Progress in the Articulation of Undergraduate and Graduate Public Health?

Historically, in the absence of baccalaureate education in the public health, entry level education was offered at the graduate level in the Master of Public Health (MPH) degree. As MPH education was not preceded by baccalaureate education in the discipline, there are not typically prerequisite requirements for MPH admission, and introductory coursework in public health has always been offered at the graduate level. Other disciplines including business and nursing offer joint and dual degree programs; however, these programs are typically designed to accelerate completion of baccalaureate and graduate degrees (1–4) rather than supplement graduate with undergraduate education. While the developers of new undergraduate public health programs may look at the experience in other disciplines, public health presents the atypical characteristic that well-established graduate education preceded undergraduate education. In addition, review of a variety of accelerated programs at different universities demonstrates that they tend to be unique to individual universities rather than of a standard design.

Historically, in the absence of baccalaureate education in the public health, entry level education was offered at the graduate level in the Master of Public Health (MPH) degree. As MPH education was not preceded by baccalaureate education in the discipline, there are not typically prerequisite requirements for MPH admission, and introductory coursework in public health has always been offered at the graduate level. Other disciplines including business and nursing offer joint and dual degree programs; however, these programs are typically designed to accelerate completion of baccalaureate and graduate degrees (1)(2)(3)(4) rather than supplement graduate with undergraduate education. While the developers of new undergraduate public health programs may look at the experience in other disciplines, public health presents the atypical characteristic that well-established graduate education preceded undergraduate education. In addition, review of a variety of accelerated programs at different universities demonstrates that they tend to be unique to individual universities rather than of a standard design.
The recent establishment of undergraduate public health degree programs presents an interesting situation for students seeking an MPH degree following completion of their baccalaureate degree. The typical curricula at both the undergraduate and graduate levels will require similar, but not identical introductory courses that likely vary in depth and breadth as detailed elsewhere by the authors (5,6). Consequently, these students will potentially experience unintended duplication of content with additional costs of time and money.
As undergraduate public health education began to experience interest and rapid growth, one of the authors of this commentary published a paper Articulation of Undergraduate and Graduate Education in Public Health (7). The paper addressed the benefits of designing strategies to better coalesce or articulate undergraduate and graduate education, identifying barriers to articulation and strategies to achieve alignment between undergraduate and graduate education. The paper additionally presented a set of issues that were unanswered and require careful consideration. It is now 6 years later, and the authors wish to assess progress in articulating undergraduate and graduate public health education to achieve greater harmony between the two degrees. In doing so, we presume that improving the articulation of undergraduate and graduate programs to better align public health in a manner similar to many other disciplines is beneficial and have not heard arguments to the contrary.
While there has not been a systematic national effort to catalog implementation of these strategies experience requirements for students with baccalaureate practicum experiences admitted directly to graduate education: in addressing "practical skills" CEPH accreditation criteria call for a planned, supervised and evaluated practice experience for all graduate professional degree students. However, individual waivers may be granted based on welldefined criteria, the possession of a prior professional degree in another field, or prior work experience. It is possible that an MPH student with an undergraduate degree in public health may be eligible for a waiver; however, the value added in an additional practical experience would need to be carefully considered. • A small number of advanced or specialty MPH or MSPH degree programs designed exclusively for graduates of baccalaureate public health curricula could be established: this remains an interesting strategy and would be reflective of education in a discipline such as nursing. At this stage of baccalaureate development it is unlikely that such an MPH program could generate the critical mass of applicants to be successful, while concurrently denying access to other applicants. • Students with a baccalaureate degree in public health could be offered the opportunity to bypass a master's degree and proceed directly to doctoral education: this option exists in some universities for disciplines in the arts and sciences. The examples presented are anecdotal as there presently is not a formal national mechanism to collect and disseminate information about undergraduate program innovations. Presently, there is not even agreement in regard to the definition or number of undergraduate programs (Tarasenko and Lee, submitted). While the concept of articulation of the MPH with other graduate and professional degrees including the MSW, MA, MS, MHA, MBA, MD, PharmD, DMD, MSN, and JD is well accepted, articulation with undergraduate degrees is a relatively new framework. Issues related to course academic content and rigor, degree requirements, graduate school policies, and accreditation must be considered in planning for the articulation of undergraduate and graduate public health degrees. Efforts by ASPPH, CEPH, and the Association of American Colleges and Universities have contributed to the advancement in the development of undergraduate education; however, issues related to national policies promoting degree articulation have not yet been addressed.
As both interest in undergraduate education and the number of programs and students grow, issues related to the career paths of baccalaureate graduates and their opportunities to pursue graduate degrees in an efficient manner will continue to receive attention. While examples of articulation better aligning undergraduate and graduate public health education are available, these examples tend to be exceptions to convention associated with a not yet mature undergraduate degree. Articulation has the potential to facilitate the admission of students into MPH programs and additionally, provide opportunities for MPH programs to adjust their curriculum to accommodate students with relevant educational preparation. Given the ever increasing direct and indirect costs of graduate education, schools and programs in public health might wish to consider creating opportunities for students to complete their degrees in a shorter period of time using articulation with undergraduate public health education as one way to accomplish this goal. Actions to address these policies will facilitate public health education and the students we serve.

AUTHOR NOTE
The authors who presently serve in administrative leadership positions in graduate education have both previously served as directors of undergraduate programs in health administration as well as on committees and the Board of the Association of University Programs in Health Administration and as site visitors for Council on Accreditation in Health Management Education.