CHAPTER 24
On the Cutting Edge
Public health has been around, in one way or another, for hundreds of years—but it is still very much an evolving discipline. Schools of public health are introducing new programs, health departments are looking for innovations, and new diseases and challenges continue to appear. The careers in this chapter address some of the newest and fastest evolving areas of public health, from new technology to new ways of looking at familiar work. They are heavy on research, because even the top experts are still figuring out the best approaches and the smartest policies.
These careers are just a sample of what is currently happening in the evolution of public health. Over the next several years, it will be interesting to see where these fields are headed, and what other new developments occur.
For more ideas about emerging careers in public health, check out the course catalogs from some schools of public health—there are often classes that cover new developments and trends. And there are always interesting people to meet and careers to discover at the American Public Health Association’s annual meeting, where innovations from all areas of public health are presented and discussed.
PUBLIC HEALTH GENETICS
Job Description
Knowledge about genetics has always been important in health care, but it has become a more prominent topic in recent years. Genetic studies have shown why certain medications do not work the same way for everyone. More and more genetic tests are becoming available, promising to predict the future in terms of health and disease. At the same time, our understanding of genetics remains limited. We do not always know how to interpret test results, because even if we know a certain gene is associated with a disease, we may not completely understand all the other influences. We only know how to tailor a very few treatments to genetic makeup. And we are only just starting to explore the connection between genetic expression and the environment.
Public health geneticists straddle the line between genetics research and the development of public health programs and policy. Historically, public health has incorporated genetics mainly in the form of newborn screening programs, which look for genetic diseases. However, this has been expanding as we learn more about the human genome and how genes work. The human genetics department at the University of Pittsburgh, which was the first genetics department at a School of Public Health in the United States, identifies three roles: looking at causes and treatments for both acquired and inherited diseases, understanding genetic differences among human populations, and looking at how genetics impacts public health and the prevention of disease. A public health geneticist might focus on how genetic makeup influences the development of common diseases, so that prevention efforts can take this into account. They might look at all those new genetic tests and how much the results really tell us, so they can be used wisely and not cause harm. They might study how environmental factors, from pollution to emotional stress, can influence genetic expression, or how different genetic variations allow some people to avoid a disease while others are affected. Some public health geneticists focus on the ethics of genetics in medicine and public health. Some translate research results into education for legislators, doctors, and the general public, and advise on policies that will benefit the public’s health.
Public health genetics is often an office job that includes analyzing data, writing reports, collaborating with other scientists, and educating various stakeholders.
Education and Certification
The best degree for a public health geneticist depends on career goals. For a research-focused career, a PhD in human genetics would be a good choice. If your interest is more in applied research (figuring out how current genetics knowledge can be used to improve health on a population level), it is possible to earn an MPH or a PhD with a focus on public health genetics. However, only a small number of schools of public health offer a specific genetics track. Some incorporate the study of public health genetics into a more general epidemiology track. Because this is still an evolving field, many of the current experts come from other backgrounds, having incorporated genetics and public health into their work.
Core Competencies and Skills
Understanding of scientific and clinical research methods
Strong knowledge of applied statistics
Good background in molecular biology and genetics
Knowledge of core public health principles, particularly epidemiology
Scientific curiosity
Ability to understand how information from basic research and human behavior interacts
Ability to translate difficult concepts into straightforward language
Compensation
The National Human Genome Research Institute gives a salary range for public health geneticists starting at about $36,000 and rising to $101,000, with a median of $65,000. Upper-level professors, researchers, and public health leaders can earn more.
Workplaces
There are public health genetics experts working in research and academic settings, in laboratories, and at health departments and the Centers for Disease Control and Prevention (CDC).
Employment Outlook
Public health genetics is a growing field, and there seems to be room for both MPH and PhD graduates. The CDC has a special division for public health genomics. (Genomics is a subset of genetics that looks at a person’s whole genetic makeup, and how genes interact with each other and the environment.) Some state health departments have special sections dedicated to the connection between genetics or genomics and public health. There has been increasing interest in tailoring prevention and treatment to individuals’ specific genetic variations, which may lead to more jobs in industry; although not strictly “public health,” these roles use many of the same skills. It seems likely that this field will continue to expand as more is learned about the connections between genetics and health.
