Cover page

Table of Contents

Title page

Dedication

Figures and Tables

Figures

Tables

Foreword

Preface

Organization of This Book

Conclusion

Acknowledgments

The Editors

The Contributors

Part 1: Defining Transdisciplinary Research and Education

Chapter 1: Transdisciplinary Public Health: Definitions, Core Characteristics, and Strategies for Success

The Four Phases of a TD Initiative

Characteristics of TD Public Health

Summary

Key Terms

Review Questions

Chapter 2: Transdisciplinary Training and Education

Value of Transdisciplinary Approaches for Health Promotion

Attributes of Successful Transdisciplinary Teams

The Genesis of Interdisciplinary and Transdisciplinary Training

Summary

Key Terms

Review Questions

Chapter 3: Competencies in Transdisciplinary Public Health Education

Competencies for Transdisciplinary Public Health

Development of Transdisciplinary Competencies

Implementation of Transdisciplinary Competencies in the MPH Curriculum

Integrating Transdisciplinary Competencies into Nontransdisciplinary Coursework

Integrating Transdisciplinary Competencies into the MPH Culminating Experience

Development of a Transdisciplinary Public Health Professional

Summary

Key Terms

Review Questions

Chapter 4: Measuring Success: An Evaluation Framework for Transdisciplinary Public Health

Overview of TD Initiative Evaluation

An Ecological Evaluation Framework

Strategies for Implementing a TD Initiative Evaluation

Case Study: Applying the Framework to an Initiative

Summary

Key Terms

Review Questions

Part 2: Cross-Cutting Themes in Transdisciplinary Research

Chapter 5: Transdisciplinary Approaches: Sorting Out the Socioeconomic Determinants of Poverty and Health

Models of Health Behavior

Analytical Tools for Addressing Poverty and Health

Innovative Transdisciplinary Policy Interventions

Disseminating Results of Transdisciplinary Analysis

Summary

Key Terms

Review Questions

Chapter 6: Transdisciplinary Public Policy: The Roles of Law and Public Health in Creating Public Policy

Why Policy and Law Are Important to Public Health

Roles for Law and Public Policy in Public Health

A Public Health Perspective on Public Policy and Law

Summary

Key Terms

Review Questions

Chapter 7: Sociocultural Perspectives Applied to Transdisciplinary Public Health

Problem Analysis

Solution Analysis

Summary

Key Terms

Review Questions

Chapter 8: Evidence-Based Decision Making: Transdisciplinary Problem Solving to Improve the Health of the Public

Historical Background and Core Concepts

Key Characteristics of Evidence-Based Decision Making and Transdisciplinary Problem Solving

Analytical Tools and Approaches to Enhance Uptake of EBPH

An Approach to Increasing Use of Evidence in Trandisciplinary Public Health Practice

Barriers to EBPH and Potential Solutions

Summary

Key Terms

Part 3: Transdisciplinary Practice: Case Studies in Domestic Health

Chapter 9: Transdisciplinary Methods in the Prevention and Control of Maternal-Child Obesity

Application to Real-World Problems

Course Section 1: Introduction to Transdisciplinary Problem Solving

Course Section 2: Transdisciplinary Problem Analysis

Course Section 3: Transdisciplinary Solution Analysis

Course Section 4: Presentation of Team Solutions to Partners and Stakeholders

Systematic Evaluation Methods

Summary

Key Terms

Review Questions

Chapter 10: Transdisciplinary Approaches to Violence and Injury Prevention and Treatment among Children and Youth

Overview and Rationale

Injury Prevention, Causes, and Impacts

Problem Identification and Structuring

Solution Analysis and Evaluation: Case Examples

Dissemination of Findings

Measures of Collaboration and Change

Ongoing Needs

Summary

Key Terms

Review Questions

Chapter 11: Transdisciplinary Problem Solving for Integrating Public Health and Social Service Systems to Address Health Disparities

The Challenge

Course Overview

Lessons Learned

Summary

Key Terms

Review Questions

Part 4: Transdisciplinary Practice: Case Studies in Global Health

Chapter 12: Transdisciplinary Problem Solving for Global Hunger and Undernutrition

