COMMENTARY

Anticipating Change, Sparking Innovation: Framing the Future

As the 100th anniversary of
the 1915 Welch-Rose report
approaches, the Association
of Schools and Programs of
Public Health (ASPPH) has
been pursuing two initiatives
to spark innovation in academic partnerships for enhancing population health:
(1) Framing the Future: The
Second 100 Years of Education for Public Health and (2)
Reconnecting Public Health
and Care Delivery to Improve
the Health of Populations.
We describe how ASPPHmember schools and programs
accredited by the Council on
Education for Public Health,
along with their extraordinarily diverse array of partners, are working to improve
education that better prepares health professionals
to meet 21st-century population health needs. (Am J
Public Health. 2015;105:
S46S49. doi:10.2105/AJPH.
2014.302379)

Donna J. Petersen, ScD, MHS, CPH, John R. Finnegan Jr, PhD, and Harrison C. Spencer, MD, MPH, CPH

SINCE THE 1915 WELCHROSE

report called for a new professional training program in the
emerging eld of organized
public health, the eld has
struggled to secure its identity
among the various clinical and
nonclinical professions that contribute to population health.1---3
Al Sommer famously penned in
1995 that public health is
a goal, not a profession.4(p657)
He reected both the importance
and the enormity of the task and
the great diversity of people who
contribute to improvements in
health through myriad institutional structures, organizations,
and systems. Although Welch--Rose clearly articulated the need
for professionals trained in
public health, it equivocated on
the degree to which public
health should belong to a cadre
of specially trained professionals. Recent opportunities,
including the 2010 Patient Protection and Affordable Care
Act,5 are inspiring academic
public health to encourage systems capable of navigating rapid
changes in education and health
care to ensure population health.
As the 100th anniversary of the
Welch-Rose report approaches,
the Association of Schools and
Programs of Public Health
(ASPPH) has been pursuing two
initiatives to spark innovation in
academic partnerships for enhancing the publics health:
Framing the Future: (1) The Second 100 Years of Education for
Public Health Task Force (Framing the Future or task force) and
(2) Reconnecting Public Health
and Care Delivery to Improve the
Health of Populations.

S46 | Commentary | Peer Reviewed | Petersen et al.

FRAMING THE FUTURE

In summer 2011, the Education
Committee of the Association of
Schools of Public Health (now
ASPPH) was faced with a conuence of exciting new initiatives.6
The Undergraduate Public Health
Learning Outcomes Model had just
been released. Growing pressure to
develop guidelines for baccalaureate degrees in public health competed with the need to revisit and
revise the Master of Public Health
(MPH) core competencies developed in 2006.7 Innovations in the
academic sector presented opportunities to rethink how education
in public health is delivered. The
rapidly changing health care landscape and policymakers demands
for increased accountability in
higher education and for health
care and services that respond
more efciently and effectively to
population health needs provided
new opportunities to reconsider
public health content in other
health professional training, as well
as consider integrating public
health and the social determinants
of health into elds and disciplines
beyond the clinical arena.
The committee created a special
task force to take an empty room
approach to exploring these issues and assembled a broadly
representative group of stakeholders. The task force has 56
members from academia, governmental public health, other health
professions, employers of public
health professionals, foundations,
the Council on Education for
Public Health, and educational
organizations including the Association of American Colleges and
Universities and the League for

Innovation in the Community

College. The task force conducts
its work through subcommittees,
inclusive of six expert panels and
one advisory board (Figure 1).
To propel maximum stakeholder engagement in innovative
thinking, the task force developed
a multidimensional approach.
ASPPH created a Web site providing an easy-to-access platform
for task force members and others.
A blog posed provocative questions to stimulate discussion
around critical issues considered
by the task force. Those interested
were encouraged to host town hall
meetings to explore the latest
thinking on the next 100 years of
education in public health, of
which 20 have occurred to date.
Members submitted abstracts for
presentations at partners conferences, and the chair conducted
open discussions at every ASPPH
major meeting as well as in-person
task force meetings and conference calls. A 33-member Blue
Ribbon Public Health Employers
Advisory Board provided
guidance to the task force on
21st-century workforce needs
across the health system and how
educational innovations can
promote readiness.8
It was clear from the beginning
that establishing the task force
aligned fully with major change
trends already evident. Following
the initial creation of schools of
public health at the time of the
Welch---Rose report (circa World
War I), new schools of public
health emerged slowly and almost
exclusively at the graduate level
for much of the 20th century. A
few schools offered undergraduate degrees, all offered the MPH,

