School of Public Health: External Review Report
Prepared by:
Kristan J. Aronson, Queen’s University
Craig R. Janes, University of Waterloo
Beth Virnig, University of Minnesota
Robert Tyler, University of Saskatchewan
March 24, 2015 (Final External Review Report)
EXECUTIVE SUMARY
We recognize that the School of Public Health at the University of Saskatchewan has been through a
turbulent time. A difficult leadership transition coupled with rapid growth in student numbers
without commensurate growth in the faculty complement has compromised its charter mission and
vision. Nevertheless, it is important to acknowledge at the outset many of the accomplishments and
achievements made over the eight years since its inception:
• The School was able to establish a successful MPH program. Numbers have grown
substantially since its launch, and the School was able to achieve accreditation for the MPH
program from the Agency for Public Health Education Association (APHEA) in 2014. This
accreditation recognizes clearly that the program has met, despite growing pains, an
“international standard” for public health education.
• The School has been able to launch a MSc/PhD program in Epidemiology, and in Vaccinology
and Immunotherapeutics, and participates in a collaborative MSc/PhD program in
Biostatistics.
• Selected faculty members (both those appointed to the school and joint appointments) have
established successful individual research programs. Several faculty members are committed
to and demonstrate excellence and innovation in teaching.
These are important accomplishments and should provide a good foundation for the School as it
moves into the next phase of its development. However, several serious issues and problems were
identified in this review.
• There appears to have been a shift in mission and vision over time that has led to conflict
among faculty and between units. Partly this shift may rest on the decision by SPH leadership
early on to focus heavily on MPH growth at the cost of other programs and development of a
coherent research focus. This has led to a troubled history of collaboration with key UofS
partners, especially the College of Medicine, in particular the Department of Community
Health and Epidemiology, but also including a number of research centres (VIDO, CCHSA,
SPHERU, IPHRC), the School of Public Policy, and the School of Environment. Engagement
with the public health system of the province and local community was also noted to be
weak: the School has not stepped into the position of public health leadership that was
envisioned in its charter mission and vision.
• In terms of governance the School has been troubled from the beginning. Initially meant to
be a unit with a large faculty complement, comprised in part by a significant number of
primary joint appointments, the School, for a variety of reasons, has not achieved the critical
mass necessary to meet its principle research and educational objectives. This may in part
stem from the early development of the School when the resources and incentives available
were insufficient to attract and retain the support of key stakeholders. The School was never
able to engage constructively with the Department of Community Health and Epidemiology,
its most obvious (and needed) partner. Leadership difficulties, perceived lack of consultation
with rank and file faculty, and flawed decision making processes have become barriers to
building a cohesive, collegial and positive community within the School. Lacking effective
partnerships either within the University or in the external community, and having failed to
engage constructively with Community Health and Epidemiology, without significant
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•
•
organizational and structural changes the School is in our view unsustainable.
The focus on the MPH degree as the principal means of School growth and development was
possibly misplaced, and has led to the atrophy of graduate research programs as well as the
attenuation of collaborative programs that would have better linked the School to other
programs and research units.
The rapid growth of the MPH and the pressures on faculty that this entailed may in large part
be responsible for the unremarkable research profile of the School. While some faculty have
established strong research careers, in general the research profile of the School is modest
and unfocussed; this will compromise further growth and development of the School. The
School never embraced the research leadership that might have been provided by the two
Chairs it was allocated – the Centennial Chair and the Canada Research Chair in
Environmental Health. We observed with concern that some faculty may not be well
positioned to secure tenure.
In order to address these problems we recommend that the School, along with its University and
community partners and the upper administration, engage in a period of conversation and reflection
about the future of the School. We identify a number of specific recommendations in the text of this
document. In general these recommendations may be summarized as follows:
• School faculty and leadership, and their internal and external partners, need to reflect on,
clarify and/or rethink the mission and vision of the School, resolving the conflicts or
divergences that may have arisen since 2007.
• The relationship between the School and the Department of Community Health and
Epidemiology must be resolved. There is no plausible future option for the School that does
not include integration with that Department. The Department of Community Health and
Epidemiology cannot be allowed to remain on the sidelines of this discussion, and must take
some leadership responsibility going forward.
• Identify and engage leadership who can begin to repair some of the distrust and bad feelings
that now characterize relationships between the School and other partner units. Welldesigned and substantive democratic and consultative processes are clearly needed.
• Assertively engage partners both external and internal to the University.
• Rethink the strategic enrollment plan of the School, identifying means for balancing
enrollment in the MPH and research degrees in the context of the available faculty
complement.
• Develop and reward effective research partnerships that link School faculty with researchers
in other units.
• Develop means for providing research mentorship for faculty and ensure that faculty time for
research is protected.
