摘要：From 1999 to 2009, the Eliminating Health Disparities Pre-doctoral Fellowship Program provided specialized education and mentoring to African American graduate students in public health. Fellows received a public health degree, coursework in understanding and eliminating health disparities, experiential learning, mentored research, and professional network building with African American role models. We describe successful strategies for recruiting and training fellows and make 5 recommendations for those seeking to increase workforce diversity in public health: (1) build a community of minority students, not a string of individual recruits; (2) reward mentoring; (3) provide a diverse set of role models and mentors; (4) dedicate staffing to assure a student-centered approach; and, (5) commit to training students with varying levels of academic refinement. Increasing minority participation in public health careers and graduate education programs is a priority for many organizations and disciplines 1 – 8 and essential for achieving greater success in eliminating health disparities that exist among populations. Although racial and ethnic minority groups account for over 30% of the United States population (increasing to nearly 50% by 2050), they are a far smaller proportion of the total workforce in health professions. Currently, the Institute of Medicine classifies African Americans, Latinos, American Indians and Alaskan Natives, and some Asian American and Pacific Islander subgroups as “underrepresented minorities”; they are underrepresented in health professions relative to their numbers in the general population. 9 Many of these same groups also experience a disproportionate burden of health problems and receive lesser quality health care. 10 This leads to the incongruous situation of having large racial and ethnic population subgroups with significant unmet health needs that cannot be addressed by the groups’ own members. One of the most important competencies for a public health professional is the ability to work in culturally and racially diverse populations. 11 A diverse workforce of health professionals can play an important role in eliminating racial health disparities. 12 – 14 Racial and ethnic minority health care professionals were more likely than their White peers to serve patients of color, indigent patients, and work in medically underserved communities. 9 , 15 , 16 In addition, patients from minority groups were more likely to report receiving preventive care, needed medical care, and greater satisfaction with care from health care professionals that shared their racial/ethnic background. 17 – 19 This may be based on comparatively negative experiences patients had with nonracially/ethnically concordant providers, or the expectation that experiences of disrespect in other aspects of society will occur with members of the medical community. 20 In particular, African Americans have been underrepresented in health professions and the graduate education programs that led to these professions. 21 , 22 In 2008, African American doctoral degree recipients represented only 7% of all doctoral degrees earned from United States universities; that proportion was even lower in many science fields. African Americans represented 6.2% of doctoral degrees in social science, 4.5% in life science, 3.8% in engineering, and 3.2% in physical science. 22 Compared with White doctoral students across all fields of study, African American doctoral students graduated with a greater debt load, were less likely to report teaching and research assistantships as a primary source of educational support, and were more likely to rely on their own financial resources. 22 Certain minority-focused programs showed promise for increasing participation in public health graduate studies, 23 and Schools of Public Health have made great strides increasing minority enrollment in recent decades. However, these gains have stagnated somewhat among African American students. From 2001 to 2007, African American graduate student enrollment changed little, from 12% to 11%. 24 – 31 The proportion of these students earning doctoral degrees was lower. In 2008, member institutions of the Association of Schools of Public Health awarded 9% of doctoral degrees to African American students. African Americans were especially underrepresented among tenured faculty members at Schools of Public Health. In 2008, only 46 of 1431 (3%) tenured faculty members in United States Schools of Public Health were African Americans. 32 Improvements in both areas are needed to develop a well-trained and diverse next generation of public health professionals to help improve the health of all populations and address the complex challenge of eliminating health disparities. To help meet this need, we created the Eliminating Health Disparities Pre-Doctoral Fellowship Program (hereafter “program”) for African American graduate students in public health. Established in 1999 and funded first by the Centers for Disease Control and Prevention's Prevention Research Centers Program and later the National Cancer Institute, the program trained 33 fellows in the last decade. The purpose of this article was twofold: (1) to describe core program elements, the approach to recruiting, selecting and placing fellows, and key responsibilities of program leaders; and (2) to present 5 lessons learned from 10 years of experience. We hope that sharing our approach, successes, and challenges will help other institutions continue or build momentum in their efforts to develop a diverse public health workforce for the future.
