Physician Assistant Studies MMS
Major: Physician Assistant Studies
Degree Awarded: Master of Medical Science (MMS)
Calendar Type: Semester
Minimum Required Credits: 109.0
Classification of Instructional Programs (CIP) code: 51.0912
Standard Occupational Classification (SOC) code: 29-1071
About the Program
Physician Assistant Program Mission
The mission of the Salus at Drexel University Physician Assistant program is to graduate collaborative clinicians who will serve the health care needs of a global community with intelligence, compassion and integrity.
Master of Medical Science Physician Assistant Program
Our competitive, full-time, 25-month Physician Assistant (PA) program prepares graduates to join one of the fastest-growing professions in the country and become integral members of today’s health care delivery team. The program consists of a 12-month didactic phase and a 13-month clinical phase. Upon successful completion of the program, students receive a Master of Medical Science degree.
The program is patient-centered with a primary care philosophy and holistic approach, so our students appreciate the need to care not only for the patient, but about the patient. Our outstanding faculty is accessible and committed to the personal and professional development of our students.
Early clinical experiences plus innovative teaching through small-group and case-based learning are integral to the program. The clinical phase is dedicated to supervised clinical practice experiences that afford direct patient care in primary and specialty care disciplines.
Salus at Drexel University Physician Assistant students receive:
- A strong basic science and pathophysiology foundation for clinical medicine
- Anatomy instruction with an onsite full cadaver dissection lab augmented with virtual anatomy
- Innovative, evidence-based instruction integral to the development of critical thinking skills
- Observational patient care introduced in the first year
Admission Requirements
The Drexel University Physician Assistant program actively seeks individuals with an undergraduate degree and diverse life experiences who desire to become physician assistants.
Application Processing & Review
The Drexel University Physician Assistant program accepts applications only through the Centralized Application Service for Physician Assistants (CASPA).
The processing of applications by CASPA begins in April, 16 months before the year of desired enrollment. Applications must be received by CASPA on or before December 1 of the year before desired enrollment.
Student application reviews begin when CASPA has verified an application.Interviews are scheduled and initiated, beginning in July.
The Admissions Committee admits candidates on a rolling basis with a maximum entering class size of 50 students. It is to an applicant’s advantage to apply as early as possible to ensure priority consideration for admission.
It is recommended that students with a grade point average below 3.0 consult the Office of Admissions before applying.
Criteria
To be considered, an applicant must:
- Submit a properly completed application to CASPA.
- Submit official transcripts from all colleges and universities attended (or currently attending) directly to CASPA.
- Complete a bachelor's degree and admissions prerequisites before enrollment (see Prerequisites section below).
- Submit three letters of recommendation:
- One must be written by a person with authority (e.g., professor, work supervisor, etc.) who knows you well enough to speak to your work ethic and professionalism, and can assess your qualifications for graduate education, ability to complete graduate work, and qualifications for entering a health profession career.
- A letter from a physician assistant is recommended.
- Arrange for the required letters of recommendation to be sent directly to CASPA.
- Accrue a minimum of 300 hours of direct patient care experience. This may be a volunteer and/or employed position(s).
- A minimum of 20 hours of PA shadowing is required. Shadowing PAs in various medical disciplines is highly recommended.
- Optional: Submit Graduate Record Exam (GRE) score results. If you choose, you may submit GRE results directly to CASPA (Designated Institution code is 0432).
- International students, please review any additional requirements below.
- All credentials submitted on behalf of an applicant become part of that applicant’s record with the University and cannot be returned.
If accepted, an applicant must:
- Complete a criminal background check, child abuse clearance, annual health clearances, fingerprinting and drug screening.
- Immunization requirements are compliant with state regulations and CDC recommendations for health care providers.
- Students are responsible for all fees associated with these clearance protocols.
- Provide proof of health insurance before the start of the program.
- Meet the Technical Standards (see section below) with allowance for reasonable accommodations.
The following institutions have formed articulation agreements with the Salus at Drexel University PA program:
3+2 Physician Assistant Program:
- Western New England University
4+2 Physician Assistant Program:
- Caldwell University
- Cedar Crest College
- Immaculata University
- Indiana University of Pennsylvania
- Keystone College
- Messiah University
- Rosemont College
Please refer to the drexel.edu website for additional information regarding the criteria for each articulation.
