Meditations on the MPH, Part 1

by JP Leider, PhD

Meditations on the MPHWhen 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

Meditations on the MPH

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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Author Profile

JP Leider
Jonathon P. (JP) Leider, PhD, is an independent consultant in the public health and health policy space, as well as a Senior Lecturer at the University of Minnesota and Associate Faculty at the Johns Hopkins Bloomberg School of Public Health. He has active projects and collaborations with foundations, national public health organizations, public health researchers and academics, and public health practitioners. His current projects focus on public health systems, the public health workforce, and public health finance. He holds a PhD in Health Policy and Management from the Johns Hopkins Bloomberg School of Public Health.


  • Elisabeth Gleckler

    Starting a couple of years ago, I have had students who are recent graduates tell me that they feel that the private sector will hire more public health students in the future. They point out that big tech is hiring and buying up talent and companies who work in prevention. I am grateful for the new professionals who never stop thinking and wondering – and then shared their observations with me.

    • At APHA, I heard from leadership at an east coast school that FitBit was hiring some of their grads, and that they consider it a win. I tend to agree! I think there’s a lot about public health, content and skill wise, that’s a good fit. I do think the question is more about the scale of these hires (is it a one-off / anecdote vs a pipeline that we’re developing). Thanks for the comment —

  • How do you factor in the plethora of undergraduate public health degree programs which were nonexistent in the 90’s and the sharp reduction in governmental public health budgets which impact hiring into your hypothesis?

    • Oscar, I appreciate the questions. As to the former, there are (just) a few data points from PH WINS and from the Association of Schools and Programs of Public Health that show 1) very few staff, even younger ones, have undergraduate PH majors in health departments and that 2) undergraduate public health graduates are generally going into the for-profit and healthcare sectors, not governmental public health. So, we don’t see a strong substitution effect between bachelors and masters (yet). As to your second point – you’re right, the public health enterprise has not quite kept up with inflation, and many agencies have seen their budgets cut. The workforce has been reduced by 50,000 in the past decade, according to NACCHO estimates. It may be that many LHDs can’t afford MPH-trained staff, or that State Health Agencies can’t compete on salary for data-analyst types with the private sector. To me, though, that just makes the question about the future of the MPH more poignant. Thanks –