Strategies for Preparing Future Public Health Leaders: Learning from Trailblazing Women in Health Education

Abstract

Many female health education pioneers made seminal contributions to public health and social justice, yet these examples are not well documented in textbooks or integrated into public health curricula as pedagogical learning opportunities. Providing biographies and lessons learned from the past leaders within undergraduate health education curricula can help develop students’ skills as future leaders and address gender inequities in the field. Gender inequities in higher education as well as many public health practice settings result in lower salaries, slower career advancement opportunities, fewer supervisory positions, increased work-life conflicts, and heavier workloads. Developing women’s competencies in leadership and professionalism early in their careers is critical to meeting public health challenges such as COVID-19. We present four female health education trailblazers from different historical eras and various workforce sectors who exemplify leadership attributes (i.e., courage/risk taking, vision, advocacy, mentorship) and can be highlighted as a part of future health education curriculum. Innovative methods and approaches are provided for integrating these leadership lessons into undergraduate public health courses, in alignment with the HESPA II 2020 competencies. Learning from the past to inform the future is critical to inspiring and shaping the careers of emerging health educators.

Keywords

leadership history health education competencies undergraduates pedagogy

Background

Incorporating history, including learning from former trailblazers within the field, can be critical in preparing the next generation of public health professionals to tackle contemporary public health challenges and become leaders (Perdiguero et al., 2001). Despite significant focus on equity and social justice, gender inequities in leadership persist in the academic and practice environments in public health. Female public health professionals experience lower salaries, slower career advancement opportunities, fewer supervisory positions, increased work-life conflicts, heavier workloads, and other disparities compared to their U.S. male counterparts (Yassine et al., 2022). Women in social and other sciences are granted fewer professorships or endowed chairs, are less likely to receive top-tier grant funding and hold fewer editor-in-chief or editorial board appointments of scientific journals (Khan et al., 2019).

Women also constitute most of the public health workforce yet are less likely to hold supervisory positions and earn less compensation than their male peers in state/local public health agencies (Chapple-McGruder et al., 2020). Those earning higher salaries in a state health agency or a large local health department are more likely to be males, have white non-Hispanic race/ethnicity, and work in a supervisory or clinical/laboratory/other scientific position (Sellers et al., 2019). More than 75% of all health educators are women, yet few have advanced to leadership positions in state/local health departments (Cinnick et al., 2023). Moreover, gender inequalities in public health are more pronounced among women of underrepresented races, ethnicities, or other identities (Yassine et al., 2022).

This suggests a critical need to address gender and diversity gaps in the field early in the career trajectory of health educators, in part by enhancing their leadership competencies. Currently, the development of leadership knowledge and skills is typically emphasized in graduate public health curricula or public health institutes for working public health professionals (Grimm et al., 2018). We recommend including leadership skills in professional preparation curriculum at the undergraduate level. This article provides pedagogical strategies for baccalaureate leadership development utilizing the examples of four female health education trailblazers who overcame gender bias, advocated for racial and social justice, and advanced to prominent academic and/or practice positions. Utilizing biographies as a pedagogical approach, as has been done in other fields such as medical education, can help students explore the trials and challenges of key figures and inspire their reflection on “deeper questions regarding their professional identity and role in society.” (Fagiolo, 2021, p. 512). We offer innovative teaching strategies to develop baccalaureate students’ intra- and inter-personal leadership knowledge and skills.

Leadership Competencies and Female Health Education Trailblazers

Various characteristics of effective health education leadership are reflected in the Health Education Specialist and Practice Analysis II 2020 Areas of Responsibility, Competencies, and Sub-Competencies (HESPA II 2020), which form the basis for the Certified Health Education Specialist (CHES): specifically, Area V - Advocacy, Area VII - Leadership & Management, and Area VIII - Ethics and Professionalism (Knowlden et al., 2020; See Table 1).

Table 1.

HESPA II 2020 Areas of Responsibility Reflecting Entry-Level Leadership Skills.

