Peer Review

From the Guest Editor

The work of public health has but one goal: to diminish human suffering. A pragmatic field of inquiry and endeavor, public health organizes ideas and ideals about human health and well-being through action for the world. The field is fundamentally concerned with human and environmental interdependence and thus with sustainability.

As the Association of American Colleges and Universities (AAC&U) embarked in collaboration with other organizations to advance the study of public health across and within undergraduate disciplines, we discovered just how powerful a concept the health of global humanity has become in our era. We see activity that may signal the formation of a new inter- or multidisciplinary field of study. The subject of public health exercises an undeniable attraction—for students, staff, faculty, and communities.

As a field of practice and, eventually, a profession, public health arose with the modern social sciences in the nineteenth century. It also appeared in narrative, in a story of a neighborhood in London in 1854. In an early moment of epidemiological discovery, John Snow concluded that waterborne cholera would kill fewer people if the neighborhood would stop drinking from the contaminated public well. He removed the pump handle; the outbreak declined. The kind of evidence-based thinking that led to this act of prevention is rooted in the same ground as nineteenth-century liberal education, as it was indeed then called. Public health study developed within the same fertile ground as the fields that became the twentieth-century arts and sciences—at the center of undergraduate curricula before the more recent rise of professional fields. In 1920, Charles Winslow defined public health as “the science and art of preventing disease, prolonging life and promoting physical health and efficacy through organized community efforts for the sanitation of the environment . . . and the development of social machinery which will ensure every individual in the community a standard of living adequate for the maintenance of health . . . to enable every citizen to realize his or her birthright and longevity” (Winslow 1920). In 1987, David Fraser, a physician, epidemiologist, and then president of Swarthmore College, published an influential article in the New England Journal of Medicine titled “Epidemiology as a Liberal Art” (Fraser 1987).

In the twentieth century, building on these foundations, public health study developed primarily as a graduate/professional field. Study of public health has long appeared in undergraduate curricula in nursing and undergraduate health studies, including environmental health. A number of accredited graduate schools and programs in public health also offer degree programs for undergraduates. Not until recently, however, did public health begin to appear in courses, curricula, cocurricula, and general education across a broad spectrum of undergraduate programs. Because of this complicated history, we understand the recent appearance of public health programs across undergraduate study, including the liberal arts, to be continuous rather than new.

In partnership with the Association of Schools of Public Health (ASPH) and the Association for Prevention Teaching and Research (APTR), AAC&U has advocated for undergraduate public health education as a sound example of a practical liberal education—one that develops students’ capability to understand and take action to solve complex, unscripted, real-world problems.

Joining a cooperative effort with undergraduate arts and sciences institutions and health professions educational organizations, AAC&U stepped forward to lead an initiative called the Educated Citizen and Public Health (ECPH). The initiative intends to foster curricular and cocurricular program development for undergraduates across all institutional types and to frame this work within liberal education. It simultaneously aims to fulfill the Institute of Medicine’s recommendation that all undergraduates should have access to education in public health. Asking “Who will keep the public healthy?” the Institute of Medicine called in 2003 for an educated citizenry capable of responding to the world’s escalating health challenges (Gebbie et al. 2003). ECPH thus intends to bring integrative study of public health to all four-year and two-year undergraduate institutions, to foster interdisciplinary and interprofessional collaboration, and to link to initiatives that address human health and environmental sustainability.

As we launched this initiative, we sought to make evident how the cross-disciplinary and applied work in public health aligns with the Liberal Education and America’s Promise (LEAP) essential learning outcomes and the high-impact practices most likely to get students to achieve those outcomes. Understanding this initiative within the LEAP campaign, we hope to follow and guide undergraduate education in public health through the current period of transition and to raise the level of college student achievement for all students to meet the social, scientific, and economic demands of a globally interdependent world.

We have drawn on generous help extended by graduate programs in public health and health professions education, including nursing. As the initiative matures, we find evidence, once again, that AAC&U member campuses are taking the lead in the development of new curricula—pushing thinking and actions across higher education in new directions. This new work is emerging as the health professions have begun to emphasize prevention of illness as a model for learning—moving beyond models founded on treatment of disease. As evidence-based practice and prevention have begun to reshape health professional education, partnership with undergraduate liberal education is a welcome and logical next step.

References

Fraser, D. W. 1987. Epidemiology as a liberal art. The New England Journal of Medicine 316 (6): 309–14.

Gebbie, K., L. Rosenstock, and L. M. Hernandez. 2003. Who will keep the public healthy? Educating public health professionals for the 21st century. Washington, DC. National Academics Press..

Winslow, C. E. A. 1920. The untilled field of public health. Modern Medicine 2: 183–191.

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