On a cold Tuesday morning with light snow falling from a dull February sky, public health studies major Stephanie Irwin ’15 clambers aboard first one, then another Hopkins shuttle to make her way from the Homewood campus to the Johns Hopkins Bayview Medical Center in East Baltimore. She will spend the next three hours in a windowless room, helping low-income patients connect with social services, such as food stamps or GED classes.
Stephanie Irwin ’15 counsels a client at Health Leads.
It’s Irwin’s weekly shift with Health Leads, a nonprofit group employing college-student volunteers and using health clinics as a point of contact to connect low-income patients with services they need. Patients fill out screening forms listing basic needs they are struggling to meet, and Irwin and the other volunteers help them navigate the public and nonprofit resources available, either in person or over the phone.
“Oh, hi, Stephanie—yeah, I’m doing OK,” a gravelly voiced man says from a speakerphone. Irwin is following up on her previous efforts to help the man apply for a discounted bus pass. A veteran, the man suffers from post-traumatic stress syndrome and pulmonary edema. He’s caught in one of poverty’s common Catch-22s: A disabled knee limits his mobility, but he often lacks money for bus fare to get to his appointments. (He once walked three painful miles to Bayview.) “They told me it would take 10 days to find out if I can get [the pass], but I can’t imagine I wouldn’t be eligible,” he says. “My legs, you know, just don’t hold up so good.”
“It’s eye-opening how real people’s challenges are,” Irwin says before dialing up the next person in need. (The winter weather has left the clinic quiet, so it’s all phone work today.) “One client was in his late-60s and living alone on benefits when his food stamps got cut, and he was basically just hungry all the time.”
The term “social determinants of health” refers to the conditions in which people are born, grow, live, and work and how these factors can affect health and well-being. In Baltimore, with its great socioeconomic disparities, a person’s zip code says a lot about how healthy he or she is likely to be. Irwin first encountered the concept as abstraction on a lecture hall white board. Health Leads puts it in her face. This sort of beyond-the-classroom exposure to public health issues is required of all students in the public health major. It’s called the Applied Experience.
Irwin’s classmate Michael Longo ’15 recently got his own reality check, on the steamy banks of Uganda’s Lake Victoria. He was there in January as part of the public health studies study-abroad program focused on the African nation’s multiple health issues. He witnessed fishermen scrambling aboard fleets of flimsy wooden boats to cast nets all day in dangerous and backbreaking conditions.
“They don’t really see a light for tomorrow,” Longo says. “Alcohol abuse is a huge problem, and the HIV transmission rate is three times that of an urban setting. Hopelessness leads to dangerous behaviors.”
The study of public health has been around for centuries and became a critical field with the onset of the Industrial Revolution. Rapid urbanization and cramped conditions caused sanitation issues that led to disease among the working population.
Today, as the planet’s population slides past the 7 billion mark, public health pressures mount—be they 7,000 miles away from Johns Hopkins in equatorial Africa, or just seven blocks distant on the back streets of Baltimore, where nearly one in four citizens lives below the federal poverty level.
The challenge of addressing local, regional, and global public health needs is unglamorous, arduous, often underpaid … and more popular at Johns Hopkins than ever. For the last five years, public health studies has been the largest major at the Krieger School of Arts and Sciences. Interest in the major exploded tenfold among freshman applicants between 2002 and 2012. While 29 freshmen and sophomores took up the major when it debuted in 1975, today it is home to some 350 students. Hopkins helped pioneer the idea of undergraduates studying public health, and more and more colleges are following suit. Only 73 colleges offered such a major in 2000; now nearly 200 do, according to the Association of Schools of Public Health. Many schools have reached out to Johns Hopkins for help in getting their new programs started.
A Major for the 21st Century
The Krieger School’s interdisciplinary program with Hopkins’ Bloomberg School of Public Health is built around a quartet of foundation classes covering epidemiology, environmental health sciences, health policy and management, and biostatistics. Students spend their first three years taking classes on the Homewood campus and their last year at the Bloomberg School taking upper-level electives alongside graduate students. There is also a joint BA/MHS track. Having such ready access to the No. 1-ranked public health graduate school might explain some of the undergraduate major’s popularity. But there’s more to it than that.
“When I started here in the late ’90s, there was already a buzz around campus about the public health studies major,” says James Goodyear, the program’s associate director. “Though it’s conjecture, one theory that has merit is that the HIV/AIDS problem became so enormous, and entered into the consciousness of so many people, that it led to other interests in public health.”
“Public health,” once a murky concept at best for many, is something that appears to have come into focus for the millennial generation.
“I think people are more aware of public health issues from the Internet and from globalization,” says physician Kelly Gebo, director of the public health studies major and also a professor at the Bloomberg School. “We used to just see the kids in the UNICEF commercials who were starving, and now we have students who have been to those places and have a much bigger understanding of public health emergencies. They’ve lived through SARS. They know about pandemics.”
