Amuwo, Shaffdeen PhD, MPH; Scrimshaw, Susan PhD; Adefuye, Adedeji MBBS, MPH; Washington-Calvin, Dorothy MA
Since its establishment in 1972, the University of Illinois at Chicago School of Public Health (UIC-SPH) has been a part of the Urban Health Program (UHP) of the University of Illinois at Chicago. The UHP is a State of Illinois Initiative within UIC aimed at increasing the number of Blacks/African Americans, Hispanic/Latino/Latinas, and Native Americans in the health professions, whose increased representation in the profession could help meet the health care and health needs of minority communities in the urban areas of Illinois.
The UIC-SPH is the only accredited and comprehensive school of public health in Illinois. Using a public health strategy of partnership concepts to address the need of the community, the UIC-SPH partnered with public health-related entities to increase the number of minorities with public health credentials. Much of our early efforts focused on (1) encouraging undergraduate students to pursue public health credentials such as an MPH, MS, PhD, or DrPH; and (2) promoting the need for public health-credentialed persons among workers with no public health degree and among other health professions students in medicine, dentistry, and nursing.
While the strategy was helping to increase the number of applicants and admissions, it did not increase the pool of potential applicants. Neither did it markedly increase what the general public knew about public health. To address these concerns, we developed the Chicago Health Professions Partnership Initiative (CHPPI), increasing the partnership to include all stakeholders in the community and focusing on the preparation of students at the K–12 levels.
Building a Pipeline
Many attempts by health professions schools and related associations to develop programs that address deficits in applicant pools have fallen short of expectations, although a few (as well as some federal programs) have shown some good results. A common feature among successful programs is the use of a pipeline program and partnerships, although, the partnerships' contributions to diversity in the applicant pool have not been fully tested.
Our HPPI is based on a tripartite model of increasing diversity in the health professions through significant relationships with major stakeholders (with each providing significant services): (1) municipal health agencies provided access to mentors, clinics, clinicians and other health care professionals, and additional funding streams; (2) educational systems (K–12, two-year and four-year colleges) provided students from underserved communities; and (3) community-based and faith-based organizations provided relevance to students from underserved communities.
Municipal health agencies
Since the CHPPI is an HPPI led by a school of public health, it has different partners than the other programs. For example, the UIC-SPH collaborated with several major municipal health care agencies of governments with the responsibility for the health of their respective domains: the Illinois Department of Public Health is run by the Illinois state government; the Chicago Department of Public Health is run by the City of Chicago local government; and the Cook County Ambulatory and Community Care Network is run by the Cook Country Government.
All members of the coalition have extensive involvements in these communities, signed affiliation agreements, and were involved in the design and implementation of the objectives of CHPPI. This strategy has enabled all partners to see themselves as stake holders and willing to promote our K–20 pipeline strategy.
For example, the Illinois Department of Public Health provided personnel from disadvantaged communities to serve as mentors and presenters at school assemblies. The Chicago Department of Public Health also provided mentors to the program and opportunities for students to sit at the deliberations on Board of Health regulations. Cook County provided counselors and recruiters who organized mentoring and shadowing opportunities for students with primary care physicians, public health nutritionists, and health administrators.
Students and communities
At UIC-SPH, we have been tracking two cohorts of students (approximately 1,000) starting from when they were in the sixth grade. At the end of the 2005 academic year, our first cohort will be in the 11th grade while our second cohort will be in the eighth grade. Additionally, we have been working with students at the community college, four-year, and graduate/professional school levels and have graduated over 100 students with MS, MPH, PhD, DrPH, MD/MPH, DDS/MPH, and MPH/MSN degrees. These students have informed our understanding of which HPPI students will best meet health care needs in the underserved areas of Chicago.