Area of responsibility	Relationship to entry-level leadership skills
Area V: advocacy	A key characteristic of an effective leader is the ability to engage in advocacy for the field and community through bringing groups together, empowering communities to identify and address key public health issues requiring policy change. Leaders can spearhead efforts to bring together members from different communities, coalitions, task forces, and other organizations to develop persuasive messages and educate stakeholders on a proposed policy, system, or environmental change. Additionally, they can use media to conduct advocacy and utilize evidence-based evaluation efforts to evaluate the outcomes of their efforts.
Area VII: leadership & management	Identifying and involving stakeholders and community partners in health education programing requires key leadership skills. For example, a leader who is a mentor will be able to connect and build effective teams and positive work environments. They can develop training programs for others to provide health education. Their ability to develop a vision can provide direction for program planning and evaluation.
Area VIII: ethics and professionalism	Effective health education leaders demonstrate established ethical principles. Through mentorship, they also provide others with examples and feedback on applying these principles and contribute to the profession through scholarship and volunteerism. Through courage, they promote and advocate for conditions and behaviors that promote equity and social justice even in the face of challenges. They promote the health education profession to stakeholders, the public, and others.

We profile four female health education trailblazers who served as president of the Society for Public Health Education (SOPHE) from 1953 through 2001: Drs. Lucy S. Morgan, Sigrid G. Deeds, Noreen M. Clark, and Karen Denard Goldman. These women were selected because they: (1) addressed serious and contentious public health issues of their eras that are relevant to contemporary public health issues (e.g., social justice, gender bias, women’s reproductive rights, climate change); (2) worked as leaders in multiple public health sectors; (3) advanced health education scholarship and practice; and (4) provided substantial volunteer service to the health education profession (See Table 2). Additionally, only females who had served as SOPHE presidents and were deceased were considered for this paper as a way to incorporate important health education history.

Table 2.

Profiles of Female Health Education Trailblazers.

Education	Career highlights	Selected contributions to health education
Lucy S. Morgan (1900–1994)
1932: MS in Biology 1938: PhD in Public Health	Founding chair, Department of Health Education, University of North Carolina, Chapel Hill and thereafter as Professor emerita Joined the U.S. Public Health Service in 1941 Founded a community health program in Hartford, Connecticut that served as a model for similar programs Consultant on international health projects, on behalf of WHO, to Africa, Asia, South America, Australia, and New Zealand	Fourth SOPHE President (1953–1954). First female President of SOPHE. Developed the nation’s first graduate training program for public health educators at UNC, Chapel Hill. Promoted integration between health education classes at NCCU and UNC during the time of Jim Crow laws that enforced racial segregation. Students from both campuses met together in a journal club. Created graduate public health education program at North Carolina Central University (NCCU), an HBCU, for the training of African American professionals. Served as the first chairperson of the department and is one of the persons for whom an academic building was named in her honor (Miller-Morgan Building) at NCCU. Member of APHA Subcommittee that authored Proposed Report on the Educational Qualifications of Community Health Educators in 1948.
Sigrid G. Deeds (1923–2011)
1960s: MPH in Health Education 1977: DrPH in Health Services Administration	Executive Director, Planned Parenthood of Contra Costa, CA Chief of Health Education, Alleghany County Public Health Department Faculty, Johns Hopkins School of Hygiene and Public Health Director of Education and Training, American Red Cross Director of Member Health Education, Kaiser Permanente Medical System of Southern California	29th SOPHE President (1978–1979). Founder of SOPHE’s Three Rivers Chapter (Pennsylvania). Founding mother and editor of Health Education Monographs (later renamed Health Education Quarterly and Health Education & Behavior). Authored first textbook to prepare health educators for the CHES certifying examination. Secretary, Public Health Education Section (now PHEHP) of American Public Health Association. Chair, Annual Meeting PHEHP Section Program Committee, American Public Health Association.
Noreen M. Clark (1943–2013)
1972: MA in Higher & Adult Education 1976: PhD in Adult Education Research	Director, Columbia University School of Public Health’s Public Health Education Program University of Michigan School of Public Health – 1981–2013 Professor & Dept Chair of Health Behavior & Heath Education & Dean; Founder & Director, Center for Managing Chronic Diseases	36th SOPHE President (1985–1986). 17 years of editorial service to Health Education Quarterly, which was expanded to 6 issues in 1987 as Health Education & Behavior. National Program Director for the Robert Wood Johnson Foundation Allies Against Asthma Program. Chair, Public Health Education Section of the American Public Health Association. Many awards, including SOPHE Distinguished Fellow and Healthtrac Foundation Elizabeth Fries Health Education Award. Member, Institute of Medicine of the National Academy of Sciences.
Karen Denard Goldman (1949–2015)
1980: MS in Community Health 1992: PhD in Health Education	Program Director, New York Lung Association Associate Professor & Chair of Public Health, Long Island University Special Project Coordinator, Bureau of AIDS Program Services Founder, KDG Consulting Director of Training, Bureau of School and Adolescent Health Interim Director, Lead Poisoning Prevention Program Special Project Coordinator, Bureau of AIDS Program Services	52nd SOPHE President (2001–2002). Co-authored over 75 “Tools of the Trade” columns in three “Tools of the Trade” textbooks published by SOPHE. Board member, Public Health Association of New York City. Co-founder, New York State Coalition for Health Education. Charter Member, National Center for Health Education Member, National Commission for Health Education Credentialing, Inc.