Prerequisites
A candidate must have completed a bachelor’s degree from an accredited undergraduate institution. Candidates must have a minimum cumulative and science GPA of 3.0 on a 4.0 scale.
Prerequisite courses must be completed within ten years of the anticipated entrance date to the program. An applicant may have prerequisites in progress at the time of application; however, all outstanding prerequisites must be successfully completed before enrollment. So the Admissions Committee can fairly evaluate a candidate, it is recommended that no more than two prerequisites be outstanding at the time of the interview.
Undergraduate credits must include the courses listed below, completed with a 2.0 (C) or better.
Given the COVID-19 pandemic, the program will accept pass (P) as satisfying any of the program’s academic course prerequisites that were taken during spring or summer 2020 and on a case-by-case basis otherwise. Grades reported as failing (F) or as incomplete (I) will not be considered as fulfilling prerequisites. Please note that courses taken for pass/no pass will not be considered in GPA calculations.
Four semester credits* are required in each of the following courses:
- Anatomy and Physiology I (or Anatomy) with laboratory
- Anatomy and Physiology II (or Physiology) with laboratory
- Biology I with laboratory
- Biology II with laboratory
- Chemistry I with laboratory
- Chemistry II with laboratory
*Three semester credit course/s will be reviewed on an individual basis.
Three semester credits are required in each of the following courses:
- Microbiology (laboratory recommended, but not required)
- Organic Chemistry (laboratory recommended, but not required)
- Psychology
- Statistics or Biostatistics
- English Composition
Courses that are recommended, but not required:
- Medical Terminology (strongly recommended)
- Physics
- Genetics
- Immunology
- Embryology
- Histology
- Biochemistry
- Cell Biology
- Public Speaking
- Ethics
- Developmental or Abnormal Psychology
International Students and Practitioners
International Transcripts
For applicants who have attended foreign and French-Canadian schools, please provide the Office of Admissions with the following information:
- A course-by-course credential review from a NACES-recognized agency that evidences all post-secondary studies completed. Please consult the agency’s website for requirements to complete the evaluation.
- Recommended agencies include:
- World Education Services
- SpanTran
- Recommended agencies include:
- An official evaluation may be sent from the agency directly to CASPA.
- Instructions for submitting a foreign credential evaluation.
English Language Proficiency
Fluency in written and spoken English is essential for success in a Drexel University academic program as well as to help ensure patient/client/student safety and/or effective communication with members of a health care or education team.
Official results from the TOEFL iBT, TOEFL Essentials, IELTS, or Duolingo examination are required of all non-native English speakers. One of these approved exams must be taken within two years before the start date of the entering class to which an applicant seeks admission.
For applicants to the Physician Assistant program, the minimum required score for the TOEFL iBT is 94.
- A minimum score of 26 is required for the speaking section; a minimum of 24 for the writing section; a minimum of 22 for the listening section; and a minimum of 22 for the reading section.
- Official scores from the TOEFL Essentials, IELTS, or Duolingo English Test examination will be accepted in substitution for the TOEFL iBT (minimum score requirements comparable to the TOEFL iBT).
While we recommend that applicants submit and hold at least the required minimum scores for TOEFL iBT, TOEFL Essentials, IELTS, or Duolingo, exceptions will be considered for foreign applicants who meet one of the following criteria*:
- Successfully completed a degree or diploma from an accredited, post-secondary institution where the coursework was entirely in English, and provide evidence that it was conducted in English.
- Successfully completed, and provide evidence of an approved English language learner’s program.
*Note: All exemption materials and other appeals are reviewed on a case-by-case basis and subject to the Admission Committee’s final discretion. Should any exceptions not be accepted toward the English language requirement, the Office of Admissions will inform the applicant of an alternative to fulfill it.
Compliance Requirements
All students admitted to the Salus at Drexel University Physician Assistant program are required to have a criminal background check, child abuse clearance, annual health clearances, fingerprinting and drug screening. Immunization requirements are compliant with state regulations and CDC recommendations for health care providers. Students are responsible for all fees associated with these clearance protocols.
Students will be responsible for uploading their required documentation via CastleBranch, an online tracking system, and monitoring their compliance records to ensure that all information remains current and accurate. Clinical sites that require such clearances may deny a student’s participation in a clinical experience based on the results of these clearances.
