The importance of public health became glaringly apparent through the COVID-19 crisis, prompting a soaring demand — and interest — in public health degrees and careers.
According to the Association of Schools and Programs of Public Health Schools, applications for undergraduate and graduate programs increased 23% from 2019-20. Between 2020 and 2021, that number jumped 40%.
That trend is playing out locally as well, says Ameena Batada, a professor in the health and wellness department at UNC Asheville and co-director of UNC Asheville-UNC Gillings Master of Public Health program in Chapel Hill.
“One of the changes during and in the wake of the pandemic is that a lot more people understand what public health is and are tuned into public health, which has raised a lot of interest among students wanting to pursue public health careers,” Batada explains. “We’ve had several people who were contact tracers during the pandemic or who worked with COVID-19-related response jobs come into our program because of that direct interest.”
The 21-month masters degree program, which launched in 2018, is through the UNC Asheville-UNC Gillings in Chapel Hill, although the students study on the campus of the Mountain Area Health Education Center .
The school also announced a partnership in December with the WNC Health Network, an Asheville-based nonprofit that supports health and well-being programming in Western North Carolina. The partnership will give students more real-life experiences in various aspects of public health within the region.
Batada says students are drawn to public health for a variety of reasons, including a desire to engage in social justice, earn a sustainable living and contribute to social good.
“We’ve had pharmacists and people in the dental field come through — as well as medical doctors and Ph.D.s — who want to get that public health lens,” Batada adds. “They want to be better equipped to do their jobs and to influence systemic change.”
But as the demand for public health education rises, future public health practitioners are considering how to address the mistrust of governmental institutions and the larger medical industry spurred by the pandemic.
Seat belts, cigarettes and alcohol
While the field of public health has been around for more than a century and touches many aspects of life, many people may not have considered the subject until they were impacted by public health decisions during the pandemic.
“I don’t think that most people had really thought of public health before, and then maybe during the pandemic and people think about [Dr. Anthony] Fauci as a public health practitioner who stands up in front of people and tells them to wear masks,” says Dakotah Fozzard, a first-year master of public health student with an undergraduate degree in food, nutrition and health.
Fozzard says that public health has been behind well-known health campaigns such as educating women about the dangers of drinking alcohol while pregnant, promoting seat belt use and highlighting the risks of smoking.
“But public health is so much more than that. It is broad, it is impacting everybody’s lives all the time,” Fozzard says. “This stuff is everywhere.”
Today, the field of public health encompasses public health policy, communications, environmental health, sanitation and more.
“Right now, there are a lot of opportunities in public health because it is so broad. Transportation, education, even access to housing, wages and economic stability may be seen through a public health lens,” says Batada.
That rings true for Amber Chapman, also in the UNC Asheville-UNC Gillings Master of Public Health program. Chapman, who graduated with an undergraduate degree in gerontology and began working with aging adults, now works as a clinical partnership adviser at the N.C. Center for Health and Wellness.
She was drawn to the public health degree as a way to enhance her understanding of the interconnectedness of the health care system and to increase access to resources for aging populations.
“Before the pandemic, I had no idea that everything I had done before was public health,” Chapman explains. “I really wanted to deepen my understanding of the systems that are in place and how to communicate that, which can be really hard to understand unless you have the background and education.”
For her part, Fozzard, who has a background in nutrition and loves agriculture and farming, is pursuing a public health degree to address the health and wellness needs of farmers and seasonal migrant workers.
Keeping it local
While the field of public health may suggest national or even global health policy, Fozzard says the UNC Asheville-UNC Gillings public health program emphasizes “place-based” health, which homes in on regional or even neighborhood-level health needs and concerns.
“You could really zoom in on each community, and each community has totally different health issues that they’re facing and priorities that they want to have. Appalachia has its own culture, its own place. And therefore, it’s going to have its own sort of struggles and priorities,” she explains. “And then even, there are microcommunities within Appalachia, within Western North Carolina.”
Some of those public health needs specific to Western North Carolina may include heart disease, substance use or a lack of mental health practitioners or other providers.
“We’re losing a lot of our services in rural areas, especially in terms of maternal health services and hospital services for certain populations,” Batada adds. “Some of the big areas of public health in our area are climate change and the environment, and also substance use, particularly e-cigarette use.”
“Public health practitioners do not need to look to other countries to find problems to solve. There are plenty of public health issues that we can work on here in Western North Carolina, and there are a lot of underserved communities,” adds Fozzard.
Batada says that students undertaking the public health degree have opportunities to work within their local communities, and many continue that work after graduating.
“In Western North Carolina, we’re committed to improving health in this region through the work we do,” Batada says. “And we have over 80% of our graduates who stay in the area and work here. That’s really important to us.”
While the pandemic brought a heightened awareness and increased demand to public health, it also thrust the field into the center of the highly politicized debate between personal choice and common good.
“[The pandemic] has increased a lot of people’s willingness to engage in public health measures,” says Batada. “However, I think that it has revived this debate between public good and individualism. And so there has been some backlash around public health [measures] because people see it as potentially limiting their rights or freedoms.”
Mistrust of public health initiatives and programs has been around as long as the field itself, says Fozzard. While some fear may be due to misinformation, government institutions, which are reacting to public health concerns, can and do make mistakes.
“Mistrust of institutions is an enormous roadblock for anybody who is working in the public health sector,” says Fozzard. “There have been a lot of mistakes in the past, so there’s lots of reasons why people have this feeling of distrust towards public health institutions. That’s totally fair. We should always have to be trying to prove ourselves as trustworthy because public health has harmed people in the past.”
She points to what she calls fear-based public health campaigns, such as abstinence-only sexual education or the Drug Abuse Resistance Education, otherwise known as DARE, that aims to prevent substance use. Studies show that the DARE program, which was implemented in 75% of U.S. schools in the 1990s, was found ineffective at preventing drug and alcohol use in part because of its zero-tolerance approach.
“These fear-based health programs often seem to backfire,” Fozzard notes. “It’s tough because the pandemic was such an emergency situation — so many people were dying — and you have to use whatever tools you can to try and help alleviate the situation for the sake of the whole population. But it’s important to design an appropriate campaign that gets more people to follow whatever public health policy you’re trying to institute without making them feel ashamed, afraid or stigmatized.”
Chapman says she sees the role of public health practitioners as interpreters that share health information in plain language, while allowing individuals and families to make their own decisions about health.
“People don’t like to be told what to do,” Chapman says with a laugh. “And that’s not our job. Our job is giving them all the tools and resources and education and also leading with empathy and figuring out what works and what doesn’t. What we’re seeing now is that people are really starting to understand that they’re masters of their own health and that they’re going to take care of themselves. And we have to give them the tools and resources to do so.”
Both Fozzard and Chapman say that the person delivering public health messages is important. Public health practitioners should partner with community members, faith leaders and others to start conversations about health early before public health crises emerge.
“I think one of the major issues with public health is that in the past, it’s sort of been this delivery from ‘on high’ sort of situation, and there’s no reason why people should feel good about that or reason why they should follow that,” says Fozzard. “If you choose somebody that the community trusts to deliver that message, that health program is going go a lot further.”