Who Will Keep the Public Healthy? pptx

Kristine Gebbie, Linda Rosenstock,
and Lyla M. Hernandez,
Editors
Committee on Educating Public Health Professionals
for the 21st Century
Board on Health Promotion and Disease Prevention
INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES
THE NATIONAL ACADEMIES PRESS
Washington, D.C.
www.nap.edu
Who Will Keep
the Public Healthy?
Educating Public Health Professionals
for the 21st Century
THE NATIONAL ACADEMIES PRESS • 500 Fifth Street, N.W. • Washington, DC 20001
NOTICE: The project that is the subject of this report was approved by the Governing Board
of the National Research Council, whose members are drawn from the councils of the
National Academy of Sciences, the National Academy of Engineering, and the Institute of
Medicine. The members of the committee responsible for the report were chosen for their
special competences and with regard for appropriate balance.
Support for this project was provided by Contract/Grant No. 042024 between the National
Academy of Sciences and The Robert Wood Johnson Foundation. The views presented in
this report are those of the Institute of Medicine Committee on Educating Public Health
Professionals for the 21st Century and are not necessarily those of the funding agencies.
Library of Congress Cataloging-in-Publication Data
Who will keep the public healthy? : educating public health
professionals for the 21st Century / Kristine Gebbie, Linda Rosenstock,
and Lyla M. Hernandez, editor(s).
p. cm.

Includes bibliographical references and index.
ISBN 0-309-08542-X (hardcover)
1. Public health—Study and teaching. I. Gebbie, Kristine M. II.
Rosenstock, Linda. III. Hernandez, Lyla M.
RA440.W47 2003
362.1’071—dc21
2003001043
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Shaping the Future for Health
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v
COMMITTEE ON EDUCATING PUBLIC HEALTH
PROFESSIONALS FOR THE 21ST CENTURY
KRISTINE GEBBIE, Dr.P.H., R.N. (co-chair), Associate Professor of
Nursing, School of Nursing, Columbia University

LINDA ROSENSTOCK, M.D., M.P.H. (co-chair), Dean, School of Public
Health, University of California, Los Angeles
SUSAN ALLAN, M.D., J.D., M.P.H., Health Director, Arlington County
Department of Human Services, Arlington, Virginia
KAYE BENDER, Ph.D., R.N., Deputy State Health Officer, Missis-
sippi State Department of Health
DAN BLAZER, M.D., Ph.D., M.P.H., J.P. Gibbons Professor of Psy-
chiatry and Behavioral Sciences, Duke University, and Adjunct
Professor, Department of Epidemiology, School of Public Health,
University of North Carolina
SCOTT BURRIS, J.D., Professor, School of Law, Temple University
and Associate Director, Center for Law and the Public’s Health,
Georgetown and Johns Hopkins Universities
MARK CULLEN, M.D., Professor of Medicine and Public Health,
School of Medicine, Yale University
HAILE DEBAS, M.D., Dean, School of Medicine, and Vice Chancel-
lor, Medical Affairs, University of California, San Francisco
ROBERT GOODMAN, Ph.D., M.P.H., M.A., Usdin Family Professor,
Health Sciences Center, Tulane University
ALAN E. GUTTMACHER, M.D., Deputy Director, National Human
Genome Research Institute, National Institutes of Health
RITA KUKAFKA, Dr.P.H., M.A., Assistant Professor of Public Health
(Sociomedical Sciences) and Department of Medical Informatics,
Mailman School of Public Health and the College of Physicians
and Surgeons, Columbia University
ROXANNE PARROTT, Ph.D., Professor, College of Liberal Arts, Penn-
sylvania State University
SHEILA M. SMYTHE, M.S., Executive Vice President and Dean, School
of Public Health, New York Medical College
WILLIAM VEGA, Ph.D., Director, Behavioral and Research Training