For Further Information
Human Genetics department at Pitt Public Health, University of Pittsburgh
www.publichealth.pitt.edu/human-genetics
Institute for Public Health Genetics, University of Washington School of Public Health depts.washington.edu/phgen
World Health Organization (WHO) Human Genetics Programme
www.who.int/genomics/en
American Society of Human Genetics (ASHG)
www.ashg.org
Centers for Disease Control and Prevention (CDC) Office of Public Health Genomics
www.cdc.gov/genomics
PUBLIC HEALTH PROFILE: Public Health Genetics
W. David Dotson, PhD
Senior Coordinating Scientist
Office of Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, GA
Describe the sort of work you do.
My job title is health scientist, and although I sit at a desk most of the day, I am often doing research at the same time. My area of expertise is in the development of evidence-based information on the use of genomic applications in clinical and public health practice. For example, with the increasing availability of tests that pertain to common, complex conditions that have been made possible following completion of the Human Genome Project in the early 2000s, we need to look at which tests are ready for safe and responsible use at the population level. The research that I do is typically based on analysis of existing scientific literature, so I don’t need to be in a laboratory. I also help design and implement databases and online tools intended to inform stakeholders (including health practitioners, researchers, health care payers, and the general public) and help integrate evidence-based genomic applications into practice.
What is a typical day like at your job?
Usually the first thing I do every morning is to check my e-mail. I get anywhere from 1 to 20 e-mails per day that need a response. I answer a lot of questions from people, both at the CDC and elsewhere, who need to know about genomic research and information for their own work.
I attend at least one meeting per day, and occasionally even three or four. Some are weekly team gatherings to plan and implement new databases, or to prepare our weekly e-newsletter update. Other meetings are phone calls with representatives from state public health genetics programs that work with the CDC through cooperative agreements. I also plan meetings for an independent panel that our office supports, which is devoted to the evidence-based evaluation of genomic tests.
I would say that approximately half of my day is spent working collaboratively on projects that require face-to-face or virtual team activities. Even when I am working alone in my office, however, the projects I am doing are part of larger products that are owned by various teams. So I could be writing commentaries on current policy issues in genomics for publication in a journal, or writing a blog to inform people what the evaluation panel has determined, or writing an e-mail to invite someone from another office within the CDC to consider collaborating with us on a project. In every case, I am working to help develop, support, and maintain activities and programs that support both the mission of my office and of my agency.
What education or training do you have? Is it typical for your job?
I earned a BS in biochemistry and PhD in microbiology. After deciding that I wanted to pursue a career in public health, I completed an online graduate certificate in the core concepts of the field from the University of North Carolina at Chapel Hill. I also earned an online graduate certificate in applied statistics from Penn State University, as a means to expand my analytical skills. I think it would be more typical to go straight for an MPH or even DrPH.
What path did you take to get to the job you are in today?
During graduate school, I did laboratory research in fungal genetics and molecular biology. I also worked as a teaching assistant for an undergraduate microbiology laboratory class. After I earned my PhD, I went to work as a postdoctoral fellow in the biotechnology industry, doing research on similar topics. My first job after completing that training was in the pharmaceutical industry. My title was senior medical writer, and the work included medical writing, project management, and reviewing promotional materials for accuracy and regulatory compliance. But I wanted to feel more like my work was making a difference in the world, and I found an opportunity to work as a contractor at the CDC through a public health jobs website. Later, when a full-time federal position opened up that I was qualified for, I applied and got that job, where I remain today.
Where might you go from here, if you wanted to advance your career?
I really enjoy working for the CDC, and they are involved in a wide range of really important health areas, so I would look for opportunities to advance here.
What is the worst or most challenging part of your job?
Working collaboratively on writing projects is both the most rewarding and the most challenging part of my job. It is rewarding because I get to meet and work with a lot of really wonderful people, and the final products turn out better than if only one of the authors had done all the work. It is challenging because often you need to build consensus around ideas that people may feel strongly about. It can be difficult, and sometimes frustrating, but when you achieve that, and finish the project, there is a great feeling of accomplishment.
What is the best part?
The best part of my job is that I feel like I am contributing to something that has value and will be helpful to society. On top of that, I get to meet a lot of really talented, kind, and hardworking people who devote their lives to trying to improve health. It is really inspiring!
What advice do you have for someone who is interested in your career?
I recommend developing a solid background in the aspects of genomics that interest them—that is, they may have an interest in pathogen genomics, or human genetics, or laboratory aspects of genomics, or bioinformatics. But don’t neglect social science courses! So much of public health, genomics or otherwise, requires an understanding of behavioral, economic, ethical, and societal issues. Likewise, statistical analysis is a valuable skill across disciplines in public health. Whether someone actually does numerical analyses or not, it is absolutely critical to be able to understand what the results mean.
IMPLEMENTATION SCIENCE
Job Description
Implementation science can be considered an offshoot of translational research, which looks at how the results of basic scientific studies, such as in the laboratory, can be “translated” into treatments or practices that directly benefit health. In public health, implementation science aims to find better ways to disseminate effective innovations, replicate successful programs in different communities, and prevent useful knowledge from being overlooked or lost. Even in the Internet age, there is no single repository for evidence-based public health knowledge, and no efficient way for public health practitioners at local health departments to keep up with each others’ work. Furthermore, it is not always clear how best to translate a successful program from one location to another: What works in one setting often fails in a different one. Sometimes a program will work for a while but then start to fail, without an obvious reason. Often there is more than one way to approach a problem—and it is not clear which one to choose, or if it would be better to combine them. Implementation science looks at social, behavioral, economic, and administrative influences to see what might be acting as a roadblock and what might be helping a program or policy succeed. This research can involve community-level programs, laws, and policies, or direct-care health services that need improvement on a wide scale.
Methods developed by implementation science can be put into practice at all levels of public health, but careers specifically in this area tend to be research oriented. Implementation science researchers combine knowledge on topics such as systems analysis, monitoring and evaluation, comparative effectiveness, behavioral sciences, economics, and more to investigate best approaches in public health. Examples in health care delivery include looking at what helps HIV patients in different settings to follow up with treatment, or figuring out how to encourage doctors to follow guidelines for managing heart disease so that evidence-based practices will be more widely used. In community-level work, a researcher might look at the effects of different programs to encourage exercise and why some are more successful than others, or at how a successful program to promote safer driving can best be disseminated to other communities. The job may involve travel to sites where programs or policies are being implemented, to observe and gather data. Researchers who are also professors will generally teach classes in addition to their research work. Depending on the researcher’s interests, the work can range from local to global.
Education and Certification
As of 2015, the Association of Schools and Programs of Public Health did not include implementation science in its list of public health focus areas, and it was not common to find degree programs specifically in implementation science focusing on public health. More often, implementation science is taught as part of other disciplines such as health services research and quality improvement, health policy and management, or social and behavioral health sciences. Because this is still a new field, it is likely that more educational opportunities will be developed in future years. Meanwhile, there are some brief training courses and certificate programs that can provide an introduction to the field, and a limited number of fellowships for PhD or MD graduates.
Core Competencies and Skills
Understanding of how to carry out and interpret research and conduct statistical analyses
Ability to collaborate with public health professionals who are implementing programs and policies
Understanding of how clinical practice works and how clinicians think
Ability to think creatively about problems and obstacles
Understanding of cultural differences and how they can impact approaches to health
Compensation
Job descriptions that incorporate implementation science vary, and there are no national salary statistics. Salaries for university-based researchers would be expected to be typical for professors.
Workplaces
Implementation science researchers and specialists work at universities, government agencies and health departments, intergovernmental agencies like WHO, and major nonprofit organizations and consulting firms.
Employment Outlook
There is a lot of interest in what implementation science can offer. As both public health and health care focus more and more on measuring outcomes and impact, the demand for implementation science experts is likely to grow. Applying the tools of implementation science in real-world scenarios holds great promise for the future of public and global health.
For Further Information
Several of the agencies within the U.S. Department of Health and Human Services (HHS) are doing work in implementation science; in 2015, some of the agencies with information on their websites were the National Institutes of Health (NIH), the CDC, the Substance Abuse and Mental Health Services Administration (SAMHSA), and the National Cancer Institute.
University websites are another good way to start learning about implementation science. Look for programs based at global health programs or schools of public health.
NANOTECHNOLOGY
Job Description
It is only in the past few decades that we have started to understand the properties of matter on the nanoscale level. Nanoscale is really, really small: According to the National Nanotechnology Initiative, a single sheet of newspaper is about 100,000 nm thick. The basic properties of materials—such as melting point, chemical reactivity, and even color—change as they get down to this size. Most biological processes occur at the nanoscale level, which makes knowledge about what happens very useful for developing new medical technologies. But it also raises questions about the safety of nanoparticles for human health.
Nanotechnology has become a very important part of industry. It has been estimated that by 2014, 15% of all products would use nanotechnology in some way, totaling nearly $2.6 trillion in manufactured goods. Cosmetics companies are advertising wrinkle treatments and cleansers made with nanoparticles. Nanoscale materials are being used on clothing to help resist staining and wrinkling. They are in our eyeglasses and computer displays, because they can make surfaces nonreflective and scratch resistant. They are in food packaging, helping to keep sodas bubbly and food fresh. Nanotechnology is used in electronics, in fuel production, in medical devices. And yet we do not know the full impact of absorbing or ingesting nanoparticles, the true spectrum of risks in manufacturing, or what happens when recycling releases nanoscale particles into the environment. Workers in industries using nanotechnology may need special protections. There may be new concerns about air or water pollution.
Nanotechnology experts in public health can do a variety of different jobs. One role is in academia, as a faculty member doing research on the safety, ethics, and public health risks of nanotechnology. Others work for federal or state governmental agencies, on research, regulation, or policy development. Some experts with public health training have jobs in the private sector, such as working with an industry to ensure the health and safety of workers using nanotechnology in science or manufacturing. There are also opportunities to work on developing nanotechnology applications for health or environmental purposes. Public health and environmental health professionals in nanotechnology often interact and collaborate with a wide variety of other highly trained professionals, such as engineers, biologists, chemists, physicists, and business experts.
Education and Certification
Depending on the type of job and the employer, there are many different paths to a career in nanotechnology and public health. Physicians may work in occupational health and safety, for example, in a clinical capacity, research, or both. A public health degree, such as an MPH, DrPH, or PhD, can lead to research-based, policy-based, or other types of positions within academia, government, or industry. Many of the people who have found their way to public health nanotechnology research come from other backgrounds. For example, faculty working on nanotechnology at schools of public health include physicists, bioengineers, environmental science experts, pathologists, and other types of specialists.
Core Competencies and Skills
Interest in scientific and medical information
Knowledge of public health, occupational medicine, and environmental health and safety
Strong understanding of scientific research and (for researchers) knowledge of how to design a scientific study
Good understanding of risk assessment
Ability to work with people from varied other disciplines—such as engineering, business, physics, and chemistry
Ability to explain complex ideas to people from different fields
Compensation
The opportunities in this emerging field are too varied to give a single estimate for salary. For a general idea, look at the salary ranges for more specific roles—such as public health advisor, public health physician, bioengineer, professor, and so on.
Workplaces
Work concerning nanotechnology’s impact on public health is going on at colleges and universities, at nonprofit organizations, and at state and federal agencies. There are also opportunities at private companies for people with public health training, such as overseeing worker and consumer safety.
Employment Outlook
Nanotechnology is a rapidly growing field with a quickly expanding workforce. Although right now nanotechnology is still an emerging specialty in public health, it is likely that there will be increasing needs and opportunities in the future, particularly relating to occupational medicine, health care, and environmental health.
For Further Information
National Nanotechnology Initiative
nano.gov
PUBLIC HEALTH PROFILE: Nanotechnology
Sara Brenner, MD, MPH
Assistant Vice President for NanoHealth Initiatives, Assistant Professor of Nanobioscience
Colleges of Nanoscale Science and Engineering (SUNY Poly CNSE), SUNY Polytechnic Institute, Albany, NY
Describe the sort of work you do.
As a faculty member at SUNY Poly, I have three main jobs: research, teaching, and service to the university. The primary focus of my research is occupational exposure assessment for the nanotechnology workforce, which includes developing methods to measure inhalation and cutaneous (skin) exposure for workers in the semiconductor industry. I collaborate with colleagues who have very different areas of expertise from me. Only through interdisciplinary teams are we able to advance the state of the science with regard to measurement (quantification) of nanomaterials and how exposure relates to health outcomes. My research group also links occupational health to nanotoxicology research where we investigate biological responses to specific nanomaterials. Another related aspect of interest is environmental health. For example, my team investigates how engineered nanomaterials move through the industrial waste stream and the potential effects they may have on the environment.
For my role as a teacher, I designed a nanomedicine course focusing on applications for prevention, diagnosis, and treatment of disease. I also teach an ethics course on the societal implications of new and emerging technologies. Additionally, teaching includes day-to-day mentorship and guidance of graduate students (PhD and MS) in their research, as well as coordination of teams of students including undergraduates and high school students who work under my guidance on health-related projects.
My service activities are quite varied and include activities such as serving on our admissions committee and institutional review board (which helps ensure that research is ethical), as well as designing and delivering education and outreach activities related to my work that engage the greater community. I am also responsible for helping to build new programs (such as the MD/PhD program in nanomedicine), centers (such as the NanoHealth & Safety Center), and initiatives (such as partnerships with federal agencies, companies, and other groups), and scope out new directions for SUNY Poly CNSE in health and medicine.
What is a typical day like at your job?
Every day is different—which is part of what I love about my job—but each week typically contains a few main themes. One is conducting research and orchestrating my research team, which includes staff, undergraduates, and graduate students. I spend a lot of time training, mentoring, and working with them. I do a great deal of writing—such as scientific research papers, book chapters, proposals, and grant applications. I also review and prepare feedback on writing prepared by others, such as scientific papers being considered for publication and grant applications being considered for funding. For my classes, I prepare lectures and grade papers, and, of course, there is time spent teaching and meeting with individual students who are taking part in SUNY Poly CNSE’s immersive educational experience, enabling them to pursue a growing number of high-tech careers across New York State and beyond.
Another part of each week involves strategizing and preparing information and presentations for colleagues, collaborators, administrators, and the public. This is where I link the nitty-gritty details of my research and other activities of the college to the “bigger picture” of what is going on with the nanotechnology community as a whole, locally, nationally, and internationally. I do a lot of thinking about national priorities and strategies for the future of nanotechnology and health. That includes doing talks for federal agencies, scientific conferences, local or community organizations such as professional groups or schools, as well as presentations for the general public such as those hosted by museums. Another big slice of time is spent on building partnerships and strategic or research-focused relationships with the clinical community, the public health community, federal agencies, and industry. That can include phone calls, meetings, and e-mails, or travel to in-person meetings. In addition, I spend time each week learning, either through these activities or through time dedicated solely to expanding my own knowledge base. I devote time each week to reading papers and learning from many different disciplines that are important to understanding nanotechnology and its implications. The science is moving so quickly that if you take your foot off the gas for even a short time, you’re way behind!
What education or training do you have? Is it typical for your job?
My path is rather serendipitous and definitely not typical. However, in the future, I don’t think there will be a “typical” route into nanotechnology. I did my BS with a focus on genetics and philosophy before going to medical school. I realized early in medical training that I was different than other physicians-in-training. I was always interested in disease prevention (even more so than treatment, from a philosophical standpoint) and became increasingly interested in health care systems, the delivery of medical services, and health policy. I completed my MD and went on to residency training in internal medicine and then specialized in preventive medicine and public health (including an MPH). I’m the only faculty member at my institution with an MD; other faculty members have PhD terminal degrees. Medical doctors who do research are more often located at academic medical centers; however, the MD degree is becoming one of the most versatile degrees out there, and many physicians are forging careers outside of clinical practice. I believe this is a good thing, as the role of physicians in the health care system and in society is changing and will evolve in coming generations due to a variety of factors, including the integration of advanced nanotechnologies into medicine.
What path did you take to get to the job you are in today?
I started this job right after residency. My main focus during medical school and residency was federal health policy, and I was solely interested in moving to Washington, DC, to pursue a career in the federal government. At the tail end of residency (literally in the final weeks), I happened to attend a lecture on nanotechnology and medicine, and it really piqued my interest—so just out of curiosity, I asked if I could do a short rotation with the head of the nanobioscience department here; he said, “Sure!” and I quickly discovered how fascinating and transformative nanotechnology will be in all industries, including medicine. I became so fascinated that I still haven’t left.
Where might you go from here if you wanted to advance your career?
There is a lot that I want to do right here! SUNY Poly is growing at lightning speed, with more than $20 billion in investments at its world class Albany NanoTech Complex alone, and nanotechnology is the future in so many industries. I want to help advance this technology and also safeguard the advancement from a health and safety perspective. SUNY Poly CNSE is a unique institution, where we are connected to all sectors—academia, industry, and government. There’s no better platform for the type of work I want to do.
What is the worst or most challenging part of your job?
The most difficult part of being on faculty is wanting to do more than I can fit into each day! I know many colleagues feel this way as well. Time management can be challenging, because there are so many different activities going on and all of them are interesting and important.
What is the best part?
The most rewarding part is helping shape the future, in the sense that we are advancing science that will propel humanity forward. Nanotechnology has been heralded as the next industrial revolution, it’s the nexus of thinkers, scientists, entrepreneurs, humanitarians, and futurists. The other way in which I can shape the future is through teaching and mentoring students who will carry on this work. They will carry the torch, they will create what comes next. And I love the diversity in my work—from the activities every day to the progression of science to the different people I work with.
What advice do you have for someone who is interested in your career?
Follow your passion. Embrace risk. Create opportunity. Engage tenacity. Don’t be afraid to pursue a direction that others don’t understand. The future is defined by those who see things differently and who do things differently. If you can envision a path that doesn’t yet exist, don’t let the unknown dissuade you. And preserve your sense of curiosity and wonder along the way.