Wk 1 Individual Assignment: Community Newsletter Assignment Content Imagine you have been asked by your local government to help create a newsletter for

Wk 1 Individual Assignment: Community Newsletter Assignment Content

Imagine you have been asked by your local government to help create a newsletter for your community. For the first issue, they have asked you to provide an overview of public health.

Write a 700- to 1,050-word article in which you:

Define public health.
Explain the historical development of public health.
Identify careers within public health.
Include at least 3 references.

Format your assignment according to APA guidelines. 1114237 – Jones & Bartlett Learning ©

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By the end of this chapter, the student will be able to:

•   describe roles that education and credentialing play in the development of health professions, such as
medicine and nursing.

•   describe the continuum of public health education and identify educational pathways for becoming a
public health professional.

•   identify recent changes in the education of physicians.
•   describe the educational options in nursing.
•   identify components of prevention and public health that are recommended for inclusion in clinical

•   explain the concept of primary care and differentiate it from secondary and tertiary care.
•   identify a range of mechanisms used to compensate clinical health professionals and explain their

advantages and disadvantages.

Upon your arrival at the hospital, the nurse specialist examines you and consults with the radiologists, the
gastroenterologist, and the general surgeon. Your medication is reviewed by the pharmacist and your meals by
the clinical nutritionist. Throughout the hospitalization, you are followed by a hospitalist. Once you get back
home, the home care team comes to see you regularly for the first two weeks, and the certified physician assistant
and the doctor of nursing practice (DNP) see you in the office. You realize that health care is no longer just about
doctors and nurses. You ask yourself: What roles do all of these health professionals play in the healthcare

Jenna decides that after college, she wants to become a doctor and practice medicine. “I thought there was only
one kind of doctor who could diagnose disease and prescribe medicine,” she mentions at a career counseling
meeting. “Not so, anymore,” says her advisor. “There are allopathic and osteopathic physicians. In addition, there
are nurse practitioners who are authorized to diagnose and prescribe medications, and there are physician
assistants who do the same under a physician’s supervision. The universe of ‘doctors’ now includes doctors of
nursing practice, as well as other doctoral degree professionals, such as pharmacists, occupational therapists,
and physical therapists.” Understanding careers in health care can be as difficult for students as it is for patients,
Jenna thinks to herself. Now she understands why her advisor asked: “What do you mean by ‘practice’? What do
you mean by ‘doctor’?”

Sarah was about to begin medical school and was expecting two years of “preclinical” classroom lectures
focusing on the basic sciences, followed by the study of clinical diseases. Then, as she had heard from her
physician father, she expected two years of clinical hospital “rotations” and electives investigating specialties. She
is surprised to find that medical school has changed. There are small-group, problem-based learning sessions
where she needs to be able to locate and read the research literature. There is contact with patients and their
problems right from the beginning. There is increasingly a four-year approach instead of a preclinical and clinical
approach to medical education. She wonders: Are these changes for the better? What else needs to be done to
improve medical education?

You are interested in clinical care, as well as public health. I need to make a choice, you think to yourself. “Not
necessarily,” your advisor says. “There are many ways to combine clinical care with public health.” After a little
investigation, you find out that undergraduate public health education is increasingly seen as preparation for
clinical education, and clinical prevention and population health are increasingly becoming part of clinical care. In
addition, many careers, from health administration, to health policy, to health education, to clinical research,
combine the individual orientation of clinical care with the population perspective of public health. So what is the
best pathway to a public health career for you?

1114237 – Jones & Bartlett Learning ©


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Until the early years of the 1900s, education and practice for the health professions in the United States
were an informal process, often without standardized admissions requirements, curricula, or even
formal recognition of a profession. Throughout the 1900s and into the 2000s, there has been an
ongoing movement to formalize and standardize the education process for health professionals. These
formal requirements have come to define what we mean by a “health professional” and include
admission prerequisites, coursework requirements, examinations of competency, official recognition of
educational achievements, and granting of permission to practice. Today, the list of formal health
professions is very long. Clinical health professions include physicians, nurses, dentists, pharmacists,
optometrists, psychologists, podiatrists, and chiropractors. They also include nurse practitioners,
physician assistants, health services administrators, and allied health practitioners.1 “Allied health
practitioner” is a broad category in its own right, ranging from graduate degree–trained professionals,
such as physical therapists, occupational therapists, and medical social workers, to technical
specialists often with an associate’s degree, such as dental assistants, sonographers, and laboratory

Education and training are central to the development and definition of most health professions.
Education implies that a student is pursuing a degree or certificate from an accredited educational
institution. Training is often organized and directed outside of educational institutions. Hospitals,
health departments, and large group practices often have the responsibility of training new health

Before we take a look at specific health professions, let us step back and ask the more general
question: How do education and training serve to define health professions?

