Although service has traditionally been viewed as a responsibility of academic faculty, it has been seen as less important than the functions of teaching and research. However, in public health there is growing discussion about the importance of service as a scholarly activity that contributes not only to the knowledge base but also to improving the health of the public. This section examines the role of academia in providing service to the community through collaborative efforts (participation in training centers and institutes, service learning, and other mechanisms). Next, barriers to active participation in service are discussed, and a recommendation for overcoming the impediments to faculty participation in scholarly service activities is made.

A Pew Health Professions Commission report (O'Neil, 1998) stated, "The nation and its health professionals will be best served when public service is a significant part of the typical path to professional practice." The academic community provides three kinds of service:

1. Community service, that is, service to state and local health departments, community organizations, and individuals;

2. Policy guidance, that is, helping to inform the public debate; and

3. Service to the profession, for example, providing peer review for professional journals, serving as officers of professional associations, and serving on committees both within academia and for professional organizations.

As the center of expertise in research and teaching, academia is uniquely positioned to provide technical assistance and service, based on credible evidence from its research and the expertise of its faculty and students, for the development and implementation of programs and policies designed to assure and improve the health of the public. For example, state public health departments might use academically developed information about computer technology and health informatics to implement a statewide surveillance and information system. Community workers might use the results of research on nutrition and behavior modification to organize a campaign designed to address the current obesity epidemic. Health care delivery systems use information and expertise developed in academia to design and implement smoking cessation programs and to coordinate efforts aimed at preventing and managing diabetes. Businesses and employers rely on academia for consultation on the design, implementation, and analysis of therapeutic intervention studies. Policy makers might respond to information emerging from academia that points to the need for new legislative or regulatory programs, for example, the presence of toxic residues in children resulting from exposure to residential pesticide use. Finally, the media use evidence developed in academia to inform the public regarding the impact of global infections on health.


As communities try to address their health issues in a comprehensive manner, all of the stakeholders will need to sort out their roles and responsibilities, which will vary from community to community. These interdependent sectors must address issues of shared responsibility for various aspects of community health and individual accountability for their actions. They also must participate in the process of communitywide social change that is necessary for health improvement efforts and related performance monitoring to succeed (IOM, 1997b).

Fundamental to effective service is effective collaboration. Emerging emphasis is being placed on academia's participation in collaborations, partnerships, and coalitions as mechanisms for improving the health of the public. Nelson and colleagues (1999) define collaboration as "a purposive relationship between partners committed to pursuing both an individual and a collective benefit." According to Berkowitz (2000), collaboration is "a method used by members of communities when developing coalitions, by organizations when doing strategic planning, and by researchers who desire the partnership of those being studied." Feighery and Rogers (1990) define a coalition as "an organization of individuals representing diverse organizations, factions or constituencies who agree to work together in order to achieve a common goal."

Collaborations are attractive for a number of reasons. They emphasize communitywide behavioral change through the use of a "multicomponent, multisector" approach to changing the environments that establish and maintain behaviors (Roussos and Fawcett, 2000). Success in affecting today's public health problems and their determinants requires the resources and trust relationships of a broad-based coalition of partners (Green et al., 2001). Bringing together people with different perspectives increases the potential to identify new and better ways of thinking about health issues (Lasker, 2000). Additionally, governmental financial and programmatic constraints require health partnerships, coalitions, and shared resources to achieve public health objectives (Baker et al., 1994).

What makes for a successful collaboration? The results of a study conducted by Kegler and colleagues (1998) to identify factors that contribute to coalition effectiveness suggest that coalitions with higher-quality action plans are better able to mobilize resources and implement activities, and that good communication, devotion of sufficient staff time to the coalition, a sense of cohesion, and a defined structure with multiple task forces appear to be related to the ability to implement activities. Such findings support the idea that developmental or formative activities are important for project success. Butterfoss and colleagues (1993) suggest that coalitions develop in stages (formation, implementation, maintenance, and outcomes) and that different sets of factors may be important to coalition functioning at each stage. For example, articulation of a clear mission, a spirit of cooperation, and positive expectations of outcomes are important during the formation stage, whereas formalization or definition of operational procedures, a strong central leadership, pooling of member assets (e.g., staff support, fundraising capability, meeting space, and access to relevant policy makers), the degree of membership participation, the continued perception of the partners that the benefits outweigh the costs of participation, and skills training are important during the implementation and maintenance stages.

Active involvement by many different parts of the community is believed to increase the likelihood of success for collaborative efforts (Feighery and Rogers, 1990; Israel et al., 1998; Lantz et al., 2001; Seifer and Krauer, 2001). Coalitions take time to coalesce; and the issues to be addressed immediately include agreement on a mission statement with goals and objectives, clarification of roles and relationships, definition of a decision-making process, development of an organizational structure, the frequency and length of meetings, and the benefits for each member of the coalition (Feighery and Rogers, 1990).

