Australia's University Courses: Are They Meeting the Educational Expectations of the National Environment: Health Strategy?

Abstract Australia has developed a national strategy to encourage an intersectoral approach to environmental health and the creation of an environment that promotes good health and prevents problems. This strategy has implications for the education and training of the workforce. Therefore, the authors conducted a survey of courses in environmental health and other courses highly relevant to the environment offered by Australian universities in 2000. The purpose was to determine the extent to which those courses meet the educational expectations of the National Environmental Health Strategy. Results of the survey showed that Australia's universities are not meeting all the educational expectations of the national strategy. These findings might prompt other countries that agree with the thrust of the strategy to review their own educational offerings.

Introduction

In October 1999, the Commonwealth Government of Australia launched a national strategy to better identify and manage environmental health problems (Commonwealth Department of Health and Aged Care, 1999). The National Environmental Health Strategy was developed by The National Environmental Health Forum. The forum involved directors of environmental health from the commonwealth, state, and territory governments; the Australian Institute of Environmental Health; the Australian Local Government Association; and the New Zealand Ministry of Health. The Australian Institute of Environmental Health is a nonprofit, registered company whose members are environmental health officers. It monitors and advises state and territory governments on relevant legislation and its administration.

The National Environmental Health Forum was convened in response to the concern of governments and other stakeholders that Australia's ability to predict and manage environmental health threats was impeded by the fragmentation of environmental health management across three levels of government (commonwealth, state or territory, and local government) and a focus on prescriptive regulation and law. It was felt that a broader, more cooperative approach was needed. The National Environmental Health Strategy is designed to improve collaboration between government and stakeholders, decision-making ability, management practices, and communication; its purpose also is to promote healthy environments, and it describes strategies through which each of these objectives might be achieved.

The strategy, which will drive the policy and provision of environmental health services in Australia into the future, is being implemented by the National Environmental Health Council. The National Environmental Health Council consists of representatives from commonwealth, state, and territory governments; the National Public Health Partnership; the Australian Institute of Environmental Health; the Australian local Government Association; the community; the public-health sector; and the environment sector (Environment Australia). There is also a chairperson agreed upon by the Australian Health Ministers Conference.

The way the National Environmental Health Strategy sees environmental health, the environmental health workforce, and environmental health practice has implications for education and training. Environmental health, according to the strategy, comprises those aspects of human health determined by physical, chemical, biological, and social factors in the environment. The environmental health workforce is considered to include environmental health officers, indigenous environmental health workers, researchers, and academics, as well as policy officers, urban planners, engineers, administrators, allied health professionals, other professionals, and managers.

The strategy sees environmental health practice as covering not only the assessment, correction, control, and prevention of environmental factors that can adversely affect health, but also the enhancement of those aspects of the environment that can improve health. The expectation is that education and training will continue to cover the provision of clean water, waste disposal, safe food, safe living, and safe working through public-health legislation and regulation, but will also emphasize the potential contribution of health promotion to environmental health.

Activities arising from the National Environmental Health Strategy will be guided by the Australian Charter for Environmental Health, which consists of guiding principles developed by the National Environmental Health Forum. The nine principles are as follows:

1. Threats to health posed by environmental hazards should be identified as early as possible, and appropriate safeguards should be introduced.

2. Economic development should proceed hand in hand with measures to protect the environment and to promote high standards of environmental health.

3. Future human health requires that development meet the needs of the present without compromising the ability of future generations to meet their own needs.

4. Environmental health programs need to take into account that global environmental protection requires local action and that local actions have global impacts.

5. Planning, implementing, and evaluating environmental health programs requires that all involved work together.

6. Risk assessment and risk management are tools that can be used to address existing or potential environmental threats to human health and the adverse effects on people, communities, and economic interests.

7. Decisions and deliberations must be based on a careful analysis of available scientific evidence about potential environmental risks to human health.

