Report of the Public Health Task Force

February 9, 2006

Background

Task Force Membership

  • Richard Myers, Chair (Professor of Biology)
  • Laird Bell, M.D., Cox Health Systems
  • Harold Bengsch, Greene County Commissioner
  • David Brown, Director of Field Experiences and Professor of Education
  • Thomas Burnett, Professor of Health, Physical Education and Recreation
  • Dalen Duitsman, Director of OPHI, Professor of Health, Physical Education and Recreation
  • Alex Hover, M.D., St. John's Health Systems
  • Robert Lunn, Professor of Management and Director of the Master of Health Administration Program
  • Cynthia Pemberton, Dean, College of Health and Human Services
  • Susan Robinson, Associate Professor of Physical Therapy
  • Mark Rushefsky, Professor of Political Science
  • Sue Yarbrough, Instructor of Nursing

These 12 individuals serving on the Public Health Task Force are either members of the Missouri State University community or representatives of the southwest Missouri region. All have an impressive knowledge of Public Health education and research and as well as issues surrounding the field of Public Health.

Definition of Public Health

Public Health is the science and practice of protecting and improving the health of a community, as by preventive medicine, health education, control of communicable diseases, community health crisis management, application of sanitary measures, and monitoring of environmental hazards. Public Health programs are responsible for protecting the public through the prevention and control of disease and injury. In short, it has a unique focus on entire populations rather than individual patients. This is different from the familiar one-on-one health care provider-patient relationship. Missouri State University already does a great deal in the one-on-one arena through the nursing, physical therapy, physician assistant and sports medicine/athletic training programs, radiography and medical technology as well as others.

Need for a Public Health Program

There is a significant need for Public Health workers in Missouri and these needs are growing rapidly. St. Louis University has the only Public Health program in the state and may have difficulty meeting the state's need in the future. Not only are there current shortages, but forecasts indicate that the shortages will increase. Terrorist's attacks on the Twin Towers and more recently, Katrina's devastation on the Gulf coast have made us acutely aware of inadequacies in Public Health infrastructure.

National and state health is progressively impacted by aging, maldistribution of health resources, chronic disease burden, the adverse health effects of the uninsured or underinsured, smoking, drug usage, and emerging new infectious illnesses. The demand for health resources may be approaching the limits of national capability. Most of the nation and state health care dollars are now being spent on chronic disease, such as diabetes, heart disease, chronic lung disease, depression, and arthritis.  Individual health care is unable to address these population based health problems. These problems require population strategies that come from educated public health professionals.  State and national government representatives are beginning to understand the need for population strategies and will look to our universities to provide such professionals.

There is significant community interest in an expanded role for Missouri State University in Public Health training and research. Missouri State University engaged in developing health-related educational programming some time ago. In 1994, the faculty of the Health, Physical Education, and Recreation department included in their five year plan a proposal to develop a Master in Public Health degree. Today, Missouri State University offers a Master of Public Health (MPH) degree that is a 48-hour interdisciplinary program (a 37-hour Professional Option is available). Additionally, the Missouri State University Board of Governors (March 18, 2005) and the Missouri Coordinating Commission approved a School of Public Health for Missouri State University last year. This establishes Missouri State University as the only School of Public Health program within the state universities. The University of Missouri does not currently have Public Health programs. Consideration of Public Health comes at a time when Missouri State University is increasingly emphasizing development of extramurally funded research and developing entrepreneurial alliances. There are no state dollars available or anticipated for academic program development, so a School of Public Health must develop an ongoing, expanded extramurally funded research program. Programs at other universities are run primarily with extramural funding (such as that available from the Centers for Disease Control and prevention and the National Institutes of Health). Funding agencies require CEPH (Council on Education for Public Health) accreditation.

Public Health's relationship to the Missouri State University mission

Public Health embodies the Public Affairs mission of Missouri State University. Health is one of the five themes in the mission and the educated person understands the challenges of public problems. Public Health is an eclectic discipline with components in almost every discipline on campus. It provides a perfect venue for collaborative projects on campus and in the community for students and faculty to work to fulfill the University's statewide mission.