• While CEPH accreditation should remain a goal, it can only be realistically pursued if all of the
above issues are dealt with first.
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TABLE OF CONTENTS
1. Introduction ................................................................................................................................................... 5
2. Mission and Vision of the School of Public Health.......................................................................................... 6
3. Organizational Structure and Governance ....................................................................................................10
4. Academic and Educational Activities ............................................................................................................. 12
5. Research Activities ......................................................................................................................................... 16
6. Partnerships ................................................................................................................................................... 18
7. Conclusions and Overarching Recommendations ......................................................................................... 19
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1. INTRODUCTION
The site visit was conducted on January 28 and 29. The School did not prepare a self-study
document in preparation for the visit nor were we provided with an updated document reflecting
the current mission and vision of the School. We relied in our analysis on an “overview” (positioning
paper) document from 2015 provided to us; the three planning cycle reports for 2003-2016; several
reports and data tables from the accreditation self-study report prepared for the European-based
Agency for Public Health Education Association (APHEA); and some written notes and documents
provided to us by individual faculty from the SPH and CHE. We met with several stakeholders in oneon-one and small group meetings. These stakeholders included: Ernie Barber, Interim Provost;
Nazeem Muhajarine, Interim Executive Director for the SPH; George Mutwiri, Assistant Executive
Director and MPH Program Director for the SPH; Suresh Tikoo, Graduate Chair, V&I Program Director
for the SPH; Michael Atkinson, former Provost and current Executive Director of the Graduate School
of Public Policy; Adam Baxter-Jones, Dean of the College of Graduate Studies and Research; Bruce
Reeder, Professor in the Department of Community Health & Epidemiology; Preston Smith, Dean of
the College of Medicine; and (by phone) Robert Buckingham, Professor and former Executive
Director of the SPH. We also had group meetings with: SPH staff; external partners from the local
public health community; SPH faculty members; UofS Health Science Deans/Leaders; and
representatives from the Collaborative MSc and PhD Program in Biostatistics and the PhD Program in
Epidemiology (which included representatives from the Vaccinology and Immunotherapeutics
program and current department heads of Community Health & Epidemiology, and Mathematics
and Statistics), and a group of graduate students.
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2. MISSION AND VISION
The charter vision of the School of Public Health (SPH) developed in 2007 focused on creating a
center of excellence in interdisciplinary public health research and education in areas of identified
strength in the University. These areas centered on veterinary public health, agricultural and rural
public health, Aboriginal people’s health, and socio-behavioral health. As part of a University
commitment to interdisciplinary and collaborative models of graduate education, the School was to
be built on a framework of existing centers of academic excellence present in several Schools,
Colleges, and research institutes, with additional new investment in faculty appointments, including
a Canada Research Chair and a Centennial Chair. The School was to focus on outreach to and
engagement with the local and provincial public health community, building on some successful
relationships already developed by the Department of Community Health and Epidemiology (CHE)
within the College of Medicine. One of the principal objectives of the new School was to attain
accreditation from the U.S.-based Council on Education for Public Health (CEPH), a key milestone
that was intended to signal the quality and national/international standing of the School.
In the overview paper provided to us, an updated vision for the School from December 2014 is
expressed quite simply as a commitment to becoming a “preeminent center of learning,” bringing
together innovative thinkers from multiple disciplines to solve public and population health
problems. This newer vision also articulates values of respect and integrity, collaboration among
disciplines, environmental stewardship, social justice, and sustainability. Several aspirational
objectives follow; these focus somewhat more on gaining international recognition than the original
vision, in addition to continuing local engagements. Consistent through all the documents is a strong
emphasis on interdisciplinarity.
We found that that many key stakeholders who were active in the founding of the School continue
to endorse in broad strokes the original mission and vision. We agree that the University is
particularly well positioned to develop programs in veterinary public health (OneHealth) initiatives,
rural and agricultural public health, and Aboriginal peoples’ health. However, there did not seem to
be a clear consensus in the School that the founding mission and vision remained fully relevant,
especially in terms of whether or how the School might engage with and advance these broader
initiatives, either within the University, or with partners in the wider provincial or national public
health community. In part this lack of clarity may be related to the enormous stresses experienced
by faculty as a result of rapid growth of the training program, insufficient faculty to meet the training
obligations, and a difficult leadership transition. These stresses have understandably turned the
focus of the School inward as faculty struggle to maintain their individual teaching and research
responsibilities.
