Advances U Receives $15 Million for Homeland Security â€˘ page 14
S U M M E R 2004
from the University of Minnesota School of Public Health
HEALTH POLICY PERSPECTIVES IN AN ELECTION YEAR SPH Experts Weigh In
WALKING STUDY TO ADDRESS ADDRESSES
Direct Mail as Cancer Prevention SPH GRAD JOINS CDC
Herbal Products Cause Confusion
FROM THE DEAN: Dear Friends, With the November presidential election fast approaching, we the electorate are being inundated by messages from the right, the left, and all points in between. And there is no shortage of important, pressing public health policy issues to consider as we move into the heat of election season. Within our School there are numerous faculty members representing a broad range of issues who are helping to craft and analyze public policy. You can read about this in the cover story beginning on page 2. The public health policy topics we are engaged in range from the local (tobacco bans in Twin Cities bars and restaurants) to the national (Medicare reform, covering the uninsured) to the international (infectious disease). And of course, the work of educating and advocating on public health issues is by no means confined to the School’s faculty members. See page 17 for a story on just a few of our illustrious alumni who are engaged in public health policy work. Even our students get into the action. You can read about their work on page 16. These issues are on the minds of our School’s donors as well. A belief in the importance of health services research and policy is something that spurs SPH professor John Kralewski to make philanthropic contributions in support of fellowships for SPH students pursuing a doctoral degree in this area. See page 11 for a profile of Dr. Kralewski. He is one of many donors who are giving back to advance significant public health issues through the education of tomorrow’s public health leaders. For that, I offer Dr. Kralewski and our School’s many other financial supporters my profound thanks.
SCHOOL OF PUBLIC HEALTH LEADERSHIP Mark P. Becker Dean
John Connett Head, Division of Biostatistics
John Finnegan, Jr. Associate Dean for Research and Academic Affairs
Susan Bartlett Foote Head, Division of Health Services Research and Policy
Debra Olson Associate Dean for Public Health Practice Education
Robert Jeffery Interim Head, Division of Epidemiology
Mary Story Associate Dean for Student Affairs
William Toscano Head, Division of Environmental Health Sciences
Editor Diana Harvey
Managing Editor Kristin Stouffer Contributing Writers Dixie Berg Carmela Kranz Kristine Menas Art Direction Todd Spichke Riverbrand Design
Contents Table of
Feature: Health Policy
From Medicare reform to tobacco control, lawmakers look to
SPH research when shaping policies aimed at improving the health of Americans
Diabetes threatens the thin and inactive, birthdate indicates newborn health, conference addresses balancing work and family, and more
SPH professor gives back to the division he helped found, U president launches historic scholarship drive
Faculty awarded for excellence in teaching, scholars gather to discuss social capital, commencement recap, and more
Graduate joins CDC training program, students are inspired by hands-on policy work
Alumni discuss how their studies prepared them for policy work in Washington, D.C.
2 University of Minnesota School of Public Health
F E AT U R E S TO RY
HEALTH POLICY PERSPECTIVES IN AN ELECTION YEAR SPH Experts Weigh In
To the public, health policy can bring to mind a complex and often confusing set of rules and regulations. To legislators, it can be what sets the stage for a battle of wills. To voters, it’s an issue that has remained at the top of their list—even during times of more vocal debate over taxes, war, and national security. To virtually everyone, issues of health policy are played out every day, in a variety of ways. To the faculty at the University of Minnesota School of Public Health, health policy is a subject of rigorous study, and a subject on which they often share their expertise with lawmakers and the public. At the SPH, work in the area of health policy can take the form of funded research by a bevy of government agencies, including the Department of Health and Human Services, the National Institutes of Health, and the Centers for Disease Control and Prevention, or private foundations like the Commonwealth Fund or the Robert Wood Johnson Foundation (RWJF). It can be faculty members invited to serve on a government committee or called to testify at a Congressional hearing. Or, at its most informal, it can be answering a phone call from a legislator or a staffer interested in getting objective information on a hot issue.
Sound Information for Good Policy Susan Bartlett Foote, head of the School’s Division of Health Services Research and Policy, sees two themes in current debates over health policy: how to tackle the high costs of care, especially prescription drugs, and how to improve access to care, especially for the growing number of uninsured Americans. “Health policy in this sense, and more so in an election year, is what role the government should play in addressing these issues and problems,” says Foote. Foote says it’s the role of her division to provide sound data for good policy. “We do highly sophisticated data analysis and then translate that data so it’s useful to people outside of the University,” she says. “Lawmakers see us as an objective resource for information.”
More than knowing how to generate complex information, Foote understands how to translate that information specifically for legislators. Her decade on Capitol Hill—as an RWJF fellow, a senior health advisor to former Sen. Dave Durenberger, and a consultant on health policy—means she understands the rhythm and time constraints of a legislative session. “Having been in that arena, I know what staffers need in terms of data,” she says. “And I know how to synthesize that data so it can be easily and quickly understood.”
2004 Elections Project Foote and her division colleague Lynn Blewett are currently serving as special affiliates to the 2004 Election Project at the University’s Humphrey Institute of Public Affairs. The purpose of the project is to provide timely, non-partisan commentary and analysis on this year’s elections. The project focuses on the Upper Midwestern states of Minnesota, Iowa, Wisconsin, and South Dakota, which have emerged as critical swing states in the upcoming national elections. For the project, Foote and Blewett each have authored policy briefs—short and accessible reviews of regional developments related to critical issues of national policy. In her brief on Medicare reform, Foote finds that while the new prescription drug benefit helps poorer Americans, it brings “concern about unsustainable cost escalations.” Blewett’s brief on health insurance discusses policies to address the high rates of health insurance coverage in the Upper Midwest. She says that expanding public programs to cover more of the uninsured is not viable without additional federal or state revenue. John Kerry “explicitly promises higher federal matching rates for existing state programs,” she says, continuing that the Bush proposal “addresses a small proportion of the uninsured through a tax credit proposal.” But none of the candidates address the rising cost of health care. The policy briefs, along with the latest polling information and candidate profiles, can be found at the 2004 Election Project’s Web site at http://www.hhh.umn.edu/centers/csp/elections/.