“It’s a major for the 21st century,” Goodyear adds. “It provides a young person with curiosity and motivation to make a difference. We are a resource for that sort of individual who is intellectually curious, academically enthusiastic, and also has more than a modicum of volunteerism in them.”
Many graduates of the program go on to medical school, and Gebo says the public health background gives them a different perspective. “Physicians are used to treating individual people,” she says. “Public health gets people to think about populations.”
The Applied Experience requirement was added for the Class of 2013, though Gebo notes the vast majority of students in the major were already getting their feet wet in the field on their own as volunteers or interns. “We just made it a more formalized process,” she explains. “They come up with learning objectives so they can come back with some academic way we can quantify what they are learning.”
Above, Michael Longo ’15 walks with a family in a rural area of Uganda, where he traveled to study health issues in populations residing near Lake Victoria. [Photo by Yong Kai Saw ’16]
When Stephanie Irwin first arrived at the Homewood campus from suburban Austin, Texas, she intended to go into engineering as a materials science major. But that barely lasted two semesters. “It was a lot of solitary work in the lab, whereas I wanted something really hands-on that was working with actual people,” she says. “I feel like public health provides that, and you can sort of see the results of your work.”
Medical school or perhaps work in health policy lies in her future, though the broad nature of her major makes rigid career linearity less urgent. “One thing I like about public health is that it’s very interdisciplinary, and so if you aren’t sure yet what you want to do, you can apply to a bunch of different fields,” she says. “I think a lot of my friends in the major picked it because it opens a lot of doors as far as fields you can go into.”
Scarsdale, N.Y., native Longo says he has long envisioned a career in medicine and plans to become a pediatric cardiac surgeon.
“The public health major’s ability to engage me in so many different aspects of the health field just seems like a good fit for me,” Longo says. “From a very young age I’ve always wanted to be involved in some form of public service, and public health majors have a genuine inclination toward this, whether that be in sanitation health, or reducing drug use, or other fields.”
Longo calls his time in Uganda an “absolutely unbelievable experience” and hopefully the first of many such trips to study and help address entrenched public health issues. Closer to home, whenever his academic and football practice schedules allow (he is team captain and a standout member of the defense), he volunteers at a Baltimore men’s shelter serving recovering addicts.
Public health major Samuel Kebede ’15, meanwhile, didn’t need UNICEF or Bill Gates to expose him to international poverty and health challenges. He only had to look out his window. The native Ethiopian is from Addis Ababa, the son of doctors, and a member of the troubled country’s emerging middle class.
“We lived right across the street from the biggest slum in the city,” Kebede says. “Every day whenever I walked to school we would see poverty—rickety housing, stray dogs, just people suffering.”
The task of addressing this inequity drew him to the public health major. For his Applied Experience he returned to Africa during the 2011 intersession, this time to the Congo. The project he devised, facilitated by the World Health Organization (WHO) and the United Nations Development Program (UNDP), was to compile an annotated bibliography of that nation’s scattered and often haphazardly stored health data.
“I was literally going from archive to archive in these really dark basements and libraries and trying to find books, reports, data—anything health or illness related within the context of the Congo,” Kebede says, noting that copies of his finished bibliographic document were given to both the WHO and the UNDP.
When he looks at his fellow students, he sees a hopeful optimism—and not born of a naïveté or a vast underestimation of what will be involved in improving the health of billions of people.
“Public health not only has a socioeconomic perspective, but it is also really grounded in science,” Kebede says. “It’s not striving for this idealistic world without having a concrete plan to do it. You can be optimistic—I am optimistic—that at some point, maybe not in my lifetime, a lot of these health disparities that we see can be reduced.”
After the Degree
The major’s earliest roots at the Krieger School date back to 1974—the year Gerald Ford ascended to the presidency following Richard Nixon’s resignation, and when the world’s population was nearly half of today’s total. Leaders and professors at what was then the Johns Hopkins School of Hygiene and Public Health considered the desirability of a pre-professional program in public health. Among those prompting the discussions was the physician Abraham Lilienfeld, then a Johns Hopkins professor and giant in the field who’s been called the “father of contemporary chronic disease epidemiology.”
One early document detailing the major’s formation notes that a “primary motivation” for the professors to help create such an undergraduate degree was to “gain a source of outstanding Hopkins students for their graduate programs.” And they succeeded. Roughly 45 percent of public health studies graduates go straight on to a medical school or to graduate school in the field, with the lion’s share of them heading over to the Bloomberg School. About 35 percent enter the workforce—joining health departments or NGOs. (And among those going straight to work, most will end up in graduate school in a few years’ time after their real-world experiences help hone their professional focus.) About 10 percent can be filed under “other,” which could be a period of travel, or volunteering, or perhaps a bit of both, such as with the Peace Corps.
Whither the Public Health Grad?
