Growing Careers in Environmental Health and Eliminating Fixes that Backfire 2010 - 2011 Environmental Public Health Leadership Institute Fellow: Catherine Zeman, AAS, AS, BS, MS, PhD Associate Professor and Director; University of Northern Iowa Health Division, School of HPELS and RRTTC/CNS 207 WRC Cedar Falls, IA 50614-0241 319-273-7090 [email protected]

Mentors: Niki Lemin, MS, RS, MEP Safety Engineer, The Ohio State University Medical Center Ralph R. Van Houten Assistant Regional Director; New York State Dept. of Health

Acknowledgements: Dr. William Stigliani, PhD Professor, University of Northern Iowa Dr. Timothy J. Murphy, PhD Associate Professor, The University of Findlay

2010–2011 Fellow Project

National Environmental Public Health Leadership Institute

EXECUTIVE SUMMARY: Complex problems of environmental degradation and their relationships to human health and wellbeing call for interdisciplinary solutions. Practitioners’ who have a solid grounding in the basic sciences along with an ability to analyze environmental health science problems through a systems thinking lens will be best prepared to solve these problems. Students receive a balanced introductory education to these principles through accredited well-designed, interdisciplinary environmental health science educational programs. Without such programs, students do not develop the important interdisciplinary thinking and framing skills necessary to effectively address complex real world issues. It is possible that impacts from a paucity of comprehensive training extend into deficits in providing the 10 essential services of environmental public health as county and state health departments find it difficult to justify and advocate for their programs through the use of assessment and evaluation data. This can then translate into a lack of funding. This project investigated factors affecting the support for comprehensive environmental health education programs by exploring the barriers and enablers of interdisciplinary programs, in general, in the academy. This was explored with a cross-sectional study design using a convenience sample of faculty and staff at a mid-size regional university and through an email distribution list of faculty at educational institutions offering environmental health science education programs. Questions explored job related demographics, respondent’s views of barriers (i.e. funding, enrollment, promotion and tenure committees) and respondent’s views of enablers (i.e. administrative support, alumni support, etc.). Findings can be used to provide leadership and develop policies and incentives both within and outside the academy that support and encourage these programs which can help to strengthen long-term delivery of the 10 essential services. INTRODUCTION/BACKGROUND: We elders have an obligation to provide the upcoming generation with overviews that are simultaneously understandable, realistic, forwardlooking, and whole. I will call this the "obligation of the elders." -- Stephen Jay Kline (1) Kline traces the history of the professions in his foundational work on multidisciplinary thinking from the pre-Enlightment period of church doctrine when all knowledge was non-empirical but unified, to the development of the “natural history” paradigm based on the writings of Greek philosophers, particularly Aristotle, and on through the development of empiricism when Galileo and Newton were working on the laws of physics and planetary movement, noting that what followed was a massive blossoming of specialization and increasingly powerful applications of empiricism to explore, understand, and harness the power of natural forces and natural law (1). This also lead to a continued specialization of knowledge and professions, often developing mutually exclusive and ever more narrowly focused and specialized bodies of knowledge, professional organizations, and areas of professional practice. He notes that this continued and was reflected in the division of departments and colleges in institutions of higher learning up

