Public Health Magazine: Winter 1995, Vol.5, No.1
Program profile: Health Promotion/Disease Prevention

Giving M.P.H. students hands-on experience

Smita Pamar describes an incident with one of her clients: a homeless man, incarcerated several times, chemically dependent, with serious health problems. He was standing among other clients on the bus while returning from an excursion. People were singing, playing games, and taking turns talking about the tuberculosis (TB) program in which they were participating. Pamar was surprised when the man said, "You're the only family I have. If it weren't for you I'd probably be dead."

In her practicum work on directly observed TB treatment, the Health Promotion Disease Prevention (HPDP) graduate encountered public health in its most immediate form. "It was one of the most profound experiences I've ever had," said Pamar, "the enormity of problems people face, their amazing spirit, and seeing how a small group of workers could have such an impact." She also saw how what she was learning on campus was put into effect. "People have to have the perception of being at risk, but with the ability to change," she said. "Then you have to have an enabling environment, accessibility, supportive staff, and a reinforced plan of care."

In the HPDP program, the message is driven home through course work and practica that preventive health behaviors are key to reducing the incidence of numerous chronic illnesses, such as heart disease, AIDS, TB, hypertension, diabetes and cancer. The basic mission is to train students to implement and evaluate health promotion projects in a variety of settings. The HPDP program offers an M.P.H. to prepare students for careers as health promotion specialists in government health agencies, community-based organizations, and the private sector.

According to SMS's program coordinator, Susan Milligan, M.A., the HPDP program began in 1991 in response to a growing need for trained prevention professionals, but the division was uncertain as to how many students might be interested in enrolling. Eight students enrolled in the first year, followed by 17 in 1992--93, 33 in 1993--94, and 52 in the current academic year. "The division is swamped with applications," Milligan said. "It's an idea whose time has come."

"In the three years since the HPDP program began," said Professor Marysol Asencio, Dr.P.H., "students have expressed interest, excitement and anxiety about the careers they will enter when they graduate." Career development is important because a significant portion of students who enter the HPDP program come directly from undergraduate school, explained Asencio, who is an SMS graduate herself and now is practicum director.

With funding from the federal Human Resource Services Administration (HRSA), the program includes field work opportunities in New York City's most medically underserved areas. "The idea was to make the program more practice oriented," said Robert Fullilove, Ed.D., director of the HPDP program. Now, students have the opportunity to integrate academic and social science principles with work in communities hit hardest with public health problems. "Everyone's talking about prevention," explained Fullilove. "But this is an area where we need people, better research, better practice. The hope is that it will lead to people doing better jobs."

As part of its HRSA grant, the HPDP program also has added several new courses, including Health Communications: Issues in Social Marketing; Media Interventions for Public Health; Community Development; and Health Promotion at the Worksite. In addition, the program has begun a mentoring program, designed to link HPDP graduates with students currently enrolled in the program.

Center co-director Donald Gemson, M.D., M.P.H., noted that the center is the only CDC prevention site that has an urban, African-American focus. Its mission--reduction of morbidity and mortality in Harlem--stems from a now-famous study, "Excess Mortality in Harlem," which found that a man in Harlem is less likely to reach the age of 65 than a man in Bangladesh.

Working with community organizations, government and private agencies, the Harlem Center is finding out how to prevent the afflictions of America's inner city--diseases like prostate cancer, which has a higher incidence in Harlem than anywhere else in the world. The center is trying to identify risk factors for other health problems prevalent in Harlem: Alzheimer's, hypertension, teen pregnancy, liver disease, high cholesterol, and asthma. The center is also educating local physicians in preventive care, and developing the principles necessary for successful intervention in other "hard to reach" inner-city, African- American communities.

"HPDP is riding the crest of the future of public health," notes division head Litwak. "As containing health costs becomes more important for the nation and as we learn more about the factors that lead to poor health, keeping populations healthy will need to become a major focus. Our program will be training new generations of leaders to meet the challenges."