Federal Student Loan Debt in Public Health and the Opportunities for Loan Repayment Programs.

OBJECTIVES: A need persists for graduates with public health training in government public health roles; however, earnings for these positions tend to be lower when compared with earnings for people with undergraduate or graduate training who are working in other sectors, such as private health care or pharmaceuticals. This study assessed federal student loan debt associated with education for public health, with an aim to quantify the need that may be met through the federal Public Health Workforce Loan Repayment Program (PHWLRP), which is one tool that policy makers have proposed to incentivize people with public health training to pursue employment in government public health. METHODS: We analyzed federal student loan data provided by the National Center for Education Statistics College Scorecard for the 2018-2019 academic year. We merged these data with the Integrated Postsecondary Education Data System to estimate the number of degrees awarded. We used Spearman rank correlation to compare associations between debt and annual earnings by award level (bachelor's, master's, and doctoral degrees). RESULTS: Across all award levels, the median level of federal student loan debt associated with education for public health was $33 366. The median annual earnings 1 year after graduation were $80 687 for graduates with doctoral degrees and $33 279 for graduates with bachelor's degrees. CONCLUSIONS: As policy makers attempt to strengthen the public health workforce with a focus on funding and implementing the PHWLRP, the existing levels of student debt should be considered to ensure that programs such as the PHWLRP are funded and reflect the needs of graduates and government public health employers.

Keeping the "public" in schools of public health.

In this article, we compared the characteristics of public and private accredited public health training programs. We analyzed the distinct opportunities and challenges that publicly funded schools of public health face in preparing the nation's public health workforce. Using our experience in creating a new, collaborative public school of public health in the nation's largest urban public university system, we described efforts to use our public status and mission to develop new approaches to educating a workforce that meets the health needs of our region and contributes to the goal of reducing health inequalities. Finally, we considered policies that could protect and strengthen the distinct contributions that public schools of public health make to improving population health and reducing health inequalities.

Maximizing resources with mini-grants: enhancing preparedness capabilities and capacity in public health organizations.

INTRODUCTION: The Illinois Preparedness and Response Learning Center engages in efforts to develop and maintain a competent, sustainable, and prepared public health workforce in Illinois. Training, education, and technical assistance activities are driven by assessments conducted to identify preparedness gaps, needs, and priorities of public health organizations and the communities they serve. BACKGROUND: Many public health organizations face limited resources to engage in activities they identify as essential to building preparedness and response capabilities and capacity. In response to this challenge, the Illinois Preparedness and Response Learning Center adapted a mini-grant program to support short-term, targeted preparedness-related activities for which there was a need but no discretionary resources available. METHODS: A mini-grant program was implemented on the basis of a request for proposals, with projects funded for a 6-month period. An evaluation was conducted at 6 and 12 months to assess the impact of the local project on the capabilities and capacity of the organizations that participated. RESULTS: Thirteen projects were funded in local health departments and other organizations in a variety of communities across Illinois. Evaluation results indicate that these short-term projects contributed to the organization's preparedness efforts and local partnerships 6 and 12 months after funding ended. DISCUSSION: Even relatively small amounts of funding can assist public health agencies and their community partners in improving capabilities and building organizational and community capacity. LESSONS LEARNED: (1) The mini-grant program model can help develop and cultivate preparedness partnership between academia and practice to achieve positive outcomes despite limited funding. (2) Funding self-assessed needs of organizations through a mini-grant process may have value for larger programs without the staff resources or time to provide customized preparedness services to a large target market/service area. (3) There appear to be benefits to channeling small amounts of funding to address targeted needs and gaps identified by organizations.

In the name of global health: trends in academic institutions.

