Beyond Women’s Health: 

Incorporating Sex and Gender 

Differences Into Graduate 

Public Health Curricula
This publication was produced by the Health Resources and Services Administration, Office of Women’s Health, with 

the Association of Schools of Public Health (ASPH) under order No. 03-0206P and through an ASPH subcontract 

with Holly Grason, Johns Hopkins Bloomberg School of Public Health. Additional support was provided from 

the Department of Health and Human Services, Office on Women’s Health; National Institutes of Health, Office of 

Research on Women’s Health; Centers for Disease Control and Prevention, Office of Women’s Health; and the Agency 

for Healthcare Research and Quality, Director, Women’s Health and Gender-Based Research.
i

Director, Women’s Health and Gender-Based Research
PREFACE

The Congressional appropriations report for Fiscal Year 1993 requested that the National 

Institutes of Health (NIH), Office of Research on Women’s Health (ORWH) examine women’s 

health in the medical school curriculum. The following year, the appropriations report 

broadened to include curricula of all the health professions. The first report was released in 

June 1997, entitled Women’s Health in the Medical School Curriculum: Report of a Survey 

and Recommendations. This report was then followed by two reports: Women’s Health in the 

Dental School Curriculum, Report of a Survey and Recommendations and Women’s Health 

in the Baccalaureate Nursing School Curriculum. In order to continue the work cited in the 

appropriations, the Association of Schools of Public Health, supported by NIH ORWH; the 

Health Resources and Services Administration (HRSA), Office of Women’s Health (OWH); 

Department of Health and Human Services (HHS), Office on Women’s Health (OWH); Centers 

for Disease Control and Prevention (CDC), Office of Women’s Health (OWH); and Agency 

for Healthcare Research and Quality (AHRQ) Director, Women’s Health and Gender-Based 

Research, supported the analyses and preparation of a curriculum review study in 2003 of 

women’s health in the core courses for the Masters of Public Health (MPH) degree at accredited 

schools of public health (SPH). 

The primary recommendation of the project was that MPH core curricula incorporate the 

following educational components:

· Knowledge of the major sex and gender differences in health and disease across the life span,

 particularly in terms of physiological, behavioral, and societal factors that influence health 

 behaviors and health status among culturally and socio-economically diverse populations;

· Understanding of the similarities and differences between men and women concerning 

 interaction and communication with the health care system, and the impact of multiple social 

 roles and life cycle events on shared health care decision making for self and family; and

· Knowledge of the historical and contemporary social and cultural determinants of health and 

 wellness across the life span, particularly with respect to sex and gender roles.

Study participants agreed that women’s health should be included in public health education 

through incorporation of content specific to the health of women but also to include sex and 

gender differences in health problems and health behavior across the life span. By providing 

students at SPH with training that is relevant to sex and gender differences, and that also is 

appropriate to the different life stages, students will further increase the use of preventive 

services and reduce health disparities as they venture into the public health field. We are grateful 

for the dedicated assistance to this effort from ASPH to continue the work of previous curricular 

reports addressing women’s health in the health professions training. Without ASPH’s efforts, this 

report would not have been possible. 

ii
This document contains important information regarding “what should be taught” and “what 

is taught” in the MPH curriculum. We hope public health education institutions will use this 

information to develop curricula to improve the health of women and men across their life span. 

Wanda K. Jones, DrPH Yvonne Green, RN, CNM, MSN 

Deputy Assistant Secretary for Health (Women’s Health) Director, Office of Women’s Health

Department of Health and Human Services Centers for Disease Control and 

 Prevention

Vivian W. Pinn, MD Sabrina Matoff-Stepp, MA

Associate Director for Research on Women’s Health Director, Office of Women’s Health

Director, Office of Research on Women’s Health Health Resources and Services

National Institutes of Health Administration 

Rosaly Correa-de-Araujo, MD, MSc, PhD 

Senior Advisor on Women’s Health 

Agency for Healthcare Research and Quality

iii

Director, Women’s Health and Gender-Based Research
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TABLE OF CONTENTS

Executive Summary ................................................................................................................... 1

Introduction ................................................................................................................... 7

Summary Findings ................................................................................................................... 9

Focus Group Findings ................................................................................................................... 11

Student and Recent Alumni Survey Findings ......................................................................... 20

Women’s Health Elective Courses in Schools of Public Health ............................................. 24

Summary and Conclusions ..................................................................................................... 26

Recommendations ................................................................................................................... 27

Reference List ................................................................................................................... 30

Appendix I – Participating ASPH Member Schools ........................................................... 32

Appendix II – Women’s Health Interest Group and Expert Advisory Group ................. 33

Appendix III – Methods ................................................................................................................... 35

Appendix IV – Women’s Health Elective Courses ........................................................... 48

Appendix V – Resource Materials ..................................................................................................... 54

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EXECUTIVE SUMMARY

Many diseases affect women disproportionately, predominately, or differently than they do men. 

The view of women’s health has also moved away from maternist traditions toward broader 

conceptualizations based on social, educational, and economic status, as well as on reproductive 

choices and family composition. Within this context, a partnership of five Federal agencies1 has been 

instrumental in examining the integration of women’s health in the training curricula of the health 

professions. 

Given its orientation to the health of populations, and anecdotal information about increasing interest in 

women’s health, the Association of Schools of Public Health (ASPH), in collaboration with the Federal 

agencies’ women’s health partnership, undertook a curriculum review study in 2003 of women’s health 

in accredited schools of public health (SPHs). The aim of the study was to assess how women’s health is 

addressed in required and elective courses for the Master of Public Health degree (MPH). Through this 

project, ASPH and its Federal partners sought to expand the available information at SPHs regarding an 

increased recognition of women’s health issues across the life span. 

Project Approach and Methods

ASPH organized an approach to the project that involved several working groups and a set of structured 

data collection activities. The initiative included convening a Women’s Health Interest Group, consisting 

of women’s health faculty from each of the 34 schools of public health, and an expert advisory group 

(EAG), which additionally included experts in women’s health from associations involved in education 

and practice of public health and women’s health experts from Federal agencies. A focus group 

methodology was selected for collecting information about what a typical MPH graduate is exposed 

to in core MPH courses concerning women’s health. This strategy was adopted to ascertain nuanced 

information regarding factors involved in pursuing a women’s health focus in the MPH curriculum, and 

individual perspectives about what should be done to build upon the current status of such interests and 

efforts. Nine focus groups were conducted in July and August of 2004, each addressing a particular 

perspective: The women’s health faculty focus groups discussed “what should be taught” in core MPH 

programs in regard to women’s health, and the core course faculty focus groups discussed “what is 

taught.” These focus group discussions also addressed barriers, opportunities, and strategies related to 

enhancing and expanding a focus on women’s health in MPH programs.

An on-line survey of ASPH interns and fellows in August 2004 provided a sampling of student and 

recent alumni experience and perspectives regarding women’s health-related topics in core MPH courses. 

Concurrently, information on course offerings related to women’s health was systematically abstracted 

from SPH 2003 course catalogues. The course data were then vetted by the designated women’s health 

interest group member from each school. A final step in preparing this report entailed convening the 

EAG in a daylong meeting in October 2004 to consider findings and develop a set of recommendations.

1 Health Resources and Services Administration (HRSA), Office of Women’s Health (OWH); Department of Health and 

Human Services (HHS), Office on Women’s Health (OWH); National Institutes of Health (NIH), Office of Research on 

Women’s Health (ORWH); Centers for Disease Control and Prevention (CDC), Office of Women’s Health (OWH); and Agency 

for Healthcare Research and Quality (AHRQ) Director, Women’s Health and Gender-Based Research. 

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Findings

The primary recommendation of the project, as informed by the data and with the advice and expertise 

from the women’s health EAG, was that MPH core curricula incorporate the following educational 

components:

· Knowledge of the major sex and gender differences in health and disease across the life span, 

 particularly in terms of physiological, behavioral, and societal factors that influence health behaviors 

 and health status among culturally and socioeconomically diverse populations;

· Understanding of the similarities and differences between men and women concerning interaction 

 and communication with the health care system, and the impact of multiple social roles and life cycle 

 events on shared health care decision making for self and family; and

· Knowledge of the historical and contemporary social and cultural determinants of health and 

 wellness across the life span, particularly with respect to sex and gender roles.

These statements of principle are intended to move beyond exclusive attention to women’s health 

for several reasons. First, study participants acknowledged the legitimacy of and sought to address 

counterarguments to a women-specific focus that pose the question, “Why women’s health and not men’s 

health?” Secondly, and equally important, participants sought to address the general concern in the field 

of public health about health disparities as reflected in “Healthy People 2010 Objectives for the Nation,” 

U.S. Department of Health and Human Services (HHS) priority initiatives, and Institute of Medicine 

(IOM) reports. This expanded approach enables ASPH and Federal partners to achieve the multiple 

objectives of addressing prior neglect of women’s health in both public health research and graduate 

education, as well as implementation of IOM-recommended workforce competencies for public health 

professionals related, in particular, to genetics, cultural competence, communication, and diversity.

Other specific findings from the focus groups, student survey, and course review include the following:

1. Sex and gender differences, diversity within gender, social determinants of health, and a 

 lifespan perspective should provide the foundation efforts to incorporate women’s health into 

 the MPH core curriculum. Women’s health faculty proposed that the current focus in public health 

 on health disparities and cultural competency should serve as the backdrop and rationale for inclusion 

 of women’s health concepts in the educational core curricula of MPH students. There was substantial 

 agreement among core course faculty, as well as among students surveyed, that these women’s health 

 concepts were important. Moreover, the students and recent alumni surveyed overwhelmingly 

 indicated that they anticipated needing women’s health knowledge in their professional careers. 

2. There should be greater emphasis on women’s health in the MPH core curriculum through 

 integration into core courses rather than by requiring a separate course specific to women’s 

 health. The main themes identified for integration into core courses included sex and gender 

 differences, health disparities, and cultural competence. 

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3. The principles identified as important by women’s health faculty currently are incorporated 

 into the core MPH curriculum to at least a moderate degree. Overall, about one-third of the 

 participating faculty believed that the concepts and principles identified as essential already received

 full exposure when they considered the entire array of course offerings for their MPH programs. 

 Student survey results appear to confirm these faculty reports. 

 The systematic review of 2003 SPH course catalogues and follow-up with each school representative 

 identified a total of 324 women’s health-related courses. Slightly less than 20 percent (60 of 324) of 

 the total number of courses identified appeared to have a focus on women’s health beyond 

 reproductive health, maternal and child health, or nutrition. Sixty women’s health courses were 

 found, 112 MCH/Perinatal, 74 Reproductive Health/Family Planning, and 78 other courses, which 

 included specific courses such as midwifery and specific nutrition courses. Not surprisingly, the 

 elective courses were more frequently offered in the largest schools. Only two schools did not offer 

 courses in the categories named.

4. Challenges in promoting a targeted emphasis on women’s health include the limited number 

 of public health faculty with expertise in women’s health, and aspects of the academic culture 

 related to independence of faculty in determining course content. In addition, schools of 

 public health exercise broad latitude in determining their overall curricular approach and the specific 

 assemblage of their MPH degree requirements. The concept that the faculty focus group said would 

 be most difficult to incorporate into the MPH curriculum is the lifespan approach to women’s health.

5. Faculty expertise and research interests are important factors in determining the extent to 

 which women’s health is or could be taught in the core MPH curriculum. The interest levels of 

 both deans and students also are key drivers in this regard. Student interest in women’s health 

 appears to exist, as reported by both faculty and students, with over 75 percent of students reporting 

 that women’s health would be important to their careers to a moderate or substantial degree. A long-

 term strategy would be needed, however, to expand the cadre of public health faculty with expertise in 

 the area of women’s health.

6. Compiling and sharing resources specific to women and public health among all schools could 

 be a significant help to core course faculty. Particularly important for inclusion would be data 

 sets, case examples or modules, bibliographies, and course syllabi. Opportunities to promote 

 inclusion of women’s health concepts in the core MPH curriculum are present when faculty 

 recruitments and curricula review are underway in the schools of public health. Moreover, more 

 efforts can be made to collaborate with faculty colleagues from schools of medicine, nursing, 

 and women’s studies programs in schools of arts and sciences. In addition, staff from State and local 

 health departments, and faculty from the HHS National Centers of Excellence in Women’s Health can

 be approached to further enhance the presentation of women’s health in schools of public health. 

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Recommendations

As conceptualized in this report, leadership for implementation, while a collaborative/partnership effort, 

falls primarily into two domains: that of the Association of Schools of Public Health; and that of the 

Federal partner agencies—Health Resources and Services Administration (HRSA), Office of Women’s 

Health (OWH); the Department of Health and Human Services (HHS), Office on Women’s Health 

(OWH); the National Institutes of Health (NIH), Office of Research on Women’s Health (ORWH); the 

Centers for Disease Control and Prevention (CDC), Office of Women’s Health (OWH); and the Agency 

for Healthcare Research and Quality (AHRQ) Director, Women’s Health and Gender-Based Research. 

Additional suggestions are offered for consideration by philanthropic organizations and by professional 

journals.

Association of Schools of Public Health (ASPH)

For its part, ASPH should take the following steps toward implementation:

1. Promote, through a public statement promulgated by the deans of the schools of public health, the 

 incorporation of content specific to sex and gender differences in health problems into the core MPH 

 curriculum. 

2. Establish an ad hoc advisory group to guide efforts that promote integration of the aforementioned 

 key principles related to sex and gender in the MPH curriculum. The charge of this advisory group 

 would be to:

a) develop a set of educational competencies specific to sex and gender health differences that 

 would provide the basis for development of public health teaching materials and courses;

b) develop and promulgate recommendations for specific strategies for incorporating concepts 

 related to sex and gender health differences into the MPH core curriculum (for example, 

 identifying the specific concepts and teaching materials that fit best in each public health core 

 discipline), using the competencies noted above as the focus;

c) guide development of a set of teaching resources on sex and gender health differences and make 

 them available via the Internet to all SPH faculty and academic administrators. Such resources 

 would include syllabi, readings, data sets, case examples, and teaching and assignment modules 

 that would be keyed to the competencies noted above;

d) examine information further and deliberate issues related to developing a set of recommended 

 elective courses on women’s health; and 

e) explore further the potential for drawing on women’s studies programs and on Federal 

 programs, to strengthen the teaching of sex and gender health differences in schools of public 

 health.

3. Continue to include student perspectives in this and all other curricula development and use SPH exit 

 surveys and other appropriate mechanisms to monitor the extent to which recommended changes 

 yield desired outcomes.

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Federal HHS Partner Agencies

HHS partner agencies should take the following steps toward implementation:

1. Assemble educational resources for SPH faculty interested in incorporating sex and gender specific 

 content into MPH core courses and/or developing women’s health-specific elective courses. Online 

 resources can be posted on the HRSA Web site (www.hrsa.gov) or on the National Women’s Health 

 Information Center Web site (www.womenshealth.gov) with linkages to all HHS agencies.

