Kingsborough Community College Program Serves as a Model, Offers New Insight Into Health Workforce Solutions

By Alex McEllistrem-Evenson, Editor, Health Workforce News

	Said one, to his please, “It’s a marvel to me That you’d give so much greater attention To repairing results than to curing the cause, When you’d much better aim at prevention.
	– Joseph Malins, 1895

Dr. Karen Denard Goldman, Co-Director of the Community Health program at Kingsborough Community College in Brooklyn, New York (KCC), likes to share a poem with her students titled “The Ambulance in the Valley” as a means of illustrating the importance of public health professionals.

The poem¹ presents the case of a community that chooses to cope with a dangerous cliff by funding an ambulance service at the base of the valley, to handle the bodies. One person suggests they build a fence at the precipice as a more sensible alternative, but the masses ignore him. Goldman presents the fence-builder as a community health worker, illustrating the need for both cure and prevention: “Of course, yes, if somebody does go over, you need to take care of them, but you also need the person who’s focusing on prevention – keeping healthy people healthy.”

“You need them both,” she continues. “Either one alone is one hand clapping – it doesn’t work. You need the hands not only to clap but to clasp.”

While effective with her students, the poem might also serve as an apt metaphor when considering new roles community colleges can play in alleviating persistent health workforce crises. In profiling the unique Community Health program at KCC, it is clear that Goldman is in search of some hands which she and her colleagues can clasp.

“People have always recognized community colleges as a source of certain levels of health workforce professionals,” muses Goldman. “Whether it’s nurses, surgical technicians or allied health professionals, people know that we’re out there. They probably just haven’t thought that one of the possible programs to come out of community colleges would be community health programs like Kingsborough’s.”

There are currently 1,177 community colleges spread across the United States, serving 11.7 million students and awarding over a million associate degrees and certificates annually, according to the American Association of Community Colleges. Despite this proliferation, KCC is one of only two community colleges in the U.S. with a community health major, and one of just two Associate Degree programs with a concentration in health education and promotion.

“We originally had the impression that there were about a dozen or so” schools offering community health as a program of study at the community college level, according to Goldman. Recently, however, “we’ve gone back and looked at the course content of degree programs categorized as community health/community health services. If you look specifically for courses associated with community health—an introduction to the field, the principles, and history; epidemiology; and global health; the things that constitute a true public health, population-based, prevention-oriented approach, they’re not there. Based on our review of course catalogues, web sites, and college guidebooks, it seems that for the past 25 years we’re the only community college that has been offering a ‘true’ community health curriculum. Howard Community College in Maryland came on board with their public health degree earlier this year. It would be wonderful if this approach became a trend!”

Preparing students to transfer to a four-year college to complete their studies is hardly innovative; offering an Associate of Science degree in community/public health, with three possible areas of concentration (health education and promotion, gerontology, and health administration), however, is. Says Goldman: “It’s wonderful to be able to introduce students in their first two years of college to community health. Perhaps even more important than the basic course work is the focus on what it means to have a community-health mindset. For many people, it’s a new way of looking at the health industry. Here at Kingsborough, the community health major is all about teaching students to look at the advantages of a population-based approach to health and community-level interventions, focusing on primary prevention, and talking about how the medical and public health models complement each other.”

Focusing on developing an awareness of and appreciation for a community health approach, and launching professional preparation programs in health education and promotion and health services administration in particular, is unusual – which is too bad, according to Goldman. There is a definite need and interest. In fact, over the last two years, the number of students majoring in community health at KCC has tripled, to almost 160 students.

Usually, high school students are unaware of community health as a major or career. “Just as everyone mistakenly thinks that community colleges are all about remediation and vocational training – everyone thinks that health careers are about providing clinical care – surgery and medication – to people who are sick or injured. The other side of this very valuable coin is public health: coordinated community-based efforts to prevent disease, disability, and premature death through mass media campaigns, legislative advocacy and policy change, community organizing, community outreach, innovative use of technology, equipment/service/environmental changes, economic sanctions, and health education.”

In addition to community health, there are numerous other unsung or under-sung health professions which could make a similar claim about alternative mindsets and approaches. The overwhelming amount of media, research, and policy attention paid to physicians, nursing occupations, and primary care as a general topic could be viewed as both a cause and a result of this phenomenon. Virtually everyone agrees upon the necessity of all health professions and acknowledges that critical workforce shortages exist outside of physicians, nursing occupations, and primary care as well, yet pipeline efforts tend to focus on a select few areas.

Goldman observes that community colleges are uniquely positioned to help, due primarily to their multifaceted nature and diverse student bodies. “Respected organizations such as the Institute of Medicine and people in the trenches agree: the health workforce needs diversity and involvement of people from their local communities. If you look at the health disparities map of New York and then see who’s going to school at Kingsborough, it’s a perfect match. Let’s promote community health careers to the people we need working in the field right where so many of them already are – community colleges,” she observes.

“Kingsborough’s student body is incredibly diverse – they come from 142 nations and speak over 70 different languages” elaborates Goldman. “Also, I’ve found that most KCC students are very career oriented and are eager to identify a profession to begin to study for right away. They are typically older, often the first person in their families to go to college, economically challenged – which is a powerful motivator to succeed, commuting, and employed full or part time in addition to coming to school. Our students represent communities currently experiencing major health disparities and are passionate about achieving health equity in their communities and others like theirs. Based on my five years at KCC and my 15 years in community health, I am convinced that community colleges are uniquely poised to launch the next generation of the community health workforce.”

