Abstract
Keywords
If current population trends continue, the U.S. population will be a “majority minority” nation in 2044 according to a report by the Brookings Institution (Frey, 2014). Based on the United States Census Bureau projections, the non-Hispanic White population will decrease by 9.5% from 2016 (61.3%) to 2060 (44.3%; Vespa et al., 2020). In 2060, those who self-identify as White will make up 68.0% (44.3% self-identifying as non-Hispanic White) of the population; these percentages are 15.0% for Black people, 9.1% for Asian people, 1.4% for American Indian and Alaska Native people, 0.3% for Native Hawaiian and Other Pacific Islander people, and 6.2% for multiracial people (Vespa et al., 2020). Hispanic people will comprise 27.5% of the population (Vespa et al., 2020). These changing demographics have implications for the practice of public health and medicine, and the composition of the workforce. Foremost in responding to the needs of an increasingly diverse U.S. population is attaining a racially and ethnically diverse workforce at the organizational and systems levels. This diverse workforce, inclusive of interdisciplinary perspectives, would need to be culturally responsive and structurally competent to inform strategies for effective public health data and action (Hansen & Metzl, 2016). Coronado et al. (2020) contend “Public health agencies that employ a diverse workforce are better positioned to implement targeted approaches in communities where they are needed, create systems to support those needs, and supply a greater variety of effective solutions to help address health disparities” (p. 390). Intentional and progressive pedagogy is needed to ensure an educational pathway for currently underrepresented students to pursue careers in public health, medicine, and other health-related fields.
The Centers for Disease Control and Prevention (CDC) Undergraduate Public Health Scholars (CUPS) Program is a summer internship pipeline program established by the Office of Minority Health and Health Equity (OMHHE; CDC, 2021a). The purpose of the program is to expose undergraduate students interested in minority health to the field of public health research and practice, and ultimately, increase the number of underrepresented minorities in public health and health care, including biomedical sciences (Bouye et al., 2016). Cultivating a diverse workforce equipped to address health disparities and achieve equity for all populations requires strategic approaches for experiential learning and mentoring. This perspective provides a brief history and overview of the essential components of the CUPS Program. In addition, it highlights the pedagogy approach of the CUPS Program that have shown to be promising from the evaluation conducted by Young et al. (2021).
Established in September 2011, the goal of the CUPS Program is consistent with the larger U.S. Department of Health and Human Services’ (HHS; 2011) Action Plan to Reduce Racial & Ethnic Health Disparities—released 25 years after the landmark 1985 Secretary’s Task Force Report on Black and Minority Health (Heckler, 1985) and which amplified the urgency of increasing the diversity of the workforce and the need to increase all health professionals’ ability to identify and address racial and ethnic health disparities (Cohen et al., 2002; Hilliard & Boulton, 2012). By recruiting racially underrepresented undergraduate students interested in minority health and exposing them to public health research and practice and equipping them with knowledge and skills necessary to identify and address health disparities in a summer experiential learning program, the CUPS Program directly addressed HHS’s goal.
Prior to 2011, OMHHE had a long and rich history leveraging CDC resources and expertise to meet recommendations of the 1985 Secretary’s Task Force Report on Black and Minority Health. For example, OMHHE prioritized initiatives and partnerships that “examine ways to increase minority representation in preventive medicine, public health, health education, communications, and other health professions” (Heckler, 1985, p. 24). Over more than 30 years, OMHHE has collaborated with minority-serving institutions, such as the Minority Health Professions Foundations, Morehouse College, Hispanic Serving Health Professions Schools, and the Kennedy Krieger Institute, to increase public health knowledge and skills among racial and ethnic minoritized students through internships and fellowship programs like the Dr. James A. Ferguson Emerging Infectious Disease Fellowship Program, the Public Health Summer Fellows Program, and the Research Initiatives for Student Enhancement (RISE) Program. In 2010, OMHHE reorganized a variety of student programs that had been in place for more than two decades under a single cooperative agreement and expanded the focus to include undergraduate students. The CDC funding opportunity announcement published in 2011 consolidated objectives from multiple programs into one summer public health experience for underrepresented undergraduate students. Four academic institutions (i.e., Morehouse College, Columbia University, the University of Michigan, and the Kennedy Krieger Institute) were funded to implement the program (CDC, 2021b). The University of California, Los Angeles, the fifth site, was added in 2017 to give even more students an opportunity to participate in the program (CDC, 2021b). Eligible undergraduate students had to be rising juniors at an accredited university. While open to all students, the program is tailored to ensure recruitment efforts are targeted to increase the participation of students currently underrepresented in public health and medicine and who demonstrate interest in ultimately working with communities that experience health disparities and inequities.
For the past 10 years, the CUPS Program has been a highly sought out and selective program. More than 35,000 students have applied to the program and more than 1,600 have been accepted. On average, each institution hosts between 40 and 50 students a year, producing 200 to 250 scholars a year. All the institutions carry out five focus areas of the CUPS Program: (1) student recruitment and selection, (2) academic enrichment/public health orientation, (3) experiential learning projects, (4) mentorship, and (5) networking and learning among alumni (CDC, 2021c). These shared focus areas are implemented in the unique environments and surrounding communities of the host academic institutions.
Student Recruitment and Selection
The recruitment and selection of students is essential to the success of the CUPS Program. By focusing on undergraduate students with a minimum of 2 years of college education, the program is able to engage students who are in the midst of exploring academic and career interests and making critical career decisions. Thus, the program and its mentors play a pivotal role in facilitating and influencing students’ career paths. The deliberate efforts to recruit underrepresented minoritized students who are diverse and reflective of the U.S. population including students with physical disability, low English proficiency, students of all gender identity and sexual orientation, and students from various geographic locations across the country for public health professions distinguishes the CUPS Program from other pipeline programs. The multisite approach allows the CUPS Program to further diversify its recruitment strategies by tapping into the networks and community and organizational relationships of the host academic institutions. Underrepresented minoritized students recruited include those population groups reported by the Institute of Medicine as severely underrepresented among the nation’s health professionals. These groups include African Americans, American Indians and Alaska Natives, many Hispanic/Latino populations, some Asian Americans (e.g., Hmong and other Southeast Asian people), and Native Hawaiians and other Pacific Islanders (Sullivan, 2004).
Selection criteria for the CUPS Program group applicants into three groups: little or no public health/health background, health-related background, and established public health background based on self-reported questionnaires on the application. This allows the students’ selection committee to conduct a comprehensive review of applications to ensure an optimal mix of diverse students are selected into the program. The final list of accepted participants is inclusive of students from various racial/ethnic backgrounds, academic institutions (e.g., predominantly White institutions [PWIs], historically Black colleges and universities (HBCUs), Hispanic-serving institutions (HSIs), and others), geographic distribution (e.g., urban, and rural), and interests. The students’ demographic profiles, academic institutions, and primary place of residence are analyzed periodically and used to inform subsequent recruitment strategies implemented by the host institutions.
Academic Enrichment/Public Health Orientation
Once in the program, the academic enrichment component provides an introduction to the science and practice of public health. University faculty and guest lecturers teach foundational courses in public health such as epidemiology, biostatistics, program planning, research methods, and social determinants of health, to name a few. Through the program, scholars also obtain a basic knowledge and introduction to professional competencies essential for public health work. Some host institutions provide Graduate Record Examination (GRE) prep courses and tutorials in study skills for their students which are extremely beneficial to minoritized students who otherwise have limited access to these resources.
At the end of the summer experience, CUPS scholars typically spend up to 3½ days at the CDC headquarters in Atlanta, Georgia. The orientation at CDC consists of a series of group discussions, information exchanges, and innovative learning opportunities that introduce scholars to CDC’s priorities, programs, and emerging topics. The orientation is intended to heighten scholars’ awareness and interest in a range of public health disciplines and careers, as well as to help clarify what is required to become part of the nation’s public health workforce.
Experiential Learning Projects
Learning by immersion in the organizations and the communities that the five CUPS host institutions serve is a large part of the summer experience for CUPS scholars. Scholars are placed in state and local health departments, community-based organizations, universities, and at CDC to complete an 8- to 10-week community project or research project curated by the host academic institutions. During this time, scholars learn by shadowing, observing, and applying what they have learned from the classroom into real-life projects (e.g., data analyses, needs assessments, health education) with mentor supervision. They also learn health communication strategies and share lessons learned and research findings through written reports and presentations at conferences, including at CDC. These experiential learning projects are designed to heighten scholars’ awareness of and interest in public health careers, reducing and eliminating health disparities, and pursuing health equity.
