Schools of Public Health in North America

There were two distinct phases of public health education in the United States: 1914 to the mid-1930s when schools of public health were mainly established and funded by the great philanthropies, and the period of federal and state funding from the mid-1930s to the present (Fee, 2003). The latter commenced with the New Deal and Social Security Act of 1935 which provided federal grants to states for public health, required states to establish minimum qualifications for health personnel, and recommended at least 1 year of graduate education at an approved school of public health. In 1936 the American Public Health Association (APHA) reported that 10 schools offered degrees or certificates; by 1939, 45 institutions were offering 18 different degrees, certificates,rift gold and diplomas in public health.

In 1941 representatives from Columbia, Harvard, Johns Hopkins, Michigan, North Carolina, Toronto, and Yale met to organize the Association of Schools of Public the Committee on Professional Education of the American Public Health Association took over the job of monitoring the standards of public health education. The first standards for accreditation were undemanding, but these became more rigorous over time. At the same time there were continuing changes in the curriculum, in particular the impact of social medicine led to greater inclusion of the social and economic context for public health. Since 1974 the ASPH transferred responsibility for accreditation to the independent Council on Education for Public Health. The number of accredited schools of public health continued to increase, most recently from 24 in 1999 to 38 in 2007. This is still a minority of the estimated 300 plus institutions offering some type of graduate degree in public health in the United States. State funding first provided as part of the New Deal increased in the 1950s. The 1957 Hill-Rhodes Act resulted in over $30 billion in support to health professions’ schools, including public health. Over the second half of the twentieth century there was increased funding for biomedical research; in particular, National Institutes of Health grants which were seen as a politically acceptable way to fund medical schools, and for which schools of public health also had to compete. The federal research funding streams were increasingly important to schools of public health as the philanthropic foundations lost much of their enthusiasm for funding public health education in the postwar period. A few schools, especially Johns Hopkins and Harvard, grew large and prosperous, but the majority struggled. Within the schools, laboratory sciences generally thrived, whereas public health practice and teaching suffered, and the number of students fell.

Since the 1950s the Pan American Health Organization also moved away from sending foreign students to study in the U.S., further reducing student numbers and schools’ income. Since the 1960s some schools of public health lost their independent status and were absorbed into other parts of their universities.

Schools of public health were affected as were other parts of academia by the swings in the wider U.S. political climate, from the increasing political conservatism of the 1950s, to new growth in the 1960s, and then further cuts or threats of cuts in the 1970s and 1980s. In the late 1980s the Institute of Medicine (IOM) published a landmark report on The Future of Public Health (Institute of Medicine, 1988). Although the focus was on public health practice, the report made a number of recommendations for schools of public health; for example, education programs should be more integrated with state agencies and more targeted on the needs of practitioners. The years since the IOM report have seen continued expansion by schools of public health, yet fundamental tensions remain. A number of commentators have identified the continuing tensions between medicine and public health,rift gold and Fee (2003) has highlighted the continuing divide between schools of public health (mainly research institutes with scientists and researchers with PhDs) and state public health departments (lacking in skills and qualifications).