2. Promote further attention and support to public health and research training programs funded by HHS 

 that focus on integrated models, such as the NIH Building Interdisciplinary Careers in Women’s 

 Health (BIRCWH) program, the National Centers of Excellence in Women’s Health program, a 

 variety of CDC public health training programs, and the HRSA Geriatric Education Centers.

3. Increase the number of junior faculty development awards that focus on sex and gender health 

 differences research and outcomes, and that involve graduate student roles, recognizing the 

 importance that research funding has on graduate education. 

4. Continue to support and expand funding opportunities for schools of public health and other health 

 professions training programs in their collaborative efforts to integrate the study of sex and gender 

 differences into graduate education curricula.

Additional Suggestions

The EAG discussed the potential contributions of philanthropic organizations. Specifically noted was 

the model of the American Legacy Foundation’s funding for curricula development and dissertation 

research specifically related to elimination of tobacco-use. EAG members further suggested that 

consideration be given to soliciting the interest of a professional journal (e.g., American Journal of Public 

Health, Public Health Reports, Women’s Health Issues/Jacobs Institute) in publishing a special theme 

issue or supplement devoted to enhancing attention to women’s health in graduate education programs.

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INTRODUCTION

Many diseases affect women disproportionately, predominately, or differently than they do men. Over 

the past 40 years understanding of women’s health has evolved from the maternist traditions of the first 

half of the 20th century (1,2) to broader conceptualizations. Concurrent trends in the social, educational, 

and economic status of women, and choices about reproduction and family composition, point to an 

increasingly complex social context influencing their health (1,2,3,4). This new perspective recognizes the 

impact of women’s multiple roles in society on health, rejects a false dichotomy between reproductive and 

non-reproductive health, and focuses on women’s health assets rather than on health problems alone (3). 

Within this context, the Health Resources and Services Administration (HRSA), Office of Women’s 

Health (OWH); the Department of Health and Human Services (HHS), Office on Women’s Health 

(OWH); the National Institutes of Health (NIH), Office of Research on Women’s Health (ORWH); the 

Centers for Disease Control and Prevention (CDC), Office of Women’s Health (OWH); and the Agency 

for Healthcare Research and Quality (AHRQ) Director, Women’s Health and Gender-Based Research 

have been instrumental in examining the integration of women’s health in health professions’ training 

curricula. This important work stems from the fiscal year 1993 Congressional report language that 

directed the NIH ORWH to examine the integration of women’s health in the medical school curriculum 

(5). This work was subsequently expanded to include the dental and baccalaureate nursing health 

professions (6,7) and is currently being examined in pharmacy schools. These study reports provide a 

snapshot of the recent integration of women’s health into the different health professions’ curricula, and 

they also provide recommendations for future inclusion. Heightened attention among health services 

researchers is also found in the establishment of a Women’s Health Interest Group at AcademyHealth (8). 

Given its orientation to health of populations, and anecdotal information about increasing interest in 

women’s health, the Association of Schools of Public Health (ASPH), in partnership with HRSA OWH, 

HHS OWH, NIH ORWH, CDC OWH, and AHRQ, undertook a curriculum review study in 2003 of 

women’s health in accredited schools of public health (SPHs). The aim of the study was to assess how 

women’s health is addressed in required and elective courses for the Master of Public Health degree 

(MPH). 

Public health is a broad, multidisciplinary field, incorporating clinical, social, political, educational, and 

economic disciplines, and a range of analytic methods such as biostatistics, epidemiology, demography, 

among others. The Association of Schools of Public Health is the only national organization 

representing the deans, faculty, and students of the 37 accredited schools of public health. The schools of 

public health vary greatly in a number of ways, including size of student body (ranging from 13 to 272), 

size and constellation of the faculty, institutional nature (i.e., public or private), and the types of degrees 

offered (e.g., MPH, MHS, PhD, DrPH, ScD, ScM). Variation is also seen in the mix of public health 

disciplinary, topic, and orientation foci and strengths (e.g., international-domestic mix, policy-behavioral 

sciences). The primary commonality among the schools is with respect to the MPH degree, where the 

five discipline areas of epidemiology, biostatistics, environmental health, behavioral sciences, and health 

services management/administration constitute a core curriculum. This core was first established by the 

American Public Health Association in the 1940s and revised minimally since then by the Council on 

Education for Public Health (CEPH). Though the defined core areas do not specifically include women’s 

health, there is broad latitude for schools to determine the overall curricular approach and the specific 

assemblage of MPH degree requirements, including length of time to complete a full-time program (11 

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months–2 academic years), required credit hours, and choice of electives. 

The challenge in determining how women’s health is addressed across the institutions is substantial in 

the face of such diversity. A multi-component strategy was therefore developed within project funding 

and timeframe parameters that would tap into information from teachers, learners, and curriculum 

materials.

Approach and Methodology

As noted above, through this project ASPH and its Federal partners sought to extend beyond anecdotal 

reports the available information at SPHs on women’s health issues across the life span. To this end, 

ASPH organized an approach to the project that involved several working groups and a set of structured 

data collection activities. ASPH first formed a Women’s Health Interest Group consisting of women’s 

health faculty selected by the respective deans from each of the then-34 schools of public health in 

summer 2003. From this group, an Expert Advisory Group (EAG) was formed, which also included 

experts in women’s health from associations involved in education and practice of public health, and 

women’s health experts from Federal agencies (see Appendix II). ASPH asked well-known women’s 

health expert Dean Susan Scrimshaw of the University of Illinois at Chicago School of Public Health 

to oversee the project and chair the EAG. In addition, ASPH subcontracted with a women’s health 

consultant at one of the accredited SPHs to conduct the project. 

Through panel discussions conducted via conference calls and through electronic communication 

led by consultant Holly Grason, the EAG identified the specific information to be gathered through 

ASPH-funded faculty focus groups and through a student/alumni on-line survey. The EAG also 

evolved a definitional statement of women’s health so that participants could respond with a common 

understanding of “women’s health.” This statement read as follows:

Everyone has their own frame of reference for the meaning of “women’s health.” In some circles, 

the term has been operationalized by a primary focus on the health of women as it relates to their 

childbearing potential and/or experience (reproductive health or maternal and child health). 

Most commonly, however, a far more expansive concept of women’s health is embraced by health 

professions (including public health), encompassing (1) sex/gender differences in social and biological 

status reflected in health and disease over the entire life span and regardless of reproductive status, 

and (2) a holistic view rather than a disease or “body parts” approach.

Early on in the project, a focus group methodology was selected for collecting information about what 

a typical MPH graduate is exposed to in core MPH courses concerning women’s health. This strategy 

was adopted in order to ascertain nuanced information regarding factors involved in pursuing a women’s 

health focus in MPH curriculum, and individual perspectives about what should be done to build upon 

the current status of such interests and efforts. In addition, when interviewed by ASPH staff, health 

profession associations2

 that conducted the previous curriculum reviews (5,6,7) indicated that the focus 

group methodology offered an appropriate alternative to the survey approach that was used for their 

women’s health curricula projects.

2 Association of American Medical Colleges, American Dental Education Association, American Association of Colleges of 

Nursing, and American Association of Colleges of Pharmacy

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The focus groups were conducted in July and August of 2004 and addressed two perspectives regarding 

women’s health in core MPH programs: the focus groups consisting of women’s health faculty discussed 

“what should be taught,” and the focus groups consisting of core course faculty discussed “what is 

taught.” Hypothesizing that some differences in experience might relate to the size of each SPH, 

participant groupings for both the women’s health faculty and core course faculty groups were stratified 

by school size (see Appendix III for methods). 

Multiple logistical considerations led to a decision to employ two additional strategies for collecting 

information. For the student/alumni perspective, it was determined that it would be more efficient to 

administer an on-line survey of the current 188 ASPH interns and fellows to assess their knowledge of 

women’s health-related topics in their core MPH courses. This group included current SPH students and 

recent alumni (within 5 years of graduation). Moreover, as focus group methodology is not well suited 

for enumeration of specific factual information, it was decided to systematically abstract 2003 SPH 

course catalogues to obtain information on current course offerings related to women’s health. These 

data also were collected in July and August of 2004 from SPH faculty. More detail on each method is 

found in Appendix III. 

A final step in compiling information for this report entailed convening the EAG in a daylong meeting in 

October 2004 to consider findings and develop a set of recommendations. 

In the sections that follow, a brief synthesis of the overall findings is presented. Subsequent sections 

discuss the results of the focus groups, student/alumni survey, and curricula review, respectively. 

Conclusions and recommendations of the EAG follow. A set of appendices that include detailed 

descriptions of methodology is also provided.

SUMMARY FINDINGS

Nine focus groups, comprising 43 faculty members, provided their perspectives on “what should be 

taught” and “what is taught” in the core MPH curriculum related to women’s health. The focus group 

discussions also addressed barriers, opportunities, and strategies related to enhancing and expanding a 

focus on women’s health in MPH programs. In addition, a group comprising 90 students and/or recent 

SPH alumni participated in an on-line survey regarding women’s health in the SPH curriculum. 

1. Substantial concurrence evolved among participating women’s health faculty that sex and

 gender differences, diversity within gender, social determinants of health, and a lifespan 

 perspective should provide the foundation for such a focus. Issues specific to women’s status in 

 society, multiple social roles, and women’s interaction with the health system (including 

 communication and access concerns) also were noted as key concepts that should be included. 

 Women’s health faculty proposed that the current focus in public health on health disparities and 

 cultural competency should serve as the backdrop and rationale for inclusion of women’s health 

 concepts in the educational core curricula of MPH students. There was substantial agreement among 

 core course faculty, as well as among students surveyed, that these women’s health concepts were 

 important. Moreover, the students and recent alumni surveyed overwhelmingly indicated that they 

 anticipated needing women’s health knowledge in their professional careers. Faculty, however, noted 

 | 9
 a number of challenges in promoting a targeted emphasis on women’s health. Challenges include the 

 limited number of public health faculty with expertise in women’s health, and aspects of the academic

 culture related to independence of faculty in determining course content.

2. The predominant consensus of both women’s health and core course faculty supported greater 

 emphasis on women’s health in MPH core curriculum through integration into core courses 

 rather than by requiring a separate course specific to women’s health. The main themes 

 identified for integration into core courses included sex and gender differences, health disparities, and 

 cultural competence.

3. From focus group discussions with both sets of faculty, the concepts and principles identified as 

 important by women’s health faculty currently are incorporated into the core MPH curriculum 

 to at least a moderate degree. Overall, about one-third of the participating faculty believed that the 

 concepts and principles identified as essential already received full exposure when they considered the 

 entire array of course offerings for their MPH programs. Student survey and course catalogue review 

 findings appear to confirm faculty reports. A total of approximately 325 courses specifically focused 

 on women’s health, perinatal or maternal and child health, and reproductive health were identified (see 

 Appendix IV). A lifespan approach to women’s health was reported by core course faculty to present 

 particular challenges in terms of incorporation into MPH core course teaching.

4. Faculty expertise and research interests were noted as important factors in determining the 

 extent to which women’s health is or could be taught in the core MPH curriculum. The interest 

 levels of both deans and students also were discussed as key drivers in this regard. Student 

 interest in women’s health appears to exist, as reported by both faculty and students, with over 

 75 percent of students reporting that women’s health would be important to their careers to a moderate 

 or substantial degree. A long-term strategy would be required to expand the cadre of public health 

 faculty with expertise in the area of women’s health.

5. There was substantial agreement among all faculty participating in the focus groups that 

 compiling and sharing resources specific to women and public health among all schools 

 could be a significant help to core course faculty. Particularly important for inclusion would be 

 resources such as data sets, case examples or modules, bibliographies, and course syllabi (examples 

 of resources can be found in Appendix V). It was frequently noted in focus group discussions that 

 faculty colleagues expert in women’s health could be found at their affiliated schools of medicine, 

 nursing, arts and sciences, as well as at HHS National Centers of Excellence in Women’s Health and 

 local public health agencies. These individuals, however, are not called upon for assistance in 

 teaching women’s health as often as they might be. 

6. With respect to strategies for advancing women’s health themes in public health curricula, 

 faculty suggested that times or events when other aspects of the SPH environment are changing 

 be seized as opportunities for inserting women’s health into the change agenda. Opportunities 

 are likely to be found to move an interest in women’s health forward, given that at any point in 

 time SPHs are usually engaged in one or more processes such as faculty and/or department chair 

 recruitments, curricula overhaul, and/or self studies for CEPH reviews.

10 |
As is reflected in the material that follows detailing findings from each component of the study, time 

and again similar results were produced through each independent data collection strategy. Therefore, 

sufficient credence can be given to these findings to substantiate actions proposed by the project’s EAG.

In addition, some of these findings correspond with the other curriculum reviews performed by the 

medical, baccalaureate nursing, and dentistry schools (5,6,7). All four curricula reviews recommended 

a focus on the life span of the woman, as well as the impact of cultural, economic, and social aspects 

on women’s health. Also noted was the importance of faculty interest in emphasizing women’s health 

in curricula. Lastly, while all of the schools supported greater emphasis on women’s health in their 

respective curricula, only the medical school offered suggestions for an actual core curriculum on 

women’s health.

FOCUS GROUP FINDINGS

The intent of the focus groups was three-fold: (1) identify those concepts, principles, and other content 

that should be taught in MPH program core courses/curricula such that there is confidence that all MPH 

graduates attain knowledge and/or mastery before graduation, (2) learn the extent to which what should 

be taught is currently taught, and (3) explore potential vehicles for enhancing the inclusion of women’s 

health in core MPH curricula.

What Should Be Taught in the MPH Core Curriculum

Although the women’s health experts focus group participants articulated a broad spectrum of ideas, 

they concurred on specific women’s health-related principles that should be considered for incorporation 

into the core MPH curriculum. This concurrence was observed across all groups, such that few 

noteworthy distinctions emerged between faculty from small as opposed to large MPH programs. The 

two most prominent sets of ideas related to (a) gender differences, and (b) women’s roles in society 

and the consequent impact as related to health. Discussions related to gender differences included a 

number of specific considerations such as patterns of disease, social roles, health behavior, and health 

care utilization. Several of the focus group discussions summarized these topics under the rubric of the 

role of gender in health disparities. In addition, a number of faculty noted that it would be important 

to include a historical perspective on women and health in the curriculum. When discussing ideas 

related to principles associated with “women in society,” concepts such as social determinants of health, 

women’s experience related to poverty and its influence on health, and access to and use of health care 

services emerged. Women’s multiple social roles, and cultural messages related to women also were 

raised as issues of note. The subject of domestic violence surfaced several times in discussions of this 

latter topic. Some of the representative statements were as follows:

It would be hard to teach women’s health if you didn’t go at it both from a clinical perspective as well 

as from a cultural perspective, political perspective, feminist perspective...