The female SOPHE trailblazers exemplified four selected leadership attributes: Courage/Risk Taking, Vision, Advocacy, and Mentorship. The authors acknowledge there are other qualities of great leaders; however, these four attributes emerged as important for addressing public health concerns. Additionally, these leadership attributes are still relevant today, particularly for addressing contemporary issues such as social justice, diversity, equity, and inclusion, and health communication challenges in various health education settings. We acknowledge these were all white women, in part reflecting SOPHE’s lack of racial and ethnic representation from 1953 through 2001, and points to the importance of strategic efforts to diversify our profession’s future leadership.

Lucy S. Morgan

Of the many attributes associated with great leaders, courage is among the most important although seldom discussed in health education literature. Courageous leaders do not focus on making things better for themselves but rather making society better for others, often by taking significant risks. In addition to embracing risks, traits of courageous leaders include intentionality, purpose, curiosity, openness, commitment, adaptability, and acceptance (Hermans, 2022).

Dr. Lucy Morgan exemplified the characteristics of a courageous and risk-taking leader. Between the late 1800s until the civil rights movement in the 1950s, Jim Crow laws required racial segregation of Southern schools and public transportation. Dr. Morgan risked integrating her public health education classes in the 1940s at the University of North Carolina (UNC) with students from North Carolina Central University (formerly North Carolina College for Negroes). She recognized African American health educators were needed to effectively reach Southern communities affected by tuberculosis, venereal disease, inadequate environmental sanitation, and other health conditions.

UNC President Emeritus William C. Friday referred to Dr. Morgan as a “pioneering integrationist with a depth of soul that was instructive and remarkable; a revolutionary, in the best sense of that word” (Kastleman, 2006). Dr. Morgan also has been credited for creating the first graduate health education program as a discipline in a school of public health and an early advocate for codifying the distinct training of health educators (Eriksen, 1990).

Sigrid G. Deeds

Dr. Sigrid Deeds demonstrated vision over her six-decade career, contributing her expertise broadly to advance the health education profession. At the Alleghany, PA County Health Department, Dr. Deeds ascended to chief of health education and collaborated with city officials to address the inner-city rodent problem that caused rampant infectious disease (Gielen, 2011). She simultaneously worked as an adjunct professor of public health practice at the University of Pittsburgh Graduate School of Public Health. One colleague wrote “In Western Pennsylvania, her theory, science and skill sets of health education were applied masterfully in creating and organizing community groups for action. She used the tools and skills of health education to promote social justice and social policy” (Roccella, 2017, p. 193).

At the Johns Hopkins School of Hygiene and Public Health, Dr. Deeds mentored numerous students, one of whom wrote, “Sigrid appreciated, communicated, taught and demonstrated the interrelationship and synergy of theory, research and practice” (Dorfman, 2022).

