Author: Karla Hignite

The community as the classroom: What School of Public Health students will learn

School of Public Health leaders identify seven unique attributes of the new Master of Public Health degree program and share how they define public health

 

This fall, several dozen students became part of history as the inaugural cohort of the university’s new Master of Public Health in Public Health Practice and Administration program, the first degree offering of The University of Texas School of Public Health San Antonio. But what will these students learn as they usher in an era of immersive research and learning, exploring effective public health solutions in partnership with local populations? Academic leaders share how this program is essential and unique for South Texas.

 

COMMUNITY-LED

I refer to this sixth school of our university as “The People’s School” because people are at the center of everything

that we will do. Our mission is community-driven. We think of our school as something integrated into the community from conception. That means we see an accountability of the school to the community, and we treat the community as equals in what we’re doing. We use words like co-contribution, co-learning and co-ownership to indicate the community is the classroom.

Within our tripartite mission of education, research and service, we see ourselves as a catalyst and facilitator that brings community stakeholders together and synergizes that effort to result in changing the health of the community as a whole.

One of our missions — education — is itself a primary social determinant of health overall because education gives you economic opportunities. We are building a curriculum that is flexible so that we can accommodate the work schedules of our students while also providing a pathway where they can receive applied practical experiences working with local organizations. These experiences are critical, as these organizations might serve as their future employers.

What is public health? Public health is about partnering with the wide fabric of community stakeholders on leveraging assets and addressing concerns that determine the well-being of all individuals. Our missions of research and service revolve around working with community partners to identify and fine-tune the solutions that already exist for achieving success. This means working with The University of Texas at San Antonio, the Metropolitan Health District, Bexar County’s Preventative Health and Environmental Services Department and with a range of faith-based and non-governmental organizations and non-health care-related services like transportation, housing, utilities and law enforcement.

 

SERVICE-FOCUSED

Our strategic vision for this program and for our school emphasizes the importance of service that meaningfully impacts the community we are serving. To that purpose, our curriculum engages students in coursework related to public health practice and administration that adheres to the guidelines and criteria set by the Council on Education for Public Health.

We are excited about our multidisciplinary faculty and advisers who will assist students and mentor them through the process not only of what they learn in the classroom, but also as they translate this knowledge into practical terms when they engage in their applied practice experience working with community organizations.

Among the council’s guidelines we’re following is to require each student to complete a capstone learning experience or discovery-based paper. This takes place in the student’s final year after being exposed to various knowledge bases in the classroom and completion of their internship. This integrative learning experience equips students to synthesize their didactic classroom learning and experiential learning within the community to prepare them for their future work as public health practitioners.

What is public health? We know that where you live, your income, your education and your access to health care play a big role in your health outcomes. In fact, the American Public Health Association has identified that your ZIP code could influence your lifespan by as much as 15 years. The science is clear that poverty and poor health often go hand in hand, and to advance our nation’s health, growing income inequality also must be addressed. So, we must shift the main focus of our health system from one that focuses on treating illnesses to one that focuses strongly on prevention. That is what public health is about.

 

STORY-DRIVEN

All students will have foundational competencies in all areas of public health and will pick an area in which they want to specialize. Within that context, we are the department that will help students accomplish their work by incorporating methods, statistics and epidemiology.

There can be a tendency to lean very heavily toward the numbers, the quantitative. But the qualitative piece really gives a story to those numbers. Most people tend to gravitate toward one or the other. Instead of picking their favorite tool, I want students to learn to pick the right tool or the right combination that addresses the problem with which they are dealing.

One way to approach a new problem is to start with qualitative methods, such as having focus groups and doing interviews where students go to the community and learn the community’s language and how they’re talking about a problem. Doing qualitative research with smaller numbers of people can inform how we can then conduct a survey to capture larger populations in a meaningful way because we’ve learned the right ways to measure things. This collection of qualitative and quantitative information can inform interventions, which can then inform policy.

One example of how we’ve managed to move qualitative and quantitative information to policy is with policies for legal-age requirements for the purchase of alcohol. In the 1980s, to address the problem of how much alcohol was in high schools, we moved the legal age to buy alcohol to 21. The result was a significant reduction in adolescent drinking and drunk driving accidents. More recently, we’ve started to do this with tobacco. Just a few years ago, Texas passed a law that you need to be 21 to buy tobacco. Yes, those under 21 still get access to these things, but at much lower rates.

What is public health? Public health is not about scaling up an individual medical intervention or treatment. This is much more about structural change. It’s about prevention and intervention — intervening further upstream so that we are focused not on treating a chronic illness, but on preventing it from happening.

 

EVIDENCE-BASED

The two broad areas of interest for this department are environmental health, with a focus on developing preventive strategies to improve the quality of our environment and mitigate the health effects of pollution and contaminants on communities, and occupational health, with a focus on developing strategies to promote a safe and healthy work environment. Our  department is also interested in policy and advocacy, studying how environmental and occupational health policies contribute to developing regulations and advocating for policies that promote health and well-being.

For example, if you think about heat waves, those affect communities and certainly affect workers, including agricultural workers and construction workers. We need to protect these workers and their communities, and there are a lot of things that we can do, like having shade for breaks. We need to focus on the things a community can do something about.

