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Public Health Imperative: Prescription For Change

Public Health Imperative: Prescription For Change

New public-health schools at Black colleges offer chance to graduate more Black  students

JACKSON, Miss. — Growing up in the Mississippi Delta, Rodrick Jordan saw firsthand how poverty and inadequate health care debilitated and diminished the lives of Black people he knew. That early exposure to deprivation and disease inspired Jordan to dedicate himself to becoming a physician.
But after pursuing biology and pre-med studies at Jackson State University as an undergraduate, Jordan decided against applying to medical school his senior year in 1998. Instead, health-care administration became his goal, and he sought admission to public-health programs at Tulane University and the University of Southern Mississippi. Jordan, a native of Jackson, wanted most to attend a program close to home.
Sometime later, Jordan learned that Jackson State would be launching a master’s program in public health in the fall of 1999. “I had no idea this was going to happen,” he says. He applied and enrolled in the program.
In the past year, both Jackson State here and Morgan State University in Baltimore have launched ambitious graduate programs in public health. While Jackson State officials are aggressively moving to establish their program as the first school of public health based at a Black institution, Morgan State’s program has the distinction of being the first one to grant doctoral degrees in public health at a historically Black institution.
In Baltimore last fall, roughly two dozen students began taking classes as members of that school’s newly inaugurated doctoral program in public health. This year, the program has teamed up with other schools on research projects as well as picked up research grants on its own.
“Each faculty member is considered an entrepreneur, and is expected to bring in their own research and funding,” says Dr. Yvonne Bronner, director of public-health education at Morgan State.
Jackson State and Morgan State are the newest in a group of five Black schools to offer master’s programs in public health. All these programs owe their establishment, in large part, to the growing emphasis that federal and state officials are placing on reducing and eliminating health disparities between racial minorities and White Americans. In recent years, Florida A&M University has established a graduate program in public health. Other public-health programs that grant graduate degrees exist at the Morehouse School of Medicine in Atlanta and the Meharry Medical School in Nashville.
Citing both a need for aggressive health initiatives in poor minority communities and a shortage of trained minority health professionals, officials are looking to these state-school programs to have a significant impact on minority health at the national level.
“There is an under-representation of minorities at the doctoral level in this field, and addressing that would enable us to tackle minority health disparities more effectively,” says Dr. Earl Richardson, president of Morgan State University.

Morgan’s Practitioner Approach
In the eyes of many, the focus on health disparities is long overdue.
“The fruits of the civil rights movement have not moved into the health-care arena,” says Dr. Jay Carrington Chunn, Morgan State’s associate vice president for academic affairs.
The recent move to expand public health education shows that Black school officials are taking seriously the goals set forth by U.S. Surgeon General Dr. David Satcher in his Healthy People 2010 plan. Satcher is the first Black male to hold the post.
“The plan has two goals: to increase the years and quality of healthy life, and to eliminate disparities in health based on race and ethnicity,” Satcher told the Morgan State community at the February convocation of the new doctoral program.
Back in the early 1990s, it became clear to Chunn that traditional public-health initiatives by local, state and federal governments were failing within Black communities. Woefully ineffective efforts were being made to stem the tide of a growing HIV/AIDS epidemic, lessen gun violence and reduce the incidence of behavior-sensitive diseases, such as heart, lung and kidney ailments.
Chunn, who had signed on with Morgan State in 1993, saw that part of the problem was rooted in the traditional research approach taught to doctoral students in public health. He sought to rectify the problem.
“The reason why I conceptualized the idea for this program was that AIDS was running rampant … as well as cancer, heart disease and the advent of urban violence,” in Black communities, Chunn says.
Chunn theorized that a doctoral program producing public-health practitioners rather than researchers could have a more decisive impact upon public-health policy. The practice-oriented doctoral and master’s students would be trained to help solve health problems prevalent in poor minority urban communities based on the community-oriented focus of the degree program. Graduates also would be advocates of prevention-oriented solutions to health problems.
“Our task in public health is to make health care more accessible and move [government officials] to action to eliminate health disparities,” Chunn says.
He adds that minorities have been most vulnerable to diseases where prevention can make a critical difference, and he points to figures that show poor minorities suffer disproportionately from “third wave epidemics,” diseases spread primarily by human carriers or conditions resulting from dysfunctional behavior, such as drug abuse. Chunn says lack of health-care prevention is a major problem.
“We’re spending a trillion dollars on health care in this nation, but only 1.4 percent of that goes to prevention,” Chunn says.
To help put this new public-health vision into action, the W.K. Kellogg Foundation awarded Morgan State a $264,000 planning grant in 1995. In late 1998, the Maryland Higher Education Commission approved the practice-oriented program, which is the school’s sixth doctoral program.
“That grant was very important because it helped us become confident that we could launch this program and it would have support,” Richardson says.
Bronner, who was hired away from Johns Hopkins University in Baltimore to head Morgan State’s program, says graduates will be trained in health policy advocacy in addition to their academic specialties, which cover five core public-health disciplines. The disciplines are epidemiology; biostatistics; health services management and policy; environmental and occupational health; and social and behavioral sciences.
“We’re equipping our students to conduct the kind of analysis to do strategic planning and public policy,” she says. “Health disparities remain problematic and [we] lack solutions. It calls for a new approach to how we do business,” she adds.