As participation in clinical experiences is a required component of the curriculum and a requirement for graduation, denial by a clinical site may result in a delay of graduation, the inability to graduate from the program, or the inability to obtain certification or licensure as a health care professional.
Advanced Placement or Transfer Credit
The Salus at Drexel University Physician Assistant program does not grant advanced placement based upon transfer of credits for academic work completed at other institutions of higher learning or prior experiential learning. All courses within the curriculum are required.
Matriculating students who have withdrawn or been dismissed from the program may be awarded advanced placement depending upon the designed remediation plan related to their readmission.
Deferment of Admission
An accepted student to the Salus at Drexel University Physician Assistant program with an unforeseen, extenuating circumstance prohibiting them from matriculating may request a deferment of admission in writing. The request must be directed to the PA program director and made via the Office of Admissions.
For deferment consideration, the following is required:
- A deferment request submitted in writing by May 15, before the August start of the academic year. Please note that submission of a deferral request by the deadline does not guarantee approval.
- Official documentation verifying the extenuating circumstance.
- All nonrefundable deposit fees and the matriculation supplement must be received (as directed in the University’s official letter of acceptance).
If deferment is approved:
- Admission will be extended to the August matriculation of the next academic year.
- A deferment will not extend beyond one admissions cycle.
- The student must contact the PA program director, in writing, by April 1 of the deferred admission calendar year regarding their intention to resume enrollment.
- The student will be required to meet with the PA program director before matriculation.
If a deferral request is denied:
- A student has the option to withdraw acceptance from the program, or reapply through CASPA for future admission.
Technical Standards
Minimum Technical Standards for Admission, Continuation and Graduation
Technical standards are defined as the attributes considered necessary for students to complete their education and training, and subsequently enter clinical practice. These standards are prerequisites for entrance to, continuation within and graduation from the Salus at Drexel University Physician Assistant program. They are also prerequisites to licensure by various state professional boards. Reasonable accommodation will be offered for persons with disabilities in conjunction with the Americans with Disabilities Act and Section 504 of the Rehabilitation Act.
Students must possess aptitude, ability and skills in the following five areas:
- Observation
- Communication
- Sensory and motor coordination and function
- Conceptualization, integration, and quantitation
- Behavioral and social skills, abilities and aptitudes
The functions described below are critically important and must be autonomously performed by the student. It should be understood that these are standards for minimum competence in the program:
Observation
Students must be able to observe demonstrations and conduct experiments in the basic sciences, including but not limited to, chemical, biological, anatomic and physiologic sciences. Students must be able to observe details through a microscope and observe demonstrations in the classroom, including films, projected overheads, slides or other forms of visual presentation.
Students must be able to accurately observe a patient near and at a distance, noting nonverbal as well as verbal signs. Specific vision-related criteria include, but are not limited to, detecting and identifying changes in color of fluids, skin, culture media, visualizing and discriminating findings on X-rays and other imaging tests, and reading written and illustrated materials.
Students must be able to observe and differentiate changes in body movement, observe anatomic structures, discriminate among numbers and patterns associated with diagnostic tests such as an electrocardiogram, and competently use diagnostic instruments such as an otoscope, ophthalmoscope and microscope.
Communication
Students must be able to relate effectively to patients while conveying compassion and empathy. They must be able to clearly communicate with patients in order to elicit information, accurately describe changes in mood, activity and posture of patients, and understand verbal as well as nonverbal communication.
Communication includes not only speech, but also reading and writing. Physician assistant education presents exceptional challenges in the volume and breadth of reading required to master subject areas and impart the information to others. Students must be able to communicate quickly, effectively and efficiently in oral and written English in the classroom and later with all members of the health care team. Specific requirements include but are not limited to the following: rapidly and clearly communicating with the medical staff on rounds or elsewhere, eliciting an accurate history from patients, and communicating complex findings in appropriate terms to patients and to various members of the health care team. Students must learn to recognize and promptly respond to emotional cues, such as sadness and agitation.
Students must be able to accurately and legibly record observations and plans in legal documents, such as the patient record. Students must be able to prepare and communicate concise, complete summaries of both limited patient encounters and complex, prolonged encounters, including hospitalizations. Students must be able to complete forms in a timely fashion and according to directions.
