Trends in Degree Conferrals, Degree-Associated Debt, and Employment Outcomes Among Undergraduate Public Health Degree Graduates, 2001‒2020

Abstract

Objectives. To characterize the trends in degree conferrals, degree-associated debt, and employment outcomes among undergraduate public health degree (UGPHD) graduates.

Methods. We reported administrative data on degree conferrals from 2001 to 2020 from the National Center for Education Statistics (NCES). For alumni graduating from 2015 to 2019, we also reported degree-associated debt and earnings 1 year after graduation compiled by NCES. Finally, we utilized a data set on 1-year postgraduation employment outcomes for graduates from 2015 to 2020 from the Association of Schools and Programs of Public Health.

Results. As of 2020, more than 18 000 UGPHDs were awarded each year, more than 140 000 in total over the past 20 years. UGPHD graduates are highly diverse, with more than 80% being women and 55% being individuals from communities of color. We find alumni worked mostly in for-profit organizations (34%), health care (28%), nonprofits (11%), academic organizations (10%), government (10%), and other (6%). Degree-associated debt was $24 000, and the median first-year earnings were $34 000.

Conclusions. While growth in UGPHD conferrals has slowed, it remains among the fastest-growing degree in the nation. However, the limited pathways into government remains a significant challenge. (Am J Public Health. 2023;113(1):115–123. https://doi.org/10.2105/AJPH.2022.307113)

The undergraduate public health degree (UGPHD) surpassed the master’s degree in 2020 as the most conferred public health degree in the United States.¹ This rapid growth began in 2004, fueled in part by the rise in bioterrorism concerns and interest in strengthening the nation’s public health system in the aftermath of 9/11 and the 2001 anthrax attacks.² The growth was also fueled by the seminal work published in the 2003 Institute of Medicine report recommending that all undergraduates have access to education in public health and the proliferation of accredited graduate schools and programs of public health.³ More than twice the number of undergraduate students graduated with public health degrees from 2008 to 2012 than from 1992 to 2008, and the majority of students graduated with UGPHDs in general public health and health education or behavioral sciences.^4,5 It is also a degree whose recipients are far more racially and ethnically diverse than recipients of graduate degrees in general.⁵ Yet, despite this marked growth, the UGPHD is once again in transition.

Degree conferrals have been driven both by growth within existing programs and by new entrants to the marketplace.^4,5 About 271 institutions offered UGPHDs in 2016 compared with 179 in 2012, with about 50% coming from institutions with public health degree programs that were accredited by the Council on Education for Public Health (CEPH).^5,6 CEPH was established in 1974 to serve as the independent accreditation body for graduate schools and programs of public health.⁷ CEPH’s standalone baccalaureate accreditation was introduced in 2016; there are currently 25 standalone CEPH-accredited baccalaureate programs.⁸ The expansion of standalone programs is indicative of an expanded breadth of programs without other master’s-level public health training.⁶ Furthermore, this new accreditation offers the opportunity to greatly expand the reach of public health education to other institutions across the country and to increase diversity both in student populations and geographic regions.⁶

Before this effort, UGPHD programs were only accredited if they were conferred by a CEPH-accredited graduate school of public health. However, now, with the drastic increase in undergraduate public health program offerings and with the number of UGPHDs conferred, several key questions have arisen regarding the UGPHD. Questions include the potential role of the UGPHD on the field’s ability to diversify the public health workforce, establish pathways for training, reduce overlap with the graduate-level curriculum, and ultimately rebuild the governmental public health workforce with new UGPHD graduates.¹

Especially of note are the employment outcomes for bachelor’s students, including both what types of jobs they would get in general and, specifically, whether those jobs would substitute for master’s-trained alumni, as had happened in other fields in previous decades.^1,3,9,10 For example, there is a current debate about whether hospitals should hire a certified registered nurse anesthetist or an anesthesiologist, with the former being less expensive, yet debate on cost-effectiveness and ultimate practice models remains.^11,12

Given these questions, as well as the recent increased limelight on public health as a result of the COVID-19 pandemic, in this study, we explored recent trends in public health undergraduate education with a focus on first-destination outcomes, including employment or further higher education, of UGPHD recipients.