1114237 – Jones & Bartlett Learning ©

Defining and enforcing educational requirements is central to creating and maintaining a profession.
This can be accomplished using two basic approaches: accreditation and credentialing.

Accreditation implies a process of setting standards for educational and training institutions and
enforcing these standards using a regularly scheduled institutional self-study and an outside review.
Accreditation is used by most health professions to define and enforce educational expectations. At
times, these expectations may be laid out in detail down to the level of square footage per student for
laboratory space and the number of hours devoted to specific subjects. In other health professions,
educational subject areas may be outlined and institutions left to judge how to best implement the

Credentialing implies that the individual, rather than the institution, is evaluated. “Credentialing” is
a generic term indicating a process of verifying that an individual has the desirable or required
qualifications to practice a profession. Credentialing often takes the form of certification. Certification
is generally a profession-led process in which applicants who have completed the required educational
process take an examination. Successful completion of formal examinations leads to recognition in the
form of certification.

Certification also has come to define specialties and even subspecialties within a profession.
Successful completion of a specialty or subspecialty examination may entitle a health professional to
call him- or herself “board-certified.” Certification is often a prerequisite for licensure, which is a state
governmental function and usually requires more than certification. It may include residency
requirements, a legal background check, continuing education requirements, etc. Licensure, when
applicable, is usually required for practice of a health profession.

Thus, in order to understand what is meant by a particular health profession, it is important to
understand the credentials that are expected or required. Let us take a look at the education required
for public health, as well as for physicians and nurses.

Within public health, there is a growing array of health specialties. Some specialties require bachelor’s
degrees, such as environmental health specialists and health educators. However, many public health
roles require graduate degrees that focus on disciplines including epidemiology, biostatistics,
environmental sciences, health administration and policy, and social and behavioral sciences. Box 9-1
discusses the development of what is being called the continuum of public health education.

BOX 9-1 Development of the Continuum of Public Health Education2

The history of public health education as a formal academic activity in the United States dates back
approximately 100 years to the 1915 Welch-Rose Report. Funded by the Rockefeller Foundation, this report
set the stage for development of separate schools of public health focused on graduate education
designed for those with previous professional education, particularly as physicians, nurses, and engineers.

The focus on graduate-level education of those with previous professional education remained the
norm for half a century after the publication of the Welch-Rose Report. This began to change in the 1970s
and 1980s with the growth of schools of public health as well as programs in public health, often located
in medical schools. By the 1980s, a substantial portion of the students entering graduate training in public
health had a bachelor’s degree but no prior professional training.

In addition, graduate training in public health increasingly became specialized, with master of public
health (MPH) degrees often focusing not only on a generalist core but also on a specialty area, such as
epidemiology, biostatistics, environmental health, health administration, health policy, health education,
health communications, etc. This was accompanied by the growth of doctoral programs, including both
PhDs and doctor of public health (DrPH) degrees.

1114237 – Jones & Bartlett Learning ©

Undergraduate public health education began as specialty areas, such as health education,
environmental health, and health services administration, during the last half of the 1900s. For instance,
health education developed its own undergraduate degree programs, competencies, and certifying
examination, the certified health education specialist (CHES).

A major change in public health education began in 2003 with the Institute of Medicine’s
recommendation that “all undergraduates should have access to education in public health.”3 This
recommendation launched what came to be known as the Educated Citizen and Public Health movement,
a collaborative effort of undergraduate education associations and public health education associations.
The Educated Citizen and Public Health movement led to a series of recommendations, including the
Critical Component Elements of an Undergraduate Major in Public Health. These recommendations are
now being used by the Council on Education for Public Health (CEPH) as part of the accreditation process
for undergraduate majors in public health, including those providing generalist education and specialty
education, as well as those in institutions with and without graduate public health education.

