Advances FROM THE UNIVERSITY OF MINNESOTA SCHOOL OF PUBLIC HEALTH
Forging worldwide One Health Life-saving collaborations from Kabul to Kinshasa Major gift to help fight viruses, virtually Giving women power over poverty
Notes Field from the
SPH students learn lessons abroad
School of Public Health Leadership
Mary Story Senior Associate Dean for Academic and Student Affairs Debra Olson Associate Dean for Education William Riley Associate Dean for Strategic Partnerships and Relations Beth Virnig Associate Dean for Research Mary Ellen Nerney Assistant Dean for Education Operations
Bradley Carlin Head, Division of Biostatistics Bernard Harlow Head, Division of Epidemiology and Community Health Rose Jones Senior Director, Advancement and External Relations Ira Moscovice Head, Division of Health Policy and Management William Toscano Head, Division of Environmental Health Sciences Joe Weisenburger Chief Administrative Officer/Chief Financial Officer
Advances Executive Editor Rose Jones Editor Kristin Stouffer Managing Editor Martha Coventry Contributing Writers Beth Dooley Susan Maas Art Direction Cate Hubbard Design firstname.lastname@example.org Advances is published by the University of Minnesota School of Public Health. To submit comments, update your address, or request alternative formats email email@example.com.
Once again, I’m pleased to present our annual global issue. Its cover story, “Notes from the Field,” gives a glimpse of the hands-on work our students are doing as part of their graduate studies. In summer 2012, they spent time at the World Health Organization in Geneva and the UN’s Food and Agriculture Organization FROM THE DEAN in Rome. Several students worked in isolated areas of Africa, while others headed to Latin America. A special thanks goes to Jennie Meinz, who was in Ecuador, for her photograph on the cover. The picture is a testimony to how the field experience fosters understanding and changes the lives of our students, as well as those they meet along the way.
2 Notes from the field Each year, SPH students set off around the globe to use the skills they learn in class, broaden their vision of public health, and become citizens of the world.
6 Small world, big risks To tackle the emergence of new diseases and the threat of pandemics, an approach called One Health is the world’s best hope, and SPH is helping make it work.
SPH alumni are also actively involved in international work. One example is Barbara Knust, a 2010 MPH graduate and epidemiologist for the Centers for Disease Control and Prevention, who went to Uganda this summer to investigate the Ebola outbreak. Her work follows the principles of One Health, a public health approach that we embrace and encourage in order to develop a unified, strategic response to global disease threats. You can read about SPH’s One Health efforts on page 6.
10 Global public health In India, Afghanistan, Saudi Arabia, and various countries in Africa, SPH experts are collaborating with their international colleagues to address public health challenges. 12
On pages 10–11, you’ll learn more about how our faculty and researchers work with international agencies, organizations, and universities to secure safe blood supplies, stem the tide of malaria, assess the health impacts of gold mining, optimally deliver HIV treatment, and address other public health concerns. And our virtual connection with public health students and professionals all over the world continues to grow via the online courses and programs of SPH’s Centers for Public Health Education and Outreach (CPHEO), which now reach more than 46,500 people.
Bridging the distances Logging on to the Internet makes public health education accessible worldwide, thanks to SPH programs.
13 Big picture thinking Family physician Therese Zink writes about how an MPH broadens her viewpoint and skills.
In closing, I extend my sincere gratitude to the Bentson Foundation for its generous gift to support infectious disease prevention. The Center for Infectious Disease Research and Policy (CIDRAP) will use that gift, in part, to sharpen its ability to communicate effectively using the web, social media, and other online tools. The gift was given especially to support outreach—a land-grant component as essential to the University’s mission today as it was 150 years ago. Thank you, Bentson Foundation.
Have training, will travel
Departments DEPARTMENTS 8 Findings
New Food Safety Center of Excellence; sports drinks an unhealthy choice; finding genetic markers for coronary artery disease; alcohol linked to neighborhood crime; flex sig to reduce colon cancer rates; and more.
SPH alum Lizz Hutchinson works to empower women in developing countries through CARE’s Pathways initiative.
Yours in health,
Printed on recycled and recyclable paper made in Minnesota with at least 10 percent postconsumer material.
John R. Finnegan, Jr., PhD Assistant Vice President for Public Health Dean and Professor © Regents of the University of Minnesota. All rights reserved. The University of Minnesota is an equal opportunity educator and employer.
PHOTO BY RICHARD ANDERSON
John Finnegan Dean
School news SPH collaborates on two new minors that will add a public health perspective to more disciplines; Bentson Foundation gift enhances efforts to prevent infectious diseases.
Notes from the field
Send public health students into the field, then watch as they put their classroom knowledge to work in countries and cultures far from home, often with no electricity or running water, needed supplies, or the right vocabulary. This past summer, SPH students were scattered around the world for their global field experience. Their emails and blogs had a common thread—a newfound realization of how culture influences health.
Que dios le pague. Several times a day, Jennie Meinz (see cover photo) would hear this phrase from the elder Ecuadorians at the local community centers. “Roughly translated, it means ‘May God pay you’ or ‘May God bless you,’” says Meinz, a Community Health Promotion major. “Although these seniors have very little, they are extremely grateful for a space to eat and to chat with friends and visitors.” Meinz spent her global field experience in Pedro Moncayo County, about two hours from Quito, Ecuador. She worked at CECUIDAs (Centro Comunitario de Cuidado Diario del
Adulto Mayor), community centers that provide food, health, and social services for senior citizens. “For about $1.50 per day, per person, CECUIDAs feed and care for the senior population and serve approximately 450 people,” says Meinz. Besides coordinating blood glucose and blood pressure screenings, she talked with older adults about their eating patterns to help them understand the development of chronic diseases. “It was challenging to interview them in Spanish, but after the first few conversations, I started to learn more of the local food vocabulary,” she says.
Africa in an island
Ramatoulie Jallow returned to her native Gambia to help give girls the education they deserve.
