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advances Winter 2012

f r o m t h e U n i v e r s i t y o f M i n n e s o ta S c h o o l o f P u b l i c H e a lt h

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Wicked Problems

SPH faculty devote their careers to solving the unsolvable


from the dean 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

Dear Friends,

Rose Jones Senior Director, Advancement and External Relations

This time of year, potential graduate and professional students are finalizing their plans to pursue a public health career and deciding whether our school is right for them. As they make this important decision, a few sometimes ask how I landed in public health. Essentially, public health chose me—an academic mentor thought my communication skills would be a good fit with a field that needed people with all kinds of talents. In time, public health became a career home and a passion.

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 Nicole Endres Art Direction Cate Hubbard Design cat7hubb@gmail.com Advances is published by the University of Minnesota School of Public Health. To submit comments, update your address, or request alternative formats email sphnews@umn.edu.

The draw for me? It is the most multidisciplinary field I know and relentless in transforming knowledge to address complex, seemingly unsolvable problems that affect the well-being of populations and communities. That tenacity is reflected in the cover story about SPH researchers pursuing answers to four very “wicked” challenges. The field’s breadth and diversity keep me energized. The expanse of interests, talents, and approaches required to address challenges in public health brings great opportunities to make a difference. For example, on page 2, you’ll meet an SPH student whose Hurricane Katrina relief efforts have added a new flavor to local and global fundraising. Similarly, lessons learned from the hurricane’s emergency response efforts prompted an SPH alum to craft Connecticut’s first coordinated emergency rescue program for animals. You’ll find that story on page 15. The rich history of public health also drives my commitment. Public health pioneers and practitioners have helped shape the course of human development. On page 10, you will learn about how early leaders in cardiovascular epidemiology—some of them from our own SPH—forever changed our understanding of heart health. And finally, I’m invigorated by the field’s cycle of renewal as a cadre of new graduates joins our alumni ranks each year. This spring, we’ll welcome some 250 into our SPH global family. I know they’ve been well equipped with the knowledge and skills needed to address tomorrow’s thorniest public health issues. I’m also confident that each one will make a significant difference in the health and vitality of communities worldwide. I can’t wait to see how their own public health stories unfold.

Yours in health,

Printed on recycled and recyclable paper made in Minnesota with at least 10 percent postconsumer material.

© Regents of the University of Minnesota. All rights reserved. The University of Minnesota is an equal opportunity educator and employer.

John R. Finnegan, Jr., PhD Assistant Vice President for Public Health Dean and Professor

Photo by richard anderson

John Finnegan Dean


Winter 2012

contents

Features

Departments

2 Food for Thoughtfulness

8 Research News

Wanting to contribute to Hurricane Katrina relief and short on resources, Emily Torgrimson did what she could: cook. Now her Eat for Equity organization raises money for local and global causes.

photos by Emily Rumsey and Tim Rummelhoff, illustration by Jacob Thomas

3  the World’s Wicked Problems

SPH faculty take on some of the toughest challenges to the health of humans and the planet. Four researchers profiled tackle water pollution, the obesity epidemic, tobacco use, and HIV transmission. 10 Birth of a Discipline

Cardiovascular epidemiology is a relatively new field and SPH professor emeritus Henry Blackburn did some of the first research. His new history project traces the colorful beginnings of this global endeavor.

Helping medics on the front lines; a fresh look at nutrition labels; obesity and youth sports; new cancer screening guidelines. 12 school News

The Minnesota model for food safety; Vernon E. Weckwerth chair; Peace Corps Master’s International program; and more. 16 alumni News

Alumni board call for nominations; MHA grad designs pediatric IV poles; class notes.

15 Emergency Relief for Animals

Arnold Goldman was concerned with the public health implications of dealing with pets in a disaster, so he forged Connecticut’s first coordinated animal rescue program.

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Food for thoughtfulness Eat for Equity founder, SPH student Emily Torgrimson, helps a little go a long way.