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until about the 1950’s. After this point in time, the various disciplines began to see and seek multi and interdisciplinary relationships and collaborations, to construct systems of knowledge. This is especially true in the fields of environmental science and ecology which became formally established in the 1950s (1-3). Environmental public health, public health, and sanitary health work predates the renewed emphasis of knowledge in the ecology and environmental sciences, however; dating back to sanitary practices of antiquity (3). As a recognized field in the United States it dates to the early 1900s, being perhaps one of the earliest professional fields (along with medicine) to rely on a multi and interdisciplinary knowledge base to solve practical, applied problems (2). The need for solid waste management, disease management at the population level, along with clean air and water was keenly recognized in the early 1900s, as industrialization brought many environmental public health challenges to the growing industrial cities of the United States. Despite these slight differences in timelines historically; it is safe to say that the early half of the 20th Century was a time during which the professions and the academy were again awakening to the importance of seeing the “big” picture in order to address the increasingly complex problems of society(4). The sociological understanding of the construction and organization of knowledge along with how it patterns the knowledge, skills, and abilities of the larger society is an area of inquiry that has come to be recognized as important to understanding how the transfer of knowledge and technology impacts the professions and the larger community (5,6). As the historical era of increasing specialization and diversification peaked in the mid-1950s , the development of multi and interdisciplinary perspectives led to new ways of organizing and understanding systems, and systems theory found it first expression during the post-World War II era also (7,8). Environmental public health, EPH by its nature was both shaping, to some extent, and being shaped by these changes. The increasing proliferation of departments and degrees and the expansion of both the public and private post-secondary institutions reached its zenith in the mid-1970s when the new mutli and interdisciplinary fields of inquiry along with systems theory were really beginning to take off (9). From the Post-secondary education perspective it has been a struggle with decreasing enrollments, and decreasing Federal and State institutional support from that point forward (9). Driven by the demographic realities of a shrinking post-baby boom enrollment period and excess capitalization, the Universities have struggled to contain costs, pay faculty, and continue to offer innovative programs while competing for dwindling student enrollments (9). The boom days for departmental specialization and growth of new degree programs was about to come to an end in the mid-1970s and has not infrequently been replaced with recurring waves of restructuring. This has impacted the environmental health sciences through the consolidation and elimination of these, often, smaller programs, and lower enrollment courses. These are things that characterize multi- and interdisciplinary areas of study and specialization which tend to be newer, low enrollment areas having developed out of trends occurring since only about the mid 20th Century (10-13). This has had an impact on the number and vitality of environmental public health, EPH academic programs focused specifically on preparing practitioners who can function within the 10 essential services areas of environmental public health service (14,15). And this is occurring at a time when society and the profession needs more, not fewer well trained multidisciplinary problem solvers and leaders to deal with humanities looming sustainability challenges (16,17).

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The demographics of the baby-boomers continue to challenge environmental public health as a profession. The baby-boomers which had such an impact on college enrollment trends are now entering retirement. The field of EPH is expected to experience on-going waves of baby boomer retirements beginning in 2012 when 23% of the current workforce will be of retirement age (14). This is occurring at a time when both EPH and Public Health in general is continuing to experience a critical shortage of workers and an estimated 250,000 public health workers will be required to meet staffing needs by 2020 with at least 10% of those positions being EPH positions (14,15). With less than 30 accredited EHP programs around the United States, it is obvious that it will be very hard to meet the employment needs of the workforce (15). Further, it is only through accredited multi and interdisciplinary programs that the full range of skills such as the fundamental content of biology, chemistry, environmental and health sciences and the pedagogical practices of advocacy, planning, implementing, and evaluation are melded into a multi and interdisciplinary whole (18-20). This whole produces a practitioner who is much more likely to successfully and holistically deliver the 10 essential EPH services in their communities. Systems analysis offers a lens through which problems such as this can be analyzed. Meadows describes systems analysis approaches as a means of identifying and studying the parts of problems, how they affect one another, how they act together in a system, how that system responds to outside forces and maintains its characteristics over time, and how the system results or direction can be changed by changing the relationships between the parts (21). Systems theorists’ have determined a number of archetypical systems processes that help to explain systems function and can be useful in the development of system changes designed to improve systems outcomes and remediated systems related problems. Given these realities a leadership development project was proposed by the author for the 20102011 EPHLI cohort that would entail combining a systems analysis of the challenge in maintaining viable educational programs with a survey of key participants in program delivery and support in order to better understand the variables and interplay between the variables of this systems problem. The following sections of the report introduce the problem under study, describe the major trends and systems processes associated with the problem, identify its association with the 10 essential service areas of EPH, provide a logic model overview of the work, describe methodology, describe results, and conclude with a discussion of future efforts. Problem Statement: Why are essential, inter- and multidisciplinary programs, Environmental Health Science, EHS being one of them, not given broader support and funding within the Academy? The following graphics offer insights into societal and system pressures that may be influencing this problem statement along with describing a project that sought to identify barriers and supports within the academy to multi- and interdisciplinary programs such as EHS.