The Krieger School’s public health majors pursue a wide variety of career and education options once they graduate. While graduate school and medical school are popular options, some students choose to work at non-governmental organizations (NGO) or policy making agencies. Below is a breakdown of where public health undergraduates go once they get their degree:
45% Graduate School
Of those going to graduate school
51% Bloomberg School of Public Health
14% other graduate schools
26% medical school
Of those with jobs
10% Fellowships, Peace Corps
Program alum Jeffrey Duong completed the joint public health BA/MHS program in 2009 and is on track to earn a Bloomberg School PhD in mental health this May. He wanted to become a physician when he first came to Hopkins in 2005 but soon found the pure science classes didn’t engage him. A friend told him to try public health.
“I took a seminar course that covered health issues that exist here in Baltimore—a course that I found very appealing,” Duong says. “I came from a lower income household, and when [my professors] talked about health issues that affect underserved groups, I could relate to that, as opposed to learning about all these biochemical processes.”
It was while volunteering as a tutor and aide at a West Baltimore after-school program that his public health aspirations came into focus. “I basically saw kids beating each other up all the time and saw that youth violence was a major issue and I really felt compelled to do something about it,” Duong says.
He returned to the Krieger School last spring as a Gordis Teaching Fellow leading a public health studies class called Youth Bullying, Aggression, and Public Health. The Gordis program invites advanced graduate students from the Bloomberg School to develop and teach innovative undergraduate courses that incorporate new trends and topics in public health. Attending medical school remains in the offing for Duong. “But now first and foremost I want to be a public health practitioner,” he says. “I just feel that medical training would be very useful in order to better understand the ways I can serve youths who have been bullied.”
More recent public health grad Minhaj Chowdhury ’11 is busy garnering investors for Drinkwell, a social enterprise he co-founded last year to tackle one of the most entrenched and tragic public health issues out there: the mass poisoning of Bangladeshis from arsenic in their groundwater. The World Health Organization warns that as many as 77 million people are at risk of ingesting this tasteless and odorless element that occurs naturally in the nation’s aquifer. As many as one out of four deaths in the country is related to arsenic poisoning, by some estimates.
Chowdhury was one of those globalized Millennials who wanted to travel and learn about the world when he first came to Hopkins. In 2009, the Bangladeshi-American traveled to his ancestral homeland to install 100 household water filters in a remote village, a trek partially funded by the JHU Institute for Global Studies Summer Research Fund. When he returned to the village on a Fulbright Fellowship in 2011, Chowdhury was shocked to find that only three of the filters were still in place. The rest had been broken up and their component parts sold. “Turns out, giving away stuff is the worst thing you can do,” he says.
Drinkwell takes a community-based, franchise approach to the arsenic issue by empowering local entrepreneurs to build central filtering hubs that can sell clean water to a whole village. The approach creates sorely needed jobs and incentivizes maintaining the equipment. “People will buy water when their friend sells it, rather than from a foreign NGO that rolls into the village in a white UN truck,” Chowdhury says of this market-based approach, a version of which one of his Drinkwell partners has already successfully tested in India. He hopes to begin in-country implementation in 2015.
Sarah Benett extracts DNA from African mosquitoes to determine if they are carrying malaria.
Changing the World
So will the major keep growing? “At some point, we will hit a plateau, but I don’t know where that is yet,” says program director Gebo. She notes, however, that the Association of American Medical Colleges is changing the Medical College Admission Test next year to include a greater emphasis on behavioral and social sciences. This might lead still more students to select public health studies or social policy studies as their pre-med degree.
Since her arrival in 2005, Gebo has seen the number of public health studies faculty more than triple, and what was once a smattering of largely part-time advisers and administrators become a bona fide staff of half a dozen.
Going forward, Gebo hopes to form new academic partnerships and collaborative classes. The Women, Gender, and Sexuality Program, the Center for Africana Studies, and the School of Nursing are some possible partners for collaborations and academic synergies.
In the meantime, students keep finding their way to the program. Students like Sarah Benett ’16 from San Francisco, who credits her father for discovering it as they pored over various college catalogs. “He knew I always talked about wanting to help people, so I looked at it and fell in love with the major,” she says.
Benett’s ongoing Applied Experience differs from the out-in-the-field work of her classmates Irwin and Longo, underscoring the diversity of opportunities within the major. Since last fall she has been assisting at the Norris Lab in the Johns Hopkins Malaria Research Institute and Department of Molecular Microbiology and Immunology at the Bloomberg School conducting lab work extracting the DNA from the bodies of mosquitoes collected in Zambia and Zimbabwe. She helps perform an analysis to determine their species, and if they are carrying malaria, information then conveyed back to Africa to help health workers target preventive measures.
“I have always been a person who wants to change the world,” Benett says. “I think that, as a generation, we’ve grown up with this notion that we have an opportunity to change the world. With public health, there are just so many opportunities to try and do that. It doesn’t necessarily have to be in the medical field. It can be in policy, creating new laws, or it can be just going out and helping with Habitat for Humanity.”