METHODS

We used 3 data sets to characterize the UGPHD trends in the United States: the Integrated Postsecondary Education Data System (IPEDS),¹³ the College Scorecard from the National Center for Education Statistics (NCES), and first-destination outcomes from the Association of Schools and Programs of Public Health (ASPPH).¹⁴

Our research utilized IPEDS data that catalogued degree conferrals for UGPHD programs in the United States that were reported from 2001 through 2020. IPEDS data are reported annually by all public and private postsecondary institutions that receive federal support, including federally backed financial aid. Degree conferral data are one of several required reporting areas, which also include enrollments, admissions, academic offerings, salary spending on faculty and staff, and staff composition, among other organizational characteristics.

IPEDS maintains data on institutional characteristics for each college or university in its data set; of primary interest are institutional (Carnegie) classification, control institution (public, private not-for-profit, private for- profit), and geographic region. UGPHD programs were identified with Classification of Instructional Program (CIP) codes (National Center for Education Statistics, https://bit.ly/3gCEbHC), including for public health (CIP 51.22XX), as well as for health policy analysis (44.0503), epidemiology (26.1309), and biostatistics (26.1102), which IPEDS classifies outside of public health (Table A, available as a supplement to the online version of this article at https://ajph.org). While NCES does not include biostatistics, epidemiology, or health policy, they have long been included as core degrees or program offers in public health institutions. IPEDS data before 2010 are crosswalked to the 2020 CIP code standards.

NCES constructs estimates of earnings and degree-associated debt using federal administrative data and publishes these data annually via the College Scorecard. These estimates are reported by institution, degree, degree level, and 4-digit CIP code family. NCES constructs these estimates by 2-year cohorts, with earnings information drawn from Internal Revenue Service filings of graduates 1 year after graduation and degree-associated debt from Free Application for Federal Student Aid filings. Data were available on students graduating in 2015 through 2019 at the time of this analysis, in spring 2022. NCES notes that institution-level data may be censored if there are insufficient student record matches or number of graduates. NCES data are thought to constitute the universe of public health degree conferrals in the United States but do not include first-destination outcomes.

The third data set was provided by ASPPH. Since 2016, ASPPH has collected first-destination outcomes data through its membership, CEPH-accredited schools and programs of public health in the United States and abroad (only domestic data were used in this analysis). Students who are graduating, and up to 1 year after graduation, report first-destination outcomes to their schools and programs of public health. These data are de-identified and reported to ASPPH. Among those reporting employment outcomes, both broad employment sector and detailed sector are reported. The most recent available data are from graduating years 2015 through 2020 (collected up to 1 year later) and are included in this assessment.

ASPPH data include graduates of UGPHD programs at accredited schools and programs of public health, which represent approximately 48% of graduates from UGPHD programs in the United States captured in IPEDS data. Please see Figure A (available as a supplement to the online version of this article at https://ajph.org) for the number of applicants to MPH programs in Schools of Public Health Application Service, the centralized application service, by major or concentration in undergraduate degrees.

We calculated descriptive statistics to report findings from the administrative data sources. We used Stata version 17.1 (StataCorp LLC, College Station, TX) and Tableau Desktop (Tableau Software, Mountain View, CA) for analysis.

RESULTS

In 2001, colleges and universities across the United States reported awarding 1480 UGPHDs, compared with 5576 graduate public health degrees. By 2020, 18 289 UGPHDs and 19 641 graduate public health degrees (18 044 and 1597 master’s and doctorate degrees, respectively) had been awarded (Figure 1). The UGPHD grew an average 13.4% each year over the past 2 decades, eventually eclipsing the master’s degree as the most conferred public health degree type in the United States in 2020.

FIGURE 1—

Number of (a) Public Health Degrees Awarded and (b) Degree-Awarding Institutions: United States, 2001–2020

Demographics of Degree Grantors and Recipients

The number of institutions awarding solely UGPHDs with no graduate public health degrees has also grown substantially, from 44 in 2001 to 183 in 2020. As of 2020, more than 550 institutions awarded either a UGPHD or graduate public health degrees, with 392 awarding at least 1 UGPHD and 265 institutions awarding at least 10 UGPHDs. In terms of the size of graduating classes by institution, the median was 20 degrees conferred in 2020, with the 25th percentile at 7 degrees and the 75th percentile at 55 degrees. Between 2001 and 2020, 143 000 UGPHD conferrals were captured by NCES, of which about 24 000 were conferred between 2001 and 2010, 35 000 between 2011 and 2015, and 79 000 between 2016 and 2020.

