Comunale B, Jackson-Ward E, Davis S, Baldridge A, Ward L. Untapped potential: the need for DrPH professionals to mitigate the next public health crisis, lessons learned from the COVID-19 pandemic. HPHR. 2021;35.
The COVID-19 pandemic upended “life as we knew it” seemingly overnight. However, for public health professionals, the vulnerability of our systems and subsequent devastating outcomes did not come as much of a surprise. This commentary aims to reveal the untapped potential of Doctorate in Public Health (DrPH) professionals and their role in contributing to the future mitigation of public health crises. In this context, “DrPH professionals” are defined as doctoral awardees (or current students) of the advanced, terminal degree in pursuit of a career in public health practice and leadership. Research suggests the importance of public health interventions in reducing the burden of disease, but the opportunities and visibility of DrPH professionals specifically over the past year have been limited. By working to include these professionals at all levels of proverbial planning tables, future public health pandemic responses will be all the better for it. Public health has never been as visible—and the need for trained public health leaders has never been as critical—as it is today. In this commentary, we recommend actions that should be championed by DrPH practitioners to improve the resiliency of our global health care systems.
Prior to the COVID-19 pandemic, public health vernacular such as “herd immunity,” “PPE,” and even the difference between pandemic and epidemic were not commonplace. Funding at federal, state, and local levels was inconsistent and unreliable, epidemiologists were far from the foreground, and modern-day preventive medicine was taken for granted with infectious disease considered a thing of the past or restricted to low-income countries. For most, this was the reality of the public health field. For public health professionals, however, the pandemic was not only anticipated, but also served as a broad casting call of sorts for a diverse group of skilled professionals who were ready to keep pace with and tackle the pandemic head-on.
Within and across hospital administration, clinical trial management, technology innovation, safety-net leadership, public service, and the like, lies an untapped network of the aforementioned skilled workforce with a shared foundational and technical understanding of public health–DrPH professionals. Deeper than a traditional MPH and more applied, in terms of practical implementation, than a PhD, the DrPH degree is designed for “the integration and application of a broad range of knowledge and analytical skills in leadership, policy, program management, and professional communication” (JHU, 2021; Park et al., 2021). With the goal of linking theory to practice, the DrPH was established as a practice-based doctorate degree in 1919 by the American Public Health Association (Lee et al., 2009). It was not until several decades later that the Institute of Medicine published a report noting the important role of public health practice, ultimately acknowledging the critical leadership role that DrPH professionals play in “keeping us healthy” as a product of the advanced training (DrPH Coalition, 2021).
Despite the rigor, relevance, and capacity of DrPH professionals (and trainees) in contributing to the field of public health, little attention has been paid to the significant and potential role these professionals have had, collectively within and across sectors, in mitigating the ongoing pandemic this past year.
Millions have been affected by the COVID-19 pandemic, not only in terms of health, but also with regards to housing and employment status, financial and food security, and inequalities related to adaptability and sustainability (Blake & Wadhwa, 2020). Few crises before the current pandemic have severely impacted this many people in such a short time frame. While many governments tried to proactively mitigate risk and contain viral spread, poor infrastructure and overall unpreparedness limited efforts to effectively keep up with health service demands.
Across the globe, health systems at every level have been overloaded. From stretching the physical capacity of facilities to pushing the limits of providers’ mental, emotional, and physical strength, the stress on the system at large has been appropriately referred to as being “unprecedented.” In the midst of a healthcare challenge, systems must be resilient enough to maintain consistent care while simultaneously being able to address urgent and emergent disease (Kruck et. al. 2017). System resiliency relies, in large part, upon the wellbeing, strength, and availability of the healthcare workforce to provide high-quality care safely and consistently amidst health system shocks. While this scenario has played out before, lessons and adaptations continue to be gleaned from each subsequent health crisis.
