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The Academic Health Department

Aging Gracefully?

Erwin, Paul Campbell, MD, DrPH; Brownson, Ross C., PhD

Journal of Public Health Management and Practice: January/February 2019 - Volume 25 - Issue 1 - p 32–33
doi: 10.1097/PHH.0000000000000924
25 Years of Publication: Twelve Major Themes: Commentary

School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama (Dr Erwin); Prevention Research Center in St Louis, Brown School (Dr Brownson), and Division of Public Health Sciences and Alvin J. Siteman Cancer Center, Washington University School of Medicine (Dr Brownson), Washington University in St Louis, St Louis, Missouri.

Correspondence: Paul Campbell Erwin, MD, DrPH, School of Public Health, The University of Alabama at Birmingham, RPHB 140A, Birmingham, AL 35294 (perwin@uab.edu).

The authors declare no conflicts of interest.

Appropriate for a practice-focused journal, articles and special issues on the academic health department (AHD) have appeared in the Journal of Public Health Management & Practice's (JPHMP's) pages since at least the sixth volume (2000). Although still somewhat of a clumsy moniker, we have used the AHD label to signify partnerships between public health practice and academia, intended to be mutually beneficial across the domains of teaching, service, and research. Bill Keck,1 who penned the first article in JPHMP with that label in January 2000, was himself the very embodiment of the AHD, serving simultaneously as the Director of the City of Akron Health Department and Chair of the Department of Family and Community Medicine at the Northeast Ohio Medical University. Reading Bill's words now 18 years later is an experience in time travel:

To be effective ... [p]ublic health departments must be positioned as the health intelligence centers of their respective communities; that is, they must be the source of epidemiologically based critical thinking and analysis of their community's approach to dealing with health matters. They must be facilitators of strong and meaningful community participation in the assessment and prioritization of community health problems and issues. They must be major participants in public policy decision making and they must both deliver and broker the delivery of services needed by their constituent populations. Finally, they must be focused on health outcomes as measures of the impact of interventions.1 (p48)

Who doesn't see in these words the concepts of Evidence-Based Public Health (EBPH) and Public Health 3.0, especially the notion of the local health department (LHD) director as the “chief health strategist” of their community? To achieve this, however, Keck noted the critical importance of partnerships in general, naming one specific type of partnership—with academic institutions—as having the greatest potential to “improve capacity to describe and solve community health problems.”

In our own efforts to contribute to the AHD enterprise, our explorations have traveled the paths from case studies of AHDs2 , 3 to describing the characteristics of AHDs (both from the practice and the academic perspectives),4 , 5 developing a research agenda for establishing the evidence base for AHDs,6 to an analytical study in progress on demonstrating that LHDs in AHD partnerships conduct (and have greater support for) evidence-based interventions at significantly higher rates than LHDs with no such partnerships. We note the passage of 18 years from concept development from the Bill Keck article in 2000 to more recent evidence of effect! Much of this work has appeared in these pages, and the two of us find ourselves conducting trainings in EBPH with public health practitioners whose introduction to AHDs may have come from JPHMP. For both of us—having begun our public health careers in the practice setting—this is coming full circle.

Throughout this journey, we have also attempted to refine and articulate a clear scientifically informed definition of the AHD. Surely, Yogi Berra must have said something akin to, “If you can't define it, any measurement will do.” We believe there are at least 3 critical components to a functional, researchable definition of the AHD, as earlier described in the 2014 special issue focus of JPHMP.7 First, the AHD is a partnership between an academic institution and a governmental health agency. The academic institution may be an accredited school or program of public health, a school of medicine, or other health-related academic program. It may reside in a graduate program, a 4-year institution, or a community college. The governmental health agency may include any or all of the full range of federal, state, territorial, local, or tribal health agencies. Second, it is critical for the definition to explicitly describe mutual benefits (as a true partnership) to both the public health practice and the academic entity—mutual benefits in teaching, research, and service. The realization of these benefits is in academia-informed practice of public health, practice-informed curriculum, and practice-based research. A third critical component is that the AHD operates through the sharing of resources. In a work in progress, we make note of the importance in distinguishing between formal and informal AHD partnerships. By formal, we include AHDs with a formal written partnership agreement (such as a Memorandum of Understanding), shared staff, or shared financial resources. An informal AHD relationship can be one in which the academic-practice partners are engaged in some aspect of teaching, research, or service, but without any of these 3 formal AHD components. Although formal AHD partnerships may be the goal, informal AHD partnerships still provide a greater value vis-à-vis EBPH than no partnership at all and may be a stepping-stone to a formal relationship.

Where does the journey take us for the next 25 years of the JPHMP? We have suggested a research agenda for the AHD,6 based on a logic model first described in JPHMP.8 Using this agenda as a template, we need to better understand the descriptive epidemiology of AHDs (leading to a typology of AHDs that summarizes the various types of AHDs). We need longitudinal studies to fully understand the impacts of AHDs (eg, natural experiments). In addition, rigorous qualitative case studies are likely to answer “how” and “why” questions related to AHD formation and sustainment.

What better venue to engage in such practice-based research than in the AHD setting itself, where the focus of the scientific inquiry can be mutually generated between practice and academia, with an obligation that the application of results in both settings can be immediate and replicable to the wider academic-practice community. But we keep such expectations somewhat in check, heeding to what we feel certain Yogi Berra did say: “It's tough to make predictions, especially about the future.”

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References

1. Keck CW. Lessons learned from an academic health department. J Public Health Manag Pract. 2000;6(1):47–52.
2. Hamilton CB, Buchanan ML, Grubaugh JH, Erwin PC. Forming an academic health department: a case example. J Public Health Manag Pract. 2014;20(3):304–309.
3. Chudgar R, Shirey LA, Sznycer-Taub M, Read R, Pearson RL, Erwin PC. Local health department and academic institution linkages for community health assessment and improvement processes: a national overview and local case study. J Public Health Manag Pract. 2014;20(3):349–355.
4. Erwin PC, Barlow P, Brownson RC, Amos K, Keck CW. Characteristics of academic health departments: initial findings from a cross-sectional survey. J Public Health Manag Pract. 2016;22(2):190–193.
5. Erwin PC, Harris JK, Wong R, Plepys CM, Brownson RC. The academic health department: academic-practice partnerships among accredited U.S. schools and programs of public health, 2015. Public Health Rep. 2016;131(4):630–636.
6. Erwin PC, Brownson RC, Livingood WC, Keck CW, Amos K. Development of a research agenda focused on academic health departments. Am J Public Health. 2017;107(9):1369–1375.
7. Erwin PC, Keck CW. The academic health department: the process of maturation. J Public Health Manag Pract. 2014;20(3):270–277.
8. Erwin PC, McNeely CS, Grubaugh JH, Valentine J, Miller MD, Buchanan M. A logic model for evaluating the academic health department. J Public Health Manag Pract. 2016;22(2):182–189.
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