Each one matters
SPH STUDENTS LEARN LESSONS ABROAD
Tending to the elders
Ramatoulie Jallow, a Community Health Promotion major, returned to her native Gambia to work for Starfish International, a U.S.-based empowerment program for girls in her country. She co-taught a health class for young women, covering subjects such as selfcare and hygiene, healthy relationships, and preventable diseases, including HIV/AIDS, which are culturally unacceptable for Gambian women to discuss. “In Gambia, talking about sexual and reproductive health remains taboo,” she says. Jallow’s role was to provide young women with a safe
space to discuss these issues and to give them the tools they need to take control of their own health. She used teaching styles she has learned the most from— including games and role-playing—to help the girls understand the material. “I believe that knowledge is health,” says Jallow. “My greatest accomplishment was that I not only taught the students everything I wish I’d known when I was a high school student in Gambia, but that I was also able to create a safe environment for them. They are so eager to learn and so full of hope for the future.”
Mfangano lies in Lake Tanganyika, about three hours away by boat from the Kenyan mainland. Community Health Promotion major Autumn Durfey spent the summer on the island working on sustainable community health projects and a water treatment study. The island is a microcosm of the public health challenges seen in the rest of Africa—lung and eye problems from indoor cooking fires, food insecurity, unsafe drinking water, and, most devastating, high rates of HIV (30 percent of the island’s population is infected). In the struggle to tackle the island’s HIV rate, Durfey saw the effectiveness of community health workers, people especially critical on Mfangano, which has one hospital—albeit without a medically trained doctor—for its 20,000 residents and the citizens on surrounding islands. “Thanks in a big way to their work, HIV is now talked about freely and not tip-toed around as it had been for three decades,” she says. In her time on Mfangano, Durfey witnessed what so many other SPH students found in their global field experiences: “There is a fine line to tread between instituting Westernized methods and preserving culture and tradition.” Autumn Durfey with her host parents, Charles and Eunice.
SPH student Andy Tompsett took a photo of the group responsible for building and maintaining the beehives hung in the tree branches. Money from honey sales support vulnerable children.
Community care Andy Tompsett is no stranger to Tanzania. Between college and graduate school, he spent three and a half years in the country as a Peace Corps volunteer. Returning for his field experience, he focused his attention on helping orphans and vulnerable children through a project called Pamoja Tuwalee, which in Swahili, means, roughly, “let’s care for them together.” “Pamoja Tuwalee is a unique project [in Tanzania] because it increases a community’s capacity to care for children through income-generating projects and small savings and lending groups,” says Tompsett, a Community Health Promotion major. Tompsett was officially an intern with Africare, which manages the USAIDfunded Pamoja Tuwalee and issues subgrants to other organizations to run the programs. His job was evaluating the subgrantees and helping them improve their grant proposals to Africare. Initially, Tompsett wondered if he’d be prepared to do the kind of work this internship would demand of him. “Most of the courses I took last year at SPH were on domestic public health issues, yet I was amazed how comfortable I felt working alongside my colleagues at Africare,” he says.
2 University of Minnesota School of Public Health advances.umn.edu/f12 3
Notes from the field Toward better beginnings SECOND TIME AROUND
Megan Ghai outside the World Health Organization (WHO) in Geneva.
Building relationships When Megan Ghai first went to Geneva as an intern at the World Health Organ ization (WHO), it was hard for her to find her place among so many people. But that difficulty didn’t last long. “Throughout my internship, I was able to develop close relationships with employees at WHO, as well as other interns,” she says “[Making these connections] has been one of the most rewarding components of my time in Geneva.” Ghai, a Public Health Admin istration and Policy major, worked in the Department of Pandemic and Epidemic Diseases on a variety of projects related to Yellow Fever and the use of oral cholera vaccines. She quickly discovered that her SPH classes gave her an advantage. “Courses such as International Health Systems and Cost-Effectiveness Analysis provided me with the rhetoric to interact with departments across WHO,” she says. While Ghai knew that public health efforts are often underfunded at local and state levels, she was surprised to learn that WHO activities also have limited financial support. “I was shocked to see that even on the international level, public health programs that seem indispensable are not impervious to budget cuts,” says Ghai.
4 University of Minnesota School of Public Health
Last summer, Colin Gerber went to Uganda for his field experience. In summer 2012, he was back in Africa serving as a group leader and mentor for American high school students spending five weeks in Ghana. “I found that my field experience and SPH studies helped me in unanticipated ways,” says Colin Gerber, right, with Peter Agor, his host Gerber, a Community Health and local coordinator in Ghana. Promotion major. “I could speak with authority about various health and sanitation issues, and I had no problems managing the group Watch Colin Gerber in a video budget. I felt prepared and confident, about SPH global connections despite the fact that this type of at advances.umn.edu/f12/gerber. work was new territory for me.”
Making way for new thinking In the Ugandan village of Namunkesu, there is no electricity, let alone access to the Internet to search for information. “We were isolated, [but] my studies at SPH helped me design edu cation sessions that were both accurate and culturally appropriate,” says Hally Turner, a Public Health Admin istration and Policy major.
As an intern with the Uganda Village Project, Turner introduced good health behaviors by discussing such subjects as sanitation and hygiene, eye care, nutrition, HIV/AIDS, sexually transmitted diseases, and family planning. Her biggest hurdle, besides the rainy season, was developing the trust of local people so she could move them beyond traditional beliefs. “We were not always successful promoting changes in behavior because of deeply rooted cultural practices,” says Turner. “[For example,] one woman explained to me that she would not improve airflow in her kitchen where she cooked with charcoal because witches would watch her through the ventilation holes.”
Hally Turner, left, with a fellow intern and local school children in Namunkesu, Uganda.
Megan Peck in Rome on the rooftop balcony of the UN’s Food and Agriculture Organization (FAO).
Finding what works Like most Westerners, Megan Peck had no idea that rabies was such a scourge in the developing world. An estimated 65,000 people die from the disease each year. Peck, a Community Health Promotion major, traveled to Rome for her field experience, where she worked at the United Nation’s Food and Agriculture Organization (FAO). There she evaluated rabies prevention and control activities of an FAOimplemented campaign in Kenya. “Ninety-five percent of rabies deaths occur in developing countries,” she says. “I find this number particularly disturbing because
the disease is preventable.” Peck also attended summit meetings of the Codex Alimentarius Commission, created in 1963 by FAO and WHO to establish international standards for safe and equitable food trade. One of the topics was excessive commodities speculation, the effect of which Peck experienced first hand in 2010-11 while living in Kenya. “When there was even [just]talk of increasing oil prices, the cost of food increased,” she says. “This dynamic leads to a volatile food market, which can have devastating effects on developing countries.”