Student Population
At the end of the spring semester, 23 students completed the first academic year of the four-year program. About 40 percent of them attend the program on a part-time basis.
“We have a variety of people from different backgrounds. Most of the students are mid-career people,” says Bronner, noting that physicians and social workers  are among the entering class.
This fall, the master’s program in public health, which is just starting, will enroll 10 students. By launching a master’s degree track, Morgan State’s public-health program will be eligible to seek accreditation, according to Bronner.
One goal of the program is to achieve a “school of public health” status. The school would be subdivided into independent academic departments. There are only 28 schools of public health in the United States, none of which are based at an HBCU.
Achieving this status would enable the program to compete for millions of dollars in federal funding for which public-health programs are not eligible.
On the sponsored research front, the new program has gotten off to a quick start. The Morgan State program has established seven research centers from which faculty members and students will compete for research and program grants. The seven centers are: Center for Urban Health Budget, Policy and Evaluation; HIV Prevention, Evaluation, Research and Policy Research Center; Public Health Learning Distance Center; Center for Male and Family Research and Resources; Minority Health Center; Youth Violence Prevention Center; and the Morgan State University Cancer Prevention and Screening Center.
Morgan State is partnered with Harvard and the University of Michigan on an international research project investigating why nations with large wealth disparities have poor health status. Three postdoctoral fellows participating in the study will be in residency at Morgan State this fall.
Morgan State also is paired with its cross-town neighbor,
Johns Hopkins, on a venture to conduct community outreach, screening and prevention work around
tobacco- and smoking-related diseases. The work is being funded by tobacco settlement monies, of which the Morgan State public-health program is expected to receive $1.3 million annually over the next decade.
Bronner estimates that the sponsored research and health-practice funding for the program will be $2.5 million in 2000-01. In its first year, the program spent $250,000 in sponsored program monies.
In an initiative highlighting its practice-oriented focus, the program picked up a contract this past spring from the city of Baltimore to evaluate the new men’s health clinic. The clinic, which is the first of its kind in the nation, was assessed by a team of Morgan State doctoral students for the quality of service during the first months of its operation.
“It’s a marriage of interests…with the community-level type of work that’s part of their program” that led city officials to hire the Morgan State doctoral team, according to Kossi Dambita, the head of health statistics for the Baltimore city health department.

Mississippi Learning
As dean of the newly established School of Allied Health Sciences at Jackson State University, Dr. Thomas M. Dunaye had less than a year to get a graduate program in public health up and running.
With state funding resulting from one of the settlements in the long-running Ayers vs. Musgrove desegregation lawsuit, the program enrolled 20 students last fall and has hired nine faculty members and a director. The state is considering the expansion of the program into a school of public health, which could occur as early as the fall of 2001, according to Dunaye. The program also has attracted Harvard and the University of California-Los Angeles to enlist Jackson State as a research partner on pending grant proposals.
“I think we’ve done pretty good,” says Dunaye, a veteran health-sciences administrator and professor who has had appointments at Yale and other wealthy universities.
Dunaye says the public-health program is sorely needed in a state whose health indices are consistently ranked at the lowest levels among the 50 states. Like the Morgan State program, Jackson State will focus heavily on the health problems of low-income Blacks. “Our interest is very much applied and practical,” Dunaye says.
The program is based at a nationally recognized medical education and health-care center complex known as the Jackson Medical Mall. The facility is a joint operation among Jackson State, Tougaloo College, the University of Mississippi Medical Center and local and state agencies. Jackson State’s public-health program is seeking to participate in research projects conducted by partnering organizations within the Jackson Medical Mall.
One of the strategies for the new program is to partner with prominent universities, such as Harvard and UCLA, which are beginning to pay serious attention to the health disparity issue. “Jackson State is not a recognized player in health research, so we’re looking to piggyback on projects,” Dunaye says. He adds that large, traditionally White universities are beginning to conduct research on health disparities and are looking to partner with minority-serving institutions on such studies.
Jackson State also has convinced federal officials that it has the capacity to handle major health research and intervention projects on its own. Before the establishment of the public-health program, school officials secured federal support as the lead institution in the $9.4 million Jackson Heart Study program. The study is one of the largest investigations ever into heart disease among African Americans. Last school year, officials landed a $9 million grant from the Centers for Disease Control and Prevention for an AIDS research and intervention development program.
Dunaye says the fledgling public-health program can only help strengthen Jackson State’s capacity as a leader in health-care research and advocacy. The program plans to offer doctoral degree education within the next two to three years.
“The opportunities are there for us to have a great impact,” he says.    

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