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For a Global Generation, Public Health Is a Hot Field

By David Brown
Washington Post Staff Writer
Friday, September 19, 2008

Courses in epidemiology, public health and global health -- three subjects that were not offered by most colleges a generation ago -- are hot classes on campuses these days.

They are drawing undergraduates to lecture halls in record numbers, prompting a scramble by colleges to hire faculty and import ready-made courses. Schools that have taught the subjects for years have expanded their offerings in response to surging demand.

At Johns Hopkins, which has offered an undergraduate major in "public health studies" since 1976, there were 159 students studying the field 10 years ago; this year, there are 311 majors. At the College of William and Mary, a freshman seminar called "Emerging Diseases" is so popular that it is offered in two sections each semester. "It fills up instantly," said Beverly Sher, the immunologist who teaches it.

"We see exponential growth going on in the interest in these subjects," said Richard Riegelman, an epidemiologist and chief voice of the Educated Citizen and Public Health Initiative, which was put together two years ago by several higher education organizations and advocates undergraduate study of public health.

That group argues that the subject is essential knowledge in the flattened, crowded and worried world of the 21st century.

A recent survey by the Association of American Colleges and Universities found that 137 of its 837 members, or 16 percent, now offer majors or minors in public health. (The number offering single courses is unknown.) Nearly two-thirds of the schools in that group require students majoring in the subject to undertake fieldwork or research.

For the past two years, the association has offered summer workshops for colleges that want to add public health to the curriculum or expand their offerings. Representatives of 63 schools have attended.

"Today's students want to contribute, to empower individuals and communities to take charge of their own health," said Ruth Gaare Bernheim, who teaches health policy at the University of Virginia. "I think they also intuitively realize that the world is their community and that the gains of the 21st century will be in global public health."

Several years ago, students at the University of Virginia started a Global Public Health Society, which sponsors various activities and service projects. Two years ago, the school began offering a global public health minor.

Many forces have converged to make these subjects competitive for students' attention. For starters, global health is a huge growth industry.

The President's Emergency Plan for AIDS Relief has spent about $15 billion in the past five years, and funding is being nearly tripled for the next five. Bill Gates and Warren Buffett are channeling billions into public health initiatives. Malaria eradication -- which failed in the 1950s and 60s -- is again on the table.

Furthermore, the headlines are full of global health news. Today's freshmen experienced the SARS (severe acute respiratory syndrome) and bird flu scares in their adolescent and high school years, and they have lived their entire lives in the shadow of AIDS.

"It would not have happened without AIDS," said Thomas Coates, head of the global health program at the University of California at Los Angeles, describing the new interest in public health.

AIDS is a dramatic example of how whole populations, not just individuals, can be at increased risk for disease -- a key epidemiological concept. The emergence in the mid-1990s of life-extending treatment, which is only now being brought to Africa and Asia, where most AIDS patients live, provides a lesson in equity -- the principle that underlies public health.

"It took something like HIV/AIDS -- because it is so lethal and now that it is so treatable -- to capture our attention and make us realize that there were such inequities in the world," Coates said.

But the benefits of studying public health go considerably beyond understanding infectious disease.

The concepts introduced in basic epidemiology courses include causation and correlation, absolute risk and relative risk, biological plausibility and statistical uncertainty. Nearly all health stories in the news -- from the possible hazards of bisphenol A in plastics and the theory that vaccines cause autism, to racial disparities in health care and missteps in the investigation of tainted peppers -- are better understood with grounding in that discipline.

Other forces driving interest in public health include the Internet's ability to put students in touch with far-flung people and institutions, and the expectation at many colleges that students will study or work abroad.

Observers also credit a flowering of social consciousness in today's students. While the causes of their parents' generation were fueled by protest and relied heavily on symbolic victories, the interest in public health reflects this generation's more communitarian and practical outlook.

"There is a very idealistic aspect to this -- the idea that 'I am living in this world, and it could be a better place,' " Riegelman said. "This is a student-driven movement. The drive is not just intellectual, it is passionate as well."

Kelly Gebo, an infectious-diseases physician who directs the public health major at Johns Hopkins, said that in the past, college students who wanted to do something about global health were limited to collecting money, sending it to UNICEF and hoping for the best.

"Now they can get on a plane, get off in Cape Town and help out in a clinic," she said. "They aren't happy with just collecting pennies. They want to do stuff."

Joanna Stephens fits that description well.

A fifth-year senior at William and Mary, Stephens, 21, spent two spring vacations helping deliver medicines to a charity in Ghana. The team of 16 students -- she led one of the trips -- raised money during the year to pay for the drugs. The receiving clinic was run by Ghanaian health workers. "We were not dropping out of the sky with American doctors," she said.

The project was one of 16 international service trips open to William and Mary students. Others went to Belize, Nicaragua and the Dominican Republic.

Last winter, Stephens, whose home is in Fairfax Station, struck out on her own. She found a community development organization in Gvozd, Croatia, and asked by e-mail whether it took interns. A woman in charge said she could come.

Stephens rented a room, cooked her own meals and got a Croatian tutor. She put together a hygiene course for young children and helped around the office. She spent Christmas and the winter term there and hopes to return.

"It was an amazing experience. The people were so welcoming," she said last summer while working in the District at the Elizabeth Glaser Pediatric AIDS Foundation. But, she added, "It is important to make sure that the work you're doing is actually needed."

Stephens's parents are immigrants from South Africa, so she has a personal interest in that country. In the summer of 2007, she got a $3,000 grant to live in Johannesburg and research the relationship between public health and apartheid. On the side, she did her own epidemiological study.

She spent two days a week at an HIV clinic surveying patients about the use of traditional remedies. She asked how many had heard of, and were following, recommendations by the country's controversial health minister to take garlic and beet root. Her paper was published and won a college award.

Although her major is international relations, Stephens has also completed pre-med requirements and is applying to medical school. She realizes that public health may not have the cachet there that she and her friends see in it.

"Surgical procedures are perceived by our society as glamorous. Vaccination programs are not seen as glamorous," she said.

But that doesn't bother her a bit.

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