The campaign’s organizers are pointing to 2005—without the distraction of a presidential campaign—to press Congress to pass legislation to help cover the 43.6 million Americans who, according to the Census Bureau, lack insurance coverage.
Medicare: The Debate Continues Some who believe that Medicare is financially unsustainable are calling for increased competition between Medicare and private health plans—resulting in one of the most hotly contested debates in Medicare reform. Advocates of increased competition say that it will bring about higher quality care and lower government costs, which means a lower price tag for taxpayers. Opponents argue that direct price competition will threaten the viability of traditional fee-for-service Medicare.
SPH Study Finds 20M Workers Lack Health Coverage An SPH study recently made national headlines by reporting startling numbers on who in America lacks health insurance. Conducted by the School’s State Health Access Data Assistance Center (SHADAC), the study used data collected by the CDC and found that more than 20 million working adults lacked health insurance in 2002. In 38 states, one in 10 working adults lacked health coverage; in 6 states, one in five working adults was uninsured. In addition, the study found that adults who lacked health insurance were less likely to receive preventive care, less likely to have a primary care physician, and more likely to rate their own health as only “poor or fair” than those with coverage. Michael Davern, SHADAC research director, and Jeanette Ziegenfuss, doctoral student and SHADAC research assistant, conducted the study. “This study puts a more accurate face on the uninsured,” says associate professor Kathleen Thiede Call, who is coprincipal investigator for SHADAC, which helps states to monitor rates of health insurance coverage and to understand factors associated with uninsurance. “In order to have effective policies aimed at the uninsured, you have to know who the uninsured are.” SHADAC partnered with their primary funding organization, the Robert Wood Johnson Foundation (RWJF), to release the study findings as part of the annual “Cover the Uninsured Week,” a national campaign led by RWJF to raise awareness of the uninsured. 4 University of Minnesota School of Public Health
Professors Bryan Dowd and Roger Feldman have been providing technical assistance on Medicare reform to government agencies for nearly fifteen 15 years—and in doing so, have become national experts on the subject. Serving as technical consultants to the Centers for Medicare and Medicaid Services, Dowd and Feldman designed a blueprint for a system in which traditional Medicare would compete with managed care plans on the basis of premium bids. They also provided estimates of how beneficiaries would choose among the competing plans and whether plans that offered better benefits would attract higher risks. What they found suggests that increased competition would, in fact, help control Medicare spending by keeping premiums close to a health plan’s true cost without a substantial amount of risk selection. But scientific findings are just half of the battle. Increasing competition in the Medicare market must have political backing to become a reality. Although there were legislators who supported the concept, the design was blocked by other influential members of Congress acting on behalf of interest groups and lobbyists. However, a demonstration of competitive pricing was enacted as part of the Medicare Prescription Drug and Modernization Act of 2003, which was passed by Congress and signed by President Bush. The demonstration is not scheduled to begin until 2010, but Feldman says, “We need to start planning for Medicare reform now, before the program is overwhelmed by retiring baby boomers and rising costs.”
Clean Water and Air During the first weeks of the Minnesota Legislative session, faculty in the Division of Environmental Health Sciences informally briefed state legislators on a host of environmental concerns, including arsenic standards for water, using alternative energy sources over coal, and the clean-up of meth labs. “There’s a real interest on their part to use science to inform policy,” says associate professor Pat McGovern, who organized the briefing, which included eight of her colleagues and division head William Toscano. Minnesota Senator and Majority Whip Linda Higgins concurs. “It was a grand, eyeopening day,” she says, “It’s wonderful to have access to people who do this research and who want to share it.” Clean water was the topic of a March briefing for Sen. Mark Dayton at his Minnesota office. Deb Swackhamer, SPH professor and co-director of the University-based Water Resources Center, was among six University experts at the briefing, which focused on mercury issues. Two weeks later, she was on hand for “Minnesota Water 2004: Policy and Planning to Ensure Minnesota’s Water Supplies,” a biennial conference hosted by the University. Gov. Pawlenty spoke at the conference in support of his clean water initiative. Mike Osterholm, SPH professor and director of the Center for Infectious Disease Research and Policy, spoke on protecting the nation’s and state’s water supplies from terrorist attack.
