Dear colleagues, welcome to my very first blog, and thank you, in advance, for your patience. Ok – here goes. I am a public health educator who first studied health education at the Master’s degree level at Hunter College, CUNY. My undergraduate degree was in French literature (sans blague!) from a school that prided itself on mandating a well-rounded education. It may seem strange, but I’d like to start a dialogue on the pros and cons of beginning a community health major – with a concentration in health education and promotion – at the community college – yes, the 2-year college – level. Now, I want to be clear. I am not saying I think someone is prepared to sit for the CHES exam without a 4-year college degree in something from an accredited college and at least 25 credits of health education based on the seven areas of responsibility. However, I do believe that the community college is a great source of future public health workers, and, most immediately, of Community Health Workers. On the other hand, a la Lowell Levin who I think may have started SOPHE in his garage or something like that – there’s a strong argument to be made for having future health educators get a good solid well-rounded liberal arts education and then go on to study health education using the undergraduate education as a strong foundation for the additional skills needed in health education. Dr. Levin argued that a liberal arts education provided an incredibly important background in history, economics, politics, anthropology, sociology, etc. – all invaluable in the provision of quality health education services. Are your freshman and sophomore years of college too soon to be thinking about a major and taking courses to prepare you for a profession? Especially if they “shortchange” you in terms of not having a chance to study so many other topics. On the other hand, does going to a community college to study community health jeopardize the effectiveness of Community Health Workers? Are they too “academically contaminated” to be as effective as they would be otherwise? Some days I’m sure, and other days I wonder. What do you think? kdg
My First Blog!
About Mark J Kittleson
Mark J. Kittleson is in his 37th year as a health educator, having spent over 21 years at Southern Illinois University and having been at New Mexico State University since January 2011. Dr. Kittleson is best known for his development and management of the HEDIR Discussion group, as well as his efforts to help the profession of health education utilize technology.8 Responses to My First Blog!
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Karen,
Welcome as a new blog message poster. It is good to have you on board. You pose a challenging question with whichprofessional health educator and community organizer have wrestled a great deal. When you have an effective "indigenous health worker" by whatever name we use, do they lose their effectiveness when they advance their education, incomes, and/or other indicators of upward social mobility?
Anyone who has worked in community settings know the immense value of having a "grassroots" health worker who is intimately familiar with the values and mores of the local population, particularly when this person has a high degree of trust from members of the community the program intends to help. Many of us have seen these "local" health workers become ambitious and seek to gain additional knowledge, skills and credentials. Some of them seem to be able to do this without a loss of trust by their fellow community members. Others tend to lose some of the trust they previously enjoyed. A lot depends upon perceptions of what added knowledge, skills and credentials mean to both the health worker and their fellow community members.
In some communities, there are fairly strong demarcations of "us" and "them". "Us" are the members of the community with low education, low income, little property and low social status. "Them" are members of the community or professionals from outside the community seeking to serve members of the community with higher levels of education, income, credentials, property and social status. When the gain in education, income and credentials that symbolize higher social status is crossed, an individual is seen as becoming a "them" rather than an "us". In communites with less clear demarcation of an "us" and "them" dichotomy, it may be easier to maintain the level of trust the community health worker enjoys. Also, a lot depends upon the attitude of the community health worker who gains education, higher income, added credentials, etc.
KDG, Nice thoughts and questions. I am not sure what I think of a community college level community health worker because I have never really thought about it. I have considered this though… What is uniquly qualifying about having a diploma on a wall from a university? Why does our society say that that piece of paper is valuable? Does it indicate that one with the paper is smarter than one without it?
Perhaps we need to take a step back and define WHY a lib arts education makes you more qualified to meddle in others health issues. And is learning only done when you are inside the walls of the hallowed Ivory tower?
TDub
2 thoughts more thoughts– 1. In international health I teach about lay health workers and the amazing work these individuals are doing in underserved areas with as little as a few days of training (attendant midwives, nutrition educators, micro-credit leaders). There is no doubt that people with a strong desire to improve those around them and a little knowledge can change the world.
2. However, America is far removed from most of those developing countries… and primarily because of advanced formal education. So I have frequently believed, both as a health educator, and as an administrator, that a formal education (up to the BA/BS level) is requisite to be dealing what really is life and death issues (after all, would you go to a surgeon who only had 2 years of education to remove a tumor? even if he was bright, passionate, and practiced?). If we want to continue to make gains I think formal education helps us maintain a minimum standard of knowledge, skills and abilities…………….
With all of that said, I was in the military, and some of the best public health practitioners in the world don't even have a 2 year degree… They are wise, quick, and learn on the job!
Do any of you remember reading Jack Rothman's book, Planning and Organizing for Social Change? I read it at least 15 years ago when I was working on my PhD in health education at NYU (after my MS in Community Health from Hunter, I realized just how big the field was and how much I didn't know I didn't know – got that? and felt compelled to get a doctorate! – By the way, for those who care, my French Lit degree was from Beloit College, in WI!).
I was struck at the time with the concept that after 6 months of exposure to academics and/or formal training and trained program people, lay health advisors and natural helpers "assimilated," thus losing their unique benefit / feature / asset – identification with and connection to the community.
What's interesting to me is that the Community Health Workers I've talked to haven't studied anything other than what their employers taught them to fulfill their responsibilities on the job. The absence of standard skills and competencies inhibits their advancement on many levels. Anyway, what they said loud and clear goes something like this:
"Yes, we'd like to take a few college courses to give us the documentation that we've had some formal training in core competencies and that this can be verified and we can therefore move more easily from one employer to another when the funding ends on our current project. However, we do NOT want an associate's degree to be a requirement for Community Health Worker certification."
That is why we're piloting a project at Kingsborough Community College to (1) identify four core courses from the AS degree in Community Health that would form the basis of a CHW Training Certificate Program – eventually…we're not there yet – (2) make sure we're integrating recognized national competencies for CHWs into those four courses, (3) getting CHW input into the curriculum; and (4) using CHWs and CHW supervisors to help teach the courses.
What's really fascinating is trying to find the balance between the rigors of a good college course – remember, my friends, all community college courses are NOT remedial…in fact, I teach a Personal Health and Fitness class for Honors Program Students only – and the more open, experiential, empowerment driven, Frierian-type learning experience. You can see why I've named the program, "Between Ad Hoc and a Hard Pace."
Tyler,
Even in the good ol' USA, there are populations in which lay health workers with less than a hgh school diploma can assist in delivery of health information and peer counseling services. This is true in colonias in which undocumented foreign works live and in such activities as peer counseling among street people, particularly homeless youth. The key is to have knowledgeable and skilled professionals trianing and guiding the services of theese lay health workers, with clearcut instructions about the paramemters within which the lay health workers function.
Tyler,
That degree, whether you hang a certificate on the wall or not, represents knowledge, skills and exposure to exercises in thinking and problem solving that increase the prospects that the graduate can perform useful work. There is an abundance of data that shows that people with college degrees, on average, earn more and enjoy better employment opportunities than those without college degrees.
This does not mean that there are not some very intelligent people without colloge degrees or that some peole without degrees do not excell. It merely shows that society, in general, and many employers value the college degree.
Kare,
I certainly remember Rothman's writings. Helen Ross and Paul Mico authored a book on public health education practice in the 1970s that drew upon Rothman. Later, Bob patton and I edited a community organization book that drew upon both Rothman and Ross and Mico writings.