The University of Michigan, an encyclopedic survey ... Wilfred B. Shaw, editor.
University of Michigan.
Page  248

SCHOOL OF PUBLIC HEALTH

Many of the problems in public health, particularly those of disease prevention and the control of the environment, which stimulated the development of professional education, have persisted. The horizon of public health, however, has broadened to encompass all problems associated with the improvement of social as well as physical conditions which affect the health of the individual in his community, be it local, state, or the world. Problems associated with the better planning for utilization and development of resources for the provision of more adequate health services for all people present many different facets for the public health workers. There is a new emphasis on problems of environmental control, resulting from increased population, rapid expansion of industry, changes in transportation, and our mode of living, combating the increase in chronic diseases and emotional health conditions, meeting the challenges associated with the serious nature of the many poor health practices, and the lack of sound health education that characterizes a large segment of our population. Furthermore, there is renewed emphasis on prevention and greater participation of citizens in sharing responsibility with professional health personnel and legislative bodies in finding solutions to these problems. Qualified manpower to provide the leadership and to coordinate the efforts and contributions of these various segments of society is in short supply. This places a heavy burden on institutions of higher learning, and particularly on schools of public health, in fulfilling their social responsibility. The phenomenal growth of knowledge related to health problems and the rapid expansion of technologies useful in the realistic application of this knowledge to a variety of complex and rapidly changing situations present serious challenges. A diversity of skills is needed.

Professional education in public health at Michigan has recognized the importance of diversity and balance in the preparation of public health personnel since the establishment of the Division of Hygiene and Public Health in 1921. The approach to professional education has been comprehensive rather than restrictive. It has aimed to prepare students not only to meet the current health needs of society but to anticipate the possible solution of Page  249future ones. The School of Public Health is unique because of the wide variety of disciplines represented. This is reflected in the composition of the student body, which includes previous professional preparation in such areas as medicine, nursing, dentistry, dental hygiene, engineering, education, veterinary medicine, social work, and diatetics. In addition, the academic disciplines of mathematics and the natural and social sciences have received heavy emphasis in the previous preparation of some students. The diversity of backgrounds is reflected in the enrollment in the sixteen different public health specialty programs of study at the master's level.

In the past fifty years there have been one Director and two Deans for Public Health. John Sundwall (M.D., Ph.D.) was the Director of the Division of Hygiene and Public Health during its entire existence (1921-41). Henry F. Vaughan (Dr.P.H.) became the first dean of the School of Public Health in July 1941 and continued until his retirement on June 30, 1959. Myron Wegman (M.D., M.P.H.) succeeded Dr. Vaughan in the fall of 1960. In the interim period (July 1, 1959, to August 31, 1960) William Gibson (B.S.C.E., M.P.H.), Professor of Environmental Health, served as Acting Dean, with the assistance of the Executive Committee of the School.

Developments within the School of Public Health since 1955 have been characterized by increase in size and complexity. Changes resulting from this, however, produced worrisome problems, such as excessive separation and isolation. Growth and change are most evident during the period 1955-70 in (1) the teaching programs, with increase in course offerings, (2) the amount and variety of research, (3) enrollment and involvement of students and alumni, (4) departmental organization, bureaus, institutes, and centers, (5) size of faculty, and (6) expansion of the physical plant and budget.

As there has been expansion of the different programs of study (curriculums) the number of course offerings has nearly doubled since 1955 (155-300). This reflects the increasing specialization within the eleven different master's level programs of study existing in 1955, the four new ones established subsequently, the Master of Hospital Administration transferred to the School in 1967, and the considerable expansion of the doctoral programs. While the broad fields for specialization within public health have not changed much during the past thirty years, the emphases within the areas have. Examples are in the programs of environmental health, industrial health, and maternal and child health, where several different sequences Page  250of study have been established as specific community needs relating to these areas have become apparent.

A current need is for health personnel in the broad area of planning. This has led to the establishment in 1970 of an interdepartmental program of study in health planning "designed to produce planners with the ability to apply sensibly the tools of various disciplines to the solution of health policy problems." Other programs of study that have developed, some as offshoots of older programs, during the past fifteen years have included: Population Planning (1966-67), Community Mental Health (1965-66), Maternal and Child Health (1956-57), and Adult Health and Aging (1961-62). The establishment of all of these programs has been related to the availability of federal or private grants to initiate and partially support them. Older established programs providing specialization in public health administration, public health nursing, public health nutrition, epidemiology, public health laboratory practice, medical care organization, health education, public health dentistry, and biostatistics, as well as those in environmental health and industrial engineering, have undergone changes and expansion to meet the new demands of the times.