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Behavior Over-Time Graph: The following graph illustrates the major societal trends impacting the system relationships associated with this problem:

Funding Pressure Budget Cuts Program Development Capable Workforce 1975

1985

1995

2005+

Figure 1: Societal Trends Impacting Multi and Interdisciplinary Program Offerings

Institutional enrollment, federal and state grant dollars, and campus and program expansion increased through the 1950s and 1960s with enrollments jumping five-fold at public institutions during that period. The profile shifted in the mid-1970s and student populations along with both State and Federal financial support have since fallen (9).

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Causal Loop Diagrams and Applicable Archetypes: This diagram illustrates the internal relationships focusing on the problem statement and viewed through the systems archetypical lens of, “fixes that backfire” or “policy resistance” where actors in the system are working at odds, pulling the system in different directions, with the result that the short-term fix has larger, often unwanted long-term consequences (21).

Figure 2: Loop Diagram: Fixes that Backfire Archetype and Multi and Interdisciplinary Programs in Academe

In this case funding pressure is initially addressed through administrative budget cuts, whether targeted or across the board, small, inter- and multidisciplinary programs fair poorly in these environments. Consolidation into larger units such as biology or environmental programs often results in a loss of unique coursework; work which imparts much of the multi- and interdisciplinary nature of the EPH program. Entrenchment into traditional departments and protectionism decreases multi and interdisciplinary collaboration of the professoriate and creates a downward spiral of lack of innovation and lack of inter- and multidisciplinary enrichment. The capability of the workforce decreases as consolidation in course offerings decreases

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opportunities for multi- and interdisciplinary course offerings, leading to generalists that are often lacking in skills needed to deliver the 10 essential EPH services. 10 Essential Environmental Health Services: This project seeks to ensure fulfillment of the 10 Essential Environmental Public health services by identifying attitudinal barriers and systems archetypes that may be contributing to a lack of support for multi- and interdisciplinary programs in the Academy. Environmental public health being multi- and interdisciplinary requires entry level workers who possess skills enabling them to deliver the 10 essential services detailed in Figure 3. Thus, this project is designed to aid in the assurance of a competent workforce.

Figure 3: 10 Essential Environmental Health Services (22).

National Goals Supported 1. This project contributes information that may be of value in meeting CDC Healthy People 2020 goals by shedding light on how to achieve the educational and community base programs’ goals of incorporating more environmental health sciences content in a variety of public health education courses and programs, including such programs as public health nursing. Healthy People 2020 Objectives can be found at the following link: http://www.cdc.gov/nchs/about/otheract/hpdata2010/abouthp.htm . 2. This project contributes information that will be of assistance in understanding the forces that contribute to too few accredited EPH programs and a lack of multi- and interdisciplinary program offerings such as EPH sciences coursework. In doing so it helps to address, “Goal V. Develop the Workforce” of the National Strategy to Revitalize Environmental Public Health Services: http://www.cdc.gov/nceh/ehs/Docs/nationalstrategy2003.pdf

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3. This project aids in understanding factors that can lead to the elimination of key EPH skills such as assessment and evaluation, and how the development of generalist degrees from nonmultidisciplinary and interdisciplinary consolidated programs along with loss of multi- and interdisciplinary coursework in general can lead to a “deskilling” of the entry level worker. These are reflected in the, “Recommended Competencies” section of the “Environmental Health Competency Project: Recommendation for Core Competencies for Local Environmental Health Practitioners” of the American Public Health Association. http://www.apha.org/programs/standards/healthcompproject/corenontechnicalcompetencies.htm

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Project Logic Model: The following logic model overviews the major inputs, outputs, and anticipated short and long-term impacts of this leadership project:. Goal: To understand the pressures and relationships between pressures that exist during both good and difficult economic times which Influence the development of and support for multidisciplinary academic programs such as environmental health science.

