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Public Health Learning Outcomes for All Undergraduates
"Public health is the science and art of protecting and improving the health of communities through education, promotion of healthy lifestyles, and research for disease and injury prevention." (http://whatispublichealth.org/)
Public health focuses on protecting the health and well-being of entire communities, from small towns to large countries to the global population. In 2003, the Institute of Medicine (IOM) recommended "that all undergraduates should have access to education in public health." The IOM's rationale was based on the premise that public health is an "essential part of the training of citizens" and that "[p]ublic health literacy is an appropriate and worthy social goal" (Gebbie, Rosenstock, and Hernandez 2003). Indeed, advocates of public health education believe that it prepares students to contribute to the health of the public through positive decision-making and constructive action in personal, professional, and civic arenas.
Despite the strong rationale for widespread access to public health education, formal education for public health has long been centered at the master's level, with students coming from a variety of undergraduate and professional backgrounds. Nevertheless, undergraduate public health majors and minors now exist in many two- and four-year institutions. In fact, Karin Fischer and David Glenn identified public health as one of five college majors on the rise, with bachelor's degrees doubling from 2003 to 2007 (2009), and an analysis by the Educated Citizen and Public Health initiative showed public health to be a growing presence in undergraduate education (Hovland et al. 2009).
In response to increased student interest, institutions have sought guidance on optimizing the format and content of undergraduate public health education. At the same time, new courses and programs of study are engaging faculty across disciplines and fields in collaborative work connected to undergraduate general education or to various majors or minors. Public health topics facilitate, and indeed require, such integration.
The IOM recommendation and the explosion of public health on college campuses have jump-started several activities:
- the Association of American Colleges and Universities' (AAC&U's) Educated Citizen and Public Health initiative, which aims to advance public health education in undergraduate curricula
- the Association for Prevention Teaching and Research (APTR) and AAC&U's "Recommendations for Undergraduate Public Health Education," which features a series of introductory courses in public health, epidemiology, and global health (Riegelman and Albertine 2008)
- the American Public Health Association's policy statement on "The Integration of Core Public Health Education into Undergraduate Curricula" (http://www.apha.org/advocacy/policy/policysearch/default.htm?id=1390)
Subsequent to these initiatives, the Association of Schools of Public Health (ASPH), in close collaboration with AAC&U and APTR, began a process to craft a model of public health learning outcomes that could be made available to all undergraduate students. The model is geared toward educating citizens who know about and are able to promote public health both locally and globally to eliminate health disparities in populations around the world. This article presents the results of the ASPH-led Undergraduate Public Health Learning Outcomes Development Project.
Enhancing Public Health Literacy
"Both arts and sciences and public health should share in fostering and developing an educated citizenry." (Riegelman and Albertine 2008)
In 2009, ASPH partnered with AAC&U and APTR, combining their efforts to ensure that all undergraduates have opportunities to develop basic public health literacy. ASPH, AAC&U, and APTR, as well as the Centers for Disease Control and Prevention, invited representatives from both public health and liberal arts and sciences disciplines to join a leadership group that would define and drive the project. The process has engaged over 125 individuals to date.
The leadership group chose the framework of AAC&U's Liberal Education and America's Promise (LEAP) initiative to guide the development of undergraduate public health learning outcomes. By following the LEAP paradigm, the project team discouraged disciplinary silos and enabled participants to think broadly about the knowledge, skills, and attitudes necessary for public health literacy. Furthermore, the LEAP philosophy "support[s] the integration of public health education into general and liberal education with an aim to produce an educated citizenry" (Albertine 2008).
The first three LEAP domains align beautifully with the aims of public health education:
- Knowledge of Human Cultures and the Physical and Natural World (in this case, as related to individual and population health)
- Intellectual and Practical Skills
- Personal and Social Responsibility
For each domain, a core workgroup was tasked with identifying and specifying learning outcomes. Each core workgroup consisted of ten faculty members from universities across the United States, representing both public health and the liberal arts and sciences. Each group had two cochairs—one from public health and one from the liberal arts and sciences—who oversaw all activities. In addition, each domain had a resource group of over thirty academics who provided "reality checks" in response to emerging recommendations that the core workgroups drafted.
To reach consensus about learning outcomes across all three domains, the workgroups used an online modified Delphi survey process with three rounds. After each round of the survey, the core workgroup discussed the results and decided which draft learning outcomes would advance to the next round. Only the core workgroups responded to the first round, while the resource groups participated in rounds two and three. The overall response rate for all three surveys was 90 percent. On completing the surveys, the core workgroups presented selected learning outcomes at a model integration meeting attended by leadership group members and domain cochairs. The goal of the integration meeting was to bring cohesiveness to the model.
In developing the learning outcomes, the core workgroups referred to Bloom's Taxonomy to ensure that they included both cognitive and affective learning outcomes. The workgroups also assessed the draft learning outcomes to understand the level of the behaviors—from the simplest (knowledge) to the more complex (application, evaluation)—that were emerging. Because the learning outcomes were targeted for all undergraduates across all majors, lower level categories predominated.
The leadership group used the fourth and final LEAP domain, Integrative and Applied Learning, to identify the best instructional methods and learning practices for introducing and integrating public health content. All core workgroup members from domains one, two, and three provided input about domain four, which emphasizes student-centered learning over more traditional faculty-focused modes of teaching and assessment.