Policy as Prevention Helping to form policies that encourage healthy behaviors is a driving force behind the work of some SPH faculty. In “Public Health Policy as a Prevention Strategy”—a course she created in 1989—professor Jean Forster teaches the next generation of public health leaders how even small behavioral changes in large populations can bring about substantial improvements in population health. Forster’s own work directing several major tobacco control studies demonstrates this point well. One such study is tracking 3,600 Minnesota youth for seven years to determine which local and state-funded programs are most effective at curbing smoking. “The state stopped funding most anti-
Shaping the Future of Long-Term Care Professor Robert Kane is working with the Minnesota government on projects that could change the landscape of long-term care for Americans. Kane, who holds the Minnesota Chair in Long-Term Care and Aging, is helping to redesign the way the state reimburses nursing homes. Under the new plan, facilities would receive financial reward for demonstrating efficiency and quality of care. The project, which partners with the University’s School of Nursing and the state Department of Human Services (DHS), marks the first time a state has built quality and efficiency into long-term care reimbursement. Kane is also working with the DHS Board on Aging to develop a more systematic way for families to make longterm care decisions. “Deciding on long-term care for a family member is a terribly complicated, emotional decision,” says Kane. “By structuring the process, we’re making the decision less overwhelming and more appropriate to the needs of the family.” The program, to be offered on the Web, takes users through a series of questions on facility type (nursing home, assisted living, in-home care) and preferences on factors such as location, ambiance, and quality. The program then matches the user’s preferences to a facility. In response to Gov. Tim Pawlenty’s initiative to make use of private funds for long-term care, Kane and colleagues are working with the DHS, analyzing state demographics to forecast demand for long-term care—and how prepared people will be to pay for that care, which “is not looking good right now,” according to Kane. Researchers are looking into the viability of private funding options like long-term care insurance, leveraging mortgages, and government incentives. Kane says increased knowledge of these options will foremost make people more aware of the high cost of long-term care. “It hasn’t been a public policy priority and it needs to be,” he urges. 5
tobacco media and tobacco control programs during the course of the study,” says Forster. “So tracking this cohort into adulthood will allow us to see how those policy decisions affect the health of young adults.” “Policy changes at the federal, state, local, and institutional level can help to reduce health related problems,” says assistant professor Traci Toomey. “It’s a belief that guides my work.” That work includes teaching “Legislative Advocacy Skills for Public Health”—a course in which students shadow lobbyists and community activists in the field—and studies aimed at policies to reduce illegal and irresponsible alcohol sales at bars, restaurants, and community festivals. “Research can help to draw attention to an issue,” says Toomey. “But ultimately I want my research to be used to make effective policies that improve health.”
Calling on SPH Expertise School of Public Health faculty are frequently called upon by government to speak or advise on health policy issues. Following are some recent highlights. • Mark Becker is on the steering committee of the State of Minnesota Eliminating Health Disparities Initiative. He is also a board member for Alliance for Healthy Homes, a national health advocacy organization interested in affordable, healthy, and safe housing. • Lynn Blewett was invited to present at a meeting sponsored by the Agency for Healthcare Research and Quality (AHRQ) about how the Medical Expenditure Panel Survey (MEPS) can be used to inform health policy. She was also invited to testify before the Minnesota Senate Health, Human Services Budget Division on demonstrating the link between uncompensated care and public program enrollment. • Kathleen Thiede Call serves on the Cover All Kids Coalition, a public-private coalition launched in 2001 by leaders within the administration of former Gov. Jesse Ventura. Call has also directed several statewide surveys for the Minnesota Department of Health, documenting health insurance coverage and access. • Call and Donna McAlpine completed a project assessing barriers to care for Minnesota public program enrollees. The study focused particularly on disparities in access to preventive health care services among African American, 6 University of Minnesota School of Public Health
American Indian, Hispanic/Latino, Somali, and Hmong Minnesotans. • Roger Feldman testified before the U.S. House Subcommittee on Health for the Committee on Energy and Commerce on “Designing a 21st Century Medicare Prescription Drug Benefit.” • Feldman and Robert Town gave presentations to the U.S. Department of Justice and the Federal Trade Commission, which held joint hearings on health care. • Susan Bartlett Foote was appointed by the secretary of the U.S. Department of Health and Human Services to serve on the Medicare Coverage Advisory Committee, which advises Medicare on coverage of controversial technologies and procedures. • Jean Forster serves on a CDC community prevention guidelines task force on youth access to tobacco. She testified at a Minnesota House Commerce Committee hearing, where she presented information opposing the weakening of the state’s youth access to tobacco laws. • Simone French is a member of the Institute of Medicine’s Committee on the Prevention of Obesity in Children. She was recently interviewed by General Accounting Office policy analysts about revenues generated from competitive foods in schools for a report commissioned by Sen. Tom Harkin and Sen. Patrick Leahy. The report will be used to guide legislative efforts in the area of school food recommendations. • Russell Luepker chairs the NIH Working Group on Reporting Genetic Results and Research Studies, which advises on the many issues of reporting genetic data to study participants. • Ira Moscovice is one of 11 national experts serving on the Future of Rural Health Care Committee for the Institute of Medicine. • Jim Neaton serves on the Panel on Clinical Practices for the Treatment of HIV Infection, a joint effort of the U.S. Department of Health and Human Services and the Henry J. Kaiser Family Foundation. • Mike Osterholm testified at the Senate Permanent Subcommittee on Investigations on the country’s ability to deal with the possible reemergence of SARS. • Traci Toomey testified at a state Commerce Committee hearing on law enforcement compliance checks for selling alcohol to underage youth.
Environmental Health Sciences
Direct Mail Testing Improves Colorectal Cancer Screenings
Balancing Work and Family is Topic of Fall Conference Women returning to work following the birth of a child face a host of challenges including balancing work and family responsibilities, dividing household chores, meeting increased financial demands, and maintaining their health and the health of their family. How these challenges are met will be the topic of a conference titled, “After Birth: Policies for Healthy Women, Families, and Workplaces,” to be held Friday, Oct. 1, 2004, at the Humphrey Institute of Public Affairs. Faculty from the division of Environmental Health Sciences (EnHS) and the University’s Humphrey Institute of Public Affairs have planned a conference that offers a variety of perspectives on the issue of women returning to work, including those of employees, employers, families, and legislators. EnHS associate professor and conference organizer Pat McGovern will present findings from the Minnesota Women’s Postpartum Health Study, along with study co-investigator and professor of medicine Dwenda Gjerdingen, who will discuss women’s postpartum mental health. “We are very excited to work with professor Sally Kenney and her colleagues at the Humphrey Institute and throughout the community to shed light on issues of work and family,” says McGovern. These issues are particularly relevant in Minnesota, as it ranks first among the states for having the highest female labor force participation rate.” The conference fee is $45, which includes all sessions, and breakfast, lunch, and a reception. For more information and to register online, visit http://www.hhh.umn.edu/afterbirth/.