Cook it, and they will come When Torgrimson was a junior at Boston University, Hurricane Katrina hit the Gulf Coast. Wanting to help, she made a big batch of jambalaya and asked friends to come eat with her and throw in a dollar or two for hurricane relief. A hundred people showed up, and she cooked again the next month. Eat for Equity was born. 2 University of Minnesota School of Public Health

“By pooling all our fairly small contributions, we felt we could make a collective impact,” she says. When Torgrimson returned to Minnesota, she brought Eat for Equity with her—it has been thriving here since 2007.

Everyone deserves to eat well In the spring, Torgrimson will graduate with a degree in community health promotion. Not surprisingly, her particular interest is food access and affordability. “With Eat for Equity, we spend an average of $3 per person and buy local, organic products whenever possible,” she says. “Part of my personal and professional mission is to show that, although it’s not easy, it is possible to eat ethical food on a budget.” Soon Torgrimson will be taking the Eat for Equity model on the road. Last Thanksgiving morning, NBC’s “Today Show” aired a segment on Eat for Equity. Since then, Torgrimson has received inquiries from dozens of people who want to learn from her experiences and start their own chapters. This summer, Torgrimson and the E4E volunteer staff are launching a mobile kitchen tour to spend a week each in 24 cities training a core group of organizers on how to bring people together in the spirit of giving and to feed them well. Learn more about Eat for Equity at eatforequity.org.

Photo by Emily Rumsey

The crowd mills around the living room as cheerful guys pour homebrewed beer. People chat with newly made friends and eye the food being carried out of the kitchen and filling the dining room table. In the backyard, others gather around a campfire, talking, laughing, and listening to music. All have donated a modest amount to be part of the evening and support a cause they believe in. MPH student Emily Torgrimson is the creative force behind these sympatico gatherings and the growing community that comes together every month to “eat, drink, do good, and be merry.” As founder of Eat for Equity (E4E), a non-profit with food as its centerpiece, Torgrimson is nurturing a new generation of philanthropists. Over the course of the last five years, Eat for Equity has given away more than $30,000 collected at the dinners. “That amount was made up of $5 or $10 or $30 donations,” says Torgrimson. “I’m so touched when I think of how many people helped raise that money.” Recent E4E beneficiaries include the American Refugee Committee, Heart of the Beast Theater, and Youth Farm and Market Project.


Taking on the

SPH faculty devote their careers to solving the unsolvable.

W

Illustrations by Jacob Thomas

ater pollution, the obesity epidemic, tobacco use, and HIV transmission are members of an exclusive and infamous club—the “wicked” problems of the world. In 1973, two professors of design and urban planning at the University of California at Berkeley coined the term “wicked” to describe the messy and multilayered challenges that defy traditional problem-solving approaches. These challenges also tend to have a major impact on the fundamental health and well-being of individuals and the planet. It takes grit, imagination, scholarship, and an endless supply of patience to take on these issues. Most likely, there will be no satisfactory and tidy solutions or great game-changing discoveries, just many steps in the right direction. Wicked problems are the daily diet of public health professionals, as they chip away at making the world a better, healthier place. Using whatever means they can, from the latest social networking tools to traditional consensus building, the four SPH faculty members profiled here manage to find the enthusiasm and determination to make a difference in spite of the odds when wicked problems are at play. And they are all making slow, but significant, progress.

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“If we can develop the appropriate modeling to estimate how much run-off is coming from what areas, the farmers in that area could collectively decide how to reduce their pollution.” Clearing the waters Minnesota may be the “land of sky blue waters,” but if you fly over Fort Snelling State Park, you can see the snaking brown ribbon of the Minnesota River swirling and then melding into the still relatively clean Mississippi. The Minnesota drains a watershed of nearly 17,000 square miles and carries the run-off from thousands of cultivated acres. That run-off contains nitrogen from agricultural fertilizer, and it pulls along eroded soil, some from plowed fields. Both elements are creating severe problems that deeply concern Deb Swackhamer, professor of environmental chemistry in the School of Public Health; co-director of the University’s Water Resources Center; and Charles M. Denny, Jr. Chair in Science, Technology, and Public Policy at the Humphrey School of Public Affairs.

