Some Trends in Schools Public Health
of
MARGIE R. MATTHEWS, DrPH
Just over 20 years ago, C.-E. A. Winslow assessed the schools of public health: In general, we may take pride in the progress made on this continent during the past forty years in the preparation of public health personnel.... The general plan and structure of our educational program is . . . sound. It is based on a conception which we, in the United States, are apt to take for granted, but which is strange and unfamiliar in most other countries. This is the concept that public health is not a branch of medicine or of engineering, but a profession dedicated to a community service which involves the cooperative effort of a dozen different disciplines. The fact that doctors and dentists and nurses and engineers and health educators and microbiologists and statisticians and nutritionists sit together in our schools and take the same degrees is of incalculable importance. It is based on bold assumptions; but it has worked. It provides the only sure basis for true cooperative service in the future.'
At the time Winslow wrote this description there were 11 accredited schools of public health. Today there are 19 in the United States and Canada, with two others in process of development. Nonetheless, Winslow's central points are still salient, even though the problems, the mix of disciplines necessary for their understanding and solution, and the composition of the student bodies in the schools have all changed since the early days of public health. These changes have been logical and necessary-in response to changing public needs and resources. Some data from recent years are assembled herein as indication of changes occurring in the schools of public health.* Each school has its own characteristics, however, and any trends discernible for the schools as a whole may not apply to an individual school. Periods of time for which there were comparable statistics are indicated. 1. Total fall term enrollments in a 4-year period for United States schools rose from 3,483 students in 1969 to 5,320 in 1972. Judging by an unprecedented increase in qualified applicants in the past few years, a continued trend toward increased enrollments seems likely unless the schools are forced to make major cutbacks because of financial pressures in the mid- and late 1970s. 2. The number of graduate degrees granted by United States and Canadian schools increased from 708 in 1959-1960 to 2,229 in 1971-1972.t Total graduates at * Data compiled from statistics on file at the American Public Health Association, Washington, DC. t Includes estimate for Toronto for 1971-1972.
masters and doctoral levels during this 13-year period numbered approximately 16,440.4 3. During the 12 academic years, 1959-1960 through 1970-1971, the overwhelming majority of the degrees awarded by the accredited schools were at the masters level (13,290, or 93.5 per cent). Within this category, the MPH and the DPH (awarded in Canada) declined somewhat relative to all other masters degrees, dropping from 79.4 per cent in 1960 to 69.9 per cent in 1971. During this same period the proportion of doctorates rose from 4.8 per cent to 9.3 per cent, with an average for the 12-year period of 6.5 per cent. Although the number of DrPH degrees increased, as a percentage of all doctoral degrees the DrPH fell (from 58.8 per cent in 1960-1961, to 25.1 per cent in 1970-1971) relative to the PhD, which became the major doctoral degree granted by the schools (rising during those years from 8.8 per cent to 55.5 per cent). The ScD accounted for the remaining doctoral degrees granted. 4. In the last few years many schools have moved toward lengthening the period of full-time study required for the MPH degree from the traditional 9 to 11 months to 18 to 24 months, including internships or field experience. This has been necessitated by the increasing number of entering students who come directly from undergraduate programs or for those who have had no prior experience in the health field. There is also an increasing trend toward part-time study for students who are enrolled in regular graduate degree programs while also employed at least part-time. Completion of degree requirements takes substantially longer for these students. 5. In addition to graduate programs, many of the schools have recently instituted undergraduate degree programs. 6. A number of schools have established, or are considering initiating, external masters degree programs for selected groups of state or local health department employees or others in full-time employment in the field of public health. 7. Continuing education activities have burgeoned. They range from short courses of a few days, to institutes of several weeks, to entire summer programs. Most of these have been noncredit courses, although some have been offered for limited credit toward a graduate degree. During the last year for which there is accurate data (1969-1970), t Includes estimates for 1970-1971 for Puerto Rico, and for 1971-1972 for Toronto. TRENDS IN SCHOOLS OF PUBLIC HEALTH