...people need to understand certain [issues] across genders. In other words, frequencies of disorders 

and where resources should go and why... the reproductive cycle should be [understood] across both 

genders and integrated both ways so that people really understand what are the major driving forces 

behind the health care focus on those issues important in women’s health....

 | 11
I think it should be a requirement in each course actually, ... [to] focus on gender, race so that it’s 

more like a competency.

Other prominent themes that emerged were that of perspective over a life span, and recognition of 

diversity within gender. The importance of life span was generally acknowledged by all participants, 

and some specifically noted the need to address older women and aging, particularly given current 

demographic trends. With specific regard to concepts of diversity, focus group participants emphasized 

that it was important to go beyond consideration of race/culture and socioeconomic status. The need to 

address issues specific to subgroups based on sexual orientation was mentioned on several occasions.

...social role differences and what difference that makes in terms of women’s health and women’s 

experience with health care... give students some understanding of the diversity in women’s experience 

and the diversity around gender.

...a life course or a holistic perspective.... I would not like to see women’s health be narrowed down to 

maternal and child health. I think it should be across the life span.

Several focus group discussions centered on women’s experience within the health care system, 

including barriers to access, and women as health care consumers. Related to discussion of such 

material were several conversations about women’s communication styles and patterns, and the 

association of these with health education strategies specific to women. Table 1 shows the leading 

women’s health topics as mentioned by the women’s health faculty focus groups.

Table 1. Women’s Health Principles That Should Be Included in the Core MPH Curriculum.

Group I Group II Group III Group IV Group V

Women’s reproductive health 1 0 2 0 1

Health communication and education 1 2 2 0 0

Women’s experience with health system 3 0 3 0 0

Lifespan perspectives 2 0 2 2 2

Women in society 3 2 5 2 0

Cultural competence 0 2 1 2 3

Gender differences 5 2 2 4 3

N=5 N=2 N=6 N=4 N=5

Mention was made of some specific topic areas that should be covered in MPH program curricula. 

These topics were women’s reproductive health; women’s mental health; women-specific environmental 

health issues; and women and violence.

The first set of focus group discussions yielded a set of three composite statements reflecting what the 

women’s health faculty believed should be included in the MPH core curriculum. The consensus ideas 

were summarized as follows:

12 |
· Knowledge of the major sex and gender differences in health and disease across the life span, 

 particularly in terms of physiologic, behavioral, and societal factors that influence health outcomes 

 among culturally and socio-economically diverse populations of women.

· Understanding of women’s interactions with the health care system, including the impact of multiple 

 social roles and life-cycle events on women’s health, and incorporating women’s access to care; 

 women’s patterns of health care access and health care seeking; women’s forms of communication

 and interaction; and women’s health decision making for themselves and others.

· Knowledge of the social determinants of the health of women across the life span and in the 

 historical and contemporary context of culture, particularly with respect to gender roles and social 

 status.

The focus groups held with core MPH course faculty each began with a presentation and a request for 

commentary on how to incorporate into the core curriculum the above content related to women’s health. 

Most core course faculty instructors felt that one or more of the concepts should be incorporated through 

examples and other pedagogic strategies. Their perspectives are reflected in statements such as the 

following: 

I guess I basically agree with these statements, but I wouldn’t necessarily specifically try to 

incorporate them into whatever I do or present in class. It would depend a lot on the examples in the 

textbook or whatever field I happen to be consulting with at the time.

I would see all of these three points as important—and yet I also see them as something where I would 

expect that either through examples or reading they’d be introduced in core [courses]... any real 

depth with regard to these concepts and principles would have to come in elective courses.

I see sex and gender differences as being a common theme that should run through all of the core 

courses sort of much the same way that, you know, we’re now looking at cultural competencies or 

racial and ethnic differences. 

A few core faculty focus group participants, however, felt that none of these concepts should be 

incorporated into the core, and about one fourth noted that there should never be requirements to 

incorporate any material specific to particular populations. These perspectives are perhaps best 

represented by the following comment:

We have to assure that students are coming away with cultural competency skills and understanding 

what that means and how to evaluate them. I’m not a hundred percent sure that pushing a particular 

research agenda or particular social science agenda within the core...is the right way to do it and I’m 

not sure it’s the right place to do it.

Faculty in both focus group categories frequently noted faculty independence in teaching, variation 

depending on faculty interest, and funded faculty research to be important considerations in regard to 

incorporation of women’s health into the core MPH curriculum (see below for further discussion).

 | 13
What Concepts Related to Women’s Health Are Currently Being Taught 

in the Core MPH Curriculum?

When asked about the extent to which women’s health is currently a part of the core MPH curriculum, 

slightly over half of the women’s health faculty indicated that some of the content and principles already 

were incorporated into core courses, particularly in epidemiology and social and behavioral sciences 

courses. Nearly one-half of the MPH core course instructors indicated that the concepts and information 

reflected in the first statement articulated by the women’s health faculty were built into core course 

syllabi. Concepts articulated in the second and third statements were reported to be included in the core 

MPH curriculum less often. Only two core course faculty indicated that gender differences were not 

covered at all, and one individual indicated s/he was not sure. 

Participants in both sets of focus groups indicated that MPH students learned about women’s health 

through teaching examples. Elective courses available to MPH students constituted the second most 

frequently noted mechanism. Overall, about one-third of the participating faculty believed that there 

was full exposure to this set of ideas and content when one considered the entire array of MPH course 

offerings.

Representative statements in these discussions from both sets of focus groups include the following:

I think we [include women’s health] pretty well because we just happen to have sort of the 

configuration of the right faculty at the right time.

... [women’s health is included in] social and behavioral sciences parts of our courses, because of the 

people who teach it, not because of the course itself.

I think that it’s variable, and subtle, and it varies according to who’s teaching the core course... and 

who’s on sabbatical, and who isn’t on sabbatical. I would say it’s not built in consistently.

I think we cover issues related to health care system access to care for women throughout the life cycle 

and health care seeking behaviors in both our community health science course, that’s a core class, 

and in our health policy course. Again it’s a function of who the main instructor is.

The faculty instructors of core MPH courses were asked which concepts would be easiest and 

which would be most difficult to incorporate into their teaching. Gender differences and the social 

determinants of health were most frequently noted as the easiest to incorporate:

The last point, the social determinants of health for women across the life span, is an emphasis of 

ours—and a growing emphasis of ours throughout our curriculum—because we’re looking at a lot of 

areas of issues of health disparities across gender and ethnicities.

Sometimes they come up because I’m always looking for problems that will be current and of interest 

to the students so that they will be a little excited by biostatistics. ... for example when the Women’s 

Health Initiative came out with their results about hormone usage we picked up some data from that 

and used it as examples for some of our problems.

I can use gender issues in illustrating a particular analytical tool.

14 |
I think any content area of epidemiology, those content specialty courses, definitely look at gender and 

sex.

Some core faculty noted that the presentation of a women’s health lifespan approach in the core 

curriculum was one of the more challenging of the concepts to incorporate:

The first and third specific statements both take a kind of lifespan approach. [This] isn’t the approach 

we use in our health education course or in our epidemiology course so neither model works. The 

second one is focused on the health care system, and we’re very much a primary prevention program, 

so that one doesn’t work either.

None of our courses, to my knowledge, take a specifically lifespan approach.

One of the things that jumps out at me is one that seems pretty difficult as an epidemiologist to 

quantify, the impact of multiple social roles and life cycle events on women’s health.

What Factors Drive Incorporation of Women’s Health Material Into the Core MPH Courses? 

Focus group discussions among both women’s health and core course faculty were consistent in themes 

and specific examples. Faculty interest and expertise were universally mentioned as the determining 

factors as to whether women’s health was included in the teaching of core courses. Some participants 

from both faculty groups specifically indicated that women’s health is included because instructors of 

core courses embraced women’s health as the area of interest for their research scholarship. A few focus 

group participants noted that there are relatively few SPH faculty with a women’s health research focus. 

Thus a targeted recruitment effort would be needed in order to increase teaching of women’s health in 

the MPH curricula. Moreover, in nearly every focus group discussion in both categories, participants 

raised the issue of faculty independence in designing course syllabi and material. Nearly all faculty 

involved in the focus groups noted that it would be inappropriate and infeasible to require inclusion 

of women’s health in the core courses. Another issue mentioned frequently was the fact that the core 

curriculum for MPH programs is already quite extensive (as identified by the Council on Education for 

Public Health), and that fitting in additional required concepts would be problematic, particularly in light 

of the eight new competencies for public health professionals articulated by the Institute of Medicine: 

communication; community-based participatory research; cultural competence; ethics; genomics; global 

health; informatics; and public health policy/law (IOM, 2003). Specific comments in this regard were:

I struggled with this to some degree, because we don’t all have control over what other people teach 

in different courses, and people teaching in different courses also have different sets of skills and 

expertise.

I think that if an instructor had a research interest in an area relevant to women’s health, it was much 

more likely that he or she was going to include that information in the core course. 

It’s really about personalities. The chair of [the epidemiology-biostatistics department] is an 

epidemiologist who’s particularly interested in women’s health epidemiology ... and she’s on the MCH 

concentration faculty even though she’s not in that department.

 | 15
I would recommend that you find the main pieces of information and do it across core courses. And 

that has to be done within the environment of each school’s curriculum, because everyone’s school is 

a little bit different.

You’re burdened with ... history of curriculum and students can only take so many courses. So how do 

you build competencies in a structure that’s fairly hard to change, hard to move? One way is just to 

do this through having faculty do research [in women’s health] and bringing students on board.

Two other “drivers” of MPH curriculum content and emphasis identified were: (1) the interest of the 

deans, and (2) the interest of students. Both were noted to exert influence, formally and informally. 

Though participants indicated that the primary interest of students is to garner skills, the demand 

for content related to women’s health is also evident. In this regard, specific mention was made of 

international health, maternal and child health, lesbian health, sexuality, and reproductive health. One 

core course instructor (of epidemiology or biostatistics) indicated that in the first class of the term, s/he 

asks students about their interests, and then seeks out material/data to include in the teaching of that 

course.

... reproductive epidemiology and the controversies in women’s health research were, are, 

extraordinarily popular with students.

The issue of the influence of funding on the extent to which any given public health issue or target 

population is included in MPH curricula also surfaced in several conversations. Funding was mentioned 

in terms of the role training grants play in curriculum design, as well as related to how the availability 

of research funding in a given area can influence the number of faculty prepared to teach the subject 

matter. That is, when there is a substantial emphasis in the research arena on a specific topic, then 

faculty get involved in those topics, and, in turn, use that information in their teaching.

In a similar vein, several focus group discussions centered on the role in curriculum played by women’s 

studies programs that exist in many schools of arts and sciences as well as the HHS National Centers of 

Excellence in Women’s Health grants held by a number of universities with schools of public health. It 

was noted that students sometimes take courses in these other departments to broaden their electives 

for women’s health studies. Also, there is great potential for shared resources between the SPHs, other 

departments, and with the Centers of Excellence.

Specific Strategies for Incorporating Women’s Health Into the MPH Curriculum

A number of long-term, broad strategies were offered, such as a public statement from ASPH that 

women’s health is important to include in the MPH curriculum.

A statement from ASPH that gender, race, ethnicity and vulnerable populations should be included in 

examples in all school required classes for the general MPH would be absolutely amazing.

Having a unified set of core concepts that is endorsed by the larger community is a really valuable 

way to build a curriculum.

16 |
I also really think a body like ASPH could have a major influence. I think it’s very important that it be 

seen as kind of a national initiative.

An even broader strategy noted for enhancing women’s health content in the MPH core curriculum 

would be an increased number of faculty with specific research focus on women’s health. As noted 

above, achieving a larger cadre of women’s health faculty would depend in large part on the availability 

of money in women’s health research, and specific initiatives to increase the number of doctoral students 

with women’s health as their research focus.

With regard to the means of ensuring greater emphasis on women’s health in the MPH core curriculum, 

the consensus among both women’s health and core course faculty was to do so through content 

integration into core courses (and not through any required separate course). Although no objection 

to separate elective course(s) on women’s health was voiced, no one felt that there should be a separate 

required course on women’s health. Appendix IV lists courses identified through systematic search of 

all 34 SPH catalogues and with review by each of the schools. 

The focus groups identified the coverage of sex and gender differences, health differences, health 

disparities, and cultural competence as the primary way to integrate women’s health into the core 

courses.

None of us, I think, are thinking you should have a course in women’s health that’s required in the 

MPH core curriculum.

We have to be careful that we make sure that what we decide is really important actually can 

legitimately be taught within the context of the courses that are taught in the program.

I too am resistant to sort of really having a women’s health focus per se in our core courses. I’d much 

rather have it be a broader sense of, you know, the importance of gender, class, race, ethnicity.

There is a tremendous focus on diversity and disparities, health disparities. Now most of that focus is 

around race, but it seems to me that’s also a pathway or an opening.

Notwithstanding a general reluctance to endorse requirements and an expressed respect for faculty 

independence in teaching, the discussions in both categories of participating faculty were rich with 

examples of what could facilitate incorporating women’s health into the MPH core curriculum. 

Women’s health faculty noted that:

...examples that go in the [epidemiology] courses, the biostatistics courses, and the health policy and 

management courses, and even environment. And particularly to focus on women over the life course, 

and particularly thinking about the effect of environment on their reproductive health status, and then 

the health of their offspring. And the behavioral sciences making sure that the social roles and the 

definitions of gender versus sex actually get brought into those courses. I think probably that and the 

health management courses are probably where I might actually think about some specific lecture or 

some specific material besides examples brought in.

 | 17
Table 2. SPH Faculty-Recommended Resources for Enhancing Teaching of Women’s Health in the MPH Core Curricula.

Women’s Health Faculty

Women’s health teaching materials for core course instructors, such as 

data sets, syllabi, readings, and lecture modules

Women’s health-specific competencies

Marketing to enhance interest in women’s health among public health 

faculty

Faculty development workshops and seminars

Guest speakers on women’s health

MPH Core Course Faculty

Data sets

Case examples, articles and readings

Women’s health content modules

Women’s health-specific competencies

Guest speakers on women’s health

When you ask [biostatistics and epidemiology] people who may not work in these areas to talk about 

social factors—if they’re not equipped to really know a little bit more about the topic, then when things 

go forward—and it’s great to see them so excited about something—it might backfire on you. We 

might need to do more than just, you know, give them a couple of examples.

There was substantial overlap in the specific ideas generated in both sets of focus group discussions for 

incorporating women’s health into the core curriculum, as reflected in Table 2 (above).