8. Improving the delivery of environmental health services, encouraging innovation, and carefully examining how environmental health services are provided, including the relative costs and benefits of each alternative, are important considerations for optimal environmental health outcomes.

9. Australians should be provided with access to appropriate environmental health services.

The Australian Charter for Environmental Health has implications for the education and training of the environmental health workforce. Courses (or programs, in American terminology--see sidebar above) need to cover early identification and cost-effective control of hazards; economic development and environmental protection; sustainability; the global impact of local actions; collaborative work with stakeholders; the assessment and management of risks to health; the use of evidence in decision making; assessment of the cost-effectiveness of environmental health services; and inequalities in access to services and environmental health justice.

The national strategy emphasizes the need for a strong research base and for the use of reliable scientific data in making decisions about policy, management strategies and methodologies, and the identification of emerging hazards. The expectation is that environmental health courses will include a strong research focus.

The strategy also sees environmental health practitioners as having a broad scientific base acquired through undergraduate courses and postgraduate qualifications in specialist areas such as food safety or waste management. It enumerates the following disciplines as contributing to the skill base of environmental health practitioners: chemistry, microbiology, engineering, statistics, physiology, epidemiology, toxicology, virology, sociology, communications, health promotion, law, management, planning, and finance.

The strategy emphasizes that environmental health practitioners will need to constantly update their knowledge and skills. Although it calls for the professional development program of the Australian Institute of Environmental Health to be improved and extended, the strategy acknowledges that employers often encourage staff to undertake courses offered by universities.

The strategy points out that for environmental health outcomes to be maximized, the different skills of professionals and practitioners from a wide range of sectors need to be acknowledged and fully utilized, and that, for this to happen, all relevant professionals need to have a strong understanding of the philosophy and practice of environmental health. One way to achieve this scenario, according to the strategy, is to provide environmental health training to members of allied professions, such as urban planners, environmental officers, and other health professionals.

Before the National Environmental Health Strategy was adopted, Australian universities developed courses in environmental health without the benefit of unified national definitions for environmental health, the environmental health workforce, and environmental health practice. Therefore, the advent of the strategy raises the question of whether university undergraduate and postgraduate courses have evolved naturally to produce the attitudes, knowledge, and skills considered necessary to environmental health practice in the future, or whether changes are needed. This paper describes a study funded by the Commonwealth Government to determine the extent to which university courses are meeting the strategy's educational and training expectations.

Methods

A survey was taken to assess 1) environmental health courses and 2) other courses on or of high relevance to the environment offered by Australian universities in 2000. As well as courses in environmental health, the former category included postgraduate first courses (see sidebar on page 10) in ecological public health and second courses in environmental health management, environmental toxicology, environmental health in combination with occupational health, and safety science. The latter category included courses in the following areas related to environmental issues: design, development, economics, education, engineering, impact assessment, law; management, planning, environmental science and environmental studies, food science and technology, natural resources management, and occupational health, hygiene, or safety. The sources of information were the World Wide Web and university handbooks.

From responses to the survey, the authors derived the subjects offered by undergraduate and postgraduate first courses in environmental health. The number of courses that included subjects from the disciplines that the national strategy saw as contributing to the skill base of environmental health were calculated. Also calculated were the numbers of courses that offered subjects whose availability is implied by the following considerations:

* what the strategy was designed to achieve;

* its view of environmental health practice, which includes the promotion of health as well as the prevention of problems;

* the importance of research; and

* the Australian Charter for Environmental Health.

Subjects that met these criteria were, respectively,

* decision making, management, communication, and health promotion;

* environmental management, water quality, waste management, food safety, occupational safety, legislation and regulation, and health promotion;

* research methods or research projects; and

* economics, environmental protection, sustainability, global issues, environmental health impact assessment, critical appraisal, health informatics, evaluation, social justice, and rural and indigenous health problems.

The study also recorded the number of postgraduate (second) courses offering specialist training and the areas covered. In addition, the study looked at the numbers of universities offering honors years, Master's degrees by research or by research and coursework, and research doctorates in environmental health.