During the 2009-H1N1 pandemic, the ability of countries to appropriately respond and provide adequate care was undermined by their inability to access assistance (PAHO 2010; Wilson, Brownstein, and Fidler 2010). In the context of the COVID-19 pandemic, access to personal protective equipment (PPE) and a sufficient health workforce were essential needs that were only sporadically met across health systems. The rapidly changing landscape of recommendations, unstable supply chains, and exponential growth of patients with COVID-19 impeded many health systems’ abilities to effectively respond to the pandemic. These issues were systemically exacerbated by the political climate, dismissal of health officers, and resignation of public health officials (Al-Arshani, 2020; Makridis & Rothwell, 2020; Press et al., 2020; Halverson et al., 2021). Impactful rapid response frameworks and successful longer-term strategic prevention plans are contingent upon public health leaders’ abilities to collect and disseminate information transparently, gain political will, and effectively communicate a consistent plan of action to the public.
The effectiveness of pandemic response measures is also dependent on which authoritative figures are given the responsibility to guide the general population through health crises. Medical providers and clinicians are vital in commanding operations within the healthcare sphere–but there is more power in collecting, analyzing, and disseminating relevant risk communication information to the public if clinicians and government officials partner with public health professionals to do so, particularly those who hold a DrPH. Such professionals have been specifically trained in epidemiology, crisis management, disease surveillance, risk communication, health literacy, community needs assessments, and quality improvement methods to enhance the delivery and efficiency of services.
Despite the availability of and access to such a specific combination of skills, these trained professionals do not yet necessarily have a consistent seat at the table to share knowledge and effectively inform policies. This is in part due to the fact that the field of public health–let alone the role of those with DrPH degrees–was largely unknown to the average person before the pandemic. This invisibility has become apparent through poorly coordinated response plans, dissemination and perpetuation of disinformation, as well as through the disconnect between decision makers and community stakeholders (Castrucci, Juliano, & Inglesby, 2021).
Public health professionals, especially those with DrPH degrees, should be considered and included as valuable contributors to initial surveillance and disease control recommendations. Per their training, DrPH professionals are uniquely equipped to promote community engagement and conduct tailored needs assessments to quickly identify which priority targets to engage, based on the highest risk and/or need. Subsequently, government entities could lean on such recommendations in order to allocate resources accordingly. Health indicators and measures could be improved to minimize variation in terms of what and how data are collected and reported, and such consistency in expertise would aid in data analyses and thus consequential recommendations. DrPH professionals would also help inform leadership collaboration across disciplines and advise on how to curtail disruptive organizational turnover, grounded in their training of elevating partnerships in acknowledging that “no one leader has all of the answers” (Halverson et al., 2021).
Lastly, DrPH professionals would utilize the CEPH (Council on Education for Public Health) competencies, which are embedded in the philosophy of public health programs, including the DrPH, to engage community stakeholders, promote health advocacy, encourage critical analyses, and influence decision making, policies, and laws (ASPH, 2009; The World Bank, 2020). They would interpret and translate evidence-based information for the general public in a manner that would be tailored according to individuals’ literacy levels, ultimately ensuring the likelihood of positively modifying behaviors (Paakkari & Okan, 2020). Risk would also be communicated through cohesive messaging for all members of society, from community to state to national levels.
Even beyond the collective contributions listed, the impact of applied public health practitioners in leadership and decision-making positions in a crisis extends beyond personal aspirations or individual organizations’ success. DrPH-trained leaders’ sphere of influence spans individual to population health, primary and secondary prevention, education and emergency preparedness, short- and long-term health outcomes (American Public Health Association, 2021). All organizations seeking to influence health would be behooved to include a doctoral-level public health practitioner within their ranks.
Public health has never been as visible—and the need for trained public health leaders has never been as critical—as it is today. We recommend the following actions be championed by DrPH practitioners to improve the resilience of our global health care systems:
The applied knowledge and expertise associated with a DrPH are critical in skillfully navigating complex situations that concern the population’s health. Without specialized public health leadership, experts in other fields may not be able to integrate or translate information as effectively. In looking ahead, public health professionals should be incorporated into decision-making processes for all matters related to community health, be it the current pandemic or future crises. Having professionals with such skillsets will aid in emergency preparedness, reliable data collection, community health advocacy, cohesive messaging, and integration of professional networks to successfully collaborate across disciplines (Michener et al., 2020). Moreover, the values and insights contributed by public health professionals can be applied by experts in other fields who may wish to adopt an interdependent and cooperative mindset that will equip them to efficiently handle matters in their respective settings.