Resources/Inputs

Expertise • Survey design • Study design • Analysis

Webhosting • UNI • Constant Contact

Partners • UNI • Survey Participants • EPHLI • AEHAP

Outputs TIER I

Activities

• Appropriate bibliography • Beta questionnaire • 5, Beta test subjects

Develop questionnaire for web survey • Literature review • EPHLI project review • Identify beta test subjects

Obtain HSRB approval and post survey for access. • HSRB application • Online survey software • Post survey, recruit subjects. Analyze data and report findings. • Use JMP 8.0 • Analyze data, look for trends • Report to EPHLI • Report to other professional associations as appropriate to findings • Publish in appropriate venues

• HSRB application • HSRB approved project • On-line ready final questionnaire • On-line survey available • 300+ email requests for participation, notice of survey availability in UNI on-line

• Excel raw data • JMP converted data • Analyzed data

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Short & Long Term Outcomes, Impacts. Resources • Additional bibliography in this area of academic inquiry • Questionnaire available to share with future researchers

Data • Opinions from academic community and academic leaders • On-line survey form also available for future researchers

Insight and Professional Reflection • Increased understanding of problems faced by interdisciplinary and multidisciplinary fields in academic setting • Ability to engage other academics in discussion of this area with pertinent, timely data

Action Items • Increased leadership capacity of environmental public health educators • Increased ability to advocate for EPH programs both in and out of the academy

Results • More efficient and effective environmental public health education • Increase support for new and existing programs

National Environmental Public Health Leadership Institute

PROJECT OBJECTIVES/DESCRIPTION/DELIVERABLES: The following provides an overview of the leadership project’s goals and objectives with an analysis of contributing factors as envisioned prior to the project survey. Program Goal To understand the variables and relationships between variables that exist during both good and difficult economic times which influence the development of and support for multidisciplinary academic programs such as environmental health science. Health Problem The quality of environmental public health services and programs is dependent upon a welltrained workforce. Environmental public health administrators note that of the 10 essential services the ability to baseline monitor and to evaluate environmental public health outcomes is the most difficult for the workforce to accomplish. One possible variable is likely to be how well employees are trained to take a systems approach to accomplishing their work. Entry level workers from non-environmental health oriented programs would have less public health, epidemiology, and environmental sciences training which tends to take a more systems oriented approach to understanding environmental/human health problems, making them less likely to understand systems oriented problems, analysis, and evaluation approaches, leading to an under skilled workforce. Outcome Objective By December 31st, 2010 elucidate the knowledge of, opinions of and perceptions of faculty of the University of Northern Iowa and through the Association of Environmental Academic Programs in regard to multi-disciplinary educational programs, their support within the academy, and the support for systems approaches to education within the institution. Determinant The number of accredited, environmental health academic programs with a systems analysis and problem solving approach is low. Impact Objective By January 31st, 2011 present findings of a cross sectional study and make recommendations tailored to the academic environment which would create supportive environments for multidisciplinary and interdisciplinary programs with a systems approach to understanding, analyzing, and solving societal problems. Contributing Factors 1. Lack of adequate funding due to budget pressures. 2. Traditional entrenchment in non-interdisciplinary, units worsened by budgetary competition. 3. Lack of interdisciplinary program development, presence. 4. No motivation to collaborate when intense pressure to attain limited resources is standard operating procedure.

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5. An “old-guard” of senior faculty ensconced in traditional disciplines is actually suspicious of inter- and multi-disciplinary programs, seeing them as a means of corporatization which undermines a basic liberal arts education. Process Objectives 1. Develop initial questionnaire for web survey review by at least 3 colleagues by August 15th, 2010. 2. Obtain HSRB approval to post survey and make available to UNI Faculty and AEHAP Members by December 1st, 2010. 3. Analyze findings and report via EPHLI and professional association outlets by January 18th, 2011 METHODOLOGY: The research portion of this project was conducted as a cross-sectional study design utilizing a convenience sample. A total of N= 711 faculty were outreached to through email and on-line newsletter requests to participate in an on-line survey. The survey instrument consisted of a 26 item questionnaire with sections covering personal and professional demographics, the respondents experiences with multi and interdisciplinary programs, the respondents perceptions of the supports to such programs and the barriers to such programs. The recruitment phase consisted of open enrollment from December 1 through December 31st , 2010 with 7 appeals via on-line newsletter and direct email appeal occurring during that time. Following full informed consent, the survey took approximately 15 minutes to complete. A total of 51 respondents completed the survey. The following events and activities detail the development and delivery of the research portion of this EPHLI project. Events and Activities Process Objective 1: Event: Beta survey developed and tested Activities: Review related literature Review past EPHLI projects Contact past EPHLI fellows Ask colleagues to review questionnaire, make suggestions Process Objective 2: Event: Approved survey completed, distributed, and in-data collection phase Activities: Submit HSRB approval application for survey Identify survey development and on-line conversion software Finalize survey once approval is obtained Post and run survey while monitoring response rate If necessary repost survey after sending email request for participation 2010–2011 Fellow Project