About 148,000 Americans are diagnosed with colorectal cancer each year and 56,600 die from the disease. Several studies have shown that screening reduces death from colorectal cancer. Half of the U.S. population, however, does not take advantage of colorectal cancer screening. To investigate ways to improve screenings rates, SPH associate professor Timothy Church and other University colleagues, with the collaboration of the Wright County Community Health Foundation, the Minnesota Department of Health, and Buffalo Hospital, conducted a randomized trial in which direct mail of fecal occult blood test (FOBT) kits combined with follow-up reminders increased colorectal cancer screening. “This study shows that direct mailing of FOBT kits can be used to improve the screening behavior of a large number of people,” says Church. “It also shows the value of research partnerships with governmental and community organizations.” The 1,451 trial participants, aged 50 or more, were placed into three groups: the control group received only a questionnaire that asked about their use of colorectal cancer screening tests; a second group received a questionnaire followed by an FOBT kit; and the third group received a questionnaire followed by an FOBT kit and additional reminders to complete the test. One year later, the researchers sent participants a follow-up questionnaire again asking about their screening use. After a year had passed, the percentage of people who reported following the FOBT guidelines increased by 2 percent in the control group, 17 percent among those who received FOBT kits, and 23 percent among those who received kits with reminders. Overall colorectal cancer screening compliance also increased significantly in the intervention groups. Study findings were published in the May 19 issue of the Journal of the National Cancer Institute. 7
The next step will be to analyze the volunteer activity data in conjunction with detailed geographic data of the neighborhoods. Researchers hope urban planners can use the findings to design communities that encourage healthier, more active lifestyles. The study is part of a $12.5 million Active Living Research project, a national program supported by the Robert Wood Johnson Foundation.
‘Walkability’ Study Examines Link Diabetes Threat Looms For Between Environment and Obesity Inactive Thin People Does where you live affect what you weigh? To answer that question, SPH researchers have embarked on a two-year, $600,000 study to pinpoint what neighborhood features are more likely to promote walking. They will consider a range of factors—block length, destinations like coffee shops and grocery stores, and street safety—to determine what encourages people to get out of their cars and into their walking shoes. “We can only explain 25 percent of the variability in physical activity through personal characteristics, so at least some of the remaining 75 percent must be attributable to the environment in which you live. This study aims, in part, to discern how much of the variability in non-leisure activity can be attributed to environment,” says SPH assistant professor Katie Schmitz, who is serving as an investigator on the project along with SPH assistant professor Michael Oakes. The study also includes researchers from the University of Minnesota College of Architecture and Landscape Architecture. “The collaboration between public health and architecture is key, in light of the obesity epidemic and a recent national study that linked urban sprawl to obesity,” says Schmitz. Researchers recruited 720 residents from 36 Twin Cities neighborhoods of varying house density, street patterns, and other features. For a week, the volunteers were equipped with accelerometers, devices that precisely measure movement and physical activity. 8 University of Minnesota School of Public Health
It’s not just the old and the obese who get diabetes. SPH research on young adults finds that being fit in early adulthood, regardless of weight, significantly decreases the chances of developing diabetes. But the slim and idle face a higher risk of the disease, defying its commonly held image. The study focused on the health effects of exercise in young adults. It concluded that those aged 18 to 30 with low to moderate fitness levels are six times likelier to develop diabetes than those who are highly fit. Fitness was measured on a treadmill. “The big finding here is that young adults are already at substantial risk,” says David Jacobs, professor of epidemiology and co-author of the 15-year study of 4,500 people. “This study brings the point home in a very significant way.” Researchers followed residents of three U.S. cities, who were 18 to 30 when the study began in 1985. As participants got older, researchers tested them for Type 2 diabetes, which typically occurs in adults. Obesity has long been identified as a major risk factor for Type 2 diabetes, but Jacobs and his team found that inadequate exercise in average-weight people placed them at higher risk. In Jacobs’ view, the best reason to be fit at a young age is that “you can chase your grandchildren when you’re older.” But the pattern needs to be set early in life. His advice: “Establish an active lifestyle and stick with it.” Article adapted from an original story in the Minneapolisbased Star Tribune.
Birthdate Can Indicate Newborn Health
SIDS: Searching for Answers A lack of answers is partly what makes sudden infant death syndrome (SIDS) so frightening. Research has led to recommendations on reducing the risk of SIDS but, still, it remains largely unpreventable and unpredictable. Previous studies have shown that rates of SIDS are higher in the winter. Assistant professor of biostatistics Melanie Wall investigated whether the seasonality in SIDS cases could be explained by seasonality in births. Simply put, do more babies who are born in the summer months result in more cases of SIDS in the winter months, when those infants are at the age of greatest risk? In her study, Wall used Minnesota birth data. Similar to national trends, in May, June, and July, the state experiences a birth rate 15 percent higher than that of November, December, and January. She found that the occurrence of SIDS remained high in winter months even after taking into account the fluctuating birth rate throughout the year. Says Wall, “ruling out one of the explanations behind the seasonality of SIDS—that being higher birth rates do not mean a higher incidence of SIDS—will help guide future research in this area.”