Some evidence was provided that suggested that leadership who shaped the direction of the School
after 2007 may have pursued a somewhat different set of objectives for the School than initially
envisioned, shifting from a programmatic focus on the local and provincial public health community
to one less focused on local partners and situated more in terms of “international” public health
priorities (though we were not provided with a cogent, written formulation of this vision). For
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example, SPH faculty expressed a conflict between those within the School wishing to be
international in scope and those who wanted a smaller, more local, community-based School that
would primarily serve the needs of the province and health region. It is not clear to us whether this
apparent discordance in scope is widely perceived, nor is it clear that emphasis on one orientation
necessarily precludes the other. However, we found that the lack of consensus among key
stakeholders as to a clear current mission and vision, when coupled with other pressures and
stresses on a too-small faculty complement, has contributed to failures to meet the ambitious School
objectives identified in the founding proposal. These have attenuated or precluded the
development of necessary partnerships internal to the University, and have compromised ties to the
local public health community. It is unlikely, however, that differences in opinion about the
appropriate mission and vision fully explain all of the conflicts and problems that have emerged since
the founding of the School in 2007.
Our discussions with key stakeholders and review of prior reports pointed to the following ongoing
issues related to a lack of a coherent mission and vision for building the School:
•
Relationships with the College of Medicine, in particular the Department of Community
Health and Epidemiology, broke down early in the development of the School. This clearly
hamstrung the development of a fully functional School with expertise in all of the core areas
of public health. The University now has two largely non-cooperating public health academic
units. This is not sustainable.
•
Issues of whether an independent School could be trusted to meet Medical School
accreditation needs was repeatedly raised. The extent to which the needs of the Medical
School drive the structure of public health entities needs to be addressed at the highest level
of University leadership.
•
As we document in more detail in the “Partnerships” section below, the School was unable
to, or chose not to, establish strong collaborative relationships with key University partners in
other health sciences units and research centers. Failure to fully establish collaborative
relationships within the University extends as well to key external bodies. The School has not
been well engaged with the provincial public health system nor with community partners
outside of meeting needs for MPH student practicum placements. As a consequence, the
School has not yet been able to engage in or foster much applied public health research.
Although we acknowledge that it takes time to build such relationships, efforts in this domain
have been inadequate.
Positive achievements were also noted. The School was able to launch a sizeable MPH program,
which after some early problems, appears to have stabilized under recent new leadership. Thesisbased programs have also been established: the collaborative program in biostatistics and the
vaccinology and immunotherapeutics program are potential successes. An online MPH program has
been launched, although numbers are to date smaller than anticipated. Accreditation of the MPH
program by the Europe based accrediting agency (APHEA) is an important accomplishment. Some
individual faculty members have been able to establish or maintain successful research programs.
Because CEPH accreditation was considered from the beginning to be an important objective of the
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School, and central to its mission and vision, it deserves a special note of explanation and analysis.
CEPH accredits public health education in two ways: First, it accredits individual public health
programs, primarily the MPH degree, but also the DrPH and a growing number of baccalaureate
programs; “academic” research degrees (MSc/PhD) may be included under a program’s
accreditation umbrella (or “unit” of accreditation). Program accreditation at this level does not
require establishment of an independent School. Secondly, CEPH accredits structurally independent
“Schools” of public health (similar in structure to Colleges or Faculties). Here the standard is much
higher in terms of the size of the faculty complement and the range of specializations; e.g., a
minimum of five faculty in each of the five pillars of public health (epidemiology, biostatistics,
environmental health, health management & administration, and social-behavioral health sciences).
This second model requires much greater investment on the part of the institution and accreditation
criteria are much less flexible. To date in Canada, only the University of Alberta has achieved
accreditation as a School. Simon Fraser University and the University of Montreal have their specific
programs accredited (at Simon Fraser University all degrees are included under the accreditation
umbrella: BA, BSc, MSc and PhD degrees in Health Science, as well as the MPH). All CEPH accredited
Schools and Programs are invited to join the Association of Schools and Programs of Public Health,
which is the major public health education association in North America.
At present, CEPH requires that any independent institution of public health that is identified by the
nomenclature of “college” or “school” adhere to the more stringent requirements, although these
criteria are currently under review by CEPH’s governing body. 1 Thus, in order to be accredited by
CEPH, the School of Public Health would need to remain independent of other units (particularly the
Medical School), would need to build a sizeable complement of faculty, multiple MPH streams and a
PhD in at least three streams. Thus the School would not only need a considerable investment of
new resources, it would require that the Department of Community Health and Epidemiology join
the School, along with several other faculty from partner units. It does not appear to us that the
University at the time of the creation of the School provided the necessary resources, nor did it
evidence the political will to make this happen. At least in terms of CEPH accreditation, the School’s
aspiration appeared doomed from the beginning. Thus, although the vision and mission point clearly
to establishment of an independent School, requisite resources to do this in a way that would meet
the standards of accreditation were not provided at any point in the School’s development.
Recommendations – Mission and Vision
1) It is our opinion that the School needs to undertake a period of reflection on its
educational and research mission, ideally with its natural allies and partners within the
University and community, in order to reinvigorate its mission and vision and to produce
an updated and realistic agenda and action plan, supported by clear University resource
commitments, for meeting the renewed set of objectives that will no doubt emerge.
