If we leave the training of public health leaders and practitioners to academia, we will miss something. For years the formal training in public health and the practice of public health have been worlds apart, neither valuing the worth of the other. Very few persons obtaining a master's in public health degree did so to lead a public health department, and very few leaders in the governmental practice of public health led because of an academic discipline in public health. The successes of either were not dependent on the other.
The challenges of public health demand a closer association of the two-a defining of public health as a system and a realization that education and training are responsibilities of all of us. The relegation of the responsibility for training as within the sole purview of academic centers is a liability.
Public health is dynamic and played out in real time. On any given day an organism is mobilizing to attack; a case of tuberculosis is made difficult by cofactors of alcohol usage, mental illness, homelessness, and language barriers. On any given day the case manager attempting to ensure a healthy start for newborns may encounter a methamphetamine operation, abandoned children, a battered woman, or a potentially life-threatening situation due to random gunfire in the community. At some point, a council member will challenge the trustworthiness of numbers-not because they are wrong, but because the numbers and epidemiological evidence are irrelevant to the personal agenda of the elected official.
The events of 9/11-events that will be used as examples for so many things for years to come-elevated the necessity for competency training to an urgent status. So much of the learning of practitioners occurs on the job as necessity because access to timely and appropriate skills training is not always possible. Still today, the formal piece lags behind. What particular discipline in an academic setting is integrative enough or sensitive enough unless you bring the practice into the classroom? Situations encountered in practice are typically not covered in formal instruction. Therefore, an insertion of daily situations into academic preparation has to be more than wishful thinking; it has to be a scheduling commitment.
The public health system's challenges to have healthy and protected communities are addressed by certain skills and the basic principles of public health. It is as importantly addressed by character; relationships; community knowledge; political savvy; being able to synthesize, analyze, and finesse; patience; and the ability to teach, motivate, communicate, be humble, be diplomatic, be authoritative, and think strategically. Practitioners have long acknowledged what the gaps in knowledge, infrastructure, and skill sets are; yet only in a few cases have they moved to build the bridge with academia as a proactive strategy or take matters into their own hands.
In August 2002, the Metro Public Health Department launched Lentz University, an internal department initiative. Its mission is to raise the collective public health knowledge of all Metro Public Health Department employees and to provide the fundamental skills needed to successfully affect the health of the public. The goals over the next five years regarding public health competencies are as follows:
* To prepare a competent and confident workforce in the practice of public health
* To ensure the public health competencies of public health employees
* To foster an appreciation for the "big picture" of public health
* To facilitate the advancement of internal and external partnerships
Ninety percent of the Metro Public Health Department will be ready to pass "the test" by 2007; that test could be "certification." The faculty of Lentz University comprise master's and terminal degreed practitioners from the Metro Public Health Department. The dilemmas of public health are interwoven throughout the curriculum with competencies and skills (a compilation of those identified through the works of Kristine Gebbie, PhD, Bernie Turnock, PhD, the Council on Linkages, and the National Public Health Workforce Taskforce). A community scholars' level will be added in 2003 to further catalyze the community toward a healthier lifestyle. Community members and organizations will be invited to participate, thus increasing total community capacity as health promoters and researchers to affect health status.
Because Metro Public Health Department feels responsible for training in public health, the relationship with the academic centers in Nashville, such as Tennessee State University, Meharry Medical College, Vanderbilt University, and Belmont College, has resulted in Metro Public Health Department teaching Public Health 101 at the undergraduate level and epidemiology and community planning at the graduate level. Furthermore, the director of the Metro Public Health Department is sitting as the acting director for the new Division of Public Health Practice at Meharry Medical College, School of Graduate Studies. In this instance the health department is the foundation of public health learning and practice.
Whether employing new models or old models with new strategies, the partnership between formal and informal training is critical. The partnership allows for timely and anticipatory learning; it also acknowledges the value of experience and reality of practice in a way not captured through books, tapes, or lectures, even when given with the greatest level of enthusiasm by the most researched expert in the field. The expertise of academia is put to the test in the real setting, and the chasm between theory and practice minimizes. Public health is and defies static approaches.