We’ve all heard of family planning, but the research of SPH professor Chap Le could take this concept to a new level. Le has found that birth date can be a strong predictor of newborn health. In a study published last year in the journal Statistics in Medicine, Le and colleagues from the SPH and the University of Minnesota Medical School developed a statistical model that correlates birthdate and the occurrence of ear infection and studies related issues. In doing this, Le and colleagues examined cord blood samples from 600 infants to measure the level of pneumococcal antibodies. Pneumococcal bacteria can lead to a host of childhood infectious diseases, among them otitis media, commonly known as ear infection. The data showed that occurrence of otitis media among babies born in the early fall is much higher that of those born in early spring. This seasonal aspect of disease occurrence is not new, especially for infectious and respiratory diseases. What’s new is the remarkable finding that infants born in the fall have less than half the antibody levels compared to those born in the spring, a result of the mother’s lack of recent exposure to pneumococcus before the baby is born. Here’s how it works: In the winter months, the expectant mother is likely to spend time in a sealed house, exposing herself to indoor air pollutants such as pneumococcus. She builds up antibodies, which are transferred to her unborn child through the placenta. Thus, babies born in early April have the benefit of a high level of antibodies and are less apt to get sick. Conversely, in the summer, the expectant mother spends more time outdoors and in a home that allows for more air exchange. Thus, she doesn’t build up antibodies to infectious disease and therefore the developing baby doesn’t get the benefit of those antibodies. So the baby born at the end of September has a low level of antibodies. This is compounded with the fact that the season is changing, homes are sealed against the cold, the baby is exposed to more indoor air pollution and is thus more likely to get sick.
The study highlights the conflicting role of indoor air pollution: bad for the mother, but in the end, good for those babies born in the spring. Le and his colleagues have, through the use of analysis, shed light on a confounding public health problem: why children born at a particular time of year have more ear infections. What’s more, Le is taking this newfound knowledge of antibodies to other research realms in the hopes of solving other public health puzzles.
Health Services Research and Policy
“Our results show the difficulties the public faces in choosing among myriad products of commonly used herbs,” says Garrard. “The paucity of clinical trials, outcome studies, and established standards make it even more daunting for health care professionals to advise patients on the responsible use of herbal products.”
Variations in Labeling of Herbal Products May Create Problems for Consumers When consumers take over-the-counter herbal products, they may be unknowingly ingesting ingredients substantially different from those recommended by health researchers, according to a study led by SPH professor Judith Garrard. Findings also suggest that patients who report use of herbal products to their physicians may not be able to accurately describe the ingredients or label-recommended dosage because the products for the same herb may greatly differ from product to product. The study examined variations in label information of products for each of the 10 most commonly purchased herbs, including echinacea, St. John’s wort, and Ginkgo biloba. At the 20 stores Garrard’s team looked at, there were 880 different products, sold under 241 brands, for those herbs. Fewer than half of the herb products were consistent with certain “benchmark” recommendations of dosage and ingredients. The benchmark the researchers used was a professionals’ handbook on alternative medicine. Because the United States does not regulate dietary supplements as it does prescription drugs, there are no established federal standards for ingredients or dosage of herbs. More than one-third of the products had labeling that was too vague to determine the ingredients, including the plant species and plant parts used. 10 University of Minnesota School of Public Health
Universal Depression Screening Premature While the majority of people with depression see their primary care physician each year, those doctors fail to recognize between a third to a half of all depression cases. To remedy this situation, the United States Preventive Task Force (USPSTF) recently recommended that primary care physicians begin screening all adult patients for depression. While screening for a prevalent illness substantial in both economic costs and human suffering appears to be a sound move, SPH researchers have found that for the screenings to be effective, much more needs to be known about the screening protocol and treatment process. Donna McAlpine and Amy Wilson, faculty members in the division of Health Services Research and Policy, compared the evidence supporting the screening recommendations to established criteria for effective screening programs. They found that simply detecting more cases of depression does not mean that those cases will be treated effectively. Added to this is that the screenings may lead to false positives, resulting in lost time for the physicians, higher costs for the health care system, and social stigma for the patients incorrectly diagnosed with depression. “Implementing the USPSTF’s universal depression screenings runs the risk of harm toward the patient and inefficient use of health care dollars,” says McAlpine. Adds Wilson, “We suggest that targeting screenings to groups at a higher risk for depression may lead to a more effective use of health care resources.”
PHILANTHROPY Health services research is a booming field, according to Kralewski, especially today with the focus on the organization of health services and on the cost and quality of care. Few issues are as front and center across all sectors— business, politics, and consumer—as health services. Devising solutions will require the brightest and best minds. That’s why the Kralewskis have chosen to back the doctoral program. “We need to attract the best students, and we can only do that with a strong scholarship program,” says Kralewski. “Earning a Ph.D. is a long, hard haul. It is our hope that the financial assistance offered through our fellowship helps lighten the burden for these students.” From left: John Kralewski, Elizabeth Habermann, recipient of the John E. and Marjorie L. Kralewski Family Fellowship, and Bryan Dowd, director of graduate studies for the Health Services Research, Policy, and Administrative program.
SPH Professor Supports Best and Brightest in Health Services Research
Photo: Chris Polydoroff
What motivates faculty to contribute funds to their universities? In the case of John Kralewski and his wife Marjorie, the reasons are simple and yet complex: “To enable people to achieve their full potential when it is becoming increasingly expensive to gain access to higher education.” Kralewski often quotes John Gardner, former president of the Carnegie Foundation and architect of President Johnson’s Great Society Program, who once noted that “talent is distributed without regard to gender, race, or wealth, but the ability to develop that talent is constrained by all of these conditions.” Kralewski hopes that his family can in some small way help level that playing field. “Too often money is a limiting factor to people pursuing higher education,” says Kralewski. “It becomes a psychological barrier where people convince themselves they can’t pursue their dreams because it is too expensive.” Kralewski, who holds three degrees from the University of Minnesota (a B.S. in pharmacy, and an M.S. and Ph.D. in health administration), says he is motivated to give something back to the institution where he earned his academic credentials and has spent the last 26 years of his career. He helped build the School’s division of Health Services Research and Policy from a center he started in 1979 to the thriving area of study it is today, with a nationally recognized faculty and robust research program. The division turns out highly sought after graduates, many of whom go on to faculty or research positions at major universities.
