|
COPYRIGHT 2005 Springer
INTRODUCTION
During the past 30 years several important changes have characterized Master of Public Health (MPH) programs. The number of such programs has greatly increased as has the length of time required for completing the degree. In addition, most students are enrolled part-time in contrast to the dominance of full-time students in the 1960s and earlier. Special extended degree and executive degree programs are now available which offer classes over a weekend once a month and more intensive coursework during the summers. (1,2) A variety of on-line MPH degrees are also available, not only to students in the United States but also to those overseas. This latter development has overcome the once limiting boundaries of geographic catchment areas. (3,4)
Concurrent or dual degree offerings such as MD/MPH, MSN/MPH, DO/MPH, and MBA/MPH have now become popular at a number of institutions as have MPH degree programs leveled to residency training in primary care specialties such as internal medicine and family practice. (5-7) Many of those enrolled part-time in MPH degree programs are already public health practitioners employed in a variety of government, community based and other settings. Davis et al., in a survey of forty programs, found that 91% of 3456 enrollees were earning MPH degrees and that two thirds of them were employed while doing so. (8)
These developments also characterize schools of public health which in addition to offering MPH degrees also offer doctoral level degrees, maintain significant research enterprises, and possess larger facilities divided into several departments. As with programs, the majority of students in schools of public health are part-time and internet and executive type degree tracks are increasingly common.
The changes in curricular scheduling so as to make MPH degrees more easily accessible has in general been accompanied by higher standards for program completion. This usually translates into a longer period of time necessary to fulfill all course requirements compared to a few decades ago. In addition, the MPH degree is now sought by many as a basic credential to enhance career development and not necessarily as required preparation for executive leadership in the public health & health care fields as was often the case decades ago. This very changed picture of MPH degree offerings by both programs and schools is not one that could have been foreseen in 1976 when the Milbank Memorial Commission for Public Health laid out broad goals and objectives for the preparation of public heath professionals by both schools of public health and MPH programs. (9)
BROOKLYN AND ITS POPULATIONS
Brooklyn was an independent city until 1898 when it was united with New York City as a borough. Originally an amalgamation of several towns and villages created by seventeenth century Dutch and English settlers, Brooklyn as a city eventually came to occupy all of the County of Kings with which it is geographically identical today. The Borough of Brooklyn is the most populous of New York City's five boroughs where 2,465,326 people (30.8%) of the city's total population of 8,008,278 live. In the 2000 census, 931,769 foreign born people lived in Brooklyn, representing 32.5% of the 2,871,032 foreign born in the city. (10)
Long a gateway for immigrants, Brooklyn currently possesses a rich diversity of peoples from many different parts of the world. At present, 38.5% of the inhabitants of Brooklyn are foreign born (Table 1). They come from a variety of countries in Africa, Asia, the Caribbean, Europe and Latin America.
In Central Brooklyn, where the State University of New York Downstate Medical Center is located, the percentage of foreign born (49.6%) is even greater than that for the borough as a whole (Table 2). The majority of foreign born in Central Brooklyn come from the English-speaking Caribbean and Haiti with steadily increasing numbers from Mexico and Panama. (10) (p. 62) As shown in Table 3, the leading four countries of origin for the three neighborhoods that comprise Central Brooklyn are Guyana, Haiti, Jamaica, and Trinidad and Tobago.
The public health and health care issues affecting Brooklyn's populations have long been of concern to the Downstate Medical Center. Disparities in morbidity and mortality rates for a number of diseases as well as health care access have adversely affected the health and well being of Brooklynites.
Beginning in 2000, Downstate's newly installed president, Dr. John C. LaRosa, greatly concerned about these issues, requested that a series of detailed reports be prepared on health and disease in Brooklyn. Ten of these reports have now been published covering topics as diverse as infant mortality, and substance abuse (Table 4).
