Undergraduate Public Health Degree Programs

Public Health in Undergraduate Education

In 2003, a report sponsored by the Institute of Medicine recommended that “all undergraduates have access to education in public health” (Gebbie, Rosenstock, & Hernandez, 2003). Until then, undergraduate degree programs in public health or related specializations in the United States were few in number. By 1992, there were 45 schools of higher education with one or more public health–related undergraduate programs. In 2000, that number increased to 76 out of 4,182 postsecondary Title IV institutions in the United States (Riegelman, Albertine, & Wykoff, 2015; Snyder & Dillow, 2015). In 2006, the Association of American Colleges & Universities highlighted Essential Learning Outcomes (ELOs) for undergraduate education that included tenants of personal and global citizenship and applied learning. The ELOs influenced the growth of the Educated Citizen and Public Health movement (Riegelman et al., 2015), which helped spur the development of even more undergraduate public health curricula and degree programs.

By 2008, the number of schools of higher education offering an undergraduate curriculum in public health rose to more than 130 (Riegelman et al., 2015). Furthering the momentum, the Association of Schools and Programs of Public Health (ASPPH) convened the ASPPH Framing the Future Task Force in 2011. The ELOs developed by the Association of American Colleges & Universities became the framework for the ASPPH Undergraduate Public Health Learning Outcomes included in the first report. This was an important development for undergraduate education in public health as it set standards for accreditation of undergraduate stand-alone baccalaureate programs (SBP) through the Council on Education for Public Health (CEPH; Riegelman et al., 2015).

In 2014, the ASPPH Framing the Future Task Force, along with the League for Innovation, released the Community Colleges and Public Health Project final report. The report provided detailed frameworks for developing the following two public health associate degree programs in community colleges: (1) Public Health: Generalist & Specializations and (2) Health Navigator (Riegelman, Wilson, Dreyzehm, & Huffard, 2014). Detailed courses and outcomes were included in these prototype curricula models to help increase the number of public health programs in community colleges in order to support the public health education initiative. Notably, though, this report lacked justification for these associate degrees using workforce and labor needs as drivers for program development. For many community and technical colleges, regional employer needs and the ability for students to obtain employment on graduation with an associate degree must be considered. Yet there is no single mention of the word “job” or “employment” in the report except when describing potential job titles for graduates. This failure to explicitly consider the needs of workforce-focused colleges could prevent these colleges from becoming partners in the public health education initiative and could alienate graduates from these colleges from becoming future public health practitioners.

Community and Technical Colleges Should Train Public Health Workers

In the 1920s and 1930s, junior colleges were formed in the United States, later to be known as community colleges, which largely focused on academic courses that could transfer into baccalaureate programs. In the 1940s, vocational technical institutes were founded, later referred to as technical colleges, which focused on job-based and job-upgrading training (Scott-Clayton & Weiss, 2011). The demographics of community and technical colleges contrast with the traditional public 4-year schools of higher education. Across all community and technical colleges, 60% of students are female, 61% attend part-time, and 48% are a person of color (American Association of Community Colleges, 2015a, 2015b). A significant portion of this student population are low-income (family income of less than $25,000 per year), first-year college students who are entering college with a GPA on average less than 3.5 and with few (if any) higher order math courses (Algebra II or Calculus I) taken in high school (Berkner & Choy, 2008). This unique student population represents a significant potential for diversifying the public health workforce, an important public health initiative aimed to help decrease health disparities and increase access to quality health care (Hilliard & Boulton, 2012).

Degrees offered in community and technical colleges are extremely varied, although technical colleges still largely offer technical degrees (also known as workforce, career, or occupational degrees) as part of their mission and strategic plan. In 2010, associate degrees in career/technical programs accounted for 60.4% of all associate degrees awarded for colleges that participate in the Title IV federal student financial aid program (National Center for Education Statistics, n.d.). Recently, public pressure on community and technical colleges to demonstrate a return on investment and increase graduation rates has forced colleges to track and analyze student outcomes beyond graduation, including job placement rates. Some states such as California and Arkansas use these data for career counselling, while others such as Tennessee and Wisconsin actually provide funding to colleges based on workforce outcomes (Nye, Rowlett, Sonnenschein, Van Eaton, & Wissel, 2015). This need to connect educational programs to demonstrated workforce placement provides a unique opportunity for community and technical colleges to train public health practitioners with real-world, hands-on skills for immediate benefit to the public health workforce.

