Summit on Public Health Education Sets Course for Change

Deans and associate deans from 47 of the 50 member schools of the Association of Schools of Public Health (ASPH) gathered at the Mailman School for a daylong summit on innovations in graduate public health education that focused on themes of leadership and meeting future needs.

A June 3 reception and dinner at the Bloomberg Foundation, hosted by Mayor Michael Bloomberg and Mailman School board member Diana Taylor, marked the start of the conference, titled "Innovations in Public Health Education." The following day, Dean Linda P. Fried, MD, MPH, gave a welcoming and framing address, followed by a keynote speech by Howard Koh, MD, MPH, assistant secretary of health in the U.S. Department of Health and Human Services. Both talks focused on the necessity for change in graduate public health education as a foundation for goal-setting and a call to action.

Continuing throughout the day, the agenda focused on major categories of innovation underway in many ASPH member schools: innovations in the content of education, in the methods of delivery, and in the evaluation of success. The conference concluded with a brainstorming session as attendees developed a call to action and initial plans for next steps.

"An Historic Opportunity to Lead"

The  summit comes at a time when public health schools are wrestling with how to innovate to best meet the health needs of the 21st century. A 2010 report of the Lancet Commission on Education of Health Professionals for the 21st Century crystallized an emerging consensus that students need to be prepared differently to meet health needs of the coming decades. The report charged that professional health education had not significantly changed since the mid-20th century, and that the time is ripe—and it is critically important—to create health professional education that addresses  health systems alongside emerging challenges and threats.

In her opening remarks, Dean Fried made a strong case that a new kind of public health education is needed to help society effectively respond to a host of challenges: the health effects of globalization; urbanization; aging and migration; chronic disease and obesity; climate and other environmental changes; as well as pre-existing health needs. At the same time, new technical skills are being demanded of public health graduates, who must be adept with cutting-edge scientific methods, including a life-course approach to prevention and systems science, and leadership education.

Dean Fried stated that these challenges demand that we see, think, and act differently: “It is not just a challenging time; it is also a propitious time to take stock, analyze the changes needed, and then take an historic opportunity to lead,” said Dean Fried. She pointed out that redesigned graduate public health education would provide an incentive for the federal government to meet the Lancet commission’s call for highly scaled-up investment in training a workforce that is ready to serve in more effective health systems.

"A Natural Training Ground for Leaders"

In his keynote address, Dr. Koh discussed the theme of public health leadership. The mission to help people be their healthiest not only represents a profound calling but also imbues public health work with special meaning, he said. At the same time, practitioners face significant hurdles. The issues are enormous, stem from complex causes, and impact a vast array of stakeholders. Finding solutions isn’t easy, and progress is often difficult to gain and sustain.

“Public health should be a natural training ground for leaders because so many enter the field determined to change the status quo,” said Dr. Koh. Yet in several important ways, he added, public health schools haven’t given students the skills to navigate the reality of public health work. Chief among these is being comfortable on the public stage. Public health leaders must be effective communicators and stand ready for criticism from advocates, the public or the news media.

“There is always a counter-argument to every decision made by a public health professional," said Dr. Koh. "Students need to be prepared to handle those challenges and be able to communicate their position succinctly and persuasively.”

Being a good negotiator is another critical skill—particularly when it comes to budgeting. Dr. Koh related how during a class he taught at Harvard, he had his students do an exercise where they initially had to agree on budget funding levels for a wide range of public health programs. When they finally came to a consensus, to the students’ dismay, he would announce a budget cut and require them to start over and try to find consensus yet again. “We have a field where the needs are always infinite and the resources are always finite.”

In his concluding remarks, Dr. Koh drew an analogy between leadership and conducting an orchestra. A leader sets the theme, tempo, and tone of an organization. He encourages harmony in the midst of cacophony. He must direct the drums to play softer and the piccolos to play louder. But when the curtain goes up, the audience expects and deserves a quality product—often forgetting that the conductor is even there at all.

Reporting on Innovations

A number of innovations in graduate public health education were reported at the conference: leadership education at the University of California Berkeley School of Public Health, systems science at the University of Pittsburgh, and teaching innovative thinking at the University of Texas. Columbia’s Mailman School reported on its school-wide initiative, begun in 2009 and implemented in 2012, to significantly redesign its MPH and doctoral education, an effort that involved almost 200 faculty, plus students, alumni and employers. The revamped curriculum creates an integrated and interdisciplinary core founded on a life-course approach to prevention and systems thinking, and is designed to develop a 21st Century knowledge base with critical thinking, innovation, and leadership skills, along with deepened disciplinary capabilities.

Conference attendees also reported on methodological innovations including “flipped classrooms”, interdisciplinary education, distance learning, use of the case method, and providing incentives for innovative teaching. Carrie Hessler-Radelet, acting director of the Peace Corps, invited the deans to partner with them both in arranging for student practica with the Peace Corps and in encouraging Peace Corps members to attend schools of public health.

Discussion about innovations in educational assessment began with a presentation by George E. Thibault, MD, president of the Josiah Macy Jr. Foundation, who placed public health education in the context of health professions education. Other presentations included topics on assessing competencies, measuring assessments of a radical curriculum change, and tracking career metrics.

The conference created a summary of the innovations in progress in many of the attending schools. In an effort to learn from each other, summit attendees contributed abstracts describing their curricular innovations, and a compendium of these submissions was distributed.

Creative Ways Forward

 

As a transition to a brain storming mode for the afternoon session, conference-goers enjoyed a performance by the SYOTOS jazz ensemble during the lunch. Chris Washburne, ensemble leader and director of the Louis Armstrong Center for Jazz at Columbia, and Dean Fried together explored what jazz can reveal about the dynamics of creativity and horizontal leadership, and how to harness constructive competition to achieve greater goals.

In jazz, Professor Washburne explained, effective leadership requires trust in the talents of your fellow players that gives them room for creativity. Coming together, the group reaches higher accomplishments and creates a whole greater than the sum of the parts. Competition, he said, is essential in pushing musicians to excel, but even more important is teamwork, if you want to create beautiful music.

The final brainstorming session, moderated by journalist Perri Peltz, brought about a consensus regarding a need for significant change in graduate public health education, to build on the discussions of the day by creating a formal statement of the case for change, and sharing and formulating goals going forward.

Funding for the conference was provided by the Josiah Macy Jr. Foundation.