The nitrogen gives a boost to aquatic plant life that, as it decomposes, uses oxygen faster than it can be replaced. This decrease of oxygen in the water leads to dead zones, like in the Gulf of Mexico, that are devoid of animal life. Nitrogen also pollutes the Mississippi, which is a source of drinking water for cities along its course. The clay and silt particles from soil run-off stay suspended, carrying pollutants with them, burying important aquatic life habitat, and eventually constricting the river channel. Agriculture contributes 70 percent of the nitrogen load in the Minnesota River, and total nitrogen in the Minnesota and Mississippi has increased over the past 20 years. During that time, the larger agriculture community has tried to voluntarily engage in better land and water management, but its efforts have not decreased the load. And no regulations can be put in place because farmers’ fields, along with rooftops, lawns, and golf courses, for example, are

4 University of Minnesota School of Public Health

considered “nonpoint sources” for pollution. They are diffuse, hard to identify, and not overseen by the U.S. Environmental Protection Agency or the Minnesota Pollution Control Agency. “If we don’t change how we handle this issue, we’ll never be a state that has clean water,” says Swackhamer. “And I don’t believe that’s acceptable to anyone in Minnesota.” The issue of agricultural chemicals and soil run-off in state waters has been exceptionally divisive, making real progress close to impossible. But Swackhamer believes that for the first time, there’s a sincere interest on everyone’s part to come together to address the problem. In 2009, with input from the farming community, private industry, environmental groups, and dozens of water experts from around the state, Swackhamer and her colleagues crafted the Minnesota Water Sustainability Framework at the behest of the Legislature. Funded by the state’s Clean Water, Land and Legacy Act, the framework is a 25-year working plan for the sustainable management of Minnesota’s water resources and the first of its kind in the nation. Swackhamer hopes it proves successful in controlling agricultural pollution. “[Part of the framework] proposes creating agriculture management areas that would regulate themselves,” she says. “If we can develop the appropriate modeling to estimate how much run-off is coming from what areas, the farmers in that area could collectively decide how to reduce their pollution. The government would assess a fine, as it does with regulated sources, if an area doesn’t show progress.” Building trust among all parties involved and working out the fine points of such an arrangement could take up to 10 years, says Swackhamer, and, she adds, “We have to get where we need to go without pointing fingers or expecting a simple fix. I have my fingers crossed.”

 louds in C the distance When it comes to wicked problems, which new ones are gathering on the horizon? Public health faculty give their opinions on what we might have to deal with in the near future. Read their views at advances.umn.edu/w12/clouds.


The forest and the trees “The problem of obesity in our country isn’t going anywhere,” says Jennifer Linde, epidemiology assistant professor. “Despite the best efforts of a lot of people, the rates aren’t improving.” According to the Centers for Disease Control and Prevention, in 2010 no state had a prevalence of obesity among its citizens of less than 20 percent and most had rates of 25 percent to more than 30 percent. In the face of this stark reality, Linde, who joined the SPH faculty in 2005 is undaunted. Although she and her colleagues are concerned with the larger cultural and social factors implicated in the rise of obesity, her research drills down to the individual and the struggle to lose weight and keep it off. Her focus is behavior tracking. “There’s a whole camp of people who think regular weighing is a bad idea,” says Linde. “But the more we’ve looked at the evidence, the more it appears that tracking weight, calorie intake, and exercise helps improve the weight loss process.” So what has stood in the way of making this a successful strategy? Human nature. People find it a bother and a nuisance to keep a diary of their eating and exercise habits. But in the past five years, there has been a major shift in what Linde is able to ask people to do and, certainly, in how they can do it. What changed can be summed up in two words—WiFi and apps. In 2007, Linde submitted a feasibility grant application to study the impact of tracking long-term weight loss. It was turned down, partially because she offered no new ways to make tracking easier and more successful. Then last year, she submitted a proposal for a full-scale intervention trial on the same issue, and the National Institutes of Health accepted it for funding. “This technology is exactly what I’d been waiting for,” says Linde. ”We now have iPods with dietary and physical activity tracking software. There’s a scale that’s WiFi enabled and with an app that can send your weight to your desktop computer or your smartphone. On your smartphone, there’s another app that helps you determine your calorie intake and tracks your exercise level.” All information can be collated, graphed, charted, and fed back to the user in myriad ways to give him or her a full picture of successes and challenges. And Linde’s job is now easier when it comes to collecting data. For Linde, the wicked problem of increasing obesity needs a forest-and-trees approach