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Process Objective 3: Event: Completed survey data analyzed and written-up. Activities: Present to EPHLI fellows Present to appropriate professional associations, venues Develop a written article describing findings and making practical suggestions RESULTS: The following select results are presented as a result of preliminary data analysis with a summary of demographic characteristics followed by a brief presentation of major potential supports to and barriers of multi and interdisciplinary programs in the academy. Table 1: Demographics of Respondents

Demographic (n=51) Faculty Years worked Tenured? Rank

EHS% (% UNI) Classes taught per year Gender

Mean/Percentage 96% (4% staff, n=1) 12.8 69% 43% Associate; 28% Full; 21% Assistant; 8% Adjunct 22% (78%) 6.2 49% female; 51% male

sd/sem *** 7.8/ 1.12 *** ***

*** 2.36/0.33 ***

As seen in Table 1, the respondents consisted overwhelmingly of faculty with the exception of one staff person, no administrators responded to the survey. The average number of years worked was almost 13 years with well over half of the sample having received tenure. The majority of respondents were either Full professors or Associate professors (0.71). The majority of EPH respondents were off campus and the strictly EPH participants made up 22% of the sample. Average number of courses taught per year was six with a range of 1-14 classes taught. The sample was roughly evenly divided between male and female participants. When the sample was asked about their experiences and training in advocacy techniques and issues, evaluation techniques, and systems thinking approaches to problem solving, 59% of the sample reported training in systems thinking approaches to problem solving, 51% reported training in evaluation techniques, and 39% reported training in advocacy techniques. When the EPH participants responses were isolated the percentages reporting advocacy techniques training dropped to 25%, while the percentage reporting evaluation training increased to 67%, and the percentage reporting systems thinking training increased to 75%. The respondents were also asked if they felt that better students were attracted to multi- and interdisciplinary program areas with 67% indicating, yes. Sixty-five% agreed that multi- and

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interdisciplinary program areas offered increased opportunities for publication and 82% agreed that multi- and interdisciplinary programs offered increased opportunities for obtaining grant funding. Interestingly, 80% agreed that in their experience multi- and interdisciplinary academic programs were more attractive to potential University donors. Respondents were asked to identify the main supporters and barriers to multi and interdisciplinary education on a Likert scale consisting of the options never, rarely, sometimes, very often, and always. Tables 2 (support) and 3 (barriers) present the top faculty identified supporters of multi and interdisciplinary programs (a fusion of the very often and always categories) and the top faculty identified barriers to multi and interdisciplinary programs in the academy respectively and in order of ranking. Table 2: Potential Supporters of Multi and Interdisciplinary Academic Programs

Demographic (n=51) Administration Students Faculty Regents Community Legislature

Total % 44 39 26 24 20 18

Always % 0 6 4 2 4 0

Very Often% 40 33 22 22 16 18

As Table 2 indicates, respondents identified University Administration as offering the highest degree of possible support for multi and interdisciplinary programs followed by Students and then Faculty. The Legislature was seen as least supportive of such endeavors. Table 3: Potential Barriers to Multi and Interdisciplinary Academic Programs

Demographic (n=51) Administration Faculty Legislature Regents Community Students

Total%

Always% 30 30 25 18 6 6

8 4 2 4 0 2

Very Often% 22 26 23 14 6 4

Table 3 indicates that while Administration and Faculty are viewed as having the highest degrees of support they are also viewed as presenting some of the greatest barriers. The position of the Legislature in the top three as a barrier to multi and interdisciplinary programs is consistent with its low ranking as a support to such programs. Data analysis is on-going with bivariate analysis indicating significant relationships between select responses and demographics such as years of experience, tenure status, faculty rank, college affiliation, number of classes taught, and gender. These analyses will be included in a manuscript which is being prepared for submission to the professional literature.

