Public Health, Inc.

Most people don’t think of schools of public health in terms of traditional business models. But at today’s top universities, the study of population health and prevention is a complex multimillion-dollar enterprise—one that requires the strategic planning and high-stakes decision making of other industries.

Researchers face pressure to think boldly about growing new and traditional research programs in an increasingly competitive grant-funding environment. Educators must keep pace with public health fields that have changed more in the past decade than perhaps at any time to date. And institutions are competing for students on a global scale in ways no one could have imagined just a few years ago.

While academic public health may seem a world apart from the business sector, the challenges are strikingly similar: embrace technology, anticipate new markets, and compete globally— all in a vulnerable economy. The added threat to academic public heath is a turbulent political debate that questions the very act of publicly investing in health, education, and the well-being of populations.

The changing business of educating professionals and researching population health has important implications, in light of public disinvestment in higher education. It means the walls between the public and private sectors will continue to come down. It means new educational opportunities must continue to develop for working professionals. And it means unprecedented threats to longstanding workforce training initiatives and new worries over federal research funding. But for those organizations willing to think entrepreneurially, it also means new opportunities.

Entrepreneurial history

An entrepreneurial spirit has for years been at the heart of the mission of the University of Minnesota School of Public Health. At various times throughout the school’s history it has resulted in dramatic shifts in the way the organization conducts business. In the 1980s, it meant the SPH went from being primarily an educator for preventive medicine (aimed at mainly nurses and doctors) to an organization that was also focused on research. By the late ’80s, the institution was leading some of the earliest and largest community-based health interventions— many of them still going today.

But the school had not made gains in educational programing. In 1998, the student body was 362, far less than some of the SPH’s competitors. School leaders worked to add new programs and revamp curricula in anticipation of emerging areas and to meet the needs of the practice community. By 2003, the student body had more than doubled. Today, it has nearly quadrupled, with 1,237 students.
Funding vs Medical School, College of Engineering

The faculty, numbering around 135, is also the largest in school history, growing by nearly 50 percent since 2004. In the process, the school’s research portfolio has grown to record highs. Sponsored research in 2010 stood at $65 million, or $113 million in terms of multi-year awards.

“We’ve always had think entrepreneurially,” says Joe Weisenburger, SPH chief administrative officer and chief financial officer. “State support has historically been a small part of school funding, so finding other sources of revenue has always been an important part of how we do business.”

Productivity powerhouse

A cornerstone of the school’s growth is founded in a culture that encourages each faculty member to secure at least half of his or her annual support from extramurally funded research. The model means that the school grows at a financially manageable pace, and that research is focused on issues of strategic value to the faculty, school, and University. It has also made the school’s faculty one of the most productive groups of researchers in the country. Since 2007, the SPH has ranked first in research awards per capita from the National Institutes of Health.

Among all units at the University of Minnesota, the SPH is solidly first in external support expenditures per faculty member. That means that on average the school’s 135 faculty members each carried about $840,000 in sponsored awards in fiscal year 2010. The next closest unit at the University is the College of Science and Engineering, with about $359,000 in awards per faculty member. If one considers only the full-time equivalent SPH faculty, awards become about $1 million per member. “No other unit at the University—and I dare say no other school of public health—comes close to our level of faculty productivity,” says SPH dean John Finnegan. “Raw numbers are indicative, but you have to drill down. It’s really the scientific and public impact of our work that matters most.”

E-learning takes off

Another area of growth that keeps the SPH engine humming is online education. In 2002, school leaders committed several million dollars over 10 years to develop online programs. By 2006, that investment helped to bring in $20 million in workforce training grants, $10 million in online course tuition, and $11 million in tuition through the school’s Public Health Practice major, a program that blends online and on-campus learning. The overall result was about $8 returned for every $1 invested in online programs, which now accounts for more than 20 percent of the school’s annual tuition revenue.

Despite state disinvestment in higher education, the SPH has managed to keep tuition at a reasonable level, compared to its chief public university competitors. Of the six highest ranked public university-based schools of public health—according to the latest U.S. News and World Report ranking—Minnesota’s resident tuition ranks fourth while its non-resident tuition ranks sixth.