that involves both addressing the big picture of excessive weight gain and tackling it one individual at a time. “I don’t think any one person has his or her arms around how we can truly solve the problem of excess weight gain and its impact on health,” she says. “Most of us in the field

think we can build a pretty good behavior change intervention, for example, but then we live in an environment that is essentially toxic in terms of weight control. But I believe that the more people we can get working together on the problem of obesity, the better chance we’ll have in finding a solution.”

“This technology is exactly what I’d been waiting for.We now have iPods with dietary and physical activity tracking software.”

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Fighting the good fight

The battle between those who want to stop smoking prevalence and the tobacco companies looks like a clear David and Goliath confrontation, but even that classic example is too tame.

Epidemiology professor Harry Lando has a public health colleague in the country of Georgia. He’s a one-person tobacco control program in a country where more than half the men smoke. The Georgian government gave him $43,000 for smoking cessation efforts, an amount it later reduced to $2,000. He placed antismoking messages on billboards around the capital, Tbilisi, but a tobacco company quickly bought the billboards and replaced those messages with its own ads. Lando cites his friend’s experience as a cautionary tale. “[Trying to decrease worldwide] smoking is like spitting into the wind,” says Lando. “To be honest, sometimes I want to throw up my hands and say the problem is too big and the tobacco companies’ resources are too great. But on the other hand, even if you can make an incremental difference, you can potentially save millions of lives.” In 1988, Lando came to the University to research addiction and smoking cessation techniques. Then in 2000, he became increasingly concerned with rising global tobacco use and committed himself to helping developing countries enact antismoking campaigns. “If we can reduce smoking prevalence in the United States by one percent, that’s a step in the right direction, but there’s a whole world out there,” Lando says. “The U.S. has thousands of people engaged in tobacco control, as well as organizations like the NIH and CDC. We must be at the table in helping other countries who don’t have the resources.” The tobacco industry spends more than $30 billion a year on cigarette advertising and promotions, and the developing world is ripe for the picking as incomes rise. Young people are heavily targeted, often with no public health restrictions in place against such practices. WHO projects a billion deaths in the 21st century due to tobacco use if trends continue, with most of those occurring in low- and middle-income countries.

Driven by his concern for the victims of tobacco use, his dedication to helping his global colleagues, and sheer antipathy for an industry that freely markets a product that “kills when used as intended,” as he says, Lando spends a large portion of his time helping organize the World Conference on Tobacco or Health, held once every three years. The battle between those who want to address smoking prevalence and the tobacco companies looks like a clear David and Goliath confrontation, but even that classic example is too tame. “David at least had the element of surprise,” says Lando. “The tobacco companies know exactly what we’re doing and they have billions in cash to undermine any public health policy.” Despite the odds, Lando will not let up. “There are a few concrete examples, despite all the bad news, that show the movement toward awareness and prevention is going in the right direction,” he says. Lando has been involved with an NIH-funded anti-smoking project in Indonesia, a country that, when it comes to smoking, is where the United States was in the 1950s. Last year, the medical school at Gadjah Mada University in Yogyakarta voted to go smoke-free. Other countries with limited public health resources are showing signs of change, too, like Thailand, Uruguay, and Brazil. Though progress is slow, some nursing and medical school programs in developing countries are beginning to address smoking in their curricula. Lando sees himself as “a cheerleader” who, with his expertise and position, can support his public health colleagues in the developing world. And he will continue to bang the drum, helping to rally the international tobacco control community to identify strategies for the ongoing campaign against Big Tobacco.