It is imperative that the community and technical college system be included in national conversations surrounding public health education. This ensures not only a comprehensive integration of public health into undergraduate curriculum but also access by minority, place-bound, and disadvantaged populations into this field. Training the next generation of public health workers is important for the future health of this nation. ASPPH estimates that more than 250,000 new public health workers will be needed by 2020 to replace retiring public health workers and to fill employment gaps where there is a lack of newly trained workers (Rosenstock et al., 2008). Public health programs are well-suited for colleges that have an emphasis on workforce, rather than an emphasis on scaffolding into higher order degrees. The development of accreditation for the stand-alone baccalaureate set the stage for the community and technical college system to increase offerings held to the gold standard of CEPH accreditation. Yet, as of fourth quarter 2015, only one community or technical college has applied for CEPH stand-alone baccalaureate accreditation out of all applicants: Lake Washington Institute of Technology (LWTech), located in Kirkland, WA (CEPH, 2015).

Lake Washington Institute of Technology: A Model for Public Health Education in Technical Colleges

There are 29 community colleges and 5 technical colleges in Washington State. Among them, LWTech exists as a technical college, which was integrated into the community and technical college system in 1991 (Scott-Clayton & Weiss, 2011). The college’s mission statement is “to prepare students for today’s careers and tomorrow’s opportunities” (LWTech, 2015a). LWTech offers over 100 professional/technical degree and certificate options to its surrounding community in the eastside suburbs of Seattle, WA. Their programs range from nursing and computer technology to welding, culinary arts, engineering graphics, and physical therapist assistant, among others. During the 2014-2015 academic year, student enrollment at LWTech was 6,999 (LWTech, 2015b). In fall 2014, LWTech enrolled 62% females and 38% males, with 37% students of color. The Washington State Community and Technical college system as a whole averaged 56% females and 44% males, with 41% students of color. LWTech’s median age served is 30, compared with a system’s median age served of 26 (Washington State Board for Community & Technical Colleges [SBCTC], 2015a). For the 2014-2015 academic year, 62% of all students were enrolled in workforce degree programs at LWTech, with the remaining students enrolled in basic skills (11%), transfer (15%), and other (12%; LWTech, 2015b). At LWTech, 39% of 3,961 students surveyed were full- or part-time workers, and 41% were out of the labor workforce in fall 2014. This compares with only 30% of students in the entire Washington state system who indicated that they were out of the workforce (SBCTC, 2015a).

It is essential to note that there are demographic and academic differences in community versus technical colleges around the United States and especially in Washington State. For students who attend technical colleges, 66% are enrolled for the purpose of upgrading job skills. Only 11% attend community colleges for the same purpose (Scott-Clayton & Weiss, 2011). Completion rates for LWTech’s 2014-2015 academic year shows that 31% of the 1,101 students who finished with some certificate or degree had graduated with an AAS (Associate of Applied Science, a workforce-designated degree), while 43% graduated with a workforce-related certificate (89 quarter credits or less; LWTech, 2015b). This focus on workforce educational programs is a key difference between community and technical colleges that is often overlooked when the two are considered as if they are one entity. It is also an important distinction when it comes to implementing public health education into the community and technical college system.

In 2015, LWTech launched the Bachelor of Applied Science in Public Health (BASPH) program. The BASPH was developed for several purposes. The program serves the college’s mission by providing a pathway for students who complete “terminal” AAS degrees in technical programs to advance toward a 4-year degree. Many students have returned from the workforce to upgrade their skills or to obtain a bachelor’s degree in order to retain or advance within their jobs. The program admits, through selective admission criteria, students with an associate degree in allied health programs (or related) or credit-hour equivalent (90 quarter credits in college-level courses). This model is referred to as the 2+2 model, where the AAS is considered the first 2 years of coursework, and the BASPH program provides coursework at the junior and senior levels. The BASPH is the only public health degree in the community and technical college system in Washington State, and one of few nationwide, and will graduate its first cohort of students in June 2016.