The Promise of Tomorrow University of Minnesota President Robert Bruininks recently announced a $150 million scholarship drive, the largest effort in University history, to raise merit and need-based scholarships for undergraduates and professional students on all campuses. The multiyear drive, named the Promise of Tomorrow, will increase the number of students receiving scholarships by 50 percent. A new matching fund, the President’s Scholarship Match, has also been created to encourage donors to make endowed scholarship gifts. Through the program, income from new endowed scholarships will be matched by funds from the University, doubling the impact of a donor’s gift. “The University-wide program will be instrumental in our School’s efforts to make public health education available to a variety of students,” says School of Public Health Dean Mark Becker. “Endowed funds are important because they provide a continuous and growing source of revenue far into the future, and because they help us to continue to attract and retain talented and motivated students.” The President’s Scholarship Match is open to donors making endowment gifts of at least $25,000, the minimum amount for creating an endowment at the University. Employer matching funds may be used to reach the $25,000 level, making it possible for donors to stretch their philanthropic dollars even further. Gifts may be made by individuals or groups and paid over five years. For more information, go to www.sph.umn.edu/support/match/ or contact Carmela Kranz, SPH director of development, at 612-626-8481, 800-922-1663, or email@example.com. 11
Public Health Education and Outreach
Photo: Bill Alkofer
Photo: Bill Alkofer
Public Health Institute Expands Enrollment and Courses When the annual Public Health Institute began in 2002 with nine courses and 39 students, University of Minnesota faculty and staff were already looking to expand the course offerings and enrollment base of the three-week event. As public health professionals themselves, they knew their colleagues nationwide would be interested in the opportunity to hone their skills, learn from the field’s top researchers, and network with other professionals. Just two years later, the Institute has tripled its curriculum to 27 courses and increased its enrollment to more than 280 students from 17 states, plus six international scholars. Again, faculty and staff are already discussing new course ideas for next year. “It’s the responsibility of the School of Public Health to not only educate tomorrow’s leaders but to build excellence in today’s workforce,” says Debra Olson, associate dean for Public Health Practice Education and a founder of the Institute. “A strength of the Institute is that it allows people to design their own professional education.” Instructors, too, often take a customized approach to curriculum by asking students what they want to learn in a given class. “The expertise of the instructors allows them to tailor their discussions based on the learning objectives and skill level of a specific group,” explains Sharon Vegoe, Institute organizer and continuing education specialist at the Centers for Public Health Education and Outreach.
12 University of Minnesota School of Public Health
Beyond choosing how many courses to take and in which focus areas, students can decide whether they would like credits applied toward an advanced degree, a dual degree, a certificate, or continuing education. To see classroom theory put to practice, students can attend field trips to a variety of public health hotspots, including a neighborhood clinic, commercial beef farm, and poultry processing plant. National guest speakers add another theory-to-practice dimension. “Opportunity to learn outside of the classroom differentiates us from other public health institutes,” says Vegoe. Throughout its first three years, the Institute has grown not only in size but in reputation. “Our national visability and reach are growing” says Vegoe. “People in the field are beginning to view the Institute as an invaluable resource for the latest in public health knowledge and practice.”
PHI at a Glance The Public Health Institute allows students to immerse themselves in a chosen course of study—for a single day or for three weeks. 2004 focus areas include: • Culturally Responsive Public Health Practice • Food Safety and Biosecurity • Infectious Disease Epidemiology • Occupational Health and Safety • Public Health Leadership • Public Health Preparedness, Response, and Recovery Stay tuned for new focus areas for the 2005 Public Health Institute.
Institute Hosts National Speakers
Photo: Bill Alkofer
Public Health Education and Outreach
This year, Public Health Institute participants were treated to presentations by some of public health's leading voices.
Photo: Tim Rummelhoff Photo: Bill Alkofer
Edward Gabriel Who better to speak of emergency preparedness than Edward Gabriel, the deputy commissioner for preparedness at the New York City Office of Emergency Management. More than just an impressive title, Gabriel has the ultimate in street smarts to back up his credentials—his charge on 9/11 was manning the command post in the World Trade Center. Gabriel spoke of the critical need for all those in public health—from academia to health departments to emergency
response systems to hospitals—to work together in creating a unified approach to emergency preparedness. “It’s time for the walls to come down,” he said. “If we don’t talk to each other, we’re not going to do our best on the job.” Gabriel began his career as an emergency medical technician in 1973 with a volunteer ambulance agency. He has served with the New York City Fire Department’s Emergency Medical Service for 25 years, rising through the ranks from EMT to paramedic, through lieutenant to assistant chief and division commander. He shares his expertise by speaking internationally on topics such as homeland security, weapons of mass destruction, terrorism, and medical preparedness.
Janet Porter A believer and student of the “Power of One,” Janet Porter opened the 2004 Public Health Institute with an engaging lecture about finding one’s passion. Porter, an associate dean at the School of Public Health at the University of North Carolina at Chapel Hill, wanted to inspire the audience to make a difference. Porter asked, “What would you like to do so much, you would do it for free?” Then, she advised finding balance in your life. Take time to reflect.
Make time for family, friends, and hobbies. Next, she urged seeking a great job fit. Her advice was to take index cards and prioritize them according to what is important to you: job title, salary, benefits, location, etc. Once you have a clear sense of your priorities, the better the job fit will be. The final factor in the equation is to develop your skills. Invest in yourself by going to school, attending institutes, or pursuing other educational opportunities. Porter’s enthusiasm left the audience eager for three weeks of the Public Health Institute and inspired to make a difference in public health.
Reed Tuckson Standing beneath an oil portrait of Hubert H. Humphrey, Ed Ehlinger invoked the words of the late vice president when he introduced guest speaker Reed Tuckson: “The moral test of government is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; and those who are in the shadows of life, the sick, the needy and the handicapped.”
