Keynote Speech, Yale School of Public Health Centennial Alumni Day

I am so pleased to be back! This is a wonderful program. You may have heard that it’s been a challenging few weeks in South Carolina, what with a historic flood, then a historic football coach resigning.  The coaching situation brought loads of complaints and backlash, but cancelling classes for a week made me the most popular president in modern times!  Seriously, it was great to be a public health scientist under the extended conditions of boiled water advisories, no trash pickup and mass relocation of the public. 

“Don’t we need a beach volleyball team, Mr. President?”!

So it’s good to be in New Haven. I can’t help but feel nostalgic, so many familiar faces and it’s good to be with you, Paul, faculty and staff who are direct descendants of the great leaders and mentors who were here for me. This is the school of CEA Winslow and Ira Hiscock after all.

My mentor Jenny Kelsey, in addition to being one of the best epidemiologists ever produced by EPH, was also a great teacher who taught me about the importance of quality and not cutting corners—not to mention teaching me, as well as her other students, how to make ice cream! She never did convert me to a Red Sox fan though. 

Others contributed to my development, too many to name but I’d like to mention the great departed ones: Colin White, Adrian Ostfeld, Stan Kasl, Ed Cohart, Bob McCollulm, Diana Fisher, and others like Jim Jekel, Lowell Levin, Ted Holford, Jan Stolwijk, and many others. They formed the foundation for my professional education and inspired a broad commitment to public health as well as catalyzing my interest in epidemiology, teaching and therefore, albeit indirectly, higher education. Also pleased to see former classmates Ed Fitzgerald and Roberta Silbert.

Of course, Patricia is here too (that would be Patricia Moore, MPH class of ‘79), the most special contribution of EPH to my life. I met her on September 8, 1977, and, after small talk, she asked me where the Bursars office was located. I had no idea, but said I did, and after running upstairs and finding it on a map (no Google) I offered to show it to her. We got back to EPH too late for her to take the public health bus tour through the city to visit impressive sights/sites like the Hill Health Center, the Old City Dump, the City of New Haven Solid Waste Facility, the water plant, etc.  I took her on my own version of the city tour and no, I didn’t take her to the solid waste facility, but I did take her to the top of East Rock Park to show her the view...the rest, as they say, is history!

Much of my career in public health seems like history also, since 2008, when I transitioned to the university presidency, and even the small amount of time I had left before then, for public health or epidemiology, totally evaporated.  After 28 years since leaving EPH, all I knew was life as a health scientist—Assistant, Associate, Full Professor, Department Chair, Dean, Vice President for Health Sciences, and while each title came with diminished time for research, at least I was still in the public health domain.

But with the presidency came something that was difficult for me. This was transitioning from the practice of making decisions based on good data; relying on many years of experience in analysis, both statistical and observational; participating in much refutation and debate; and of course the epidemiologist’s favorite habit of always seeking alternate explanations for situations observed. 

As president, you go to meetings where people expect you to make decisions, often immediately, on topics about which you might have a “Reader’s Digest” knowledge base, or less. This includes topics like student alcohol and drug use (“Do you favor lowering the drinking age, Mr. President?”), crime near and on campus (“What are you going to do about it, Mr. President?”), sexual assault between students, cyber security, bond indebtedness, commercial real estate, neighborhood noise, MOOC’s, and of course big-time college athletics, (“Don’t we need a beach volleyball team, Mr. President?”)!

And you need to deal, personally, with situations that I was rarely required to handle before. We have had many outstanding and record-breaking successes, by the way, but also I too often call parents whose son or daughter has died while at college.  We’ve had a student shot and paralyzed near campus; a murder-suicide, (parenthetically taking the life of a beloved public health professor); several data breaches; hiring freezes; we have had a “thousand year” flood; and—the most unthinkable—a South Carolina blizzard that dumped two inches of snow on the campus. Now that was a real crisis!

But what I want you to know is that I have never abandoned my public health knowledge, experience and especially perspective. In fact, as a university president, my public health perspective has been more beneficial than you might think.

First, I’ll mention the most obvious “benefit” of running a university with public health experience, and that is, that public health has always had to do lots of important and big things without a lot of big money. You know what I mean, of course.  Public health practice is the art of doing so much with so little and we do it well and, generally, we do it without griping.

So when the recession came in the fall of 2008, weeks after my election, I did not join the Wall Streeters jumping out of windows. Just like public health professionals have been doing for ages, we tightened our belts, made adjustments, recognized that there was an even greater need for our university’s efforts, and went to work. 

So when the recession came in the fall of 2008, weeks after my election, I did not join the Wall Streeters jumping out of windows. Just like public health professionals have been doing for ages, we tightened our belts, made adjustments, recognized that there was an even greater need for our university’s efforts, and went to work. 