The BASPH is a hybrid and online program, meeting only at night in order to accommodate working students and those who may have other obligations as caregivers. Student feedback during orientations and pre-advising sessions indicated that this was an important aspect of the program that allowed them to work toward their 4-year degree when a day program was not feasible. Another beneficial component of the program is that students do not have to purchase books as the college purchases eBooks for all courses on their behalf. This removes known barriers for obtaining degrees due to additional costs and fees beyond tuition.

Developing the BASPH also serves to promote the agenda of the ASPPH Framing the Future Task Force’s 2014 Community Colleges and Public Health Project report. However, some issues with this report became clear while undergoing the program development process for developing and launching the BASPH. First, LWTech could not offer an associate degree in public health. In the Washington State system, all technical college programs, from short certificates to bachelor’s degrees, must be offered in an area of employment that is at least “balanced” but more desirably “in demand” with regard to local and regional workforce needs. If a program of study’s related employment title or Standard Occupational Classification code is “not in demand,” the program is eventually discontinued since workforce assistance programs and services for veterans cannot fund students who major in a nondemand technical study program.

Second, the curriculum in the Community Colleges and Public Health Project report was developed specifically to transfer into bachelor’s programs. The intent is very specific:

The CC&PH project worked closely with SOPHE, AUPHA, and AEHAP to develop coordinated specialty curricula designed for transfer to bachelor’s degree programs in School/Community Health Education, Health Administration, or Environmental Health, respectively. These disciplines were chosen because of the existence of well-established bachelor’s degree programs represented by national academic associations and a national accreditation or certification process. In addition, health education and environmental health offer a certifying examination at the completion of the bachelor’s degree. (Riegelman, Wilson, Dreyzehm, & Huffard, 2014, p. 9)

This is an appropriate model for those community colleges that focus on transfer degrees and do not need to meet job placement requirements for students who graduate with an associate degree. For LWTech, however, developing an associate degree only to transfer into a bachelor’s degree is not an option, neither by mission nor by legislation.

In the state of Washington, technical colleges cannot offer general education transfer degrees. Instead, programs of study must align with local and regional workforce needs and have employment options after graduation. A regional workforce needs assessment in the Seattle area revealed very few jobs at the associate level in public health. According to the Washington Employment Security Department, Labor Market and Economic Analysis Branch (2012), 2020 employment projections for public health and related jobs total more than 468,474 but are almost all for graduates with a bachelor’s degree or higher. Certain jobs such as patient (health) navigator or home health aide or community health worker could employ a graduate with an associate degree, but traditionally require only a high school diploma and/or experience.

Additionally, a survey of regional employers such as International Community Health Services, DESC (Shelter, Housing and Services for Homeless Adults in Seattle), Consejo Counseling and Referral Service, Public Health—Seattle & King County, Cancer Research and Biostatistics, Evergreen Health, and Lifelong AIDS Alliance, among others, indicated the desire to employ more bachelor-level graduates (LWTech, Employer Workplace Survey, November 2012). Dr. David Fleming, former Director of Public Health—Seattle & King County and current member of the BASPH advisory board, indicated that local businesses and public health agencies were having difficulty finding 4-year graduates. There was no voiced need for 2-year graduates by any employer surveyed or consulted over the process of program development.

LWTech used several program development best practices to ensure appropriateness of developing the BASPH. Faculty and staff assessed student demand for the BASPH degree with a student survey (Appendix A) administered to LWTech students in 12 allied health and social service degree programs as well as to students completing prerequisites to enter into these programs (N = 204). The survey was conducted both online and via paper assessment in the classroom in general science courses (chemistry, biology, nutrition, microbiology) and within the following programs of study: Dental, Energy & Science Technician, Fitness Specialist/Personal Trainer, Funeral Service Education, Medical Assisting, Nursing RN, Occupational Therapy Assistant, Physical Therapist Assistant, Social & Human Services, and Pre-Nursing DTA.