Sensory and Motor Coordination and Function
Students must possess sufficient sensory and motor function to perform physical examinations using palpation, auscultation, percussion and other diagnostic maneuvers. This requires sufficient exteroceptive sense (visual, auditory, touch and temperature), coordination to manipulate patients and adequate motor and diagnostic instruments.
Students must be able to evaluate various components of the voice, such as pitch, intensity and timbre. They must also be able to accurately differentiate percussive notes and auscultatory findings, including but not limited to heart, lung and abdominal sounds. Students must be able to accurately discern normal and abnormal findings, using instruments including but not limited to tuning forks, stethoscopes and sphygmomanometers.
Students should be able to execute physical movements needed to provide general care and emergency treatments to patients. The student, therefore, must be able to respond promptly to emergencies within the hospital or practice setting and must not hinder the ability of their co-workers to provide prompt care. Examples of emergency treatment reasonably required of a physician assistant include arriving quickly when called and assisting in cardiopulmonary resuscitation (CPR), administering intravenous medications, applying pressure to arrest bleeding, maintaining an airway, suturing wounds and assisting with obstetrical maneuvers. As further illustration, CPR may require moving an adult patient, applying considerable chest pressure over a prolonged period of time, delivering artificial respiration and calling for help.
Students should be able to learn to perform basic laboratory tests such as wet mount, urinalysis, gram stain, etc., and diagnostic/therapeutic procedures such as venipuncture or placement of catheters and tubes. The administration of intravenous medications requires a certain level of dexterity, sensation and visual acuity. Students must be able to measure angles and diameters of various body structures using a tape measure or other devices to measure blood pressure, respiration and pulse, and interpret graphs describing biological relationships. Clinical rotations require the ability to transport oneself to a variety of settings in a timely manner.
Intellectual, Conceptualization, Integration and Quantitation
Problem-solving, a critical skill demanded of physician assistants, often requires rapid intellectual function, especially in emergency situations. These intellectual functions include numerical recognition, measurement, calculations, reasoning, analysis, judgment and synthesis. Students must be able to identify significant findings in the patient’s history, physical examination and laboratory data, provide a reasoned explanation for likely diagnoses, and choose appropriate medications and therapy.
The student must be able to incorporate new information from many sources toward the formulation of a diagnosis and plan. Good judgment in patient assessment and diagnostic/therapeutic planning is also essential. When appropriate, students must be able to identify and communicate the extent of their knowledge to others.
Behavioral and Social Skills, Abilities and Aptitudes
Students must possess the emotional health required for full use of their intellectual abilities, the exercise of good judgment, the prompt completion of all responsibilities associated with the diagnosis and care of patients, and the development of mature, sensitive and effective relationships in the diagnosis and care of patients. Empathy, integrity, honesty, concern for others, good interpersonal skills, interest in people and motivation are all required personal qualities. Students must be able to monitor and react appropriately to their own emotional needs. For example, students need to maintain a balanced demeanor and good organization in the face of long hours, fatigued colleagues and dissatisfied patients.
Students must be able to develop appropriate professional relationships with their colleagues and patients, provide comfort and reassurance to patients and protect patients’ confidentiality. Students must possess the endurance to tolerate physically taxing workloads and to function effectively under stress. All students are, at times, required to work for extended periods of time, occasionally with rotating schedules. Students must be able to adapt to changing environments, to display flexibility, and to learn to function in the face of uncertainties inherent in the practice of medicine. Students are expected to accept suggestions and criticisms and, if necessary, to respond by modifying their behavior.
Admission
Candidates accepted for admission to the Physician Assistant program will be required to verify that they understand and meet these technical standards. Admission decisions are made on the assumption that each candidate can meet the technical standards without consideration of disability. Letters of admission will be offered contingent on either a signed statement from the applicant that they can meet the program’s technical standards without accommodation or a signed statement from the applicant that they believe they can meet the technical standards if reasonable accommodation is provided.
The University reserves the right of final determination for applicants requesting accommodations to meet the program’s technical standards. This includes a review of whether the accommodations requested are reasonable, taking into account whether the accommodation would jeopardize patient safety, or the educational process of the student or the institution, including all coursework and internships deemed essential to graduation.
The Office of Disability Resources and the Physician Assistant program will jointly determine what accommodations are suitable or possible in terms of reasonable accommodation, and will render the person capable of performing all essential functions established by the program.