Not that I’ve stopped griping about the serious underfunding of public higher education in my state and across the country. I haven’t quite gotten there.

The tuition increases in American public universities that resulted from the cuts to state appropriations to our schools have been real and they have been felt disproportionately by lower and middle-income families. What else is new, right?  As is the case with access to health care, those with fewer resources receive less care. 

On August 1, 2008 when I assumed the presidency of the University of South Carolina, our state funding was roughly a quarter of a billion dollars and amounted to about 20% of our annual budget. Not something to brag about, but 20% of anyone’s bottom line is nothing to sneeze at. 

Today, state support is roughly half of what it was before the recession and about 9% of our annual revenues. The revenue has been replaced—that’s the good news. The bad news is that it has been replaced by tuition and fees paid by students and families. Not something I’m proud of, but the only other recourse would have been to cut staff, which really means faculty, and therefore significantly affect the quality of the education we provide as well as our research and scholarly productivity, something that we value dearly and is also a great public value.

USC’s public funding is now in sixth place on the revenue side of our budget after in-state tuition, out-of-state tuition, grants and contracts, auxiliaries (auxiliaries include continuing education, athletics, food and residence halls, vending), and philanthropy. That’s right, our donors provide more support annually than our state government. That’s why there is a joke that says we have gone from state supported, to state assisted, to state located!

So today, most public universities have a budgetary model that is less like that of public universities of three decades ago, and more like, well, more like Yale’s, tuition-based and, to a lesser degree, endowment supported.

One tangible casualty of diminished public support and tuition increases is that many families, given the expense, now question the value of college.

The National Center for Education Statistics notes that the average full cost of attendance – tuition, books, room and board on campus, and other expenses (laundry, transportation, etc.) for a full time student at a public four year institution is now roughly $20,526 for in-state residents and $30,497 for out-of-state. Then consider that, according to census data, the median annual earnings for a family of four in South Carolina is $66,807.

The result, sadly, is that the past several years are the first since the war years of the 1940’s that college attendance in the U.S. has declined. Enrollment at four-year institutions is down and therefore the number of graduates is down. Parenthetically, enrollments are down most dramatically at private (or what we call independent) colleges, and down to a lesser degree at public community and technical colleges that usually grant the associate degrees. 

Although it isn’t really effective, I regularly suggest to our government leaders that unless we do a better job at providing more access to affordable public higher education, we will become a second tier nation—just like in health care.

And make no mistake. The defunding of higher education is no longer about the recession. Our state appropriation is still down about 50% since before the recession years of 2008-2011. 

Worse, there is shrill and cold rhetoric from legislators in nearly every state and on Capitol Hill—from talking heads on cable TV, to journalists and others about the cost of higher education, with very little constructive dialogue about how to restore a fair funding model so that college can again become affordable for those without significant family assets.

I can tell you what we’re doing to keep student debt down and therefore college more affordable.  We’re emphasizing that students take no more than four years to graduate and even less if they choose to do so. We call this initiative “On Your Time” and we’re pushing it hard. We start once students are admitted, pay their deposit and attend summer orientation.  We tell them that college is 120 credits, but does not have to be four years. We suggest several things they can do to graduate on time including make use of their AP credits; not changing their majors more than once (the average at USC is three); and, if they fall behind or if they wish to get ahead, take some courses in the summer or even on-line to help them stay on track.  

In turn, we have re-engineered the academic calendar to offer many more courses, more than ever—in the summer time but also during the January shoulder season as well as in the intensive Maymester. This summer for example, 600 undergraduate courses were taken, including 43 Carolina Core courses, approximately 20,000 classroom seats were filled, and lab sessions were compressed into one week.  

We have been disappointed by Washington as well.  (One more reason, right?)  Congress has been diminishing Pell Grant and Direct Federal Student Loan programs. Those programs are less flexible as they are not allowing funds to be used for summer college work. The White House and Department of Education have also done little.  Sure, there has been a call for free community college…but you’ve heard about the “snowball in hell?”  Free community college is an idea that didn’t stick around very long. 

Furthermore, the White House has developed a college scorecard—an oversimplified tool that purports to help college applicants pick a college based on comparing the percent of graduates who got jobs and the median salaries of graduates from different colleges. The scorecard also provides information about cost of attendance, loan default and graduation rates and average borrowing amounts. These “simple scorecards” get my epidemiological juices flowing. For example, colleges that emphasize technical or professional fields will be rated higher than liberal arts colleges.  Does that make them better? 