Students in their last quarter (N = 11) were also asked to complete a survey of interest. Responses were gathered from students in the following programs: Pre-Nursing DTA, Social & Human Services, Nursing RN, Funeral Service Education, Occupational Therapy Assistant, and Dental Hygiene. Results of this survey can be found in Appendix A. Employers were also surveyed formally and informally to determine regional needs (Appendix B), and partnerships were developed with local colleges and universities that offered similar programs (University of Washington Seattle’s School of Public Health [BA/BS Public Health], University of Washington Bothell’s School of Nursing & Health Studies [BA in Health Studies], and Seattle College’s Department of Allied Health [BAS in Allied Health]). Programmatic gaps in epidemiology and community health were identified during collaborative meetings, and LWTech closed these gaps by offering specializations in these high-need areas.

Further ensuring student success in the workforce, LWTech applied for SBP CEPH accreditation in September 2014 and developed a robust advisory board to support program development and help meet regional employer needs. As seen in Appendix C, courses developed for the BASPH program were designed to meet each domain for SBP CEPH accreditation. Advisory board members, faculty, and staff worked together to ensure rigor and appropriateness of curriculum for accreditation best practices.

Curriculum for the BASPH degree was developed to meet requirements for a bachelor’s of applied science for the state of Washington. Rigor at the baccalaureate level is achieved by course content that builds on 100/200 level courses, encouraging group and independent research; advanced writing, reading, and comprehension skills; and the expectation that students will be able to bridge theory into application and develop work-ready, practitioner skills. BASPH students use computers, case studies, active learning, group work, laboratory exercises, and capstone projects to apply their knowledge to curriculum requirements. These activities mirror real-world scenarios to ready the student for employment. Appendix D details experiential and service learning opportunities for program students. Advisory board members and public health practitioners have been invited to campus as guest lecturers and course faculty in order to bring experiential learning into the classroom. Students also complete end of the program capstone community service learning projects.

Rosenbaum, Deil-Amen, and Person (2006) found that, in general, community college advisory boards were weak (if one existed at all) and were largely unfilled by members who could directly hire graduates or provide internship opportunities. The SBCTC Policy Manual states that “each community and technical college or college district is required to have an industry advisory committee for each program (see RCW 28B.50.252) and to follow approved College Advisory Committee Procedures” (SBCTC, 2015b). No less than 21 recommendations exist for roles of the advisory board and its members. The BASPH advisory board was developed to meet these requirements by inviting members who serve to provide experiential learning for current students and hire program graduates.

The advisory board consists of members from a diversity of public and private organizations in the Seattle area such as Public Health—Seattle & King County, Group Health Research Institute, Washington State Health Advocates Association, Evergreen Health, Cancer Research and Biostatistics, Northwest Center for Public Health Practice, and others (Appendix E). All aspects of program development, from conceptualization to implementation, were introduced to the advisory board members for feedback and suggestions during biannual advisory board meetings and e-mail correspondence, ensuring program and course outcomes that create employable graduates. Any changes to the program’s scope, courses, or specializations must be approved by the advisory board. This process ensures that these public health practitioners in the Seattle area meet the program’s purpose and outcomes and help the program respond to changing and evolving employer needs.

Conclusion

By considering workforce needs, CEPH accreditation criteria, and input from a well-staffed advisory board, LWTech has created a bachelor of applied science degree in public health that meets both student and regional employer needs. The ASPPH Framing the Future Task Force’s 2014 Community Colleges and Public Health Project report detailed a clear pathway for community colleges to become a growing part of the public health education initiative across this country. Yet it is important to consider the mission and purpose of technical and workforce colleges to achieve integration of all colleges into this initiative. Faculty and staff at LWTech considered labor market needs and employer feedback and developed strong partnerships with regional employers and neighboring educational institutes to develop a public health program that meets not only the needs of the community but also the mission and strategic plan of the college. The BASPH program can serve as a model for integrating public health into colleges that serve their communities through workforce education so that they may become partners in this national conversation.