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CONCLUSIONS: The group sample size is small and that should be recognized as a limitation of the study. It should also be acknowledge that the sample was self-selected for individuals who would respond out of interest to the call for participants. While this introduces self-selection bias, it also assures that the respondents had a high degree of interest and also experience with multi and interdisciplinary programs. Generally the demographics illustrate a high degree of experience and reflect a solid sampling of faculty who are currently teaching classes. Given the years of experience it also important to note that while a majority of respondents’ had some training in systems thinking approaches, only a little over half had training in evaluation techniques and far less had advocacy training with the EPH respondents’ having the least reported training in advocacy but the greatest in systems thinking approaches to problem solving. This raises the obvious point that we cannot expect the faculty to impart to students what they are unfamiliar with themselves. And it is particularly surprising that EPH faculty had such low percentages of training in advocacy techniques which generally involve information and practical training on how to not only advocate for the communities that one serves but also to advocate on behalf of one’s programs. The findings illustrate that faculty recognize both the potential and the peril represented by Administration and other Faculty in that they are both potential supports to and barriers to multiand interdisciplinary programs. Students are seen as supporters of such programs and faculty indicated that they believed these programs have the potential to encourage increased publication activities and garner additional grant funds. These findings indicate several possible leverage points to this system process when viewed through the lens of the fixes that backfire archetype. Meadows indicates that in order to move forward out of the fixes that backfire cycle, all parties must be willing to redefine their goals through discussion so that instead of working at odds they begin working together towards a larger goal (21). This leads to several suggestions: 1. Faculty should be given the opportunity to improve their advocacy/leadership and systems thinking skills so that effective infusion of these skills occurs in the curriculum. 2. Students are seen as advocates and the community and legislature are seen as either indifferent or a barrier. Students can provide a great deal of advocacy and outreach to both of these constituencies about the importance of multi- and interdisciplinary programs, about the value of systems thinking, and about the need for entry level employees to possess these skills, if they are to address the environmental and sustainability challenges that our society faces. 3. Faculty and administration need to build bridges with each other through supportive, ongoing opportunities for faculty development and faculty/faculty and faculty/administration interactions and discussions on these topics. 4. Administration is in a unique position to encourage support for interdisciplinary and multidisciplinary efforts and to make a case for their importance and on-going funding,

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as well as supporting faculty development opportunities. This should include opportunities for multi- and interdisciplinary and team taught courses that help to break down discipline specific barriers leading to creative synthesis (23, 24). 5. The professional societies particularly in the EPH community should not be overlooked as important players in advocacy efforts with sectors of the community and legislature that may be viewed as indifferent or barriers to support of EPH academic programs. LEADERSHIP DEVELOPMENT OPPORTUNITIES: Dr. Catherine Zeman This project has provided a rich experience in understanding of self and others. The educational and professional enrichment opportunities I have been given the privilege of experiencing have been truly rewarding and I am very grateful for that. The EPHLI experience is integrated and builds on itself. In that regard the project PIs and Mentors have designed an experience which models what they, themselves teach about systems thinking and leadership development, which is both a testament to and an indication of their skill, commitment and passion for this area. I am certain that I will have many occasions to put these skills to good use in my career, thank-you again for this privilege.

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ABOUT THE EPHLI FELLOW Dr. Zeman received her Ph.D. in Preventive Medicine with emphasis on Environmental and Occupational Health form the University of Iowa and a Masters in Environmental Science from Southern Illinois University. Her undergraduate background includes degrees in nursing, biology, and Anthropology. She teaches classes in epidemiology, human diseases, environmental health, and environmental and occupational health regulations. Dr. Zeman is a member of the American Indian Science and Engineering Society and of the NAAAS Affiliate, National Association of Native American Studies Her research interests include: nitrates in the environment and their impact on human health with focus on children’s health, industrial ecological principles of precision manufacturing, international health issues, understanding the health issues of underserved populations, environmental sustainability, workplace health and safety and wellness, and documenting pollution prevention practices on worker health and safety. Dr. Zeman was a Fulbright Scholar to Romania on environmental health issues during the Spring/Summer of 2004. Dr. Catherine Zeman is also the Director of the Recycling and Reuse Technology Transfer Center, at the University of Northern Iowa where she oversees a staff of 15 student employees, researchers and full and part-time staff. She is an Associate Professor in the Health Division, School of HPELS, at the University of Northern Iowa.