Institute and Professor of Psychiatry, Robert Wood Johnson Medical
School, University of Medicine and Dentistry of New Jersey
PATRICIA WAHL, Ph.D., Dean, School of Public Health and Com-
munity Medicine, University of Washington
vi
STAFF
LYLA M. HERNANDEZ, M.P.H., Senior Program Officer, Study Director
MAKISHA WILEY, Senior Project Assistant
MARC EHMAN, M.P.H., Research Assistant through 05/03/02
ROSE MARIE MARTINEZ, Sc.D., Director, Board on Health Promo-
tion and Disease Prevention
RITA GASKINS, Administrative Assistant, Board on Health Promo-
tion and Disease Prevention
vii
REVIEWERS
This report has been reviewed in draft form by individuals chosen for
their diverse perspectives and technical expertise, in accordance with pro-
cedures approved by the NRC’s Report Review Committee. The purpose
of this independent review is to provide candid and critical comments
that will assist the institution in making its published report as sound as
possible and to ensure that the report meets institutional standards for
objectivity, evidence, and responsiveness to the study charge. The review
comments and draft manuscript remain confidential to protect the integ-
rity of the deliberative process. We wish to thank the following individu-
als for their review of this report:
Susan Addis, M.P.H., M.Ur.S., Vice-Chair, Connecticut Health Foun-
dation, Former Connecticut Commissioner of Health
Enriqueta C. Bond, Ph.D., President, Burroughs Wellcome Fund
Patricia Flatley Brennan, R.N., Ph.D., Moehlman Bascom Professor,
University of Wisconsin-Madison

Wylie Burke, M.D., Ph.D., Professor and Chair, Department of Medical
History and Ethics, University of Washington
Noreen M. Clark, Ph.D., Marshall H. Becker Professor and Dean of
Public Health, University of Michigan
Eugenia Eng, M.P.H., Dr.P.H., Professor, School of Public Health,
University of North Carolina
Bernard Guyer, M.D., M.P.H., Chair, Department of Population and
Family Health Science, Bloomberg School of Public Health, Johns
Hopkins University
Jeanette Klemczak, Ph.D., R.N., Director, College of Nursing, Michi-
gan State University
Deborah E. Powell, M.D., Dean and Assistant Vice President for Clinical
Affairs, University of Minnesota School of Medicine
Joseph Telfair, Dr.P.H., M.S.W., M.P.H., Associate Professor, Uni-
versity of Alabama at Birmingham
Thomas W. Valente, Ph.D., Director, Master of Public Health Pro-
gram, Keck School of Medicine, University of Southern California
Although the reviewers listed above have provided many construc-
tive comments and suggestions, they were not asked to endorse the con-
clusions or recommendations nor did they see the final draft of the report
before its release. The review of this report was overseen by M. Donald
Whorton, M.D., M.P.H., WorkCare, Inc., Alameda, CA, appointed by the
Institute of Medicine and Harold J. Fallon, M.D., IOM Home Secretary
and Dean Emeritus, School of Medicine, University of Alabama at Bir-
viii REVIEWERS
mingham, appointed by the NRC’s Report Review Committee, who were
responsible for making certain that an independent examination of this
report was carried out in accordance with institutional procedures and
that all review comments were carefully considered. Responsibility for
the final content of this report rests entirely with the authoring committee