MOMENTS OF JOY AND SORROW “Since I started working with African immigrants and refugees 11 years ago, I have wanted to learn to tie a baby to my back. When I arrived in Congo, I told all of the women at my church that I had to learn this one lesson before I left or my trip would not be complete. “The smallest child was chosen for me, but since babies cannot be tied to the back until they are three months old and she was too young, we had to wait. Just a week before her three-month birthday, she passed away. I knew the statistics on infant mortality in Congo: One in 10 children die before the age of five. But this child was not just a number. She was the little girl who I fell in love with and who was meant to be tied to my back. “As I finished speaking to the congregation on my last Sunday and church came to an end, my three closest friends, including Kety, the mother of the baby who had died, came up to say that I could not leave yet. Kety picked up her second child and, with tears in all of our eyes and with lots of laughter, too, I learned how to tie a baby to my back.” — JESSICA LOWE, a Maternal and Child Health major, went to Brazzaville, Congo, to work with the World Health Organization (WHO).
Ann Marie Castleman headed to Matagalpa, Nicaragua, for her field experience. A Community Health Promotion major, she worked with the Skills to Save Lives Pilot Project, which focuses on reducing maternal and infant mortality. Castleman was in charge of adapting an adolescent sexual health curriculum to be taught by midwives and community health workers in public schools and fine-tuning it for this particular rural Nicaraguan community.
Ann Marie Castleman, far left, with midwives and community health workers from four rural communities in Matagalpa, Nicaragua.
Castleman was struck by the dedication of the midwives, who get no pay for their work. “I learned that many of the midwives walk for hours—across rivers and over mountains—to visit the women they care for,” she says. “They truly live in a different world than the one I come from.” Castleman writes in her blog about how her time in Nicaragua opened her eyes to the concept of “public health.” “[For example], a pregnant woman’s health depends on things like her economic stability, education, geographic location, the politics of her government, and priorities set by world health organizations. Public health is complex. That’s the importance of this work.”
Read more about our students’ experiences at advances.umn.edu/ f12/notes.
Small world, big risks SPH helps foster a new approach to global health “We are still studying the effects of climate on the mouse population and hantavirus infection, but we know that the higher the deer mouse population, the more likely humans and mice will come into contact, thereby increasing the risk of a person becoming infected,” says Knust.
FORMALIZING ONE HEALTH SPH environmental health sciences professor Debra Olson thinks of One Health as “one science, one health, one world.” For her, this phrase emphasizes the notion of dropping the boundaries between science disciplines; between human, animal, and ecosystem health; and between countries and societies. And it is an essential way to approach the
Doing One Health demands a common strategy and way of thinking that crosses disciplines, national boundaries, and public and private domains.
GLOBAL CONCERNS Barbara Knust, an epidemiologist at the Centers for Disease Control and Prevention in Atlanta, traveled to Uganda early this summer to help deal with the outbreak of Ebola, an untreatable, deadly zoonotic disease. The past few months, she has been investigating an emergence of hantavirus, which is transmitted by rodents—deer mice, in this instance—to humans, at Yosemite National Park. Out of nine campers sickened, three have died. Knust received her MPH from the School of Public Health in 2010 after working as a veterinarian for several years. Bringing veterinary expertise together with public health training is an especially useful path for a One Health approach. In the case of hantavirus, the three components of animal health, human health, and the environment must be investigated together.
multiple layers at play in a disease outbreak. “With the One Health approach, you’re not jumping from one part of the crisis to another, you’re integrating the problem solving,” says Olson. Just how and how well we solve problems together is Olson’s concern. As associate dean for education, she is helping to facilitate One Health efforts at SPH, the University, and across the globe in two specific ways—one is through the school’s involvement with RESPOND, a component of USAID’s
6 University of Minnesota School of Public Health
Emerging Pandemic Threats (EPT) program; the other is by engaging with colleagues from the Academic Health Center to create coordinated services in support of global health and social responsibility.
WORKING AS ONE COMMUNITY The hot spots for emerging zoonotic diseases are the world’s tropical zones, particularly countries in Africa and Asia where relationships between humans, animals, and the environment are always in flux. When land is cleared for farming or roads are cut through rain forests, humans come in contact with more wildlife. Dom estic animals often live near wild animals, and many people still kill and butcher “bushmeat,” native animals that can harbor viruses. All this activity raises the stakes for the emergence of novel zoonotic diseases. SPH is a key player in RESPOND, a highly collaborative project that includes Tufts University. RESPOND brings together faculty from across the health sciences, education, and environmental sciences to build capacity for One Health in universities in 10 countries. “RESPOND is increasingly focused on the role universities play in supporting One Health,” says Katey Pelican, RESPOND’s University co-lead with John Deen, both in the Department of Veterinary Population Medicine. “Universities can build programs to create a whole different kind of health worker—a One Health worker, who can be comfortable working across disciplines and across public, private, and governmental realms.”
COMMON COMPETENCIES RESPOND has established a network of schools of public health, medicine, nursing, and veterinary medicine in Central and East Africa (OCHEA) and in Southeast Asia (SEAOHUN) to develop common competen-
REVITALIZING A GLOBAL MISSION
ILLUSTRATION BY OLAF HAJEK
hen the bubonic plague ravaged 14th century Europe, Russia, and Asia, few understood disease vectors or that the tiny flea was the ideal host for Yersinia pesti and rats were the literal jumping off point for human infection. Animals harbor thousands of viruses— most yet undiscovered—that can potentially infect humans with grave results. We’ve witnessed the damage they can cause in the AIDS epidemic and in the estimated 65,000 deaths each year from rabies. But a new approach has developed to understand, prevent, and respond to emerging high-impact zoonotic diseases, those that pass from animals to humans. Called One Health, it views animals, people, and the environment as a single system. Doing One Health demands a common strategy and way of thinking that crosses disciplines, national boundaries, and public and private domains.
cies and a unified, strategic response to global disease threats. For the past two years, RESPOND has been addressing its capacitybuilding mandate through small group meetings, international conferences, exchange programs, short courses, and residencies, including those at Makerere University in Uganda and Chaing Mai University in Thailand being modeled on the University of Minnesota Veterinary Public Health Residency. This summer, RESPOND used a model already in place—SPH’s Public Health Institute—to bring together faculty from Tufts University, OHCEA, and SEAOHUN. The RESPOND team used the three weeks they were together to address cultural barriers with a One Health approach and to begin to devel op a One Health curricu l um for participants to take back to and apply in their respective countries and universities.