“We have to let go of 20th century education and discover a new 21st century way of learning.” Turning back the tide In the early 1980s, when Simon Rosser was a young university student in Auckland, New Zealand, AIDS was “a mysterious new disease affecting gay men in the U.S.,” he says. “We wondered if it would ever reach New Zealand or if the Americans would find a cure before it got here.” Since that time, our country has gone from nearly panic-stricken about HIV transmission to blasé, as this deathsentence diagnosis became a manageable chronic illness in the United States with the introduction of highly active antiretroviral therapy—the “AIDS cocktail.” “Americans like to think the problem of AIDS is solved,” says Rosser, professor of epidemiology. “But in the coming year, 56,000 Americans will be newly infected, adding to the already 1.2 million people in this country living with AIDS. It’s a major problem, and we have to start thinking of novel solutions.” What makes decreasing HIV infection such a wicked problem is that most of the public health practices to stop the spread of infectious diseases just don’t work with HIV/AIDS. The strategy of herd protection would require getting as many people into treatment as possible to decrease the overall viral load among high risk populations, including men who have sex with men. Given the hidden nature of this population, says Rosser, wide-spread testing and

treatment may not be possible to achieve. A second line of public health defense is information, campaigns to tell men about safe sex. The trouble with this approach is that this information has been pushed for 30 years, and people are tuning it out. “People have the information, but information is not the same as education,” Rosser says. “People know what they should do; they’re just not doing it.” Rosser’s challenge is to reach new generations of gay men and sexual minorities who are at the highest risk for infection. “We have to let go of 20th century education and discover a new 21st century way of learning,” he says. As part of this exploration, Rosser has recently turned his sights to smart technology and what’s called persuasive computing. Rather than running the two-day safe-sex workshops of 15 years ago, Rosser is looking at other possibilities. His team is testing computer games as ways of changing how men perceive their risk and health. “Microinterventions” to curb risky behavior are another alternative. Rather than education programs, can 5-to-10 second messages sent at a key moment change behavior? Tied to a smartphone’s calendar, they may be delivered at crucial times, like a half hour before a scheduled date. Do you have a condom? a message might ask. Or, Remember to be safe. Knowing that approximately 20 percent of the web is devoted to pornography, Rosser

is studying if there are ways to learn more about how what gay men see drives what they do. Along with the promise of new technology to increase safer sex, Rosser finds hope for reducing HIV transmission with the new health care changes coming in 2014. “The populations disproportionately at risk for HIV are the ones historically underrepresented by health care,” he says. “As the Affordable Care Act comes into effect, the opportunity to reach a generation of people who haven’t interacted with the health care system or been tested for HIV can reasonably be expected to change.”

Putting an “e”

in public health Lively, vibrant communities now exist online. How can traditional public health research and intervention methods change to meet these virtual communities, and what will we learn from them? Profs. Simon Rosser (epidemiology), Joe Konstan (computer science) and Bill West (health communications) co-teach PubH 6025, the only course in the country that explores this new frontier and its implications for public health.

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research news

Hold the sweets When nearly half of overweight adolescents participate in organized sports, why do coaches and parents continue to hand out sodas and Oreos after a soccer game? This question is driving a new line of research by School of Public Health assistant professor Toben Nelson and colleagues from throughout the University. The Healthy Youth Sports Study is an ongoing project designed to investigate the relationship between youth sport participation and obesity prevention strategies. Physical activity is one antidote to childhood obesity and youth sports is a recommended way for children to get exercise, but it’s not enough by itself to keep unhealthy weight gain at bay. Findings show that what’s offsetting that exercise is the wide availability of high-calorie snacks, sugar-sweetened drinks, and fast foods in youth sports—before, during, and after games. In fact, the study found that kids who engage in organized sports eat more of these products than their peers who aren’t involved in sports. “The poor food and beverage choices available in youth sport settings is not a concern that’s on the radar of most parents and league administrators,” Nelson says. “They think these kids are physically active, so a little bit of extra junk food isn’t really going to hurt them. But clearly the results of our work show differently.” To read the full study in Current Sports Medicine Reports and learn more about the Healthy Youth Sport Study, visit umn.edu/~hyss.