291
298,811 participant hours were logged in continuing education courses offered by schools of public health. 8. Changes in student characteristic include the following: Professional and Educational Backgrounds
Traditionally, students entering the schools of public health had already achieved health-related professional degrees prior to matriculation. Although not completely comparable, the following percentages give some indication of the professional or educational background categories represented in the total student group in given years. Physicians predominated as students in the schools through the 1940s. For example, in 1946-1947, 61 per cent of all students admitted for the MPH degree were physicians; but by 1951-1952, this figure had fallen to 41 per cent. For the academic year 1958-1959, only 32 per cent of all enrolled students were physicians, but those enrolled who held credentials in the primary care health professions of medicine, dentistry, and nursing comprised 47 per cent of all students. Percentages for these categories of students entering in 1969-1970 were 19 per cent for physicians, and 39 per cent for the three combined professional groups above. During the five years, 1965-1969, physicians, dentists, and nurses, considered as a group, remained approximately the same percentage of all admissions, but the percentage of physicians declined after 1966-1967, from 26 per cent to 19 per cent, while that of nurses rose the fifth year to 18 per cent after remaining at approximately 11 per cent for the previous 4 years. During these same 5 years, the other largest groups of those admitted to the schools designated their professional categories as administrators (11.5 per cent), educators (8.9 per cent), laboratory scientists (7.0 per cent), sanitarians (4.9 per cent), engineers (3.4 per cent), mathematicians/statisticians (3.4 per cent), and nutritionists (3.2 per cent).
graduate educational programs. In 1960-1961, only 24.5 per cent of all graduates were under 30 years old; by 1969-1970, those in this age group had risen to 37.1 per cent of graduates. The youngest group of those under 25, although a small proportion, tripled their percentage during the decade. The 10-year age range of 30 to 39 accounted for 50.8 per cent of graduates at the start of the decade, but only 40.4 per cent at the end. Those aged 40 and over remained approximately the same, comprising nearly one-quarter of the graduates. The median age of students during the decade was in the 30- to 34-year age range.
Foreign Students Students foreign to the United States and Canada have represented a sizable proportion of all public health students since inception of the schools. For example, for the years 1948-1949 through 1950-1951, over 40 per cent of students registered for the MPH degree were from foreign countries. During 1961-1962 through 1969-1970, the percentage of foreigners awarded graduate degrees fell from 21.6 per cent to 17.3 per cent of all graduates. Of the foreign graduates, the single predominant professional group has consistently been physicians-72.8 per cent in 1961-1962, falling to 49.8 per cent by 1969-1970. This is an indication of an ever widening base for students from abroad.
Minorities Although no statistics have ever been assembled on minority students in the schools as a whole, the increases in their numbers in each of the last 5 years in many of the schools indicate that major attempts are being made to recruit and retain students from all segments of society.
Sex
Summary
Although most graduates have been male, there has been a gradually increasing proportion of women graduates of schools of public health in recent years. Their proportion fluctuated within a range of 22.7 per cent to 35.1 per cent of total graduates during the 1960-1961 to 1969-1970 period. In only the last 3 years did their numbers comprise even slightly more than one-third of the graduates and they were only 30.7 per cent of all the graduates in that decade. In 1969-1970 they represented 34.1 per cent of the total, up from 27.8 per cent and 22.7 per cent for the first 2 academic years of the decade.
Some of the recent changes in the schools of public health include: an increasing number of schools and of graduates; a decrease in both the awarding of the MPH degree as compared with other masters degrees, and the DrPH degree as compared with the PhD; a trend toward lengthening the time for achieving the MPH degree; an increase in part-time study for graduate degrees; institution of undergraduate programs and external masters degree programs; a thrust toward greater continuing education activities; and a broadened base for the student population in terms of the heterogeneity of professional backgrounds and prior experience, a wider age range with more younger students, more women students, fewer foreign students, and an increase in minority representation.
