REIMAGINING PUBLIC HEALTH EDUCATION FOR THE 21st CENTURY

A PUBLIC HEALTH EDUCATION THAT MEETS THE WORLD’S GROWING DEMAND FOR TRAINED EXPERTS NO LONGER ONLY MEANS ‘SIT IN A CLASSROOM, GET A DEGREE, AND BE DONE’. COLUMBIA MAILMAN SCHOOL IS EXPANDING OPPORTUNITIES FOR LEARNING WITH MORE FLEXIBLE, ACCESSIBLE OFFERINGS, ACROSS THE PUBLIC HEALTH CAREER SPAN AND BEYOND.

By Paula Derrow

There’s a crisis in the field of public health, one that was brewing long before COVID-19 reared its head. At a time when the nation— and the world—most needs a robust public health workforce, there is a shortage in the number of public health professionals trained to confront 21st century problems like climate change or the epidemic of obesity, not to mention the next pandemic. An analysis from the de Beaumont Foundation and the Public Health National Center for Innovations found that for our nation’s minimum public health requirements to be met, we need an 80 percent increase in people hired in the field.

Closing the gap starts with education, and Columbia Mailman School is continuing its tradition of leading innovation in public health education. In the fall of 2021, at the behest of Dean Linda P. Fried, MD, MPH, the school convened a Lifelong Learning Taskforce of faculty and staff with a mission to shape the future of public health education. “We went into it saying, ‘The sky’s the limit!’” says Michael A. Joseph, PhD, MPH, vice dean for education and associate professor of Epidemiology. “It was exciting to discuss what comes next and figure out how to bring everything to fruition.”

The first item on the Taskforce’s agenda was to document all the unconventional learning opportunities that the School already offered. When they added everything up, “it was clear that we already had excellent examples of cutting-edge courses in every department,” says Roxanne Russell, PhD, assistant dean of digital learning and Taskforce co-facilitator. The second objective was to continue to reenvision public health education. “As a school, we are constantly imagining new skills people will need, and thinking about how we can get people up to speed,” says Heather Krasna, PhD, Taskforce member and associate dean of career and professional development.

Of course, nothing can replace the unique alchemy sparked by face-to-face, in-person degree programs where students and professors connect in the classroom, the laboratory, and the community. But that doesn’t preclude the urgent need for more flexible, accessible courses and programs that reach different kinds of potential students, whether those seeking to switch careers; those who want to sharpen their skills but can’t afford to take time off work; or learners throughout the life cycle, from high schoolers to retirees. “With greater longevity, we have an opportunity to learn and contribute into the seventh decade and beyond,” says Fried. “The labor force will increasingly need the contributions of older people, and older people who keep learning and working maintain their cognitive skills and stave off isolation and loneliness.”

Just as important is the School’s commitment to preparing the public health workforce to prevent or respond to the next crisis. The field is changing so quickly that it’s difficult for even experts to keep up. “Talking to people on the ground in public health, I hear they need more skills in areas like statistics, data analysis, and program design and evaluation,” says Joseph. But that’s not all. They also need hidden, less obvious skills. “The complexity of the environment in which our students work will require them to be flexible in their thinking, and adaptable,” says Helen de Pinho, MBBCH, MBA, FCCH, associate dean of educational programs and assistant professor of Population and Family Health.

The school nurtures these traits as well. “The pandemic has shown us that public health requires a fair amount of humility. We have to go into a community and work alongside the community to build trust,” de Pinho adds. Students also need to learn how to communicate, and to navigate environments in which policy makers aren’t always partners of public health.

Increasingly, Columbia Mailman School will be bringing these skills to a core workforce that includes not just epidemiologists with PhDs but also employees of health departments, contact tracers, water inspectors—all the people who keep our world healthy and functioning. “Most of the folks on the ground in health departments or community organizations don’t have public health degrees. We need to give them more training,” says Russell. The Taskforce agreed: Expanding the vision of who public health education is for was an urgent necessity. And to do that, says Russell, “we need to keep rolling out offerings that are flexible and affordable.”

A Shift In The Conversation

THE VERY NOTION OF WHAT “EDUCATION” SHOULD DO AND LOOK LIKE, how it should be delivered, and what it should cost is already changing. “There’s been a huge shift,” says Russell, who sprinkles her conversations with terms like upskilling (learning new skills) and microcredentials (badges a student might earn for completing a course). These new kinds of learning opportunities are bringing knowledge and expertise once limited to graduate students to the wider world. “We have always been a leading school of public health for our students,” says Joseph. “Now, we have the ability to give the vast public health workforce—and even those outside the field of public health—the opportunity to also learn from us.”

The Advanced MPH Online Program does just that. “For the first time, we are offering working professionals access to our

MPH by putting our program fully online,” says Russell. Initiated in 2022, the Advanced MPH Online is open to students with two years of public health-related work under their belt or those with experience in adjacent health fields (think medicine, nursing, or social work). Those with a doctorate or master’s degree in a field outside of public health, such as an MBA or JD, and people with two years of public health research or work experience are also eligible.

