AAMC Reporter: December 2008

Viewpoint: Linking Academics to Public Health Practice Creating the Wellness Workforce

Georges C. Benjamin, M.D., F.A.C.P., F.A.C.E.P., Executive Director, American Public Health Association

A good public health system should be evidence- and science-based, reduce morbidity and mortality, and promote wellness. It may not always save money, but it should provide value for the dollars we spend. Ensuring individual health is a complex process based on an interaction between our genetics, our environment (both physical and social), and our behavior. Ensuring a population's health is even more complex, requiring the engagement of all aspects of clinical and preventive care, the full range of health promotion strategies, and a strategy to engage a full range of sectors (housing, transportation education, employers) that should be working together. One important linkage is between the academic medical and public health practice communities.

There are approximately 500,000 professional public health workers. Their average age is 46, and one-half of them are eligible for retirement. We have gone from 220 public health workers per 100,000 Americans in 1980 to 158 per 100,000 today. State public health agencies are already showing as much as a 20 percent vacancy rate in some jobs and a 14 percent annual state turnover rate. It is clear that we need to get more people interested in public health, or else our nation's public health system will suffer. There are efforts underway to build a stronger pipeline of students interested in public health as a career. The Robert Wood Johnson Foundation's Young Epidemiology Scholars (YES) program engages sixth and seventh graders in health subjects. We need more initiatives like this. We need legislation that provides more scholarship and loan repayment programs, and a reinvestment in Title VII workforce programs and leadership development programs. One effort that deserves mention is the Association of American Colleges and Universities' Educated Citizen and Public Health Initiative, which is working to build robust undergraduate courses in public health. By providing an academic experience in public health at the undergraduate level, it is hoped that a broader group of individuals will understand the tenets of population health, thereby providing a better foundation for community-based actions that ensure wellness.

Because less than 20 percent of public health leaders have graduate training in public health, there is also a strong need for graduate-level courses and a more robust continuing education program to improve and enhance the skills of the existing workforce.

The public health enterprise is actively working to improve the quality and accountability of its system by continuing to strengthen its core organizations like the Council for Education for Public Health (CEPH), which accredits public health schools and programs. It has also developed like the National Board of Public Health Examiners, which provides a certification exam for individuals who graduate from CEPH-accredited schools and programs, and the Public Health Accreditation Board, which is building upon national quality improvement efforts by creating a national entity that will accredit governmental public health agencies.

Working together, the academic and public health communities can obtain and make better use of new technologies for identifying, tracking, and mitigating diseases. Adequate communication tools, for example, are essential in a "24/7" media environment.

Public health research is an opportunity for collaboration, especially in the area of community-based participatory research, where public health has extraordinary linkages to the community. New areas of public health systems research, translational research, and creative epidemiological research need to be fully supported. Creating academic tracks that allow the achievement of tenure for public health practice is central to achieving the full engagement of public health practitioners in this kind of research.

Public health funding is inadequate and should be enhanced. Destructive funding patterns that result in the recurrent reduction of capacity to prevent or respond to disease must be discontinued and a sustained investment ensured. This investment must continue to grow and track our quest for new knowledge if strive to utilize new discoveries.

We should also strengthen our nongovernmental public health organizations to enhance their capacity for policy development, community support, and advocacy. The American Public Health Association is working to strengthen the associations affiliated with it. We should also strengthen our advocacy capacity by more effectively engaging policymakers, the private business community, the media, and the general public in a more transparent way to enhance their understanding of population health and engage them as part of a movement to improve their health and the health of their communities.

Computer scientist Alan Kay has been quoted as saying "the best way to predict the future is to invent it." By working together, the academic medical and public health practice communities can work together to address these challenges and build a robust public health system for the 21st century.

Editor's Note: The opinions expressed by the author do not necessarily reflect the opinions of the AAMC or its members.