The authors calculated the number of courses on or of high relevance to the environment that included environmental health subjects. The opportunity also was taken to explore the relationship between environmental health and public-health courses by calculating the number of undergraduate and postgraduate first courses in environmental health that included a public-health subject and, conversely, the number of postgraduate first courses in public health that included an environmental health subject.

Results

Undergraduate Courses in Environmental Health

Six universities and one college of technical and further education offer nine undergraduate courses of study in environmental health. At least one course is offered in each state of Australia. Six are recognized by the Australian Institute of Environmental Health as preparation for the student to practice as an environmental health officer. The sidebar above lists the subjects expected by the National Environmental Health Strategy, and Table 1 indicates the numbers of courses that include such subjects. The undergraduate courses do offer a broad education. Few courses, however, include subjects on finance, decision making, waste and noise management, economic development, environmental protection, sustainability, global issues, risk assessment and management, critical appraisal, health informatics, evaluation, environmental health justice, and rural and indigenous environmental health problems. Seven courses offer a professional practice subject, a placement, or field trips.

Postgraduate First Courses in Environmental Health

Two universities offer graduate diplomas, and six offer a Master's degree designed for graduates wishing to enter the field. Table 2 shows the numbers of such courses that address subjects specified by the National Environmental Health Strategy The postgraduate courses do not offer as broad an education in environmental health as the undergraduate courses. Few include subjects on chemistry, microbiology, engineering, physiology, law, management, finance, decision making, water quality, waste management, food safety and hygiene, noise, environmental protection, sustainability, global issues, critical appraisal, health informatics, evaluation, environmental health justice, or rural and indigenous problems.

Postgraduate Second Courses in Environmental Health

One university offers a general postgraduate diploma to environmental health practitioners with the aim of expanding their knowledge and skills and enabling them to adapt to the changing environmental health needs of communities. The subjects offered include biostatistics, epidemiology, toxicology chemical safety, occupational health and safety, a research project, economics, and health impact studies.

Eight postgraduate courses in specialized areas are offered by five universities at certificate, diploma, or Master's level. The areas are environmental toxicology, environmental health management, occupational and environmental health, and safety science. Another university offers graduates or diplomates with professional experience a diploma in which six out of the eight subjects taken can be chosen from an extensive list of options. The aim is to provide an in-depth understanding of a specialist area to build on education and job experiences. The options include hazardous-chemical assessment, communicable diseases, epidemiology community development, management, waste management, occupational health and safety noise, research methods, and risk assessment.

Research Focus of Environmental Health Courses

An additional (honors) year that includes a research project is available to undergraduates. Most of the postgraduate courses in environmental health include a subject on research methods or a research project. Master's degrees and doctorates involving research are available at most of the universities offering postgraduate courses in environmental health.

Relationship Between Environmental Health and Public-Health Courses

Only two of the nine undergraduate courses in environmental health include a general subject on the principles and practice of public health. All include at least one specialized subject, most frequently epidemiology or statistics and health promotion. Four of the eight postgraduate first courses include a general public-health subject, and all but one include at least one specialized public-health subject, most frequently on epidemiology or statistics and policy.

Public-health education in Australia is mainly a postgraduate activity All postgraduate first courses in public health, sometimes through collaboration with another university include at least one subject on environmental health, while many offer an environmental health stream.

Environmental Health Subjects in Other Courses on or of High Relevance to the Environment

Few of the courses on or of high relevance to the environment offered by Australian universities include a subject on environmental health. One university includes a subject called "Environment and Medicine" among the core subjects for its Master's degree in environmental studies, and that university also offers electives in environmental health; population, health, and the environment; toxicology; and occupational health or hygiene. Another university includes environmental health among the electives for its environmental-studies certificate, diploma, and Master's degree.