Data from NCES show wide racial and ethnic diversity of UGPHD graduates. In 2020, 45% were White. Hispanic/Latino students constituted the second-largest group of graduates (17%), followed by Black/African American (15%), Asian (13%), 2 or more race (4%), and American Indian/Alaska Native (1%) students. International students represented 2.5% of UGPHD conferrals, and another 2.5% of graduates had unknown race/ethnicity status. Women constituted 80% of conferrals in 2020, an increase from 69% in 2001.

Compared with graduate public health degree conferrals, during the past 2 decades, a smaller percentage of undergraduates received their UGPHD from a CEPH-accredited school or program of public health (Figure 2). Coincident with CEPH instituting a standalone undergraduate accreditation standard in 2016 (and therefore affording accreditation to students graduating up to 3 years before¹⁵), the majority of UGPHDs were conferred by a CEPH-accredited school or program of public health or a standalone baccalaureate program. In 2020, 57% of UGPHDs came from CEPH-accredited institutions and programs, compared with 82% of master’s degrees and 89% of doctoral degrees. We observed differences by race/ethnicity; 74% of Asian students received a UGPHD in 2020 from a CEPH-accredited institution and programs, compared with 56% of Black students, 53% of Hispanic/Latino students, and 55% of White students. We similarly observed differences in graduation by control of institution (public, private not-for-profit, or private for-profit) by race/ethnicity.

FIGURE 2—

Public Health Degrees Awarded, by Accreditation Status and Percentage of (a) Bachelor’s Degrees, (b) Master’s Degrees, and (c) Doctoral Degrees: United States, 2001‒2020

Note. CEPH = Council on Education for Public Health.

Conferrals by type of institution changed substantially since 2001, when 88% of UGPHDs came from public institutions, 11% from private not-for-profit, and less than 1% from private for-profit. In 2020, 75% of UGPHD conferrals came from public institutions, 22% from private not-for-profit, and 3% from for-profit institutions. In 2020, among Asian students, less than 1% of UGPHDs came from for-profit institutions, as did 9% of UGPHDs earned by Black students, 4% earned by Hispanic/Latino students, and 2% earned by White students.

First-Destination Outcomes

Among 23 810 UGPHD graduates between 2015 and 2020 with first-destination outcomes reported to ASPPH, 7% reported seeking employment, 31% reported enrollment in further study, and 62% reported having employment, a fellowship, or a volunteer position. Among the 8724 UGPHD graduates with full-time employment outcomes reported, 34% reported working within for-profit organizations, 28% in health care organizations, 11% in nonprofit organizations, 10% in academic institutions, 10% in government, and 6% in “other” (Figure 3).

FIGURE 3—

First-Destination Employment Outcomes by Sector Among Undergraduate Public Health Degree Alumni, Graduating Years 2015–2020: United States

Note. IT = information technology; NGO = nongovernmental organization; PR = public relations. Figure shows median earnings by institution. Listed percentages are rounded to the nearest whole number.

Detailed employment-sector information was provided by 10 939 UGPHD graduates. Of those working in academic institutions, two thirds worked in postsecondary education and one quarter in K‒12 education. Among those working in for-profit organizations, 13% worked in consulting; 16% in marketing, public relations, communications, and pharmaceuticals; and 8% in health insurance and information technology. Among those in government positions, 24% worked in federal, 26% in state, 38% in local, 9% in military, and 3% in “other types.” Of those working in the health care sector, 36% reported being within hospital and health systems and 6% in managed care.

Lastly, for UGPHD graduates who reported pursuing further study, 36% were pursuing a graduate public health degree, 27% were pursuing a medical or clinical degree, and 37% were pursuing another or unknown degree.

NCES publishes degree-associated debt and postgraduation earnings through their College Scorecard (Figure 4). Median degree-associated debt for students graduating in 2014 to 2019 was highest among for-profit institutions awarding UGPHDs (median = $39 800; interquartile range [IQR] = $39 000‒$42 000), compared with not-for-profit institutions (median = $26 000; IQR = $23 000‒$27 000) and public institutions (median = $22 000; IQR = $19 000‒$25 000). One-year postgraduation earnings data were comparable across all institution types (median = approximately $34 000). Median degree-associated debt and earnings varied widely for UGPHDs by geographic region, with degree-associated debt being highest in the mid-east and New England regions, and lowest in Rocky Mountain and far-west regions. Median 1-year postgraduation earnings ranged from $31 000 to $38 000 with the lowest being from the southeast region and highest from New England.