and the institution.
ix
Acknowledgments
Many people willingly shared their expertise and insights with the com-
mittee and staff during the course of this study. Their contributions invigo-
rated committee deliberations and enhanced the quality of this report.
William L. Roper, M.D., M.P.H., conceived the idea to examine public
health professional education in the 21st century, thereby prompting this
study. The committee expresses its appreciation to the Robert Wood
Johnson Foundation (RWJF) for sponsoring the study and, in particular,
to Pamela Williams Russo, M.D., M.P.H.
Elizabeth Fee, Ph.D., commissioned to write a paper on the history of
public health education in the United States, provided a tremendously
thorough and extremely readable paper that elucidated for the committee
the issues, events, and evolution of public health education over the past
century. Additionally, her comments on an earlier draft of this report
were informative and helpful in clarifying ideas. The commissioned pa-
per by James C. Thomas, M.P.H., Ph.D., on teaching public health ethics
highlighted issues of critical importance to public health education and
contributed greatly to the committee’s examination of the role of ethics in
public health education.
The committee greatly appreciates the input of speakers whose pre-
sentations informed committee thinking including: Mohammad Akhter,
M.D., M.P.H.; Elaine Auld, M.P.H.; Ronald Bialek, M.P.H.; Patricia P.
Evans, M.P.H.; Virginia Kennedy, Ph.D.; Maureen Lichtveld, M.D.,
M.P.H.; William Livingood, Ph.D.; Samuel Shekar, M.D., M.P.H.; Harrison
Spencer, M.D., M.P.H.; and Vaughn Upshaw, Ed.D., Dr.P.H. The commit-
tee extends its thanks to the Association of Schools of Public Health, the
Association of State and Territorial Health Officers, the Centers for Dis-
ease Control and Prevention, the National Association of County and

x ACKNOWLEDGMENTS
City Health Officials, and the Public Health Foundation for their thought-
ful and detailed input about the challenges facing public health and the
educational needs of public health professionals.
The Association of Schools of Public Health was also helpful in review-
ing and distributing a committee survey. Their participation was critical to
the successful conduct of this survey on progress made by schools of public
health in implementing recommendations of the 1988 Institute of Medicine
(IOM) report, The Future of Public Health. The committee is grateful to the 25
schools of public health at the following universities that took the time and
put forth the effort to complete the survey:
Boston University University of Iowa
Emory University University of Massachusetts
Harvard University University of Medicine and
Johns Hopkins University Dentistry of New Jersey
Ohio State University University of Michigan
Saint Louis University University of Minnesota
San Diego University University of North Carolina,
Texas A&M University Chapel Hill
Tulane University University of Oklahoma
University of Alabama, Birmingham University of Pittsburgh
University of Albany (SUNY) University of South Carolina
University of California, Berkeley University of Texas, Houston
University of California, Los Angeles University of Washington
Yale University
The work of this committee has been informed by several high qual-
ity IOM reports on relevant topics including: The Future of Public Health
(1988); Linking Research and Public Health Practice: A Review of CDC’s Pro-
gram of Centers for Research and Demonstration of Health Promotion and Dis-
ease (1997); America’s Vital Interest in Global Health (1997); Promoting Health:

Intervention Strategies from Social and Behavioral Research (2000); Health and
Behavior: the Interplay of Biological, Behavioral, and Societal Influences (2001);
and Unequal Treatment: Confronting Racial and Ethnic Disparities in Health
Care (2002). We acknowledge our indebtedness to the committees and
staffs of these reports.
The committee was extremely fortunate in their staffing for this study.
We wish to thank our study director, Lyla M. Hernandez, for her enormous
effort in producing a clearly written, well-organized report that reflects the
collective thought of the committee. Our appreciation also goes to Makisha
Wiley for her administrative support, coordination of committee meetings,
and maintenance of project files, and to Marc Ehman who provided re-
search assistance throughout the initial phases of the project.
xi
Contents
ABSTRACT 1
SUMMARY 3
Committee Charge, 3
Definition, 4
Challenges, 4
The Future of Public Health Education, 5
Schools of Public Health, 8
Other Programs and Schools, 17
Public Health Agencies, 20
Conclusion, 25
1 INTRODUCTION 27
Public Health Professionals, 29
Determinants of Health, 31
Challenges, 34
Summary, 39
2 HISTORY AND CURRENT STATUS OF PUBLIC HEALTH