1CEPH is in the midst of
changing its criteria for accreditation, and based on conversations with CEPH on February 13,
2015 (Janes had a telephone call with Kristin Varol at CEPH about a number of unrelated topics, but the UofS came up in
the conversation), it is possible that the School versus Program distinction may be considerably blurred or erased
altogether. This decision will be made by mid-year. If the distinction is reformulated, it may provide an opportunity for the
School to renew its progress toward CEPH accreditation as an independent unit.
.
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2) Accreditation should remain a goal, but consideration needs to be given to whether the
goal of an independent, accredited School of Public Health is attainable in the currently
constrained resource environment of the UofS. Other options, including integration with
CHE under a current Dean, should be explored.
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3. ORGANIZATIONAL STRUCTURE AND GOVERNANCE
At its inception the School of Public Health was to be organized under a collaborative,
interdisciplinary model of governance: the School would have some primary appointments but
would also be expected to bring into the School through a mechanism of joint and associate
appointments faculty from other units. The School was to be led by an Executive Director who
reports to the Provost and sits on the Council of Health Science Deans. Ideally, leadership of the
School would have been established with a Dean at the helm, and some problems may have arisen
initially through a perceived lack of equivalence of an Executive Director at the Decanal level.
Further, it is clear from our discussions (although written documents remain ambiguous on this
point) that many, if not most, of the faculty of Community Health and Epidemiology within the
Department of Medicine were expected to join the School, along with smaller numbers from most of
the other health sciences units.
Without clear incentives for doing so, coupled with the perhaps “natural” territoriality of Deans and
Department Heads, building such a collaborative unit is complex. It requires skillful leadership, a
great deal of persuasion, and, at the end of the day, some strategic influence of Provost-level
administration to make such things happen. Beyond a smile and a handshake, it is clear that for the
School to have gotten off to a good start, some major realignment and reallocation of resources
would have been required at the outset. This did not happen: the School was never able to acquire
the human and financial resources needed to meet its objectives. At present, Community Health
and Epidemiology, a key player in the development scenario, does not appear to be engaged with
the School. We consider this to be an unacceptable and unsustainable state of affairs that must be
corrected if the University is to maintain its commitment to an independent and interdisciplinary
School of Public Health. It is not efficient use of resources for the University to maintain two
separate public health programs. The Dean of Medicine, who was not at the UofS when the School
was founded, needs to support this integration and should be assured that regardless of
departmental/school configuration, the School of Medicine accreditation and training needs will be
met.
The contentious departure of the previous Executive Director led to the unpopular (from the
perspective of the School) appointment of an interim ED, which has eroded the legitimacy of the
role. Coupled with rapid, almost uncontrolled, growth of the MPH program, which requires
considerable investment of administrative resources, it is clear to us that the current organizational
and leadership structure of the School is inadequate to manage and support either teaching or
research activities. School faculty seemed adrift, struggling to meet heavy teaching and supervisory
responsibilities and often electing to delay establishing research careers in the absence of available
time, good mentorship and organizational clarity. We worry that the research careers of new faculty
will continue to be sacrificed in such an environment. And, as several reports, the survey results
provided, and our meeting with students suggest, students have also suffered. However, we hasten
to acknowledge that the MPH program has improved greatly under the administration of the interim
Executive Director and Associate Executive Director.
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Faculty morale is low. Some were quite angry with the state of affairs that they found themselves in,
many were concerned about the future of their careers and the School, and a clear desire for
effective leadership was expressed to us on several occasions. Indicative, perhaps, of an as yet unor poorly-developed management and organizational structure, concerns were expressed about
“getting credit” for things – credit for students (in the collaborative programs), credit for research
grant income if the PI is in another unit, etc. Finally, many of the faculty in the School felt that they
were rarely consulted regarding decisions that affected them, including the appointment of the
current interim Executive Director. We were also informed of a search for an epidemiologist that,
despite reported consensus decision at the School level, was declared failed at the Provost level
without apparent consultation with the School. Because this information came to us in a letter after
the site visit was completed, we are not sure whether this information is accurate or complete or
whether it was under the guidance of past or current leadership; nevertheless, this speaks to low
faculty morale and perceptions of ineffective governance and poor consultation processes.
Despite the poor state of faculty morale, staff morale generally seemed good. They were generally
positive about faculty and students, though they also worried about the poor relationship between
the School faculty and the interim ED. This, of course, is a major concern. However, the staff are
clearly hard working and dedicated, and carry a great deal of the administrative burden, especially
for the MPH program. The size of the staff complement appears insufficient to meet School
objectives if both teaching and research support are to be part of their responsibilities.
