Virtuous Schools of Public Health

 Virtuous Schools of Public Health

In public health, we long for virtue. We want to be the best, be with the best, do our best.  We score and measure virtue.  Striving for excellence gives meaning to what we do. These days companies like US News and World Report have found a way to monetize the production of virtue metrics for higher education.  Let’s reflect on virtue, especially virtue in a school of public health (SPH).

 

What would define a virtuous school of public health? 

 

Greek philosophers used the word arete “full realization of potential purpose” liberally to assign virtue to humans and non-humans.  A jug, a horse, a house, a chariot, and a warrior could all have “arete”.  Plato’s allegory of the cave, compared the archetypal ideal form of things to the realizations of everyday life.  For example, the jug on my table might have a crack making it less virtuous than the theoretically ideal jug. 

 

The name “School of Public Health” says something about how to define virtue.  The criteria—the SPH purpose—must ultimately be to contribute to the flourishing, the health of large groups of the public.  Schools prepare a workforce with the full set of skills to make large groups of people healthy. Schools also conduct research to improve the knowledge base that the workforce will use. 

 

The archetypal school of public health in Plato’s cave can only be virtuous if the community it serves is flourishing.  In this polarized world there is still consensus that preventable premature death, disability, and disease are barriers to flourishing.  The public health toolkit remains replete with institutions, policies, and interventions that could create more flourishing and to create the conditions to put them to practice.  A virtuous school of public health would support practical advocacy for the long game of setting up conditions where more civic decisions will lead to more human flourishing.  Less finger-wagging with more listening is part of this toolkit.

 

The pace of improvements in life expectancy at birth has slowed for both healthy countries and less healthy countries.  It has slowed for rich and poor.  It takes longer to go from a life expectancy of 75 to 77 than it did 40 years ago.  The same applies at lower life expectancies.  Forty years of biomedical breakthroughs and forty years of GDP growth yet, ironically public health success is becoming more elusive than ever.  For its core purpose, the public health profession and its professoriate literally has seen better days.  Its schools have lost something that they used to have.  Ironically, in terms of grant funding and student attendance, schools of public health are having the best of times.

 

Generations of calls for reform of public health teaching have asked schools of public health to produce research and a workforce that can engage communities in cycles of deliberate, evidence-based problem solving in public health. Our graduates need to be equipped to do more than publish papers about the burden and etiology of this or that disease.  They have always needed training to see and marshal the particular strengths of communities who will use that information and rally together to deploy multiple countermeasures.

 

Higher education’s incentive structures have diverted the public health professoriate from the full range of virtue.  The beatification of professors who bring the top grants and top citations has gone hand in hand with university ranking systems built on only a sliver of the mission of public health.  I think schools can continue to honor the success in scientific discoveries and add on a commitment to local transformation of the determinants of health.  It’s a matter of metrics.  

 

Putting research publication metrics at the top of the virtue list might have worked if only the full range of practical studies faced an even playing field.  But not all public health research fares equally in funding agencies and journals.  Social science, implementation science, management, political science, and advocacy are bedrock for public health practice, but they are step-children in higher education.  So called “high impact” journals like Science and Nature are not good homes for the products of this essential scholarship. 

 

It's time that schools of public health, especially those funded by state and national governments renegotiate their compact with the taxpayers who support them.  Deans and directors of schools of public health need to say clearly that the benchmark of their virtue lies in improving the health statistics and closing health disparities in their jurisdiction.  We need a lot more conversation between SPH leaders and state and local government health leaders in order to address gaps in the competencies of the public health workforce.  

 

David Bishai is Clinical Professor and Director of University of Hong Kong School of Public Health

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