Within that context, our school will assist in the transformation of South Texas through several strategies:

• Engaging with local communities to understand their unique health needs and challenges and how to tailor interventions and strategies to the specific context of South Texas.
• Conducting research on the health issues prevalent in the region, monitoring trends and identifying emerging health threats so the appropriate evidence-based interventions can be developed.

• Promoting and delivering education and training to the current and future workforce of public health professionals.

• Addressing the health disparities present in the region to ensure equitable health outcomes for all
• Strengthening the region’s capacity to respond to crises, be they natural disasters or public health emergencies, and ensuring the safety and well-being of communities in the region.

What is public health? On a broad level, public health aims to address the upstream causes, the so-called social determinants of health, or “the causes of the causes.” In that effort, public health professionals work across disciplines, sectors, domains and communities, teaching and applying environmental and occupational health, epidemiology, biostatistics, health policy and management, social and behavioral sciences and more to create conditions that support health and well-being on a large scale.

 

PARTNERSHIP-ALIGNED

This department is at the intersection of public health and health care. While not everyone knows what public health is, almost everyone understands what medical care or health care encompasses. Our mission is to advance public health through improved access to care, enhanced delivery of health care services and better population health outcomes overall and specifically for people in South Texas.

We focus on three main areas:

• Provision of health care services, including programs to evaluate and enhance availability of needed care, quality of care, health outcomes, health care costs and the health care workforce.

• Administration of organizations and systems that deliver health care services or support individuals and their families in receiving needed health care.

• Policies to advance population health at local, regional, national and international levels.

This includes working to understand and address issues including health disparities, insurance, health care financing, experience of care, social determinants of health, health care leadership and medical technology assessment.

To address these goals, we’re committed to partnering with community-based organizations, government agencies, military services, academic institutions, health care organizations,  insurers, private companies and other groups involved in health care.

What is public health? Public health is a process where members of the community and organizations supporting health and health care work together to improve population health outcomes. Because so many factors can influence the health of populations, and different factors are important for improving the health of different population groups, no one entity can do this alone. By working with partners, we can improve population health and enhance the value of health services, programs and policies.

 

SOCIETY-CENTRIC

I describe the focus of this department as covering everything from womb to tomb. We want to help people have healthier lives where they work, play, learn, pray and age. We consider every aspect of society in public health and the influences that impact how people behave, how policies are instituted and how communities and organizations are developed and evolve to help people pursue what’s best for them.

By working collaboratively with and learning from the community, we can better understand different factors that influence what’s happening within a community or population.

How our communities are organized influences how we live and what we can do. In theory, policies are based on what people want and desire. Public health, in part, helps bring awareness so people can voice their concerns and say what they want to see in the policies put in place by our policymakers.

Public health advocacy is important to help ensure those policies prioritize a healthy default for everyone so that workers aren’t spending 10 hours sitting or standing, and that neighborhoods have access to nutritious food.

What is public health? Public health is difficult for many to understand because it can be hard to measure. How do you measure something that’s not happening? Because if we are successful, there won’t be high rates of diabetes or kids smoking cigarettes. The importance of public health is helping people better understand that what happens to you impacts your neighbor. We don’t live in a vacuum. We live with each other, and how we live influences everyone else.

 

POLICY-ORIENTED

Policy development is one of the core functions of public health, which includes assessment and assurance. When most people think about policy development, they think of politicians. They  may not think about zoning, where liquor stores are located or who gets a tobacco license. They may not think about the occupational health space such as who must wear protective equipment, why they must wear it or how long it must be worn. Public policy applies to everything from zoning to ordinances around trash collection.

During the COVID-19 pandemic, when hospitals were at and beyond capacity, we all came to understand the need to prioritize public health. What we quickly learned was that in a situation where the majority of a population is at risk of illness or exposure to illness, it can cripple a  health services system if that system wasn’t made to deal with that level of burden.

What ultimately worked was adopting public health measures, like wearing masks, quarantining and all the other preventative things that help to ease the burden on the system. Those were policy decisions, and coming to those kinds of decisions usually requires dealing with various stakeholders and understanding the risk associated with action or inaction.

The curriculum we’ve designed at the UT School of Public Health San Antonio is purposed around training students to understand their role as conveners of conversations around issues that impact health. It’s been refined over time to focus on ensuring that students who will graduate from our program are equipped with the tools they’ll need to ask really smart questions to help solve problems and help people reach healthy outcomes.

What is public health? Public health is about creating conditions where everyone can be healthy. No one can change something alone, but together we can do a whole lot. And that is the point of public health. It is galvanizing people to engage in conversations that lead to solutions that impact our health and the health of the world around us.

 

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More programming to come

In addition to the inaugural Master of Public Health program launching this fall, a second dual degree program is scheduled to begin in summer 2025. The program will offer a joint Doctor of Medicine from the Joe. R. and Teresa Lozano Long School of Medicine and a Master of Public Health in Health Systems from the UT School of Public Health San Antonio. A doctoral program will follow within several years.

 

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by Orith Farago