We are indebted to our guest editors, Paul Erwin and C. William Keck, for developing this comprehensive issue on "The Academic Health Department." They have assembled a series of 17 articles illustrating the scope and importance of this movement throughout the nation. Both Drs Erwin and Keck have careers combining administration of local health departments with academic institutions. Bill Keck is recognized as a pioneer in the field. In 2000, the Journal of Public Health Management and Practice published his article "Lessons Learned From an Academic Health Department."1

The seeds for establishing a teaching health department were sown in the early 20th century. In 1932, on the basis of plans initiated by William H. Welch, the Eastern Health District was established as a cooperative endeavor of the Baltimore City Health Department, the Johns Hopkins School of Hygiene and Public Health, and several voluntary agencies. With support of private funding (the Rockerfeller Foundation) and public funding (the US Public Health Service), this district permitted the training of personnel and students, thereby serving as an early example of the "teaching health department."2,3 Both public health students and senior medical students at the Johns Hopkins School of Hygiene and Public Health were able to rotate through the Eastern Health District. Public health students spent 6 mornings observing district activities for a required public health administration course, whereas senior medical students spent 2 mornings a week in district clinics. In addition, medical students received patient assignments and accompanied public health nurses on home visits.4 Similarly, in New York City, in 1939, teaching of public health students was facilitated by colocation of the Columbia University School of Public Health with the Washington Heights District Health Center of the New York City Department of Health.5

Most of the articles in this issue depict the advantages of the Academic Health Department in the education of public health students. When one of the authors (L.F.N.) was employed by the New York State Health Department supervising public health activities, he had the opportunity to also chair the Department of Epidemiology at the University of Albany School of Public Health. In this issue, Birkhead et al describe the unique arrangement of a state health department creating a school of public health in partnership with a university.

In addition to providing opportunities for public health students, the Academic Health Department provides a valuable opportunity to educate medical students on prevention and population health. When L.F.N. was State Health Director in Vermont from 1978 to 1982, he partnered with the State Epidemiologist and the Epidemic Intelligence Service Officer to develop a teaching health department at the Vermont College of Medicine. Unlike many preventive teaching activities for medical students at the time, this course was highly evaluated: the students believed they were learning "medicine," whereas the instructors thought they were teaching epidemiology.6 This Academic Health Department has continued and is currently flourishing under the leadership of Jan Carney, Associate Dean for Public Health and former Vermont State Health Director. Current second-year medical students use the Vermont Department of Public Health as the site for their required Public Health Projects course. Department of Public Health experts who are also UVM College of Medicine faculty teach in the "Introduction to Clinical Decision Making" course that combines epidemiology, genetics, and ethics. In addition, these faculty provide instruction for an online Graduate Certificate program in epidemiology, environmental health, surveillance, environmental risk, and risk communication.7-10

In a 2004 article in Academic Medicine, Dannenberg and coauthors,11 from the Centers for Disease Control and Prevention, identify 13 health departments as having supervised at least 3 medical students on elective rotations over the 5-year period from 1996 to 2001 and 1 state medical school that arranged student electives at either the state or local health department. The authors observe that, as was seen with the Vermont experience,

...that health departments can benefit from training enthusiastic medical students via such electives; these students bring fresh ideas to these departments.... Ideally, in the future every medical school will offer a state or local health department elective so that all medical students will become aware of the epidemiology and public health career options.

As noted by Erwin and Keck, another impetus to the formation of Academic Health Departments oriented to the teaching of medical students is the Regional Medicine Public Health Education Center led by Rika Maeshiro and funded by an American Medical Association Cooperative Agreement with the Centers for Disease Control and Prevention in 2 phases: 2003 (a pilot with 7 medical schools funded) and 2006-2010 (11 medical schools funded). A requirement for the first phase of funding was an affiliation between the medical school and a public health agency for teaching purposes. In the first phase, one of the Regional Medicine Public Health Education Centers was established at the SUNY Upstate Medical University with the Onondaga Health Department. One of the authors (L.F.N.) served as both the Director of the Preventive Medicine Program at Upstate Medical University and the Commissioner of the Onondaga Health Department. Onondaga Health Department physicians were employed through a contract with faculty members at SUNY Upstate. These faculty members also taught medical students prevention and epidemiology. This involvement continues currently with another author (C.M.M.), formerly one of the faculty members and now employed by the County as Health Commissioner, continuing to serve as faculty for the medical students.

Receipt of grant funding from the American Medical Association/Centers for Disease Control and Prevention and the Josiah Macy Foundation also enabled the expansion this teaching health department's role beyond the classroom into clerkships with construction of "Cases in Population-Oriented Prevention," teaching cases featuring the role of health departments in population and clinical prevention.12 Community site visits during which third- or fourth-year medical students are paired with public health staff were instituted in the pediatric clerkship. Of interest, with formation of the Central New York Master of Public Health program at Upstate Medical University and Syracuse University, this teaching health department is now used for public health students as well.

A teaching health department can provide significant advantages for the education of medical students in clinical and population-based preventive medicine. Because health departments are the focus of preventive and public health activities for the community, they can provide students with ideal opportunities to acquire and apply skills in preventive medicine just as a teaching hospital or an ambulatory clinical setting can provide a superb learning environment for students to develop clinical skills.

For those of us who have labored in the vineyards of teaching prevention to medical students, we can resonate with the statement of Wilson Smillie referring to this type of education in Promise for the Future, A Chronicle of the Development of Public Health in the United States, 1607-1914: "The subjects were assigned to one or more professors who were most interested in these fields, and a series of didactic lectures were given to apathetic and uninterested students."13 The Academic Health Department provides us with a more optimistic outlook.

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