The scorecard does not evaluate learning outcomes, student satisfaction, long-term student success; factors that I say are very valuable and are areas where institutions that value general education would likely perform well. This will drive even more students away from majors in the arts and sciences and, believe me; they need no encouragement because there is encouragement to abandon liberal arts and sciences majors in every corner.

Florida’s Governor Rick Scott said, “If I’m going to take money from a citizen to put into education then I’m going to take that money to create jobs.  So I want that money to go to degrees where people can get jobs in this state.  Is it a vital interest of the state to have more anthropologists? I don’t think so.” 

Many states, including mine, now provide differential tuition support depending on the student’s registered major or program of study. There’s nothing evil or perhaps even wrong with providing incentives for students to pursue the STEM areas or professional areas of study.  There are, after all, good and plentiful jobs in the fields of cyber security, data analytics, bioengineering, accounting and tourism management—but also air traffic control, web design.

Should colleges develop curricula based on the short term workforce needs or should we stick to the centuries-old tradition of a liberal core curriculum that, more than any other attribute, has made American higher education the envy of the world? Maybe something in between, you’re thinking, some blend between reading the great books but also doing an internship that could better prepare one for job entry.  I wouldn’t disagree but I can tell you that there is great pressure toward the abandonment of American liberal arts education altogether. 

Before you consider me too dramatic, let me say that the students of today and their parents are part of the chorus. The evidence is clear: majoring in many of the stock arts and sciences is down – including English, history, philosophy and even chemistry and physics. 

So just like health care expenditures by big Pharma, and I would add, by the NIH, are over weighted toward basic science research and marketing of extraordinary high tech drugs, gadgets and other interventions that usually focus on relatively less common conditions for people who have better insurance, so has the drift of higher education moved us away from the fundamental attributes that served American society so well for so long—what we know as the liberal arts model. 

The liberal arts model at my university and pretty much everywhere, says that a college graduate should have spent roughly half of their college credits developing good habits in critical reading, satisfactory writing, reasonable understanding of scientific principles, basics of math and other topics including analytic problem solving, ethics, logic, etc. These courses, tagged as satisfying a core requirement, are well enrolled, others, not as well. 

The students backing away from majors and minors in the arts and sciences including English, history and math are going to majors like business but also to other professional disciplines including journalism, tourism or sport management, pharmacy, nursing, and even public health (good for us!).

Were it not for our core curriculum requirements, in fact, the provost and deans would be hard pressed to allow faculty vacancies in departments like religious studies, philosophy, language and linguistics.

Degrees in humanities disciplines combined represented only 10.4% of all bachelor’s degrees awarded in 2013, the smallest share since 1970’s. By contrast, environmental studies rose 63% and computer science, posted a 109% increase. 

Furthermore, we are pressured by state officials to insert more time in specific job training activities.  Legislators let it be known all the time that their preference would be for us to tailor our curricula to the needs of the largest employers in the region, and that is not a S.C. phenomenon, trust me. 

Sometimes, it gets to be just a little too much and I say, “You mean you want more students to study welding, or web design, or data entry?”  Hoping I would get at least a facial expression of understanding, but usually I get a nod and the laugh is on me.

In turn, when faculty vacancies occur in the Arts and Sciences, the provost—being responsible for the allocation of new positions—is more likely liable to withhold these faculty lines in favor of those professionally oriented slots. Business school faculty searches comprise about 2/3 of all our open searches at the present. Public health does very well too, by the way.

Of course, if there are fewer faculty in the Arts and Sciences, there will be fewer faculty competing for scholarly and research activity in fields that traditionally compete for the NSF budget, which is being depleted. This, of course, will result in less basic science output or lesser quality science and scholarship. Again, this is bad news for our nation. 

At Carolina, we often note that an exceptional liberal arts program will produce future leaders, critical thinkers and problem-solvers. 

At Carolina, we often note that an exceptional liberal arts program will produce future leaders, critical thinkers and problem-solvers.  I am convinced that the majority of our graduates do emerge as student-leaders who have been steeped in a well-rounded curriculum augmented by exposure to a diverse global student body, to research and internship opportunities, to study abroad experiences plus a full campus life. Critical to our approach is the extensive service connection our students must make with those communities that exist beyond our campus boundaries.  All of these elements and more are the hallmark of a strong liberal arts education.    

 And although it usually feels like I’m speaking into the wind, I tell parents and students at freshman convocation not to overlook great majors like history, math, chemistry and other fundamental disciplines. When they ask me what their daughter or son could do with those majors, I say “anything.” 

By the way, speaking of daughters and sons, did you know that women are outperforming men on college campuses?  More are admitted (we are about 55/45); they advance, graduate on time, and win more academic and community service awards than male students. They also get into trouble a lot less often!  Nationally, it’s the same. For every 100 women who matriculate at an American university, there are only 88 males, and for every 100 females who graduate, only 75 males receive their bachelor’s degrees. 