American Journal of Public Health | Supplement 1, 2015, Vol 105, No. S1

COMMENTARY

Undergraduate Public
Health Education
Expert Panel
(20112012)

MPH Expert
Panel
(20122014)

Community Colleges
and Public Health
Expert Panel
(20122014)

Task Force empaneled

(2011present)

DrPH
Expert Panel
(2014)

Blue Ribbon
Public Health
Employers
Advisory Board
(2013present)

Workforce
Development
Expert Panel
(2014present)

Population
Health in All
Professions
Expert Panel
(2014present)

Note. ASPPH = Association of Schools and Programs of Public Health; DrPH = Doctor of Public Health; MPH = Master of Public Health

FIGURE 1Expert panels and advisory board for The Framing the Future: The Second 100 Years of
Education for Public Health Task Force.

some offered other masters degrees, most offered the Doctor of

Philosophy (PhD), and some offered the Doctor of Public Health
(DrPH). Despite the creation of
a mechanism for academic accreditation in 1945,9 it took
more than 60 years after the
1915 Welch---Rose report before the number of accredited
schools reached 20. It took another 20 years to reach 30
accredited schools. Beginning in
the late 1990s, however, growth
began to accelerate. In the next
decade, another 10 accredited
schools emerged, and in the following three years, another 10.
Accredited programs experienced
a similar growth trajectory. It took
30 years for the rst 26 accredited
programs to appear and less than
half that time to accredit another
76 (Christine M. Plepys, MS, e-mail
communication, May 2014). Although this was extraordinary
growth, it was mostly limited to an
increase in the number of schools
and programs and did not extend
to educational innovations.

A similar increase occurred

among undergraduate public
health programs. After identifying
more than 100 such programs
many in liberal arts collegesthe
ASPPH formed the Undergraduate
Public Health Education Expert
Panel in 2012. Invited members
were charged with pinpointing the
critical issues in undergraduate
public health education. The panel
then worked to produce The
Recommended Critical Component Elements of an Undergraduate Major in Public Health,10 a report that the Council on Education
for Public Health adopted in
its entirety as part of its inaugural criteria for the accreditation
of stand-alone baccalaureate
programs. As of summer 2014,
12 such programs are in applicant status and currently preparing self-studies (Laura Rasar
King, MPH, oral communication,
August 2014). This was an early
and important innovation of
the larger process in rationalizing
the components of baccalaureate
education in public health and its

Supplement 1, 2015, Vol 105, No. S1 | American Journal of Public Health

distinctive purpose and content as

compared with graduate-level
learning.
The task force convened a second expert panel exploring the
role of two-year colleges in education for public health. This
activity aligned well with the national rising interest in the role of
two-year colleges eager to support
those students transferring to the
new 4-year programs in public
health. Beyond designing models
for two-year associate of arts
transfer degrees, the group explored the development of standalone associate of science degrees
in public health and considered
the essential role two-year colleges
could play in workforce development, a persistent need in a eld
still dominated by those not
trained in public health. The
League for Innovation in the
Community College staffed this
panel; its report was completed
in fall 2014. The rst phase of
the project produced a series of
Foundation and Consensus Statements11 in 2013 that reected

what public health and community colleges could do together.