FIGURE 4—

Earnings 1 Year After Graduation and Degree-Associated Debt Among Undergraduate Public Health Degree Alumni by (a) Bureau of Economic Analysis Region and (b) Control of Institution: United States, Graduating Years 2014–2019

DISCUSSION

In 2020, nearly 20 000 UGPHDs were conferred. While UGPHDs have overtaken master’s degrees as the most-awarded public health degrees in the United States, accredited master’s degree conferrals still substantially outnumber accredited undergraduate degrees. This is not surprising given IPEDS reporting indicates that 89% of doctoral and 82% of master’s degrees were conferred by universities with a CEPH-accredited schools and programs of public health while only 57% of UGPHDs were conferred by a university with a CEPH-accredited public health school, program, or standalone baccalaureate program.

UGPHD graduates secure employment in multiple industries upon graduation, and many pursue further higher education, including graduate studies in public health. Of those graduates securing employment, relatively few have pursued a job in governmental public health (10%), while the majority (62%) enter the workforce in the for-profit sector or in the health care sector. This differs somewhat from graduate program alumni, where 17% have pursued jobs in governmental public health and 41% landed in the for-profit or health care sector. Further more, the percentage of graduate program alumni working in governmental public health has increased each year since ASPPH began collecting first destinations outcomes data, with 21% of master’s and doctoral graduates entering the governmental public health workforce in 2020.¹⁶ This might suggest that UGPHD and graduate alumni are not competing for the same jobs as has been previously hypothesized.

However, it is reasonable, if not prudent, for public health practitioners to concretely distinguish job tasks and desired skills of undergraduates from graduates in the workplace while academic public health better communicates the continuum and progressive nature of the competencies that graduates demonstrate at the undergraduate, master’s, and doctoral level.^9,17 These distinctions would ensure undergraduates and graduates do not compete for the same position and limit the ongoing concern about the threat of a “substitution effect,” in which baccalaureate degree holders are preferentially hired at lower wages for the same jobs that graduate degree-holders had been previously recruited, in the government sector (or elsewhere). The concern arises from a history in other fields.^4,5,9,17 The best way to ensure a substitution effect does not occur is through task and skill differentiation for different levels of academic achievement.

We show that undergraduate public health is continuing to grow, that several hundred institutions are now offering these degrees, that graduates are pursuing a variety of jobs and sectors as employment outcomes, and that there is a wide range of earnings and debt loads associated with UGPHDs across the United States. Heterogeneity in UGPHDs, and education more broadly, is to be expected, even in an accredited field. In some respects, education is a marketplace, not just of ideas, but also one based on consumer and employer interests and needs, as well as one in which competition rewards positive program outcomes. A breadth of public health offerings should be encouraged, if they are indeed identifiable as public health programs.¹⁷

Institutions of higher education, in our view, should hold to core tenets of academic rigor and integrity and the pursuit of knowledge. At the same time, public health degrees are traditionally viewed in the vein of a professional degree, even at the undergraduate level, even where it is offered in the context of more general humanities or liberal arts programs. Fundamentally, after all, UGPHDs must be competency- and skill-based to be accreditable. There remains an open question about market saturation, especially considering continued and sustained growth, as well as broader opportunities for undergraduate public health‒trained professionals to work in nontraditional areas, such as in public education, urban development, and political science. These remain substantive points for future discussion and research.

Reflections in Light of the Great Resignation

As we reflect on the future of undergraduate public health and its relationship to governmental public health, data presented in this article suggest that the United States may be approaching a point of opportunity. The governmental public health workforce is substantially depleted, generally since the Great Recession and specifically because of COVID-19 response (and the consequent Great Resignation/Reshuffling/Renegotiation).^18,19 Data recently released from the 2021 Public Health Workforce Interests and Needs Survey show 44% of staff are considering leaving their job or planning to retire within the next 5 years²⁰; this represents more than 80 000 staff nationwide. Are public health graduates filling this gap? If not, who will?

