Academic turfitis and budgets: public health undergraduate education (by Jonathan Mayer)

In the mid 1990s, I was asked by the Dean of the School of Public Health to develop a Minor and Public Health at the University of Washington, and it became so popular that we decided to extend that into one of the first undergraduate majors in Public Health. I developed this as well, with one other colleague, and directed this for one year, and then co-directed it. At first, because there was no budget, we did this as volunteers. We were both convinced that exposing undergraduates to public health as part of a general undergraduate education–to issues of health and well-being, and to global health–was an essential part of any broad undergraduate education. We finally were allocated a very small budget.

We structured the major in a manner that emphasized courses outside of the health sciences. In part, that was because there were very few undergraduate courses in public health, but even more than that, it was for intellectual reasons. We emphasized the geographical, economic, social, political, environmental, and biological influences on population and its health. We specifically did not want the degree to be a vocational degree, and were happy that we would be using mostly courses outside of the School of Public Health. Several of my own courses in the Department of Geography were required, and lest this seem self-serving, there was no budgetary advantage to doing this, either for the Department of Geography of for me. The real reason was that these courses fit the framework that we were using, and they were also among the very few public health courses for undergraduates at the entire University of Washington. The students enjoyed the major, and entry was very competitive. There were some years when we could accept only about 20% of the applicants.

Let us “fast forward” by a little over a decade. Like so many institutions, a new budgeting system called “activity based budgeting” was instituted. Cutting through all of the esoteric language, what this meant was that budgets would be allocated according to some complex formula considering student credit hours, grants, and other “productivity” measures. Much of this took place while I was on the Faculty Council of the School of Public Health, eventually serving as Chair, and thereby serving as the voice of the School’s faculty. There were many ironies in this. No unit of the UW were exempt from the new budgeting system, and at the same time, NIH grants were increasingly competitive. Almost all faculty members in my department–epidemiology–were and are dependent upon grants not only for their research, but for their salaries. The School gets almost no fixed monies from the State of Washington. However, people quickly realized that there could be one source of more stable funding: undergraduate teaching. Thus, for the first time, there was a real incentive to develop undergraduate courses.

In addition, the School;s administration also realized two things. First, that there would be a tremendous financial advantage to a very major expansion of the undergraduate major, and second, that the demand for the undergraduate major was higher than ever. As a result, all 5 departments in the School of Public Health developed a suite of excellent and exciting courses, and the major expanded for 50 students total to over 600, and it is still expanding. It is now rated as the top undergraduate program in public health in the US.

The next step is probably obvious. By the time of the major expansion, I was no longer the director or co-director of the major. First, two of my health and disease courses, like those in other departments, were no longer listed as required for the major. Within a year, the third course was no longer listed as required. There was a disincentive to have students take courses outside of the School of Public Health. The unintended consequence was that the enrollment in courses that I teach, and in similar courses, began to plummet, because the demand from the School of Public Health had dropped precipitously. Thus, there was a tremendous irony. I developed, directed, and then co-directed the major in public health. It was a boon to many departments in the College of Arts and Sciences, and students were getting a truly cosmopolitan view of public health. None of the students whom I knew who wanted beginning positions in public health failed to obtain them. There was a university-wide interest in public and population health.

With the new budgeting system, this all changed. There was university-wide rhetoric promoting interdisciplinary education, but the budgeting system that *did not need to be adopted* provided incentives to look inside and stay inside, and so this is exactly what happened.

From an intellectual viewpoint, I abhor what I call “turfitis”. “What does medical geography do that spatial epidemiology doesn’t do better?” is asked even more frequently than the converse. In the past, I have shut such discussions down, saying that such discussions are intellectually vacuous, and that we all share the common goal of understanding health and disease, in a manner analogous to that of systems biology, in which there is so much overlap that the disciplines themselves become unimportant. Intellectually, I still feel strongly that this is the case. But does the new budgeting scheme even allow us to be primarily concerned with the intellectual over the pragmatic, or the scientific over the budgetary?

I find myself truly straddling a fence. I have a joint appointment in the Department of Geography and in the Department of Epidemiology. What one of them gains in terms of enrolments, the other might lose. In addition, my appointments are in the School of Medicine and in two other departments in the School of Public Health.

Yes, the budgeting system is “transparent.” It hinders the very type of study that is so important in an era of cross-disciplinary understanding of complex phenomena such as health and disease. It promotes provincialism. It hinders looking outside of a particular discipline. The students are poorer, because of it. The institution is poorer because of it. It is a poorly advised additional step to the ever continuing corporatization of the industrial university. I regret for many reasons that this kind of system was ever adopted. It is one of the reasons that I am happy that the end of my university affiliated career is far nearer than its beginning. Turfitis begins to loom ever above us, perhaps even influencing the way in which we think.


About epihealth

Professor Emeritus of Epidemiology and Medical Geography, University of Washington, Seattle. Formerly Adjunct Prof, Depts of Medicine (Div of Infectious Diseases), Family Medicine, Health Services, and Global Health. President, Health Improvement and Promotion Alliance-Ghana Expertise in infectious diseases, epidemiology and clinical epidemiology, epi. of pain, community health, travel medicine, tuberculosis, disease control.
This entry was posted in epidemiology, Health, higher education, medical and health geography, public health, science, Uncategorized and tagged . Bookmark the permalink.

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