Some faculty in both sets of focus groups mentioned seminars and grand rounds as additional vehicles 

that might be employed to highlight women’s health in the core MPH curriculum. Representative 

sentiments of core course instructors are found in the following remarks:

If we rely simply all the time on whether what the particular faculty member’s research interests 

are, that can be fairly narrow, and I think it is necessary for us to have ... resources or some ways 

that faculty members who would like to integrate women’s health or minority health or lesbian, gay, 

bisexual, transgender health into their courses through examples and reading that they have some 

sense of where they might find those materials to work with, if it’s not an area that they’re real familiar 

with.

Maybe pulling together recent literature or key Web sites ... key links would be useful. ... Or data sets, 

yes. Having this all in one binder that’s divided into sections. Data sets on women’s health, links, 

syllabi, etc. That would be very nice.

Biostatisticians are always looking for neat, real-world sets of data and intriguing questions. I have a 

very rich data set that covers the demographics in which I will have gender, ethnicity, as well as added 

data obtained from epidemiological studies, clinical trials, and you name it, where it might mean that 

I have added characteristics for interests associated with an outcome that would be a better fit to 

explain the analytical tool that is being covered. ... I can use gender issues in illustrating a particular 

analytical tool.

18 |
I actually ask [students] on the first day of class [what their interests are.] And if they’ve got data sets, 

I ask them to bring them along because, if they’re working in a particular area, we frequently use what 

they’re doing.

Maybe a checklist of competencies and... some of the selected readings and perhaps even go so far as 

suggested discussion questions.

If there was a way to have a Web site that had links to articles and links to data sets regarding 

women’s health, if there was an ASPH Web site, that... would help a lot....

There was discussion in all of the focus groups about people as resources. First, faculty talked about 

inviting various women’s health experts to lecture in certain core courses. Most frequently, university 

faculty were mentioned, including colleagues in the school of public health (sometimes, but not always, 

“MCH” faculty), school of medicine, school of nursing, and from women’s studies programs in the 

school of arts and sciences. Staff from local health departments and faculty from the university’s 

National Center of Excellence in Women’s Health were each mentioned on two occasions. Many focus 

group participants noted that they did not think that they knew about all of the people available to them 

for collaboration in teaching women’s health. Moreover, it was noted in several conversations that it was 

particularly hard for new/junior faculty to become knowledgeable about colleagues that might help them 

in teaching women’s health.

In summary, a great deal of interest and excitement was expressed by both the women’s health and core 

course faculty focus group participants about the possibility of information being compiled (by each 

school, or centrally by ASPH) and shared across all schools. Particularly important for inclusion would 

be data sets, case examples or modules, bibliographies, and course syllabi. Web site posting was by far 

the most frequently mentioned vehicle for sharing such information. The only major drawback noted 

along these lines was that the information would need to be kept current in order to be useful.

Windows of Opportunity

A number of conversations in both sets of focus groups centered on process strategies, and suggestions 

were made as to how best to achieve change in the academic setting. Time and again, focus group 

participants suggested that, rather than introduce new emphases on women’s health “out of the blue,” 

opportunities should be seized to insert women’s health into the change agenda. Given that, at any point 

in time, SPHs are usually engaged in one or more processes such as faculty and/or department chair 

recruitment, curricula overhaul, and/or self studies for CEPH reviews, opportunities are likely to be 

found to move an interest in women’s health forward.

...when the curriculum is being revamped, when there’s new faculty or where there’s a new thrust 

around disparities, bring [women’s health] into that rather than kind of out of the blue saying 

okay now we’re going to do [women’s health] but it’s part of a general kind of rethinking and 

transformation. I think we’ll be much more effective.

 | 19
Overall, the focus group discussions revealed support for conceptual and cultural change related to how 

women’s health is addressed in MPH curricula. Several steps were identified to begin a change process 

with current SPH faculty nationally, and potential directions that public health leaders could take to 

evolve longer-term strategies.

STUDENT AND RECENT ALUMNI SURVEY FINDINGS

An important part of the assessment of women’s health in core curriculum is the student’s point of view. 

In the focus groups, it was noted repeatedly that student demands could drive curriculum. In addition, it 

was noted that students increasingly seek content on women’s health. 

An on-line survey was conducted of the 188 ASPH 

interns and fellows in August 2004. These interns 

and fellows were all part of ASPH traineeships and 

most were in training placements at Federal agencies. 

For full details on the survey methodology and 

design, see Appendix III.

Of the 188 possible respondents, 90 completed the 

survey, yielding a response rate of 48 percent. With 

respect to participation by gender, 81 percent of all 

respondents were female and 19 percent male; the 

gender profile for all SPHs is 70 percent female and 

30 percent male. The average age of respondents 

was 28.5 with a range of 23–49 years. The respondents were from 26 schools of public health, and the 

number of students responding for each school-size group corresponded with the size profile of the 34 

accredited schools of public health (see Table 3). Respondents were asked to list all degrees earned to 

date. As of August 2004, 63 had received an MPH (75 percent). Other graduate degrees conferred as of 

that date, and the corresponding number of recipients, were as follows: MS (13), MSPH (5), MHS (4), 

PhD (3), MD (2), MSc (2), and Other (5). Respondents were then asked to list all degrees expected. Five 

said that they were currently in an MPH program. Fourteen were working toward their PhD, two each 

on their DrPH or ScD, and one on an MD. Overall, 75 percent of the respondents either had received 

their MPH degree or were working toward its completion. 

Anticipated Need for Knowledge Related to Women’s Health

Respondents were asked to what extent they anticipated needing substantial knowledge of women’s 

health in their professional careers: 42 percent indicated that they would need it to a substantial degree; 

23 percent said they would need it to a minimal degree. No student responded that he/she would not 

need knowledge of women’s health.

Exposure to Women’s Health Concepts

The three central concepts that women’s health faculty believe should be incorporated into the core 

curricula of MPH programs were introduced as the subject of the next set of survey questions. Overall, 

respondents were in favor, either substantially or strongly agreeing, with the inclusion of each concept 

into the MPH core curriculum (Table 4).

Table 3: Student Survey Respondents, by Size of SPH, 2004.

School size

(Number of Grads)

A: <52

B: 53-83

C: 84-106

D: 107–184

E: 185–272

SPH not indicated

Number of respondents

 6

 11

 13

 21

 33

 6

20 |
Table 4: Student Level of Agreement With Women’s Health Faculty Regarding Inclusion of Concepts Related to Women’s 

 Health in the MPH Core Curriculum. 

Concept

Knowledge of the major sex and gender differences in health and 

disease across the life span, particularly in terms of physiologic, 

behavioral, and societal factors that influence health outcomes 

among culturally and socio-economically diverse populations of 

women.

Understanding of women’s interactions with the health care system 

including, the impact of multiple social roles and life cycle events on 

women’s health, and incorporating women’s access to care, women’s 

patterns of health care access and health care seeking, women’s 

forms of communication and interaction, and women’s health 

decision making for themselves and others.

Knowledge of the social determinants of the health of women across 

the lifespan and in the historical and contemporary context of 

culture, particularly with respect to gender roles and social status.

Response

Strongly agree

Substantially agree

Somewhat agree

Do not agree

Strongly agree

Substantially agree

Somewhat agree

Do not agree

Strongly agree

Substantially agree

Somewhat agree

Do not agree

Percent

54.1

34.1

10.6

1.2

45.9

35.3

17.6

1.2

55.3

30.6

12.9

1.2

Survey respondents were then asked about their exposure to each of these concepts in their core courses. 

Overall, exposure to each of the concepts was limited or moderate (Table 5). Thus whereas over fourfifths of students and alumni reported believing that the concepts should be incorporated into core 

curricula, substantial exposure to this material was reported by less than 20 percent of respondents.

Table 5: Student Exposure to Concepts that Women’s Health Faculty Believe Should be Incorporated into the

 MPH Core Curriculum. 

 | 21

(Note: 85 respondents)

(Note: 83 respondents)

Concept

Knowledge of the major sex and gender differences in health and 

disease across the life span, particularly in terms of physiologic, 

behavioral, and societal factors that influence health outcomes 

among culturally and socio-economically diverse populations of 

women.

Understanding of women’s interactions with the health care system 

including, the impact of multiple social roles and life cycle events on 

women’s health, and incorporating women’s access to care, women’s 

patterns of health care access and health care seeking, women’s 

forms of communication and interaction, and women’s health 

decision making for themselves and others.

Knowledge of the social determinants of the health of women across 

the lifespan and in the historical and contemporary context of 

culture, particularly with respect to gender roles and social status.

Exposure in MPH Core

Not at all

Limited

Moderate

Substantial

Not Applicable

Not at all

Limited

Moderate

Substantial

Not Applicable

Not at all

Limited

Moderate

Substantial

Not Applicable

Percent

12.0

32.5

36.1

16.9

2.4

14.0

43.4

28.9

10.8

2.4

12.1

37.3

28.9

16.9

2.4
Educational Format

The vehicles through which students received their women’s health knowledge in their core MPH 

curricula were determined by asking them to indicate the educational formats used to present 

information specific to women’s health in the MPH core. The majority of respondents said they 

received this information in instructor lectures or guest lectures in either social and behavioral science, 

or epidemiology courses. Required reading was the second most cited means of dissemination of 

information specific to women’s health to students. Instructor or guest lectures in biostatistic courses 

were noted as the least likely way that students received information on women’s health. See Table 6.

Table 6. Educational Formats Used to Present Women’s Health-Related MPH Coursework.

Educational Format

Instructor lectures in social and behavioral sciences

Required readings

Instructor lectures in epidemiology

Guest lectures in epidemiology

Optional readings

Guest lectures in social and behavioral sciences

Course assignments; homework problems

Instructor lectures in health services management

Noon seminar series

Instructor lectures in environmental health

Case Studies

Required course

Guest lectures in environmental health

Other

Guest lectures in health services management

N/A Not applicable

Instructor lectures in biostatistics

Guest lectures in biostatistics

Percent Response

60.5

53.1

49.4

32.1

32.1

32.1

28.4

25.9

23.5

22.2

19.8

16.0

12.3

11.1

9.9

9.9

8.6

2.5

(Note: 81 respondents)

Women’s Health Topics

To determine the women’s health topic areas that respondents learned about in their core curricula, 

respondents were asked to select from the list provided in the survey all topics that were included in their 

core curricula. 

Reported exposure was greatest with respect to “demographic implications,” followed by “socio-cultural 

and economic themes,” “common medical disorders,” “reproductive health,” and “women and HIV/

AIDS.” Topics least frequently presented were “women’s oral health,” “legal/ethical issues specific to 

women’s health/effects of gender discrimination,” and “women’s health and genetics.” 

22 |
When asked what topics the respondents would like to learn about or would have liked to learn about in 

their core curricula, “gender-specific approaches to preventive health behaviors/health promotion” and 

“women’s health and genetics” were cited most frequently. As reflected in Table 7, “risk and special 

groups,” “legal/ethical issues,” and “women and work” also ranked highly, followed closely by “lifespan 

curriculum” and “developmental and psychosocial issues.” The largest differences between “desire for 

[a topic]” and limited exposure were observed with respect to “women’s health and genetics,” “legal/ethical issues,” and “risk and special groups.”

Table 7: Students’ Perspectives Regarding Learning Related to Specific Women’s Health Topics. 

(Note: 79 respondents - bolded percentages are the five highest frequencies.)

 | 23

Women’s Health Topic

Sociocultural and economic themes

Life span curriculum (girls, adolescents, young adult women, 

women in mid-life, older women)

Biological considerations

Developmental and psychosocial issues

Gender-specific approaches to preventive health behaviors/

health promotion

Reproductive health (biology, epidemiology, disorders/conditions)

Common medical disorders/conditions (including heart disease, 

breast and cervical cancer, other cancers, autoimmune diseases, 

diabetes, osteoporosis)

Service system organization and policies (including access and 

insurance)

Demographic implications (population changes in age race/

ethnicity, SES literacy, rurality/urbanization, stages of the life 

span, immigration, etc.)

Women’s oral health

Women’s mental health and psychosocial health/wellness

Women and substance use/abuse 

Women and violence

Women and HIV/AIDS 

Menopause

Risk and special groups (e.g., lesbians, women with disabilities, 

and women who are very elderly)

Women’s nutrition fitness (including obesity, eating disorders, 

physical activities)

Legal/ethical issues specific to women’s health/effects of gender 

discrimination

Women and work

Women and caregiving

Women and sexuality

Women’s health and genetics

Percent reporting 

learning about 

topic in MPH core

57.0

27.8

41.8

27.8

35.4

53.2

55.7

30.4

62.0

2.5

16.5

15.2

34.2

49.4

16.5

17.7

30.4

11.4

16.5

17.7

22.8

15.2

Percent reporting 

desire to learn about 

topic in MPH core

31.6

44.3

30.4

44.3

55.7

34.2

29.1

38.0

32.9

32.9

40.5

36.7

34.2

27.8

34.2

49.4

43.0

45.6

45.6

39.2

39.2

55.7
Concentrations/Certificates in Women’s Health

Survey responses regarding awareness of the various women’s health programs at schools of public 

health showed that most respondents were aware of a concentration (66 percent) or certificate (8.5 

percent) program in maternal and child health. Only four responses indicated a concentration or 

certificate program in women’s health specifically. A few students noted in the “Other” category that 

their schools had concentrations with some relationship to reproductive health.

Overall, the survey indicated a high interest rate among students to include women’s health in the MPH 

degree. And despite the limited sample of student/alumni experiences and perspectives, survey results 

were generally highly consistent with the focus group findings.

WOMEN’S HEALTH ELECTIVE COURSES 

IN SCHOOLS OF PUBLIC HEALTH

The time constraints of the conference call methodology for the focus groups (50–60 minutes maximum) 

did not allow for adequate discussion of elective courses (and/or concentrations) that should be or 

are offered in schools of public health. Some limited information, however, was generated by the 

focus groups, the student/alumni survey, and by the systematic review of course catalogues of the 34 

accredited schools of public health. With respect to the women’s health faculty focus group discussions, 

a number of participants noted that their first preference for elective courses would be for an overview 

or survey course on women’s health, taught from a lifespan perspective. Several specific content areas 

were noted, although no one topic predominated. These were biology, and common medical conditions; 

policy and women’s health; women and their identities; and, communication as it relates to women’s 

health. Two additional areas where elective courses were suggested were women’s mental health; and 

social concerns of women (including poverty, domestic violence, societal influences on women’s health). 

On two occasions over the course of the focus group discussions, women’s health faculty noted that 

women’s health was particularly important in curricula presented in the domain of international health.

The student and alumni survey also captured some information in this regard (see Table 7). Topic areas 

of interest reported to be infrequently presented included women’s oral health; women and genetics; 

legal/ethical issues; women and work; risk and special groups; women’s mental health; women and 

substance abuse; women and caregiving; menopause; lifespan approach; women and sexuality; and 

women’s nutrition.