EDUCATION IN THE UNITED STATES 41
History, 41
Current Status, 50
Summary, 60
3 THE FUTURE OF PUBLIC HEALTH EDUCATION 61
Informatics, 62
xii CONTENTS
Genomics, 68
Communication, 72
Cultural Competence, 78
Community-Based Participatory Research, 84
Global Health, 93
Policy and Law, 95
Ethics, 98
Summary, 105
4 FUTURE ROLE OF SCHOOLS OF PUBLIC HEALTH IN
EDUCATING PUBLIC HEALTH PROFESSIONALS FOR
THE 21st CENTURY 108
Overview, 108
Education, 109
Transdisciplinary Research, 117
Policy, 120
Academic Collaboration, 121
Access to Life-Long Learning, 122
Community Collaboration, 125
Faculties for Schools of Public Health, 126
5 THE NEED FOR PUBLIC HEALTH EDUCATION IN
OTHER PROGRAMS AND SCHOOLS 129
Graduate Programs in Public Health, 129
Medical Schools, 131

Schools of Nursing, 136
Other Schools, 142
6 PUBLIC HEALTH AGENCIES: THEIR ROLES IN
EDUCATING PUBLIC HEALTH PROFESSIONALS 145
Local Public Health Agencies, 145
State Public Health Agencies, 151
Federal Public Health Agencies, 157
Recommendations, 162
CONCLUSION 168
REFERENCES 171
CONTENTS xiii
APPENDIXES
A SCHOOL OF PUBLIC HEALTH CATALOGUE
ABSTRACTION 183
B SCHOOL OF PUBLIC HEALTH SURVEY INSTRUMENT 190
C ORGANIZATIONAL INPUT 199
D EDUCATION OF PUBLIC HEALTH
PROFESSIONALS IN THE 20TH CENTURY 222
E OCCUPATIONAL CLASSIFICATIONS 262
F A COLLECTION OF COMPETENCY SETS 265
G PUBLIC MEETING 278
H COMMITTEE BIOGRAPHIES 283
INDEX 289

Who Will Keep
the Public Healthy?
xvi
1
In a world where health threats range from AIDS and bioterrorism to
an epidemic of obesity, the need for an effective public health system is as

urgent as it has ever been. An effective public health system requires
well-educated public health professionals. Public health professionals re-
ceive education and training in a wide range of disciplines, come from a
variety of professions, work in many types of settings, and are engaged in
numerous kinds of activities; however, all public health professionals
share a focus on population-level health. The committee developed the
following definition, used throughout the report. A public health profes-
sional is a person educated in public health or a related discipline who is em-
ployed to improve health through a population focus. Many institutional set-
tings play important roles in public health professional education
including schools of public health, degree granting programs in public
health, medical schools, schools of nursing, other professional schools
(e.g., law), and local, state and federal public health agencies. It is impor-
tant that the education provided by these programs and institutions is
based upon an ecological model of health. An ecological model assumes
that health and well being are affected by interaction among the multiple
determinants of health.
Further, it is important that public health professional education in-
clude not only the long recognized five core components of public health
(i.e., epidemiology, biostatistics, environmental health, health services ad-
ministration, and social and behavioral science), but that it also encom-
pass eight critical new areas: informatics, genomics, communication, cul-
tural competence, community-based participatory research, policy and
Abstract
2 WHO WILL KEEP THE PUBLIC HEALTHY?
law, global health, and ethics. Understanding and being able to apply
information and computer science technology to public health practice
and learning (i.e., public health informatics) are necessary competencies
for public health professionals in this information age in which we are
vitally dependent upon data. Genomics is helping us understand the role