When the University was established as a land-grant institution in 1862, part of its mission was to make knowledge accessible to the world. In the past several decades, the University’s reputation as a health and science educator, leader, and innovator has gone global. People from multiple disciplines at the University, along with their international colleagues, are addressing the world’s wicked health problems with an increasingly
One Health approach. But what the University doesn’t have yet is a coordinated way to bring these efforts together to enhance their reach and impact. Olson and her fellow Academic Health Center deans have proposed a coordinated infrastructure for global health and social responsibility that would lead, foster, and engage those involved with One Health activities at the University. It would support colleges, units, and departments from economics to ecology, veterinary medicine to public policy, and technology to agriculture, as they build on their global portfolios that address issues at the intersection of animal, human, and ecosystem health. Already associate professor Jeff Bender is leading a partnership between the College of Veterinary Medicine and SPH to expand One Health educational opportunities at the University to prepare the next generation to manage the world’s complex health issues. It’s no surprise that the School of Public Health would be so deeply invested in supporting and nurturing this game-changing approach to global health. The nature of public health professionals is to make human connections, learn as much as they teach, and be aware of and work from an appreciation of the many elements that have an impact on health. As Barbara Knust says: “One Health is a great term to capture the goal and the concept that has been sought and achieved by public health practitioners for a long time.”
SPH researchers lead effort to find genetic risk of coronary artery disease
Sigmoidoscopy screening can reduce colorectal cancer rates, deaths
SPH researchers have identified two genetic markers correlated with coronary artery disease. The link could help experts determine who may be most at risk of developing the disease, which impacts more than 13 million Americans a year. “There is a lot of work still to be done,” says Weihong Tang, a genetic epidemiologist who led the research. “But our findings should set a foundation for new types of testing that will help physicians find and treat clotting diseases in the general population.” Study details at advances.umn.edu/f12/cad.
The use of flexible sigmoidoscopy screening reduces deaths from colorectal cancer cases by more than 25 percent. That’s according to results from the first U.S. randomized clinical trial that looked at the effectiveness of sigmoidoscopy. Findings were published in the New England Journal of Medicine. Listen to Public Health Moment to learn more at advances.umn.edu/f12/ cancerscreening.
Sports drinks just as unhealthy as soda More children and teenagers are opting for sports drinks instead of soda. While that may sound like a good thing, new SPH research shows that sports drinks are just has unhealthy as soda, and they are likely contributing to the obesity epidemic. “We’re seeing schools, parents,
and community • In 2010, Gatorade members making TV ads were ranked in the top the decision to swap five as the most soda for sports drinks advertised products thinking they’re seen by children decreasing children’s and adolescents. consumption of sugarPowerade TV ads sweetened beverages,” were ranked says SPH professor twenty-sixth. Mary Story. “But really, they’re replacing one sugary drink for • The market share another.” of sports drinks in The study also schools increased found that: from 15 percent in
2004 to 20 percent during the 2006–2007 school year, while sodas decreased from 40 percent to 30 percent. • More than 27 percent of parents believe sports drinks are healthy.
SPH, along with the Minnesota Department of Health, has been selected by the Centers for Disease Control and Prevention (CDC) to create a Food Safety Center of Excellence that will help prevent and respond to foodborne illnesses. Over the past several years, Minnesota has made national headlines in the successful search for the sources of two major Salmonella outbreaks. “Minnesota has been a leader in the effort to improve food safety, and [this] an nouncement means that our state will continue to be on the front lines in the fight to keep consumers safe,” says Sen. Amy Klobuchar, who authored legislation establishing the food safety centers. Learn more at advances. umn.edu/f12/foodsafety.
A new SPH study has confirmed that Minneapolis neighbor hoods with a higher density of alcohol establishments experience more violent crime. Of the neighborhoods in question, those with more on-premise outlets, such as bars and restaurants, are more likely to see violent crime than the neighborhoods with offpremise outlets, such as liquor stores. SPH professor Traci Toomey, who led the work, discusses policy implications at advances.umn.edu/f12/violence.
21st century public health What are some of the biggest threats to our health in coming years? How is public health uniquely positioned to take on these challenges? Learn more from this 120 second video at advances. umn.edu/f12/future.
Investing in quality of care for diabetic patients reduces costs
More findings at advances.umn.edu/ f12/sportsdrinks.
Alumni Notes SPH alumni bloggers are writing about their work from throughout the country and world. Check in at advances.umn.edu/ f12/alumniblogs.
8 University of Minnesota School of Public Health
Alcohol linked to violent crime in residential neighborhoods
CDC selects Minnesota for food safety center
SPH researchers have found that medical group practices can reduce costs for patients with diabetes by investing in quality of care. The researchers analyzed 234 medical group practices providing care for more than 133,000 diabetic patients. After developing a “quality of care” score based on select patient care initiatives, researchers found that providers saved an average of $51 in costs per diabetic patient for every 1 percentage-point increase in their quality of care score. “Our research should be reassuring for physicians who are joining or forming value-based Accountable Care Organizations,” says SPH professor John Kralewski. “Our data show that physicians can provide high quality care while meeting the cost savings expectations of ACOs.” More at advances.umn.edu/f12/ diabetes.
Are Americans ready to solve the weight of the nation? Over the last 30 years, the obesity epidemic has become one of our nation’s most daunting health challenges. Despite growing evidence showing that environ mental factors—schools, workplaces, communities, the food industry, and the media—drive obesity rates, most Americans believe that the solution to the epidemic rests with obese individuals and their families. SPH health policy expert Sarah Gollust—along with colleagues at Cornell University and Johns Hopkins University—recently examined this dynamic in an analysis for the New England Journal of Medicine. Their research showed that, when it comes to decreasing childhood obesity, people had a similar opinion. “We found that most people believe strongly that childhood obesity is the responsibility of parents to solve,” Gollust says. While the authors applaud efforts calling for multiple sectors of society to address obesity, they suggest that Americans, with their views of personal and parental responsibility, may not be ready to hear this message. Watch “Are Americans Ready to Solve the Weight of the Nation?” at advances.umn.edu/f12/weight.