Degree Requirements
| Required Courses | ||
| PAS 5001 | Gross Human Anatomy 1 | 3.0 |
| PAS 5002 | Medical Microbiology and Genetics | 2.0 |
| PAS 5003 | Behavioral Science | 2.5 |
| PAS 5007 | PA Seminar | 1.0 |
| PAS 5008 | Acute and Invasive Medicine | 3.0 |
| PAS 5009 | Community Health | 1.0 |
| PAS 5011 | Gross Human Anatomy 2 | 1.0 |
| PAS 5012 | Foundations of Clinical Problem Solving | 1.0 |
| PAS 5030 | Physiology and Pathophysiology 1 | 3.0 |
| PAS 5031 | Physiology and Pathophysiology 2 | 2.5 |
| PAS 5032 | Physiology and Pathophysiology 3 | 2.0 |
| PAS 5040 | Pharmacology and Clinical Therapeutics 1 | 2.0 |
| PAS 5041 | Pharmacology and Clinical Therapeutics 2 | 1.5 |
| PAS 5042 | Pharmacology and Clinical Therapeutics 3 | 1.5 |
| PAS 5050 | Clinical Problem Solving 1 | 2.5 |
| PAS 5051 | Clinical Problem Solving 2 | 1.5 |
| PAS 5060 | Physical Diagnosis 1 | 2.5 |
| PAS 5061 | Physical Diagnosis 2 | 1.5 |
| PAS 5062 | Physical Diagnosis 3 | 1.0 |
| PAS 5102 | Integrative Medicine and Nutrition | 1.0 |
| PAS 5130 | Clinical Medicine 1 | 4.5 |
| PAS 5131 | Clinical Medicine 2 | 6.0 |
| PAS 5132 | Clinical Medicine 3 | 6.0 |
| PAS 5140 | Advanced Clinical Skills 1 | 2.0 |
| PAS 5141 | Advanced Clinical Skills 2 | 3.0 |
| PAS 5142 | Advanced Clinical Skills 3 | 2.5 |
| PAS 5901 | Transition to Practice | 2.0 |
| PAS 5930 | Capstone Project 1 | 0.5 |
| PAS 5931 | Capstone Project 2 | 0.5 |
| Rotations | ||
| Required courses: | 45.0 | |
| Emergency Medicine | ||
| General Surgery | ||
| Internal Medicine | ||
| Prenatal Care/Women's Health | ||
| Pediatrics | ||
| Behavioral Mental Health | ||
| Elective Rotation 1 | ||
| Elective Rotation 2 | ||
| Family Medicine/Primary Care 1 | ||
| Family Medicine/Primary Care 2 | ||
| Total Credits | 109.0 | |
Sample Plan of Study
| First Year | ||
|---|---|---|
| Fall | Credits | |
| PAS 5001 | Gross Human Anatomy 1 | 3.0 |
| PAS 5002 | Medical Microbiology and Genetics | 2.0 |
| PAS 5007 | PA Seminar | 1.0 |
| PAS 5012 | Foundations of Clinical Problem Solving | 1.0 |
| PAS 5030 | Physiology and Pathophysiology 1 | 3.0 |
| PAS 5040 | Pharmacology and Clinical Therapeutics 1 | 2.0 |
| PAS 5060 | Physical Diagnosis 1 | 2.5 |
| PAS 5130 | Clinical Medicine 1 | 4.5 |
| PAS 5140 | Advanced Clinical Skills 1 | 2.0 |
| Credits | 21 | |
| Spring | ||
| PAS 5003 | Behavioral Science | 2.5 |
| PAS 5009 | Community Health | 1.0 |
| PAS 5011 | Gross Human Anatomy 2 | 1.0 |
| PAS 5031 | Physiology and Pathophysiology 2 | 2.5 |
| PAS 5041 | Pharmacology and Clinical Therapeutics 2 | 1.5 |
| PAS 5050 | Clinical Problem Solving 1 | 2.5 |
| PAS 5061 | Physical Diagnosis 2 | 1.5 |
| PAS 5102 | Integrative Medicine and Nutrition | 1.0 |
| PAS 5131 | Clinical Medicine 2 | 6.0 |
| PAS 5141 | Advanced Clinical Skills 2 | 3.0 |
| Credits | 22.5 | |
| Summer | ||
| PAS 5008 | Acute and Invasive Medicine | 3.0 |
| PAS 5032 | Physiology and Pathophysiology 3 | 2.0 |
| PAS 5042 | Pharmacology and Clinical Therapeutics 3 | 1.5 |
| PAS 5051 | Clinical Problem Solving 2 | 1.5 |
| PAS 5062 | Physical Diagnosis 3 | 1.0 |
| PAS 5132 | Clinical Medicine 3 | 6.0 |
| PAS 5142 | Advanced Clinical Skills 3 | 2.5 |
| Credits | 17.5 | |
| Second Year | ||
| Fall | ||
| PAS 6233 | PA Rotation 1 | 4.5 |
| PAS 6300 | PA Rotation 2 | 4.5 |
| PAS 6232 | PA Rotation 3 | 4.5 |
| Credits | 13.5 | |
| Spring | ||
| PAS 6234 | PA Rotation 4 | 4.5 |
| PAS 6235 | PA Rotation 5 | 4.5 |
| PAS 6236 | PA Rotation 6 | 4.5 |
