How American Schools of Public Health Are Shaping Global Health Strategies
Imagine an invisible shield protecting millions of people from disease, injury, and premature death. This is the work of public health—the science of protecting and improving the health of communities through education, policy, research, and disease prevention.
American schools of public health serve as multidisciplinary research centers driving innovation in population health.
Training the next generation of health professionals who track outbreaks, set standards, and develop health programs.
From the Rockefeller Foundation's visionary investments in the early 20th century to their modern-day role as multidisciplinary research powerhouses, American schools of public health have developed a distinctive model that offers both inspiring innovations and cautionary lessons for the United Kingdom and beyond 8 .
The creation of dedicated schools of public health in the United States represents a deliberate departure from the medical school model, born from a recognition that population health requires distinct expertise.
The catalyst came in 1914 when Wickliffe Rose of the Rockefeller Sanitary Commission, frustrated by the lack of dedicated public health officers during hookworm eradication campaigns, concluded that a new profession was needed—experts who would devote their entire careers to controlling disease and promoting health at a population level 8 .
The Social Security Act of 1935 dramatically expanded public health education, requiring states to establish minimal qualifications for health personnel and recommending at least one year of graduate education at an approved school of public health.
This legislation triggered unprecedented demand for public health credentials, shifting education toward practical training. By 1936, ten schools offered public health degrees, and by 1938, more than 4,000 people (including 1,000 physicians) had received public health training through federal funds distributed to states 8 .
Key Developments: First schools of public health established; Johns Hopkins (1918), Harvard, Toronto
Funding Sources: Rockefeller Foundation and other philanthropies
Educational Focus: Laboratory sciences, infectious diseases, biomedical research
Key Developments: Social Security Act spurs expansion; state universities create public health programs
Funding Sources: Federal and state funding through Public Health Service
Educational Focus: Practical training, public health administration, field training
Key Developments: Growth of social medicine concepts; increased research competition
Funding Sources: National Institutes of Health research grants
Educational Focus: Social and economic context of health, interdisciplinary approaches
Today's public health practice operates under a comprehensive framework known as the 10 Essential Public Health Services, originally released in 1994 and updated in 2020 to incorporate a stronger focus on equity 5 .
Population health status, factors that influence health, and community needs and assets.
Health problems and hazards affecting the population.
Inform and educate people about health, factors that influence it, and how to improve it.
Mobilize communities and partnerships to improve health.
Champion and implement policies, plans, and laws that impact health.
Use legal and regulatory actions designed to improve and protect public health.
Enable equitable access to individual services and care needed to be healthy.
Support a diverse and skilled public health workforce.
Enhance public health functions through evaluation, research, and quality improvement.
Build and maintain a strong organizational infrastructure for public health 5 .
This framework guides the work of diverse public health professionals, including epidemiologists tracking disease outbreaks, restaurant inspectors ensuring food safety, health educators developing community programs, policy analysts crafting health legislation, and environmental health specialists addressing pollution and other environmental risks .
The American experience with schools of public health offers valuable insights for the United Kingdom, where several medical schools have recently reorganized academic public health into 'schools of public health' or 'health sciences.' The U.S. model demonstrates both notable strengths and significant limitations in this regard 1 .
The UK system has historically maintained relatively close links between public health and medicine, and between academia and service, with a stronger focus on applied work.
| Feature | U.S. Model | UK Model | Implications |
|---|---|---|---|
| Structure | Independent schools of public health | Often integrated with medical schools | Independence fosters research focus; integration maintains clinical connections |
| Research vs. Practice | Excels in research; weaker in service leadership | Stronger connection between academia and service | U.S. produces more research; UK may be more effective at implementation |
| Funding Sources | Competitive federal grants; historic philanthropy | State funding; different incentive structures | U.S. system more research-intensive; UK system potentially more stable |
| Scope | Range from basic science to health policy | Traditionally more focused on applied work | U.S. approach more comprehensive; UK approach potentially more targeted |
For the UK, this suggests that while adopting the research advantages of the U.S. system might be beneficial, it should not abandon its traditional strengths. A balanced approach that encourages multidisciplinary research while maintaining strong ties to service public health and applied work would likely serve the UK best 1 .
Perhaps no single experiment better illustrates the ethical perils of public health research without proper oversight than the "Tuskegee Study of Untreated Syphilis in the Negro Male." This infamous study, conducted by the United States Public Health Service from 1932 until its exposure in 1972, represents one of the most egregious examples of medical racism in American history 3 .
The study began in 1932 with the stated goal to "observe the natural history of untreated syphilis" in Black populations. Researchers enrolled 600 African American men from Macon County, Alabama—399 with syphilis and 201 without. The subjects were told they were being treated for "bad blood," a colloquial term encompassing anemia, syphilis, fatigue and other conditions, but in reality, they received no meaningful treatment 3 .
The study must be understood within its historical context of pseudoscientific racism prevalent in the early 20th century. During this period, many medical authorities held harmful false beliefs about African Americans, including that they possessed primitive nervous systems, experienced less pain than white people, and had fundamentally different physiological responses to disease.
men died from syphilis or complications
wives were infected
children with congenital syphilis
participants alive when study ended
600 African American men enrolled without informed consent
Required testing and treatment for venereal diseases; ignored by researchers
Denied to participants; USPHS opens Rapid Treatment Centers
World Health Organization publishes ethical guidelines; study continues
Peter Buxtun's whistleblowing ends study after 40 years
Congress establishes regulations for human subject research
The study finally ended in 1972 after Peter Buxtun, a whistleblower, leaked information to the New York Times, which published a front-page exposé. The resulting public outrage led to:
The legacy of Tuskegee continues to affect American healthcare today. Studies estimate that the disclosure of the study reduced the life expectancy of black men by up to 1.4 years, and many believe it continues to impact the willingness of black individuals to participate in medical research 3 .
Modern public health researchers employ a diverse array of methods and frameworks to protect population health while maintaining rigorous ethical standards.
Ongoing collection and analysis of health data to track disease patterns and outbreaks, enabling rapid response to emerging threats.
Comprehensive roadmap for public health activities, emphasizing equity and removal of systemic barriers to health 5 .
Independent committees that review research involving human subjects to ensure ethical standards, including informed consent 3 .
Systematic processes to identify community health needs and assets, enabling targeted interventions addressing local priorities.
Methods for evaluating potential health impacts of policies, laws, and regulations before implementation.
Science-based approaches to effectively inform and educate diverse populations about health risks and protective behaviors.
This toolkit continues to evolve, incorporating new technologies like data science and artificial intelligence while maintaining its foundation in ethical principles developed through difficult lessons like the Tuskegee Study.
The American experience with schools of public health offers a complex picture of scientific excellence coupled with ethical challenges.
The U.S. model demonstrates the research advantages of independent, well-funded institutions that bring together multidisciplinary teams.
The Tuskegee study serves as an enduring reminder that without proper ethical safeguards, public health interventions can cause profound harm.
For the United Kingdom and other nations, the optimal approach may lie in synthesizing the strengths of different models.
Most importantly, any public health system must center equity, ethics, and community engagement to avoid repeating catastrophic moral failures.
As global health threats continue to evolve—from pandemics to climate change to antimicrobial resistance—the role of public health education has never been more critical. By learning from both the triumphs and failures of different approaches, nations can build public health systems that effectively protect population health while maintaining the trust and respecting the dignity of all communities served.