Findings from the systematic review of 2003 SPH course catalogues, vetted by each school 

representative (see Appendix III for information on methods employed) is summarized in Table 8, 

on the next page. A total of 324 courses were identified from catalogue abstraction and follow-up. 

Not surprisingly, the elective courses were more frequently offered in the largest schools of public 

health, although the University of Puerto Rico SPH and University of South Carolina SPH also listed 

a substantial number. Only two schools did not offer courses in the categories identified. Overall, the 

review indicated substantial depth and breadth of courses related to maternal and child health, perinatal 

health, and reproductive health. Slightly less than 20 percent (60 of 324) of the total number of courses 

identified appeared to have a focus on women’s health beyond reproductive health, maternal and child 

health, or nutrition when all other categories were excluded. 

24 |
Table 8. Number of Women’s Health Elective Courses Offered at Each School by Category, 2003-2004.

 | 25

MEZACOPH(AZ) 1 2 - 3 6

University of South Carolina Arnold SPH - 3 7 5 15

University of Puerto Rico SPH 1 4 3 8 16

University of North Texas SPH - - - - 0

University of Massachusetts SPHHS 1 - - - 1

University at Albany (SUNY) SPH 1 1 1 1 4

University of Iowa CPH 1 1 1 - 3

School of Public Health (Schools listed 

in ascending order by school size.)

Women’s 

Health

MCH/

Perinatal

Reproductive 

Health/Family 

Planning

Other TOTAL

UMDNJ-SPH 1 1 - 1 3

San Diego State University GSPH 1 - - - 1

Saint Louis University SPH - 1 - - 1

Texas A&M University SRPH - - - - 0

Ohio State University SPH 1 - - - 1

University of Pittsburgh GSPH 3 2 3 - 8

University of Oklahoma CPH - - - 2 2

University of Texas Houston SPH - 1 - - 1

University of Illinois SPH 2 5 1 4 12

Loma Linda University SPH 1 4 2 1 8

University of Washington SPHCM - 4 1 - 5

University of Alabama at Birmingham SPH - 7 2 1 10

University of South Florida CPH 1 3 1 1 6

University of Minnesota SPH 1 2 2 5 10

University of CA - Berkeley SPH 1 4 1 2 8

Yale University SPH 2 3 1 - 6

Boston University SPH 4 9 4 5 22

Columbia Mailman SPH 2 2 6 1 11

Harvard SPH 9 5 7 11 32

University of Michigan SPH 5 2 9 3 19

George Washington University SPHHS 1 3 3 7 14

University of CA - Los Angeles SPH 5 4 - 2 11

University of North Carolina Chapel Hill SPH 2 10 4 2 18

Tulane University SPHTM 4 6 8 2 20

Emory University Rollins SPH 4 8 2 1 15

Johns Hopkins Bloomberg SPH 3 9 6 6 24

TOTAL 60 112 74 78 324

NY Medical College SPH 2 6 - 3 11
Included in the “Other” category were 15 courses specific to nutrition, 12 related to adolescent health, 

and 4 courses titled “reproductive and perinatal epidemiology.” Violence (family, community, or specific 

to women), immigrant health, and family and community health broadly presented, also were identified 

with some frequency. Although caution is warranted when examining this enumeration by category (see 

discussion on “limitations” in Appendix III), it is generally reflective of the scope and mix of women’s 

health-related courses available at schools of public health.

SUMMARY AND CONCLUSIONS

Addressing the question of the current and desired extent of teaching of women’s health in MPH core 

curricula, study participants agreed that women’s health should be included in public health education 

through incorporation of content specific to sex and gender differences in health problems and health 

behavior across the life span.

Focus group findings reveal broad interest in this area, both among women’s health faculty and faculty 

instructors of core courses. This study further documented that inclusion of women’s health in the MPH 

curriculum currently exists to a moderate degree, but is highly variable across schools of public health 

nationwide. Student/alumni survey results were consistent with these focus group findings. Information 

gathered on the number, type, and range of course offerings related to women’s health, based on a 

systematic review of course catalogues, appears to further substantiate focus group and survey findings 

in this regard.

Beyond the question of interest, students and alumni surveyed indicated a need for continued and 

perhaps expanded focus on women’s health, as they believe women’s health will be important in their 

public health professional positions throughout their careers. This need also was reflected in comments 

related to student demand for women’s health courses made by both women’s health and core course 

faculty during the focus group discussions. Moreover, student/alumni survey findings revealed student 

interest in a number of women’s health-specific topical concerns for which course offerings are quite 

limited.

The primary finding of the project, as informed by the data and the advice and expertise of the women’s 

health EAG, was that required MPH curricula should incorporate the following educational component, 

using the definitions of terms in Fig. A:

· Knowledge of the major sex and gender differences in health and disease across the life span, 

 particularly in terms of physiological, behavioral, and societal factors that influence health behaviors 

 and health status among culturally and socio-economically diverse populations;

· Understanding of the similarities and differences between men and women concerning interaction 

 and communication with the health care system, and the impact of multiple social roles and life cycle 

 events on shared health care decision making for self and family; and

· Knowledge of the historical and contemporary social and cultural determinants of health and 

 wellness across the life span, particularly with respect to sex and gender roles.

26 |
- Culture

 Culture is an integrated pattern of human behavior, which includes but is not limited to – thought, 

 communication, languages, beliefs, values, practices, customs, courtesies, rituals, manners of 

 interacting, roles, relationships and expected behaviors of a racial, ethnic, religious, social or 

 political group; the ability to transmit the above to succeeding generations; dynamic in nature.3

- Sex

 Sex refers to the classification of living things, generally as male or female according to their 

 reproductive organs and functions assigned by chromosomal complement.4

- Gender

 Gender refers to a person’s self-representation as male or female, or how that person is responded 

 to by social institutions based on the individual’s gender presentation. Gender is rooted in biology 

 and shaped by environment and experience.5 

- Lifespan Perspective

 A lifespan perspective is longitudinal, rather than cross-sectional in nature. This perspective gives 

 recognition to the fact that individuals have different health and psychosocial needs as they 

 encounter transitions across their lives and that the positive and negative effects of health and 

 health behaviors are cumulative.

These statements of principle are intended to move beyond exclusive attention to women’s health 

for several reasons. First, study participants acknowledged the legitimacy of and sought to address 

counterarguments to a women-specific focus that pose the question, “Why women’s health and not men’s 

health?” Secondly and equally important, participants sought to address the general concern in the field 

of public health about health disparities as reflected in “Healthy People 2010 Objectives for the Nation,” 

HHS priority initiatives, and recent reports issued by the Institute of Medicine (9). This expanded 

approach enables ASPH and Federal partners to achieve the multiple objectives of addressing prior 

neglect of women’s health in both research and graduate education, as well as implementation of IOMrecommended workforce competencies for public health professionals related, in particular, to genetics, 

cultural competence, communication, and diversity.

RECOMMENDATIONS

To further the incorporation of the key principles related to sex and gender health differences across the 

life span in MPH core curriculum, the EAG developed specific recommendations. As conceptualized 

in this report, leadership for implementation, though a collaborative/partnership effort, falls primarily 

into two domains: that of the Association of Schools of Public Health, and that of the Federal partner 

agencies—HHS Office on Women’s Health, NIH Office of Research on Women’s Health, the AHRQ 

Director, Women’s Health and Gender-Based Research, the HRSA Office of Women’s Health, and the 

CDC Office of Women’s Health. Additional suggestions are offered for consideration by philanthropic 

organizations and by professional journals.

3 National Center for Cultural Competence—Georgetown University Center for Child and Human Development, 2001.

4 Institute of Medicine, 2001.

5 Institute of Medicine, 2001.

 | 27

Fig. A. Definitions for Educational Components
Association of Schools of Public Health (ASPH)

For its part, ASPH should take the following steps toward implementation:

1. Promote, through a public statement promulgated by the deans of the schools of public health, the 

 incorporation of content specific to sex and gender differences in health problems into the core MPH 

 curriculum.

2. Establish an ad hoc advisory group to guide efforts that promote integration of the aforementioned 

 key principles in the MPH curriculum. The charge of this advisory group would be to:

a) develop a set of educational competencies specific to sex and gender health differences that would 

 provide the basis for development of public health teaching materials and courses;

b) develop and promulgate recommendations for specific strategies for incorporating concepts related 

 to sex and gender health differences into the MPH core curriculum (for example, identifying the 

 specific concepts and teaching materials that fit best in each public health core discipline), using the 

 competencies noted above as the focus;

c) guide development of a set of teaching resources on sex and gender health differences and make 

 them available via the Internet to all SPH faculty and academic administrators. Such resources 

 would include syllabi, readings, data sets, case examples, and teaching and assignment modules 

 that would be keyed to the competencies noted above;

d) examine information further and deliberate issues related to developing a set of recommended 

 elective courses on women’s health; and to

e) explore further the potential for drawing on women’s studies programs and on Federal programs, to 

 strengthen the teaching of sex and gender health differences in schools of public health.

3. Continue to include student perspectives in this and all other curricular development and use SPH 

 exit surveys and other appropriate mechanisms to monitor the extent to which recommended changes 

 yield desired outcomes.

28 |
Federal HHS Partner Agencies

HHS partner agencies should take the following steps toward implementation:

1. Assemble educational resources for SPH faculty interested in incorporating sex and gender specific

 content into MPH core courses and/or developing women’s health-specific elective courses. Online 

 resources can be posted on the HRSA Web site (www.hrsa.gov) or on the National Women’s Health 

 Information Center Web site (www.womenshealth.gov) with linkages to all HHS agencies.

2. Promote further attention and support to public health and research training programs funded by HHS 

 that focus on integrated models, such as the NIH Building Interdisciplinary Careers in Women’s 

 Health (BIRCWH) program, the National Centers of Excellence in Women’s Health program, a 

 variety of CDC public health training programs, and the HRSA Geriatric Education Centers.

3. Increase the number of junior faculty development awards that focus on sex and gender health 

 differences research and outcomes, and that involve graduate student roles, recognizing the 

 importance that research funding has on graduate education. 

4. Continue to support and expand funding opportunities for schools of public health and other health 

 professions training programs in their collaborative efforts to integrate the study of sex and gender 

 differences into graduate education curricula.

Additional Suggestions

The EAG discussed the potential contributions of philanthropic organizations. Specifically noted was 

the model of the American Legacy Foundation’s funding for curricula development and dissertation 

research specifically related to elimination of tobacco use. EAG members further suggested that 

consideration be given to soliciting the interest of a professional journal (e.g. American Journal of Public 

Health, Public Health Reports, Women’s Health Issues/Jacobs Institute) in publishing a special theme 

issue or supplement devoted to enhancing attention to women’s health in graduate education programs.

 | 29
References

1. Weisman, CS. 1998. Women’s Health Care: Activist Traditions and Institutional Change. Baltimore, 

 MD: Johns Hopkins University Press.

2. Weisman, CS. 1997. “Changing definitions of women’s health: Implications for health and health care 

 policy.” Maternal and Child Health Journal, 1, 179–189.

3. Grason, HA, JF Hutchins, GB Silver, eds. 1999. Charting a Course for the Future of Women’s and 

 Perinatal Health: Volume I – Concepts, Findings, and Recommendations. Baltimore, MD: Women’s 

 and Children’s Health Policy Center, Johns Hopkins School of Public Health.

4. Strobino, DM, H Grason, C Minkovitz. 2002. “Charting a course for the future of women’s health 

 in the United States: concepts, findings and recommendations.” Social Science & Medicine. 

 54(2002): 839–848.

5. U.S. Department of Health and Human Services. Women’s Health in the Medical School Curriculum 

 - Report of a Survey and Recommendations, 1996.

6. U.S. Department of Health and Human Services. Women’s Health in the Dental School Curriculum 

 - Report of a Survey and Recommendations, 1999.

7. U.S. Department of Health and Human Services. Women’s Health in the Baccalaureate Nursing 

 School Curriculum - Report of a Survey and Recommendations, 1998.

8. Correa-de-Araujo, R. “A wake–up call to advance women’s health.” Women’s Health Issues, 2004: 

 14:31–34.

9. Institute of Medicine. Who Will Keep the Public Healthy? Educating Public Health Professionals for 

 the 21st Century. Washington, DC, National Academies Press, 2003.

30 |
Appendices

 | 31
Boston University School of Public Health

Columbia University Mailman School of 

Public Health 

Emory University Rollins School of 

Public Health

George Washington University School of 

Public Health and Health Services

Harvard University School of Public Health

Johns Hopkins University Bloomberg School 

of Public Health

Loma Linda University School of Public Health

Mel and Enid Zuckerman Arizona 

College of Public Health

New York Medical College School of 

Public Health

Ohio State University School of Public Health

Saint Louis University School of Public Health

San Diego State University Graduate 

School of Public Health

Texas A&M University System School of 

Rural Public Health

Tulane University School of Public Health 

and Tropical Medicine

University at Albany SUNY School of 

Public Health

University of Alabama at Birmingham 

School of Public Health

University of California at Berkeley 

School of Public Health

APPENDIX I – Participating ASPH Member Schools 

University of California at Los Angeles 

School of Public Health

University of Illinois at Chicago School 

of Public Health

University of Iowa College of Public Health

University of Massachusetts School of 

Public Health and Health Sciences

University of Medicine and Dentistry of 

New Jersey School of Public Health

University of Michigan School of Public Health

University of Minnesota School of 

Public Health

University of North Carolina at Chapel 

Hill School of Public Health

University of North Texas Health Science Center School 

of Public Health

University of Oklahoma College of Public Health

University of Pittsburgh Graduate 

School of Public Health

University of Puerto Rico School of 

Public Health

University of South Carolina Norman 

J. Arnold School of Public Health

University of South Florida College of 

Public Health

University of Texas School of Public Health

University of Washington School of Public Health and 

Community Medicine

Yale University School of Public Health

32 |
Emily Abel, PhD

University of California at Los Angeles

School of Public Health

Barbara Abrams, DrPH, RD

University of California at Berkeley 

School of Public Health

Barbara Anderson, DrPH, MS

Loma Linda University School of Public Health

*

Mary Applegate, MD, MPH

University at Albany SUNY

School of Public Health

Mary L. Aquilino, PhD

University of Iowa College of Public Health

Elizabeth Barbeau, ScD, MPH

Harvard School of Public Health

Susan Blake, PhD, LCP

George Washington University 

School of Public Health and Health Services

Heather Brandt, PhD, CHES

University of South Carolina 

The Norman J. Arnold School of Public Health

Margaret O. Caughy, PhD

University of Texas School of Public Health

*

Wendy Chavkin, MD, MPH

Columbia University 

Mailman School of Public Health

Claudia Coggin, PhD, CHES

University of North Texas Health Science Center 

School of Public Health

*

Ellen Daley, PhD, MPH

University of South Florida

College of Public Health

Alicia Dorsey

Texas A&M School of Rural Public Health

APPENDIX II - Women’s Health Interest Group and Expert Advisory Group

Jo Anne Earp, ScD

University of North Carolina at Chapel Hill 

School of Public Health

*

Cathey Falvo, MD, MPH

New York Medical College 

School of Public Health

Melissa Galvin, PhD, MPH

University of Alabama at Birmingham

School of Public Health

Iman Hakim, MD, PhD, MPH

Mel and Enid Zuckerman Arizona College of 

Public Health

Arden Handler, DrPH

University of Illinois at Chicago 

School of Public Health

*

Wendy Hellerstedt, PhD, MPH

University of Minnesota School of Public Health

Carol Hogue, PhD, MPH

Emory University Rollins School of Public Health

*

Sharon Homan, PhD

Saint Louis University School of Public Health

*

Rosanne Hooks, MD

American College of Preventive Medicine

Jeanettee Ickovics, PhD

Yale University School of Public Health

*

Deborah Parra-Medina, PhD, MPH

University of South Carolina

The Norman J. Arnold School of Public Health

*

Jeanette Magnus, MD, PhD

Tulane University School of Public Health and 

Tropical Medicine

Carol McAllister, PhD

University of Pittsburgh 

Graduate School of Public Health

Chair, Expert Advisory Group

Dean Susan Scrimshaw

University of Illinois at Chicago School of Public Health

School of Public Health Interest Group (*Expert Advisory Group Member)