The second phase produced prototype curricular models designed
for associates degrees and academic certicate programs in
community colleges.
Discussion around nextgeneration transformation of the
MPH centered on changes in the
eld of public health, workforce
needs, and changing educational
technologies. The Patient Protection and Affordable Care Act accelerated changes in health care,
including new emphases on prevention and health promotion,
outcomes metrics, values-based
payments, electronic health records, and patient-centered care.5
Combined with a greater emphasis
on population health, the nation
continues to move toward a conceptualization of a health system
truly focused on health improvement for all, from the clinical
setting to the community. Reaching this goal requires a new relation between public health and
health care delivery as well as
reenvisioning interprofessional
education of health care professionals beyond high-performing
clinical teams alone. How will
public health engage in, collaborate with, and affect this new
environment? Technological innovations are also changing where
and when health care can and
should be delivered, challenging
us to rethink our approach to
teaching and modes of learning.
These two revolutions in health
care and higher education provided
an immense opportunity for public
health and led to the formation of
four more expert panels focusing on
(1) the MPH degree, (2) the DrPH
degree, (3) the integration of population health across all professions,
and (4) workforce development.
In light of other health professions moving to the doctorate as

Petersen et al. | Peer Reviewed | Commentary | S47

COMMENTARY

the terminal degree, the MPH Expert Panel deliberated on the

value of the MPH and determined
that it was here to stay. Several
visionary recommendations from
the expert panel included
the emphasis on an integrated
common core rooted in professional practice (and not in the
traditional ve core disciplines);
the liberation of graduate programs from the requirement that
they offer the MPH in the ve
core disciplines toward encouraging the creation of concentrations
more reective of the strengths of
the institutions and the needs of
the communities each serves; and
the clear emphasis on preparing
professionals with a denitive
area of expertise.12(p373)

Thus, the MPH is now clearly

distinguished as a specialty degree
but with greater emphasis on shared
professional content across specialty
areas. The conversations taking
place in town halls, at conferences,
and with employers and thought
leaders consistently emphasized that
greater attention be paid to the
knowledge, skills, and values underlying public health practice in the
new century and that more active,
integrated, and student-centered
approaches to learning are needed.
At the same time, the need for
individuals with depth of knowledge
and breadth of skills was equally
apparent. The expert panel handled
this challenge by reecting on both
design elements and critical content
of the MPH degree.
This shift in thinking about the
MPH and learning approaches is
intended to stimulate creative strategies and experimentation in
schools and programs across the
United States. Schools such as the
Mailman School of Public Health
at Columbia University (the host
of the symposium that led to this
special issue) have successfully
implemented a redesigned MPH
program with a fully integrated core
curriculum.13 The School of Public

Health at Loma Linda University

has eliminated its traditional
discipline-specic departmental
structure and reorganized around
three academic centers. Other examples can be found in these pages,
and the innovations will continue.
The MPH degree report issued
in January 2014 supersedes the
prior MPH core competencies developed in 2006,7 whereas the
DrPH Expert Panel is building on
the DrPH core competencies from
200914 and more clearly dening
the role of DrPH degree holders as
transformative practitioners and
leaders who parlay evidence-based
ndings in health systems that are
increasingly focused on population
health approaches to improving
health outcomes at lower health
care costs. This report was also
nalized in fall 2014.
The late-breaking Population
Health in All Professions Expert
Panel formed in light of the growing recognition that improving
health outcomes will require increased attention to population
health in the education and practice of all professions. The panels
goal is to propose a framework for
professional education addressing
population health in the preparation of professionals in health
elds and other disciplines. In
recognizing that what is true for
the health professions is equally
appropriate for other professions
that affect the publics health, such
as architecture and urban planning, law, public administration,
civil engineering, economics, business, and international affairs, the
opportunity for cross-training is
nearly limitless. This panels report
is anticipated during winter 2015.
A recently formed expert panel
in conjunction with the Association of State and Territorial Health
Ofcials will examine the opportunities for and roles and responsibilities of academic public

S48 | Commentary | Peer Reviewed | Petersen et al.

