From the Schools of Public Health

Abstract

Bridging the gap between the academy and public health practitioners often has the appearance of a divorce settlement, with each party speaking past the other or through a representative, but never really hearing what the other has to say. Indeed, we come from different organizational cultures with different funding pressures, reward systems, and structures for accountability. 1 Since the 1988 Institute of Medicine (IOM) report The Future of Public Health, 2 and in subsequent reports, we have been reminded of the gaps and weaknesses on both sides of the table. A large portion of the public health workforce—working at all levels of government and in non-profit agencies—lack formal degrees in public health, with only an estimated 15% to 20% of the public health workforce currently being trained by schools of public health. On the other side of the continuum, many academics conducting research and teaching in public health have had no practice-based experience and their research may appear abstract and too controlled for the practitioner to adapt and utilize. But our shared vision for reducing ethnic and economic health disparities and improving the populations’ health where we work and live keeps us coming back together. As noted in the most recent IOM report, one means of bridging the academic-community health practice gap is through “increasing integrated learning opportunities for students in public health.” 3 The contention of a significant number of faculty and public health practice advocates is that by increasing the capacities of our students to work in real public health settings, we not only assist the development of public health practice, but also its scholarship. 1,4 The challenge is doing this in a meaningful way. Helitzer and Wallerstein observe that in the curriculum of many schools of public health, “designated ‘practicum’ blocks are often divorced from theory-based learning.” 5 They recommend that graduate programs incorporate practice-based classes that demonstrate the inter-relationship of practice to theory, research methods, program planning, evaluation, policy advocacy, and health and disease content areas. There are few examples in the literature of practice-based public health courses that attempt to address these multiple competencies. 6 This report presents a case study of the evolvement of a community-based practice and learning course in Yale University’s School of Public Health (SPH). It documents changes in the course content, relations with community agencies and student learning, and ultimately, the challenges and rewards for faculty, students, agencies, and the school in engaging in public health practice courses.