As the COVID-19 pandemic prompts national conversations about the prioritization of public health, students and faculty at Yale’s School of Public Health are calling on the University to grant the school institutional autonomy and dictate a clear vision for Yale’s efforts in the field.
Following evidence that suggested School of Public Health Dean Sten Vermund was pushed out of his role, faculty and students at SPH have called on Yale’s administration to articulate a vision for the school and remove it from beneath the School of Medicine’s umbrella. Despite the major scientific and public health contributions the school has made in the past year, including developing the saliva-based COVID-19 test SalivaDirect, various SPH professors and affiliates shared that the school still faces a lack of autonomy, financial support and vision from the School of Medicine.
“All of us are really sorry to see Dean Vermund step down under the circumstances that he did,” said Cary Gross, professor of medicine and of epidemiology at the School of Public Health. “It is really apparent that he didn’t have adequate support from the institution at large. This really raises the question of the future, which is the most important.”
Autonomy of YSPH
While the School of Public Health is one of the University’s seven self-supporting schools, which means that it pays the central University administration to use the Yale name and facilities, it operates under another school — the School of Medicine.
With Vermund’s departure, affiliates have voiced concerns regarding the school’s lack of autonomy from the School of Medicine. According to Gregg Gonsalves, associate professor of epidemiology, SPH is the only school of public health in the country that operates under the administration of a medical school.
“Some universities have no public health schools and thus have a department of public health in their medical schools,” Gonsalves wrote in an email to the News. “But we are an accredited school of public health and still under the control of the medical school.”
Gonsalves said that because medical school deans are not necessarily trained in public health, the issue with SPH’s structure is more than just an administrative problem. While there is overlap between medicine and public health, the fields are not the same –– medicine prioritizes individual health and public health focusing on the health of populations. As a result, according to Gonsalves, public health is foreign to those who oversee the medical school — and therefore, those who ultimately oversee the School of Public Health. Current School of Medicine Dean Nancy Brown is a clinical pharmacologist. Her predecessor Robert Alpern was a nephrologist — a specialist in kidney disorders. Brown did not respond to questions for this piece.
In total, 10 faculty members at the School of Public Health expressed concerns about the school being housed under the School of Medicine.
“The Yale School of Public Health has many challenges,” Harlan Krumholz, professor of medicine and professor in the Institute for Social and Policy Studies at Yale, told the News. “It is housed within a School of Medicine that, by definition, has many priorities. Resources are quite limited compared with many of its peer institutions.”
Associate professor of epidemiology Luke Davis said that independence is a key criterion for being considered a leader in science. The School of Public Health, then, should be independent, he said.
According to Howard Forman, professor of radiology and biomedical imaging, it would be easier for the University to determine the adequate amount of resources and funding to allocate to SPH if the school were not within the School of Medicine. He also believes that SPH should be an independent institution.
Donna Spiegelman, professor of biostatistics, shared her hope that University administrators would take advantage of the time of transition between deans and the opportunities presented by the performance of the endowment funds over the past year to remove SPH’s governance from the medical school, establishing it as one of the University’s independent schools.
Vermund explained that if the School of Public Health were to be an independent institution, it could face financial challenges given that the school is subsidized by the School of Medicine. Otherwise, according to Vermund, the current professional and mutual relationships across schools would not change and the benefits of YSPH being independent would be improving the school’s standing among peer institutions, being able to make appointments with criteria suitable for public health professionals rather than physicians and acknowledging that public health is not a subset of medicine.
Brown previously told the News that “YSM benefits when YSPH is strong.”
“Yale School of Medicine values our close partnership with Yale School of Public Health and never more so than after the last 18 months,” Brown wrote in a previous email to the News. “We share many faculty members and collaborate extensively.”
SPH faces financial barriers
SPH currently runs an annual deficit that is covered by the medical school. Vermund said that there are a number of reasons why the school has been unable to balance its budget, which include a need to use tuition income to support scholarships, comparatively low endowment income and “increased University assessments.”
In light of Yale’s endowment increasing to $42.3 billion, SPH community members noted that increased endowment support to the school could relieve financial challenges.
“Another way to think about it is that the School of Public Health would not have a deficit if it was receiving a level of support by either the University or the medical school that would allow it to operate at a budget-neutral level,” said Forman. “It is a very artificial thing to say an institution has a deficit because the School of Management had a deficit until several years ago, [and] the School of Medicine until 10 or 15 years ago ran annual deficits every year.”