The benefits of successful collaborative efforts and partnerships are many. Collaborations can reduce disparity in access to information, resources, and skills; increase public health's understanding of community needs and assets; and lead to the development of a process for continual improvement in public policy and health systems (Berkowitz, 2000). Additional benefits include the freedom to become involved in new issues without bearing sole responsibility for managing or developing those issues; developing widespread public support for issues, actions, or unmet needs; developing a critical mass for action; minimizing duplication of effort and services; mobilizing a broad array of talents, resources, and approaches to problem solving; providing a mechanism for recruiting participants with diverse backgrounds and beliefs; and having flexibility in providing an opportunity to exploit new resources in changing situations (Butterfoss et al., 1993; Green et al., 2001).

Centers and Institutes

Academia engages in service to the community in many ways. One approach to service is through various centers and institutes. For example, in 2002 the University of Washington's Center for Ecogenetics and Environmental Health conducted a town meeting to engage in discussions with the community on racial disparity, poverty, and pollution. Activities brought together researchers, legislators, and community members to discuss the health risks of pesticides to agricultural workers and their families, contamination of seafood by marine toxins and chemical pollutants, hazardous waste sites, culturally appropriate research strategies, and links between indoor and outdoor air pollution and asthma. These discussions led to a number of projects designed to address community-identified concerns and needs.

The three newly funded CDC Centers for Genomics and Public Health, located at the University of Michigan, University of North Carolina, and University of Washington, are another mechanism through which service to the community can be provided. Each center will develop a regional hub of expertise for the use of genetic information to improve health and prevent disease. In addition to contributing to the knowledge base on genomics and public health and providing training for the public health workforce, the centers are to provide technical assistance to regional, state, and local public health organizations. "With this collaborative approach, CDC hopes to

. . . demonstrate—through real examples—the translation of gene discoveries into disease prevention and improved health" (CDC, 2001d).

Of primary importance in providing service to the working public health community is the Public Health Leadership Institute. The institute was developed as a collaborative effort of CDC and the Western Consortium for Public Health to provide leadership training for senior public health officers in state and local health departments. The University of North Carolina now coordinates its efforts. Each year a cohort of senior public health officials is selected to participate in a 12-month program that includes self-study, teleconferences, electronic seminars, action-learning projects, and an intensive on-campus week. The curriculum is centered around four modules concerning the challenges to public health: the study of the future, leadership and vision, communication and information, and political and social change (Scutchfield et al., 1995). The institute has spawned the development and growth of regional leadership training efforts aimed at increasing the leadership skills of public health practitioners at various levels of the system. Other approaches to service include the summer institutes and courses discussed above in the section Education and Training. These institutes and courses provide education and training to state and local health departments and other members of the community.

Academia's contributions to service also can be seen in the work of the Centers for Public Health Preparedness funded by CDC. There are academic centers, specialty centers, and local exemplar centers (see Table 8-3).

Academic centers aim to increase individual preparedness at the front line by linking schools of public health, state and local public health agencies, and other academic and community health partners. Specialty centers focus on a topic, professional discipline, core public health competency, practice setting, or application of learning technology. Local exemplar centers develop advanced applications at the community level in three areas: integrated communications and information systems, advanced operational readiness assessment, and comprehensive training and evaluation. Table 83 lists the centers in existence as of the writing of this report.

The centers work in collaboration with partners across their regions to assure a well-trained and prepared public health workforce, informed health care providers, and an alert citizenry to protect against terrorism. In September 2000, CDC, the Association of Schools of Public Health, state and local public health agencies, and other academic communities entered into a partnership to begin development of a national system of Centers for Public Health Preparedness (DHHS, 2002).

Service learning (also discussed above in the section Education and Training) is another way in which academic institutions engage in community service. Academic service-learning organizations and activities are growing and include the following: (1) service-learning centers on college

TABLE 8-3 Centers for Public Health Preparedness

Type Location

Academic centers University of Illinois at Chicago School of Public Health

University of North Carolina, Chapel Hill, School of Public Health

University of Washington School of Public Health and

Community Medicine Columbia University Mailman School of Public Health University of Iowa College of Public Health University of South Florida College of Public Health St. Louis University School of Public Health

Specialty centers Dartmouth College Medical School Interactive Media


Saint Louis University School of Public Health

The Johns Hopkins University Bloomberg School of Public

Health and the Georgetown University Law Center University of Findlay (Ohio) National Center of Excellence for Environmental Management

Local exemplar centers DeKalb County Health Department Denver Public Health Monroe County Health Department campuses across the United States that support and facilitate student and faculty work in communities; (2) the National Service-Learning Exchange, which provides training and technical assistance to service-learning programs; (3) campus compact (a national organization of more than 750 college and university presidents), which offers workshops, tool kits, and publications aimed at encouraging student and faculty involvement in community and public service; (4) research opportunities and studies; and (5) a planned National Center for Service-Learning Research (Howard, 2001).