As a final note, we did not undertake a careful analysis of financial resources in the School. We
understand that a new activity-based and transparent budget model will be phased in shortly. What
figures we had available suggested that the School will be adequately resourced for its educational
activities, and shows some room for expansion. Interestingly, we were informed by some that the
School has surplus resources, and that in the past some available funding for graduate students from
the graduate school had been foregone. In light of complaints about insufficient faculty resources,
the appearance of surplus or unused funds is paradoxical. We are not sure whether this is an
outcome of poor financial management in the School, or a reluctance by upper administration to
invest further resources in the School in the context of its publically visible problems and conflicts.
Recommendations – Organizational Structure and Governance
1. Clearly some decisions need to be made regarding the relationship between the SPH and CHE.
There are a number of options for doing this, which we articulate with some specificity in the
final section of this report. Regardless of which option is chosen, a focus on effective
leadership and the development of a consultative model of governance, respectful of
democratic decision-making processes, is essential at this time. There is a considerable level of
bad feeling and distrust that has affected faculty morale, and likely their productivity. The
politics underlying the SPH are long standing and appear to continually re-infect new faculty.
It is likely that trust will need to be established well before any significant structural changes
can be implemented. It will also be important that senior academic leadership commit to
actively supporting whichever future option is selected.
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4. ACADEMIC AND EDUCATIONAL ACTIVITIES
The School of Public Health currently offers a professional (generalist) MPH degree, MSc & PhD
degrees in Vaccinology and Immunotherapeutics and a PhD in Epidemiology, and it collaborates with
CHE and Mathematics and Statistics to offer a MSc and PhD in biostatistics. Although not necessarily
obvious from the inception documents, the primary focus of the SPH as it developed became the
rapid growth of the MPH. The leadership of the School pursued an approach where students were
seen as the principal mechanism by which the faculty complement would grow, and once the faculty
grew, research-based (thesis) programs could be developed. We noted, however, that this particular
strategy was not articulated in the framing proposal for the School, nor was it clear that the
successful development of the School depended solely on the rapid roll-out of a large MPH program.
Some of the key stakeholders consulted suggested that this shift in strategy may be one of the points
where the later mission and vision diverged from the original charter, leading to some of the
challenges identified above.
With the information provided to us it was not possible for us to fully judge the quality of
educational programs nor their educational/knowledge outcomes. However, we did note that the
School was able to achieve accreditation for the MPH program from the European APHEA. The selfstudy and subsequent accreditation report suggest that the MPH program meets “international
standards” for quality, scope and breadth of the curriculum. Although APHEA noted “growing
pains,” their site visit report was overall positive.
Many of these growing pains were evident in the survey responses provided to us (the survey was
administered for purposes of this review). There were quite a few complaints by students and
alumni about the quality of the program, coherence of the curriculum, availability of courses,
teaching, difficulties obtaining practicum placements, and general faculty support. Other than what
we were able to glean from the survey of alumni, no data were provided on what MPH graduates did
after completion of this degree. The survey responses did indicate that the program was generally
helpful in providing the skills that graduates needed for their current job. We did hear from a
sampling of MPH students and stakeholders concerns that the program grew more rapidly than the
local public health market was able to sustain.
The thesis-based research programs are quite small at this point. We met with a few students from
these programs in a group context. No clear message regarding program quality emerged from
these discussions (the MPH students were more vocal). Some expressed satisfaction, largely based
we believe on the quality of mentorship they received, or were receiving, from their faculty
supervisors. Some indicated that the focus on the rapid scale-up of the MPH led to the “neglect” of
the research based programs.
Despite some of the difficulties flagged by students and in the survey, our meeting with students
suggested that many positive changes have occurred over the past year or so, improving things for
current students, especially in the MPH program. The current MPH director was reported to have
done a good job in dealing with many of the program’s growing pains, and currently enrolled
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students generally expressed satisfaction with the program.
Faculty representatives generally felt that the quality of the collaborative biostatistics program was
high, though they felt that the program could be better organized, and collaboration could be
enhanced. However, all felt the program got off to a great start and was providing excellent
research skills to graduates. We believe this collaborative approach might be an effective model for
other programs. Conversely, we found that the School-based program in Epidemiology is struggling.
Program representatives indicated that there were not enough faculty, and in one case a faculty hire
in epidemiology was scuttled at the Provost level. Shortages of funding across all of the programs
was noted as a particular problem, though in at least one report, $30,000 in funding allocated by the
University to SPH students was left on the table.
Several faculty noted the failure of the School to develop and offer a thesis-based MPH option with
the MPH program. School faculty blamed upper administration for stalling or blocking this degree.
Others outside the School faulted the School and its leadership. Regardless of who or what is to
blame, the rationale for offering such a degree was not clear to us. Some additional strategic
thinking about this and the other research programs is clearly in order, though we acknowledge that
this will depend on other decisions, especially the future of the School and the size of the faculty
complement.