As the 100th anniversary of the Welch-Rose Report neared, public health educators and practitioners
joined with undergraduate educators and health profession leaders to form the Framing the Future Task
Force: The Second Hundred Years of Education for Public Health. At the heart of the task force’s
deliberation was how to create a continuum of public health education. Key to the continuum was
undergraduate public health education, including public health education as part of the curriculum of
community colleges. The task force created the Community College and Public Health project, which is
developing prototype curriculum models that encourage articulation of community college associate
degrees and bachelor’s degrees in both specialty areas as well as generalist degrees. In addition,
community colleges are beginning to look at how to integrate public health into their own areas of strength
and interest, including programs such as public health preparedness/disaster planning, health information
systems, and health navigator/community health worker.

Thus, today, formal public health education includes degree programs at community colleges and four-
year colleges as well as at the master’s and doctoral level. The process of articulating these degrees and
ensuring the development of career ladders is well underway. The continuum of public health education
has been established as a goal and is rapidly becoming a reality.

In addition to the educational options that lead to becoming a public health professional, a large
and growing number of options are available to combine public health education with other
professions. Combined or joint degrees with medicine, nursing, and physician assistants are widely
offered. Combinations with law, social work, international affairs, and a range of other fields are also
being offered. Combined or joint degrees often allow students to reduce the total number of credit
hours required to satisfy the requirement for the two degrees.

Public health professionals today include those who specialize in a wide range of disciplines and
work in a variety of settings, from governmental public health to not-for-profit and for-profit
institutions, as well as in educational and healthcare institutions. There are approximately 500,000
public health professionals in the United States, and it is estimated that in coming years, there will be a
substantial shortage.4

Public health is one of the last health fields to formalize educational and professional
requirements. Today, many public health professionals are trained exclusively in public health, and the
process of formal credentialing is underway. The recognition of public health as a distinct professional
field with its own educational process has been formalized through accreditation of public health
schools and programs by the Council on Education for Public Health (CEPH). CEPH requires five areas
of knowledge basic to public health: biostatistics, epidemiology, environmental health sciences, social
and behavioral sciences, and health services management. Specific disciplines within public health,
such as epidemiology and social and behavioral sciences, have provided recognition for specialized
training through advanced degrees, such as the academically oriented doctor of philosophy (PhD)
degree and the practice-oriented doctor of public health (DrPH) degree.

Specific technical areas have existed within public health for many years and have included
competency examinations, especially in fields such as occupational and environmental health. Health
educators in recent decades have formalized and standardized their education and increasingly taken
on the structure of a profession, including examinations, certifications, and continuing education

1114237 – Jones & Bartlett Learning ©

Formal certification as a public health specialist has only been available since 2008, when the first
certifying examination was given. The examination covers the five areas expected for a professional
master’s degree, such as a master’s of public health (MPH). These are biostatistics, epidemiology,
environmental health sciences, social and behavioral sciences, and health policy and management. In
addition, new cross-cutting competencies have been defined and are being incorporated into the
examination. These include communications and informatics, diversity and culture, leadership,
professionalism, program planning, systems thinking, and public health biology.

The certifying examination tests core competencies, rather than more specialized competencies
that students also frequently achieve as part of an MPH degree. Certification is a voluntary process,
though it is expected that many employers will look for certification as an important credential in the
future.5 Licensure of public health professionals is not yet an issue. Thus, public health, along with
health care, has increasingly formalized its educational requirements, formal credentialing, and
competencies. This process is likely to continue.

Physicians are a central part of what is called the practice of medicine. They can be categorized as
allopathic or osteopathic physicians. Allopathic physicians graduate with an MD degree, while
osteopathic physicians graduate from osteopathic medical schools and receive a DO degree.
Graduates of both allopathic and osteopathic medical schools are eligible to apply for the same
residency and fellowship programs for their postgraduate medical education. The number of
osteopathic medical schools has grown rapidly in recent years and now totals approximately 30
nationwide. Allopathic medical schools number approximately 130 and have only recently begun to
again grow in size and number.a

Within medicine, specialties and subspecialties continue to emerge. For instance, hospice and
palliative medicine has recently been added to the list of specialties, and others, such as hospitalists,
may be moving in that direction. Table 9-1 outlines many of the current specialties and subspecialties
within the field of medicine.6 Box 9-2 discusses the process of medical education and the changes that
have occurred in recent years and continue to evolve.7

1114237 – Jones & Bartlett Learning ©

TABLE 9-1 Selected Specialties and Subspecialties of Medicine

Example of
specialty area Example of subspecialty area
Anesthesiology Critical care medicine

