The Athletic Trainer's Contribution to Public Health Practice

Athletic training remains a relatively young profession, and as athletic trainers we continue to discover our identity, find new ways to be nimble in an ever-changing health care arena, and recognize ways we have long contributed to the health and well-being of individuals and populations. In the few words I have here, I hope to advance the athletic trainer's understanding of public health as a discipline, why much of what athletic trainers do falls under the broadly defined public health umbrella, and why the profession of athletic training should consider introductory public health education in our programs.

It is important to note up front that I do not have a degree in public health. However, I have had the opportunity to be part of a leadership team in a college that recently pursued and received accreditation from the Council on Education for Public Health. Through that process I learned a great deal about the public health discipline: the work, the practitioners, the passion, and the identity. In some ways the parallels between athletic training and public heath are remarkable. For example, there is an ongoing initiative to help people understand public health, called This is Public Health,¹ aimed at highlighting things around all of us that fit under the public health umbrella. On the educational front, discussions about competencies, degree level, and accreditation standards are common to both fields. Over the past few years, as I have worked more and more with people traditionally trained in public health and gained a deeper understanding of the scope of the discipline, it didn't take long to realize that much of the work done by athletic trainers is public health!

In August of 2015, the College of Public Health and Human Sciences at Oregon State University hosted the inaugural Athletic Training and Public Health Summit. We brought together people from the fields of athletic training, public health, and medicine. Over the course of the 2-day meeting, areas of professional overlap, collaboration, and next steps were identified. One of the outcomes from the meeting focused on the educational need for athletic trainers in some of the traditional areas of public health education. Traditionally, public health education has been divided into the subdisciplines of biostatistics, environmental health sciences, epidemiology, health services administration, and social and behavioral sciences. Although the clinical practice of athletic training may not overlap extensively with all of these subdisciplines, the areas of intersection and potential collaborations within the broader fields of athletic training and public health are evident. For example, athletic trainers partner with epidemiologists in injury surveillance programs related to the incidence of concussions or orthopaedic injuries as well as provide expertise in the development of sport safety policy development and implementation.

Critical to the discussion of public health education for athletic trainers is the fundamental understanding that public health practice focuses on population-level work whereas the practice of athletic training is traditionally viewed as focusing on the individual. In fact, in public health the term population health is becoming more widely used because of the clear focus on the health outcomes for a group or population. There are many areas of athletic training where public health practices are used. For example, in the athletic training context this may be studying the population of physically active females with respect to anterior cruciate ligament injury, understanding a methicillin-resistant Staphylococcus aureus outbreak, promoting a tobacco-free sport environment, or assessing a concussion policy.

We are not the first health care profession to have a discussion about how our work intersects with public health. Many areas of medicine, especially primary care, have embraced the understanding that care of and attention to the individual are enhanced by work focused at the population level. In fact, the Centers for Disease Control have an entire set of resources called Public Health and Clinical Care Integration, focused on connecting primary care and public health.² In athletic training, we have for a long time focused on the health of groups: a team, the athletes at a school, or the athletes in a defined age group. Critical now is that we embrace our connection with public health and focus on ways to educate the developing and existing athletic training workforce in ways that expand our traditional focus on the individual to include basic tenets of public health education and practice.

The idea of how the profession of athletic training can contribute to the health of different populations has been discussed informally for years. I first heard Jennifer Hootman, PhD, ATC, FNATA, talk about this connection in 1997. Ten years later, Stephen Thacker,³ MD, MSc, published an article in 2007 focused on injury surveillance and the importance of data to drive initiatives and the associated funding. In 2012, David McClaskey,⁴ ATC, wrote an article titled “The Relevance of Athletic Training to Public Health” and identified the athletic training educational competencies most directly connected to public health practice. Indeed, one of the most significant steps for highlighting the role of athletic trainers as public health practitioners was the addition of the Prevention and Health Promotion (PHP) content area in the fifth edition of the Athletic Training Educational Competencies.⁵

Although most athletic training educators appreciate the daunting task of developing the competencies for our profession, it is time for a small upgrade to the PHP section of the document. Although combining the areas of management/prevention and nutritional considerations was a critical step, the addition of a small set of competencies more specifically directed to understanding the field of public health and the appreciation that much of the work done by athletic trainers has a population focus that extends beyond the individual would provide a formal mechanism for incorporating public health principles into athletic training education.

In closing, the ideas here are not to suggest that every athletic trainer needs a degree in public health, nor to expand the scope of how and where athletic trainers practice. However, it is being suggested that the athletic training profession (1) take steps to help athletic trainers understand the public health discipline and be able to differentiate public health/population health from personal health, (2) help athletic trainers understand the strong potential of collaborating with public health researchers to understand population-level problems affecting the individuals athletic trainers treat every day, and (3) clearly articulate that athletic trainers frequently participate in public health practice and thus would benefit from a greater understanding of and collaboration with the public health profession.