of genetic factors in leading causes of morbidity in the United States,
information that public health professionals must be familiar with to im-
prove health. Public health professionals must be proficient in communi-
cation to interact effectively with multiple audiences. They must also be
able to understand and incorporate the needs and perspectives of cultur-
ally diverse communities in public health interventions and research, and
to understand and be able to influence the policies, laws, and regulations
that affect health. New approaches to research that involve practitioners,
researchers, and the community in joint efforts to improve health are
becoming necessary as we recognize the importance of multiple deter-
minants of health, for example, social relationships, living conditions,
neighborhoods, and communities. Understanding global health issues is
increasingly important as public health professionals are called upon to
address problems that transcend national boundaries. Finally, public
health professionals must be able to identify and address the numerous
ethical issues that arise in public health practice and research.
We need high quality public health professionals contributing through
practice, teaching, and research to improve health in our communities. This
report provides a framework and recommendations for strengthening pub-
lic health education, research, and practice skills that can be used by the
institutions and organizations responsible for educating public health pro-
fessionals and supporting public health education. Public health profes-
sionals’ education and preparedness should be of concern to everyone, for
it is well-educated public health professionals who will be able to effec-
tively shape the programs and policies needed to improve population
health during the coming century. If we want high quality public health
professionals, then we must be willing to provide the support necessary to
educate those professionals.
3
Many achievements in reducing mortality and morbidity during the

past century can be traced directly to public health initiatives. The extent to
which we are able to make additional improvements in the health of the
public depends, in large part, upon the quality and preparedness of the
public health workforce, which is, in turn, dependent upon the relevance
and quality of its education and training. This report examines an essential
component of the public health workforce—public health professionals.
COMMITTEE CHARGE
The charge of this committee was to develop a framework for how,
over the next 5 to 10 years, education, training, and research in schools of
public health could be strengthened to meet the needs of future public
health professionals to improve population-level health. The committee
also was asked to develop recommendations for overall improvements in
public health professional education, training, research, and leadership. A
wide range of institutional settings, including not only schools of public
health but also degree-granting programs in public health, medical schools,
schools of nursing, other professional schools (e.g., law), and local, state,
and federal public health agencies, play important roles in public health
education, training, research, and leadership development. This report pre-
sents conclusions and recommendations for each of these institutional set-
tings that are directed toward improving the future of public health profes-
sional education in the United States.
Summary
4 WHO WILL KEEP THE PUBLIC HEALTHY?
DEFINITION
Public health professionals receive education and training in a wide
range of disciplines, come from a variety of professions, work in many
types of settings, and are engaged in numerous kinds of activities. One
thing public health professionals have in common is a focus on population-
level health. For purposes of this study, therefore, the committee developed
the following definition: A public health professional is a person educated in

public health or a related discipline who is employed to improve health through a
population focus. Nearly all public health professionals encompassed by this
definition have earned at least a baccalaureate degree.
CHALLENGES
As we begin the 21st century, public health professionals are faced
with major challenges including globalization, scientific and technologi-
cal advances, and demographic changes. The health of the U.S. popu-
lation is increasingly affected by globalization and its accompanying
environmental changes. Increased travel, trade, economic growth, and
diffusion of technology have been accompanied by negative social and
environmental conditions, a greater disparity between rich and poor, en-
vironmental degradation, and food security issues. There is increasing
cause for concern about drug-resistant strains of emerging and re-emerg-
ing diseases (e.g., HIV/AIDS, tuberculosis, hepatitis B, malaria, cholera,
diptheria, and Ebola). Along with the transmission of microbes and vi-
ruses, the increase in international trade is fostering the distribution of
products associated with major health risks, for example, alcohol and
tobacco.
Major challenges related to advances in science and medical tech-
nologies include important ethical, legal, and social questions. Communi-
cation technology, for example, offers increased opportunity for dissemi-
nation of health information but also requires response to the misleading
or incorrect information spread through the use of this same technology.
Public health informatics (i.e., the systematic application of information
and computer science and technology to public health practice, research,
and learning [Yasnoff et al., 2000]) offers great potential for improving
our public health surveillance capacity and response but is accompanied
by concerns regarding confidentiality and security of the information sys-
tems. Genomics holds the promise of helping us understand the role that
genetic factors play in morbidity and mortality in the United States. How-

