According to the IOM 2003 report “Who Will Keep the Public Healthy? Educating Public Health Professionals for the 21st Century”, there are areas, in addition to the traditional core areas of public health, where education and learning must be focused to develop effective leadership within the profession. These areas are considered ‘new’ and are considered ‘additions’ to the currently defined core. Each of these areas has a place within the core and overlaps of understanding exist between the traditional and new core areas. Of these areas:
“Informatics, genomics, communication, cultural competence, community-based participatory research, policy and law, global health, and ethics” (IOM, 2003, 1-2); community-based participatory research (CBPR) has the greatest relevance to 21st century public health and public health leadership and workforce development.
Community based participatory research engages community members as key shareholders in the health improvement and the health improvement planning processes. The focus of this approach to public health and population health planning is on the capacity of the community to define and assess strengths as well as needs. Research participants and methods are derived directly from community input. Action and program planning is strategically based on achieving common goals and direct shareholder involvement is encouraged. Community based participatory research addresses concerns from within the existing community infrastructure based on community priorities and capacity. This approach emphasizes the input of individuals and organizations from within the community and de-emphasizes the role of the ‘expert’. The public health professional engages directly with the community to assist in the assessment of the priorities of the community and in guidance toward appropriate approaches to addressing the priority concerns. There is a greater control from within the community over what is researched, as well as how research is conducted within the community, through the members’ direct involvement and participation in the process of planning and design, implementation, and evaluation, “the study of clinical interventions can most usually be achieved by recruitment of consenting patients or subjects, interventions at the community level require an altogether different paradigm, in which investigators and the community or population to be studied are partners” (11).
Community Based Participatory research is the evolutionary result of the ecological model of public health. It is developed based on the concepts of the layers of influence or determinants of the ecological model and its recognition that these layers of determinants overlap in their influence and are part of an iterative, non-linear process of understanding. The processes of CBPR strive to guide to engage participants to improve applicability of results. Cultural competence is a significant part of CBPR, as professionals will need to be sensitive to the culture of the community with whom they engage, and though this is not new, in the future it will be more significant because professional have recognized the effectiveness and efficiency of drawing from within for success, rather than trying to impose an externally defined model of success. I champion this process and am drawn to it because of my background in cultural anthropology, strong personal commitment to positive empowerment, and belief that communities thrive through this methodology of working from within; making public health from the perspective more relevant to the human family in the 21st century.
In the future of public health education, it is suggested that “Specialty certification attests to skills beyond the legal minimums that apply to a limited set of patients (e.g., pediatrics), conditions (e.g., infectious diseases), or interventions (e.g., anesthesia) . . . Therefore, the committee recommends the development of a voluntary certification of competence in the ecological approach to public health as a mechanism for encouraging the development of new M.P.H. graduates”(8). As a working professional, voluntary certification is something I would pursue, could I do so under professional supervision combined with distance learning, in order that I could for all practical purposes, engage with the community of interest (normally, the one in which I live).
Calling for, “vastly expanded practice rotations; and enhanced education for competence in specific careers (e.g., biostatistician or health care administrator)” (11) the committee’s report speaks to me directly as an online graduate student in an isolated community. My practicum experience provided excellent networking opportunities and a valuable overview of the local public health system, at the end of my studies. It would have greatly enhanced my experience to have been able to work through a series of practicums or ‘rotations’ as is suggested. However, development of infrastructure for public health leadership development through FIU in my community can be strengthened. When selecting a practicum site in Key West, I had limited choices of a preceptor because there are very few MPH’s here. Moreover, some of the health professionals with whom I spoke were interested in ‘doing something like that’ but ‘would not know where to begin’. Perhaps expanded training to professionals through institutes of higher learning specifically geared toward developing professional mentoring techniques and increasing the frequency of supervised experiences in the educational process would improve leadership, increase opportunities, and meet the following: “The committee recommends a significant expansion of supervised practice opportunities and sites (e.g., community-based public health programs, delivery systems, and health agencies). Such field work must be organized and supervised by faculty who have appropriate practical experience” (11).
Hinchcliffe, S., Jackson, M., Wyatt, K., Barlow, A., Barreto, M., Clare, L., Depledge, M., Durie, R., Fleming, L., Groom, N., Morrissey, K., Salisbury, L., and Thoman, F., (2018). Healthy publics: enabling cultures and environments for health.
Institute of Medicine. 2003. Who Will Keep the Public Healthy?: Educating Public Health Professionals for the 21st Century. Washington, DC: The National Academies Press.