by JP Leider, PhD

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When I was a boy, I had a dream.

It was to be a veterinarian, I think. Honestly, it’s a bit hard to remember.

In the intervening decades, that dream changed and morphed, dozens of times. I was less motivated and gifted than Jeff Lynne’s titular character, but generally these (professionally-oriented) dreams revolved around being of some use to society. Public Health is pretty great for that, turns out. As I continue to read about the history of our field, I’ve become more and more surprised that in these same decades that I was working to establish my own identity, our field was both static and extremely fluid.

Growth of local health departments and simultaneous expansion of public private and public health care access in the 1970s and ‘80s helped lead to the landmark ‘88 IOM report. The 90s had the 10 Essential Services and Core Functions of public health, the 2000s had bio terrorism and the first public health workforce IOM report. What’s so interesting, though, is that through all of this time and all of these changes, some fundamental assumptions about public health have stayed the same. Namely, that the schools and programs of public health are primarily responsible for supplying the governmental public health workforce (with a special focus on leaders and managers). That’s just not the case. As I mentioned in a recent interview on JPHMP Direct, I’m not sure that it ever was. But now we have 30,000 public health students graduating each year. Where are they going? Certainly not just health departments (Figure).

Figure: Graduate outcomes from Columbia’s Mailman School of Public Health

Source: Krasna et al

The Welch-Rose report talked about educating the public health workforce in 1915. We’ve had a hundred years of this core assumption. We’ve had dozens of reports since then about the future of public health education, but almost all of them have had a central tenant, that the MPH is the entry point to our field. At last count, only about 8% of the governmental public health workforce said they had an MPH, and 14% a public health degree at any level. That doesn’t mean the foci of the 20-year-old IOM report were at all misplaced because the recent Framing the Future public health report acknowledges MPH employment outcomes are changing. What it means is that we should continue to question or otherwise assess our assumptions. Especially when those data points ostensibly drive policy decisions. Not to be too much of a nerd about it (though I am), but that’s the thesis of this blog series.

I hope to engage with JPHMP Direct readers around some of the core questions of our field, and understand how systems research and data collected in other sectors for other reasons can bear on how we do the important current and “futuring” in work of our field. To me, that means that we need to continue to have debate and discussion with data, and also understand the lived experiences and sentiments of people in practice. So, I hope to feature voices of students in practice so that their voices help move forward the conversation about how our field proceeds, and where we might focus our efforts, in the coming years.

Maybe I’ll see you around?

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• Meditations on the MPH, Part 2