Education in Public Health
Expanding the Frontiers
David J. Hunter, MBBS, MPH, ScD, Ian Lapp, PhD, Julio Frenk, MD, PhD, MPH
A
competent workforce is critical to the main-
tenance and expansion of public health activities.
The signature degree in the field—the Master of
Public Health (MPH)—is available to students who can
commit 1–2 years (depending on prior degrees and
experience) for full-time residential study; to those who
can commit 2–4 years for part-time study; and as an
online degree; to those who can pay tuition, often
representing a heavy financial burden.
Despite these multiple options for public health
education, it is estimated that approximately 80% of
local health department directors in the U.S. do not have
graduate degrees in public health.1 Barriers to this
training include the costs of tuition and the opportunity
costs of taking time away from full-time work.
The digital revolution offers the opportunity to expand
the availability and uptake of education in public health,
at much lower costs than programs that demand 1 or
more years of full-time residence. Digital courses can be
offered in a variety of formats. For instance, beginning in
2002, the Open CourseWare movement pioneered by the
Massachusetts Institute of Technology (MIT) offered the
slide sets and lecture videos of some courses on a year-
round basis; among other academic institutions, the
Johns Hopkins School of Public Health has posted more
than 100 of its courses as Open CourseWare.
Only recently, however, have global improvements in
Internet bandwidth permitted real-time video streaming,
leading to the advent of Massive Open Online Courses
(MOOCs) that are much richer in format than most
examples of Open CourseWare. These MOOCs not only
permit the posting of lecture videos, but also the hosting
of moderated discussion boards available to thousands of
students, online administration of homework sets and
exams, and assessment of students in a manner that is
similar to conventional residential grading schemes. In
contrast to the earlier generations of online education,
From the School of Public Health, Harvard University, Boston,
Massachusetts
Address correspondence to: David J. Hunter, MBBS, MPH, ScD, Office
of the Dean, Harvard School of Public Health, 677 Huntington Ave, Boston
MA 02115. E-mail: dhunter@hsph.harvard.edu.
0749-3797/$36.00
http://dx.doi.org/10.1016/j.amepre.2014.07.047
S286 Am J Prev Med 2014;47(5S3):S286–S287 & 2014 Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine.
This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/).
MOOCs offer a platform for high-quality, interactive
learning.
Alongside important advances in cognitive science and
an explosion in the global demand for knowledge, these
new technologic platforms are enabling exciting oppor-
tunities for educational innovation. To take advantage of
them, the Harvard School of Public Health (HSPH)
launched in 2010 a comprehensive review of its educa-
tional strategy, which was completed in 2013—in time to
celebrate its 100th anniversary.
As part of this process, the HSPH decided to develop
versions of the MPH Core Curriculum to be offered as
MOOCs through the HarvardX component of edX, a not-
for-profit company founded by MIT and Harvard Uni-
versity in May 2012. To date, the following four public
health courses have been offered, which cover the Council
on Education for Public Health–defined core requirements
for the MPH degree2: an Epidemiology/Biostatistics course
and courses in Environmental Health, Social and Beha-
vioral Sciences, and Health Policy and Management.
The courses were largely designed to conform to the
“chunk and test” format of short video segments (5–10
minutes) followed by self-assessment questions designed
to test knowledge of the segment. These were released on
an approximately weekly basis but could be viewed
asynchronously at any time students worldwide wished
to access them. Additional formats such as interviews with
experts, presentation of published papers, documentary-
style video materials, access to online textbooks, live
online-streamed discussions, and use of smart boards to
illustrate materials were variably incorporated into the
courses. Homework assignments and quizzes were admi-
nistered at regular intervals and machine-graded.
As of June 2014, 177,363 students had registered for
one of the four completed or ongoing courses (the
courses remain open for students to register for and take
in a self-directed learning approach). Students registered
from 182 countries. In each case, the most common
country of residence was the U.S., with the second most
common being India, followed by Spain, Argentina, and
Germany. In total, 11,885 Certificates of Completion
which correspond to a passing grade in at least one of
these courses were issued, with many students complet-
ing a large fraction of the coursework without taking all
the assessments needed for a Certificate.
 Hunter et al / Am J Prev Med 2014;47(5S3):S286–S287
HSPH’s preliminary experience with MOOCs allows
the conclusion that there is a substantial interest in public
health training via these courses, at least the first time
they are offered. Worldwide, these public health courses
have an approximately equal balance of men and women
registrants; the modal age category of learners was 20–29
years, although the age distribution included teenagers
and people aged over 70 years—a broader spectrum than
typically seen in residential courses. Although the courses
were only taught in English, interest was substantial from
countries in which English is not the primary language of
instruction.
The present analysis of this preliminary experience
with teaching MOOCs in public health has several
limitations. The authors do not have complete informa-
tion on the motivations of most registrants, or their
expectations upon entering the course and whether they
did not complete it because their expectations were not
met in terms of content or learning approaches. These
assessments will be built into future iterations of the
courses.
Of particular importance, information is lacking on
the retention of the information or durability of learned
skills (although this is frequently true of residential
courses). The authors have limited information on the
proportion of participants for whom these were their first
courses in public health and how many were brushing up
or supplementing their skills. Finally, it is currently
unknown whether the information and skills have been
put to use by those earning Certificates of Completion
and whether the courses have enhanced their profes-
sional careers and helped advance public health.
In summary, MOOCs may be a means to train and
provide continuing education for public health workers
worldwide in a cost-efficient manner. However, many
questions remain about the degree of knowledge retention
and the attainment of competencies versus information
acquisition. These all represent research opportunities
November 2014
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that should help develop over time an evidence base on
which educational innovations work best. From an
institutional perspective, there are additional questions
regarding the financial models that will sustain invest-
ment in the faculty and teaching assistant effort, and
production resources that are necessary.
The Commission on the Education for Health Profes-
sionals for the 21st Century3 noted that although 73% of
articles on health professional education address medical
education and 25% nursing education, only 2% focus on
the education of public health professionals. Under-
standing best practices in digital education will be
essential to redress this imbalance in order to meet the
requirements for a competent public health workforce
that is up to the complex challenges of the times.
Publication of this article was supported by the U.S. Centers for
Disease Control and Prevention (CDC), an Agency of the
Department of Health and Human Services, under the
Cooperative Agreement with the Public Health Foundation
and University of Michigan Center of Excellence in Public
Health Workforce Studies (CDC RFA-OT13-1302). The ideas
expressed in the articles are those of the authors and do not
necessarily reflect the official position of CDC.
No other financial disclosures were reported by the authors
of this paper.
References
1. CDC, U.S. Congress, Senate, Committee on Appropriations. Public
health’s infrastructure; a status report. Atlanta GA: CDC, 2001. stacks.
cdc.gov/view/cdc/11337.
2. Council on Education for Public Health. Accreditation criteria: public
health programs. Silver Spring MD: Council on Education for Public
Health, 2011. ceph.org/assets/PHP-Criteria-2011.pdf.
3. Frenk J, Chen L, Bhutta ZA, et al. Health professionals for a new
century: transforming education to strengthen health systems in an
interdependent world. Lancet 2010;376(9756):1923–58.