Public Health Learning Outcomes
Beginning with an initial slate of 394 proposed learning outcomes, the project team developed a final list of thirty-four recommended learning outcomes across the first three domains. These outcomes represent what all undergraduates, as educated members of society, should know and be able to do to promote their own and their communities' health. The concepts and skills can be integrated into both curricular and cocurricular learning opportunities. The list is neither comprehensive nor prescriptive. Instead, it illustrates the myriad ways public health contributes to quality of life locally and globally, while also facilitating adoption of the LEAP model in undergraduate education. In the long term, education geared toward these outcomes will promote a healthier citizenry empowered with the basic knowledge, skills, and attitudes to assist in eliminating health disparities in populations around the world.
The thirteen learning outcomes for the first domain, Knowledge of Human Cultures and the Physical and Natural World as it Relates to Individual and Population Health, encompass a wide variety of topics relevant to the humanities and sciences. A few outcomes focus directly on public health knowledge, including its definition, governmental roles, and key milestones in the field's development. Others point to developing an appreciation of community collaborations and an understanding of how diverse demographics within a community influence health. The outcomes encourage comparisons of certain factors at the local, national, and global levels: environmental hazards, risk factors for infectious and chronic diseases, and leading causes of death. They include valuing the relationships between human rights and health, science and technology and health, and medical and public health services and health. A learning outcome unique to this domain is to identify reciprocal relationships among literature, the arts, and public health.
The ten learning outcomes for domain two, Intellectual and Practical Skills, focus on understanding health information and data, and the methods of discovering and investigating related evidence. They include appreciation for the multiple determinants of health and for the interconnectedness of physical, social, and environmental aspects of community health, such as the impact of policies, laws, and legislation. The domain is rounded out with practical skills: research, analysis, teamwork, and communication.
The eleven learning outcomes in domain three, Personal and Social Responsibility, range from endorsing prevention and promoting healthy individual lifestyle behaviors to participating in community engagement for promoting public health, whether through active involvement in health promotion programs or in the political process. Ethics and social justice are included in this domain, focusing on the space where an individual's rights and preferences converge with the greater public good. Diversity is an element of domain three, appearing through the outcomes of valuing multicultural perspectives and collaborating with others from diverse backgrounds.
Student-Centered Integrative Learning Methods
How can faculty best ensure that these learning outcomes are integrated in undergraduate curricula across the breadth of students' education? Public health is a versatile topic that relates to many subjects in many different ways. Domain four suggests methods for incorporating or integrating the learning outcomes into general education or discipline-specific courses, into cocurricular and experiential learning opportunities.
Workgroup members provided examples of high-retention and high-impact educational practices that would apply to specific learning outcomes. The model suggests the wide array of possibilities for incorporating the outcomes in a variety of undergraduate learning opportunities.
Table 1 illustrates how particular integrative learning methods can encourage specific learning outcomes.
Formal faculty development will be essential for suffusing the model across the curriculum. While the project provides examples for faculty seeking ideas about how to integrate public health into their teaching, the challenges of engaging faculty and developing their public health knowledge are topics for further exploration.
Beyond the plan for facilitating learning for citizens educated in public health regardless of college major lies the need to define academic benchmarks for undergraduate public health majors and minors. With the rise in undergraduate public health programs comes growing interest in clarifying the distinctions between undergraduate study in public health and the Master of Public Health degree. ASPH currently has a set of competencies for the Master of Public Health degree (http://www.asph.org/publication/MPH_Core_Competency_Model/
index.html) and is beginning to create a competency model for undergraduate public health majors and minors. The goal of identifying undergraduate competencies accords with Healthy People 2020's national objectives for improving the health of all Americans, including the new objective to "[i]ncrease the proportion of four-year colleges and universities that offer public health or related majors and/or minors which are consistent with the core competencies of undergraduate public health education." As ASPH develops undergraduate competencies, it will also review the competencies for the master's degree. ASPH is planning to correlate the two projects to ensure the development of a well-articulated learning ladder for public health education.
For more information, visit www.asph.org/competency.
Editor's note: The authors wish to acknowledge that this article was partially supported under a cooperative agreement from the Centers for Disease Control and Prevention (CDC) through the Association of Schools of Public Health (ASPH) Grant Number CD300430. The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of CDC or of AAC&U. The authors retain the copyright to the article.
Albertine, Susan. 2008. "Undergraduate Public Health: Preparing Engaged Citizens As Future Health Professionals." American Journal of Preventive Medicine 35 (3): 253-57.
Fischer, Karin, and David Glenn. 2009. "5 College Majors on the Rise." Chronicle of Higher Education, August 31. http://chronicle.com/article/5-College-Majors-On-the-Rise/48207.
Gebbie, Kristine, Linda Rosenstock, and Lyla M. Hernandez, eds. 2003. Who Will Keep the Public Healthy? Educating Public Health Professionals for the 21st Century. Washington, DC: National Academies Press.
Hovland, Kevin, Brenda A. Kirkwood, Caleb Ward, Marian Osterweis, and Gillian B. Silver. 2009. "Liberal Education and Public Health: Surveying the Landscape." Peer Review 11 (3): 5-8.
Riegelman, Richard K.,and Susan Albertine. 2008. Recommendations for Undergraduate Public Health Education. Washington, DC: Association for Prevention Teaching and Research and Association of American Colleges and Universities.
Donna J. Petersen is the dean of the University of South Florida College of Public Health and chair of the Undergraduate Public Health Learning Outcomes Development Project; and Christine M. Plepys is a project manager for the Undergraduate Public Health Learning Outcomes Development Project at the Association of Schools of Public Health.