With scheduled online classes just two evenings each week and the rest of the material available online 24/7, the program accommodates busy professionals. Case in point: The pilot class of 17 students included clinical researchers, MDs, and folks from the psychology field. “For the coming year, we’ve enrolled people with a law degree and an MBA,” says Russell. The second class is on track to double, with the goal being to expand to two online classes of 60 students each.

The Advanced MPH Online program will be a model for more fully online learning options at the School. “We are steadily building the technology infrastructure and capacity for more programs,” says Russell. The Advanced MPH Online also fits in well with the continued development of Columbia University’s online portal, Columbia Plus. Launched last spring and initially available only to alumni, this platform will ultimately provide a unified, all-online way for anyone to register for, enroll in, and pay for any course in the university, including nondegree offerings.

Another alternative to the traditional two-year path to a public health degree is the Accelerated MPH Program for students with advanced degrees, which compresses all the coursework into a single year. “It’s especially popular with medical students or residents who have a gap year, or other students who have advanced degrees or who are in public-health-adjacent fields who want an inperson residential experience and the chance to interact with classmates and professors face-to-face,” says Joseph.

Making Summers A Time For Public Health

“IT’S SO IMPORTANT FOR PUBLIC HEALTH PRACTITIONERS TO KEEP UP THEIR METHODS, especially when it comes to things like statistical modeling and AI,” says Thelma J. Mielenz, PT, PhD, MS, OCS, assistant professor of Epidemiology. Enter episummer@Columbia, which offers any student with the right prerequisites the opportunity to build the foundational knowledge or applied skills necessary for doing population research. Directed by Mielenz and run by the Department of Epidemiology, episummer@Columbia served more than 500 students with 30 online and in-person courses in June 2023. Students include both public health novices and experts: Nearly a third of participants work for the New York City Department of Health and Mental Hygiene, and another 20 percent are public health master’s and doctoral students who come for cutting-edge courses they can’t get at their own institutions. “Whenever a new faculty member comes in, we ask them what they’re teaching that’s brand new,” says Mielenz. “That’s how we ended up offering an infectious disease modeling course—which is especially popular after COVID—as well as a new course on machine learning to allow people to stay on top of the latest research methods.” And with prices ranging from $250 for a 4-hour course to $1,800 for a 40-hour one, the offerings are affordable, particularly with 100 scholarships given out in 2023, according to Mielenz. “Any profit we make goes to supporting our students who need to travel to conferences to present their research,” she says.

DEGREE OR NOT DEGREE?

ONE WAY THE THINKING IS CHANGING is that not every course—or program—needs to lead to a formal degree to be helpful. “Nondegree credentials allow people to upskill faster and more flexibly so they can get that promotion or change careers more affordably,” says Russell. The short, intensive courses in SHARP (Skills for Health and Research Professionals) are led by the Department of Environmental Health Sciences. The nearly 30 summer trainings in technical and current environmental health topics are offered both in person and online and include a course on climate change and health and a popular, new two-day course on environmental justice. As with the Advanced MPH Online Program, students tend to be professionals and researchers in the field, though SHARP boot camps are open to anyone. Courses are only two to three days, but pack in up to 24 hours of theory and practice, along with opportunities for networking.

Turning Medical Staffers Into Public Health Leaders

“WE KNOW THAT IT’S VITAL FOR PHYSICIANS TO UNDERSTAND not only the biology of what makes someone sick but the factors that might have led to their illness—to also consider social, environmental, and policy determinants of health,” says Joseph. That’s one of the goals of LEAD (Leadership Education and Development). Run by the Department of Health Policy and Management in collaboration with NewYork-Presbyterian Hospital and Columbia Business School, the 18-month program also gives physicians the crisis management and business skills they need to ensure their institutions can cope with future challenges. For instance, as part of its health system simulation, Columbia Mailman School offers the first pandemic simulation, designed to help healthcare execs learn to deal with everything from supply chain breakdowns to staff mental health issues.

Another leadership-focused program is REACH (Responding to Epidemics and Crises in Health) Academy, run by ICAP at Columbia University with the Dalio Center for Health Justice at NewYork-Presbyterian. This one-year fellowship offers staffers from NewYork-Presbyterian training in how to predict, manage, and lead responses to complex health crises. The current group of fellows includes a chaplain, a community affairs manager, a nursing informatics officer, and a chief physician assistant, all of whom are taking what they currently do to the next level, whether by learning how to create a more resilient supply chain or how to better reach underserved members of the community.