With research funding from the National Institutes of Health, Dr. Deeds demonstrated the effectiveness of educational interventions in improving patient outcomes. Later in her career, she directed education and training at the American Red Cross, applying health education interventions to hypertension control and then later at the Kaiser Permanente Medical System of Southern California with the advent of health maintenance organizations. An unflappable leader, Dr. Deeds delivered her final SOPHE Presidential address at a New York City Chinese restaurant with poor acoustics and no microphone by standing on a table in full formal attire (Gielen, 2011). She envisioned trends that would impact the health education profession over subsequent decades, such as lack of involvement in federal decision-making, chapter relations, and membership challenges (Eriksen, 1990).

Noreen M. Clark

Dr. Noreen Clark was a formidable advocate for excellence in the teaching, research, and practice of health education. At The University of Michigan School of Public Health, she led transformation of the campus into a crossroads where faculty, students, and community members collaborated as equal partners in pursuing health equity (Israel et al., 2014). With charm, humility, and quick wit, she often persuaded individuals with opposing views in the highest ranks of administration and policy to ultimately see her vision.

Dr. Clark also was a staunch advocate for the role of behavioral sciences in the management of chronic disease, publishing more than 150 scholarly articles in collaboration with many experts outside her discipline. As SOPHE president, she spearheaded efforts to eliminate specific requirements for membership, helped negotiate a lucrative publishing contract for the organization’s fledgling journal, and catalyzed the development of the first health education research agenda.

Building on the work of other behavioral scientists, Dr. Clark challenged health educators to work across at least three levels: governmental, organizational, and individual. “We have to consciously target ‘key’ government and community leaders, organizational decision makers, individuals at risk. . . . We need organizations that enact healthful policies, maintain healthful facilities, implement healthful programs. We need individuals who are healthful in their behavior, and in the physical and psychological aspects of their life” (Clark, 1994, p. 496).

Karen Denard Goldman

Dr. Karen Denard Goldman embodied what it is to be a mentor and served as one-to-many students, colleagues, and professionals. She was well known for her key phrase, “Behold the Turtle! Who only makes progress by sticking their neck out.” (NJ SOPHE & K. Goldman, n.d.). Dr. Denard Goldman took on challenging risks in different settings, ranging from directing health programs in non-profit agencies, being a professor, and establishing her own consulting business; she provided a clear example of how professionals can “reinvent themselves” by using their skills in new workforce capacities.

Dr. Denard Goldman’s dedication to scholarship, mentorship and volunteerism is reflected in the more than 75 “Tools of the Trade” that she co-authored (K. D. Goldman & Schmalz, 2005, 2009, 2015). These tools, including one entitled “Follow the Leader: Mentoring,” served as practical guides to health education professionals and followed her KISS Rule of keeping it simple (K. D. Goldman & Schmalz, 2005). An effervescent, energetic speaker, she shared practical ways of connecting research and practice at many SOPHE chapter conferences and local workshops.

In 2005, New Jersey SOPHE created the Karen Denard Goldman Scholarship Award (NJ SOPHE & K. Goldman, n.d.) to memorialize her contributions to the field and dedication to promoting student success. National SOPHE’s Karen Denard Goldman Health Education Mentor Award recognizes a professional who exemplifies mentorship and effectively interweaves research and practice.

Recommendations for Strengthening Leadership in Professional Preparation

One approach to closing the gender gap in public health is to begin addressing leadership in students’ formative undergraduate years. Using examples of female health education trailblazers can instruct and inspire students. Table 3 provides teaching/learning strategies that are integrated, bidirectional and can be used to develop baccalaureate students’ inter- and intra-leadership competencies that align with HESPA II 2020. These strategies can be implemented in person or online, in team-based and individual assignments, and integrated with various media tools for increasing student engagement. Studying these female archetypes also can motivate students to plan their professional volunteer journey and anticipated contributions to the profession. The activities outlined in Table 3 can be applied to all four of the leadership attributes. Pre- and post-tests about students’ knowledge, skills and self-efficacy as future leaders may serve as one evaluation approach for measuring learning outcomes.

Table 3.

Learning Strategies to Strengthen Undergraduate Leadership in Health Education.