One innovation in the public health nursing program was the development of cooperative relationships with Wayne State University (Detroit) and Western Reserve University (Cleveland) Schools of Nursing, whereby qualified students from these two universities spent one semester at the School of Public Health, studying public health, and then returned to their respective universities to complete the requirements for their master's degree in nursing. This arrangement, initiated in 1952, continues with Wayne State, but Western Reserve has developed its own program on the basis of the affiliation experience.

Another innovation was the development of an arrangement between the programs of study in Medical Care Organization and the School of Social Work, whereby qualified students may complete requirements for both the Master of Social Work and the Master of Public Health degrees in three years.

Cooperative arrangements among different programs of study such as public health nursing, medical care organization, community mental health, maternal and child health, health education, population planning, and dental public health have enabled students to gain a specialty within more than one discipline. There have also been joint programs of study between environmental health and sanitary Page  251engineering in the College of Engineering. Cooperative relationships between the School of Public Health and other schools and colleges and various departments of the College of Literature, Science, and the Arts have long existed.

These developments have been accompanied by strengthened admission requirements, increased enrollments, and greater availability of financial support from federal and private agencies. For many years the admission requirement for the master's degree emphasized preparation in the natural sciences and specified substantive areas such as physics, chemistry, and bacteriology, with less emphasis in the social sciences, as well as three years of acceptable experience in public health or a related field. Because of the wider diversity of programs of study, each requiring some difference in undergraduate preparation for graduate professional study, the faculty broadened the basic admission requirements to the School and established additional specific requirements for each of the programs of study. Present admission requirements stress previous substantial preparation in a discipline or subject area "relevant to public health," with or without previous experience. The length of program varies from three terms (one calendar year) to six or more, depending on the previous preparation and the program of study pursued.

Since public health is a multidisciplinary field, one of the persistent problems in professional education has been the determination of the basic required courses which would provide the substantive common experiences or core in public health for all students, regardless of discipline and field of specialization. Major changes were made in the "core" program beginning with the 1966-67 academic year.

The student body of the School has always been an international and multiracial one. The proportion of students from other countries and of different racial groups regularly exceeds that of the University as a whole. Following the tragic assassination of Martin Luther King, a group of white students initiated a vigorous and successful program of recruitment from minority groups. Special attention has always been given to students from abroad, with special orientation programs in cooperation with the International Center and the English Language Institute.

Relations with alumni have always been cordial, but in 1965 at the annual American Public Health Association, these Page  252were formalized by the organization of an Alumni Association. Representatives of the Board of Governors of this Association have met periodically with the faculty to review the School's progress and to make suggestions from the alumni viewpoint. The School of Public Health has many distinguished alumni, many of whom hold outstanding positions of leadership in other countries as well as in the United States.

Expansion of various programs has been accompanied by increased enrollments, most striking in the fields of medical organization care, population planning, maternal and child health, and health planning. Older programs such as environmental health and public health nursing, which over the years have provided the largest number of students, have continued to maintain a high level of interest.

Completion of the master's-level program is considered essential basic professional education in public health for leadership responsibility. The number of master's degrees in public health has increased about five-fold since the School was established (July 1941) and two and one-half times since 1955. The increase in enrollment at the master's level is due somewhat to the reduction of undergraduate students associated with the phasing out of the program in public health nursing in January 1962. During the first fifteen years of the School's history, public health nursing students composed as much as 50 percent of the total enrollment of the School, and of these the number of undergraduates often greatly exceeded the number of graduate students. Besides the discontinuance of undergraduate programs of study, additional significant changes have been the expansion of doctoral studies and the establishment, in cooperation with the Horace H. Rackham School of Graduate Studies, of programs leading to the Master of Science and Doctor of Philosophy degrees, with the specialty in public health.

Two other undergraduate curriculums leading to the B.S.P.H. degree, one in sanitary science and the other in health administration were initiated on an experimental basis in 1950-51 with a grant from the W. K. Kellogg Foundation. These programs were short-lived, lasting less than ten years. Fewer than 40 students completed the requirements for the B.S.P.H. degree between 1951 and 1959.

The discontinuance of the baccalaureate preparation for public health may have been premature in view of the present demand for personnel prepared at various academic Page  253levels and the increase in the number of community colleges and universities developing such training programs. Schools of public health have assumed, however, that their major role is in graduate professional education, preparing individuals for community leadership positions in the various public health disciplines and for teaching and research. This is evident in the expansion of the doctoral level study.

The M.P.H. (I.H.) degree, with specialization in industrial health, established in 1954 as a special three-semester program, was discontinued in 1966 when the general requirement for the M.P.H. degree was increased to three semesters.

The program in Hospital Administration and the Bureau of Hospital Administration, established in the School of Business Administration, were transferred to the School of Public Health for administration, space, and budget by the Regents in January 1967. Successful completion of this two-year program leads to the Master of Hospital Administration degree, offered by the School of Public Health. Enrollment in this program has been increasing also.