Pathways For The Next Generation

“AS SCIENTISTS, WE HAVE A RESPONSIBILITY TO DO CUTTING-EDGE, IMPACTFUL RESEARCH—but part of that responsibility is making sure that we are supporting the next generation of scientists in an equitable and just way,” says Anne Nigra, PhD ’20, assistant professor of Environmental Health Sciences. Over many years, Nigra and other Columbia Mailman School faculty have mentored high school students living in tribal communities in South Dakota, Montana, and Nebraska. “Now, we’re taking that further by creating an accessible training opportunity for young people interested in environmental science and public health,” Nigra says. Launched last summer, EARTH (Environmental heAlth sciences Research for Teachers and High school students) enables a small group of high schoolers from Indigenous communities to spend their summer vacation working on an environmentally focused research project where they live. Three teachers are each in charge of three high school students who focus on a relevant, local research project of their choice. Students participate in weekly Zoom seminars and workshops across the groups, meant to expose them to everything research related, from how to write an abstract to ethics in science. “The program is part of a grant from the National Institute of Environmental Health Sciences to collaborate with Indigenous communities living in the northern Plains, as part of our effort to reduce their exposure to arsenic and uranium in their water supply,” says Nigra, EARTH’s director. “There aren’t many rigorous, paid scientific training experiences available to kids and teachers in remote communities like these. Ultimately, we want people leading research efforts in these communities to be from these communities.”

Another next-generation effort is PrIMER (Program to Inspire Minority and underserved undergraduates in Environmental health science Research). “It gives college students the knowledge and skills to handle the pressing public health issues that are not going away any time soon,” says Joseph. Aimed specifically at students from marginalized communities or first-generation undergraduates in New York City who might not otherwise pursue a public health degree, PrIMER “initiates young people into the field by allowing them to engage in science and research while working side by side with top experts in the discipline,” says PrIMER director Ana Navas-Acien, MD, PhD, MPH. Students are paired with a faculty member who mentors them throughout two 10-week sessions over two summers, as well as five hours a week during the school year. And each student is paid for their efforts.

Another pathway program, the BEST (Biostatistics Epidemiology Summer Training) Diversity Program, involves undergraduates from racial and ethnic minority groups and from disadvantaged backgrounds, as well as those with disabilities, who participate in an eight-week research project with a faculty member. Students take classes in biostatistics and statistical computing and receive training and mentoring that sets them up for getting into and succeeding in a public health graduate program.

Of course, if young people aren’t aware of the field of public health, they won’t dream of going to school for a public health degree or getting a job in the profession. That’s why an overarching goal of pathway programs like PrIMER, BEST, and the Summer Public Health Scholars Program is to get young people excited about public health as a possible career. The pandemic has put the field in the spotlight like nothing else could, but “most high schoolers or undergraduates are more likely to say, ‘I want to be a doctor or a nurse’ than ‘I want to be an epidemiologist or a toxicologist,’” says Joseph. The Summer Public Health Scholars Program immerses college juniors and seniors from historically excluded and socially disadvantaged backgrounds in a 10-week program of classwork, internships, and field trips. (Other faculty members raise awareness of public health careers in different ways. For more than a decade, Robert E. Fullilove, MS, EdD ’84, professor of Sociomedical Sciences and associate dean for community and minority affairs, has been teaching in six New York state prisons as part of the Bard Prison Initiative, which trains incarcerated students for future careers, including in public health.)

Columbia Mailman School’s dual degree 4+1 programs bring interested students into the public health fold by inviting undergraduates at Barnard College, Columbia College, Columbia School of General Studies, Dickinson College, Hostos Community College, and Vassar College to spend the fall semester of their senior year at Columbia Mailman School. After graduating from their respective universities, students then go on to earn an MPH in a one-year accelerated program that includes a summer practicum.

Free For All

“BEFORE COVID-19, IT DIDN’T SEEM LIKE THERE WAS A NEED TO KNOW HOW TO ADVOCATE for something as obviously beneficial as public health,” says Krasna. “Now, we’ve seen the damage that comes from people attacking the public health infrastructure, including withdrawing funding and legal authority from health departments.” Columbia Public Health Advocacy Academy, the School’s newest MOOC (a Massive Open Online Course), aims to change that troubling trend. Launched this fall on the edX platform and developed by Krasna, the free online course is a direct reaction to recent attacks on the field of public health. “My hope is that anyone in public health and health-related fields will take this course, which covers the details of lobbying government, including how to get a bill passed into law, how to persuade a policymaker to take action, and how to build relationships with city councils and local boards of health,” says Krasna.

Given the success of Columbia Mailman School’s past MOOCs, like the School’s 2019 Protecting Children in Humanitarian Settings and its 2018 Fighting HIV With Antiretroviral Therapy, the newest addition is bound to make an impact, providing knowledge on how to save public health—and save lives.

Taskforce members and other faculty members continue to have ideas for further innovation. High on the Taskforce’s list of plans for future Columbia Mailman School offerings are stand-alone certificates for people who may already have a degree in public health, but are seeking credentials in another public health specialty, for instance. (Currently, only students enrolled in a degree program at Columbia Mailman School can get such a certificate.) And the School recently began awarding continuing medical education (CME) credits for its first class, one of the episummer@Columbia courses. “It would be great if we increasingly offer courses that help professionals keep their credentials up,” says Russell. “To keep reaching the audiences we want to reach, the choices are going to have to keep growing. I think education is going to look different in five years.”