Council on Education for Public Health (CEPH) accreditation

CEPH is an independent agency recognized by the US Department of Education to accredit schools of Public Health and some other Public Health programs.  Accreditation is not easy to obtain and requires a significant number of faculty and budgetary commitments. However, with accreditation comes an opportunity for extramural funding from a variety of federal, state and private agencies—CEPH accreditation is required to be eligible. Of the 37 CEPH accredited programs, the closest to Springfield are Saint Louis University in St. Louis and the University of Arkansas in Little Rock.

Structure of a Public Health program

To be accredited, a School (or College) of Public Health must function at "the highest level of organizational status and independence available within the university context."  This means that, even if there are other professional degree-granting units within the university reporting at lower levels, an accredited school of Public Health must have a reporting structure that reflects the greatest degree of independence possible. Thus, the best structure for Public Health at Missouri State University is a College of Public Health. A successful college will require collaboration between schools and colleges throughout the University. Cross-divisional teaching, research and service activities will be important and should be encouraged. To develop the new college, it might be advantageous to combine current discipline, module and center units that have common faculty affiliation. Using this multidisciplinary approach, a degree should provide broad knowledge of the five Public Health disciplines:

  1. biostatistics
  2. epidemiology
  3. health administration
  4. environmental health sciences
  5. social and behavioral sciences

A College of Public Health must offer at least three doctoral degrees or one doctoral degree with three concentrations. The degree at Missouri State University would be a Doctor of Public Health (DrPH). A masters program would continue to offer the Master of Public Health (MPH). The College of Public Health could also offer interdisciplinary combination degrees at both the master and doctorate level (i.e., MSN/MPH, MHA/DrPH or MSW/MPH).

Task Force Charges and Recommendations

Charge 1: Recommendations on a School of Public Health

What aspects of Public Health can reasonably be addressed at Missouri State University? Should a doctorate of Public Health (DrPH) be offered?

Currently, there is a very large unmet need for Public Health workers in Missouri and the nation, and manpower forecasts indicate that the trend will continue. Missouri State University finds itself within a window of opportunity to take a leadership role in Public Health service, teaching and research in Missouri since there are no Colleges of Public Health at public institutions in the state. Additionally, there is strong community support for expansion of the role Missouri State University plays in Public Health. Both St. John's Health System and Cox Health System representatives have indicated that collegial partnerships will provide support for a Public Health program at Missouri State University. In addition, the Public Affairs mission of our university encourages our involvement in Public Health since it publicly acclaims our responsibility to the community to address social, health, education and wellness issues of our service population. The Public Health issue is nothing new for Missouri State University. For several years, we have been developing health-related educational programming, including an MPH degree. Toward this end, the Missouri State University Board of Governors and Missouri's Coordinating Commission have approved a School of Public Health.

It is the opinion of the Public Health Task Force that Public Health education should become a priority for Missouri State University and with proper leadership become an outstanding component of our educational programs. As discussed, accreditation is critical to a viable program, so the program should be developed with the intent of securing full accreditation from CEPH. The Task Force recommends development of a CEPH accredited College of Public Health. It should offer the Dr.PH and continue to strengthen the MPH and other programs within the purview of an accredited program. A major consideration for establishing a College of Public Health should be its survivability with strong focus on population based health studies and outcomes. It should be noted that many universities with public health programs have medical and dental schools, but the public health program and the professional schools are not necessarily related.

Charge 2: Recommendations on resources and accreditation

What would the organizational structure of a School of Public Health look like? What about resources and accreditation?

The College of Public Health should be a stand-alone College with the Dean of the College of Public Health reporting directly to the Provost.

