Date: Nov. 4, 2002
Contacts: Christine Stencel, Media Relations Officer
Andrea Durham, Media Relations Assistant
(202) 334-2138; e-mail <>

Publication Announcement

Overhaul in Public Health Education Needed
To Address Health Challenges

Who Will Keep the Public Healthy? Educating Public Health Professionals for the 21st Century, a new report from the Institute of Medicine of the National Academies, suggests specific ways to improve public health professionals' capabilities to address new and complex challenges. Public health professionals in government health departments, other health services, community agencies, and universities have a shared responsibility to prevent illness and injury and keep communities healthy. Because the extent to which the nation can continue to protect the public's health depends in large part on the quality and preparedness of its public health work force, the findings of an inadequately prepared work force are of particular concern and need to be squarely addressed. In addition, the critical role the work force plays in responding to terrorist threats heightens the urgent need to make the changes recommended in the report.

Of the more than 450,000 public health workers in the United States, only a fraction receives formal public health training. Most professionals who do earn public health degrees receive their education from schools of public health and, to a lesser extent, public health degree programs. Unlike members of virtually all other health professional groups, graduates of these programs are not certified as to their competencies. The report recommends that this issue be addressed.

Schools and programs of public health can play a significant role in advancing public health by fostering collaborations with other professional schools and degree programs, local and state health departments, and community organizations. These partnerships will facilitate the kind of interactions required to tackle complex health problems that are influenced by many factors -- social, behavioral, environmental, and cultural as well as biological causes. Public health training programs should assure that education also encompasses a number of emerging content areas critical to responding to a world changing rapidly because of globalization, medical and technological advances, and rapid demographic shifts. These areas include informatics, genomics, communication, community-based learning and research, and competence and sensitivity to cultural differences.

Recent events, particularly those of Sept. 11, 2001, highlighted the need to connect the spheres of health care and public health, both to each other and to the public. Medical care and public health gradually diverged over the past decades as the number of public health professionals with medical degrees declined. Physicians have emphasized treatment through medical intervention, while public health professionals have concentrated on prevention through methods including environmental and behavioral changes. This divergence poses a significant obstacle to the nation's ability to cope with health problems that cannot be resolved through medical treatment alone. Currently, most medical students receive little or no training in public health, and few receive advanced training. The report calls for all medical students to receive basic public health training as part of their curricula and recommends that a substantial portion -- perhaps as much as half -- obtain master's-level public health training. In addition, joint classes and other collaborations that link public health with medicine in disease prevention and chronic care should be developed.

Nurses form the single largest group of professionals practicing public health, and nursing schools and schools of public health should develop partnerships aimed at increasing effective public health practice. Schools of public health should pursue similar partnerships with other professional schools, such as law and urban planning, to encourage basic understanding of public health among all professionals whose work helps influence society's health. The report recommends that all undergraduate students have access to education in public health.

Funding of public health research also needs to be boosted to resolve the imbalance in the proportion of spending on public health research compared with biomedical research. It is estimated that only 1 percent to 2 percent of the U.S. health care budget is currently spent on population-based prevention, with a fraction of that going toward research. To facilitate the needed funding boost, the report recommends a significant increase in federal support for research in population health and primary prevention, as well as community-based research and public health systems research. Specifically, the report recommends changes in the approaches to and levels of funding by the National Institutes of Health, the Centers for Disease Control and Prevention, and the Agency for Healthcare Research and Quality.

The report was sponsored by The Robert Wood Johnson Foundation. The Institute of Medicine is a private, nonprofit organization that provides advice on health policy issues under a congressional charter to the National Academy of Sciences. A committee roster follows.

Read the full text of Who Will Keep the Public Healthy? Educating Public Health Professionals for the 21st Century for free on the Web as well as 2,500 other publications from the National Academies. Printed copies will be available next year from the National Academies Press; tel. (202) 334-3313 or 1-800-624-6242 or order on the Internet at Reporters may obtain a pre-publication copy from the Office of News and Public Information (contacts listed above).

Board on Health Promotion and Disease Prevention

Committee on Educating Public Health Professionals for the 21st Century

Kristine M. Gebbie, Dr. P.H.* (co-chair)
Associate Professor
School of Nursing
Columbia University
New York City

Linda Rosenstock, M.D., M.P.H.* (co-chair)
School of Public Health
University of California
Los Angeles

Susan M. Allan, M.D., J.D., M.P.H.
Health Director
Arlington County Department of Health Services
Arlington, Va.

Kaye W. Bender, Ph.D.
Deputy State Health Officer
Mississippi Department of Health

Dan G. Blazer, M.D., Ph.D.*
J.P. Gibbons Professor of Psychiatry
Duke University Medical Center
Duke University
Durham, N.C.

Scott Burris, J.D.
Associate Director
Center for Law and the Public's Health
Georgetown and Johns Hopkins Universities, and
School of Law
Temple University

Mark R. Cullen, M.D.*
School of Medicine
Yale University
New Haven, Conn.

Haile T. Debas, M.D.*
School of Medicine, and
Vice Chancellor
Medical Affairs
University of California
San Francisco

Robert Goodman, Ph.D., M.P.H., M.A.
Usdin Family Professor
Health Sciences Center
Tulane University
New Orleans

Alan E. Guttmacher, M.D.
Deputy Director
National Human Genome Research Institute
National Institutes of Health
Bethesda, Md.

Rita Kukafka, Dr. P.H.
Assistant Professor
School of Public Health
Columbia University
New York City

Roxanne Parrott, Ph.D.
College of Liberal Arts
Pennsylvania State University
University Park

Sheila M. Smythe, M.S.
Executive Vice President and Dean
School of Public Health
New York Medical College

William A. Vega, Ph.D.
Behavioral and Research Training Institute, and
Professor of Psychiatry
Robert Wood Johnson Medical School
University of Medicine and Dentistry of New Jersey
New Brunswick

Patricia Wahl, Ph.D.
School of Public Health and Community Medicine
University of Washington


Lyla Hernandez
Study Director

* Member, Institute of Medicine