Brief History

Conceptual Framework

Content and Application of TPS Approaches

Evaluation Methods

Summary

Key Terms

Review Questions

Chapter 13: Implementing Public Health Interventions in Developing Countries: A Transdisciplinary Solution for Safe Drinking Water in Rural India

General Heuristic for Solution Analysis

Case Study: Water Contamination in Alakudi

Lessons Learned

Summary

Key Terms

Review Questions

Chapter 14: Indoor Air Pollution and Respiratory Health: A Transdisciplinary Vision

Household Air Pollution: A Complex Challenge

Ineffective and Failed Interventions: Explanations and Challenges

Household Air Pollution and Health Effects: A Transdisciplinary Approach

Transdisciplinary Framework for Examining Respiratory Health Outcomes from Clean Cookstoves

Summary

Key Terms

Review Questions

Name Index

Subject Index

Title page

For Corrie, Joel, and Chris

For Shirley L. Porterfield

Figures and Tables

Figures

Figure 1.1. Four phases of a transdisciplinary initiative

Figure 3.1. Mapping transdisciplinary competencies to specific course assignments

Figure 3.2. Disciplines students identified as likely to be relevant to solving a particular public health challenge

Figure 4.1. Evaluation logic model for transdisciplinary public health

Figure 5.1. A social ecological model of health behavior

Figure 5.2. Investment and consumption in the health capital model

Figure 8.1. Transdisciplinary evidence-based decision making

Figure 8.2. Sources of evidence

Figure 8.3. A framework for evidence-based public health

Figure 9.1. A framework to prevent and control overweight and obesity

Figure 10.1. An ecodevelopmental perspective

Figure 10.2. Trends in intentional and unintentional injury rates per 100,000 children, 2001–2009

Figure 12.1. Maternal and child undernutrition

Figure 12.2. BCC messages

Figure 12.3. KickStart irrigation pump effects on nutrition and health

Figure 12.4. CDC logic model components

Figure 13.1. Water structures in Alakudi

Figure 13.2. Water tap distribution in Alakudi

Figure 14.1. Conceptual model of sociocultural, technological, market, and ecological drivers influencing sustained use of clean cookstove technologies

Figure 14.2. A framework for studying respiratory health outcomes from clean cookstove use

Tables

Table 1.1. Goals and processes of the four phases of a transdisciplinary initiative

Table 3.1. Examples of core competencies in twelve areas of public health for MPH graduates, as defined by ASPH

Table 3.2. Example of a matrix for assessing inclusion of TPS competencies in an MPH curriculum

Table 3.3. Questions to assess transdisciplinary aspects of group work

Table 4.1. Transdisciplinary program evaluation measures and sources

Table 4.2. Assessment tools for evaluation of TD students

Table 4.3. Mapping the evaluation framework onto the Washington University TD initiative

Table 5.1. Summary of effects of health capital model variables on health status

Table 6.1. Defining law and public policy

Table 6.2. Examples of interventional public health laws

Table 8.1. Contextual variables for intervention design, implementation, and adaptation

Table 8.2. Competencies in evidence-based public health

Table 8.3. Potential barriers and their solutions in evidence-based decision making

Table 10.1. Connecting age and developmental levels to prevention strategies

Table 10.2. Roles and expertise of selected disciplines in injury prevention and intervention

Table 12.1. Examples of program types for addressing undernutrition

Table 13.1. Key course elements

Foreword

Transdisciplinarity has become the academic and policy word of our time in public health. Research initiatives, teaching and degree programs, public health interventions, service delivery systems, even ideas about architecture, are being defined by the promise of this new approach to framing problems and solutions across disciplinary lines.

We are still at the beginning of this project, the hopeful stage. We still have more rhetoric than we have useful examples and evidence of the payoffs of this approach. This book makes a great leap in the conceptualization of transdisciplinary approaches and also provides concrete examples in practice, teaching, policy, and research.

