To The Dean Who Wants to Create an Undergraduate Public Health Major: Consider a Liberal Arts Approach

Mona Hana-Attisha, MD MPH is the whistle-blower physician who brought the lead-poisoned water of Flint, Michigan to public consciousness. Like other doctors who spend every day managing burgeoning client loads, she easily could have focused on her pediatric patients and missed the wider social and political contexts — the upstream determinants of health.

But she didn’t. Instead she asked why the children in Flint had surprisingly high blood lead levels. Connecting her cases to the larger community, she went even further, translating the meaning of those data to the public.

For her work, she recently was named one of Time magazine’s Top 100 people of the year.

How can college faculty systematically cultivate leaders and health professionals like Hana-Attisha, who respond creatively in the face of health disaster?

Increasingly complex health challenges call for alternatives to strictly pre-professional training. In the age of Flint, society benefits when health issues are taught through the lens of the liberal arts. That’s because public health is more than a set of rapidly-evolving facts: it requires discovering, connecting, integrating, critiquing, creating, and applying information across complex contexts.

There’s a place for an undergraduate pre-professional health track, to be sure. But Morgan and colleagues rightly suggest that that developing more effective clinicians, meeting local workforce needs, and training health visionaries only benefit with liberal arts approaches.

For instance, to remediate unsafe drinking water, we need to understand how different strands of culture and science inform each other, sometimes antagonistically, sometimes synergistically. We cannot fully understand the biological toxicity processes of lead in drinking water without carefully considering other, more macro-social processes, such as the neighborhood a person lives in or how environmental racism operates.

As of this writing, more than 70 undergraduate programs in the United States are accredited by the Council on Education for Public Health (CEPH). Most of their websites identify public health as either their “fastest growing major” or as preparation for the “fastest growing field.”

There are many types of undergraduate programs, and they all have their merits. The program we know best — the Culture, Health, and Science Program at the Five Colleges in Western Massachusetts, USA — offers a certificate allowing students in any major to add a health-focused curriculum to their course of study. Students learn through a wide array of interdisciplinary channels, including coursework from multiple categories, laboratory experiences, internships, community meetings, fieldwork, lectures, and panels. These activities expose students to different vantage points on biomedicine and health care.

At the Five Colleges, this liberal arts pedagogy has been used in small private liberal arts colleges and a large public university in the context of teaching undergraduates about health. We expect that our model could also be adopted by a range of other types of schools (e.g., mid-size universities, community colleges) in relation both to health and other professional content areas such as law and business.

Though accreditation bodies usually expect relatively uniform content, the CHS program aims for a model of equivalent or adaptable content. Indeed, rapidly changing global health challenges require a public health education that is flexible in course selection while developing disciplinary skills. CHS’s guiding principles can be used to design undergraduate health curricula relevant to a wide range of health careers. The program has thrived for 20 years, providing a successful, tested model for schools at the early stages of designing their own undergraduate health programs.

To the dean who wants to create a public health major: rather than taking a strictly competencies approach, we ask you to consider building on your institution’s strengths and then foster a liberal arts approach. One of our graduating seniors, Emily Bai ’16, had this to say: Even if my next step is a professional school to learn a specific skills set in healthcare, it will be a very different experience than if I had entered without my undergraduate interlude. I’ll go in with the critical mindset and curiosity to think about what I am being taught.

Undergraduates today will soon be those who are making health policy and delivering health care. Indeed, with more water crises brought to the public’s eye each week and water scarcity a global issue, we need to strategically prepare undergraduates in translational medicine. Medical schools want this too if the latest Medical College Admission Test is any indicator, revised in 2015 to include a whole new section called “Psychological, Social, and Biological Foundations of Behavior.” Understanding and addressing how upstream factors affect downstream living is what Dr. Jim Kim, president of the World Bank and global health leader, would call the “real rocket science” of healthcare.

Benita Jackson, PhD MPH, is Associate Professor in the Department of Psychology at Smith College, and serves on the Five College Culture, Health, and Science Steering Committee.

Miriam Shafer, MPH, is a former Program Assistant for the Five College Culture, Health, and Science Program.

James Trostle, MPH PhD, is Professor of Anthropology at Trinity College, and was Founding Director of the Five College Program in Culture, Health, and Science.

Alan Goodman, PhD, is Professor of Biological Anthropology at Hampshire College, and Co-Developer of the Five College Culture, Health, and Science Program.