Although the doctoral degree in public health was established by the Regents in 1911, from 1941 to 1957 the degree was limited primarily to physicians interested in public health administration. Since 1957, seven different teaching units — epidemiology, environmental health, public health administration, public health laboratory practice, dental public health, population planning, and industrial health — have developed doctoral programs approved by the faculty. The doctoral programs leading to the Ph.D. degree, with specialization in some aspect of public health, have been in operation for many years. The oldest of these programs is in the field of epidemiology. Other approved programs include biostatistics, environmental health sciences (including environmental chemistry, food, water, radiological health, hospital and institutional environments, and administrative practice), epidemiologic science, industrial health, medical care organization, and public health administration. A Ph.D. program with emphasis on health education has existed since 1947, under the combined auspices of the School of Education and the School of Public Health.

Other Graduate School programs lead to the Master of Science degree, with emphasis on environmental health science, epidemiologic science, industrial health, population planning, and nutritional science. Interdisciplinary Page  254programs leading to the Master of Science, Doctor of Philosophy, and/or Master of Public Health degree exist in environmental health and sanitary science, water resources science, water resources management, and toxicology.

Another educational opportunity for advanced students has been the establishment of three different residency programs leading to specialty certification by the American Board of Dental Public Health and the American Board of Preventive Medicine. The program in dental public health is carried on cooperatively with the Department of Community Dentistry in the School of Dentistry and appropriate public health agencies. The School, the Institute of Environmental and Industrial Health, the Medical Center, and selected industries cooperate in the residency program in occupational medicine. The residency training program in general preventive medicine offers physicians specialty training in epidemiology, environmental medicine, maternal and child health, medical care organization, population planning, or health administration.

Formal classroom instruction each year is supplemented by eight to ten Assembly programs, with distinguished lecturers, many from abroad. These are capped by Honors Assembly, initiated in 1961, at the end of the academic year. At this time two special awards are given: the William C. Gibson Memorial Award, established in 1962, for excellence in environmental health, and the Emilie Gleason Sargent Prize, established in 1964, for excellence in public health nursing.

Continuing education programs — a service to practitioners in various fields of public health — have been maintained at the level of about ten each year. There have been many publications resulting from these courses. The programs have brought many distinguished visitors to the campus, both as faculty and as participants. Extension teaching and the provision of service courses to students enrolled in other units of the University, however, have decreased.

Most of the recent increase in teaching programs has been made possible by financial grants from federal agencies, but private foundations, such as the Ford, Kellogg, and Rockefeller foundations, have also supported special areas. Indeed, by the end of the decade, roughly a quarter of the expenditures of the School were from general funds. About 28 percent of the outside funds, totaling about $1,750,000, went to student support. Of the remainder Page  255approximately 60 percent was for sponsored research and 40 percent was used to strengthen educational programs.

Growth of research within the University is reflected in the School of Public Health, where an extraordinary number of projects have been carried on through all departments. Long-term projects include: studies of respiratory infection and viruses, prepaid health insurance plans and quality of health care for selected groups, stream pollution, effects of radiation, effects of toxic substances and other industrial hazards. Some of these, such as the influenza studies, had their origins during World War II, when Dr. Thomas Francis, Jr., chairman of the Department of Epidemiology, became chairman of the Influenza Commission of the Armed Forces (1941).

An interdisciplinary study on the methods of evaluating various categories of public health practices and on factors influencing health behavior was developed by Dr. Vlado Getting and Dr. Irwin Rosenstock. The largest long-term interdisciplinary project is known as the "Tecumseh Study," initiated in 1956 with a grant from the Human Resources Funds of the University and subsequently supported by grants from the National Institutes of Health. It is a study of the total community of Tecumseh, Michigan, concentrating on the continuing health status of all the residents and the environmental conditions and external factors that may influence the development of disease. Particular attention has been given to cardiovascular diseases. This project became the nucleus for the establishment of the Center for Research on Diseases of the Heart and Circulation and Related Disorders, established in 1961 under the joint auspices of the School of Public Health and the Medical School, with Thomas Francis, Jr. as director and Frederick H. Epstein as associate director. Dr. Epstein succeeded Dr. Francis as director of the Center in 1969.

There have been changes in the departmental organization within the School. Of the original four departments (1943) — Epidemiology, Environmental Health, Public Health Practice, and Tropical Disease, only Epidemiology continues as one of the present six. The other five departments formed were: Biostatistics, formerly part of the Department of Epidemiology, became a separate department — Public Health Statistics — in 1950, and in 1962 changed its name to Biostatistics. In 1970 the Department of Environmental Health combined with the Department of Industrial Health (1957) to form the Department of Environmental and Industrial Health. The Department of Page  256Public Health Practice, once the largest in terms of student enrollment and number of teaching programs (1941) was divided into two departments in 1961 — the Department of Community Health Services and the Department of Health Development. The program of study in medical care organization, formerly a part of the Department of Community Health Service, became a separate department in 1965. The research arm of this department is the Bureau of Public Health Economics, established in 1945, and the oldest Bureau in the School of Public Health. It maintains an extensive reference collection and publishes the Medical Care Review, a nationally circulated monthly digest of current opinions, events, and summaries of publications in the field of medical care.