There are many barriers between us and the ultimate success of this enterprise. Scholars select a particular discipline for deep personal and professional reasons, and they are socialized and reinforced early in their careers to achieve excellence within a relatively narrow band of research. Incentives, from funding to academic promotion, reinforce these boundaries. Organizations—from academic departmental structures to research institutes to public sector agencies to professional societies—define a certain scope of interaction and discourse. Outlets like professional journals and conferences by and large line up along traditional lines of disciplines and program interventions. More subtle barriers—like language, psychology, culture, status differences within the sciences, “town and gown” tensions between potential community and academic partners, and academic prejudices—also get in the way of the free flow of ideas and academic traffic that is envisioned by this field.

The good news is these barriers are breaking down at a furious pace. Funding is starting to reward transdisciplinary work in a serious way. Pioneer academics and practitioners—such as those contributing to this book—are conceptualizing the field, creating methods of transdisciplinary work, and training the next generation of scholars and practitioners. Organizational innovation and true partnerships are lagging behind, but the right relationships and conversations are emerging.

So I cannot help but think what the next generation, the second edition of this book, will look like. Let’s imagine that transdisciplinary time is like Internet time, and the pace of innovation and change in the field will occur at warp speed. The next edition of this book will not be a collection of individual chapters by individual authors, but rather team written, using a common language and replete with the kinds of innovative models, practice solutions, pedagogies, policy breakthroughs, and organizational inventions that are the promise of the transdisciplinary field. The teams will operationalize the kinds of scholarly, practice, and translational collaborations that are the vision of this book. As Daniel Stokols and his colleagues state in chapter 1 of this first edition in their definition of the field, “scholars and practitioners from both academic disciplines and nonacademic fields work jointly … to yield innovative solutions to particular scientific and societal problems” [emphasis added]. The next generation book will have evidence and evaluation not only of process approaches to transdisciplinarity but also of effective interventions, solutions, and outcomes.

In the meantime this book, Transdisciplinary Public Health, has given us the wherewithal to make great and rapid progress in advancing this field. We have new conceptual and definitional clarity and a roadmap for some of our intellectual and practice development, such as in systems science and cross-sector service delivery approaches. We have examples of early success and early innovations across teaching, research, and service delivery applications. Perhaps most important, the book conveys the sense of excitement and energy that this vanguard of academics and practitioners is bringing to this new field.

Edward F. Lawlor

Preface

As public health and social problems have become more complex, the understanding of these problems and the design of solutions to these problems requires both perspectives from multiple disciplines and fields and cross-disciplinary research and practice teams. This need to blur the boundaries between disciplines and between fields, to bring in scholars and perspectives from a range of disciplines, has led to the development of the field of transdisciplinary public health. Transdisciplinary collaborations require the creation of fundamentally new conceptual frameworks, hypotheses, and research strategies that synthesize diverse approaches and ultimately extend beyond them to transcend preexisting disciplinary boundaries and ultimately to translate research findings into practical solutions to real-world social problems.

In two path-breaking reports,1,2 in 2003 and 2006, that respond to the growth of the literature on transdisciplinary methods, the Institute of Medicine reviewed this literature and spoke to the need to expand beyond traditional educational methods that favor unidisciplinary approaches (focusing, for example, on epidemiology, behavioral science, or economics) and that teach students to focus on individual pieces of population health puzzles. These traditional approaches maintain the existing scientific knowledge “silos” that can limit the understanding of complex systems that affect population health. In contrast, transdisciplinary methods hold promise as an effective tool set for problem solving in public health research and practice. However, effective use of these methods requires the development of public health professionals who can understand the interactions among the biological, behavioral, social, and public health sciences; use this knowledge in the development of shared disciplinary frameworks for analyzing health problems; and then improve practice by integrating and evaluating transdisciplinary solutions. Thus, as with any new public health methodology, this approach requires the development of new knowledge and skills and their integration into public health education programs and schools. In the words of the reports:

The most striking change in public health research in the coming decades is the transition from research dominated by single disciplines, or a small number, to transdisciplinary research. … The practical ramifications of the transdisciplinary approach to education are that schools of public health may need to rethink their structure and modes of instruction in order to develop professionals that can interact synergistically when confronting health concerns. … Schools of public health have a primary responsibility for educating faculty, researchers, and senior-level practice professionals. The challenges of the 21st century require an educational approach that is ecological in nature, an approach that emphasizes the determinants of health and their interaction. Education for public health in the 21st century requires cultural competence, and broad new competencies in information technology, communication, and genomics, and a vast reemphasis on practical aspects of training.1

 Through transdisciplinary research, we can achieve a far greater understand­­ing of how the interactions of social, behavioral, and genetic factors affect health and illness. This knowledge, in turn, will enable major improvements in the well-being of individuals and populations. … Many intermediate steps are required, including the training of investigators in transdisciplinary research.2

Organization of This Book

Transdisciplinary Public Health: Research, Education, and Practice, provides a roadmap for educating students in public health programs in ways that develop competency in transdisciplinary research and practice. The book is divided into three sections.

Part 1 provides an overview of the concepts and practices involved in designing a public health education program. It begins with a chapter by Daniel Stokols, Kara Hall, and Amanda Vogel titled “Transdisciplinary Public Health: Definitions, Core Characteristics, and Strategies for Success.” This chapter provides a foundation by describing transdisciplinary research and practice as it is conceptualized in this book (and currently in the public health research community). The conceptualization reflects the unique characteristics of the approach. This is followed by a description of the four phases that make up a transdisciplinary initiative and the goals and processes that define each phase. This discussion takes into account the roles of individuals, teams, and organizations in carrying out an initiative. Finally, the important factors and characteristics specific to transdisciplinary public health are presented.

In chapter 2, Sarah Gehlert and Teri Browne describe best practices for training a new generation of scholars to function in a transdisciplinary way. They also provide a review of the literature on the components of successful transdisciplinary teams, discuss how this literature is incorporated into model transdisciplinary training programs, and offer recommendations for training.

Designing transdisciplinary education and training requires specific attention to the transdisciplinary competencies and skills needed by students, a subject explored by Lauren Arnold, J. Aaron Hipp, Anne Sebert Kuhlmann, and Elizabeth Budd in chapter 3. Building on the foundations of the previous chapters, they describe transdisciplinary competencies as important guiding principles for public health, and provide steps for ensuring that appropriate transdisciplinary skills are integrated into public health degree programs.

Chapter 4 presents an innovative evaluation framework, created by chapter authors Douglas Luke, Sarah Moreland-Russell, and Stephanie Herbers, that is useful for planning and implementing evaluations of transdisciplinary training programs in public health. This framework can be applied to the evalua­­tion of transdisciplinary initiatives across any institution; it offers objective indices for assessing transdisciplinary training programs and institutional transdisciplinary integration in an academic setting. The chapter also pro­­vides an example of one such initiative and recommendations for future evaluations.

The chapters in part 2 address cross-cutting themes underlying transdisciplinary research and practice. They offer readers the opportunity to reorganize individual, team, and organizational thinking and practice around trans­disciplinary research and practice, as a means of promoting long-lasting solutions to complex problems in human health. In addition, they present four diverse perspectives on transdisciplinary methods as applied to several public health issues.

In chapter 5, Timothy McBride, Lisa Pollack, Abigail Barker, and Leah Kemper focus on the issue of the social determinants of health, and particularly the role of economic inequality, from a transdisciplinary point of view. They present examples of innovative transdisciplinary theories from public health and economics that are being used to understand the impact of inequality on health, and then they offer a range of new empirical methods, drawn from the burgeoning field of simulation models, that mirror these transdisciplinary theoretical methods in order to illustrate how these methods can be used to understand complex public health problems. Finally, these authors explore how such methods are translated into policy, the final action step of transdisciplinary practice.

The use of law and public policy as prime tools for implementing transdisciplinary research is explored by Sidney Watson in chapter 6. Though such use is not widely understood or explored, Watson argues that law and public policy are at the core of transdisciplinary public health research and practice, and she describes methods that allow lawyers to work more effectively as part of transdisciplinary teams using public policy and law.