Strategies/activities	Description	Examples
Journal Article Club Presentations	Students will read selected journal articles that highlight leadership qualities, female public health and/or health education leaders, and attributes of female leaders. Students will take turns presenting the main points of their articles and moderate a discussion for the club.	Example Discussion Questions: What attributes or characteristics do successful female leaders in health education share across the selected articles? How can aspiring health education leaders develop these attributes? In your opinion, what are the most important takeaways from the articles in terms of promoting female leadership in health education? What insights have you gained into your own career path based on these articles?
Reflection Paper	Students will attend a seminar or webinar on leadership skills development, particularly focusing on female leadership and the unique challenges in public health. Then, students will write a reflection on key take-aways.	Example Reflection Questions: Describe at least two strategies or leadership approaches discussed during the seminar or webinar that particularly resonated with you. How might you apply these strategies in your future career in health education? In what ways can effective leadership skills, as discussed in the seminar or webinar, contribute to improving public health outcomes and addressing health disparities? Provide a specific example.
Interview Presentations	Students will identify female leaders in health education, develop a set of interview questions, and interview a selected female leader. Ideas for overcoming challenges of preparing female leaders will be included.	Example Interview Questions: What skills and qualities do you believe are essential for being a successful health education leader? Can you share some of the key challenges you have faced as a leader in health education and how you addressed them?
Research Paper	Students will conduct a review of the literature on the attributes of effective leadership skills of female leaders and unique challenges of working in public health. The results will be presented in the format of a research paper.	Example Prompt: Identify a minimum of three different female leaders who have worked in health education. Next, summarize their educational and professional experiences in health education or public health. Finally, identify which of the following leadership attributes applied to each leader and why: Courage/Risk Taking, Vision, Advocacy, and Mentorship.
Ethical Dilemma Scenario	After reviewing the Health Education Code of Ethics, two students will be teamed up to describe a public health ethical issue from past or contemporary society and how a specific health educational professional in a leadership position could address it. Students will present their ethical dilemma scenarios, identify the relevant ethical code article or violation, and recommend a course of action of the health education professional could take to address it.	Example Scenario: The manager of the local health department’s tobacco control program is working with an external evaluator to evaluate a local community campaign to decrease tobacco product waste in the area. The manager learns that the external evaluator has previously worked with tobacco retailers. What ethical dilemmas may the manager face? What course of action should they take?
Advocacy Service-Learning Project	Students will develop a service-learning project working with selected community level agencies to support the professional preparation of female leaders in health education.	Example Project: Student works with the local injury prevention coalition to create a female youth advisory board that trains future leaders in child safety advocacy (e.g., enactment and/or enforcement of bike helmet laws, or correct installation of infant car seats).
Student Organization Involvement	Students will identify a student organization on their campus and 1) take on a leadership role, or 2) attend and take minutes at organizational meetings. Students will write a reflection paper on the challenges and rewards of participation as an individual leader or in terms of overall group dynamics and accomplishments.	Example Scenario: A student joins their university’s Eta Sigma Gamma Chapter or public health club and serves as the social media coordinator. The student oversees a subcommittee to identify important public health messaging on campus and promote the club or chapter events. Their paper summarizes challenges and rewards of overseeing a group of volunteers and leadership competencies used or needed to develop in the future.

Conclusion

Learning from public health history is important to the development of future public health leaders. Incorporating biographies and various pedagogical strategies to help students explore female archetypes and the historical challenges they overcame can help them develop leadership competencies and influence their future career growth in various practice settings. This article profiles four female health education trailblazers whose contributions reverberate throughout the years and across work settings. Their courage/risk taking, vision, advocacy, and mentorship have changed the field of health education and helped pave the way for future generations of women to overcome gender bias, promote social justice, and improve population health. They serve as examples of other female public health leaders who could be highlighted in undergraduate health education courses, and the need for increasing the diversity of future health education leaders. Learning from the past to inform the present and future is a vital component of an agile health education curriculum.

Supplemental Material

sj-pdf-1-php-10.1177_23733799241235924 – Supplemental material for Strategies for Preparing Future Public Health Leaders: Learning from Trailblazing Women in Health Education

Supplemental material, sj-pdf-1-php-10.1177_23733799241235924 for Strategies for Preparing Future Public Health Leaders: Learning from Trailblazing Women in Health Education by M. Elaine Auld, Deborah Fortune, Julia M. Alber and Angela D. Mickalide in Pedagogy in Health Promotion

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

M. Elaine Auld

Angela D. Mickalide

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