 | 33
Lois McCloskey, PhD, MA, BS, BA

Boston University School of Public Health

Dawn Misra, PhD, MHS

University of Michigan School of Public Health

Electra Paskett, PhD

Ohio State University School of Public Health

Melba Sánchez, PhD

University of Puerto Rico 

Graduate School of Public Health

Darcel Scharff, PhD

Saint Louis University School of Public Health

Sharyne Shiu-Thornton, PhD, MA

University of Washington School of Public Health and 

Community Medicine

*

Mary Fran Sowers, PhD, RD

University of Michigan School of Public Health

Donna Strobino, PhD

Johns Hopkins Bloomberg School of Public Health

Gregory A. Talavera, MD, MPH

San Diego State University

Graduate School of Public Health

*

Doug Taren, PhD

Mel and Enid Zuckerman Arizona 

College of Public Health

*

Kathryn Tracy, DrPH, MPA

University of Massachusetts

School of Public Health and Health Sciences

Lynn Waishwell, PhD, CHES

University of Medicine and Dentistry

of New Jersey

School of Public Health

*

Robert Wild, MD, MPH, PhD 

College of Medicine at the University of Oklahoma 

Health Sciences Center

Kirsten Aghen, MPH 

Department of Health and Human Services

Office on Women’s Health

Rosaly Correa-de-Araujo, MD, MSc, PhD

Agency for Healthcare Research and Quality

Linda Frazier, MD, MPH

Association of Teachers of Preventive Medicine

Yvonne T. Green, RN, CNM, MSN

Centers for Disease Control and Prevention

Office of Women’s Health

Barbara Hatcher, PhD, MPH, RN

American Public Health Association

Wanda K. Jones, DrPH

Department of Health and Human Services

Office on Women’s Health 

Sabrina Matoff-Stepp, MA

Health Resources and Services Administration 

Office of Women’s Health

Vivian Pinn, MD 

National Institutes of Health 

Office of Research on Women’s Health

Joyce Rudick

National Institutes of Health 

Office of Research on Women’s Health 

Maranda Ward, MPH

ASPH/HRSA Fellow 

Expert Advisory Group Members (non-ASPH faculty)

34 |

School of Public Health Interest Group - continued

(

*

Expert Advisory Group Member)
Appendix III - Methods

Methods for Focus Groups

Organization and Composition of Focus Groups

The following organizations were drawn on to populate the focus groups. 

1. Women’s Health Interest Group faculty, as designated by the Office of the Dean in each SPH; and

2. Faculty instructors of core courses of the MPH curriculum at each SPH, as designated by 

 department chairs in epidemiology, biostatistics, environmental health, behavioral sciences, and 

 health management and administration.

Structuring and Sequencing the Focus Groups

Hypothesizing that some differences in experience might relate to the size of each SPH, participant 

groupings were stratified by school size. Using 2003 ASPH annual report data, the 34 accredited SPHs 

were listed in order by size, as identified by the number of MPH graduates in that year. The schools 

were divided into five primary sampling groups as follows: 

SPH Size 

Group

A 

B 

C 

D 

E 

Number of MPH 

Graduates in 2003

<52

53-83

84-106

107-184

185-272

Number 

of Schools

8

7

7

6

6

Both the women’s health faculty and core course faculty participants were assigned to focus groups 

using this school size schema. 

The objective of gathering information about MPH core curricula and soliciting perspectives of 

faculty involved in teaching core courses introduced additional variation, as we primarily sought equal 

distribution of the five core disciplines across the 34 SPHs. Using the same school size listing (Groups 

A–E), disciplinary representation for the MPH core course faculty focus groups was achieved by random 

assignment such that, for each SPH, a primary discipline (e.g., epidemiology, environmental health) 

was identified for participation. Each of the five disciplines was assigned a number between 1 and 5. 

Within the schools ordered from smallest to largest according to size of graduating class, each school 

contributed one disciplinary representative. 

Figure 1 outlines our approach for random assignment of MPH core disciplines for participation. For 

example, school #7 was assigned to provide a representative from Environmental Health (#2), since 

school #6 was assigned faculty representation from Biostatistics (#1). The first school thereafter in 

 | 35
increased size was assigned the next number corresponding to another MPH discipline. Replacements 

were similarly assigned. Thus, while each group did not include representation of each of the five 

disciplines, equitable disciplinary representation was achieved across the full spectrum. 

 MPH Discipline #

SPH # Participation Assignment

1 1

2 2

3 3

4 4

5 5

6 1

7 2

8 3

9 4

10 5

11 1

12 2

13 3

14 4

15 5

etc. etc.

Fig. 1. Approach used to assign discipline representation in focus groups.

Development of Discussion Guides

Over a 2-month period, two guides were developed through an iterative process of exchange and 

refinement among ASPH staff, the consultant, the Health Resources and Services Administration project 

officer, and ASPH’s Expert Advisory Group for the project. The consultant prepared preliminary draft 

discussion guides drawing on: (a) summaries of ASPH conference calls with the Federal partners, 

representatives from other health professional organizations, and with the 34 members of the Women’s 

Health Interest Group; and (b) examination of the surveys and reports from the previous women’s health 

curriculum reviews in medicine, nursing, and dental schools. Questions were sequenced to reflect the 

Expert Advisory Group’s determination that the priority for information collection was to be about the 

core MPH curriculum. Thus, the questions were sequenced to reflect the EAG areas of greatest interest. 

Figure 2 includes the discussion guide questions for each faculty group. The focus group guide was 

prefaced with a broad statement reflecting the operational definition of “women’s health” being used. 

This statement read as follows:

Everyone has their own frame of reference for the meaning of “women’s health.” In some circles, 

the term has been operationalized by a primary focus on the health of women as it relates to their 

childbearing potential and/or experience (reproductive health or maternal and child health). 

Most commonly, however, a far more expansive concept of women’s health is embraced by health 

professions (including public health), encompassing (1) sex/gender differences in social and biological 

status reflected in health and disease over the entire lifespan and regardless of reproductive status, 

and (2) a holistic view rather than a disease or “body parts” approach.

Biostatistics = 1; 

Environmental Health = 2; 

Epidemiology = 3;

Health Services Management = 4; 

Social and Behavioral Sciences = 5

36 |
6 The focus group guides that include probes for discussion items are available on request from ASPH.

Fig. 2. Focus group discussion questions.6

Women’s Health Faculty

 1. First, I would like each of you, to, in turn, identify the top 3 women’s health knowledge 

 areas or skill competencies that you believe should be covered in required curricula for all 

 MPH students. Please also then explain your rationale for your first choice.

 2. What do you believe is the best way to include women’s health content (concepts and 

 principles) in the core required courses within the MPH Curricula?

 3. In general, would you say that “women’s health”-related content is currently being presented 

 in the core MPH curriculum in your SPH?

 4. Whom do you believe should be responsible for assuring incorporation of this women’s health 

 content into the MPH core curriculum?

 5. Are you responsible for any teaching with respect to women’s health? If you do teach, please 

 describe the nature and scope of your teaching in this regard.

 6. As your school’s women’s health expert, are you tapped (called on) to assist other faculty in 

 incorporating women’s health into core MPH courses and if so, how so?

 7. How could you be used to assist faculty instructors of core MPH curriculum?

 8. Now, I’d like to move to the question of freestanding elective courses related to women’s 

 health that the SPH should offer. Let’s go around again, and will each of you tell us... beyond 

 these areas that you identified as critical to include in the core MPH curricula, what additional 

 3 knowledge and/or skill areas should be the focus of one or several elective courses? 

 9. Again for each of you, what material (knowledge, skills) should be included in an academic 

 track or concentration (a “MPH major”) related to women’s health?

10. At your school of public health how are issues specific to maternal and child health 

 addressed in relation to the women’s health curriculum?

Core Course Faculty

 1. I’d like to hear from each of you your reaction to the statements of women’s health experts 

 that the following set of concepts and principles should be incorporated in core MPH courses.

· Knowledge of the major sex and gender differences in health and disease across the life

 span, particularly in terms of physiologic, behavioral, and societal factors that influence 

 health outcomes among culturally and socio-economically diverse populations of women;

(focus group questions continued on next page)

 | 37
· Understanding of women’s interactions with the health care system, including the impact 

 of multiple social roles and life cycle events on women’s health, and incorporating women’s 

 access to care; women’s patterns of health care access and health care seeking; women’s 

 forms of communication and interaction; and women’s health decision making for 

 themselves and others; and

· Knowledge of the social determinants of the health of women across the lifespan and in the 

 historical and contemporary context of culture, particularly with respect to gender roles and 

 social status.

2. Thinking about this core women’s health content, can you tell us generally how much of 

 this content is integrated into the core MPH curriculum? 

3. Thinking about a set of women’s health-related concepts and principles, what would you 

 think would be easy to include? 

4. Thinking about a set of women’s health-related concepts and principles, what would you 

 think would be difficult to include?

5. Are there specific teaching approaches that you use to teach these women’s health content 

 areas?

6. Who or where would you go to for consultation if you had a curriculum-related question 

 about women’s health?

7. Do you draw upon the women’s health experts in your school or university in developing and/

 or presenting course material related to women’s health? Why or why not?

8. What do you see as the demand among students for curriculum specific to women’s health?

Logistical Arrangements

As noted previously, Women’s Health Interest Group faculty were identified by the deans’ offices. In 

order to form the four core MPH faculty focus groups, ASPH staff worked with department chairs to 

identify and secure participation. The Johns Hopkins Bloomberg School of Public Health Committee on 

Human Research reviewed and approved the study proposal. 

ASPH staff contacted participants to schedule the focus groups and sent email communications 

confirming date, time, and dial-in information. Attached to that message was a document with a letter, 

project overview, disclosure statement, and discussion questions. Background information on the intent 

of the focus groups and on conceptualization of “women’s health” prefaced the question list. Focus 

groups with women’s health faculty were held first in order to analyze their perspectives regarding 

“what should be taught” in the core MPH curriculum. This analysis was then used to form Question 

1 for the focus groups with the core MPH faculty, asking them to respond to what the women’s health 

faculty thought should be taught on women’s health. Arrangements were made by ASPH for digital 

transcription of the focus group discussions by Conference America, Inc.

38 |
Focus Group Participants

Participation was sought from all 34 eligible schools of public health in both sets of focus groups. 

The women’s health focus group participants ultimately consisted of a panel of 22 women’s health 

representatives from 22 different SPHs. Most women’s health focus group participants were female (20 

of 22). Participation across the spectrum of school size was fairly evenly distributed. Two-thirds of 

the public SPHs and 60 percent of the SPHs located in private universities were represented among the 

women’s health focus group participants. Those SPHs where the representative faculty failed to dial in 

and participate were evenly distributed in the size groupings and type. The predominant departmental/

disciplinary affiliation was behavioral sciences (10 of 22). A profile of women’s health focus group 

participants is provided in Table A.

Table A. Profile of Participants in Women’s Health Faculty Focus Groups

Focus 

Group

Total 

Participants

Sex SPH Size 

(number of SPHs)

School Type 

(number of SPHs)

Public Private

Department/Discipline 

(number of participants)

M F

I 5 1 4 A(5) 4 1 Behavioral Sciences (3)

 International Health (1) 

 Family/Child Health (1)

II 2 - 2 B(2) 1 1 Behavioral Sciences (2)

III 6 - 6 C(6) 5 1 Behavioral Sciences (3) 

 Health Services (1)

 MCH (1) 

 Community/Family 

 Health (1)

IV 4 - 4 D(2) 2 2 Epidemiology (1)

 E(2) Behavioral Sciences (1) 

 MCH (1)

 Population/Family Health (1)

V 5 1 4 B(3) 4 1 Obstetrics/Gynecology (1) 

 C(1) Community Health (2)

 E(1) Behavioral Sciences (1)

 Epidemiology/Biostatistics (1)

Total 22 2 20 16 6

School Size Key (Number of Graduates): A <52; B 53-83; C 84-106; D 107-184; E 185-272.

Participants in the second set of focus groups consisted of 21 faculty members representing different 

core departments from 20 different SPHs; these departments included Biostatistics (3 participants), 

Epidemiology (4 participants), Social and Behavioral Sciences (3 participants), Environmental Health 

(3 participants), Health Management/Administration/Services (5 participants), Community Health (1 

participant), and Epidemiology & Biostatistics (2 participants). See Table B for more details. Again, 

most participants were female (15 of 21). An even distribution of public-private university SPHs and 

school sizes was achieved, similar to that for the women’s health focus groups. Nonparticipating SPHs 

were also found to be evenly distributed across the size category groupings. | 39
Table B. Profile of Participants in Core MPH Course Instructor Faculty Focus Groups

Focus 

Group

Total 

Participants

Sex SPH Size 

(number of SPHs)

School Type 

(number of SPHs)

Public Private

Department/Discipline 

(number of participants)

M F

I 7 2 5 A(3) 6 1 Biostatistics (2)

 B(4) Epidemiology (2) 

 Behavioral Sciences (2)

 Environmental Health (1)

II 5 2 3 C(5) 4 1 Behavioral Sciences (2)

 Biostatistics (1)

 Epidemiology (1)

 Environmental Health (1)

 Health Mgmt/Admin (1)

III 5 2 3 D(5) 3 2 Epi & Biostatistics (2) 

 Community Health (1)

 Health Policy/Admin (1)

 Environmental Health (1)

IV 4 - 4 A(1) 3 1 Biostatistics (1)

 B(1) Epidemiology (1)

 C(1) Health Management/ 

 E(1) Admin/Policy (2) 

 

Total 21 6 15 16 5

School Size Key (Number of Graduates): A <52; B 53-83; C 84-106; D 107-184; E 185-272.