GLOBAL PUBLIC HEALTH A look at SPH collaborations in three parts of the world
•T hirty-nine countries still
•P er 1,000 people, the median
cannot guarantee a safe
blood donation rate in high-
blood supply and don’t
income countries is 36. In
screen all blood for HIV,
middle-income countries it
hepatitis B, hepatitis C,
is 12 and in low-income
countries it is 3.
BEST TIME FOR TREATMENT
GOOD HEALTH CARE EVERYWHERE
BANKING SAFE BLOOD
Antiretroviral treatment for people with HIV is costly, not free of toxicities, and lifelong once initiated. When to best start this therapy has been debated for years; finding an answer is critically important. To that end, the International Network for Strategic Initiatives in Global HIV Trials (INSIGHT), led by SPH biostatistics professor Jim Neaton, is conducting a definitive randomized trial. Nearly 4,000 participants will eventually be enrolled at more than 200 sites in 33 countries, including South Africa, Uganda, Nigeria, Mali, and Morocco. In addition to helping researchers discover optimal timing for treatment, many partici pants in this global study have enrolled in sub-studies specifically investigating how HIV and HIV treatments affect neurocognitive function, bone health, arterial elasticity, and lung function.
Saudi Arabia faces many of the same health care issues we do in the United States, like a growing private health insurance market and the need for efficient, cost-effective integrated delivery systems. The SPH-sponsored Executive Master of Healthcare Administration (MHA) program at the King Fahad Medical City in Riyadh will help senior physicians and administrative leaders meet those challenges. The program follows SPH curriculum and allows students to earn a University of Minnesota MHA degree in 25 months. Directed by health policy and management professor Dan Zismer and administrative program director Tom Gilliam, the Saudi Arabia partnership may be the first of many to come to help produce a stronger global medical community.
Having a safe, adequate blood supply is something few developing countries have been able to achieve. Afghanistan was one of these countries until 2010, when the Ministry of Public Health chose SPH prof essor Bill Riley, administrator Terri Konstenius, and the Medical School’s Jeffrey McCullough to assist it in building a national blood supply, including developing screening and collection procedures and systems for recruiting donors. Later that year, this public health and medicine interdisciplinary team began a similar project in Tanzania when the Centers for Disease Control and Prevention selected the University of Minnesota to help the Tanzania/ Zanzibar National Blood Transfusion Service develop a comprehensive donor recruitment program with a goal to double the blood supply in five years.
USING THE INTERNET TO STOP THE SPREAD OF HIV No one knows yet how well internet-based education and intervention techniques could lower HIV transmission among high-risk men in India—methods successful in the United States have never been tried there before. Now a University of Minnesota team has joined a California and Indiabased team to collaboratively research that potential in Mumbai. Called ISHKonnect and led by SPH epidemiology research associate Michael Wilkerson, the study will investigate basic issues like internet availability, how the internet is used to connect male sex partners, and whether conducting online focus groups is feasible and culturally acceptable. An online intervention campaign in India has the potential to reach thousands of men, reduce risky beliefs and behaviors, and prevent the spread of HIV.
SUPPORT, WHERE YOU LIVE
TEACHERS AS GAME-CHANGERS
A major challenge to worldwide efforts in scaling up HIV treatment is that patients often stop going to clinics for care. Many of those who discontinue their clinic visits either die at home or return to the clinic only after their health has significantly deteriorated. In rural southern Ethiopia, SPH epidemiology professor Alan Lifson is conducting a project to improve treatment retention by working with HIV-infected individuals where they live. The project hired and trained community health workers from the same villages or neighborhoods as their clients. They provide education, counseling, social support, referrals, and linkage to the HIV clinic. The project, which was implemented over a year ago, is currently assessing the impact of this communitybased intervention on client retention rates, knowledge, attitudes, and health status.
Bihar is one of India’s poorer states and has extra ordinarily high rates of tobacco use, even among adolescents. Epidemiology professor Harry Lando is involved with a study at government schools that focuses on tobacco abstinence among teachers. If the teachers can stop using tobacco, the hope is that they will become role models for students and others in the community, where they tend to be highly respected. After four years of the five-year project, researchers are surprised by the high numbers of teachers who have quit using tobacco. In another part of the world, Lando is working on an NIH-funded study to discern the capacity of Tunisia and other lowresource countries in the region to implement Article 14 of the WHO Framework Convention on Tobacco Control, which calls for measures to reduce tobacco dependence and increase cessation.
TURNING THE TIDE ON MALARIA
•R esearch shows that HIV first appeared in Africa in the 1920s. Most likely, bushmeat hunters killed and butchered chimpanzees infected with SIV (Simian Immunodeficiency Virus), and they, in turn, contracted the virus that
Every year, 3.3 billion people—half of the world’s population—are at risk of contracting malaria. The disease affects poor communities most, decreasing the GNP of countries with a high malaria burden by more than 1 percent. But prevention and treatment efforts are paying off. In the past 12 years, malaria mortality rates have fallen by 25 percent globally and 33 percent in Africa. SPH doctoral student John Amuasi is leading an evaluation of a malaria treatment program in his home country Ghana. Funded by the public-private financing group, the Global Fund, the pilot program subsidizes costly anti-malaria drugs with the aim of improving accessibility, availability, and affordability. Not only does early treatment save lives and prevent transmission, it reduces the use of less effective treatments to which malaria parasites are becoming increasingly resistant.
developed into HIV.
• In 2010, 90 percent of
•N early 1 million
malaria deaths occurred
people in India die
in Africa and nearly
from tobacco use
600,000 African children died.