Over 95% of the Health Professions Shortage Areas (HPSAs) and Medically Underserved Areas (MUAs) in Illinois are in Chicago, in predominantly African American and Hispanic/Latino communities. Further, within these communities, very few people know what public health does and how it affects us every day. Like the rest of the nation, the communities' populations are aging. Students from these communities face barriers such as low test scores, poverty, lack of opportunity or role models, inadequate preparation, and the cultural irrelevance of the counselors. Furthermore, in the City of Chicago, a 2000 population of 2,896,016, minorities constituted the majority (63.2%) of residents: African Americans (36.8%), Hispanics (26.0%), and Native Americans (0.4%).1 However, their population, relative to public health degree holders, is very small. Available data show that an estimated 102,725 individuals work in health-related fields in the Chicago area and only about 2,000 of the public health work force (about 8% of whom are minorities) have graduate training in public health.
Community and faith-based organizations
The CHPPI had a wide range of community partners, among them the Illinois Area Health Education Center, the Westside Association for Community Action, the Hispanic Health Alliance, the Sinai Community Institute, and Public Allies, a subsidiary of AmeriCorps. These organizations helped organize health clubs for students and linked students to community resources. In addition, community-based organizations (CBOs) have the capability of hosting health forums, town hall meetings, and career fairs. Moreover, CBOs provide a direct link for students within the community, and help students to be directly involved in advocacy for their communities on issues such as diversity and cultural competence of physicians.
The CHPPI carried out a variety of activities aimed at introducing students, teachers, and parents to careers in public health; preparing students for college; and training teachers on cultural competence and how to incorporate public health into the school science curriculum (see Table 1). Two of the activities are discussed here.
Public health curriculum
Although 75% of the over 40 years gained in life expectancy in the United States over the last decade can be directly attributed to public health efforts, public health remains a less known field when compared with high-profile health professions like medicine. The general public, let alone disadvantaged high school and middle school students, does not know about public health activities. A Harris Poll of 1997 shows that very few North Americans have any real idea of what the words “public health” mean.2 Our own study of over 500 college students who participated in our public health articulation conferences shows that fewer than 8% had heard of careers in public health before contact with us. Such invisibility not only contributes to the lack of awareness younger students have about career options in public health, but also prevents them from identifying potential mentors and from linking any particular profession or underrepresented minority professional to public health.
As a first step towards increasing the number of students who consider careers in public health, we designed and taught a public health curriculum for grades six through eight. This curriculum involves student-focused activities that supplement the science and mathematics curriculum and increases in sophistication as students advance through the middle school grades. Topics covered include career options in health care; public health issues and concepts; roles of individuals, communities, and government in assuring public health; and epidemiology as a science of detectives. The classes are taught by public health graduate students who themselves come from HPSAs and MUAs, and in some cases are alumni of participating K–12 schools. To involve parents and/or guardians, activity sheets on public health sciences are sent home with the students. Prior to starting the class, parents' consent and students' assent (if students are 12 years or older) are obtained. A pretest is used to measure the baseline knowledge of the students. A posttest is administered after curriculum delivery to measure knowledge gained. Because knowledge gained can dissipate, the posttests are administered within one week of completing teaching.
From the baseline in the sixth grade to the posttest when they reached the eighth grade, students in the first cohort (n = 419) who took the class increased their knowledge about public health, health professions, and government's role in health care by 30%, 22%, and 38%, respectively, and students in the second cohort (n = 411) increased their knowledge 42%, 28%, and 39%, respectively, Equally important is the fact that our students scored better on standardized tests than did fellow students who did not participate and students statewide.
Public Health Science Education for Teachers
The purpose of the Public Health Science Education for Teachers Program (PHSET) is to educate teachers in the Chicago Public Schools about public health sciences: What it means; its importance and relevance to maintaining school safety and a healthy society; its career paths; and how it can be incorporated into school science curriculum. The program is run in partnership with the Chicago Public Schools; the Leadership Development Institute, a minority community-based entity with over 20 years experience addressing cultural competence and cultural appropriateness issues; and the Illinois Center for Public Health Practice, a project of UIC partly funded by the Centers for Disease Control and Prevention.
