Task Force: Public Health

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OVERVIEW:

The Public Health Task Force was established on March 12, 2002 and charged by Graduate Dean David Lightfoot with providing an “intellectual agenda” for collaborative research and teaching in public health, broadly defined.  The Task Force was explicitly advised to avoid discussion of barriers to implementation, including institutional issues that currently militate against collaborative, inter-department and inter-campus endeavors.  A central goal identified by Dean Lightfoot to be addressed by the Task Force, as well as by its two companion Task Forces on Bioinformatics, Statistics, and Computing, and on Cognitive Neuroscience, was to foster greater collaboration between the Medical Center and the Main Campus.  Thus, the Task Force recommendations are explicitly designed to build bridges across these campuses, rather than to support isolated public health activities within individual departments, schools or programs. 

Membership and Process

The Task Force was composed of 13 members representing each of three Georgetown campuses – main, medical, and law.  Michael Boyle, a student in the School of Foreign Service, provided significant assistance to the Task Force as it conducted its work.  The Task Force held seven meetings between March 22 and June 7, 2002.   Four invited speakers provided invaluable input to the Task Force’s deliberations:

*Harrison C. Spencer, MD, MPH, President and CEO of the Association of Schools of Public Health
*J. Michael McGinnis, MD, Senior Vice President and Director of the Health Group, Robert Wood Johnson Foundation
*Kenneth Shine, MD, President, Institute of Medicine
*Judith Feder, Dean, Georgetown Public Policy Institute

The major tasks undertaken by the Task Force consisted of:

(1) taking an inventory of existing competencies, expertise, research, teaching, and collaboration relevant to public health at Georgetown University.  This task was aimed at providing an intellectual map of substantive areas of strength on which a coherent public health initiative could stand.  It also highlighted specific gaps that would need to be filled to sustain any credible new activity in public health.  An extensive matrix that aligns public health issues (e.g., access to care, health disparities, child and human development) with departments/ programs/ disciplines (e.g., bioethics, behavioral sciences, health policy) was developed to inform this task. The matrix, which is most appropriately viewed as a work in progress given the lack of time to canvass all relevant members of the faculty, is attached as Appendix A.

(2) placing available resources and strengths at Georgetown in the context of: (a) prior efforts to establish a presence in public health at Georgetown University, (b) the activities of public health schools and programs in proximity to Georgetown, out of which we need to carve our unique niche and upon which we can establish broader networks of activity, and (c) the immediate and future public health issues that can be informed by the research and pedagogical activities that are underway at Georgetown University, or which, with additional resources, could be addressed.  Members of the Task Force and the invited speakers provided the majority of the information for this task.  It is important to note that two forthcoming (November 2002) reports from the Institute of Medicine – Assuring the Health of the Public in the 21st Century and Educating Public Health Professionals for the 21st Century -- will provide high relevant and valuable information to supplement this report.

(3) developing conceptual recommendations that, with follow-up work focused on significant aspects of implementation, could address the charge to the Task Force.

Guiding Themes and Perspectives

As the Task Force embarked on its work, several themes and perspectives emerged that guided its deliberations.  To place this report in context, it is important to summarize these themes at the outset.

First, it is now well recognized that to improve the nation’s health profile, we must direct greater attention to the full spectrum of factors affecting health and well-being.  A seminal article, published in the Journal of the American Medical Association in 1993 (McGinnis & Foege, 1993) estimated that more than 40 percent of all deaths in the United States could be attributed to behavior-related, as distinct from medical, causes.  This realization has spurred the development of the emerging multidisciplinary field of population health, which systematically blends the medical, biological, social and behavioral sciences to address the range of social, economic, political, and medical conditions that affect health status and access to health services.  The interdisciplinary nature of the charge to the Task Force is consonant with these new directions within the public/population health sector. There are new sources of funding to support such work and a growing job market for individuals, trained within interdisciplinary programs, who are capable of researching, developing, and implementing programs to improve population health.  This significant new trend led the Task Force to emphasize population health, with its associated emphasis on the broad ecology of health (rather than on identifying individual risk factors) and on preventive efforts at multiple levels of intervention (rather than on treating diseases at the individual level), rather than traditional public, health in its recommendations.

Second, the members of the Task Force shared a strong interest in contributing to the local DC community in the context of any new population health initiative.  Despite some significant individual efforts, this has not been a hallmark of Georgetown’s public health-related activities.  Yet, the DC community has much to offer including a local laboratory for work with underserved, minority populations and substantial opportunities for student placements, as well as for recruitment of specialized, adjunct faculty.  In turn, Georgetown University has much to offer the local community on its own, as well as in collaboration with other local universities and nonprofit community-based organizations.  Further, in the aftermath of the tragic events of September 11, 2001, interest in the capacity of local communities to respond to the needs of their citizens has grown exponentially.   Any new initiative at Georgetown University, given the value it places on community service, needs to give explicit consideration to these unique, local opportunities.
 
Third, the Task Force members reflected distinct, yet complementary, perspectives on the direction that any future initiative on population health should take at Georgetown University.  One perspective focused on the pedagogical goals of the University and emphasized the development of new graduate and undergraduate training programs in population health, as described below.  A second perspective focused on Georgetown’s strong reputation as a source of policy-relevant knowledge and role in convening forums aimed at bringing together scholars and decision-makers in our nation’s capitol.  This orientation leads naturally to an emphasis on fostering the research and policy linkage activities of the University as they bear on issues of population health, several examples of which are provided below.  The Task Force was charged with addressing both the pedagogical and research dimensions of the University, rather than to portray them as opposing options, which is the spirit in which we offer our recommendations.

Fourth, while the Task Force was directed to focus on the intellectual content of a population health initiative, rather than on barriers to its implementation, it proved difficult to avoid discussion of the daunting challenges that would be faced by any such initiative.  Ed Pellegrino, in particular, reminded the Task Force of the difficulties associated not only with creating, but with sustaining, interdisciplinary (let alone inter-institutional) initiatives.  The inattention that has greeted the two prior reports relevant to this Task Force’s work (see below) is telling. Top-down approaches to such initiatives, absent substantial interest and resources at the “street level”, seldom succeed.  When such efforts do succeed, they tend to be initiated and sustained through individual networks that make connections “under” the segmented structures at the top.  At the same time, the Task Force is deeply encouraged by the new leadership in place at Georgetown University and its avowed commitment to fostering a select number of promising cross-cutting, collaborative endeavors.  There are also new structures in place, such as the development of the health services track within the School of Nursing and Health Studies that has served to broaden the student body with stated interests in health at the time of enrollment at Georgetown.  To support this commitment, we offer a few suggestions for initial steps towards collaboration (see Recommendation 4) that may address some of the associated challenges.

Recommendations

The Task Force offers four groups of recommendations:

(1) A proposal for a Masters of Science Program in Population Health

2) A proposal for a new Undergraduate Minor in Population Health

(3) Several options (by way of example) for areas that could provide “signature” programs of Research and Policy Linkage in Population Health.

(4) A call to establish Public Health Task Force II and designate a point person to take charge of follow-up to this report.

These recommendations are specifically directed at the charge to the Task Force, and thus emphasize cross-campus initiatives in teaching, research, and policy-linkage.  While it would be inaccurate to portray them as consensus recommendations, the vast majority of Task Force members feel that these proposals warrant further consideration and development en route to establishing a stronger, more coherent, campus-wide presence for Georgetown University in the area of population health.

Download the complete "Task Force Report on Public Health"     (517 kb, 55 pages)