That famous quote was apropos given Tuckson’s topic, “Decreasing Racial and Ethnic Health Disparities.” Tuckson, senior vice president of Twin Cities-based United HealthGroup, brings a great deal of expertise to the topic, including experience serving as the commissioner of public health for the District of Columbia. He is a member of the Institute of Medicine and has had a distinguished career of leadership across the academic, public health, and health care sectors. He brought a fiery passion to his talk that made for an extraordinarily compelling 90 minutes. A videotaped version of Tuckson’s address can be viewed at www.cpheo.umn.edu/roundtable/. 13
SPH professor Michael Osterholm will serve as co-principal investigator for the University-wide research team. He directs the Center for Infectious Disease Research and Policy, an internationally recognized resource for public health preparedness, agricultural biosecurity, and food safety. “The need to protect against potential deliberate contamination now creates a demand for enhanced capabilities to anticipate, prevent, respond quickly to, and minimize the impact of such attacks,” says Osterholm. “This places great importance on federal, state, and local governments and the private sector to coordinate and integrate their biosecurity activities.” “The University of Minnesota, with extraordinary strength and expertise in the health, animal, and food sciences, is uniquely positioned to develop interdisciplinary collaborations,” says President Robert Bruininks. “We’re proud to lead this important effort and look forward to working with our partners in academia, public health, industry, and government to make our nation’s food supply safer.”
International Scholars Gather for Social Capital Conference
The U.S. food system—from farms to processing and distribution to retail food service—presents an array of vulnerable targets for terrorist attack.
U Receives $15 Million for Homeland Security The University of Minnesota has been named one of three U.S. Department of Homeland Security Centers of Excellence and has received a three-year, $15 million grant to help develop ways to protect the nation’s food supply from deliberate contamination or terrorist attack. The University of Minnesota’s Center of Excellence, known as the National Center for Food Protection and Defense (NCFPD) is a national consortium of more than 90 experts from academic, private sector, and government organizations. Frank Busta, professor emeritus in the University’s Department of Food Science and Nutrition, is principal investigator on the grant.
14 University of Minnesota School of Public Health
The concept of social capital—the connections among individuals and the benefits that arise from them—is played out every day, in every country, by virtually everyone. Social capital in action can be a neighborhood crime watch group, a lawyer giving informal legal advice to her niece, or a cancer support group exchanging e-mails on the latest treatments. Social capital isn’t just the interactions that form societies— it’s the glue that holds them together. Social capital is an established concept spanning the social sciences but it’s an emerging idea in public health—and one with interesting implications. “Studies have shown that people with good social networks, regardless of income or education, have better health,” says SPH assistant professor Michael Oakes, who studies social epidemiology. Oakes and colleagues across the University of Minnesota put their own social capital to use by organizing the first ever interdisciplinary conference on the topic in May. Robert Putnam, a prominent political scientist, delivered the keynote address. School of Public Health Dean Mark Becker spoke on the critical need for interdisciplinary research. “In the social sciences, social capital is studied as an outcome, as what holds society together. In public health, social capital is viewed as a predictor of health,” explains Oakes. “This conference allowed researchers to discuss these differences as a means to forging truly interdisciplinary work in this important field.”
Photo: Bill Alkofer
Former Director SPH Faculty Honored with of the U.S. Teaching Awards spring, the University of Minnesota and School of Indian Health Each Public Health award faculty for excellence in teaching. Service Kristin Anderson is one of eight Speaks at SPH 2004 recipients of the University Commencement of Minnesota’s Award for When Michael Trujillo delivered the commencement address to the 2004 School of Public Health graduating class, he spoke of combining a solid education with a strong personal commitment. Michael Trujillo “You must bring forth your knowledge and personal commitment to public health every day,” he said. “But most of all, bring passion, something from deep inside. Drawing on who you are, where you grew up, will make the difference.” Following that advice has taken Trujillo’s to some of public health’s most prestigious posts. A member of the Laguna Pueblo in New Mexico, he served under presidents Clinton and Bush as director of the U.S. Indian Health Service (IHS), a multi-billion dollar public health agency serving 1.5 million American Indians and Alaska Natives. He is currently an associate professor in family and community medicine at the University of New Mexico in Albuquerque. Trujillo urged the graduates to be proud of their accomplishments but to always remain humble and respectful of others. “This is the beginning of your path as leaders in public health and you must advocate for those you serve. You have a commitment to society,” he said. “Above all, remain kind and caring. Remember where you come from and who you are.” It is Trujillo’s connection to his own past that brought him back to the University of Minnesota School of Public Health, where he earned an M.P.H. in public health administration more than a decade ago. “Speaking to you is an honor to me, my family, and the people I represent,” he said.
Outstanding Contributions to Postbaccalaureate, Graduate, and Professional Education. The award includes induction into the Academy of Distinguished Teachers, a group that works to assure teaching excellence at the University. Anderson has been a major contributor to teaching and curriculum development for the School’s core epidemiology courses. She was recognized for her work in developing Web-based distance-learning methods, her profound respect for students and their opinions, and her reputation as being one of the most approachable faculty members in the School. Melanie Wall is the 2004 recipient of the Leonard M. Schuman Award for Excellence in Teaching, the School of Public Health’s highest teaching honor. Nominators cited her energy and enthusiasm, her ability to make biostatistics accessible to students from diverse backgrounds, and her open and supportive classroom environment. Katie Schmitz is the 2004 recipient of the Charles N. Hewitt Creative Teaching Award for her effective and innovative teaching in Epidemiology I. Students especially liked her use of the “Bias Rap,” a rap song that clarifies systematic error.
Students As Advocates
Rhonda Jaster delivered the student address at the 2004 School of Public Health commencement.
