This post originally appeared on JPHMP Direct, the companion site of the Journal of Public Health Management and Practice.
At the 100th anniversary of the first American school of public health, there is much for the public health community to reflect upon with pride. Since the founding of the Johns Hopkins School of Public Health (now the Bloomberg School of Public Health) in 1916, the number of schools and programs of public health has grown to over 100, which are currently graduating more than 18,000 students annually. These schools and programs have had an enormously positive impact on the health of the country and the world through innovative research, practice, and workforce development. However, in the heat of the battles against infectious diseases, chronic diseases, toxins, pollutants, health disparities, and social inequities, we have lost focus on the welfare of the most important cog in the public health machine: the students.
While undergraduate public health programs continue to grow, a considerable amount of attention has focused upon their emerging presence in the workforce. However, while all schools and programs of public health have masters students, and all schools of public health have doctoral students, we have spent very little time considering their economic, social, mental, or physical welfare. For example, doctoral students are not research faculty, but they are often responsible for grant writing and manuscript preparation. Doctoral students are not teaching faculty, but many teach courses that require many hours of course preparation and grading. Doctoral students are not administrators, but many perform administrative tasks such as the preparation of IRB applications and reports. All these responsibilities are juggled while maintaining an academic course load. Despite multiple demanding roles, few data have been compiled to detect and examine any unexpected negative consequences (eg, unmanageable stress) that might result from these demands that might be used to justify and inform programs to mitigate these consequences.
Many graduate students seek and are awarded graduate assistantships. These positions vary widely in their hourly rate of compensation and benefits, but most minimum stipends (posted on university websites) range from approximately 15 – 35 dollars per hour. In actual compensation, a doctoral student (at the low end) may be expected to live on ~$15,000 or less per year (if employed for 12 months), which almost ensures a poor quality of life due to the accumulation of student loan/credit card debt, assumption of an unrelated part-time job, or both. These students are working in schools/programs of public health where scientists investigate the negative effects of poverty, student loan debt, stress, and lack of sleep. While some may rightfully assert that tuition waivers are part of many student compensation packages, tuition assistance only prevents the accrual of additional debt, rather than the provision of basic necessities.
Although the provision of health insurance is a recent development (recently complicated by the Affordable Care Act), most university students have long been provided access to campus wellness and recreation facilities, which are helpful for minor illnesses and positive stress management (ie, exercise). Unfortunately, at many institutions, the health insurance policies provided to graduate students represent a level of coverage considerably lower than afforded faculty and staff at the university. A student with a severe acute or chronic disease can expect to accrue considerable out-of-pocket expenses as a result of these low-cost, low-coverage policies. The fact that students, in their most formative years, can fall victim to an insurance shortfall, in the same building where research is conducted touting the benefits and ethics of universal health coverage, is inexcusable.
Careful, systematic consideration of graduate student welfare is necessary. While universities are actively exploring solutions to address health insurance concerns for all graduate students, schools and programs of public health should explore the establishment of maximum workloads (both official and unofficial), and minimum compensation levels commensurate with a livable wage in the community where the university is located. Some may bemoan these proposals as too expensive and/or unnecessary, as these hardships are “rites of passage” to be endured as a form of paying one’s dues. However, social change is often met, ironically, with opposition from those who endured the hardships previously. However, history is written by the victors, and university faculty often represent those who excelled, and more importantly, those who may not remember the members of their cohort who were less fortunate, did not excel, and were lost to time. If public health teaches us anything, it is that equality and equity are different constructs, never to be confused.
Justin B. Moore, PhD, MS, FACSM, is the Associate Editor of the Journal of Public Health Management and Practice and an Associate Professor in the Department of Implementation Science of the Wake Forest School of Medicine at the Wake Forest Baptist Medical Center in Winston-Salem, NC, USA. Follow him at Twitter and Instagram.