Forman explained that to his knowledge, only the School of Medicine makes a profit each year; all other schools survive by substantial subsidies provided by endowment money or other contributions. He claimed the School of Public Health’s deficit would not exist with financial support from the University.
The fiscal challenges faced by the school have impacted the experiences of students and faculty alike, three people told the News. Jackson Higginbottom SPH ’20, a program administrator at SPH, shared that he and other students experienced difficulties with financial aid during his time as a MPH student. In addition, he felt a disparity in the quality of facilities and resources provided in comparison to other schools. According to Higginbottom, many of their classes were held in the basement of the School of Public Health’s main building on 60 College St.
The University included support for public health — for faculty, academic centers, research efforts and tuition cuts — as a priority of its current capital campaign — a major fundraising push.
Forman shared that compared to the improvement and renovations made during his 25 years at the medical school, the School of Public Health has no comparable infrastructure improvements or buildings.
“If you think about the School of Public Health, I think there are 13 buildings. There is no comparable physical facility that people would look at the same way,” said Forman. “The metaphor for the entire investment in public health is the physical infrastructure of public health at Yale University.”
The vision for SPH
Under its current leadership structure, the School of Medicine’s administration is heavily involved in determining the vision and future of the School of Public Health, according to three faculty members.
With Vermund’s term ending in June, members of the community said that a vision for the school is more important now than ever, both for the future of the School of Public Health as well as for the broader global community. Recently, there is greater global attention to public health, with members of the community pointing to the ongoing COVID-19 pandemic as an indication of the need for better public health infrastructure and research.
The University has also emphasized the importance of investing in public health.
“The COVID-19 pandemic has underscored the need for greater investment in public health research and teaching and in minimizing health disparities,” University Provost Scott Strobel wrote in a letter to faculty concerning Yale’s budget for the upcoming year obtained by the News.
Faculty members likewise echoed the importance of investing in public health and a need for a clear vision for the School of Public Health.
“The importance of public health cannot be lost on anyone nowadays,” Gonsalves wrote. “Yet, it’s clear we need a new vision for the future in which public health research, teaching and practice can help us avoid and stop new pandemics, but also address the lingering health disparities in the U.S. and around the world.”
However, despite Yale’s declaration of commitment to public health, members of SPH share that there has been little communication from the broader administration as to what this new vision is exactly.
Gross said that while Vermund laid out a vision for SPH during his time as dean, he is not aware what Yale’s ongoing vision for the school, and for public health more broadly, is. Higginbottom shared that there has been little clarity or communication from the School of Medicine and University administration on both recent events concerning Vermund’s departure and their vision.
“No one has articulated this new vision,” Gonsalves wrote.
SPH faculty said that the University’s approach in its search for the next dean will be the first step that reveals Yale’s vision for the school and public health overall. According to Gonsalves, the choice of who is on the search committee for the new dean will show some of their intent. Higginbottom noted the importance of the development of the search committee and decision-making involved, as well as making sure that the alumni, faculty, staff and students are involved in this decision.
Vermund shared that University President Peter Salovey and Brown, through the process of a search committee, will determine the profile of the new dean. The provost may also play a role. Vermund views the change of leadership as an opportunity towards increased diversity and has provided suggestions for search committee membership to Salovey, at his request, he said.
Vermund’s term is set to end June 30, 2022. In a public email to the Yale community, Salovey shared that he will appoint a search advisory committee that will seek broad input from School of Public Health faculty, students, staff and alumni in addition to a search firm.
Even with concerns of vision from Yale, SPH members affirmed their belief in the progress made and potential of the school.
“The future of YSPH is very exciting,” Vermund wrote. “Our new curricular offerings in health justice, climate change and health, and maternal and child health promotion have launched. Our new online Executive M.P.H. and our new Health Informatics M.S. degrees are thriving. Student ratings of faculty teaching quality are at a historic high.”
Spiegelman shared her optimism about the future, noting that Vermund will be leaving the school in excellent shape, financially, academically and in terms of public health innovation and leadership.
“Even with those challenges the place remains a diamond in the rough,” Gonsalves wrote. “Whether it’s Yale’s name or something else, we continue to attract talented young faculty and superb students.”
The Yale School of Public Health is located at 60 College St.