Chapter 7, by Bradley Stoner, describes ways in which anthropologists and other social scientists, working as members of transdisciplinary teams, examine cultural perspectives on health and integrate these cultural approaches into interventions designed to minimize health risks.

Finally, Ross Brownson describes integrating evidence-based public health practice into transdisciplinary methods, in chapter 8. He notes that the hallmark of transdisciplinary problem solving is its emphasis on the translation of research findings into practical solutions to social problems—that is, transdisciplinary action research. This requires using evidence-based methods to inform transdisciplinary approaches and translate scientific outcomes into practical applications. This chapter comprehensively addresses the transdisciplinary aspects of each part of the process of acquiring and applying scientific evidence, and the importance of this process to public health education and training.

Parts 3 and 4 introduce six case studies of transdisciplinary methods; these cases were designed to solve real-world problems through classroom learning. The chapters are divided between domestic and international experiences. The three chapters in part 3 focus on current domestic public health issues. In chapter 9, Debra Haire-Joshu explores integrating transdisciplinary methods into an inventive course on the prevention of maternal-child obesity, a major focus of current public health policy. The course demonstrates how to employ transdisciplinary methods while working with home-visiting organizations to prevent obesity, thus operating in a real-world setting.

Chapter 10, by Melissa Jonson-Reid, Nancy Weaver, Brett Drake, and John Constantino, describes a transdisciplinary course on developing approaches to violence and injury prevention in youth. This innovative course incorpo­­rates the use of theoretical perspectives from numerous disciplines in solving child maltreatment problems and explores how this learning can lead to new solutions.

Matthew Kreuter and Debbie Pfeiffer then offer, in chapter 11, a description of another innovative course, one that uses transdisciplinary skills to link public health and social service systems in order to promote tobacco control and treatment. Collaborations involving both food stamp offices and tobacco quitlines (telephone counseling) result in a real-world illustration of transdisciplinary problem solving.

The final three chapters, in part 4, present internationally focused courses on malnutrition, water sanitation, and air pollution. First, Lora Iannotti discusses a course that reviews the critical disciplines that should serve as a foundation to transdisciplinary problem solving in relation to global hunger and undernutrition in developing countries. In chapter 12, she shows how students can use these transdisciplinary methods to track the progress of three action domain working groups (in research, programming, and policy), and she offers methods to critically evaluate student performance.

In chapter 13, Ramesh Raghavan, Ravikumar Chockalingam, and Zeena Johar present a fascinating case study of a course implemented in rural India, where students using a transdisciplinary framework developed an understanding of real-life health problems facing communities and found ways to assist these communities in overcoming the problems. Students worked on transdisciplinary teams on one of five assigned public health challenges and integrated insights from a variety of disciplines into solutions, learning how the concepts of social ecology in public health and differing worldviews can be reconciled with the realities of life in the developing world.

Finally, Gautam Yadama, Kenneth Schechtman, Pratim Biswas, Mario Castro, and Nishesh Chalise add a unique perspective to transdisciplinary public health through their description of another intriguing case study, this one focused on the evolving and interlinking trajectories of household energy choices, local ecologies, and rural livelihoods in India. Using this real-world example, the authors offer examples of the transdisciplinary training of the next generation of public health practitioners so that they can effectively address environmental issues affecting the very poor.

Conclusion

This book combines an introduction to transdisciplinary methods and practice with new perspectives on transdisciplinary public health, and applies all this to a description of how these methods can be applied and implemented in public health education and training. The chapter authors offer a range of disciplinary perspectives and contributions, providing real-world examples of the importance of transdisciplinary approaches to public health practice and training.

