Navigating the Future
League Leads Effort To Embed Colleges In Public Health Education
Community colleges long ago cemented their place as a central and critical contributor to the country’s health care workforce.
The two-year schools educate more than half of the country’s new nurses. Dental hygienists and phlebotomists can get their training at a community college. In the wake of the Sept. 11 terrorist attacks, the sector became an integral part of the country’s response. They now train about 80 percent of first responders, including emergency medical technicians.
But in one area, community colleges remain vastly underrepresented: very few community colleges are involved in educating public health care professionals, now one of the fastest-growing segments of the American health care system. For most of the past century, public health education has mainly been the province of graduate schools, with scant attention paid to undergraduates.
That, however, is poised to change in a significant way. An effort being spearheaded by the League for Innovation in the Community is aiming to embed community and technical colleges in the continuum of the professional preparation of the nation’s public health workforce — the workers who strive to prevent disease, prolong life and promote public health.
The League’s Community Colleges and Public Health Project sees vast opportunities to train a new generation of health care administrators, health educators and environmental health specialists.
Community colleges could meet the growing demand for a relatively new profession: health care navigators. Those workers are members of a health care team who, under a doctor’s supervision, help patients “navigate” the healthcare system and get timely care. Navigators help coordinate patient care, connect patients with resources, and help patients understand America’s often bewilderingly complex healthcare system.
Significantly, the League’s nascent effort has the imprimatur of prominent public health organizations. In 2011, the Association of Schools and Programs of Public Health, anticipating the 100th anniversary of the seminal Welch-Rose report — which is credited with giving birth to public health education — convened a 56-member task force charged with re-imagining public health education.
One of the unexpected outcomes of the work of Framing the Future: The Second Hundred Years of Education in Public Health was a growing interest around the role of 2-year degrees in the continuum of education in public health.
The academic journal Pedagogy in Health Promotion, published by the Society for Public Health Education, took the unusual step of devoting its entire April issue to the role that community colleges can play in building the country’s public health workforce. Just a decade-and-a-half earlier, the journal Public Health Management & Practice produced a 100-page issue that examined public health standards, requited workforce competencies and proper credentialing. Not a word was written about community colleges. How times have changed.
“It seems we have come 180 degrees from where we begin the entry-level professional preparation of public health professionals, including health education specialists,” wrote Stephen F. Gambescia, editorin-chief of the Pedagogy in Health Promotion journal.
The League, working with the Framing the Future Task Force and the ASPPH, has led the exploration of the community and technical college role in the continuum of education for public health. The League’s Community Colleges and Public Health Project started by identifying ways community colleges could contribute to public health education. In November 2014, it issued a final report that included two prototype curricular models for associate degree and certificate programs.
One model, Public Health: Generalist and Specializations, is designed as an associate degree for transfer to a bachelor’s degree program in public health, and includes health administration, health education, and environmental health specializations.
The second model, Health Navigator, prepares graduates for careers as community health workers, patient care navigators, health insurance navigators, and similar roles, and is presented as an academic certificate, applied associate degree, or associate degree program designed for transfer to bachelor’s degree programs in health education.
Richard Riegelman, professor and founding dean of the Milken Institute School of Public Health at George Washington University, is co-author of the League report.
“These programs can allow people to advance in what is becoming a burgeoning field,” he said. “This has been a major event in this field. Ten years ago, community colleges were not even mentioned when we talked about public health education. Now they are at the center of the discussion.”
“The public health education groups are all on board with increasing the role of community colleges. With the League on board, we feel like we have a consensus of community colleges. With the infrastructure in place, we have to make it happen.”
Riegelman said the interest in public health education and health navigator programs in community colleges is based on the rapid expansion in bachelor’s degree program in public health. A study reported in Public Health Reports said public health bachelor’s degrees have grown over 400 percent in the last two decades.
Health navigator programs at community colleges are positioning themselves to provide training for immediate employment.
Hospitals are particularly interested in hiring health care navigators. Their interest is being fueled, in part, by the Affordable Care Act, which places a premium on prevention and improving medical outcomes. Part of the ACA penalizes hospitals if discharged Medicare patients are readmitted with the same condition within 30 days.
“The hospitals are really interested in providing post-hospital care so these patients don’t end up back in the hospital,” Riegelman said. “The navigators, and the community health workers, can coordinate that kind of care.”
“The health navigators can make a real difference. They can increase quality and reduce costs.”
Demand is also being driven by demands for efficiency and lower costs, the need for better outcomes and insufficient access to primary care. The U.S. Bureau of Labor Statistics projects that the number of community health care workers will increase by 25 percent between 2012 and 2022. That compares to an 11 percent increase for all professions.
A handful of community colleges already offer community health care certificate programs. About 20 colleges have responded to the League’s call to develop such programs. The League is working with national practice and academic organizations to develop demonstration projects. This will allow colleges to fully develop curricula complete with learning outcomes, proficiencies, and competencies as well as assessment tools.
According to Gerardo de los Santos, former League president and CEO, community colleges and public health are natural partners. In the Pedagogy in Health Promotion journal, he wrote: “Given their historical role in preparing nurses and a range of allied health professionals, community colleges have the experience and infrastructure to develop and implement programs in public health education. With a focus on community service, these institutions have strong ties and long-standing partnerships with local and regional business, industry, and government — partnerships that can assist in recruiting qualified faculty for new programs, securing experiential learning opportunities for students, and assuring that program curricula meet the needs of area employers.”
The partnership between community colleges and the public health education infrastructure is growing, Riegelman said.
“When we started this work in 2012, it was striking how little interaction there was between public health and community colleges,” he said. “We share the same values, but we didn’t really know each other. There was a great distance, but that doesn’t exist anymore. We really hope our intellectual bond will lead to something great.”
Related Story: POWERING UP,March14 Issue, www.ccweek.com