Hospice and palliative medicine
Pain medicine


Hospice and palliative medicine
Medical toxicology
Pediatric emergency medicine
Sports medicine
Undersea and hyperbaric medicine

Family medicine Adolescent medicine
Geriatric medicine
Hospice and palliative medicine
Sleep medicine
Sports medicine

Internal medicine Adolescent medicine
Cardiovascular disease
Clinical cardiac electrophysiology
Critical care medicine
Endocrinology, diabetes, and metabolism
Geriatric medicine
Hospice and palliative medicine
Infectious disease
Interventional cardiology
Medical oncology
Pulmonary disease
Sleep medicine
Sports medicine
Transplant hepatology

Obstetrics and

Critical care medicine
Gynecologic oncology
Hospice and palliative medicine
Maternal and fetal medicine
Reproductive endocrinology/infertility


Orthopaedic sports medicine
Surgery of the hand

Otolaryngology Neurotology
Pediatric otolaryngology
Plastic surgery within the head and neck
Sleep medicine

Anatomic pathology

and clinical

Blood banking/transfusion medicine
Chemical pathology

1114237 – Jones & Bartlett Learning ©



Forensic pathology
Medical microbiology
Molecular genetic pathology
Pediatric pathology

Pediatrics Adolescent medicine
Child abuse pediatrics
Developmental-behavioral pediatrics
Hospice and palliative medicine
Medical toxicology
Neonatal-perinatal medicine
Neurodevelopmental disabilities
Pediatric cardiology
Pediatric critical care medicine
Pediatric emergency medicine
Pediatric endocrinology
Pediatric gastroenterology
Pediatric hematology-oncology
Pediatric infectious diseases
Pediatric nephrology
Pediatric pulmonology
Pediatric rheumatology
Pediatric transplant hepatology
Sleep medicine
Sports medicine

Physical medicine
and rehabilitation

Hospice and palliative medicine
Neuromuscular medicine
Pain medicine
Pediatric rehabilitation medicine
Spinal cord injury medicine
Sports medicine

Plastic surgery Plastic surgery within the head and neck
Surgery of the hand




Public health and

Medical toxicology
Undersea and hyperbaric medicine

Neurology with

qualifications in
child neurology

Addiction psychiatry
Child and adolescent psychiatry
Clinical neurophysiology
Forensic psychiatry
Geriatric psychiatry
Hospice and palliative medicine

1114237 – Jones & Bartlett Learning ©

Neurodevelopmental disabilities
Neuromuscular medicine
Pain medicine
Psychosomatic medicine
Sleep medicine
Vascular neurology


Radiation oncology
Radiologic physics

Diagnostic radiological physics
Hospice and palliative medicine
Medical nuclear physics
Nuclear radiology
Pediatric radiology
Therapeutic radiological physics
Vascular and interventional radiology


Hospice and palliative medicine
Pediatric surgery
Surgery of the hand
Surgical critical care

Urology Pediatric urology
Data from American Board of Medical Specialties. Available at: http://www.abms.org/. Accessed July 24, 2013.

BOX 9-2 Medical Education

Medical education in 19th and early 20th century America was built upon the apprentice system. Future
physicians, nearly all men, worked under and learned from practicing physicians. Medical schools were
often moneymaking enterprises and primarily used lectures without patient contact or laboratory
experiences. That changed with the introduction of the European model of science-based medical
education, hospital-based clinical rotations, and a four-year education model. The 1910 Flexner Report
formalized these standards, which soon became universal for medical education in the United States, in
what came to be called the Flexner era of U.S. medicine. This era extended into the 1980s, and at some
institutions, into the 2000s. It led to the growth and dominance of specialties and specialists within
particular medical fields.

Hospital-based residency programs and fellowships leading to specialty and subspecialty training
became the dominant form of clinical training. Emphasizing this trend, medical school education came to
be called undergraduate medical education. Medical school was traditionally formally or informally divided
into two years of basic science or preclinical training, followed by two years of hospital-based clinical
rotations in specialty areas including surgery, internal medicine, obstetrics and gynecology, and psychiatry.
This division of medical education is reflected in the examinations of the National Board of Medical
Examiners, which traditionally included part 1 after the second year of medical school, part 2 prior to
graduation, and part 3 after the first-year residency, which is often called the “internship.” Additional
specialty and subspecialty board examinations were linked to completion of training that occurs after
medical school.