The authors are public health professionals and DrPH students at the Johns Hopkins Bloomberg School of Public Health. By applying the skills they have acquired in the program to their workplaces this past year, they recognized first-hand the value of DrPH professionals in addressing health crises. These experiences have emphasized the importance of including those who have earned or are working towards their DrPH in the planning, implementation, and communication of public health responses. Medical doctors have been taught to treat patients, and politicians have extensive experience in implementing policies—but DrPH professionals have been specifically trained to bridge the gap between clinical practice and governmental policy, to drive adaptive decision making, and to lead interdisciplinary teams in the response, management, and mitigation of health emergencies. Ultimately, this experience and training will empower teams that are spearheaded by DrPH practitioners to handle—and even prevent—the next global health crisis.
Brittany Comunale leads operations for a biotech company in San Diego that is currently developing one of the COVID-19 vaccines. Her work involves coordinating research activities with international partners, developing policy memos and crisis management plans for collaborating governments and health ministries, and ensuring compliance with industry, regulatory, and ethical standards for clinical research trials. Brittany is also a certified Clinical Research Coordinator (CCRC) and Project Management Professional (PMP). She serves on the Clinical Research Ethics Committee for the Association of Clinical Research Professionals (ACRP). Brittany is currently a DrPH student in Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health, and holds an MPH from The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, an MBA from Heider College of Business at Creighton University, and a BSc from Brown University.
Erin Jackson-Ward is the Director of Community Benefit Giving at Cedars-Sinai in Los Angeles, with oversight of a philanthropic portfolio that disbursed $30 million in 2021 in support of community-based organizations serving vulnerable populations. Erin directed the strategic redesign of the Cedars-Sinai’s funding priority areas, which include Access to Care, Social Determinants of Health and Civic Engagement. Prior to joining Cedars-Sinai, Erin was involved with many nonprofit organizations throughout the country, working primarily on the sociomedical needs of pediatric HIV, homeless, and formerly incarcerated populations. Erin is a current DrPH student in Health Management and Leadership at the Johns Hopkins Bloomberg School of Public Health, and holds both an MPH from Columbia University and a BA in Psychology and Genetics from UCLA.
Stacey Davis is a seasoned public health professional with over a decade of experience working in county public health departments in communicable disease control and epidemiology. She is currently managing various aspects of COVID-19 response at the County of San Bernardino Department of Public Health in California. Her experience also includes working in the safety net health system managing various value-based care and population health initiatives. Stacey is currently a DrPH student in Health Policy & Management with a focus in Quality & Patient Safety at Johns Hopkins Bloomberg School of Public Health. She has a Bachelor degree in Biology w/ Environmental Studies from Dartmouth College and a MPH in Infectious Disease from the University of California, Berkeley.
Abigail (Abi) Baldridge is the Director of Statistics at Bluhm Cardiovascular Institute and Assistant Director of Reach of the Center for Global Cardiovascular Health at Northwestern University. Abi partners with many research teams within and external to Northwestern University to advance their research initiatives, which comprehensively aim to improve global cardiovascular health and healthcare across the spectrum of disease prevention. She has a Bachelor of Science in Biomedical Engineering from Purdue University and Master of Science in Epidemiology and Biostatistics from Northwestern University. She is currently pursuing a Doctorate in Public Health, focused on Implementation Science, at Johns Hopkins University Bloomberg School of Public Health.
Laura Ward works at McLean Hospital in Belmont, Massachusetts as a researcher and consultant in the Neurobiology of Fear and Dissociative Disorders/Trauma Research Laboratories. Her work focuses on Trauma-Informed Care, Patient Centered Outcomes Research and Public Health Outreach. She also serves as a guest lecturer at the MGH/McLean Adult Psychiatry Residency Training Program. She received her MBA from The Tuck School and her MPH from The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth.