LAUSR

At the 2016 annual meeting of the American Public Health Association (APHA), the Council on Education for Public Health (CEPH) presented its new accreditation criteria for schools and programs of public health. All schools and programs were required to comply with these new criteria by January 2018. These new criteria shifted from the previous accreditation standards that required schools and programs of public health to create competencies, and then a curriculum, that addressed the core public health disciplines to the requirement to create a curriculum from “competencies to translate that knowledge into effective day-to day practice.” This change marked “the biggest change to public health curricula since the 1940s.” The new CEPH competencies explicitly mention ethics in only one competency, and only as one aspect of a larger issue, policy making: “Discuss multiple dimensions of the policymaking process, including the roles of ethics and evidence.” Other than this single explicit mention, ethics can be interpreted to be implicit in several other competencies, when one acknowledges that several competencies evoke such traditional ethical domains as values, fairness, and relational and communication skills (ie, getting along with others). We believe that the revisiting of the CEPH accreditation criteria was a missed opportunity to acknowledge and include explicit ethics competencies as required for adequate training in public health. Although the public health literature contains an extensive conversation about the nature and definition of public health ethics, these discussions are rendered moot if schools and programs of public health do not teach these values and skills to future public health practitioners. Both of the authors are professors in an accredited school of public health at a Jesuit university (St. Louis University) that is committed to social justice and ethics. One author (S.S.C.) has developed and delivered masters-level public health ethics courses for the past 8 years and has seen firsthand positive reception and the practical benefit that these ethics courses bring to public health students, as well as the challenge of keeping these courses in the curriculum due to the increasingly robust competencies demanded of schools and programs of public health that do not include ethics competencies. This experience is not unique. In 2008, Klugman wrote that his public health ethics course was pulled from the curriculum because ethics had not been required for the previous CEPH accreditation criteria, which did not mention ethics at all. At this critical juncture for curriculum design in schools and programs of public health, we make the case that public health ethics competencies should be explicitly included in CEPH competencies. We argue that the exclusion of explicit ethics competencies does not align with 2 stated purposes of the new CEPH criteria: (1) to shift from accreditation based on knowledge to accreditation based on skills and competencies and (2) to align public health training with the needs of the public health workforce. On the contrary, public health ethics has already been conceptualized in terms of skills and competencies in the public health ethics literature in a way that easily fits into CEPH’s approach to competencies, and empirical evidence and practice demonstrate that the public health workforce needs public health ethics training. Finally, implicit inclusion is not enough. We argue that CEPH should include competencies explicitly about ethics in its new accreditation criteria; by not doing so, public health trainees risk not being adequately prepared for the challenges of public health practice in the 21st century.