Change began to accelerate in medical education during the mid-1980s with the increasing movement
of health care outside of hospitals, the increased medical school enrollment of women and minorities, a
broader view of what should be included in medical education, and a better understanding of how learning
takes place. Specific changes have occurred in the last two decades at all stages of medical education,
and new proposals for change continue to be formally reviewed and implemented. These can be outlined
as follows, starting with the premed college years and continuing through residency and fellowship

1114237 – Jones & Bartlett Learning ©

•   Premedical training in the Flexner era was largely restricted to majors in the physical and biological
sciences, plus specific social sciences such as psychology. Beginning in the early 1990s, medical
schools encouraged a wider range of majors, while usually retaining biology, chemistry, and
physics courses as prerequisites. Medical schools are increasingly receptive to a wide range of
preparation for medical education, encouraging completion of courses in behavioral and social
sciences, including public health and epidemiology.

•   The comprehensive review of the Medical College Admission Test (MCAT) has resulted in changes
to the MCAT. The changes include a new section emphasizing the behavioral and social sciences
to parallel the sections emphasizing the physical and biological sciences. A framework known as
scientific inquiry and reasoning skills (SIRS) will incorporate basic research methods and statistics
into each of the content examinations.

•   Admission to medical school was dominated by white males throughout the Flexner era. In the last
20–30 years, the percentage of women applicants has increased steadily. Today, the majority of
medical students at many institutions are females. Likewise, the increase in minority applicants
has paralleled the changes occurring in other aspects of U.S. education and society.

•    The first two years of medical school in the Flexner era were dominated by lectures and
laboratories. Basic sciences were the focus, with little or no patient contact. An important change
in the last two decades includes widespread use of problem-based learning (PBL). PBL is
characterized by small-group, student-initiated learning centered on “cases,” or patient-oriented
problems. New curricula in medical education, including evidence-based medicine, interviewing
skills, and ethics, have become a standard part of coursework. A new simulated patient interview
and physical examination are now part of the certifying examination process.

•    Changes in the third and fourth years of medical school began in the 1960s, the era of student
activism. Since then, the fourth year of medical school has been dominated by electives. Fourth-
year students may choose formal courses, elective clinical experiences, or a wide array of other
options. These usually include options for laboratory or clinical research; international experiences;
and clinical rotations at other institutions, often called “audition” rotations, designed to increase a
graduate’s potential for selection as a resident.

•   The growing trend of patient treatment outside of the traditional hospital setting has increased the
range of types and locations of clinical experiences available. Most medical schools now require
primary care experiences, along with traditional specialty rotations.

•   Residency training has paralleled the changes in medical school, with greater outpatient and less
inpatient, or hospital-based, education. Fellowship training beyond residency is now a routine part
of the process of specialization. The general move toward more and more specialization has led to
longer postgraduate training. The rigors of residency training remain, but limits have now been
placed on it by the Residency Review Committees (RRCs), which govern graduate medical
education. An average of 80 hours per week is now the maximum standard for residents.

Further changes in medical education and residency programs can be expected in the near future. The
increasing recognition that health care is a group, and not an individual, enterprise is leading to a focus on
interprofessional education and practice. An appreciation that evidence is central to improving quality and
controlling costs should continue to encourage the critical reading of clinical research as part of evidence-
based medicine in medical school and in journal clubs as part of postgraduate education. The use of
computer-based information systems should increase the sharing and coordination of information, the
ability to monitor and control health care, and the ways that physicians communicate with colleagues and
patients. Technology is also likely to have continued unexpected impacts on the ways that medicine is
taught, learned, and practiced.

Now let us take a brief look at the largest of the health professions—nursing.8

Nursing as a profession dates from the middle of the 1800s, when it began to be organized as a
profession in England. Florence Nightingale is often associated with the founding of nursing as a
profession. In the United States, the nursing profession grew out of the Civil War and the essential role
played by women in this conflict, who performed what we would today call nursing functions. Nursing

1114237 – Jones & Bartlett Learning ©

has long been organized as a distinct profession and is governed by its own set of laws, often referred
to as the “nursing practice acts.”

Today, there are a wide range of health professionals that fall under the legal definition of nursing.
Licensed practical nurses (LPNs) provide a range of services often under the direction of registered
nurses (RN). An LPN’s educational requirements vary widely from state to state, ranging from one year
of education after high school to a two-year associate’s degree. Certified nursing assistants (CNAs) …

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