TOO MUCH FLUORIDE Fluoride occurs naturally in well water, but when the water table is low, the mineral becomes concentrated. Drinking this water may lead to fluorosis, which can cause teeth enamel to erode and produce pain and damage in bones and joints. As fluorosis becomes more common around Kolar, India, SPH faculty, the Sri Devaraja Urs Medical College (SDUMC), and the Indian Institute of Science at Bangalore are collab orating to research the issue and design preventive interventions. In the first phase of this effort, SDUMC will conduct a study to estimate fluorosis prevalence in the population. The Indian Institute of Science, because it has the necessary infrastructure, will test local water and soil for fluoride. • I t is estimated that 60 million people in India are at risk for skeletal fluorosis and
CLEANER BURNING STOVES Burning solid fuels in household stoves for cooking and heating harms health and contributes to carbon emissions and climate change. Environmental health professor Gurumurthy Ramachandran, University of Minnesota civil engineering faculty, and University of British Columbia researchers comprise a team that has completed phase one of a neighborhood-scale stove replacement program in Karnataka, India. Half the households received cleaner burning stoves after the team collected data related to cardiovascular health, air pollution, and livelihood. The next phase will include collecting post-intervention data. Team members expect the new stoves will reduce indoor air pollution and improve cardiovascular health. At the end of the study, all paticipating households will receive a new stove.
•T he leading environmental cause of death in the world is indoor air pollution from household cooking fires, according to a World Health Organization study.
GOLD FIELD FALLOUT? Phased out as a major commercial venture in 2001, the centuries-old practice of mining gold in India’s Kolar District is suspected of leaving a legacy of occupational diseases and environmental health hazards. Despite possible risks, miners and their kin continue to strive for a revival of gold mining, their only source of employment. An SPH team including, environmental health professors Jeff Mandel, Gurumurthy Ramachandran, and Bill Toscano, has joined with Sri Devaraja Urs Medical College (SDUMC) in Kolar to investigate if mining is truly to blame for many of the region’s health issues—like lung and skin diseases, asthma, and tuberculosis—and to provide solid public health data for the people of Kolar. The longterm goal of the SPH/SDUMC collaboration is to establish an occupational health program at the college, which has already begun biweekly health fairs where public health information is disseminated and faculty conduct health screenings.
6 million people have already been disabled. 10 University of Minnesota School of Public Health
Bridging the distances
Having an MPH has benefited my work globally and locally. It has helped me address the sources of health problems, rather than just treat their symptoms.
Public health education at your fingertips
tries are lacking. Anna Guo works for 3M in Shanghai province, China, and manages registered nurses at eight manufacturing sites. She has a bachelor’s degree in prevention medicine and an advanced nursing diploma. Because Chinese schools of public health cannot offer ade quate advanced training, she says, her U.S. colleagues recommended CPHEO online classes for her career development.
the latest public health issues, as well as to conduct orientation or refresher training on basic public health concepts. CPHEO helps support growing academic prog rams, such as the Online Executive Program in Public Health Practice and the online program in Maternal and Child Health.
REACHING STUDENTS WHERE THEY ARE One of the centers’ great advantages is the accessibility of its programming. Nearly a third of the world’s seven billion people
12 University of Minnesota School of Public Health
Big picture thinking Family physician Therese Zink’s MPH broadens her approach to health care
PHOTO BY PATRICK O’LEARY
Offering classes online and at little cost is a rapidly growing phenomenon.
have internet access and CPHEO can reach them—and has—in Armenia, Botswana, Australia, and many other countries. Stanley Blanco lives in La Paz, Bolivia, and is in charge of USAID-funded community health projects in that country. He has an MD and MPH. Two years ago, he was appointed as an assistant mission disaster relief officer. “I recognized that I needed immediate training on emergencies, risk reduction, and disaster management, so, searching the web looking for reliable universities and courses, I found CPHEO,” says Blanco. For people like Blanco who have limited time, CPHEO’s online courses offer a convenient way to learn. For other students, the classes fill a vital need for the advanced public health training that their coun-
ILLUSTRATION BY OLAF HAJEK
map of the world showing the reach of SPH’s Centers for Public Health Education and Outreach (CPHEO) is scattered with dots of varying sizes representing the number of people from each part of the globe who have taken advantage of the centers’ courses and programs. In the nearly 12 years since it has been offering classes to the global public health community, CPHEO has grown from serving 1,483 learners in 2000 to serving more than 46,500 in 2011, with the vast majority (90 percent) getting their education online. CPHEO offers students the chance to gain more knowledge about certain aspects of public health and earn continuing education credits. NGOs (nongovernmental organizations) use CPHEO classes to keep their employees up to date on
What’s missing for Guo in her online studies is “schoolmates to exchange learning experiences with.” SPH supplements the online learning available for stud ents via CPHEO with the annual three-week intensive Public Health Institute (PHI) on the Twin Cities campus, which Guo hopes to attend one day. Over the years, SPH has also taken a program modeled on PHI—the Global Health Institute—to places such as Iceland, India, Vietnam, Thailand, and Uganda to address the growing need for coordinated and innovative global public health training. Offering classes online and at little cost is a rapidly growing phenomenon, and universities across the country are clambering to get on board. CPHEO has more than a decade-old history in delivering first-rate, consistent, and current content to computer screens—and increasingly, mobile phones—all over the world.
he group of Minnesota college students, all prehealth majors, climbed out of the old yellow school bus. The temperature that January afternoon in Nicaragua registered 35 degrees Celcius (95 Fahrenheit), much warmer than back home. They paired off, linked up with their interpreters, and tromped in different directions down the dirt roads of the village to begin knocking on doors. The students were spending their J-term with Inter Faith Service to Latin America (ISLA), and I was coordinating their weeklong activity. Thanks to the skills I’d gained through my Master of Public Health program, I suggested that ISLA do a community needs and assets assessment so we could better understand the region’s health issues. Over and over again that week, people in the village welcomed the students into their homes. One of the important findings from our community assessment was related to asthma. Students noted that locals cooked in kitchens without ventilation. Mothers reported coughing among their children, but were unaware of the relationship
between the cooking fumes and their children’s health. Later, the students and I discussed the findings. We could treat the children’s asthma in the clinic, but addressing the problem from a public health perspective would achieve broader results. Eventually, ISLA identified a Nicaraguan stove with a pipe ventilating to the outside that could be installed in homes for a reasonable price. The experience also reminded me of why I chose to pursue an MPH after working as a family physician for five years. I wanted a “big picture” perspective and the skills to affect health on a scale broader than one person at a time. Having an MPH has benefited my work globally and locally. It has helped me address the sources of health problems, as we did with the childhood asthma issue, rather than just treat their symptoms. In my practice in a small rural community in southeastern Minnesota, it is equally important for me to consider health beyond the clinic’s walls. Therese Zink , MD, MPH, earned her degree from SPH in 1992.
