Practice. 2008;14:6–14.
7. Riegelman RK, Albertine S, Persily NA. The Educated Citizen and Public Health: A Consensus Report on Public Health and Undergraduate Education. Williamsburg, VA: Council of Colleges of Arts and Sciences, 2007. Available at: www.ccas.net/files/public/Publications/Public_Health_and_Undergraduate_Education.pdf. Accessed December 19, 2009.
8. American Public Health Association. APHA policy statement 2003-2: The impact of a public health nursing shortage on the nation’s public health infrastructure. Washington, DC: American Public Health Association; 2003. Available at: www.apha.org/advocacy/policy/policysearch/default.htm?id=1235. Accessed December 18, 2009.
9. American Public Health Association. APHA policy statement 2002–10: Maternal and child health (MCH) data capacity through the national action agenda. Washington, DC: American Public Health Association; 2002. Available at: www.apha.org/advocacy/policy/policysearch/default.htm?id=2865. Accessed December 18, 2009.
10. American Public Health Association. Guiding Principles for a Public Health Response to Terrorism. Available at: http://wonder.cdc.gov/wonder/help/CMF/APHA-Terrorism.html. Accessed December 19, 2009.
11. American Public Health Association. APHA policy statement 96-13: Addressing Hispanic underrepresentation in the health professions. Washington, DC: American Public Health Association; 1996. Available at: www.apha.org/advocacy/policy/policysearch/default.htm?id=131. Accessed December 18, 2009.
12. American Public Health Association. APHA policy statement 94-14: Federal and state financial support for training of public health professionals. Washington, DC: American Public Health Association; 1994. Available at: www.apha.org/advocacy/policy/policysearch/default.htm?id=80. Accessed December 18, 2009.

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