A number of universities have or are setting up initiatives designed to encourage students to enroll in subjects offered by various faculties as part of an integrated program on the environment. At one university the engineering faculty was responsible for such an initiative; the initiative involved 12 departments, including the Department of Public Health and Community Medicine. Another university has established an Office for Environmental Programs involving 10 faculties, including the medicine, dentistry and health sciences faculties.

Environmental Health Continuing Education 

The Australian Institute of Environmental Health recognizes the importance of academic courses for its continuing-professional-development program. A few universities offering courses in environmental health allow professionals to enroll in individual subjects as continuing-education students or offer short courses in environmental health topics.

Discussion

The National Environmental Health Strategy defines the environmental health workforce very broadly. Since the strategy entails that members of allied professions will have a strong understanding of the philosophy and practice of environmental health, it must be of concern that only a small number of courses on or of high relevance to the environment include environmental health. Moreover, there are only three postgraduate diploma courses that would give graduates in other disciplines, who may want neither to enter the field nor to complete a Master's degree, a broad understanding of environmental health. Nevertheless, before it is decided that the number of such courses should be increased, it would be desirable to have data on the unmet demand for them among members of allied professions.

Conversely environmental health students need to understand what disciplines other than the health sciences can contribute to environmental health and learn to work and communicate effectively with those disciplines in solving environmental health problems. Building, planning, design, social sciences, business and administration, engineering, law, computer and information science physical and earth sciences, and the applied sciences are among the disciplines that contribute subjects to environmental health courses in Australia. There has been no research, however, into how well the courses equip students to work with these disciplines.

The National Environmental Health Strategy makes little mention of the role family-medicine practitioners play in environmental health or of their training needs. Research into the role of family-medicine practitioners in environmental health has only recently begun to appear in journals, and that role might not be widely appreciated. Family-medicine practitioners in Australia have reported that between one percent and four percent of their consultations are related to occupational or environmental health, and more than half of those practitioners are prepared to undertake further educational activities (Taylor & Ruth, 1995). Studies in the United States and Canada have also found that family physicians do not have the knowledge to manage the environmental issues they encounter (Fowler, 1992; Sanborn & Fran Scott, 1998; Szneke, Nielsen, & Tolentino, 1994).

The undergraduate and postgraduate first courses designed for students embarking on environmental health as a career vary in the extent to which they provide the broad scientific base the National Environmental Health Strategy expects environmental health practitioners to have. Universities need to review and prioritize the omissions, and explore ways of covering the topics in their courses. Recently, attention has been drawn to the advantages of including gender-related environmental health concerns into educational programs-an issue the strategy does not address (Rossignol & Neumann, 1998).

The areas in which postgraduate (second) courses give environmental health graduates the opportunity to gain specialist knowledge and skills are limited. Research is needed into the specialist training requirements of the environmental health workforce, as defined in the National Environmental Health Strategy.

The strategy emphasizes the importance of continuing education in environmental health practice. A much larger number of universities could offer and market to practitioners individual subjects from environmental health and other relevant courses.

The National Environmental Health Strategy also draws attention to the need for the environmental health workforce to better support indigenous environmental health workers. A study of the relationship between environmental health officers and indigenous environmental health workers has suggested that environmental health courses should include a subject on adult education and that communication and community development/health promotion subjects should address cross-cultural issues (Clark, 1999). The lack of subjects that address indigenous environmental health issues in undergraduate and postgraduate environmental health courses is therefore of concern. Also, few courses focus on the environmental health issues of rural and remote communities. Ways in which indigenous and rural environmental health issues can be incorporated into first-degree courses should be explored, as should the need for specialist courses in these areas.

The strategy draws attention to the need for stronger links and information transfer among universities, local government, and environmental health practitioners. Some universities give students the opportunity to work in a field placement during their training and to undertake research in collaboration with government or industry. Data are needed, however, on the effectiveness of such strategies in establishing a mutual understanding of each sector's concerns and cooperation of a more general nature.

