This issue of the Journal of Public Health Management and Practice includes an article by Bass, Guttmacher, and Nezami describing undergraduate public health degree programs at their universities. They discuss the prospects for an increase in such degrees, in response to an increasing interest in public health education. An additional and very important focus of their article is the recent introduction of accreditation criteria for undergraduate programs by the Council on Education for Public Health (CEPH). The three programs described are quite different in terms of their stages of development, their educational missions, and the university contexts in which these programs exist. We are writing this editorial from the vantage point of our own undergraduate program that is nearly 30 years old, and appreciate the opportunity to comment on points made, and issues raised, in the Bass and colleagues paper.

We agree with Bass and colleagues that the increasing attention to public health and health promotion in contemporary society is driving an interest across the country for public health content in undergraduate curricula. We also agree that the development of undergraduate degree programs raises many questions about what undergraduate education in public health should be. While the title of the Bass and colleagues paper refers to "making the case" for undergraduate public health education, it seems to us that the real issue raised by the article is the implication of accreditation requirements for an undergraduate degree in public health. An academic institution can decide to offer a nonaccredited public health degree, but the option for accreditation introduces considerations that typically accompany "legitimation" by an external body representing the profession, something that is often not associated with undergraduate education.

We also agree with Bass and colleagues on several specific points. First, it is certainly possible to integrate undergraduate public health education with traditional liberal arts education. That is the model we use at Brown, something in keeping with our "university/college" philosophy. We also agree that undergraduate public health students will come from diverse backgrounds and will have equally diverse career goals, requiring undergraduate programs to plan for this diversity. And, we agree that the initiation of more undergraduate programs will raise significant articulation issues for graduate-level public health programs when more applicants have undergraduate degrees.

The article by Bass and colleagues and our own experience clearly suggest that there is a continuum between programs explicitly designed to meet immediate public health entry-level workforce needs and programs that consider public, or community, health as a focal point around which to organize a traditional, pregraduate school liberal education. Accompanying this range of objectives, our own examination of some 20 undergraduate public health programs with the help of a Web browser reinforces the notion of diversity in curricula, with some programs requiring numerous courses while others appear far less prescriptive. One observation about the Bass and colleagues article is the sometimes-juxtaposed reference to producing graduates for public health leadership and reference to entry-level positions in public health. It is not clear to us what is expected from these undergraduate programs. Leadership positions will not easily come to graduates who obtain entry-level positions and do not go on for graduate degrees.

The ways in which universities and colleges across the country respond to the growing interest in public health will be greatly influenced by where they place themselves on this continuum. As Bass and colleagues note, not all educational institutions view their role as preparing tomorrow's entry-level workforce, while others explicitly do not aspire to meeting the most expansive ideals of liberal arts and sciences education. It is our contention that all the models that have emerged along this continuum are appropriate and necessary. Initiatives that impose or set standards and criteria that might be relevant for graduate-level professional schools should not be uniformly applied to undergraduate programs precisely because of their diversity of missions. Thus, efforts championed by the CEPH would best serve this burgeoning area of growth by advising and setting a general framework that is sufficiently flexible to embrace this diversity.

Brown's Department of Community Health has offered an undergraduate "concentration" in Community Health since 1979. Begun as an integration of the social and behavioral sciences, in a Medical School administrative structure, the "Health and Society" program began with two graduates in 1979 and now graduates some 30 students a year. All students are exposed to required methods courses as well as courses in public health, healthcare administration, environmental health, and social aspects of health and healthcare. At Brown, there are no "majors" or "minors," and there are no course content distribution requirements; rather, there are "concentrations" that characterize where students have chosen to focus their liberal education. As such, our concentration reflects the institutional policies and educational culture of the university. About a third of our students are pre-med, so their future medical education is informed by their undergraduate experience and knowledge of population sciences. Another third go on to graduate school in various areas including public health, law, or doctoral studies. The other third enter diverse work settings, both public and private sector, generally drawing upon the knowledge and skills they acquired from their public health education.

We have a CEPH-accredited MPH and have recently had a 5-year AB/MPH approved. In designing the AB/MPH program, we were extremely sensitive to the implications of reducing students' choices to explore their undergraduate liberal education opportunities fully, and advise interested students that they should seriously consider what they would be missing by "giving up" exposure to other fields to combine a liberal education with a "professional" degree program. There is undoubtedly a rich pool of high school students who have already developed a commitment to the goals of public health, due in no small part to the almost instant availability of information about health-relevant topics around the world. In fact, these students are a primary audience for undergraduate public health programs, not only students already at an academic institution who need to select a major and/or decide to transfer into public health. From our perspective, the issue is not making the case for an undergraduate public health degree; rather, the issue is ensuring that guidelines for public health undergraduate programs do not prematurely "professionalize" students into narrow career tracks. We are sure that this outcome is not the intent of any institution or individual faculty member, but the issue needs to be considered at this early phase of the development of undergraduate programs.

We at Brown are in a good position to integrate undergraduate and graduate education in public health precisely because the same faculty who teach our required MPH courses also teach undergraduates, and we have a tradition of advanced undergraduates taking graduate-level courses. At the same time, this "advantage" creates its own complications to which Bass and her colleagues allude; if undergraduates have already taken core public health courses, how will they fare when exposed to the standard MPH curriculum in graduate school? Will there be repetition? Given the increasing popularity of undergraduate public health programs, accredited or not, as these students enter traditional MPH programs they are likely to be more demanding and less satisfied with a repeat of their college courses.

The matter of accreditation is, as noted by Bass and colleagues, a key issue. It is important to avoid making an assumption that becoming an accredited program is resource-neutral to an academic institution. This is a consideration that goes beyond whether public health is consistent with an institution's mission, and may be a factor in the future decisions universities make. It is also important to think about the possibility and implications of future changes in accreditation requirements, which in all reality, are likely not going to be in the direction of fewer credit-hour requirements or curricula that have fewer course options. Accreditation is not only something that sets a program of study for undergraduate students, it also introduces professionalization to the host academic institution. If accreditation is going to be seen as a "legitimation" of an institution's undergraduate program, then perhaps there needs to be more than a single type of undergraduate accreditation, in order to recognize broadly different missions of undergraduate education. This proposal may be "upping the ante" more than originally intended by the development of undergraduate program accreditation, but we are still early enough in the process to consider the assumptions upon which such accreditation is based, relative to the missions of undergraduate education. We applaud Bass and colleagues for bringing the matter to greater attention in the academic and professional communities.

In summary, the emergence of undergraduate public health programs raises all manner of issues for the field of public health education. In light of the diversity of mission of universities in general and the growing number of public health programs, it is important that flexibility be retained in any effort to accredit these programs. Indeed, the range of questions and issues that the authors raise suggest that now is the time to discuss program diversity and its implications and not necessarily the time to prematurely set standards that unnecessarily restrict the character of undergraduate education focused on public health.