Clear and compelling evidence links the quality and length of our lives to the environment in which we live, work, play, and learn.1 Many of the strongest predictors of health status fall outside the health care setting and access to services.2 At the same time and despite a growing body of literature, remarkably few coordinated efforts have targeted the professional workforce issues germane to the intersection of engineering, planning, architecture, transportation, and public health.3–6 Supported by the Centers for Disease Control and Prevention, an Expert Panel of 30 national leaders representing academia and practice, from community design to public health, convened in September 2012. This was in response to calls from the National Prevention Strategy that “all sectors (eg, housing, transportation, labor, education, defense) promote prevention-oriented environments and policies.”2(p6) The panel was charged to recommend ways to ensure that the current and future workforce in the public health, planning, and design sectors is able to identify and respond to new and emerging opportunities and threats in the built environment that impact public health. This article summarizes select findings of the panel as seen through a public health lens. We shall begin by reviewing current developments in public health education.
The timing and rationale for the workforce panel were fortuitous, as revolutionary developments are underway in public health education. The Association of Schools of Public Health's Framing the Future Task Force is developing strategies applicable to the future of public health education for both undergraduate and graduate students. Much of the basis for modern public health education can attribute its roots to the seminal Welch-Rose report of 1915.7 This report highlights the role of health officers, the 5 core public health disciplines, and the centrality of academic university-led research.
Much has changed in the 100 years since the Welch-Rose report. The Association of Schools of Public Health appropriately identified the need to reexamine the knowledge, skills, competencies, and career opportunities of individuals possessing degrees in public health. Unlike in the past, today there are multiple entry pathways into public health careers, a multitude of career trajectories, and a growing emphasis on interprofessional and multidisciplinary education. This gives rise to the question: How much disciplined attention is being paid to the built environment in the context of public health education?
In 2007, Nisha Botchwey, a city planning and public health–trained professor, searched for courses on the built environment and public health in US colleges and universities, identifying 11. After reviewing the course syllabi, 5 classes were removed from the pool after being judged too narrow in focus and insufficiently reflective of the full intersection of public health and the built environment. The educational landscape comprising public health and built environment was essentially barren.6
New courses and initiatives have undoubtedly germinated since Botchwey's original research was published in the 2009 Journal of Preventive Medicine, but much remains to be done.6 The Expert Panel on Community Design and Public Health systematically assessed the barriers and enabling mechanisms associated with the intersection of the various disciplines. As the participants introduced themselves, it became evident that “random acts of progress” were being achieved, although much of them predictably in isolation. Much was also largely independent of the academic and training enterprise.
In illustration, the Convergence Partnership, formed in 2006, is a collaborative of influential funders whose goal is to reinvent communities through policy and environmental change. One of its 3 major initiatives is centered on the built environment and health. While the partnership provides valuable tools and resources for practitioners and is compiling a laudable inventory of case studies, there are opportunities to explore how the learning achieved therein can be more deliberately transferred to the current and emerging workforce.
Against this backdrop, the Expert Panel established 5 principal goals at the beginning of the meeting. Four of the 5 will be examined specifically in the following:
Goal 1: Confirm or revise the hypothesis that there are workforce development challenges in creating professionals who can bridge the planning, design, and public health arenas.
The panel achieved broad consensus that workforce challenges are at once present and profound. The existing academic infrastructures in planning, architecture, engineering, and public health largely respond to their respective accrediting bodies, which, in some cases, may produce boutique educational opportunities but will unlikely be of sufficient scope and influence to meaningfully change the dynamics in the field. The panel also identified opportunities outside the traditional accredited system such as community colleges and nonaccredited public health programs as well as at other levels of education such as undergraduate and high school levels that might partner in addressing these workforce challenges. At the same time, the panel felt that universities could be responsive to market forces if there was a commensurate demand for cross-trained professionals. Consensus was not achieved on whether supply or demand or both would be the most important driver.
Goal 2: Clarify the range of core competencies and knowledge necessary for a workforce that is trained to bridge the planning, design, and public health arenas.