These reports, depicting as they do population health data, have made a strong case for the need for public health interventions to achieve better health and well being for the people of Brooklyn. This pressing need in part served as the impetus for the development of a Master of Public Health program at the Downstate Medical Center
HISTORICAL OVERVIEW OF PUBLIC HEALTH AND PREVENTIVE MEDICINE TEACHING AT THE DOWNSTATE MEDICAL CENTER
The State University of New York, Downstate Medical Center (DMC), College of Medicine began as a teaching department of the Long Island College Hospital in 1860. (11) In 1930 the Long Island College of Medicine was created as a corporate entity separate from the hospital. (11) In 1950, the Long Island College of Medicine was incorporated into the newly created State University of New York as the College of Medicine at New York City, later known as the Downstate Medical Center, College of Medicine. (12) As part of SUNY, the College of Medicine moved from its physical quarters on Henry Street in 1956 to a new Basic Science Building constructed in East Flatbush opposite Kings County Hospital. (13)
Various aspects of public health have been taught at the Downstate Medical Center and its predecessor institutions since 1860 under such rubrics as hygiene, preventive medicine or environmental medicine. A Department of Preventive Medicine and Community Health was created in 1916, under the chairmanship of Dr. H. Sheridan Baketel who served part time until 1930. Following a two-year hiatus in which there was no chair, Dr. Alfred E. Shipley was appointed as head of the department on a part-time basis. Five years later, in 1937, the Gowanus-Red Hook District Health Center was erected at 248 Baltic Street by New York City. This facility, under the supervision of the New York City Department of Health, was a few blocks away from the College of Medicine. The Department of Preventive Medicine and Community Health was expanded and housed in the new district health center and Dr. Shipley given full-time status. The Commonwealth Fund gave the Department a development grant of $16,250 for 1937-1938 and $13,750 for each of the two succeeding years. Dr. Shipley retired in 1941 and was succeeded by Dr. Fred L. Moore who served as chair for a year. He was succeeded by Dr. Thomas D. Dublin in 1942, who remained as chair until 1948. (14) (p. 66), (15) (p. 42) In 1949, Dr. Duncan W. Clark became acting chair while simultaneously serving as Dean of the College of Medicine. Following the merger of the Long Island College of Medicine and SUNY in 1950, Dr. Clark left the deanship and became full-time professor and chair of the department which he renamed Department of Environmental Medicine and Community Health. (15) As Dr. Clark noted in his historical overview of the department, "The basis of the executive faculty action to change the name was to add a new teaching emphasis on medical ecology, one that included concern with social and environmental factors in illness as well. I had been chairman of the AAMC [Association of American Medical Colleges] Committee on Social and Environmental Medicine which conducted national studies and surveys of this movement in medical education. For its advancement, medical ecology was seen by me as requiring the representation of population disciplines, namely epidemiology and the social sciences since both are concerned with the social and environmental conditions under which disease occurs." (15) (p. 1)
During the 1950s, Dr. Clark recruited faculty and developed a curriculum for medical students. This curriculum included a 120-hour family case study rotation for all senior medical students which was implemented in 1950 and which represented a pioneering preventive medicine teaching initiative. (15) (p. 5) In this unique clerkship experience, all members of a family were studied equally in the environment of their own home. As Dr. Clark has described, "It served several practical purposes: a focus on clinical preventive medicine, an experience in extra-hospital medicine, design of a full plan of care, preparation to accept referral and negotiation on behalf of the family with existing community services, etc. It was not family practice nor was it aimed at recruitment to family practice. As a service, it was an early "outreach" program." (15) (p. 5)
While there had been a fourth year preventive medicine clerkship since 1938, the family case study initiative represented a new and different innovation. It was eliminated in 1970 when a curriculum revision resulted in a fourth year that was entirely elective. The clerkship continued into the 1980s as...
Read the full article for free courtesy of your local library.
|
Bookmark this article
Print this article
Link to this article
Email this article
Digg It!
Add to del.icio.us
RSS
