Although the 28 accredited schools of public health graduate 4800 master’s-level students annually, more than 43 graduate programs in public health grant an additional 600 to 700 master’s degrees each year (Association of Teachers of Preventive Medicine, preliminary data, September 2000). In other words, 1 of every 8 master’s degrees in public health is awarded from an institution other than a school of public health. “Academic public health” comprises the schools of public health plus the graduate programs in public health. Thus, the question should be “What core competencies do the 5500 annual master’s graduates need. . . ?” There are 30 accredited graduate programs in public health and preventive medicine, 13 accredited programs in community health education, and a few programs that have chosen not to go through the accreditation process.4 The accredited programs meet the same curricular requirements as schools of public health and are accredited by the same body, the Council on Education for Public Health. Schools and programs grant the Master of Public Health and a variety of other master’s-level degrees. In 14 states, graduate programs are the only source of graduate education in public health. In many locations, programs offer public health education in cities where potential students are already employed; these students would be unable to move to sites where schools of public health are located. Like schools of public health, graduate programs also offer distance-learning courses to meet students’needs. The graduate programs in public health are vitally interested in the same issues as the schools of public health: competencies for the varied practice settings of public health, accreditation requirements for graduate education, credentialing of the public health workforce, and preparation of visionary public health leaders. In fact, several of the newer schools of public health began as graduate programs in public health. Yet the graduate programs are often overlooked in the discussions and efforts exploring these topics. TheAssociation ofTeachers of Preventive Medicine serves as the coordinating organization for the Council of Graduate Program Directors. The council represents these master’slevel programs in public health and preventive medicine, just as theAssociation of Schools of Public Health represents the schools. During 2000 the council, with assistance from the Health Resources and ServicesAdministration and the Council on Education for Public Health, undertook an extensive survey of graduate programs in public health, similar to the annual ASPH survey of schools of public health.6 We will be submitting an article to the Journal that summarizes the results of that survey. 468
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The work outlined by Clark and Weist,3 on a framework for designing competencies for public health educational programs, is important to the field of public health and has implications for all institutions offering master’s degrees in public health. So far, however, the work has been limited to the schools of public health. Similarly, the effort of the American Public Health Association and the ASPH to explore issues related to credentialing of the public health workforce is vital to both the schools and the programs offering graduate education in public health. I urge the American Public Health Association, the Journal, and ASPH to consider the graduate programs in public health full partners in these efforts and to include data from the programs when information is published on graduate education in public health. Suzanne Dandoy, MD, MPH Requests for reprints should be sent to Suzanne Dandoy, MD, MPH, Association of Teachers of Preventive Medicine, 1660 L St, NW, suite 208, Washington, DC 20036 (email:
[email protected]).
References 1. Sommer A. Toward a better educated public health workforce. Am J Public Health. 2000; 90:1194–1195. 2. Wright K, Rowitz L, Merkle A, et al. Competency development in public health leadership. Am J Public Health. 2000;90:1202–1207. 3. Clark NM, Weist E. Mastering the new public health. Am J Public Health. 2000;90:1208–1211. 4. US Schools of Public Health and Graduate Public Health ProgramsAccredited by the Council on Education for Public Health.Washington, DC: Council on Education for Public Health; August 2000. 5. Katz W. Association of Schools of Public Health Annual Data Report 1998. Washington, DC: Association of Schools of Public Health; 1999.
Political Competencies and Public Health Leadership Wright et al.1 provide a useful overview of how public health training programs can develop future leaders. Their focus on leadership competencies can help public health programs target their efforts in this area. We are disturbed, however, by the authors’ emphasis on competencies in collaboration and negotiation at the expense of those that use conflict and mobilization of constituencies. From the authors’ studiously nonideological language, one would not know that many of today’s key public health campaigns involve struggles with disease-promoting organizations such as the tobacco, gun, and alcohol industries or with interest groups dedicated to restricting access to, for exam-
ple, subsidized health insurance, reproductive health care, HIV education, or worker health and safety protections. One would not know that many local, state, and federal public health officials have to make decisions daily that force them to choose between their commitment to public health values and the political demands of the elected leaders who hire and fire them. These conflicts are not new; in fact, the history of public health is the record of how public health professionals, in alliance with a variety of stakeholders, have resolved these dilemmas. Acknowledging the political dimensions of public health does not require ideological homogeneity within public health faculty or curricula. It does, however, require that our students be exposed to different ideological approaches to public health and that they develop the skills to analyze the political bases of various proposals. Italsorequires,webelieve,arejectionofthemanagement jargon of “leadership” and “excellence” without specifying for what or in what. By articulatingspecificpublichealthvalues,publichealth faculty can help students to define their broader goals and to link their leadership competencies to real improvements in people’s well-being. Public health training programs do our students a disservice if they fail to prepare them for the real leadership challenges graduates will face. Indeed, we sell our profession’s history short if we cannot explicitly discuss the political and ideological conflicts that shape the health of the public. We encourage public health practitioners, faculty, and students to open a dialogue on these issues. Nicholas Freudenberg, DrPH David Kotelchuck, PhD, MPH The authors are with the Program in Urban Public Health, Hunter College School of Health Sciences, City University of New York, New York, NY. Requests for reprints should be sent to Nicholas Freudenberg, DrPH, Program in Urban Public Health, Hunter College School of Health Sciences, City University of NewYork, 425 E 25th St, NewYork, NY 10010.
References 1. Wright K, Rowitz L, Merkle A, et al. Competency development in public health leadership. Am J Public Health. 2000;90:1202–1207.
Prevention of Toddler Drowning in Pools: Isolation vs Perimeter Fencing The recent study by Morgenstern et al. on the effects of swimming-pool fencing ordiMarch 2001, Vol. 91, No. 3