ALUMNI NEWS SCHOOL NEWS
Public Health Undergraduate Minor “Collaboration is the very nature of our field,” says Debra Olson, SPH associate dean for education, talking about the new public health undergraduate minor. The partnership between the School of Public Health and the College of Liberal Arts in creating the minor “has been one of the greatest successes in the development of the program,” she says. Its coursework will provide students with a foundation in the language, concepts, and methods used to address individual and population-level health challenges. “Whether a student’s major is pre-med, prelaw, business, or journalism,
this minor is relevant and practical,” says Tricia Todd, assistant director of the U’s Health Careers Center and SPH instructor. Offered as an option in the geography and sociology departments, the minor will provide students the tools to work across disciplines. “It meets both my personal and professional interests,” says Jess Kessler, a senior majoring in biology and environmental sciences who serves as a health advocate for her dorm. Kessler says the minor will help give academic context to the training she received to understand student health issues—physical, mental, emotional, and spiritual. “The holistic approach makes so much sense,” she
12 University of Minnesota School of Public Health 14
adds. “The public health classes are taught by graduate-level professors, so this will give me a sense of what the MPH [program] might be like. I am considering applying to SPH, and this is a good way to start to learn more about it.” Limited to 100 students, the minor drew 97 applicants the first week it was announced. Graduate Minor – Integrative Leadership “The Integrative Leadership minor is an astounding collective effort among four professional schools—the School of Public Health, the Carlson School of Management, the Humphrey School of Public Affairs, and the College of
Bentson foundation gives $1.5M to support infectious disease prevention
– John F. Kennedy
Education and Human Development,” says Louis Quast, associate chair of the Department of Organizational Leadership, Policy, and Development in the College of Education and Human Development, the minor’s academic home. Seminars in the minor will be co-led by two faculty members from different sponsoring professional schools. “Students will develop the leadership skills to create a common vision by drawing from their different areas of expertise,” says Quast. The minor’s mission is to address social, economic, and political change while training future leaders to bridge institutional, geographical, sectoral, and national boundaries. Open to all University of Minnesota graduate-level students, this new minor is the first of its kind in the country. “When you think about the different systems in our society—health care, political, educational, economic—each may cultivate leaders within its sector, but can those individuals lead across sectors?” says Sandra Potthoff, SPH associate professor. “Solutions to a society’s complex problems that come from an exchange of ideas will be far better than those coming from any one discipline.”
ttention-grabbing specters like bubonic plague, Ebola, or the slim possibility of anthrax attacks make for compelling headlines, and the University of Minnesota’s Center for Infectious Disease Research and Policy (CIDRAP) keeps tabs on all of these—along with other nightmarish, if distant, threats. Recently, CIDRAP has made headlines for its work on a more familiar, yet potentially devastating, peril: influenza. In the past few months, the center has weighed in on the possible dangers of the H5N1 man-made flu virus and investigated the H3N2 swine flu virus. CIDRAP also released a major new report on the efficacy of seasonal flu vaccines and the urgent need to improve them. Now, thanks to a $1.5 million gift from the Bentson Foundation, CIDRAP will be able to enhance efforts to prevent infectious diseases, whether emerging or familiar.
PHOTO BY RODRIGO ZAMITH
Two new minors offer major opportunities
“Leadership and learning are indispensable to each other.
Proportional response and public outreach While CIDRAP monitors scores of important issues, from hantavirus to smallpox, its priorities are governed by the princiCIDRAP recently issued a major report on the efficacy of seasonal flu vaccines. ple of proportional response, says Michael Osterholm, CIDRAP director and SPH professor. “What kills us, versus what hurts us, versus what worries us, versus what scares the other online tools for outreach, says Bentson hell out of us—often these can all be very different,” says Osterholm. “Our job is to try Foundation executive director Judi Dutcher, to make sense out of that, and to try to put the emphasis on what can hurt us or kill us.” who notes the possibility of in-person outreach Calling on sound science to educate the public, industry, and policymakers about efforts, including summits on topics deemed critilooming health threats is central to CIDRAP’s mission. That cal by Osterholm and CIDRAP education can take place on the airwaves of national news staff. “We wanted to give them Each year more outlets (Osterholm is a frequently called-upon expert), through as much flexibility as possible,” CIDRAP-hosted conferences, and in one-on-one discussions with Dutcher says. than a million government and business leaders. More than ever, that education U graduates Larry and Nancy pages are is happening online. Bentson formed the Bentson accessed on Foundation in 1956 to advance a Gift to enable website revamp and enhance outreach variety of philanthropic causes. CIDRAP’s sites. The Bentson Foundation gift is targeted broadly to outreach, and With its history of support for the “a major component of that is our web presence,” says Aaron U, including a recent gift for a new Desmond, CIDRAP’s associate director for outreach and development. The gift will School of Nursing teaching lab, and its longstandenable a revamp and integration of CIDRAP’s websites, whose users work around the ing recognition of Osterholm as an international globe (a third are from outside the U.S.) in clinical care, academia, the private sector, “thought leader,” the foundation saw CIDRAP as a government agencies, and groups such as the World Health Organization. Each year natural fit, Dutcher says. more than a million pages are accessed on CIDRAP’s sites. “We’re becoming a very close global community “I’m proud of the work we’ve done to establish CIDRAP as a trusted source for . . .the fact that we have this center that is a leader public health reporting throughout the world,” says Osterholm. “Our staff works tirein addressing emerging public health threats is a lessly to provide scientifically sound, up-to-the-moment content on critical issues.” testament to the University,” she says. “We’re really The gift also allows CIDRAP to further develop its use of social media and excited to see what’s going to be accomplished.”
Offering classes online and at
ALUMNI NEWS CLASS NOTES
Have training, will travel
Ken Bence (MHA
’92) was named director of public health for Medica Health Plans. He leads public health and clinical initiatives for Medica’s state public programs. Formerly, he served as director of community health initiatives for the State Public Programs Division of Medica.
