On the Goals of a Professional Public Health Education.
Is public health a profession? My dictionary suggests that a “profession” is “a paid occupation, especially one that involves prolonged training and a formal qualification.” Public health meets part of that definition—it does require prolonged training, particularly when one considers that most public health professionals in the country have a graduate degree of public health, therefore requiring at least six years total of university education. Public health has not coalesced around a formal licensing qualification. Although there is indeed a National Board of Public Health Examiners’ Certified in Public Health examination for public health professionals, this has far from universal adoption, and certainly most practicing public health professionals have not taken this examination. We do, however, typically call our graduate school of public health—as do our peers—a professional school.
What, then, do we mean by us being a professional school, and what, as such, are our goals in educating our students?
To answer this, we must first resolve the question of what public health is. I would argue, as professor Al Sommer has in the past, that public health is an aspiration, or formally “a hope or ambition of achieving” better population health and narrower intergroup gaps in health. It is an aspiration insofar as we will never get to achieve this goal—i.e. the health of populations can always be better—and insofar as much of what we do rests on audacity of ambition that this is a goal worth working towards, despite the often thunderous challenges.
If we accept that public health is aspirational, it suggests to me that our central goal in educating our students should be to make sure that they understand the purpose of public health so that they too can work towards our aspirational goals. It also suggests that we are interested, at core, in teaching our students how to think about public health; in socializing our students in the language of public health; and, perhaps most importantly, in making sure that our students are dexterous enough in the thinking and language of public health so as to help mold that same language and thinking as the exigencies of public health evolve over their professional life.
I worry that articulating this approach suggests a laissez-faire attitude towards education. I would argue that it suggests quite the opposite, and that this approach represents a higher bar that we have to reach than if we decided our pedagogic role was strictly didactic. How, then, would we go about preparing students for their role as public health professionals? I would suggest that such learning needs three elements.
First, we need to ensure that we do transmit knowledge to our trainees that forms the foundational principles of our field. There is much that we have learned over time, and part of our educational goal is to impart what we have learned to our students so that the next generation of professionals can start ahead of where we all started. That includes imparting a clearer understanding of the leadership and management approaches that can change the systems that produce health; the history and legal and policy precedents that inform our systems and suggest avenues for change; the burden of global disease and its causes across the lifecourse; and the quantitative methods that underpin the science and aim to better illuminate these causes and how we can influence them towards improved population health. The trick, of course, is for us to identify how we can best curate our body of knowledge to impart to our students the knowledge they need to know—knowledge that is truly foundational—in order to set the stage for the second element.
Second, we need to ensure that our trainees are equipped with the analytic capacities to forge for themselves an understanding of the complex changing world that produces the health of populations. This suggests that we need to teach our students what professor Leonard Glantz has called “principled thinking.” It means that we are teaching our students how to think, not simply how to do. This is perhaps the toughest challenge of all and must rest on us creating a generative ideas-first environment that encourages debate over disquisition, critical analysis over unquestioned acceptance of compelling ideas, and transdisciplinary synthesis over silo-ed thinking that permits me-too analysis and the propagation of the same ideas, even if wrong. This requires a commitment on our part both to structure our classes towards this end, and to create the opportunity for degree requirements that encourage students to search for, and find, novel answers.
Third, we want to make sure that our students are engaged with the mechanics of the profession early and often so that they can map their formal in-class education with the daily work of public health. It is one thing to understand a Theory of Justice , and quite another to wonder what this means for improving the health of someone born into subsidized, poor-quality housing, with a statistically near-negligible chance of changing their social circumstances in one generation. It is similarly one thing altogether to learn statistical methods that provide us confidence in our associations, and quite another to wonder whether we should be tackling well-established foundational causes of disease or behavioral factors that explain how the social environment gets under the skin. Experiential learning can, all too frequently, become passive exposure, observation of action that gives the illusion of formative experience. Exposure to the profession’s real-world engagement, however, coupled with an emphasis on principled thinking and an encouragement to forge integrative ideas at the interstices of disciplines, stands to elevate a learning experience into a unique opportunity to create an outstanding generation of public health professionals.
I have previously noted that our core role is knowledge generation, transmission, and translation. “Transmission,” an imperfect if helpfully alliterative word in this context, does not imply passivity on the part of the learner, or rigid prescription on the part of the instructor. Rather, it challenges us to figure out how we can best transmit knowledge so as to educate a generation of public health professionals who can then take our aspirations to the next level. In next week’s Dean’s Note, I shall, together with Associate Dean of Education Lisa Sullivan, articulate how we aim to meet this charge in our own curriculum.
I hope everyone has a terrific week. Until next week.
Warm regards,
Sandro
Sandro Galea, MD, DrPH
Dean and Professor, Boston University School of Public Health
Twitter: @sandrogalea
Acknowledgement: I am grateful to professors Lisa Sullivan and Leonard Glantz for conversations that helped shape my thoughts for this Dean’s Note. Any errors or weak thinking are mine alone.
Previous Dean’s Notes are archived at: https://www.bu.edu/sph/category/news/deans-notes/