The PHSET is advertised directly to teachers in our partner schools and to other teachers through a listing in the Chicago Public Schools Lane Credit Course calendar and Web site. The course's several components are bundled into four modules:
* PH 411 provides learners with competency in describing what public health is, including its unique and important features to their students;
* PH 412 provides learners with competency in applying measures of population health and illness, including risk factors, in community health improvement initiatives;
* PH 413 provides learners with competency in identifying public health and prevention strategies for prevalent health problems; and
* PH 414 provides learners with competency in describing the role of law and government in promoting and protecting the health of the public and identifying specific functions and roles of governmental public health agencies in assuring population health.
All participants take a pretest and introduction, cultural competence workshop, individual final assessment, posttest, and complete a research paper focusing on a classroom curriculum on a public health topic. All participants take PH 411 and then choose two other modules from PH 412, PH 413, and PH 414.
The PHSET has been approved for provision of lane credits and continuing education by the Chicago Public Schools and the Illinois Board of Higher Education, respectively. This is a first and a major step to educating teachers about public health and being able to guide and direct their students to public health career paths. Over 40 teachers have completed the program and passed the competency-based tests of knowledge. Another 15 are currently taking the course.
The HPPI funding has allowed us to build expanded relationships with several stakeholders. However, the depth of our agenda is not always congruent. For instance, while the HPPI funding calls for the inclusion of high-performing students that have the likelihood of completing college education and then proceed to a professional or graduate school of public health, most other partners prefer that we work with students who are borderline (i.e., students who need additional push to increase their likelihood of success). Quite often, this major difference leads to problems in the recruitment of high school students for the health clubs and the management of partnerships. Although differences exist, the partnership has produced some very tangible results. This demonstrates that partnership works even when differences exist as long as the goals are the same and compromises can be reached on areas that pose the most challenges.
Our major challenges in the implementation of CHPPI include staffing patterns, request for participation by other schools within the Chicago Public School system, the cost of retaining community partners, management of partnership, and system issues. The nine CHPPI schools, augmented by additional 11 schools supported by Health Resources and Services Administration funding through the Division of Health Careers and Diversity Programs, are scattered throughout Chicago and reflect the ethnic diversity of the city. Because of the high number of schools, distance, and ethnic distribution, it was very important for the project to engage health educators (among public health students) who had backgrounds and interests similar to the underrepresented minority student population. Recruiting students who fit our needs was a challenge. Retaining our community partners comes also at a cost.
The system issues we faced within UIC and Chicago Public Schools were the tracking of elementary students who transitioned to nonpartner high schools, bureaucracy of the Chicago Public School System, translation of curriculum materials to Spanish for non-English speaking students, and securing of the Institutional Review Board to collect personal and tracking information on students.
The project has afforded us the opportunity to reach many students who previously have not heard about public health career paths and get them interested in it. It has also helped in the academic preparation of the students to ensure their success in college and, hopefully, a school of public health.
Institutionalizing the Project
The UIC developed the UHP as part of its commitment to meet the needs of disadvantaged individuals with regards to training and access to health care. The aim is to admit and subsequently graduate significantly larger numbers of disadvantaged individuals in the health professions. The UHP is a major part of UIC commitments. At the campus level, the presence of many specialized support services and the excellent relationship they have with the School of Public Health adds to our capacity to implement the CHPPI. The services of the CHPPI are seen as a part of total effort to recruit, admit, support, and graduate students from disadvantaged communities. The CHPPI is embedded within the Office of Urban Health and Diversity Programs, which is an integral part of the Office of the Dean. As such, it is well accepted by students, faculty, partners, and disadvantaged and underrepresented communities.
In February 2006, we plan to compete for funding from the Health Careers Opportunity Program of the Bureau of Health Professions through the Health Resources and Services Administration. We have used the HPPI to leverage resources and funding for our pipeline to health professions project and will continue to look for other resources.
The authors are grateful to UIC-SPH faculty and to over 20 graduate students that serve as Health Educators and Research Assistants on the CHPPI.