health institutions in workforce

development in the traditional
public sector. This is an important
component of education in public
health, one anticipated in the
Welch---Rose report1,2 and a frequent subject of town hall meetings and task force deliberations.
The full task force continues
to engage in lively discussions
around other emerging opportunities that it anticipates in the near
future. From expanded views of
learning spaces and competencybased credentialing to kindergarten through 12th-grade education,
dual enrollment, and new forms of
certication, we expect a continued acceleration of the changes
rst signaled by the growth in the
number of schools and programs.
The Framing the Future task force
provides the means for deep discussions around these issues as we
continue to seek the best ways to
shape improvements in population
health. As promised, task force
products have been released immediately so that they can be
considered and implemented as
quickly as possible. As a nal nod
to the innovative spirit of its work,
the task force will not issue a traditional report. Rather, the products of the task force that are
already available online will be
assembled as dynamic Web-based
content designed to encourage
continuing dialogue and the addition of continuing innovations.
Each of the reports noted earlier
and a space for ongoing dialogue
via social media will be on the
ASPPH Web site (www.aspph.org/
educate) by early 2015.

RECONNECTING PUBLIC
HEALTH AND CARE
DELIVERY
As a founding member of the
Interprofessional Education Collaborative, composed of the

organizations that represent

higher education in allopathic
medicine, dentistry, nursing, osteopathic medicine, pharmacy, and
public health, the ASPPH contributed to the creation of core competencies for interprofessional
collaborative practice that guide
curricula development in all
health professions.15 In May 2014,
ASPPH and the Interprofessional
Education Collaborative, with
support from the National Center
for Interprofessional Practice and
Education,16 hosted the Reconnecting Public Health and Care
Delivery to Improve the Health of
Populations thought leaders conference. This, the rst of a series of
planned events, was intended to
meet the long-range goal to
achieve improved population
health through integrating health
professional education, public
health practice, and care delivery
in an evolving health care system.
A background concept paper
set the stage for the conference,
describing the
increasing momentum from all
sectors of health to transform
care delivery into an outcomesfocused system that improves
population health; provides
value-added services across the
continuum of care; directly engages individuals, families, and
communities in achieving health;
and that simultaneously reduces
per-capita cost (Frank B. Cerra,
MD, unpublished paper, May
2014).

Although the macrolevel system

(organizational capabilities of
entities such as academic institutions, public health organizations,
and health system agencies) is
described as evolving successfully
in connecting public health to care
delivery, the problem statement
in the paper points to the lack
of productive interaction and
integration at the micro level
(individual prociencies of health
professions students, public health

American Journal of Public Health | Supplement 1, 2015, Vol 105, No. S1

COMMENTARY

agency practitioners, and individual care providers) and at the

meso level (team performance).
Because this conference occurred too recently to have produced output, the ASPPH and
Interprofessional Education Collaborative will work with the National Center for Interprofessional
Practice and Education to follow
up and synthesize the thought
leaders suggestions at the conference regarding creating a new
health systemone that values
disease prevention and population
health promotion, provides incentives for systems leaders and providers to manage and optimize
population health data and strategies that use evidence-based
mechanisms and methods, and
demands interprofessional collaboration and training. Next steps
include setting priorities for action, identifying the implications
of change, and dening the pathways for the interface changes to
occur.
We sincerely hope that the
conversations occurring through
the Framing the Future and
Reconnecting Public Health and
Care Delivery efforts continue to
spark wildly creative ideas and
that collectively we continue to
anticipate change, advance
knowledge, and assist in public
health academes role in building a cadre of well-prepared,
inspired, and collaborationminded public health and health
care professionals for a healthier
world. j

About the Authors

Donna J. Petersen is with the Framing the
Future Task Force, the Association of
Schools and Programs of Public Health,
and the University of South Florida,
Tampa. John R. Finnegan is with the
Association of Schools and Programs of
Public Health and the School of Public
Health, University of Minnesota,
Minneapolis. Harrison C. Spencer is with
the Association of Schools and Programs of

Public Health and the Interprofessional

Education Collaborative, Washington, DC.
Correspondence should be sent to Donna J.
Petersen, ScD, MHS, CPH, Dean, College of
Public Health, University of South Florida,
13201 Bruce B Downs Blvd, MDC 056,
Tampa, FL 33612 (e-mail: dpeters@health.
usf.edu). Reprints can be ordered at
http://www.ajph.org by clicking the Reprints
link.
This article was accepted October 1,
2014.