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REFERENCES 1. Kline, S. J., Conceptual Foundations for Multidisciplinary Thinking. Stanford, CA: Stanford University; 1995. 2. Klein, J. T., Integrative Learning and Interdisciplinary Studies. Peer Review, 2005;7(4), 8+. 3. Hammond, D., The Science of Synthesis. Colorado: University of Colorado Press; 2003. 4. Brandt, A. M., and M. Gardner, Antagonism and Accommodation: Interpreting the Relationship Between Public Health and Medicine in the United States During the Twentieth Century. American Journal of Public Health , 2000; 90:707 – 715. 5. Derry, S. J., Schunn, C. D., & Gernsbacher, M. A. (Eds.), Interdisciplinary Collaboration: An Emerging Cognitive Science. Mahwah, NJ: Lawrence Erlbaum Associates; 2005. 6. Gumport, P. J., & Snydman, S. K., The Formal Organization of Knowledge: An Analysis of Academic Structure. Journal of Higher Education, 2002; 73(3), 375+. 7. Senge, P.M., Kleiner, A., Roberts, C., et al. The Firth Discipline Fieldbook, New York: Doubleday; 1994. 8. Rowitz, L., Public Health Leadership, Boston: Jones and Bartlett Publishers; 2009. 9. Sims, R. R. & Sims, S. J. (Eds.), Managing Institutions of Higher Education into the 21st Century: Issues and Implications. New York: Greenwood Press; 1991. 10. Mcgehee, J. J., Developing Interdisciplinary Units: A Strategy Based on Problem Solving. School Science and Mathematics, 2001;101(7), 380+. 11. Panaritis, P., Beyond Brainstorming: Planning a Successful Interdisciplinary Program. Phi Delta Kappan, 1995;76(8), 623+. 12. Rover, D. T., Interdisciplinary Teaching and Learning: What, Why, and How. Journal of Engineering Education, 2002; 91(4), 369+. 13. Interdisciplinary Health Research Training: Behavior, Environment, and Biology. Environmental Health Perspectives, 2004;112(1), 54+. 14. ASPH, Confronting the Public Health Workforce Crisis: ASPH Statement on the Public health workforce, February 2008 Workforce Crisis: ASPH Statement on the Public Health Workforce, February 2008, http://www.asph.org/UserFiles/PHWFShortage0208.pdf, accessed December 30, 2010. 15. CDC, A National Strategy to Revitalize Environmental Public Health Services, http://www.cdc.gov/nceh/ehs/Docs/nationalstrategy2003.pdf, accessed September 8, 2010. 16. Berg, R., Profiles in Leadership, Part II: The 15 Faces of Environmental Health Leadership. Journal of Environmental Health, 2007;69(6), 57+. 17. Clark, M. E. & Wawrytko, S. A. (Eds.), Rethinking the Curriculum: Toward an Integrated, Interdisciplinary College Education. New York: Greenwood Press; 1990. 18. Gordon, L., Setting the Context: Environmental Health Practitioner Competencies. Journal of Environmental Health, 2002;65(1), 25+. 19. Knight, P., & Yorke, M., Learning, Curriculum, and Employability in Higher Education. New York: RoutledgeFalmer; 2004. 20. Lebel, J., Health: An Ecosystem Approach. Ottawa: International Development Research Centre; 2003. 21. Meadows, D.H., Thinking in Systems, White River,Vermont: Chelsea Green Publishing; 2008. 22. CDC, Environmental Public Health Leadership Institute (EPHLI); Leadership Training

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Sessions; Atlanta, GA; February, 2010. 23. Jahanian, S., & Matthews, J. M., Multidisciplinary Project: a Tool for Learning the Subject. Journal of Engineering Education, 1999;88(2), 153+. 24. Kaufman, D., Moss, D. M., & Osborn, T. A. (Eds.), Beyond the Boundaries: A Transdisciplinary Approach to Learning and Teaching. Westport, CT: Praeger; 2003.

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