ever, we will need to ensure that individuals with certain genetic traits
and predispositions are not discriminated against in the workplace or in
obtaining insurance. While scientific advances in the biomedical field have
improved the health of the public, about half of all causes of mortality in
5SUMMARY
the United States are linked to social and behavioral factors and accidents
(McGinnis and Foege, 1993). However, the vast majority of the nation’s
health research resources have been directed toward biomedical research,
with comparatively few resources devoted to supporting health research
on social and behavioral determinants of health (IOM, 2000).
Major demographic transformations are taking place in the United
States and around the world that also present public health with new
challenges. The population is aging, and this aging is accompanied by an
increase in multiple chronic diseases, geriatric conditions, and mental
health conditions. We are faced with the challenge of better understand-
ing how to prevent, delay, or mitigate the effects of these diseases, thereby
increasing the chances for healthful, functional aging. The U.S. popula-
tion is also increasing in racial and ethnic diversity. There are large racial
and ethnic health disparities reflected in increased rates among minorities
of such health problems as heart disease, cancer, accidents, diabetes, and
HIV infections. Improving health outcomes for all populations in Ameri-
can society is a major challenge for public health in the 21st century.
THE FUTURE OF PUBLIC HEALTH EDUCATION
Public health professionals have a major role to play in addressing
these complex health challenges, but to do so effectively they must have a
framework for action and an understanding of the ways in which what
they do affects the health of individuals and populations. Several models
have been proposed for understanding the forces that impact on health,
that is, the determinants of health (Lalonde, 1974; Evans and Stoddart,
1994; IOM, 1999; Kaplan et al., 2000). While each model differs, determi-

nants include broad social, economic, cultural, health, and environmental
conditions; living and working conditions; social, family, and community
networks; individual behavior; individual traits such as age, sex, race,
and biological factors, and the biology of disease. Kaplan and colleagues
(2000), Grzywacz and Fuqua (2000), and others propose that the multiple
determinants of health are related and linked in many ways. A model of
health that emphasizes the linkages and relationships among multiple
factors (or determinants) affecting health is an ecological model. An ex-
ample of the ecological model can be found in Figure S-1. It is important
to note that the committee is not recommending any single model, but
rather emphasizing the concept that there are linkages and relationships
among the multiple determinants of health.
The committee believes that public health professionals must under-
stand this ecological model. They must look beyond the biological risk
factors that affect health and seek to also understand the impact on health
of environmental, social, and behavioral factors. They must be aware of
how these multiple factors interact in order to evaluate the effectiveness
6 WHO WILL KEEP THE PUBLIC HEALTHY?
of their interventions. They must understand the theoretical underpin-
nings of the ecological model in order to develop research that further
explicates the pathways and interrelationships of the multiple determi-
nants of health. It is through this understanding that public health profes-
sionals will be able to more effectively address the challenges of the 21st
FIGURE S-1 A guide to thinking about the determinants of population health.
NOTES: Adapted from Dahlgren and Whitehead, 1991. The dashed lines between
levels of the model denote interaction effects between and among the various levels
of health determinants (Worthman, 1999).
a
Social conditions include, but are not limited to: economic inequality, urbanization,
mobility, cultural values, attitudes and policies related to discrimination and

intolerance on the basis of race, gender, and other differences.
b
Other conditions at the national level might include major sociopolitical shifts, such
as recession, war, and governmental collapse.
c
The built environment includes transportation, water and sanitation, housing, and
other dimensions of urban planning.
Living and working
conditions may include:
•
Psychosocial factors
•
Employment status and
occupational factors
•
Socioeconomic status
(income, education,
occupation)
•
The natural and built
c
environments
•
Public health services
•
Health care services