Community colleges themselves are also unique in that they are designed to serve a variety of functions, more so than most four-year schools. As a “comprehensive” community college, KCC offers a wide range of services, including remediation for those who are unprepared for a four-year program, vocational training for people in need of a very specific skill set or professional certification, continuing education for personal or professional enrichment purposes, and academic programs comparable to the first and second years of a four-year college. In terms of degrees, KCC offers the Associate of Arts / Associate of Science (AA/AS) for students planning to move onto a four-year program, and an Applied Associate of Science (AAS), which is a terminal degree in professions such as Surgical Technology and Nursing.

“I think that the mistaken basic perception of community colleges is that they are places where people go when they can’t get in someplace else,” states Goldman. “We all need to realize that two-year colleges may have different missions and often offer a range of services – including, in many cases, rigorous academic coursework. All faculty members of the KCC community health program have a doctoral degree from accredited graduate school programs. We are all dedicated to recruiting, supporting, and preparing the future community health workforce. We know we’re someplace special – but we would be delighted to see more programs like our own across the country to meet the national demand for community health workforce development resources.”

Relative to health workforce pipeline issues, the advantage of having a diverse student body that serves distinctly different purposes for students in distinctly different stages of their lives and career development is that personal invention and reinvention become part of the culture. “A community college is definitely that,” states Goldman. “When you have a school like KCC you have the potential to attract into all our programs this wide variety of students. Certainly, some are here because they don’t know yet exactly what they want to do. Others say specifically they know what they need in terms of their career and personal life.” As a result, students have a greater propensity to conceptualize career development in a more mature manner, which is good news for many health professions.

“If you look at the literature, there’s a range of nine different stages of career development,” clarifies Goldman. “The lowest and most immature is the idea that ‘there’s one right career and somebody I know who I perceive as an authority has told me I should do this so I’ll be this for the rest of my life. I will stay there, be rewarded and promoted, and I’ll live happily ever after.’ Number one, that’s not the way the world works any more. More importantly, however, the career choice made on that premise is not a reflection of the person’s self-knowledge.”

Goldman asserts that in later stages of career development, individuals come to discover that there are “many choices that can fit, and that there is no one right career decision.” In this conceptualization, change, adaptation, creative and critical thought are viewed more as opportunities than as agents of chaos. The self-knowledge fundamental to this shift is encouraged at community colleges such as KCC that, in addition to course work, offer fieldwork and service-learning opportunities to their students, according to Goldman.

Despite the burgeoning popularity and success of KCC’s community health program, “very few students come in on day one declaring ‘I want to do population-based work that focuses on prevention, doing the greatest good for the greatest number via community health,’” clarifies Goldman. “Most have never heard of community health or health education; they have a vague idea of what a health services administrator does; but they rarely know what epidemiology is or the importance of public health systems in their lives.” Many community health majors come into the program as a result of helpful academic counseling during their first semester. Some community health majors come from the nursing program which is very competitive and has far fewer seats than candidates. Goldman has encountered many students with a strong interest in the fundamentals and approaches of public health who have no idea that professional opportunities even exist in the field. Thus, Goldman and her colleagues are responding to workforce problems in a pragmatic manner, capitalizing on the unique characteristics of their institution and student body in a way that correlates with the unique characteristics of their profession and discipline.

Essentially, KCC has chosen to construct a figurative fence at the edge of the cliff of health workforce crises, rather than to operate an ambulance service down in the valley. Goldman is enthusiastic in her belief that other community colleges can (and should) do the same.

“Given the type of workforce that is needed in community and public health over the coming decades, I’m suggesting that four-year colleges, local health departments, and potential employers of health workers reach out to community colleges and explore the possibility of creating a community/public health major,” Goldman offers. “It might fit, as it does at KCC, in the Department of Health, Physical Education and Recreation, or elsewhere. Community colleges, like four-year colleges, are organized in different ways. Consider speaking with the dean of academic programs at the community college and starting a conversation about the possibilities. Somebody should call a summit meeting; whomever has the ‘a-ha moment’ first should invite everybody over.”

Goldman believes that community colleges, already launch-pads for a wide variety of health careers, can also become a primary initial recruiting ground for the community health workforce of the future. “We have a model that has evolved over 25 years; no one needs to start from scratch, and we would benefit enormously from the opportunity to collaborate with other community colleges. Thanks to our community health program advisory board, made up of practitioners and four-year college community health related degree program directors, our program is stronger and more attractive than ever. The students who graduate with a degree in community health and have taken advantage of the fieldwork and service-learning opportunities are passionate about their calling to study and dedicate themselves to improving the community’s health. They have no doubt that they’re going to continue their education and that they will have personally and professionally fulfilling careers.”

“I will bet you money that other community colleges without a community health program have just never thought of it. The field is not as well known at the undergraduate level as it is at the graduate level. The Association of Schools of Public Health estimates that there are 250,000 vacancies in public health; they’re all over the country. I’m hoping that people will look at this and say, ‘Why aren’t we working with community colleges to launch community health careers?”

¹ Numerous variations of the poem exist, although nearly all are attributed to Malins and offer the same basic parable. Read one version here.