Seven schools of public health did not participate in either set of focus groups, primarily because of 

scheduling conflicts. Three of these schools were affiliated with private universities and four with public 

institutions. They were evenly distributed across size categories.

Focus Group Analysis

Using the electronic files of the transcripts, data reduction was initiated using a straightforward, cutand-paste method to organize the material for each question. This material was further organized by the 

primary sampling units for faculty focus group participants (women’s health = W, core course instructor 

faculty = C), as well as the sampling subunits (stratified) by school size (I, II, III, IV, V). For example:

Question 1

Women’s Health Faculty

 Group WI

 Group WII

 Etc.

 Core Course Faculty

 Group CI

 Group CII

 Etc.

40 |
The new documents derived from this process were independently reviewed by three individuals (two 

ASPH staff and the consultant) to identify themes; each reviewer independently highlighted assertions 

that could be used for coding the text of the discussions. The resulting lists of independently generated 

themes were then discussed among the three coders and merged, and a consensus-coding scheme 

was developed. All focus group transcripts were then coded independently, and checks for inter-rater 

reliability were conducted. Summary documents were created, which, where sufficient discussion 

material was present, included tables enumerating the comments by theme (e.g., faculty roles, influence 

of students, “diversity”), and/or by sampling unit. These tables, in conjunction with abstracted 

representative statements, were then used to compare responses between women’s health faculty and 

core course faculty. The consultant prepared the report narrative using the transcript information 

organized by question, themes, and sampling units.

Limitations of the Focus Group Methodology

Although the focus group methodology provides an effective strategy to generate discussion among 

colleagues, stimulate new ideas, and evolve consensus, this method fell short in several regards. First, 

focus groups are not the optimum approach for systematic collection of quantitative information, for 

example, frequency of certain events, such as number of courses in women’s health, amount of specific 

teaching, precise amount of incorporating concepts, and so forth. For this reason, additional data 

collection activities were carried out—the student survey and the review of course catalogues—to 

supplement what could be learned from the focus groups. 

Second, funding and logistical considerations required telephone focus groups. In most cases 

participants in these telephone conversations did not know one another, and of course were unable to 

read nonverbal cues; this “blindness” to one another was initially a problem for all participants, but 

especially the focus group facilitator. It took longer for participants to warm up to the discussion, and 

the overall pace of discussion was slower. As a consequence, few group discussions covered all the 

questions outlined in the focus group guide. Follow-up data collection therefore may be needed to 

provide a full picture of the current status of thinking and efforts in regard to curricula specifics. 

Methods for Student/Alumni Survey

Originally, student views were going to be collected similarly to the way they were collected for 

faculty, that is, via focus groups. Once it was realized, however, that ASPH has access to a number of 

students and recent alumni that participate in various ASPH-sponsored internships and fellowships, it 

was decided to do a web-based survey, which offered the added benefit of ease of data handling. The 

survey was designed similarly to that of the core faculty focus group, in that the three statements from 

the women’s health focus group were used to assess respondents’ reactions. See Fig. 3 for the survey 

questions. 

The survey was conducted via the Internet using SurveyMonkey.com, an on-line survey instrument. 

After an initial email was sent with a link to the survey, a reminder was sent requesting responses 

within 10 days of the initial email. The survey was sent to 188 ASPH interns and fellows, who were 

participating in internship and fellowship programs at the following Federal agencies: CDC, HRSA, U.S. 

Environmental Protection Agency, United States Department of Agriculture, National Highway Traffic 

Safety Administration, and also within ASPH. The respondents were either current students or recent 

alumni that had graduated within the past 5 years. 

 | 41
The survey questions were developed by the consultant with input from the Expert Advisory Group. 

ASPH staff used draft questions to design the survey using the question format options available through 

SurveyMonkey.com. 

Limitations of this survey include the scope of students surveyed, as a consequence of taking advantage 

of the convenience of highly accessible ASPH trainees. More than 19,000 students were enrolled in 

accredited SPHs in the fall of 2003, yet this survey was fielded with only 188 students and recent alumni. 

In addition, 20 percent (8) of all respondents were from a single school of public health. This particular 

school generally has the largest number of students involved with the ASPH internship and fellowship 

program. Sufficient background information is not available to determine possible undue influence of 

this group of respondents.

Another area to consider when reviewing the results of the survey is the length of time a given student 

has spent at an SPH. A longer time period could result in more exposure to women’s health in the 

curriculum by virtue of taking more classes, attending more lectures, or other learning opportunities.

Lastly, our findings may be skewed by the high motivation of the participating students (i.e., those that 

applied for and succeeded in obtaining an internship or fellowship), as well as by the perceived social 

acceptability of the answers. It is possible that reported interest in women’s health is inflated. 

Disclosure Statement 

The purpose of this project is to identify the current scope of how women’s health is addressed in 

MPH programs and to identify women’s health curriculum needs at accredited schools of public health 

(SPH). The intent of this assessment is to document incorporation of women’s health topics into public 

health curriculum. You have been identified for participation by your involvement in an ASPH Internship 

or Fellowship program. The information you provide will be used to enhance training of public health 

professionals at accredited SPH. Your participation is completely voluntary; you may refuse to participate 

in the assessment or may choose not to answer any specific questions. Your responses will not be shared 

with your academic program or employer and all of your responses will be kept confidential. Results will 

be reported in aggregate only in a final report. If you wish to talk with someone about this project 

please contact Holly Grason at ***-***-  or contact the Johns Hopkins office for Research Subjects 

** *-***-****.

I agree and would like to continue.

I would like to exit the survey.

1. Please indicate your gender.

 Female

 Male

 Other (please specify): 

2. Please enter your age: 

Fig 3. Student survey and recent alumni survey questions

42 (survey continued on next 4 pages) |
3. Please indicate graduate degrees earned to date. 

MPH 

MSPH 

MHA 

MHS 

MHSA 

MS 

MSc 

MA 

ScD 

DrPH 

PhD 

N/A 

Other (Please list) 

4. Please indicate graduate degrees expected (currently working toward).

MPH 

MSPH 

MHA 

MHS 

MHSA 

MS 

MSc 

MA 

ScD 

DrPH 

PhD 

N/A 

Other (Please list) 

5. Name of MPH program attended or currently attending (circle).

Emory University Rollins School of Public Health 

Yale University School of Public Health 

Tulane University School of Public Health and Tropical Medicine 

University of Michigan School of Public Health 

Saint Louis University School of Public Health 

University of Alabama at Birmingham School of Public Health 

University of North Carolina at Chapel Hill School of Public Health 

University of Washington School of Public Health and Community Medicine 

Boston University School of Public Health 

Johns Hopkins Bloomberg School of Public Health 

San Diego State University Graduate School of Public Health 

University of Texas School of Public Health 

Mel and Enid Zuckerman Arizona College of Public Health 

University of California at Berkeley School of Public Health 

University of Pittsburgh Graduate School of Public Health 

Columbia University Mailman School of Public Health 

George Washington University School of Public Health and Health Services 

Harvard School of Public Health 

Texas A&M School of Rural Public Health 

 | 43
University of Iowa College of Public Health 

University of Medicine and Dentistry of New Jersey-School of Public Health 

University of Minnesota School of Public Health 

University of North Texas Health Science Center School of Public Health 

University of Puerto Rico Graduate School of Public Health 

University of South Carolina Arnold School of Public Health 

University of South Florida College of Public Health 

Drexel University School of Public Health 

Loma Linda University School of Public Health 

New York Medical College School of Public Health 

Ohio State University School of Public Health 

University at Albany SUNY School of Public Health 

University of Arkansas for Medical Sciences College of Public Health 

University of California at Los Angeles School of Public Health 

University of Illinois at Chicago School of Public Health 

University of Massachusetts School of Public Health and Health Sciences 

University of Oklahoma College of Public Health 

Other (please specify): 

A panel of public health faculty with expertise in women’s health have identified three major concepts 

which they believe should be incorporated into the core curricula of MPH programs. 

Questions 6-8 list these three concepts. Please indicate the extent of your agreement that the

concept should be included in the core curricula of MPH programs.

6. Knowledge of the major sex and gender differences in health and disease across the life span 

 particularly in terms of physiologic behavioral and societal factors that influence health outcomes 

 among culturally and socioeconomically diverse populations of women.

Do not agree

Somewhat agree 

Substantially agree 

Strongly agree

7. Understanding of women’s interactions with the health care system including the impact of multiple 

 social roles and life cycle events on women’s health and incorporating women’s access to care 

 women’s patterns of health care access and health care seeking women’s forms of communication and 

 interaction and women’s health decision making for themselves and others.

Do not agree

Somewhat agree 

Substantially agree 

Strongly agree

8. Knowledge of the social determinants of the health of women across the life span and in the historical 

 and contemporary context of culture, particularly with respect to gender roles and social status.

Do not agree

Somewhat agree 

Substantially agree 

Strongly agree

44 |
For questions 9–11, using the scale provided, please indicate the extent to which you were

exposed in your MPH core curriculum to the areas of women’s health indicated.

9. Knowledge of the major sex and gender differences in health and disease across the life span, 

 particularly in terms of physiological, behavioral, and societal factors that influence health outcomes 

 among culturally and socioeconomically diverse populations of women. 

 Exposure in your MPH core curriculum? 

Not at all

Limited

Moderate

Substantial

N/A 

10. Understanding of women’s interactions with the health care system, including the impact of multiple 

 social roles and life cycle events on women’s health, and incorporating women’s access to care; 

 women’s patterns of health care access and health care seeking; women’s forms of communication 

 and interaction; and women’s health decision making for themselves and others. 

 Exposure in your MPH core curriculum? 

Not at all

Limited

Moderate

Substantial

N/A 

11. Knowledge of the social determinants of the health of women across the life span and in the 

 historical and contemporary context of culture, particularly with respect to gender roles and social 

 status. Exposure in your MPH core curriculum? 

Not at all

Limited

Moderate

Substantial

N/A 

12. There are many educational formats that could be used to present information specific to women’s 

 health in the core MPH curriculum. Using the check boxes, please identify the strategies that were 

 used to present content specific to women’s health in the core curriculum of your MPH program.

Instructor lectures in epidemiology 

Guest lectures in epidemiology 

Instructor lectures in biostatistics

Guest lectures in biostatistics 

Instructor lectures in environmental health 

Guest lectures in environmental health 

Instructor lectures in health services management 

Guest lectures in health services management 

Instructor lectures in social and behavioral sciences

Guest lectures in social and behavioral sciences

Noon seminar series

Required readings

Optional readings

Case studies

 | 45
Required course

Course assignments; homework problems

Not applicable

Other (please specify) 

13. In your MPH program, what women’s health-specific programs were offered? Click all that apply.

Concentration in Women’s Health

Certificate program in Women’s Health

Concentration in Maternal and Child Health (MCH)

Certificate program in Maternal and Child Health (MCH)

Others (Please list all) 

14. Using the check boxes, please indicate the women’s health topic areas that you learned about in your 

 MPH program and those that you would like to learn about (or would have liked to learn about).

 [Check box included for “Learned about” and “Would like to learn about.”] 

Sociocultural and economic themes 

Life span curriculum (girls, adolescents, young adult women, women in mid-life, older women)

Biological considerations 

Developmental and psychosocial issues 

Gender-specific approaches to preventive health behaviors/health promotion 

Reproductive health (biology epidemiology disorders/conditions) 

Common medical disorders/conditions (including heart disease; breast and cervical cancer; 

other cancers; autoimmune diseases; diabetes; osteoporosis) 

Service system organization and policies (including access and insurance) 

Demographic implications (e.g., population changes in age, race/ethnicity; SES literacy; rurality/

urbanization; stages of the life span; immigration) 

Women’s oral health

Women’s mental health and psychosocial health/wellness 

Women and substance use/abuse 

Women and violence 

Women and HIV/AIDS 

Menopause 

Risk and special groups (e.g., lesbians, women w/disabilities, women that are very elderly) 

Women’s nutrition fitness (including obesity, eating disorders, physical activities) 

Legal/ethical issues specific to women’s health; effects of gender discrimination 

Women and work 

Women and caregiving 

Women and sexuality 

Women’s health and genetics 

15. To what extent do you anticipate you will need substantial knowledge of women’s health in your 

 professional career?

None

Minimal degree 

Moderate degree 

Substantial degree

Thank you for completing this survey of Women’s Health in Curriculum at Accredited Schools of Public 

Health. If you have any questions about the project, or would like to be added to the email list for 

notification when the final report is finished, please email Christine Plepys at cplepys@asph.org.

46 |
Methods for Elective Course Review

To compile a list of women’s health-related classes for each of the ASPH member schools, course 

offerings were viewed at SPH Web sites and/or at on-line versions of 2003–04 catalogs. Often the 

information sought was available in separate documents by semester, generally under the heading of 

“Academics” or “Academic Programs.” Often searches were available only for one department at a time. 

Scanned-for courses were ones that related, for example, to women’s health, reproductive health, 

family planning, maternal and child health, perinatal health. In cases where course offerings were 

not presented as Adobe Acrobat files, page searches were conducted to correct for any omissions in 

the visual scan. Occasionally, schools (such as JHU) had a course search engine; in such cases, the 

above terms and search parameters (semester, department) were entered. Independent research and 

thesis classes for degrees pertaining directly to an MCH or women’s health concentration or track were 

excluded. Course title, number, credit value, and instructor/s were all recorded. Overall, relatively few 

schools had search engines, so multiple strategies to locate information may have introduced undesired 

variation in results. In addition, keyword definition and assignment were not consistent across school 

Web sites. Thus, it could be that course titles do not adequately highlight women’s health (see keywords) 

and so were not identified in the review. 

