Nov. 7, 2007

Epidemiology 101 As an Undergraduate Mainstay

Flip through a stack of pre-med students’ transcripts and you’re bound to notice some patterns: chemistry, biology, calculus, maybe top it off with some economics or psychology for variety. Seldom do public health courses play much of a factor.

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A group of science and liberal arts educators, backed by several higher education organizations, are trying to change that reality by persuading colleges to include such classes as part of their undergraduate curriculum. The prevailing message: Given the growing public health challenges facing the world, students — and especially would-be doctors — need an introduction to key issues in the field to be informed citizens.

“You just don’t get that in medical school,” said Richard K. Riegelman, a lead author of a report on undergraduate public health education and founding dean of George Washington University’s School of Public Health and Health Services. “Students need to know what they’re dealing with in the world.”

Several professors, including Riegelman, are in the midst of a tour to promote their ideas, and it stopped Tuesday at the Association of American Medical Colleges’ 2007 annual meeting in Washington. The public health education movement is about more than just preparing pre-meds for their careers, but the session, “Should Undergraduate Public Health Be a Prerequisite for Medical School?,” played to the audience.

The answer to that question, according to panelists, is “yes ... but let us explain.” As medical schools and other professional programs reevaluate what their students need from college to be successful at the next level, public health courses need to be part of the equation, they said. But it’s too early for a medical school to require that applicants have a certain number of public health credits, and it’s premature for students to expect colleges to offer a major in the field. Simply put, the offerings haven’t reached a critical mass.

About 100 colleges have a public health school or program (with more emerging all the time) and the majority of those offer related courses for undergraduates. The campaign is focusing not on this group but on the 1,900 other bachelor’s degree-granting institutions that aren’t attached to such a college or program, and thus are far less likely to have classes in the field. The effort isn’t to get courses started in professional-oriented schools — faculty involved in the initiative want colleges to offer general education courses. “It’s about the big middle,” Riegelman said, “where the students are.”

The idea of making undergraduate public health courses more common got a boost in 2003, when the National Academy of Sciences’ Institute of Medicine released its own report saying that all college students should be given access to a public health education, because “public health is an essential part of the training of citizenry.” Then last fall, leaders in public health education, and arts and science fields reached a consensus at a national conference that colleges should offer core courses such as “public health 101″ and “epidemiology 101.” Speakers on Tuesday also outlined their goals for another course, “global health 101.”

The courses aren’t about health and wellness — how to take care of yourself, Riegelman said. They are intended to look at public health through a historical, cultural and sociological lens, introducing students to the health care system and themes such as poverty and geography that are studied by epidemiologists. Minors could be built upon these courses, the group says, and could include service learning requirements. The courses are meant to fulfill distribution requirements and be introductions to the field, not alternatives to advanced degree programs.

Professors involved in the initiative say the time is right to introduce such courses.

“What’s different now is that the world is so challenged,” said Susan Albertine, an English professor and dean of the School of Culture and Society at the College of New Jersey, who helped write the public health and undergraduate education report. “People are worried about pandemics, climate change, population shifts. There’s more of a reason to be engaged.”

That report was released through the Council of Colleges of Arts and Sciences. The AAMC session and last fall’s conference were both sponsored by the Association for Prevention Teaching and Research, the professional group of health promotion and disease prevention educators and researchers. The Association of Schools of Public Health and Council of Colleges of Arts and Sciences also were behind the conference.

“The Educated Citizen and Public Health Initiative,” as the effort is being called, was developed in conjunction with the Association of American Colleges and Universities’ Liberal Education and America’s Promise (LEAP) initiative. The group helped organize a faculty workshop last summer that resulted in 101 course learning outcomes, and this summer it is co-sponsoring a public health faculty and curriculum development institute. While there’s no governing body in charge of the larger effort, AAC&U, APTR, CCAS and ASPH are the core groups involved, Riegelman said. Those behind the initiative are calling it an unprecedented partnership between college faculty and public health officials to discuss curricular changes.

Both Albertine and Paul Marantz, a session panelist and co-director of the Institute of Public Health Science at Yeshiva University, said epidemiology is suitable for an undergraduate audience. It teaches critical thinking and problem solving, skills that are required in medical school, they argue. Marantz said courses in the field emphasize ethics and inference more than high-level math and rote memorization, making it appropriate for all college students. And epidemiology can be easily mixed with other academic fields to form an interdisciplinary course, he added.

A history course could look at how air pollution affected the health of immigrants to the United States, for instance. Nursing faculty could combine with arts and science faculty to develop a minor that could be open to both nursing and non-nursing students, last year’s report says.

Nancy M. Bennett, a professor of medicine at the University of Rochester School of Medicine and Dentistry, said the institution is in the process of adding several public health-related undergraduate courses. When the idea was first on the table, she said some faculty there were concerned that the courses would be too trade oriented, teaching students skills needed to work in public health fields. Others also raised questions about the academic rigor of the classes.

The new courses at Rochester emphasize both theoretical and quantitative aspects of the field, and Bennett said many who worried about mission saw how the classes fit into a liberal education when more information about the courses came out. Albertine said she expects some faculty to question how new courses will fit into their college’s general education offerings, but she hopes that many more will recognize the links between public health and their field.

With the panelists saying it’s too early to talk about requiring certain courses, and with no official count on how many colleges already offer such classes, how will faculty involved in the initiative measure progress?

“My measure of success is whether this is being intellectually incorporated into the arts and sciences,” Riegelman said. “This isn’t about public health educators pushing something on colleges. It’s about everyone taking ownership.”

— Elia Powers

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