Finally, and very much a concern both for the future of the research-based programs and for the
research profile of the School more generally (as we indicate below), two Chair positions originally
allocated to the SPH – a Centennial Research Chair and a Canada Research Chair – were lost. We
were told that the Centennial Research Chair left “due to lack of support from SPH leadership,” and
that the Canada Research Chair was lost because it was never filled. Insofar as these Chair positions
would have provided critical research leadership for the School and its thesis-based programs, this is
a clear problem and area of weakness in the School.
Students expressed concerns that international students need more cultural/social support and a
more gradual orientation to their new homeland and public health system prior to starting a heavy
course load. Concern was also expressed regarding lack of communication to students regarding
standards of academic integrity, written policies with regard to procedures/guidelines for each
degree, milestones/deadlines and appeals procedures. We believe that the School may have
enrolled more international students than they had the resources to support. We suggest that the
School may wish to rethink international student enrollment targets, or bring international student
enrollments in line with those in the University as a whole.
As we discuss above, accreditation by the Council on Education for Public Health (CEPH) was highly
valued by the leadership and faculty of the SPH, and was part of the original SPH vision. This was the
rationale for the extremely rapid increase in student enrollment in the MPH program, with the logic
expressed that additional faculty hires would be offered by central administration to support the
large student body, and the number and disciplinary mix of faculty would then grow to meet the
accreditation standard (five faculty in each of the five core disciplines of socio-behavioral sciences,
epidemiology, biostatistics, health policy/leadership, and environmental health). Accreditation
remains an objective for faculty, but with its current complement of faculty the SPH cannot meet the
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CEPH standard.
Because of the very rapid growth and current large number of students, the SPH has struggled to
meet stated educational objectives, even without consideration of accreditation. We believe that
there are clearly not enough people to undertake the current teaching load and
management/operations of the School’s educational programs, even with the participation of faculty
from other units. Teaching loads appear to be high, with significant effects on faculty research
productivity.
Recommendations – Academic and Educational Activities
1. Some rethinking of the enrollment strategies in the School are needed, specifically an analysis
of target MPH enrollments in the context of the current faculty complement and the desire to
build out the research programs. A realignment of priorities to balance the professional and
research degrees is clearly in order. Student enrolment should be capped at a level that
maintains high quality educational programming. With regard to the MPH, consider linking
enrolment to needs in the public health community to avoid “flooding the market," and
remember that enrollment targets should reflect capacity for both classroom training, applied
projects and advising. The School should consider capping the percentage of international
students at 35% (the same as at the graduate level at the UofS as a whole), unless more
resources are devoted to cultural orientation, more transition time is allowed prior to starting
courses, and more consideration is given to job placement for international students postgraduation.
2. Students are very concerned about academic integrity; the School and faculty should be as
well. Modules related to plagiarism, etc., might be incorporated into foundational curricula for
all SPH programs. Violations of academic policies should be dealt with promptly, and in
accordance with University procedures.
3. The collaborative model that appears to be successful in relation to the biostatistics program
might also serve as an organizing mechanism for other programs, and will also foster
collaborative partnerships that the School has not yet been able to foster.
4. Although a thesis-based MPH degree was articulated as a key objective by many stakeholders,
the rationale for offering this degree vis-à-vis other available research-based masters degrees
was not clear. This goal should be reconsidered in light of the other strategic planning that
needs to be done to sustain public health education at the UofS more generally.
5. We endorse the objective of accreditation by CEPH, if that remains a value for the SPH.
However, consideration should be given to accreditation of the MPH program instead of the
entire School, though this will depend on revisions to CEPH criteria. Mapping course content
onto competencies expounded by CEPH and other agencies would be an excellent practice.
Also, it is important to note that meeting quality standards in public health does not mean
“standardization;” in fact, the SPH might work on a process that has the goal of identifying
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three or four niches that reflect clear strengths. We note that this was in fact part of the
original vision for the School.
6. Student funding should be a priority, and a closer relationship with Graduate Studies is
required to maintain high admission and academic standards as well as access to funding.
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5. RESEARCH ACTIVITIES
The possibility of interdisciplinary faculty collaborations and synergies was repeatedly noted as a
primary motivation for the founding of the School. This work would seem to be first manifested in
the arenas of research and scholarship. However, in spite of this initial promise, research has largely
failed to deliver on its potential.
Throughout documents and meetings, it was clear that research was not a priority in decisions
around faculty hiring, promoting growth, or internal or external collaborations. While the strategy of
focusing on teaching first and research second, using student demand to secure faculty positions,
might seem reasonable, it is also clear how it can backfire. Lacking a strong research presence, the
strongest researchers are lost to stronger institutions (e.g., the Centennial Chair). Finally, it appears
that teaching overloads have led to faculty paying too little attention to their research and,
ultimately, to underdeveloped curriculum vitae that will make tenure cases challenging in some
situations. Finally, there is little infrastructure around securing external funding, building
collaborations, or research resources.
