Obviously I feel that Public Health is one of the most important fields of work, I have two degrees in it, but yet I feel that it is often forgotten when we think about health in general. We attribute the heath field solely with healthcare, the clinical side of the field. But the public health side of the health field affects everything we do- from washing our hands to legislating indoor air pollutant policies, to community health programs improving youth nutrition and media messaging. There is public health all around you, often times in fields you didn’t even realize were relevant to health.
Why is Public Health a forgotten field? Probably multiple reasons. In my opinion, one of the major issues is that the field is so multidisciplinary that when we are talking about a public health mission, we run into issues of “That’s an engineering thing” or “That’s a doctor’s problem”. We lose the cohesiveness of the field when we look at the individual components rather than the problem statement.
For example, let’s look at indoor air pollution.
• The epidemiologists look at the number of lung cancer cases related to a pollutant.
• The medical doctors execute treatment plans for those affected.
• The engineers develop new methods of ventilating the facility to remove the pollutant from the air.
• The policymakers create legislation to require facilities to have the appropriate ventilation method in place.
• The media bundles this information and communicates it to the public.
• The medical doctors execute treatment plans for those affected.
• The engineers develop new methods of ventilating the facility to remove the pollutant from the air.
• The policymakers create legislation to require facilities to have the appropriate ventilation method in place.
• The media bundles this information and communicates it to the public.
Collectively, they are answering the public health problem of “How do we prevent lung cancer due to this indoor pollutant?” but each person or team of persons involved in solving the problem have a very different job description defining their role.
When you start your job search, you can’t type “public health jobs” into Google or Indeed. If you do that, you’ll get a bunch of RN job postings. As a professional, you typically aren’t just in public health, but you’re also in another field. This can be a huge challenge when determining where you fit in the puzzle. A friend of mine is a health policy analyst that reads and writes contracts for an international NGO. Another friend is an engineer who is working on telemedicine. And still plenty of RNs, MDs, and DOs are out there implementing direct patient care projects that are still public health programs.
Why is Public Health a forgotten field?
When we look at the history of public health it leads us back to acute infectious disease; Acute, meaning sudden onset and short duration, such as measles, rather than a chronic condition such as COPD. If you think back, John Snow (The English Physician, not the man of the Night’s Watch) witnessed a trend of patients experiencing cholera. As he treated a steady stream of patients he likely witnessed deaths of these patients and knew the deaths could be prevented if he knew the source of the cholera. He became known as the Father of Epidemiology because he recognized the point source of the cholera contamination.
After looking at this link, I have to say that Public Health may be forgotten because it was previously considered something that doctors did. Doctors provided patients with vaccinations thus preventing certain diseases. Doctors were responsible for reducing preventable diseases by telling patients to stop smoking cigarettes. Doctors provided the monitoring of blood sugar levels and teaching a patient how to manage diabetes. But it wasn’t and isn't enough- people were still dying of seemingly preventable causes, they still are, and people were starting to recognize that there were connections between conditions and exposures.
The interest of the public to connect the sources of exposure and the outcomes, and to determine the effects of chemicals and drugs on the body, or to increase the expected lifespan of our family members has lead to an intense expansion of the field of public health. We need to find the answers but before we can do that we need to understand the similarities as well as the stark differences between healthcare and public health. It is a global responsibility to ensure healthcare for all individuals.
Some Definitions of Public Health
“A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” –World Health Organization, 1946.
“A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” –World Health Organization, 1946.
“The science and art of preventing disease, prolonging life and promoting human health through organized efforts and informed choices of society, organizations, public and private, communities and individuals.” –Modern Medicine, 1920
“Something affecting the health of MANY people at once rather than the health of an individual” -Me, 2017.
The major underlying factor that perpetuates this problem is that colleges/universities that offer public health degrees and professional public health organizations such as APHA and SOPHE don't recognize this as an issue. While educational institutions benefit from the significant increase in tuition dollars generated from individuals seeking public health degrees, they seem to be clueless regarding the plight of nonclinical public health graduates who must compete with the registered nurse, social worker, and registered dietitian for non clinical public health positions.
ReplyDeleteIt is likely that most non-government employers are even aware of nonclinical public health professions because educational institutions and professional organizations have failed to promote nonclinical public health professions among employers, who would greatly benefit from their non clinical skills. For instance, if you take a look at corporations that have invested in worksite wellness programs, you will find that the overwhelming majority have hired a RN or perhaps a registered dietitian to implement and manage nonclinical wellness programs. This problem is running rampant in private and public worksites where the HR staff tends to hire a nurse for any position related to health. Clearly, this is because HR staff is very familiar with the RN as well as other clinicians, but it has not been informed about the roles of the non clinical public health generalist. I have found that the VA is notorious for hiring a RN to fill these types of nonclinical positions.
When I asked the former presidents of APHA and SOPHE about this problem I was told that they were aware and was working on it; well that was over 3 years ago, and nothing much has changed.
If HR recruiters are not aware of nonclinical public health professionals' skills and roles in reducing medical costs, they are likely to hire from among the well known and established health care professions: beginning with the nurse and then the social worker, and RD, even though none of these professional groups are academically qualified to plan, implement, promote, and evaluate public health programs. For example, the standard B.S.N. program requires students to take merely 3 credit hours in community health and no practicum; yet, nurses are hired on a regular basis to oversee community health programs because they are associated with health care.
HR directors have often explained that the public health is simply too vague and general. In fact, the US Department of Labor doesn't recognize "public health" as a profession as it is too broad, according to the economist with whom I spoke. Although you will not find the words, "public health" in the database, you will find specific public health professions such as the epidemiologist, biostatistician, health educator, environmentalist. In addition, the Department erroneously includes certified diabetes educators and health educators in the same category, which distorts the 68,900 job forecast projection for 2024. The former position is a clinical position (RD, RN).
I strongly suggest that the public health degree be replaced with specifics (health communications management, wellness program administration, health analysis, healthy policy, etc,) which are terms that HR professionals can understand and likely apply when filling positions. The public health degree is the only health related degree that is general and inclusive of various health job titles. Moreover, unlike the public health generalists, clinical public health professionals have done an effective job of clearly defining, distinguishing, and promoting their roles in the US health care system.
GIsrael