I earned a master’s in public health (MPH) with a concentration in Behavioral Science and Health Education. Right out of school, I accepted the ASPPH Philanthropy Fellowship at the de Beaumont Foundation. One of the best parts of the fellowship has been meeting some of nation’s true “public health heroes.”
On my second day, I met Karen DeSalvo, who developed Public Health 3.0, which charts the future course of governmental public health in the United States. My second week, I met health commissioners from the nation’s 30 largest, most urban cities. At the APHA annual meeting, I was introduced to Jonathan Fielding, former health commissioner of Los Angeles, founder of UCLA’s public health school, and renowned author and public health thought leader. Just the other week I met the current Surgeon General, Dr. Jerome Adams, who is bringing nontraditional partners like business into the practice of public health. These are the gatekeepers to contemporary public health work and the future of the professional health field. I aspire to a career that builds on their work. However, all of these leaders hold medical degrees. I started to wonder if I made the right choice when I picked an MPH instead of an MD?
Health directors are often legally required to be a licensed physician. Looking back into the history of public health, this made sense. The causes of disease and disability were infectious, transmitted by bugs and bacteria and remedied by advances in medicine and epidemiology. However, today’s health directors need to know more than disease pathology. The leading causes of death are complicated chronic conditions that result from lifestyle and environment, and whose prevention requires new schools of knowledge. Health commissioners need to know about public transportation, access to healthy food, and clean air, none of which are covered in traditional medical training. Take, for example, a recent Lancet article that found that air pollution was responsible for 16% of all premature deaths worldwide (about 9 million). It’s not a medical approach that’s needed, but a systems approach working to build partnerships and pass policies that improve air quality. So, if the problems have changed, why do so many cities, counties, and states require still require a medical license?
Is my future in public health capped? Is my professional growth stunted already despite my passion and professional degree? I began to search for other heroes who didn’t hold clinical degrees and found Colleen Bridger, the health commissioner of San Antonio. As a fellow non-clinical public health practitioner, I called her to learn more about her experiences and her career path.
Colleen Bridger, MPH, PhD, was appointed as health director of San Antonio in March of 2017. Before May 9, 2015, she wasn’t qualified for the job because the San Antonio city charter required that the city’s health director be a licensed physician. But, a public referendum in May 2015 eliminated this requirement. Dr. Bridger recalled being asked what she brought to the table as a public health professional without any clinical expertise. Her answer: she is able to look at the whole picture, understanding and solving health problems from the systems level, using a myriad of tools including policy. In this answer, Dr. Bridger highlighted what I’ve learned, the skills I gained without any clinical experience.
Dr. Bridger gained this system’s level perspective throughout her training in international development and public health, completing a PhD in health systems research and a dissertation in teen pregnancy prevention. Earlier this January, Dr. Bridger applied these skills when she led an effort to pass T21, which is one of the most effective methods of reducing tobacco use and its negative population health consequences, by raising the legal purchasing age to 21. I studied policies like T21; this is the type of work I want to do! I loved talking to Dr. Bridger because I relate to her. She started her career as a bilingual social worker and developed a passion for working and with vulnerable communities. There are a lot of stories like hers among young public health workers.
Dr. Bridger is excited about millennials entering the public health workforce because she says we are “natural systems thinkers”. At a time when zip code is the strongest predictor of health status, system thinkers are needed to create healthy communities. A drive for social change motivates a lot of young people like me to get into public health. I was 1 of 20,000 public health graduates in 2016, of which less than 1 of 10 intended to pursue a medical degree. There are more young workers pursing public health degrees than ever before. We need constructive, upwardly mobile career paths in governmental health agencies in order to become the next generation of “heroes” in public health.
The public health workforce is a team of public health professionals, policymakers, doctors, activists, and researchers of all backgrounds. As Dr. Bridger puts it, “there is something in it for everybody”. However, the MD requirement is a structural barrier that could prevent me, and others like me, from leading in the field. Policy needs to catch up with a changing workforce and changing health landscape by shedding the MD requirement for health agency directors. I still wonder if I made the right choice when I decided against pursuing medical school. But when I reflect on the progressive changes proposed by Public Health 3.0 and talk to public health heroes like Colleen Bridger, I am confident enough in my public health training to someday consider the health director position myself.
This year I am blogging about my experience as a fellow and what it means for the millennial generation to join and change the public health landscape. I will grapple with the changing public health workforce, interview leaders in and out of the field, and discuss the future of public health as my generation sees it. Follow along!