In short, the overall research profile of the School has not been well developed. Funding levels are
low, with modest tri-council funding noted (six current tri-council awards to current primary faculty
in the School, most of this to those in the Vaccinology program/VIDO). The publication record of
primary faculty is also quite modest. The research agenda appeared to us to be unfocussed. The
CRC in Environmental Health that was allocated at the inception of the School was not filled, and the
Centennial Research Chair was vacated when the incumbent left and there has been no
replacement. Ineffectually managed growth of the MPH program appears to have been achieved at
the expense of thesis-based research programs that might have helped foster a stronger research
program, particularly in partnership with faculty in other units.
Recommendations – Research Activities
1) Encourage SPH faculty to partner with established researchers across the University to
increase the size, scope and quality of the research portfolio.
2) Develop multidisciplinary, cross-unit mentoring plans for all tenure-track faculty. These
mentoring teams should provide advice and guidance about research focus and
strategies, grant seeking, publications, etc. Mentors should be drawn from the broad
network of centers, departments and schools discussed below in the partnerships
section.
3) Develop minimum research and teaching levels for all tenured and tenure-track faculty
in this unit. There were signs that some senior faculty were almost completely focused
on externally funded research and did virtually no teaching in the program, and some
junior faculty had the opposite profile. While, on average, all faculty teach and do
research, this model is unsustainable and unfair.
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4) Ensure that all faculty hires on tenure-track appointments include evaluation of
research potential as well as teaching potential, and that a realistic teaching and
research plan, including start-up funds, be included in the request for position
approval. Search committees should reflect the diversity of potential partner
departments.
5) The UofS should identify strategies to promote and reward cross-college collaboration
in the area of research.
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6. PARTNERSHIPS
Partnerships are essential to the success of a School of Public Health. The interdisciplinary nature of
public health leads naturally to collaboration with, and contributions from, several departments,
schools/colleges and faculties across the University, and with external agencies at all levels of
government, as well as non-governmental organizations with sympathetic missions.
The University of Saskatchewan sits at the hub of an expansive network of institutions, agencies and
organizations whose purpose and focus contributes directly to or is complementary with the mission
and goals of the SPH. As mentioned earlier, the original vision of the SPH focused on excellence in
interdisciplinary public health research and education in areas of identified strength in the University
such as veterinary public health, agricultural and rural public health, Aboriginal peoples’ health, and
socio-behavioral health. Existing centers in several schools, colleges and research institutes would
provide foundational strength for the SPH, an explicit manifestation of the University of
Saskatchewan’s commitment to interdisciplinary and collaborative models of research and graduate
education. Further, the original intent was that the School would have strong partnerships through
outreach and engagement with the local and provincial public health community, building on
successful relationships already developed by the Department of Community Health and
Epidemiology within the College of Medicine. Indeed, the public health system provincially and
nationally should be viewed as key partners in advising the SPH on needs and priorities for education
and research programs, and likewise the SPH faculty and graduating students could be of great
assistance to the provincial and national public health system by producing evidence and translating
evidence into practice through many avenues such as surveillance, analyzing trends, health
promotion, intervention research, commissioned research, expert reviews/advice, providing surge
capacity, etc.
Research groups with SPH faculty at the helm are: MERCURi Research Group, Population Health Data
Laboratory, and VIDO/InterVac. Other well-funded research centres at the University that have clear
public health mandates have more tenuous or no relationships with the SPH such as CCHSA,
SPHERU, IPHRC, Saskatchewan Cancer Control, Saskatoon HIV/AIDs, etc. There are some positive
relationships across schools/faculties apparent for some OneHealth initiatives with the Western
College of Veterinary Medicine, such as the Integrated Training Program in Infectious Diseases, Food
Safety and Public Policy (ITraP), an interdisciplinary, international training initiative with the goal of
reducing the medical, economic and social impacts of outbreaks for people, industries and the public
sector. While there is great potential for education and research partnerships with other health
sciences units (Kinesiology, Nursing, Public Policy, and Environment and Sustainability), these
relationships have not been fostered to their level of potential.
There was no evidence presented to us that the SPH has been consistently engaged with the
provincial public health system. A few community partners are engaged through hosting MPH
practicum students. The positive cross-fertilization that could occur between the practice of public
health locally and the SPH, for both public health education and research missions, is not apparent at
this time.
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Mutual benefits from strong partnerships would greatly bolster the ability of the SPH to achieve its
mission. Articulation of key principles, objectives and implementation steps through affiliation
agreements would be ideal. These partnerships between the SPH, both internal and external to the
University, ultimately will improve the health of populations though public health education,
research, and practice.