Mentorship
Mentorship is a critical component of the CUPS Program. Scholars are often paired with mentors in addition to the supervisors who oversee their experiential learning projects. These mentors are recruited from the organizations where scholars are placed for their summer experience. All mentors receive training. This approach creates supportive and nurturing connections and relationships for the scholars, and opportunities for scholars to work closely with and shadow public health professionals who are often underrepresented minorities themselves. Program staff at the host academic institutions as well as graduate students also serve as mentors. Together, these mentors provide guidance and career advice to the scholars that helps them navigate graduate school applications and facilitate their education and career decisions-making. Mentorship in the CUPS Program is beneficial to the scholars by offering the opportunity to find coaches and role models who share similar interests.
Networking and Learning Among Alumni
The last essential component of the CUPS Program is facilitating networking and learning among alumni. The diversity of the CUPS scholars in the program provides a unique learning opportunity and support for students from underrepresented and underserved populations. Host institutions facilitate networking and learning among the scholars by incorporating peer-to-peer teaching and learning sessions, thereby offering opportunities for scholars to reflect on their own experiences, share their personal stories, and learn from each other. For some scholars, the commonality of their disadvantaged background and experiences brings them together and helps them develop a sense of belonging. For others, the opportunity to experience the world through the diverse experiences of other peers offer insights to human experiences they never knew before. Ultimately, the common interest among scholars to grow, thrive, and make a positive contribution to the society through finding solutions to the long-standing issues of social determinants of health is the bond that brings them together and allows them to lean on each other for support. Through social events hosted for the scholars both in-person and via social media, the host academic institutions promote networking and facilitate the development of social, intellectual, and emotional support systems needed by the scholars as they develop personally, academically, and professionally during and after the CUPS Program.
These five essential components of the CUPS Program are the building blocks from which undergraduate students can begin their personal exploration and career journey. After completing the program, scholars will have had the opportunity to improve their academic skills, increase their understanding of public health, receive guidance when applying to graduate school, and have a greater awareness of career options. While these individual and program level outcomes are highly valued, the CUPS evaluation showed indications of increased self-confidence, greater sense of belonging, and even more passion to find solutions to eliminate health disparities (Young et al., 2021).
Producing a diverse public health and health care workforce prepared to address and reduce health disparities and achieve health equity for all populations requires strategic approaches to experiential learning and mentoring. The CUPS pedagogy enables classroom teaching and onsite learning that increases awareness of students’ strengths and unique talents, connects and matches students’ interests and skills sets to the needs of the larger community, and affords an opportunity for students to work in communities with which they may personally identify (Young et al., 2021). Participation in the CUPS Program helps build lasting relationships among scholars that will be critical in bringing about systemic changes to address long-standing health disparities and inequities.
Footnotes
Acknowledgements
The authors would like to thank the OMHHE staff and Julio Dicent Taillepierre, the Project Officer for the CUPS cooperative agreement, CDC Undergraduate Public Health Scholars Program (CUPS): A Public Health Experience to Expose Undergraduate and Graduate Students to Minority Health, Public Health and Health Professions, for implementation and oversight of the CUPS program. The CUPS program also would not be possible without the collaboration of the academic partners and staff at the Columbia University Medical Center, Kennedy Krieger Institute, Morehouse College, University of Michigan School of Public Health, and the University of California, Los Angeles.
Authors’ Note
The views and opinions in this report are those of the authors and do not necessarily represent the official position of the CDC.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
Supplement Issue Note
This article is part of a Pedagogy in Health Promotion: The Scholarship of Teaching and Learning supplement, “Preparing the Future Public Health Workforce: Contributions of the CDC Undergraduate Public Health Scholars Program,” which was supported by a cooperative agreement from the U.S. Centers for Disease Control and Prevention, Office of Minority Health and Health Equity to the Society for Public Health Education, entitled “Strengthening Public Health Systems and Services through National Partnerships to Improve and Protect the Nation’s Health” (Contract Number 5 NU38OT000315-03-00). The views and findings expressed in this issue are those of the authors and are not meant to imply endorsement or reflect the views and policies of the U.S. government. The entire supplement issue is available open access at 
.