In January 1967, the Board of Regents transferred the Program and Bureau of Hospital Administration to the School of Public Health for administration, space, and budget. Although functioning essentially as a department of the School, the interschool character is strengthened through an Advisory Committee, which includes the Deans of Public Health, Medical, and Business Administration, and the Director of the University Hospital. This Bureau also maintains a specialized reference collection, and publishes Abstracts of Hospital Management Studies.

The School of Public Health has joint responsibility with the Medical School for the Institute of Industrial Health, established with a grant from the General Motors Corporation in 1951. The name of the Institute was changed in 1970 to the Institute of Environmental and Industrial Health to parallel that of the department. The School also has direct responsibility for the Center for Population Planning, one of the three coordinated centers of the University Population Program established in 1965. The Center focuses on the preparation of students for administrative, teaching, consultant, and research careers in population planning throughout the world. The Population Studies Center in the College of Literature, Science, and the Arts is concerned with demography and related studies, and the Center for Research in Reproductive Biology in the Medical School is concerned primarily with basic laboratory and clinical investigation and training in human reproduction. The activities of these three Centers are coordinated through policy and operating committees.

In 1966 the University established a multidisciplinary Institute for the Study of Mental Retardation. The School of Public Health is one of the participating units and Dr. William A. Cruickshank of the School of Public Health is Page  257the director. The School is also one of the participating units in several other multidisciplinary activities including the Center for Research on Human Growth and Development, the Dental Research Institute, the Sea Grant Program, and the Institute for Environmental Quality.

While the School of Public Health continues a working relationship with the University Health Service, the administrative relationships have changed. At the time of the retirement of Dr. Warren E. Forsythe, Director of the Health Service and Professor of Hygiene and Public Health, in 1957, the administrative direction of this unit was placed under the Vice-President for Student Affairs. The teaching responsibility for formal courses in hygiene and public health was transferred to the School of Public Health.

Another change in relationship is that with the National Sanitation Foundation, formerly housed entirely within the School as a University courtesy. Research in environmental health particularly received impetus from the Foundation. The growth of the Foundation, however, necessitated the building of its own separate facilities, although it still maintains some space in the School of Public Health Building.

The faculty has increased five-fold since the School was established (1941) and more than doubled since 1955. The greatest change came in 1969-70 when there were thirty resignations, two retirements, two deaths, and forty-three new appointments from a regular faculty of about 200. By this date none of the faculty who had served in the Division of Hygiene and Public Health or on the first faculty of the School, were still active. Dr. Nathan Sinai had the longest full-time continuous service at his retirement in 1964. His first appointment as an instructor was in 1924.

Service to the state, nation, and to international, official, and voluntary groups by faculty members has been a tradition since the establishment of the first hygienic laboratory on campus in 1889. The Michigan State Departments of Health and Education, U. S. government departments and international commissions and committees, governing boards and councils of a wide variety of professional and voluntary organizations concerned with health and welfare have been served by faculty members in leadership positions. Honors and awards for distinguished service and scholarly achievements have been bestowed upon members of the faculty by numerous governmental and other agencies and by learned and professional societies.

Page  258Perhaps the most eminent member of the faculty in recent years was Dr. Thomas Francis, Jr., chairman of the Department of Epidemiology from its inception in 1941 to 1969 and who, as Henry Sewall University Professor of Epidemiology, held one of the first distinguished professorships established in the University by the Regents. He was honored by a Festschrift, which was to have been presented to him on the occasion of his retirement in 1970. Unfortunately, Dr. Francis' untimely death in October 1969, turned this Festschrift into a memorial to him. The influence and example of his outstanding contributions to research and teaching and to the development of the School of Public Health will long endure.

There have been two major structural additions to the School since the original building, the first completed in 1959 and the second in 1971. These additions, essential to accommodate the ever-expanding programs of the School, which by 1968 were located in thirteen different facilities, have increased by five-fold the space of the original building completed in 1943.

Despite all this progress, the problem that faces faculty and administration is that of maintaining balance among the various facets of public health teaching, research, and service to community groups, and at the same time to maintain high quality performance. There can be strength or weakness in diversity. The major task is to accept increased diversity while reinforcing and improving the common substantive preparation for all public health personnel, so that students are both generalists in public health and specialists in a particular facet.