Governmental public health has traditionally hired baccalaureate degree holders from other fields and some master’s degree holders, the latter of whom sometimes have a UGPHD. Might this change with concerted efforts to create practice-based training programs and improve pathway development from the schools and programs of public health into government? Federal public health agencies have recognized the potential future gaps in the public health workforce and have established mechanisms to increase pipelines into governmental public health careers.^1,21–23

These data suggest that now is a critical time for the initiation of partnerships between educational institutions and governmental public health agencies to better examine undergraduate public health education and to determine whether specific pathways to government are a priority and, if so, how then to implement them in ways that accomplish the desired aims. UGPHD recipients may serve health departments in key entry-level public health science and data-oriented positions. Yet, to attract these students away from health care, pharma, and for-profit firms, health departments must offer more efficient hiring processes, competitive wages and benefits, and clear opportunities for advancement, and seek to maximize engagement and perceptions of employee support within one’s organization, as these factors are all key to recruitment and retention.^24,25

A Matter of Demographics

A particular challenge undergraduate education faces broadly in the United States is the upcoming demographic cliff and the “Great Interruption” associated with COVID-19. As a result, in 2025 and beyond, fewer students are expected to graduate high school and enter college than in years past, though this has already begun in some regions.²⁶ There are simply fewer younger people seeking traditional bachelor’s degrees (and, in turn, traditional master’s), although there may be more midcareer professionals seeking further education. Further exacerbating this issue is the Great Interruption of COVID-19 whereby 21% fewer direct high school to college students enrolled in fall of 2020 when compared with 2019, and 1 in 4 college students failed to re-enroll in the fall of 2020.^27,28 In addition, uncertain macroeconomic conditions along with low unemployment rates may make college or graduate school less appealing.²⁹ These uncertain conditions will likely continue to be a concern for some time among institutions of higher education.

It is not clear to us what a broad decline in undergraduate enrollment might mean for a specific field such as public health. It may well be that in a postpandemic environment, public memory and interest in public health fade, and fewer undergraduates are aware of the public health degree. Conversely, because the next several years have dedicated federal public health infrastructure funding to grow pathways into governmental practice, schools and programs of public health may outcompete other resource-poor or otherwise flagging program areas for paid internships and better placement prospects out of school.

Even if undergraduate overall enrollment is down, public health enrollment could grow with appropriate strategy and investment such as using online education³⁰ and building and implementing an enrollment management plan.³¹ This could be critical to rebuilding the governmental public health workforce and is especially relevant as enrollment in master’s education in public health similarly in 2022 has begun again to slow down, likely attributable to degree-offering institution saturation, as had been projected for some time before the COVID-19‒associated bump in admission.³²

Limitations

When interpreting these trends, the following limitations should be considered. First, while the NCES is widely regarded as a reliable source of degree-conferral data,³² misclassification may occur. Sensitivity analyses show that if institutions are excluded that conferred fewer than 10 undergraduate public health degrees in 2020, 265 of 392 institutions remain (data not shown). It is not clear whether the differences represent true, small programs or reporting errors; these affect institution totals but do not materially affect conferral totals (these institutions represented 3.1% of conferrals in 2020).

Second, UGPHD majors are reported; public health minors are not included, thus excluding from our analysis a potentially important indicator of interest in and exposure to public health at the undergraduate level. Third, ASPPH member programs that report graduate outcomes use myriad approaches in data collection. Some augment with administrative data or publicly available data (e.g., LinkedIn scraping). As such, especially in early years of reporting, there are relatively high proportions of unknown employment sectors for employed graduates.

Lastly, a final set of limitations relate to College Scorecard debt data. NCES censors institutions when there are too few records either on salaries or on debt to ensure confidentiality of responses. As such, some institutions are not represented in this data set. Debt data include Parent Plus loans and federal direct subsidized and unsubsidized loans (Stafford loans), but do not include Perkins loans.³³ As such, data may be limited with respect to parental loan reporting around private-backed loans, which are again becoming more common in recent years.

Conclusions

Throughout the past 2 decades, there have been calls for undergraduate public health education to create a greater population-based understanding for, and higher value of, the field of public health.^6,17,34 Thoughtfully developed undergraduate programs have provided, and will continue to provide, a public health foundation to all professions, regardless of the graduate’s immediate employment sector. Our data show undergraduate public health graduates have most often entered either the health care or for-profit sectors, and relatively less into governmental public health. The nation relies on the vital roles that governmental public health agencies provide, but a post‒COVID-19 world, one with a depleted governmental public health workforce,^18,35 presents grand challenges to protecting the public’s health. However, our data show that the nation also has more than 18 000 undergraduate public health graduates each year, which highlights the potential role of undergraduate education in addressing the near-future governmental public health gaps as well as an opportunity to recruit a more diverse and representative workforce.