In an attempt to address the limitations of the Web site catalogue abstraction, the table identifying 

courses was sent to the Women’s Health Interest Group members at each school. The group members 

reviewed the course information in order to check for accuracy, and add or delete listed courses. This 

process significantly increased the number of reported women’s health-related courses. The review 

process, however, simultaneously introduced some new variation in that multiple individuals were 

responding to the term “women’s health-related course,” with some faculty appearing to interpret the 

term more broadly than others.

 | 47
APPENDIX IV - Women’s Health Elective Courses, 2003-2004 48

|

School of 

Public Health

Women’s Health MCH/Perinatal Reproductive Health/

Family Planning

Other

Univ of Iowa CPHUniv of Albany SUNY SPHUniv of Mass SPHHSUniv of North Texas SPHUniv of Puerto Rico SPH Univ of South Carolina Arnold SPHMEZACOPH (AZ)NY Medical College SPH 

The Anthropology of Women’s HealthTopics in Women’s HealthWomen’s HealthWomen: A Biosocial PerspectiveViolence Against Women• Women and Health: An  International Perspective• Issues in Women’s Health:  Epidemiology & Prevention

Maternal, Child and Family Health: An OverviewMaternal and Child Health• Legislation in MCH • Seminar on MCH Services in Developing Countries• Maternal & Child Concepts &  Strategies• Normal Obstetrics Management• MCH Education• Maternal and Child Nutrition• Maternal-Child Health Education• MCH• Women and Children Health Policy• Clinical Topics in International MCH• Legal & Ethical Issues in MCH• Introduction to MCH• Disease Prevention and Control in  MCH• Seminar in MCH• Community Needs Assessment

Epidemiology of Reproductive DiseasesReproductive Epidemiology

• Population & Family Planning

• Human Sexuality & Well Woman  Gynecology• Reproductive Physiology for Nurse- Midwives• Reproductive Epidemiology• Sexually Transmitted Diseases: Their  Epidemiology and Contro• AIDS: Epidemiology and Control• AIDS Seminar• Prevention of Teen Pregnancy• HIV/AIDS Education: Principles and  Practices• Family Life and Sex Education  Programs

Introduction to Family and Community Health• Pharmacology for Nurse-Midwifery• Problems & Complications of  Obstetrics• Maternal & Infant Nutrition• Nurse-Midwifery Practice &  Management I• Nurse-Midwifery Practice &  Management II• Nurse-Midwifery Clinical Management  & Practice• Integral & Comprehensive Care • Social Aspects on Aging• Maternal & Child Nutrition• Exercise and Childhood Obesity• Exercise Physiology of Children and  Youth• Obesity and Eating Disorders• Interdisciplinary Perspectives on Child  Abuse and Neglect• Maternal and Child Nutrition• Adolescent Health• Nutrition and Physical Activity in a  Biocultural Context• Survey of Adolescent Health and  Medicine• Nutrition in Health and  Disease• Violence: a Public Health Issue
School of 

Public Health

Women’s Health MCH/Perinatal Reproductive Health/

Family Planning

Other

Univ of Oklahoma CPHUniv of Pittsburgh GSPHOhio State Univ SPHTexas A&M Univ SRPHSt. Louis Univ SPHSan Diego State Univ GSPHUMDNJ SPHUniv of MinnesotaSPHUniv of South Florida CPHUniv of Alabama at Birmingham SPHUniv of WashingtonSPHCMLoma Linda Univ SPH

• Public Health Approaches to  Women’s Health• Epidemiology of Women’s Health• Women, International  Development, and Global HealthWomen’s Health IssuesSeminar in Women’s HealthContemporary Women’s Health Issues & Public HealthWomen’s HealthWomen’s Health Issues in Public HealthWomen in Development

• Introduction to Health Services  Mother & Child• Seminar in Maternal & Child HealthMCH EpidemiologyMaternal and Child Health• Foundations of MCH Leadership• Family Health: an Ecological Approach• MCH I: Issues & Concepts• MCH II: Case Studies in MCH  Programs, Policies & Research• International MCH• Advanced Leadership & Practice in MCH• Comparative MCH• Issues in MCH• Programs & Policies in MCH• MCH Systems of Care• Perinatal Epidemiology• Comparative MCH in Developing &  Developed Nations• Epidemiology of MCH Problems• MCH in Developing Countries• Topics in MCH I• Topics in MCH II• Epidemiology of Maternal and Child  Health• Maternal and Child Health• Seminar in MCH Practice• Seminar in Maternal and Perinatal  Health

• Seminar on Family Planning• Introduction to Population Problems• Environmental Causes of  Reproductive Failure• Race, Class, and Family Formation• Sexuality Education Reproductive Health Trends & Issues• Reproductive Health in Developing  Countries (603)• Reproductive Health in Developing  Countries (703)Reproductive Epidemiology• Reproductive Health• Issues and Programs in Family  Planning

• Pediatric Epidemiology• The Family and HealthPerinatal Health & Family Planning• Maternal & Infant Nutrition• Reproductive & Perinatal Health• Child Health• Adolescent Health• Global HealthPopulation and Community HealthNutrition in MCHMaternal and Child Nutrition
School of 

Public Health

Women’s Health MCH/Perinatal Reproductive Health/

Family Planning

Other

University of Illinois at Chicago SPHUniv of Texas SPHYale Univ SPHUniv of CA - Berkeley SPHUniv of North Carolina Chapel Hill SPH Univ of CA - Los Angeles SPHGeorge Washington Univ SPHHS

• Women’s Sexual Health (every  other year)• Women’s Health and International  Health (every other year) • Gender, Health & Development:  Program & Policy Perspectives• Health Disparities by Race & Sex:  Epidemiology & InterventionCurrent Issues in Women’s Health• Violence Against Women• Epidemiology/Prevention of  Women’s Health Issues• Women’s Health & Well-Being• Women’s Mental Health• Seminar: Advanced Issues in  Women’s Health• Women, Health & Aging: Policy  Issues• Demography of WomenWomen’s Health

• Introduction to MCH• Advanced Applied Methods in MCH  Epidemiology• Advanced MCH Applied Programs• MCH Policy & Advocacy• MCH Leadership SeminarPregnancy & Perinatal Health• MCH in a Global Context• Topics in Perinatal Epidemiology• Health of Women & Children• MCH Specialty Area Core Course• Needs Assessment of MCH• International MCH• Money, Management and MCH• Problems in MCH• MCH Policy and Program Development• Maternal & Infant Health• Research Methods in MCH• Perinatal Epidemiology• Issues in International MCH• MCH Program Planning & Evaluation• Theoretical Perpectives on MCH• MCH Program Evaluation• Advanced Topics in Perinatal &  Pediatric Epidemiology• MCH in Developing Areas• Recent Developments in MCH in  Disadvantaged Countries• Perinatal Health Care: Principles,  Programs & Policies• Women’s Roles and Family Health• MCH: I (Foundations)• MCH: II (Advanced)• MCH Policy Analysis

Family Planning: Practices & PoliciesEpidemiologic Methods in STD/HIV ResearchFamily Planning, Population Change & Health• International Family Planning• Reproductive Health Policy• Reproductive Physiology &  Conception Control• Reproductive Health in Developing  Countries: A Population Perspective• Reproductive Health and Disease• International Perspectives in the  Reproductive Health of Young People• Overview of International  Reproductive Health

• Public Health Approaches to Maternal  & Child Nutrition• Reproductive & Perinatal Health  (every other year)• Readings in Reproductive and  Perinatal Health Course (every other  year)• Public Health Aspects of Adolescent  Health• Reproductive Perinatal Epidemiology• Public Health Aspects of MCH  Nutrition• Nutrition of Children & Mothers• Maternal and Child Health Issues for  Immigrant Populations• Family and Sexual Violence• Maternal & Child Nutrition• International Family Health• Maternal and Child Nutrition• School Health• Adolescent Health• Elective & Specialty Courses (e.g.,  workplace, HIV/AIDS)• Child Health & Development• Children with Special Health Care  Needs
 | 51

School of 

Public Health

Women’s Health MCH/Perinatal Reproductive Health/

Family Planning

Other

Univ of MichiganSPHHarvard Univ

SPHColumbia Mailman SPH

• The Epidemiology of Women’s  Health• Public Health Policy Issues in  Women’s Health• Gender and Health: Ethnographic  Approaches• Intersectionality and Women’s  Health: Ethnographic Approaches  to Race, Class, Gender, and  Differences• Women’s Health Care• Women, Health and Development:  Reconciling Science & Policy• Women, Gender and Health• Advanced Topics in Women,  Gender & Health• Women, Gender & Health: Critical  Issues in Mental Health• Women, Gender & Health:  Introductory Perspectives• Practice of Preventing Intimate  Partner Violence• Health and Human Rights• Population and Development  Policymaking• History, Politics and Public Health:  Theories of Disease Distribution  and Social Inequalities in Health• Seminar in Sexuality, Gender,  Health and Human Rights• Women & AIDS

• Foundations of Reproductive,  Maternal and Infant Health• Families and Health• Issues in MCH Programs and Policies• Childbirth Health Policy and  Epidemiology• Social Services for Children,  Adolescents and Families• Infant Assessment in the Context of  Perinatal Exposure• Physical Growth and Development• Working with Women & Children in War Zones• Maternal and Child Health in  International Primary Health Care

• Fundamentals of Reproductive Health• Reproductive Epidemiology• Population Change: Sex, Gender,  Family, and Fertility• Women’s Health and Reproductive  Health• Mechanisms of Reproductive  Toxicology• AIDS: A Public Health Challenge• The Challenge of HIV/AIDS:  Strengthening Health Systems in  Resource-Poor Settings• Women’s Health and the Timing of  Reproduction• Women and Fertility• Advanced Topics in Epidemiology• Epidemiologic Research in Obstetrics  and Gynecology• Epidemiology of Reproductive  Morbidity due to Trauma, Stress and  Psych Health• Biological and Clinical Foundations of  Reproductive Health• Reproductive Health Care in  Developing Countries• Knowledge in HIV/AIDS Prevention• Sex, Reproduction and Reproductive  Health• Public Health Aspects of Reproductive Health• Theories & Perspectives on Sexuality  and Health• History of Sexual Health Promotion• Ethics & Human Rights Perspectives  on Sexuality & Sexual Health• Current Issues in Sexual Health• Reproductive Health for Refugees and  War-Affected Populations

• Maternal and Child Nutrition• Theory, Research and Practice in  Adolescent Health• Foundations of Child and Adolescent  Health• Human Development and Public  Health: A Lifecourse Approach• Health, Human Rights, and the  International System• American Violence: The Intersection  Between Home and Street• Social Policy and Legal Dilemmas:  Child Custody and Visitation• Society and its Effects on Child Health• Services for Children with Disabilities• Adolescent Health• Community-Based Child Health  Programs in Developing Countries• Mental Health of Children and  Adolescents• Nutrition in Child Growth and  Development• Adolescent HealthThe Health of Latino Children and Families
School of 

Public Health

Women’s Health MCH/Perinatal Reproductive Health/

Family Planning

Other

Boston Univ SPH

Johns Hopkins Bloomberg SPHEmory Univ

Rollins SPH

• Seminar in Women’s Health Policy  Making• Women, Development and Health• Public Health and Women• Management of Primary Care for  Women• Women’s Health• Women’s Health Policy• International Perspective on  Women, Gender, & Health• Issues in Women’s Health• Women’s Health Policy: A Lifestyle  Approach• Seminar: Race, Class, and Gender

Change

• Gender, Health and Population  Change

• MCH Policymaking• Community-Based Needs Assessment in MCH• Planning, Implementation and  Management of MCH Programs• Global MCH• MCH Research and Evaluation• Perinatal Health Services• Comparing Maternal and Infant Health  Care Systems• Planning and Managing MCH  Programs in Developing Countries• Women, Children and Adolescents:  Public Health Approaches*• MCH Legislation & Programs• Issues in Perinatal Research• Advanced Seminar in Perinatal Research• Clinical Aspects of Maternal &  Newborn Health• Maternal Healthcare in Developing  Countries• Issues in Maternal Mortality Reduction  in Developing Countries• Prevention of Infant Mortality/Promotion

of Health of Women, Infants & Children

• HIV Infection in Women, Children and  Adolescents• Research Seminar in Reproductive,  Perinatal & Women’s Health• MCH Demography• Surveillance• Pediatric and Perinatal Epidemiology• MCH Biostatistics• MCH Epidemiology methods• Applied MCH Epidemiology I, II, III  (perinatal, women’s, and children’s  health)• Field Methods in MCH Epidemiology• Introduction to MCH Program Data

• Infertility as a Public Health Problem• Reproductive Epidemiology• Population Dynamics and  Reproductive Health• Management of Reproductive Health  Programs in Developing Countries• Family Planning Policies and Programs• Couples and Reproductive Health• Reproductive Health Research in  Developing Countries: Issues and  Methods• Fundamentals of Reproductive Biology• Clinical Aspects of Reproductive  Health• Project Designs in Reproductive  Health Program• Reproductive Health Program  Management• Reproductive Epidemiology

• Professional Integration of Nurse

Midwifery and Public Health

• Sexual Violence: Public Health  Perspectives in Intervention and  Prevention• Family violence and the Practice of  Public Health• Nurse-Midwifery Management:  Normal and Complex• Introduction to Nurse-Midwifery  Management• Adolescent Pregnancy-Causes,  Consequences, Interventions- • Growth & Development I• Reproductive and Perinatal  Epidemiology• Nutrition and Growth in MCH• Principles of Health and Development  Across the Lifespan• Adolescent HealthMaternal & Child Nutrition

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School of 

Public Health

Women’s Health MCH/Perinatal Reproductive Health/

Family Planning

Other

Tulane Univ

SPHTM

• Health Care of Women• Gender, Race, and Ethnicity in  Health Education• Introduction to Issues in Obstetrics  & Gynecology• Gynecologic Problems in  Developing Countries

• Contemporary Issues in MCH• Perinatal Epidemiology• Maternal & Child Issues in HIV  Disease• Seminar in Women’s and Children’s  Health• Obstetric Problems in Developing  Countries• M&E MCH Programs in Developing  Countries

• Contraceptive Technology and Family  Planning Services• Epidemiology of Sexually Acquired  Infections & Women’s Reproductive  Health• Design/Implementation of  Reproductive Health Programs in  Developing Countries• Human Sexual Behavior• Reproductive Epidemiology• Communications Research for Family  Planning and Health• Epi of Sexually Transmitted Diseases• Epidemiology of Infectious Agents  and Reproductive Health

• Issues in Adolescent Health• Adolescent Health Policies and  Programs
APPENDIX V – RESOURCE MATERIALS

1. The Association of Teachers of Maternal and Child Health (ATMCH) offers syllabi from MCH 

 courses in the “Teaching Tools” section of its Web site. Five courses on the subject of women’s health 

 are listed. www.atmch.org/TeachingTools/TeachingTools.htm

2. The Department of Health and Human Services’ National Women’s Health Information Center offers 

 information on women’s health, including links to women’s health statistics. www.womenshealth.gov

3. The Health Resources and Services Administration Office of Women’s Health offers the Women’s 

 Health USA Databooks, plus other links to related information. www.hrsa.gov/WomensHealth/

4. The Centers for Disease Control and Prevention Office of Women’s Health offers publications and 

 other materials related to women’s health. www.cdc.gov/od/spotlight/nwhw/pubs.htm

5. The National Institutes of Health Office of Research on Women’s Health offers a multitude of 

 resources for research on women’s health. www4.od.nih.gov/orwh/

6. The Agency for Healthcare Research and Quality funds research on women’s health care. 

 www.ahrq.gov/research/womenix.htm

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