Barriers and Solutions

There are barriers to establishing successful collaborations and partnerships. Clark (1999) outlined four barriers or gaps:

• Communication—a lack of a shared language and emphases;

• Access—little access to skilled public health faculty by some practitioners and communities;

• Credibility—practitioner skepticism of academic understanding and vice versa; and

• Expectations—the failure of what it takes to operate in the real world to meet academic standards of scientific rigor.

Other investigators include as barriers perceived threats to a sense of autonomy, disagreement about community needs, conflicts over funding decisions, a lack of consensus about membership criteria or coalition structure, failure to include relevant constituencies, and a lack of leadership (Feighery and Rogers, 1990; Kreuter et al., 2000).

A continuing barrier to scholarly service and one of great concern relates to faculty rewards, promotion, and tenure. Public health practice activities are not generally valued or rewarded by most academic institutions. Israel and colleagues (2001) write that multiple means are needed to provide evidence and recognition of the scholarship of public health practice. They list a number of matters that must be addressed to overcome this barrier. For example, peer-reviewed journals must recognize difficult methodological issues associated with conducting community-based participatory research and should be willing to publish such articles. Universities need to expand their evaluation of reputable journals. Because faculty members may assist communities in preparing grant proposals, these activities should be recognized and valued by academic institutions. Similarly, training activities for and technical assistance to community partners should be given credit toward tenure and promotion.

Practice Scholarship

Efforts are in progress to overcome the institutional lack of recognition of public health practice and service as scholarly endeavors. Maurana and colleagues (2000) report on two evidence-based models for documenting and assessing community scholarship activities. The first model, the Points of Distinction Project, is part of the Outreach Committee of Michigan State University. This model identified quantitative and qualitative indicators of success for four dimensions of quality outreach. The service must have significance, in that the issues addressed are of importance and value to project goals. The context of the service is crucial, in that it should have a close fit with the environment, use appropriate expertise and methods, have a substantial degree of collaboration, and use resources sufficiently and creatively. The scholarship of the service should demonstrate appropriate application, generation, and use of knowledge. Lastly, the service should be able to demonstrate that it has influence on issues, institutions, and individuals.

The second model is the Competency-Based Model of Alverno College in Milwaukee, Wisconsin. This model divides scholarly activity into four competencies, each of which specifies skills, activities, and requirements that faculty must master for promotion. These skills include being able to teach effectively, work responsibly in the college community, develop and pursue a research agenda, and serve the wider community.

The model proposed by Maurana and colleagues (2000) defines community scholarship as "the products that result from active, systematic engagement of academics with communities for such purposes as addressing a community-identified need, studying community problems and issues, and engaging in the development of programs that improve health." They offer standards and criteria for assessment of this scholarship. Criteria evaluate goals, preparation, methods, results presentation, and reflective critique. The model also describes four types of community scholarship products:

1. Resources, such as how-to manuals, technical assistance, and tools and strategies to assess community strengths and assets or concerns;

2. Program outcomes, such as improved community health outcomes, increased community leadership and funding for health, and integration of students and residents into community-based efforts or creative education;

3. Dissemination, such as presentations, journal articles, and leadership at the national, state, and community levels; and

4. Other products, such as new or strengthened partnerships and coalitions and program development grants.

In Demonstrating Excellence, ASPH (1999: 9) discusses the issue of service as scholarship:

Service is relevant as scholarship if it requires the use of professional knowledge, or general knowledge that results from one's role as a faculty member. This knowledge is applied as consultant, professional expert, or technical advisor to the university community, the public health practice community, or professional practice organizations. The dimension of scholarship distinguishes practice-based service from a form of service known traditionally as the general responsibilities of citizenship.

To meet the requirements of scholarship as defined by ASPH, academic service must be provided through community-based participatory research, service learning or the work of the Prevention Research Centers, Centers for Genomics and Public Health, and Centers for Public Health Preparedness. Such activities to improve the health of the community not only fulfills academia's obligation of service but also expands the knowledge base and contributes to improvements in the health of the public. The value of these contributions is great and should be acknowledged by academic institutions in their promotion and tenure policies.

For these reasons, the committee recommends that academic institu tions develop criteria for recognizing and rewarding faculty scholarship related to service activities that strengthen public health practice.

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