Concern has been expressed about the separation of environmental and public health in the United States (Kotchian, 1997). In Australia, most of the universities offering first courses in environmental health also offer public-health courses, and most environmental health courses do offer public-health subjects. These subjects, however, mainly cover specialized areas, whereas a more general subject on the principles and practice of public health may be needed.

University courses in Australia do not meet the educational expectations of the National Environmental Health Strategy. Since the philosophy behind the strategy and the issues it raises are probably applicable to other countries, these findings should prompt overseas universities to review the content of their own environmental health courses. Over the next three years, changes in the aims and content of Australia's courses can be monitored against the expectations set out by the National Environmental Health Strategy. Of particular interest will be any data collected to fill the information gaps the authors have identified and any initiatives universities develop to better meet the expectations of the strategy.

Conclusion

Australia's universities are not meeting all the educational expectations of its National Environmental Health Strategy The fact that few first courses in environmental health include subjects on critical appraisal, economics, evaluation, social justice, or indigenous and rural problems undermines the Australian Environmental Health Charter principles related to evidence-based decision making, the examination of the relative costs and benefits of various approaches to providing environmental health services, and equity The guiding principle that all involved in the environment work together also is undermined--by the fact that few courses on or of high relevance to the environment include environmental health subjects. These findings might prompt other countries that agree with the thrust of Australia's National Environmental Health Strategy to review their own courses.

Acknowledgements: This project was funded by a grant from the Commonwealth Department of Health and Aged Care.

Corresponding Author: Professor Hedley Peach, University of Melbourne, Ballarat Health Services Base Hospital, Drummond St. N.P.O. Box 577, Ballarat, Victoria 3353, Australia.

REFERENCES

Clark, D. (1999). Environmental health officers' understanding about an Aboriginal environmental health worker program in the Northern Territory. Australian and New Zealand Journal of Public Health, 23(1), 93-94.

Commonwealth Department of Health and Aged Care. (1999). The National Environmental Health Strategy. Canberra, Australia: Author.

Fowler, F.J. (1992). Survey of Wisconsin primary care physicians regarding perceptions of environmental risk. Boston: Centre for Survey Research, University of Massachusetts, Physicians for Social Responsibility.

Kotchian, S. (1997). Perspectives on the place of environmental health and protection in public health and public health agencies. Annual Review of Public Health, 18, 245-259.

Rossignol, A.M., & Neumann, C. (1998), International environmental health: Priorities from Huairou. Journal of Public Health Policy, 19(3), 318-330.

Sanborn, M.D., & Fran Scott, E.A. (1998). Environmental health concerns in urban and rural family practice. Canadian Family Physician, 44(July), 1466-1472.

Szneke, P., Nielsen, C., & Tolentino, N. (1994). Connecticut physicians' knowledge and needs assessment of environmentally-related health hazards--A survey Connecticut Medicine, 58(3), 131-135.

Taylor, E.R., & Ruth, D. (1995). A survey of environmental and occupational health needs of GPs. Australian Family Physician 24(8), 1433-1439.

