academic public health practice, higher education, organizational structure and culture, school of public health



  1. Dodds, Janice M.
  2. Calleson, Diane C.
  3. Eng, Eugenia
  4. Margolis, Lewis
  5. Moore, Karen


Schools of public health have been cautioned about producing graduates and research that were disconnected from public interest. Although institutions may implement a variety of strategies to rectify the situation, institutional structural and cultural barriers impede progress. Public health practice coordinators in accredited schools of public health were surveyed to describe the presence of structural and cultural barriers to academic public health practice using the Stevens model.1 Administrative leadership and faculty reward systems are described as critical to advance academic public health practice.


For over 15 years, leading thinkers in higher education have reproached universities for their minimal investment both in the transmission of knowledge and its application to societal problems.2-6 Ernest Lynton, a former Commonwealth Professor at the University of Massachusetts at Boston, noted, "with a quarter million full-time faculty members in institutions called universities, it is very difficult to maintain the position that all faculty are scholars capable of significant original research."3(p.20) Rather, Lynton supported faculty being encouraged to utilize their expertise in new and creative ways to serve communities. Furthermore, Harkavy cautioned that "[horizontal ellipsis] universities cannot afford to become islands of affluence, self-importance, and horticultural beauty in seas of squalor, violence, and despair."7(p.A48)


The Institute of Medicine8 made a similar caution to schools of public health (SPHs) for producing graduates and research that were disconnected from public interest. The Institute of Medicine8 called for SPHs to engage communities in organized efforts "to address the public interest in health by applying scientific and technical knowledge to prevent disease and promote health."8(p.7)


One key strategy for addressing the public interest is for SPHs to develop and support community-academic partnerships.5,9,10 As universities and SPHs attempted to redefine academic missions to become viable agents for change that would benefit communities, they quickly recognized that the barriers are embedded within the institutions themselves.5,11,12 Four barriers to academic health center community-academic partnerships include: (1) decentralized arenas of activity that inhibit planning of university-wide initiatives across disciplines; (2) no database system for monitoring, coordinating, or communicating the participation of communities in research, teaching, and service; (3) promotion and tenure criteria that reward faculty for generating knowledge, more than for its application; and (4) minimal skills to address the complexity of establishing and sustaining community-academic partnerships.13 These barriers could be defined as structural. Reducing or eliminating these barriers would require changes in an institution's structure, such as its resources and formal procedures for governing, rewarding, and up-dating its performance.14


Another type of institutional barrier to community-academic partnerships could be defined as cultural. An institution's culture is its "collective, shared understanding, identities, and activities [from which its members] derive meaning and motivation for their efforts from collective sense-making."15, p.145 Multiple subcultures often coexist in institutions, based on discipline, status (e.g., tenure track, clinical track), role (e.g., student, administrator), or other attributes. When an institution's structure is decentralized, such as the multiple departments in a school of public health (SPH), these subcultures can create boundaries.15 At the same time, structural change and cultural change are not necessarily concomitant. Fairweather16 observed that when academic institutions changed their mission statement and policies to promote teaching and public service, but their institutional culture did not change, their new mission was not achieved.