Age
Since, in the past, a prospective student seeking entrance to a school of public health completed the prior education for a profession or was engaged in an occupation in the field of public health which prompted seeking advancement through further education and a graduate degree, the bulk of students have been older than in most 292
AJPH MARCH, 1975, Vol. 65, No. 3
Reference 1. Winslow, C.-E. A. The Accreditation of North American Schools of Public Health, p. 2. American Public Health
Association, New York, 1953.
of
MARGIE R. MATTHEWS, DrPH
Just over 20 years ago, C.-E. A. Winslow assessed the schools of public health: In general, we may take pride in the progress made on this continent during the past forty years in the preparation of public health personnel.... The general plan and structure of our educational program is . . . sound. It is based on a conception which we, in the United States, are apt to take for granted, but which is strange and unfamiliar in most other countries. This is the concept that public health is not a branch of medicine or of engineering, but a profession dedicated to a community service which involves the cooperative effort of a dozen different disciplines. The fact that doctors and dentists and nurses and engineers and health educators and microbiologists and statisticians and nutritionists sit together in our schools and take the same degrees is of incalculable importance. It is based on bold assumptions; but it has worked. It provides the only sure basis for true cooperative service in the future.'
At the time Winslow wrote this description there were 11 accredited schools of public health. Today there are 19 in the United States and Canada, with two others in process of development. Nonetheless, Winslow's central points are still salient, even though the problems, the mix of disciplines necessary for their understanding and solution, and the composition of the student bodies in the schools have all changed since the early days of public health. These changes have been logical and necessary-in response to changing public needs and resources. Some data from recent years are assembled herein as indication of changes occurring in the schools of public health.* Each school has its own characteristics, however, and any trends discernible for the schools as a whole may not apply to an individual school. Periods of time for which there were comparable statistics are indicated. 1. Total fall term enrollments in a 4-year period for United States schools rose from 3,483 students in 1969 to 5,320 in 1972. Judging by an unprecedented increase in qualified applicants in the past few years, a continued trend toward increased enrollments seems likely unless the schools are forced to make major cutbacks because of financial pressures in the mid- and late 1970s. 2. The number of graduate degrees granted by United States and Canadian schools increased from 708 in 1959-1960 to 2,229 in 1971-1972.t Total graduates at * Data compiled from statistics on file at the American Public Health Association, Washington, DC. t Includes estimate for Toronto for 1971-1972.
masters and doctoral levels during this 13-year period numbered approximately 16,440.4 3. During the 12 academic years, 1959-1960 through 1970-1971, the overwhelming majority of the degrees awarded by the accredited schools were at the masters level (13,290, or 93.5 per cent). Within this category, the MPH and the DPH (awarded in Canada) declined somewhat relative to all other masters degrees, dropping from 79.4 per cent in 1960 to 69.9 per cent in 1971. During this same period the proportion of doctorates rose from 4.8 per cent to 9.3 per cent, with an average for the 12-year period of 6.5 per cent. Although the number of DrPH degrees increased, as a percentage of all doctoral degrees the DrPH fell (from 58.8 per cent in 1960-1961, to 25.1 per cent in 1970-1971) relative to the PhD, which became the major doctoral degree granted by the schools (rising during those years from 8.8 per cent to 55.5 per cent). The ScD accounted for the remaining doctoral degrees granted. 4. In the last few years many schools have moved toward lengthening the period of full-time study required for the MPH degree from the traditional 9 to 11 months to 18 to 24 months, including internships or field experience. This has been necessitated by the increasing number of entering students who come directly from undergraduate programs or for those who have had no prior experience in the health field. There is also an increasing trend toward part-time study for students who are enrolled in regular graduate degree programs while also employed at least part-time. Completion of degree requirements takes substantially longer for these students. 5. In addition to graduate programs, many of the schools have recently instituted undergraduate degree programs. 6. A number of schools have established, or are considering initiating, external masters degree programs for selected groups of state or local health department employees or others in full-time employment in the field of public health. 7. Continuing education activities have burgeoned. They range from short courses of a few days, to institutes of several weeks, to entire summer programs. Most of these have been noncredit courses, although some have been offered for limited credit toward a graduate degree. During the last year for which there is accurate data (1969-1970), t Includes estimates for 1970-1971 for Puerto Rico, and for 1971-1972 for Toronto. TRENDS IN SCHOOLS OF PUBLIC HEALTH