SPH Grad To Join CDC Training Program
Photo: Bill Alkofer
Before Rhonda Jaster began her studies at the University of Minnesota School of Public Health, she researched career opportunities for graduates in her field. When she came across a training program at the Centers for Disease Control and Prevention, she made a mental note to apply for it after she earned a master’s degree in public health. “I thought it was the perfect program for someone studying community health education,” she says. “During my coursework, I kept it in mind as a goal.” Jaster achieved that goal just weeks before her graduation this year when she became one of 25 trainees nationwide to join the CDC’s coveted Public Health Prevention Service program. After one year working at CDC headquarters in Atlanta, trainees choose a two-year field assignment at state and local health agencies. The CDC initiated the program in 1997 to give graduates practical experience in public health management. As of September 2003, a total of 88 participants have completed the program and are employed in leadership positions at the federal, state, and local levels. Jaster says she is looking forward to working with leaders at the CDC and putting her skills to practice. “I’ve always envisioned myself working at a local or state health department,” she says, “I can’t imagine a better way to begin pursuing that career path.” 16 University of Minnesota School of Public Health
According to SPH associate professor Pat McGovern, it is critical that as part of their education here, students learn to synthesize what is at times complex information into something understandable and then present it in a compelling way in a public forum. “This is how important public health issues are brought before elected officials and advanced in a way that will benefit the community,” she says. McGovern teaches a course in environmental and occupational health policy. As part of a class project, students are asked to create a presentation in which they examine an environmental or occupational health policy issue, take a position, state their rationale based on health benefits, costs, political and administrative feasibility, determine key stakeholders in the debate, seek endorsement of their policy, and finally, identify key elected officials essential to moving the issue forward. One of McGovern’s students, Alecia Carter, was so inspired by the class and this exercise that while working on her project about smoke-free workplaces, she began volunteering on a community coalition whose goal is to amend the Minnesota Clean Air Act. “It was exciting to be able to transfer my learning into practice immediately and make a difference,” says Carter. Similarly, in associate professor Traci Toomey’s legislative advocacy skills for public health class, students are introduced to the state Legislature as an arena for public health practice. They are asked to volunteer for a Minnesota-based nonprofit or public health organization and shadow a lobbyist or advocate so they can see firsthand how an organization’s legislative agenda is developed and furthered. “It is my hope that this class helps prepare students to be effective advocates on public health issues, as well as to be engaged citizens who can use their learning to operate in the legislative arena on issues important to them,” says Toomey.
Alumni in public policy Alumni of the School of Public Health often take the skills and knowledge they gained as students to careers aimed at shaping public policy. Three recent graduates, Gita Uppal, Anna Stauber Sommers and Brian Palmer, are doing just that in positions they hold in Washington, D.C. For Uppal (M.P.H ’99), a Public Health Administration graduate, policy issues affecting the 8.4 million beneficiaries in the U.S. military health system are the focus. A senior analyst at the Department of Defense for more than four years, Uppal has been involved in a variety of issues, from formulating strategies to increase military medical readiness for incidents involving weapons of mass destruction to managing Congressionally mandated programs in the military health system. Uppal was at the Pentagon on Sept. 11, 2001, when terrorists struck. She says the attack re-confirmed a key lesson she learned at SPH: the importance of getting involved in the policy-making process. A former SPH student senate president, Uppal says, “Sept. 11 made me realize the importance of using the opportunities that public service offers to make a significant difference.” She credits SPH faculty with opening her eyes to “the many things I could do in the health policy arena.” Sommers (Ph.D. ’04) became a research associate in the Urban Institute’s Health Policy Center in September 2001 while working toward her doctoral degree in Health Services Research, Policy, and Administration. Since then, she has examined such areas as: the impact of Medicaid managed care on prenatal care and birth outcomes; eligibility and participation rates of adults in public insurance programs; and costs of a program allowing Medicaid nursing home residents to live in more integrated settings. Sommers points to three “all-important components” of her SPH curriculum: analytic skills— gained through coursework in statistics, health policy, and health economics —that are important in evaluating public health insurance
ALUMNI NEWS programs and policies; proposal writing and research design; and survey development and research skills. “I urge new students to gain experience in all three areas,” she says. Palmer (M.P.H ’04) began a term as national president of the American Medical Student Association (AMSA) in May, just after completing SPH studies in Public Health Medicine and medical training at the Mayo Medical School. In addition to managing the 50,000-member association, Palmer advocates for AMSA’s priority issues, including universal health care, eliminating health disparities, diversity in medicine, and transforming medical education. For example, he recently spoke to 12,000 people at the Golden Gate Bridge on single-payer universal health care. Palmer says his MPH background helps when he discusses policy with Congressional staffers, but he often finds members of Congress more compelled by the patient stories he gathered during medical training. “The MD/MPH program develops both the understanding of one-on-one patient care and an understanding of the context and systems that affect that care,” Palmer says. “As SPH people know well, policy-level interventions are the most effective way to improve health. At the same time, patients need competent, compassionate, one-on-one care. Integrating these complementary approaches to health is a distinct advantage.”
New Public Health Job Site The School of Public Health Career Services Center has launched a new online job site, where those interested in public health job, volunteer, internship, and fellowship opportunities can view the latest postings from a variety of employers. The site requires no usernames or passwords, and it allows users to submit application materials directly to employers. www.sph.umn.edu/career/postings/ 17
First International Ancel Keys Symposium on Nutrition and Health: The International Obesity Epidemic September 12-13 Minneapolis Hilton Hotel Food Fight: A Dialogue on Food Industry Litigation and the Obesity Epidemic September 14, 8:30-11:00 a.m. University of Minnesota, Coffman Union Theatre
SPECIAL EDITION SCHOOL OF PUBLIC HEALTH
Ninth Carl J. Martinson Lecture Featuring Marion Nestle September 17, 10-11 a.m. University of Minnesota
For more information on these events, go to www.sph.umn.edu.
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