Academic Health Department Partnerships: Bridging the Gap Between Town and Gown

Academic health department (AHD) partnerships are a formal affiliation between an academic institution and a public health practice organization and are certainly one mechanism available to remedy an academic–practice disconnect. AHDs, called “teaching health departments” by some, are not a new phenomenon, but they have been receiving increasing interest since the 1988 publication of the Institute of Medicine (IOM) report, “The Future of Public Health.” The report famously described public health in the United States as a “system in disarray.” Among the many deficiencies cataloged was a disconnect between academic programs in public health and public health practice settings—a situation with real ramifications for workforce training, student education, and research.¹ As the AHD concept has gained traction, researchers have begun to examine the nature and growth of AHDs. Case studies and reports describing the characteristics and prevalence of AHDs have appeared, and there is little doubt that there are benefits in terms of student training, health department capacity, and joint research efforts. A key question, however, and one of the most difficult to answer, is whether an AHD is more likely to deliver evidence-based public health services and foster advances in community health status than is a health department without an academic connection.

EVIDENCE-BASED PRACTICES

That is why the article by Erwin et al. (p. 739) is so important. It is the first to sample local health departments with the intent of determining whether evidence-based practices are more prevalent in health departments with academic partners. The findings that AHDs were more likely to engage in evidence-based decision making and to implement evidence-based public health services than are non-AHDs were encouraging outcomes of the study. These findings substantiate the authors’ suggestion that internal support for evidence-based decision making in local health departments, and that ready access to academicians who are knowledgeable about evidence-based public health practices and can participate in trainings, increase the likelihood that evidence-based interventions will be used.

Additional research must become a priority if we are to fully understand the potential benefits and possible shortcomings of academic–practice partnerships for both. An AHD research agenda that can provide some guidance for investigators interested in this topic has been developed under the auspices of the Council on Linkages Between Academia and Public Health Practice (Council on Linkages).² Erwin et al. detail research opportunities available because of existing data sources and the nature of the health department accreditation process. Prospects for valuable and groundbreaking research abound. In addition to community health status impact, it would be particularly helpful to know, for example, whether students in academic institutions that participate in AHD partnerships are better prepared for careers in governmental public health than are those in institutions without such partnerships, whether AHDs achieve accreditation through the Public Health Accreditation Board more efficiently than do non-AHDs, and whether academic programs and institutions achieve accreditation through the Council on Education for Public Health more efficiently if they are part of AHD partnerships. We should also wonder whether medical students and residents with work experience in AHDs are more likely to practice population-focused medicine.

AHD LEARNING COMMUNITY

To date, the only national effort to define, document, encourage, and support AHDs rests with the Academic Health Department Learning Community (AHDLC) of the Council on Linkages, which the Public Health Foundation staffs. In existence since 2011, the AHDLC brings together public health and health care professionals to share AHD-related knowledge and experiences and work collaboratively to support the development and enhancement of AHD partnerships across the country. Through this peer learning community, members can participate in meetings and webinars, engage in discussion, create and access resources and tools, and receive guidance to support AHD efforts. Resources, tools, and webinars are made publicly available on the AHDLC Web site.³ Membership has grown steadily over eight years to more than 1100 at this writing, indicating a strong and growing interest in the concept.

A great deal remains to be done, however, if this promising concept is to be well understood and applied more widely. Even with the need for more research, a growing number of practitioners and academics are finding value in AHD partnerships. Perhaps it is time for the profession to find the resources necessary to truly support a center—or user’s group, if you will—to better support and coordinate what is developing as a national movement. The AHDLC is playing that role and has been quite successful in bringing some clarity and coordination to the concept and in fostering communication among interested persons and institutions. Unfortunately, this support system is a bit tenuous. External funding for the effort has tightened, leading to limitations in what can be accomplished.

PUBLIC HEALTH RENAISSANCE

During the three decades since the IOM report, we have experienced a true public health renaissance. The report galvanized the public health community into action. Among the accomplishments that ensued, public health’s mission and core functions were defined. Essential services for community health were developed, as were national performance standards to measure them. Various sets of core competencies for public health students and workers were designed, certification for public health workers became available, and a national accreditation process for health departments was adopted. Public health services and systems research received new emphasis and funding support. Public health training centers were established, and meaningful practice experiences became required for public health students—providing one of the driving forces behind the expansion of AHDs.

Unfortunately, there has not been a concomitant renaissance in the organization and funding of health departments. In the aggregate, budgets have been shrinking as the public health agenda has continued to expand, and too many health departments are too small or underresourced to adequately fulfill their mandates. That reality requires existing resources to be used as efficiently and effectively as possible. The AHD concept offers practice agencies and educational institutions an opportunity to partner to expand their capacity and best ensure that the workforce is well and appropriately trained, that pragmatic research is undertaken, that evidence-based practices are the norm, and that we are doing everything we can to ensure that health departments have the means to maintain and improve population health. Only then will we have bridged the gap between health departments (town) and academia (gown).