MPH graduate Lizz Hutchinson is turning her talents to empowering women
12 16 University of Minnesota School of Public Health
Mona Bormet (MPH ’05) is
the project manager for policy and advocacy at Christian Connections for International Health, located in Washington, D.C. Bormet manages funding through the United Nations Foundation that focuses on family planning from a faithbased perspective.
Russell Currier (MPH ’69)
received the American Veterinary Medical Association’s 2012 Public Service Award. Currier, now retired, served for several years as Iowa’s public health veterinarian and worked on a range of zoonotic disease initiatives. He also launched the state’s first surveillance of
Timothy Doyle (MPH
’95) is a CDC resident advisor for the Field Epidemiology Training Program (FETP) in Mozambique. FETP is a twoyear program that exists in more than 30 countries and is modeled on the CDC’s Epidemic Intelligence Service program. Matthew Katz (MS ’95) was appointed to the boards of Connecticut’s All Payer Claims Database and HealthyCT, a consumer-oriented and -operated plan for the state. He is executive vice president and CEO of the Connecticut State Medical Society. Linda Olson Keller (MS ’79)
has received the Paul and Sheila Wellstone Public Health
Achievement Award from the Minnesota Public Health Association (MPHA). The award honors a person whose outstanding contributions exemplify MPHA’s mission to promote the health of individuals, families, and the community. Luann Reif (MPH ’81) is an associate professor of nursing at the College of St. Benedict and St. John’s University. For several years, she has led student service trips to Ecuador to work with the Yambiro community. The work centers on educational programing for children and partnering with community leaders. Rachel Roberts (MS ’12) will soon begin work as a biostatistics associate at Keio University’s Clinical Research Center in Tokyo. She will provide statistical consultation and analysis for clinical studies and teach biostatistics courses to medical students and researchers. Lorna Schmidt (MPH ’10)
manager for the Campaign for Tobacco-Free Kids in Washington, D.C. She recently completed a health communications fellow ship with the National Cancer Institute’s Tobacco Control Research Branch. Jessica Vig (MPH
’12) has completed an internship in the USAID Global Health Fellows Program II. She worked in the Orphans and Vulnerable Children Service Integration program in Washington, D.C. She will soon begin serving as an ASPH/CDC Allen Rosenfield Global Health Fellow, working as an HIV prevention specialist in Atlanta, Ga., and Botswana.
Create your own class note or read about classmates at advances.umn.edu/ f12/classnotes.
began a new position as research
PHOTO BY PAULA KELLER
Walk and Talk kicks off
PHOTO BY DARIN BACK
In her work for CARE, a leading humanitarian organization fighting global poverty, Lizz Hutchinson travels to more countries in a year than most of us do in a lifetime— Bangladesh, Ghana, India, Malawi, Mali, and Tanzania. In previous assignments, she’s been to Kenya, Mozambique, and South Africa. For fun, Hutchinson and a former MPH classmate, Sarah Sevcik, will head to Panama to sightsee this fall. In just three years of receiving an MPH in Community Health Promotion, Hutchinson is flying high. Hutchinson’s ease in relating to people has helped her land several positions since graduation, despite a grim job market. In her final semester at the School of Public Health, she requested informational interviews with numerous organizations and individuals. “I listened intently and always asked for other contacts,” she says. “Minnesota is a terrific place for global work. Everyone—professors, my parents’ friends, alumni—provided leads.” Her current position involves working with one of CARE’s most recent initiatives—Pathways—designed to enable 150,000 women who work small plots of land to develop as farmers, increase their household incomes, and realize a measure of food security. “Alleviating poverty is key to improving public health,” Hutchinson says. “And one of the best ways to do that is by empowering women so they can engage profitably with the markets.” The Pathways program, funded by the Bill and Melinda Gates Foundation, builds on CARE’s established and successful approaches. Before joining CARE, Hutchinson honed her public health monitoring and evaluation skills at Land O’ Lakes International Development, the University of Minnesota, and WellShare International, formerly Minnesota International Health Volunteers. With her graduate fieldwork in Tanzania and her master’s project in North Minneapolis, she combined academic studies, research skills, intuition, and creativity. In Tanzania, for example, she volunteered with an organization that hosted public health plays performed on the village’s busy market days. For her master’s project, a community needs assessment, she used qualitative interviewing techniques, which encourage open-ended conversations, to discern the neighborhood’s most critical health issues. Wistful about her time with the School of Public Health, Hutchinson says, “I wish I’d taken advantage of the U’s classes in economics, geography, or perhaps a language.” Given her energy and enthusiasm, it’s likely she will.
injuries among farm workers. He is currently president of the American Veterinary Medical History Society.
SPH alumni and students recently gathered at the Weisman Art Museum to launch the Walk and Talk event series. The SPH Alumni Society designed the series to provide opportunities for networking and discussion about timely public health issues. Learn about upcoming SPH events and other ways to connect with classmates and the school by signing up for monthly Alumni E-News alerts at advances.umn. edu/f12/involved.
420 Delaware Street SE Minneapolis, MN 55455 www.sph.umn.edu
Nonprofit U.S. Postage PAID Twin Cities, MN Permit No. 90155
UPCOMING EVENTS SPH Roundtable “Framing the Future: The Second Hundred Years of Public Health Education” Keynote: Donna Petersen, dean, College of Public Health, University of South Florida Friday, Feb. 1, 9 a.m. Coffman Memorial Union Theater advances.umn.edu/f12/roundtable 2013 Legislative Briefing University of Minnesota President Eric Kaler presents “Zero Percent: Can They Count on You?” Wednesday, Jan. 23, 5 p.m. McNamara Alumni Center Registration opens Dec. 3 advances.umn.edu/f12/briefing Ninth Annual National Public Health Week Film Festival April 1-5, 5 p.m. Mayo Memorial Auditorium advances.umn.edu/f12/filmfest
Sign up for monthly news alerts at advances.umn.edu/ f12/involved. From supporting fresh produce in schools to protecting the safety of our global food supply, our students and researchers are illuminating answers that are healthy for the planet and all her inhabitants.
See more highlights at advances.umn.edu. © 2012 Regents of the University of Minnesota. The University of Minnesota is an equal opportunity educator and employer.
© 2012 Regents of the University of Minnesota. All rights reserved.