Why Redefining Public Health Degrees Would Harm Native and Rural Communities 

Guest Opinion. A proposed federal policy change could have profound health consequences — especially for Tribal and rural communities. The proposal from the U.S. Department of Education, which is open for public comment until March 2nd, would exclude public health and nursing from a new definition of “professional degree programs,” and could potentially affect eligibility for scholarships and financial aid. 

As a physician, elected member of the National Academy of Medicine, public health leader, and Oglala Lakota community member from Pine Ridge, South Dakota, I am alarmed by what is at stake. 

Public health is arguably one of the most impactful professions. The greatest gains in life expectancy over the past century are largely due to public health advances — clean water, vaccination, tobacco control, maternal and child health — not medical care alone. To redefine these degrees in a way that diminishes their professional standing ignores their historic and present-day impact. 

Especially concerning is the how the “professional” designation and its implications for federal loan eligibility, impacts students. If public health and nursing lose that status, middle- and lower-income students will lose access to the funding that makes a graduate degree possible.  

As is so often the case, the burden of this change would not fall evenly. Rural communities already suffer from too few trained public health and nursing professionals. This workforce gap will increase if this policy passes, and result in greater medical costs for rural states and regions. When people have to use emergency rooms for care for illness and injury that could have been prevented by upstream public health measures, it drives greater economic, social, and human capital costs to society. 

My Indigenous students often come to public health organically: they’ve seen programs  for diabetes, vaccination, mental health, smoking reduction that improve quality of life for their families and relatives. The urgency became disastrously clear during the COVID-19 pandemic. They are motivated to pursue higher education because it will help them best serve their communities, which face some of the nation’s highest rates of chronic disease and preventable mortality.  

Workforce demographics are not symbolic — they directly affect quality of care. When health professionals share cultural understanding and lived experience with those they serve, the improved trust and communication results in better outcomes. In Indian Country, where health disparities are rooted in generations of underinvestment and structural inequity, we cannot afford to weaken the pathway for developing Indigenous public health leaders. 

This issue is personal for me. My mother was a public health nurse who dedicated her life to caring for our community. Watching her work showed me that public health is both a calling and a career. But a calling alone does not pay tuition. If mission-driven students cannot afford the education required to improve health outcomes, our workforce will become even more fragile and unsustainable. 

I’ve dedicated over 10 years to developing the world’s first Indigenous-focused Doctor of Public Health program because we need trained public health leaders who are accountable first and foremost to their communities. Policies that reduce financial access move us in the wrong direction. 

As policymakers consider this change, I would ask: What is the benefit? I have not seen a clear justification. If the goal is to save money, this approach is shortsighted — student loans get repaid, and investing in public health professionals yields measurable returns through stronger communities, reduced downstream health costs, and lives saved. What I do see is risk — to workforce development, to health equity, to affordable health care, and all of these risks would be borne disproportionately by Native and other rural communities. 

At a time when Tribal and rural health systems are already stretched thin, we should be strengthening — not restricting — the pathways into public health. I urge the Department of Education to revisit this proposal and I call on lawmakers to hold them accountable to that end. Our communities depend on it. 

About the author:  

Donald Warne, MD, MPH, is a professor in International Health and co-director of the Johns Hopkins Center for Indigenous Health. He is an acclaimed physician, one of the world’s preeminent scholars in Indigenous health, health education, policy and equity, as well as a member of the Oglala Lakota tribe from Pine Ridge, South Dakota. He is also Johns Hopkins University’s provost fellow for Indigenous Health Policy. The a