Recommendations – Partnerships
1. The School needs to be much more assertive in developing and engaging with partners
both internal and external to the University. Such partnerships were a particularly
important strategic element of the original proposal to develop the School, and will be
absolutely critical to its long-term success.
2. Increase outreach and mutual interactions with Aboriginal communities for all aspects of
mission including service and research, and to encourage Aboriginal students to apply to
graduate school.
3. Develop and foster close ties with the public health system in Saskatchewan and Canada.
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7. CONCLUSIONS & OVERARCHING RECOMMENDATIONS
Our main conclusion is that the University cannot sustain two separate public health units if the
initial mission and vision for a School of Public Health are to be met. Nearly all of the difficulties and
challenges identified in this report derive from this finding. We urge the University and its key
community stakeholders to engage in a dialogue about how to integrate Community Health and
Epidemiology and the School of Public Health, but in a way that does not attenuate or preclude
partnerships and links to other units on campus. There are a number of models for doing this, and
the appropriate solution must emerge from a careful consideration of the local context and an
intentional, facilitated rapprochement between affected units, allowing sufficient time for reflection
and input. However, ultimately all involved will have to put aside their personal concerns and
histories and commit to supporting the plan that is selected. No faculty, unit or school can have the
luxury of sitting back and waiting to see how things unfold before deciding whether to participate.
This is particularly true of the Department of Community Health and Epidemiology. This strategy of
waiting to see how things unfold may, in part, have led to the current situation and cannot be
allowed to recur. The following four options, some suggested to us by key stakeholders, are worthy
of consideration:
1) Integrate Community Health and Epidemiology into the School of Public Health, recognizing
faculty interests/needs as well as the accreditation requirements of the College of Medicine.
We understand that given a history of past conflicts and past and current reluctance of the
Dean of Medicine to relinquish the Department of Community Health and Epidemiology, not
to mention the tendency for faculty to be highly risk-averse in contemplating any such
change, this may prove to be a difficult option, and would take both time and highly effective
and skilled leadership. An advantage to this model is that it better positions the School for
CEPH School-level accreditation, national recognition, and, if handled skillfully, presents a
better model of interdisciplinary collaboration than any other of the options. If this option is
chosen, proper incentives for all concerned will need to be provided. This must be seen as a
win-win scenario. Providing growth funds to the School, prioritizing and incentivizing,
through salary and other benefits, position transfers from CHE to the SPH, and ensuring that
the College of Medicine maintains sufficient resources to staff its community medicine
programs will require significant and thoughtful investment by the upper administration.
2) The School of Public Health could be merged into the Department of Community Health
and Epidemiology within the College of Medicine. This option would clearly relinquish the
objective of an independent School, and would also conceptually envelop public health
within the College of Medicine. A long history of development of public health, especially in
the U.S., suggests that this may not be an effective way to build a comprehensive program
that addresses all elements of public health. Medicine is by its very nature dedicated to
clinical research and education. Public health within medicine is often consigned to teaching
undergraduate courses and research that has a clinical relevance (i.e., health services
research), thus failing to be comprehensive in scope or vision. The Dean of the Medical
School repeatedly noted that he was in favor of this plan and used the physical therapy
program as an example of his ability to manage non-medical units within the school. This
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analogy does not however provide compelling evidence that a comprehensive school of
public health would have the stature and independence generally required to meet the
potential and aspirations of the school and university. Furthermore, many stakeholders from
within and outside of the SPH argued that integrating the School into the College of Medicine
would damage or put at risk its links (or potential for links) with other health sciences units.
Perhaps ironically, we note that the disciplinary background and skills of the current CHE
complement are not closely aligned with what we were told were College of Medicine
objectives: most are social science/behavioral science and population health researchers;
none, as far as we could determine, do health services/systems research, for example.
However, this issue—the skills and competencies of the CHE unit—are well beyond the scope
of this review.
3) The School of Public Health and Community Health and Epidemiology could be merged
under the Council of Health Science Deans. This model, while interesting, and potentially
more politically palatable to unit-level stakeholders, appears to us to be organizationally
complex. It does have the advantage of respecting the broader interdisciplinary agenda of
the School’s Mission and Vision.
4) Invest significant resources in the School of Public Health, especially resources that would
translate into effective research and education leadership (i.e., CRC and other Chair
positions) recognizing that with such investment and a good dose of time that there may be a
natural and progressive realignment and rapprochement of CHE with the School, perhaps
enabled by hard-money offers of joint appointments or even joint leadership (e.g., a joint
executive committee, joint sponsorship of the MPH program, etc.). This option may be the
most politically neutral, but also requires the greatest investment of financial and human
resources. It would also take time and a strong commitment by the upper administration of
the University.
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