Back to making a case for preserving the liberal arts and sciences model, the Association of American Colleges and Universities found that although Arts and Sciences majors usually earn less in the early years after college than peers who major in professional fields, they earn more than those peers by the time they reach the peak earning years of 50+.

A liberal arts education also creates a strong foundation for public service and public good. Employers agree that what is needed is not a job candidate with narrow skills that will soon be out of date. Time and again, potential employers tell me that they want critical thinkers, problem solvers, and employees with, not a limited, narrow view, but an expanded worldwide view.

Now having said that, let me show a bias in saying that I couldn’t be more pleased in another national phenomenon, which is the appearance of public health in the undergraduate curricula, and it’s skyrocketing in popularity.

 As many of you know, CEPH began accrediting baccalaureate degree programs in 2008. Public Health Reports recently shared some statistics in terms of “undergraduate public health degree conferrals.”  In 1992, there were 759; in just five years, that number had almost doubled. By 2007, the number of undergraduate public health degree conferrals had reached 2,800, and in 2012, the number was at almost 6,500. 

 1992:     759

1997:     1504 (almost double)

2002:     1438

2007:     2827 (four times number in 1992)

2012:     6464

 USC’s undergraduate public health program was part of the first wave, roughly a decade ago. In 2006 we had eight students admitted (transfer/change of majors) and graduated six of them in Spring 2010. But we experienced explosive enrollment increase and this fall, Carolina has more than 600 students taking public health undergraduate courses. And we anticipate 250-300 conferrals this year. 

 The Arnold School of Public Health offers three different undergraduate degrees. 

  • The BS in Exercise Science emphasizes three tracks – health fitness, motor development, and scientific foundations. 
  • The BA and BS public health degree programs ready our graduates for a public health career or graduate school with a strong foundational knowledge of public health or a more broad based natural science curriculum for those interested in graduate work in environmental sciences or to enter medical school.

Let me also spend a few last moments saying how interesting it is for me to see how many fellow university presidents and provosts have public health backgrounds:

  • Richard Hart – Loma Linda
  • Mark Becker – Georgia State
  • Julio Frenk – Miami

I assure you that there are many more. I, and also Patricia most certainly, have used this higher platform/position to advance public health interests in and around campus and town. 

 For example, on our nine University of South Carolina campuses, we do our best to promote healthy lifestyles and sustainable living:

  • I’m proud that we became one of the first universities in the South to ban tobacco use on campus. Being a Tobacco Free zone is a very big move in a state where tobacco used to be king. 
  • Farmer’s Market on campus every Tuesday – locally produced fresh fruits and vegetables at fair prices. 
  • We promote healthy eating in our vending machines where faculty and staff can choose nutrition on the right side and, well, Oreos and potato chips, if necessary, on the left!
  • Faculty, staff and students can take advantage of Mindful Mondays and Wind Down Wednesdays with yoga and meditation sessions.
  • We offer up garden plots and raised garden beds for student and staff groups – and Patricia and I have a garden and greenhouse, as well. 
  • We entertain roughly 100 days a year with these campus and locally grown and produced foods in what we call “Palmetto-vore” meals, featuring healthy recipes from Patricia’s two cookbooks – Greek Revival: Cooking for Life and Greek Revival: From the Garden.
  • And, in residence halls we worked with our food service partner Sodexo to provide a healthy array of food choices not to mention minimizing the use of disposable utensils, plates, etc. and to compost to reduce food waste. 

Anecdotally, I learned last month that we rank among the top 75 for food services at universities in the US.  Criteria included nutrition and sustainability, accessibility and service, educational events, and the little extras such as creativity and, in Carolina’s case, no frozen foods plus nine certified executive chefs on campus.  We were ranked No. 23! I was delighted that Yale was at No. 21, and equally delighted Harvard is No. 24!

So in closing I come full circle back to this wonderful alumni event.  Let me thank Dean Cleary publicly for his nine years of leadership. I know from having been dean of the Arnold School of Public Health previously; it can be a challenging position but also extremely rewarding.  I trust the rewards have outweighed the challenges, Paul!

The Yale School of Public Health ranks highly in so many important academic indicators but none is more important than providing a high quality education to future leaders in classrooms, laboratories, management and policy positions in New Haven, Connecticut, the United States and throughout the world. 

As a reminder to my fellow alumni, it’s important that we do all we can financially, and it is also important to mentor and network the current and future classes of EPH students. 

Our world has never needed public health more than it does now. Anything given to this school is an investment in our own future. 

Our world has never needed public health more than it does now. Anything given to this school is an investment in our own future. 

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