This paper describes accelerating development of programs in global health, particularly in North American academic institutions, and sets this phenomenon in the context of earlier programs in tropical medicine and international health that originated predominantly in Europe. Like these earlier programs, the major focus of the new global health programs is on the health needs of developing countries, and perhaps for this reason, few similar programs have emerged in academic institutions in the developing countries themselves. If global health is about the improvement of health worldwide, the reduction of disparities, and protection of societies against global threats that disregard national borders, it is essential that academic institutions reach across geographic, cultural, economic, gender, and linguistic boundaries to develop mutual understanding of the scope of global health and to create collaborative education and research programs. One indication of success would be emergence of a new generation of truly global leaders working on a shared and well-defined agenda--and doing so on equal footing.

A public health training center experience: professional continuing education at schools of public health.

The Public Health Training Center (PHTC) national program was first established at accredited schools of public health in 2000. The PHTC program used the US Health Resources and Services Administration's grants to build workforce development programs, attracting schools as training providers and the workforce as training clients. This article is a reflection on the experience of two schools, whose partnership supported one of the PHTCs, for the purpose of opening a conversation about the future of continuing education throughout schools and degree programs of public health. This partnership, the Pennsylvania & Ohio Public Health Training Center (POPHTC), concentrated its funding on more intensive training of public healthcare workers through a relatively narrow inventory of courses that were delivered typically in-person rather than by distance-learning technologies. This approach responded to the assessed needs and preferences of the POPHTC's workforce population. POPHTC's experience may not be typical among the PHTCs nationally, but the collective experience of all PHTCs is instructive to schools of public health as they work to meet an increasing demand for continuing education from the public health workforce.

Public health in transition: views of the specialist workforce.

The constant structural changes to the NHS in England have created instability and lack of job security within the public health workforce in the U.K. Since posts are linked to structures which keep changing, recent years have seen constant changes in titles, responsibilities and expectations. Effective public health practice involves teamwork across sectors and strong relationships with local communities, and this constant change has posed professional challenges. The changes in 2002 offered the Faculty of Public Health the opportunity to work with the Department of Health to consult with specialists, the main objective being to reach agreement on future roles and ways of working. The lessons learnt from this exercise are described here as they remain relevant as the structural changes continue. Key messages are that if the many opportunities of the current policy agenda are to be realized, the public health profession needs to be supported to play its full role in the three domains of practice: health improvement, health protection and developing better health services. This challenge needs professional bodies to be clear on expected competence of their members; employers to be clear on the potential contribution of public health specialists not only in promoting and protecting health in communities but also within the acute sector; organizational arrangements to be in place to sustain the capacity of the workforce whatever the structural changes occurring. This lesson has yet to be learnt.

Targeting HIV clinical training with maps: lessons from the Pacific AIDS Education and Training Center.

Public health providers are increasingly called on to do more with fewer resources. Aiming to help HIV clinical training providers in 15 local sites to better target their efforts, the Pacific AIDS Education and Training Center (PAETC) implemented a method for integrating disparate information, such as program-level evaluation and publicly available health services data, into one combined and useful format. The resulting local area profiles were distributed to each training site and were updated annually for 2 years. As a result, local training teams adopted data-based approaches to doing their work. Training managers and faculty reported that data presented in spatial formats (i.e., maps) were most helpful for targeting their outreach and training. In addition to achieving the aim of supporting better programs, the project increased capacity for using data to support all aspects of training and education, from grant writing to strategic planning.

The UCLA tobacco control program.

Tobacco use, the most preventable cause of death in our society and a growing international epidemic, should be well understood by all students preparing to enter the field of public health. Despite its importance, however, tobacco does not always enjoy the prominence it deserves in public health education. We report here on efforts to expand the focus on tobacco in the University of California Los Angeles School of Public Health through a program supported by the Association of Schools of Public Health/American Legacy Foundation's Scholarship, Training, and Education Program for Tobacco Use Prevention funding mechanism. We describe steps to increase tobacco content in required and elective courses; offer elective courses on tobacco; implement a pre-doctoral scholarship program featuring coursework, fieldwork, and exposure to tobacco issues at national meetings; and establish a tobacco-focused workshop series. We outline program successes, structural barriers to achieving some programmatic goals, and the program's early termination.