Contributors
D. J. Petersen and J. R. Finnegan
developed the rst draft of the article. All
authors contributed additional material,
comments, and revisions in producing the
nal, consensus article.

Richard M. Fairbanks School of Public

HealthIndianapolis (Workforce Development Expert Panel, cochair); Terry
Dwelle, State Health Ofcer, North Dakota Department of Health (Workforce
Development Expert Panel, cochair); and
David J. Fine, President, Catholic Health
Initiatives Institute for Research and Innovation (Blue Ribbon Public Health
Employers Advisory Board, chair). Also
deserving of thanks for their leadership
and oversight of the initiative are the
following Association of Schools and Programs of Public Health board of directors
members: Michael Klag, Dean, Johns
Hopkins Bloomberg School of Public
Health (immediate past chair and board
governance committee, chair); and Gary
Raskob, Dean and Regents Professor, University of Oklahoma Health Sciences Center College of Public Health (chair-elect).

Supplement 1, 2015, Vol 105, No. S1 | American Journal of Public Health

11. Community Colleges and Public

Health Project. Interim Report. November
2013. Available at: http://www.league.
org/league/projects/ccph/les/
InterimReport_PrintFriendlyVersion.pdf.
Accessed on June 12, 2014.
12. Petersen DJ, Weist EM. Framing the
future by mastering the new public health.
J Public Health Manag Pract. 2014;20
(4):371---374.
13. Begg MD, Galez S, Bayer R, Walker
JR, Fried LP. MPH education for the 21st
century: design of Columbia Universitys
new public health curriculum. Am J Public
Health. 2014;104(1):30---36.

References

14. Calhoun JG, McElligott JE, Weist

EM, Raczynski JM. Core competencies for
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1. Welch WH, Rose W. Institute of

Hygiene. New York, NY: Rockefeller
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Practice and Education Web site. Available at: https://nexusipe.org. Accessed on
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America. 1992. Available at: http://www.
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for Interprofessional Collaborative Practice.
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Acknowledgments
The Association of Schools and Programs
of Public Health received support from
the Centers for Disease Control and Prevention for the Undergraduate Public
Health Education Expert Panel of the
Framing the Future Task Force.
The authors wish to acknowledge the
Framing the Future Task Force members
for their support and guidance on this
initiative since 2011. In particular, the
following individuals deserve thanks for
their dedication in leading most of the
task force activities and for their work in
producing consensus reports: Randy
Wykoff, Dean, East Tennessee State University College of Public Health (Undergraduate Public Health Education Expert
Panel, chair); Robert Meenan, Dean,
Boston University School of Public Health
(MPH Expert Panel, chair); Richard
Riegelman, Professor and Founding Dean,
George Washington University Milken
Institute School of Public Health (Community Colleges and Public Health Expert
Panel, cochair); Cynthia Wilson, Vice
President, Learning and Research, League
for Innovation in the Community College
(Community Colleges and Public Health
Expert Panel, cochair); James Raczynski,
Founding Dean and Professor, University
of Arkansas for Medical Sciences Fay
W. Boozman College of Public Health
(DrPH Expert Panel, chair); Ruth Gaare
Bernheim, Chair, Department of Public
Health Sciences, University of Virginia
School of Medicine (Population Health in
All Professions Expert Panel, chair); David
Goff, Dean and Professor, Colorado
School of Public Health: University of
Colorado, Colorado State University,
University of Northern Colorado (Population Health in All Professions Expert
Panel, subgroup leader); Howard Frumkin, Dean, University of Washington
School of Public Health (Population
Health in All Professions Expert Panel,
subgroup leader); Paul Halverson,
Founding Dean, Indiana University

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Petersen et al. | Peer Reviewed | Commentary | S49

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