Such an undertaking presents challenges, particularly in regard to budget, faculty and staff. Due to the importance of issues raised related to recent national disasters, funds are available from a variety of federal agencies to maintain a College of Public Health. This emphasizes the need for ongoing and sustainable extramural funding. Funds are not available to programs that do not have CEPH accreditation thus emphasizing the need to build a program that will become accredited.  Individual faculty and departments should be impacted as little as possible but the overarching principle should be the overall mission of the University in serving the community and Missouri. 

Charge 3: Recommendations on the current MPH

Make recommendations on initiatives that should be taken to further strengthen the Master of Public Health and answer questions related to housing of the program. What resources will be necessary?

A College of Public Health should house the current MPH program. It is a strong program with increasing student demand. CEPH requirements will require Missouri State University to bring the current Master program into compliance.

Charge 4: Recommendations on external and internal collaborations

What collaborations internal and external would be important to educational goals in Public Health?

At every university surveyed, the Task Force found that a College of Public Health is dependent upon a multidisciplinary approach to degree offerings. This means that internal collaborations would form across departmental lines and in some cases, individual faculty may want to develop full-time alliances within the College of Public Health. There are currently faculty on campus to teach the majority of the five core areas necessary to meet accreditation standards.  However, some additional Public Health faculty would be required.

One exciting area of collaboration exists within the community. When asked about collaboration, five major organizations within the community responded with various suggestions about collaborative work. The organizations are: Springfield-Greene County Department of Public Health and Welfare, Cox Health System, St. John's Health System, Springfield-Greene County Office of Emergency Management and Burrell Behavioral Health Center. All are significantly involved in the Public Health arena and are potential markets for our students.

Some specific examples of committed areas of communications for on-the-job training in "Core Functions For Public Health" are: Practical real time experience in biostatistics and epidemiology, real time experience in a multidisciplined approach in environmental health practice, practical application of emergency preparedness and bioterrorism, real time training and experience in control of infectious diseases, behavioral health issues for public health, occupational medicine and health, senior health and wellness, chronic disease management, public health education, communication and marketing, application of quality improvement and quality performance, community health assessment, prenatal, parenting, and early childhood developmental education, real time application of geographic information systems in public health and emergency management and real time experience in risk assessment and communication.  

Consultant's Report

Early in the process, the Task Force contacted CEPH and asked a variety of questions related to formation of a College of Public Health with plans for accreditation. We were given two programs to review—the University of Arkansas in Little Rock presumably because of its proximity to Missouri State University and the University of Kentucky presumably because it is a newly accredited program that gained accreditation on its first attempt. For help approaching our charges, we decided to ask someone with experience to come to our campus, review our situation (from budget issues to personnel) and make recommendations. We chose to invite Dr. Stephen W. Wyatt, DMD, MPH who is the Dean of the College of Public Health at the University of Kentucky. Dean Wyatt visited our campus on January 4 and 5, 2006. While here, he reviewed the need for an accredited program in Missouri, the role of Public Health at Missouri State University, the organizational location of such a program, possibility for offering a doctoral degree and finally, current resources at Missouri State University. His report is provided as an appendix. His recommendations seem to parallel the recommendations of the Public Health Task Force presented here.

Additional recommendations

Some issues became apparent to the Public Health Task Force as the Task Force debated its charge and these issues need further clarification. First of all, we recognize that the installation of a new college is an expensive endeavor. Even though such a college could develop into a revenue-generating unit within five years or so, there will need to be an initial investment. For several reasons stated above, the task force believes a College of Public Health would be a positive undertaking for Missouri State University, but should not be funded at the expense of other departments and programs but rather in concert with them. The challenge is for the University to find innovative ways and entrepreneurial ventures that position the College of Public Health for accreditation. Additionally, the initial faculty appointments should be carefully made so as not to deplete an existing department to the point that programs suffer. There are creative ways to use faculty. Dual-appointments and shared faculty are just a few of these but Missouri State University should have clear definitions of what this means to the faculty member as well as the faculty member's home department. 

Appendix

Dr. Stephen Wyatt's consultant report* is available.

*You will need Adobe Acrobat to view these documents.