291
298,811 participant hours were logged in continuing education courses offered by schools of public health. 8. Changes in student characteristic include the following: Professional and Educational Backgrounds
Traditionally, students entering the schools of public health had already achieved health-related professional degrees prior to matriculation. Although not completely comparable, the following percentages give some indication of the professional or educational background categories represented in the total student group in given years. Physicians predominated as students in the schools through the 1940s. For example, in 1946-1947, 61 per cent of all students admitted for the MPH degree were physicians; but by 1951-1952, this figure had fallen to 41 per cent. For the academic year 1958-1959, only 32 per cent of all enrolled students were physicians, but those enrolled who held credentials in the primary care health professions of medicine, dentistry, and nursing comprised 47 per cent of all students. Percentages for these categories of students entering in 1969-1970 were 19 per cent for physicians, and 39 per cent for the three combined professional groups above. During the five years, 1965-1969, physicians, dentists, and nurses, considered as a group, remained approximately the same percentage of all admissions, but the percentage of physicians declined after 1966-1967, from 26 per cent to 19 per cent, while that of nurses rose the fifth year to 18 per cent after remaining at approximately 11 per cent for the previous 4 years. During these same 5 years, the other largest groups of those admitted to the schools designated their professional categories as administrators (11.5 per cent), educators (8.9 per cent), laboratory scientists (7.0 per cent), sanitarians (4.9 per cent), engineers (3.4 per cent), mathematicians/statisticians (3.4 per cent), and nutritionists (3.2 per cent).
graduate educational programs. In 1960-1961, only 24.5 per cent of all graduates were under 30 years old; by 1969-1970, those in this age group had risen to 37.1 per cent of graduates. The youngest group of those under 25, although a small proportion, tripled their percentage during the decade. The 10-year age range of 30 to 39 accounted for 50.8 per cent of graduates at the start of the decade, but only 40.4 per cent at the end. Those aged 40 and over remained approximately the same, comprising nearly one-quarter of the graduates. The median age of students during the decade was in the 30- to 34-year age range.
Foreign Students Students foreign to the United States and Canada have represented a sizable proportion of all public health students since inception of the schools. For example, for the years 1948-1949 through 1950-1951, over 40 per cent of students registered for the MPH degree were from foreign countries. During 1961-1962 through 1969-1970, the percentage of foreigners awarded graduate degrees fell from 21.6 per cent to 17.3 per cent of all graduates. Of the foreign graduates, the single predominant professional group has consistently been physicians-72.8 per cent in 1961-1962, falling to 49.8 per cent by 1969-1970. This is an indication of an ever widening base for students from abroad.
Minorities Although no statistics have ever been assembled on minority students in the schools as a whole, the increases in their numbers in each of the last 5 years in many of the schools indicate that major attempts are being made to recruit and retain students from all segments of society.
Sex
Summary
Although most graduates have been male, there has been a gradually increasing proportion of women graduates of schools of public health in recent years. Their proportion fluctuated within a range of 22.7 per cent to 35.1 per cent of total graduates during the 1960-1961 to 1969-1970 period. In only the last 3 years did their numbers comprise even slightly more than one-third of the graduates and they were only 30.7 per cent of all the graduates in that decade. In 1969-1970 they represented 34.1 per cent of the total, up from 27.8 per cent and 22.7 per cent for the first 2 academic years of the decade.
Some of the recent changes in the schools of public health include: an increasing number of schools and of graduates; a decrease in both the awarding of the MPH degree as compared with other masters degrees, and the DrPH degree as compared with the PhD; a trend toward lengthening the time for achieving the MPH degree; an increase in part-time study for graduate degrees; institution of undergraduate programs and external masters degree programs; a thrust toward greater continuing education activities; and a broadened base for the student population in terms of the heterogeneity of professional backgrounds and prior experience, a wider age range with more younger students, more women students, fewer foreign students, and an increase in minority representation.
Age
Since, in the past, a prospective student seeking entrance to a school of public health completed the prior education for a profession or was engaged in an occupation in the field of public health which prompted seeking advancement through further education and a graduate degree, the bulk of students have been older than in most 292
AJPH MARCH, 1975, Vol. 65, No. 3
Reference 1. Winslow, C.-E. A. The Accreditation of North American Schools of Public Health, p. 2. American Public Health
Association, New York, 1953.