Over the life span
SOURCE: The Future of the Public's Health (IOM 2003).
a

b
7SUMMARY
century, including globalization, scientific and medical technologies, and
demographic transformations.
While an ecological model addresses the interactions and linkages
among determinants of health, an ecological view of health is a perspec-
tive that involves knowledge of the ecological model of determinants of
health and an attempt to understand a specific problem or situation in
terms of that model. Further, an ecological approach to health is one in
which multiple strategies are developed to impact determinants of health
relevant to the desired health outcomes.
The committee acknowledges that the traditional core areas of epi-
demiology, biostatistics, environmental health, health services adminis-
tration, and social and behavioral sciences remain important for public
health professional education. However, the committee believes that the
following eight content areas are now and will continue to be significant
to public health and public health education in programs and schools of
public health for some time to come: informatics, genomics, communi-
cation, cultural competence, community-based participatory research,
global health, policy and law, and public health ethics. These areas are
natural outgrowths of the traditional core public health sciences as they
have evolved in response to ongoing social, economic, technological,
and demographic changes. For example, community-based participa-
tory research (CBPR) can be viewed as epidemiology enriched by con-
temporary social and behavioral science because it incorporates what
we have learned about community processes and engagement, and the
complex nature of interventions with epidemiology, in order to under-
stand how the multiple determinants of health interact to influence
health in a particular community.
Education in these eight areas is important to preparing high-quality,

effective public health professionals. Understanding and being able to
apply information and computer science technology to public health prac-
tice and learning (i.e., public health informatics) are necessary competen-
cies for public health professionals in this information age in which we
are vitally dependent upon data. Genomics is helping us understand the
role of genetic factors in leading causes of morbidity in the Unites States,
information that public health professionals must be familiar with to im-
prove health.
Public health professionals must be proficient in communication to
interact effectively with multiple audiences. They must also be able to
understand and incorporate the needs and perspectives of culturally
diverse communities in public health interventions and research, and
to inform the development of policies, laws, and regulations. New ap-
proaches to research that involve practitioners, researchers, and the com-
munity in joint efforts to improve health are becoming necessary as we
recognize the importance of multiple determinants of health, for ex-
8 WHO WILL KEEP THE PUBLIC HEALTHY?
ample, social relationships, living conditions, neighborhoods, and com-
munities. Understanding global health issues is increasingly important
as public health professionals are called upon to address problems that
transcend national boundaries. Finally, public health professionals must
be able to identify and address the numerous ethical issues that arise in
public health practice and research.
Therefore, for each of these eight emerging content areas, the com-
mittee recommends that
• competencies be identified;
• each area be included in graduate level public health education;
• continuing development and creation of new knowledge be pur-
sued; and
• opportunity for specialization be offered.

The committee believes that the progress made in understanding and
incorporating these eight important areas into public health practice, edu-
cation, and research will enable us, in the future, to identify other new
and emerging areas that must be addressed. The committee also believes
that it is important to enhance the development of the public health pro-
fession. While many of the things that need to be done to enhance the
profession are beyond the scope of this study, certification is related to
public health education. Within the various professions in the world of
health and illness, specialty certification is common. Specialty certifica-
tion attests to skills beyond the legal minimums that apply to a limited set
of patients (e.g., pediatrics), conditions (e.g., infectious diseases), or inter-
ventions (e.g., anesthesia).
The range of individuals entering masters of public health (M.P.H.)
programs, many with no previous health-specific education and with no
access to any of the public health-related certifications currently in exis-
tence, makes M.P.H. students likely candidates for a certification program.
Therefore, the committee recommends the development of a voluntary
certification of competence in the ecological approach to public health as
a mechanism for encouraging the development of new M.P.H. graduates.
SCHOOLS OF PUBLIC HEALTH
The basic public health degree is the master of public health (M.P.H.),
while the doctor of public health (Dr.P.H.) is offered for advanced train-
ing in public health leadership. Schools of public health also offer a doc-
torate (Ph.D.) in various public health-related disciplines, as well as a
range of masters’ degrees. Schools of public health produce the bulk of
degree graduates. In 1998-1999, there were 5,568 graduates from the then
29 accredited schools of public health (ASPH, 2000). Davis and Dandoy