A large portion of e-learning courses are directed to students in Public Health Practice, a program aimed at working professionals who seek training to advance their careers. Public Health Practice became the fastest growing major at the school and is now its largest. Since 2002, the program has educated 360 students, who have earned either certificates or MPH degrees.

The program has become the largest in the country for Doctor of Veterinary Medicine students (from universities nationwide) who wish to earn an MPH. Certificate programs have proven to be an important draw for professionals who may not be willing to initially commit to a degree program, with about half of those students going on to earn an MPH. The school’s latest program for working professionals—an executive MHA—has exceeded expectations, admitting 75 students since 2010, its inaugural year, and generating 10 times more inquiries than available spots for incoming classes.

Threats to workforce training

Beyond certificates and degrees, the SPH works to meet the work force training needs of the public health practice community. That mission has been the focus of the school’s Centers for Public Health Education and Outreach (CPHEO).

When CPHEO opened for business 11 years ago, it was faced with responding to the needs of a post 9/11 world. With a mission to educate professionals and encourage lifelong learning among SPH graduates, CPHEO not only met those needs but anticipated many of the emerging public health issues of the past decade—from preventing the spread of pandemic influenza to protecting our global food systems to addressing the growing influence of genomics.

In the past decade, some 35,000 people have participated in face-to-face courses offered to various sectors of the workforce, including first-responders and emergency preparedness professionals throughout Minnesota and the Midwest. In the past five years, nearly 24,000 people have created accounts to participate in CPHEO online learning opportunities. Steadily, workforce training has moved beyond the region. In the past five years, CPHEO courses have reached participants in 101 countries.

While these programs have been highly successful at meeting the needs of the practice community, right now they face unprecedented federal funding cuts. The federal budget debate in Washington is expected to go into the summer before decisions are reached on whether to eliminate programs that train workers in the areas of public health preparedness and occupational health and safety.

“Eliminating funding in these areas will have a significant impact on our ability to protect workers and to respond to future emergencies and disasters,” says Sue Borowick, director of CPHEO. “The frightening thing is that the public may not realize the impact of these cuts until the next disaster hits.”

Precarious state support

The school’s era of dramatic growth—in terms of research support, students, and faculty ranks—has occurred in a time of equally dramatic cuts in state support. In 1993, state support was 18 percent of total school funding. Currently, it’s about 10 percent. From fiscal year 2009 through fiscal year 2011, state support has dropped 21 percent. It’s very likely that in the next fiscal year state support will shrink to an all-time low at the SPH and, as a result, tuition will continue to rise. “We’re starting to resemble a private school housed within a larger public university,” says Weisenburger.

Finnegan agrees, saying. “The very concept of ‘public’ education has changed. Our school is more state-located than state-funded.”

As a result, Finnegan says the school must, more than ever, rely on private support for student scholarships, and that students have already been affected, for the worse, by the drop in state investment. “The barriers to pursuing education are growing,” he says. “More and more of our students are taking on bigger loans to finance their education. The situation is not nearly as bad for our students as it is in most of the licensed health professions, but it is a concern nonetheless.”

A global ‘common cents’ approach

As federal and state-level public investments in academic public health continue to decline nationwide, it marks the beginning of a new era of collaboration. “For public health to thrive, we need to continue seeking out new partners at home and around the world,” says Finnegan.

That mindset has helped usher in an era of global research, education, and outreach for the school. Many of the initiatives unite the SPH in new collaborations with the College of Veterinary Medicine, School of Nursing, and Medical School. The work touches on infectious diseases such as AIDS, pandemic influenza, and emerging zoonotic diseases that pose a threat to both animals and humans. Partners include govern ment agencies and private-sector organizations. Other projects involve ramping up public health education and hinfrastructure in India, Africa, Thailand, and South America.

While a fragile worldwide economy hampers public health funding, it also serves as the impetus for organizations to pool resources and collaborate. “Governments and businesses are realizing that preventing disease isn’t just the right thing to do, it also makes good business sense,” says Finnegan. “It’s a ‘common cents’ approach that I think will continue to become more prominent in the coming years.”