Building an academic tobacco control program while forging links with practice: the University of Washington Tobacco Studies Program.

Despite the tremendous impact that tobacco use and tobacco smoke exposure have on morbidity, mortality, and health disparities, few schools of public health in the U.S. offer courses of study on tobacco control or make it a priority in their curricula. An academic concentration in tobacco studies and a master's-level scholarship program were developed at the University of Washington School of Public Health and Community Medicine to support and encourage students to pursue tobacco-related coursework, seminars, internships, and thesis work. This article discusses the goals, strategies, and accomplishments of the programs, emphasizing a collaborative approach between the university and state and local health departments, nongovernmental agencies, and research organizations as instrumental to the program's success and ultimate continuation.

Reducing the gap between the economic costs of tobacco and funds for tobacco training in schools of public health.

Tobacco use costs approximately dollar 167 billion annually in the U.S., but few tobacco education opportunities are available in schools of public health. Reasons for the discrepancy between the costs of tobacco use and the creation of tobacco training opportunities have not been well explored. Based on the Behavioral Ecological Model, we present 10 recommendations for increasing tobacco training in schools of public health. Six recommendations focus on policy changes within the educational, legislative, and health care systems that influence funds for tobacco training, and four recommendations focus on strategies to mobilize key social groups that can advocate for change in tobacco control education and related policies. In addition, we present a model tobacco control curriculum to equip public health students with the skills needed to advocate for these recommended policy changes. Through concurrent changes in the ecological systems affecting tobacco control training, and through the collaborative action of legislators, the public, the media, and health professionals, tobacco control training can be moved to a higher priority in educational settings.

Recommendations from the ASPH/Legacy Scholarship, Training, and Education Program for Tobacco Use Prevention (STEP UP) strategy planning meeting Chicago, May 3, 2005.

During this meeting, the participants developed a strategic set of recommendations for ASPH to continue to advance the study of tobacco control in public health through research and education/training programs. The meeting focused on sustaining and further developing tobacco-related research and education/ training programs. All four issues were addressed in depth through valuable discussion and exchange and reflected in the nine areas of focus. Recommendations for advocacy for future funding for SPH in tobacco control included developing collaborative relationships with ASPH partners, organizations, and institutions with complementary objectives (state departments of health, third party payors, etc). Priorities for sustaining and further developing research and education/training programs within SPH included developing a focus on particular research areas (e.g., special populations, economic issues, dissemination and translational issues), building on existing knowledge, and attempting to avoid the effects of "siloing" with collaborative relationships and methods for addressing the sustenance of programs beyond initial funding periods. Methods to maintain vigilance on tobacco control with increasing concerns about other risk factors included fostering an increasing awareness of tobacco-related issues, projects, and programs as well as developing collaborative relationships with organizations and institutions with complementary health-risk related objectives. Other recommendations focused on enhancing SPH leadership in the tobacco control field by developing standards and methodologies and translating research to practice. They included (1) developing standards for consistent tobacco control-related education to public health students, public health professionals, and other students and professionals; (2) developing a standardized method for evaluating tobacco-attributable factors and effects; and (3) conducting effectiveness trials of treatments known to be efficacious. Effectively addressing these perennial issues will enable SPH to enhance its leadership position and contribute greatly to research and education/training in tobacco control. All of these issues were factors in program planning for the second National STEP UP Academic Tobacco Workshop. For instance, reviews of particular research areas might be offered or facilitated as well as methods for developing collaborative partnerships and subsequent efforts. Steps toward the development of tobacco control education core competencies might be developed as well. The second National STEP UP Academic Tobacco Workshop-STEP UP to Sustain Tobacco Control and Prevention through Education and Research--was held on January 30-31, 2006. The topics of discussion ranged from use of secondary data to behavioral economics. More information about the workshop can be found at http://www.asph.org/ document.cfm?page=882. Attention to the recommendations that resulted from the planning meeting will provide a strategic platform from which ASPH and the public health community can continue to address the single greatest cause of preventable disease and death in the world.