There was a sense that discussion about evolving university curriculum is expansive and a general recognition that for fundamental change to occur, institutional commitment would be required from university administrators. While the group recognized that undergraduate programs in public health are currently thriving, some participants, unfortunately, sensed that public health students with the greatest interest in intersectional issues are those hoping to gain international experience, with far fewer interested in domestic environments. There was consensus from the panel that while it will take further discussion to develop competencies across these arenas, there is also a challenge of lack of cohesion between the “core competencies” for practitioners in the field of public health and competencies for university curriculum. This needs additional consideration in the development of shared competencies.
Goal 3: Describe and assess training systems currently in place that can bridge the planning, design, and public health arenas.
The following training opportunities were identified in traditional endogenous venues and professional associations:
- Health Resource and Services Administration training centers
- Accredited and nonaccredited programs and schools of public health
- Public health institutes
- Continuing education provided by local chapters of the American Public Health Association, the American Institute of Architects, and the American Planning Association, among others
- Public Health Foundation's TRAIN continuing education program
In addition to these, several attendees observed that for-profit and fee-for-service organizations are beginning to enter into the marketplace of built environment and public health training, either deliberately or in support of their products.
Goal 4: Develop a set of actions for moving this agenda forward
The attendees engaged in lively exchange about who was responsible and accountable for addressing the need for cross-trained professionals. In the end, several specific recommendations were tendered as possible next steps in the process.
- Align dialogue and efforts around workforce capacity building, with the goals articulated in the National Prevention Strategy. The existing Prevention Research Centers may provide a natural hub for future efforts.
- Advocacy groups and private foundations should consider entering the present void to encourage linkages between practice and workforce development. Attendees felt that foundations can create demand for cross-trained professionals working in healthy community design.
- Consider offering introductory common courses in which students from planning, architecture, public health, and other disciplines learn about community design and public health. The creation of such courses would address the necessity of a common lexicon between public health professionals and their community design counterparts.8
- Consider developing a certificate program or an inventory of continuing education courses suited for face-to-face or online distribution.
- Support development of a rapid training program for recent graduates that would lead to immediate work at the community level. This could be modeled on the “City Year” program.
- Embed applicable questions into professional certification examinations, or encourage accrediting agencies to require applicable courses in their respective curriculums.
This article highlights just a fraction of the Expert Panel's structured conversation on an emerging issue in public health workforce development: a paucity of public health professionals with experience and skills in effectively working with urban planners, city councils, and others who make decisions about the built environment. Considerable effort will be required to bridge the gap between the professions to ensure that society has the requisite intellectual capital for addressing its most pressing needs. The Welch-Rose report was published nearly 100 years ago. The academic public health community, together with its professional and academic partners in planning, architecture, and engineering, has a historic opportunity to create a workforce that can better help us achieve long and healthy lives for all.
1. Commission of Social Determinants of Health. Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health. Final Report of the Commission on Social Determinants of Health. Geneva, Switzerland: World Health Organization; 2008.
2. National Prevention Council. National Prevention Strategy
. Washington, DC: US Department of Health and Human Services, Office of the Surgeon General; 2011.
3. Pilkington P, Grant M, Orme J. Promoting integration of the health and built environment agendas through a workforce development initiative. Public Health. 2008;122:545–551.
4. Association of Schools of Public Health. ASPH Policy Brief: Confronting the Public Health Workforce Crisis. Washington, DC: Association of Schools of Public Health; 2008.
5. Emery J, Crump C. Public Health Solutions Through Changes in Policies, Systems, and the Built Environment: Specialized Competencies for the Public Health Workforce. Washington, DC: Directors of Health Promotion and Education; 2006. http://www.dhpe.org
. October 10, 2012.
6. Botchwey N, Hobson S, Dannenberg A, et al. A model curriculum for a course on the built environment and public health: training for an interdisciplinary workforce. Am J Prev Med. 2009;36(2)(suppl):S63–S71.
7. Welch WH, Rose W. Institute of Hygiene, presented to the General Education Board, May 27, 1915. RF, RG 1.1, Series 200L, Box 183, Folder 2208, Rockefeller Archive Center. http://www.bephc.com/resources/buildingbridges
. Accessed October 17, 2012.
8. Botchwey N, Trowbridge M. Training the next generation to promote healthy places. In:Frumkin H, Dannenberg A, Jackson R, eds. Making Healthy Places: A Built Environment for Health, Well-Being, and Sustainability. Washington, DC: Island Press; 2011:chap 23.