TABLE 1
Educational Expectations of the National Environmental
Health Strategy--Subjects and Numbers of Undergraduate
Courcses That Provide Them
Subject                           Number of Courses a
Chemistry b                                       8
Communication c                                   5
Critical appraisal                                0
Decision making                                   0
Economic development                              0
Engineering d                                     4
Environmental health justice                      0
Environmental management                          7
Environmental protection                          2
Epidemiology                                      6
Evaluation                                        1
Finance                                           0
Food safety and hygiene e                         8
Global issues                                     0
Health informatics                                1
Health promotion f                                6
Law g                                             6
Management h                                      4
Microbiology i                                    9
Noise                                             2
Occupational health and safety                    5
Physiology j                                      8
Planning k                                        6
Professional practice, placement                  7
or field trip
Research methods l                                3
Research project                                  5
Risic assessment and management                   3
Rural and indigenous problems                     0
Sociology m                                       4
Statistics n                                      4
Sustainability                                    0
Toxicology o                                      6
Waste management p                                2
Water quality                                     3
(a)Total number of courses = 9.
(b)Includes environmental chemistry.
(c)Includes risk communication.
(d)Includes environmental engineering.
(e)Includes food science.
(f)Includes health education.
(g)Includes environmental law, environmental health
law, legislation, and regulation.
(h)Includes management systems and public administration.
(i)Includes virology and communicable diseases.
(j)Includes biology and human biology.
(k)Includes environmental planning and municipal planning
(l)Includes research skills and enperiment design.
(m)Includes social organizations.
(n)Includes biostatissics, statistical data analysis,
and modeling.
(o)Includes environmental toxicology, chemical safety,
and drug safety.
(p)Includes solid waste and wastewater.
TABLE 2
Educational Expectations of the National Environmental Health
Strategy--Subjects and Numbers of Postgraduate Courses That
Provide Them
Subject                         Number of Courses a
Chemistry                                       0
Communication                                   3
Critical appraisal                              0
Decision making                                 0
Economic development                            3
Engineering                                     0
Environmental health justice                    1
Environmental management                        5
Environmental protection                        0
Epidemiology                                    6
Evaluation                                      2
Finance                                         0
Food safety and hygiene h                       1
Global issues                                   2
Health informatics                              1
Health promotion                                3
Law c                                           2
Management                                      2
Microbiology d                                  1
Noise                                           2
Occupational health and safety                  5
Physiology                                      0
Planning e                                      3
Professional practice,                          0
 placement or field trip
Research methods                                7
Research project                                4
Risk assessment and management                  5
Rural and indigenous problems                   1
Sociology f                                     3
Statistics g                                    4
Sustainability                                  2
Toxicology h                                    4
Waste management                                2
Water quality                                   1
(a)Total number of courses = 8.
(b)Includes food science.
(c)Includes legal studies, legislation, and regulation.
(d)Includes virology and communicable diseases.
(e)Includes environmental planning and design.
(f)Includes social foundations of public health.
(g)Includes biostatistics.
(h)Includes environmental  and industrial toxicology.

Educational Terminology

U.S. readers may find some familiar terms used in unfamiliar ways in this paper. Below is a list of educational terms used in Australia, accompanied by definitions or by American synonyms.

* Course--program (e.g., "a course in environmental health" = "an environmental health program").

* Subject--course (e.g., "a subject in chemistry" = "a course in chemistry").

* Stream--series of courses.

* Undergraduate course--basic program leading to a bachelor's degree.

* First course in environmental health--undergraduate program or basic program designed fur people who have a degree, but not in environmental health.

* Postgraduate first course--basic program designed for people who have a degree, but not in environmental health.

* Postgraduate second course--advanced program designed for people who have completed a first course either as an undergraduate or as a graduate.

* Postgraduate course--umbrella term that includes both advanced programs and basic programs designed fur people who have a degree, but not in environmental health.

* Specialist postgraduate course--specialized, usually advanced, program.

* Postgraduate qualifications in specialist areas--usually advanced qualifications in specialist areas.

* Graduate Diploma--basic diploma designed for people who have a degree, but not in environmental health.

* Postgraduate Diploma--advanced diploma.

Environmental Health Subjects

The Australian National Environmental Health Strategy expects a course in environmental health to include the subjects listed below.

Chemistry

Communication

Critical appraisal

Decision making

Economic development

Environmental health justice

Environmental management

Environmental protection

Epidemiology

Evaluation

Finance

Food safety and hygiene

Global issues

Health informatics

Health promotion

Law

Management

Microbiology

Noise

Occupational health and safety

Physiology

Planning

Professional practice, placement or field trip

Research methods

Research project

Risk assessment and management

Rural and indigenous problems

Sociology

Statistics

Sustainability

Toxicology

Waste management

Water quality