A challenge to date in the public health profession has been how to ef­­fectively and practically apply transdisciplinary concepts to public health education and training. This book presents numerous case studies that address this challenge, along with evaluation of the approaches presented and methods for implementing these approaches. It is intended that readers will discover how to engage in education, policy, and practice that recognize the linkages between and across multiple aspects of our society and its environment, and that they will then be able to integrate these findings across multiple social perspectives and fields of knowledge into solutions that lead to the betterment of the public’s health. Transdisciplinary methods represent our best hope for solving complex public health and social problems, and it is crucial that our education programs, now focused largely on unidisciplinary approaches, be developed to incorporate these methods.

Acknowledgments

We would like to acknowledge the invaluable assistance of Lisa Pollack, Kimberly Freels, and Jamie Adkisson. Karen Emmons, Vincent Francisco, Laura Rasar King, Lynne MacLean, Kenneth R. McLeroy, Robin Lin Miller, and Daniel Stokols provided valuable feedback on the original book proposal. Lynne MacLean and Kenneth R. McLeroy also provided thoughtful and constructive comments on the complete draft manuscript. Thank you to all of these reviewers.

Debra Haire-Joshu and Timothy D. McBride

Notes

1. Gebbie K, Rosenstock L, Hernandez LM; Institute of Medicine, Committee on Educating Public Health Professionals for the 21st Century, eds. Who Will Keep the Public Healthy?: Educating Public Health Professionals for the 21st Century. Washington, DC: National Academies Press; 2003.

2. Hernandez LM, Blazer, DG, eds.; Committee on Assessing Interactions among Social, Behavioral, and Genetic Factors in Health, Board on Health Sciences Policy. Genes, Behavior, and the Social Environment: Moving beyond the Nature/Nurture Debate. Washington, DC: National Academies Press; 2006.

The Editors

Debra Haire-Joshu, PhD, is the Joyce Wood Professor and associate dean for research in the Brown School at Washington University in St. Louis, and holds a secondary appointment with the School of Medicine. She is an internationally renowned scholar of health behavior who develops population-wide interventions to reduce obesity and prevent diabetes, particularly among underserved youth. She directs the Center for Obesity Prevention and Policy Research and the Center for Diabetes Translation Research. Her current research is supported by a number of National Institutes of Health (NIH) agencies—including the National Cancer Institute, the National Institute of Diabetes and Digestive and Kidney Diseases, and the Centers for Disease Control and Prevention—and the Missouri Foundation for Health. Her studies include translation of evidence-based obesity prevention approaches through national organizations. Her work includes the development of a model statewide database for evaluating obesity-related policies in Missouri. This system is now being disseminated to other states across the country. She was recently a member of the Institute of Medicine Committee on Obesity Prevention Policies for Young Children, aged zero to five years. She served as a Health Policy Fellow in the office of Senator Barack Obama and as a Robert Wood Johnson Health Policy Fellow for the Committee on Health, Education, Labor and Pensions when it was chaired by Senator Edward Kennedy. Her work as chair of the Health Policy Committee of the Society of Behavioral Medicine led to her appointment as a Distinguished Fellow of that society. She is also a member of Delta Omega, the honorary society for public health. She has published and presented her research extensively, and reviews for numerous professional journals and NIH research review groups.

Timothy D. McBride, PhD, is a professor in the Brown School at Washington University in St. Louis, and a health policy analyst and leading health economist shaping the national agenda in rural health care, health insurance, Medicare policy, health economics, and access to health care. He is currently studying the uninsured, Medicare Advantage and Medicare Part D in rural areas, health reform at the state and national levels, access to care for children with special health care needs, and long-term Social Security and Medicare reform. In addition to his scholarly publications in leading journals, he has produced a collection of reports, white papers, and other policy products that have contributed to the national policy debate. He has testified before Congress and consulted with important policy constituents on Medicare and rural health policy. He is a member of the Rural Policy Research Institute Health Panel that provides expert advice on rural health issues to Congress and other policy­makers. He serves as a member of several national committees and boards, including the advisory board of the American Society of Health Economists (ASHE), the editorial boards for the Health Administration Press and the Journal of Rural Health, and the methods council for AcademyHealth, and is cochair of the Health Policy Faculty Forum for the Association of University Programs in Health Administration.

The Contributors