| PAS 6237 | PA Rotation 7A | 2.5 |
| PAS 5930 | Capstone Project 1 | 0.5 |
| Credits | 16.5 | |
| Summer | ||
| PAS 6238 | PA Rotation 7B | 2.0 |
| PAS 6239 | PA Rotation 8 | 4.5 |
| PAS 6242 | PA Rotation 9 | 4.5 |
| PAS 6243 | PA Rotation 10A | 2.5 |
| Credits | 13.5 | |
| Third Year | ||
| Fall | ||
| PAS 6244 | PA Rotation 10B | 2.0 |
| PAS 5931 | Capstone Project 2 | 0.5 |
| PAS 5901 | Transition to Practice | 2.0 |
| Credits | 4.5 | |
| Total Credits | 109 | |
*PA Rotation 1-10 includes the following Rotation courses: Emergency Medicine, General Surgery, Internal Medicine, Prenatal Care/Women's Health, Pediatrics, Behavioral/Mental Health, Family Medicine/Primary Care 1, Family Medicine/Primary Care 2, Elective Rotation 1, and Elective Rotation 2. The order in which these Rotation courses occur differs for each student.
Program Level Outcomes
Upon completion of the Drexel University Physician Assistant program, a student is expected to have achieved the following program-defined competencies:
Knowledge for Practice
- Identify the signs and symptoms of commonly presenting disease processes.
- Construct a differential diagnosis for commonly presenting symptoms.
- Identify the indications for diagnostic and therapeutic procedures commonly utilized in outpatient and emergency medical settings.
- Recognize and treat common medical conditions.
- Identify indications, contraindications, side effects and drug interactions for commonly used medications.
- Approach the use of diagnostic studies and therapeutic management with a cost-effective perspective.
Interpersonal and Communication Skills
- Provide accurate and appropriately formatted documentation for patient history and physical examinations.
- Present the data gathered in patient encounters in a concise and accurate summary.
- Establish rapport with patient and family, and demonstrate concern for patient’s welfare with consideration of family/support systems and cultural influences.
Person-Centered Care
- Obtain both a comprehensive and problem-focused history.
- Perform both a comprehensive and problem-focused physical examination.
- Synthesize information acquired through all aspects of a patient encounter, demonstrating appropriate progression of thought.
- Manage conditions specific to the patient’s presentation, to include referral if needed.
- Provide medical education at the patient's and/or family’s level of comprehension while incorporating patient preferences to enhance shared decision-making.
- Demonstrate technical ability while safely performing entry-level procedural skills.
Professionalism and Ethics
- Demonstrate awareness of appropriate professional behavior and insight regarding clinical practice limitations.
- Accept constructive criticism and demonstrate the ability to improve performance based on that feedback.
- Apply ethical principles as they relate to patient care.
Practice-Based Learning and Quality Improvement
- Utilize current evidence-based medicine in the care and management of patients.
- Demonstrate the ability to self-reflect on strengths and weaknesses of knowledge and practice and address deficiencies.
Interprofessional Collaboration
- Work and communicate effectively with other health professionals to provide collaborative, patient-centered care.
Society and Population Health
- Apply principles of epidemiology to identify health problems, risk factors, treatment strategies, resources and disease prevention/health promotion efforts for individuals and populations