SPH faculty contribute to new screening recommendations When and why women and men should be screened for cervical or prostate cancer has changed in the past year, in part due to the work of SPH faculty. Shalini Kulasingam, assistant professor of epidemiology, helped to craft two sets of draft guidelines, one for the U.S. Preventive Services Task Force and the other for a coalition that includes the American Cancer Society. Both influential groups are now in agreement that women be screened only once every three years instead of annually for cervical cancer. “What should be noted with these recommendations is that they recommend screening beginning at age 21, that it be conducted every three years if you are doing it with cytology, and that screening

can end at age 65 [if screenings are normal and there’s been no increase in risk],” Kulasingam says. Too much screening (from offering annual cytology to women of average risk for cervical cancer) can lead to false positives that in turn can prompt treatment and potentially severe complications, especially for women of child-bearing age, says Kulasingam. Having regular PSA screenings was one way men thought they could get a jump on prostate cancer and save their lives. But according to clinical trials conducted by professor of environmental health sciences Tim Church, annual screenings for prostate cancer may lead to more diagnoses of the disease, but not fewer

8 University of Minnesota School of Public Health

prostate cancer deaths. What’s more, Church found, the pot­ ential harm from PSA screening outweighs the benefit for healthy men. “[With these tests,] not only is there cost involved, inconvenience, and the pain that might be involved with diagnostic workups, but some men — considerable numbers of men — end up impotent or incontinent and with chronic pain and with blood in their urine, due to the effects of the falsepositive screening tests,” says Church. The U.S. Preventive Services Task Force now recommends against using the PSA test to screen men for prostate cancer who have no risk factors.


When every minute matters University health sciences researchers have received an $11 million Department of Defense grant to define the best methods for training military combat medics, especially as they encounter the most critical situations: massive bleeding and the need for airway management. SPH professor François Sainfort is the co-principal investigator leading the comparative study of alternative training methods. Working with him are SPH professor Julie Jacko, who is looking at how external factors influence medics in the field,

and SPH assoc­i­ate professors William Riley and Sandra Potthoff, who are conducting a cost analysis. “We’re very interested in understanding how things like temperature, humidity, stress, olfaction, and a whole variety of different environmental stressors affect performance,” says Jacko. “And how, perhaps, some of those environmental factors can be mitigated, based upon the way that these combat medics are actually trained.” Using mannequin simulation and Medical School facilities to replicate

battlefield conditions, Sainfort’s team will monitor medics’ perform­­­ances and compare them to current training protocols as they perform life-saving maneuvers. The goal of the research is to provide the Department of Defense with a plan it can follow to develop novel simulation tools to ensure combat readiness for military first responders. Learn more about the Department of Defense grant  at advances.umn.edu/w12/DoD.

Checking the label When you look at nutrition labels in the grocery store, where do your eyes go first? Calories? Fat content? Vitamin amounts? SPH researcher Dan Graham wanted to examine consumer habits to see if current nutrition labeling was effective. He developed a study where participants were provided product information on a computer screen. They were then asked to evaluate the product and decide whether they would buy it. Nutrition information was included. Graham’s team used an eye-tracking device to determine what participants looked at and for how long. The findings showed that people tended to look at the nutrition facts panel more if it was in the center of the screen rather than the sides. They also looked more at information nearer the top of the label than near the bottom. Overall, people were more interested in calories than everything else—vitamins, minerals, fats, carbohydrates, protein, etc. Further data suggested that the average consumer reads only the top five lines on a nutrition facts label. The study suggests that a nutrition label would get more attention if it were on the front of the packaging and that putting the most relevant nutrition information in the first few lines would be more effective. “If we could have the nutrients that are most relevant to public health in a…prominent place on that label, it seems like [they] could draw consumer attention,” says Graham. “And, from there, perhaps we could make the leap to saying that consumers would eat more healthfully.”

Watch a video of Dan Graham explaining eye tracking at advances.umn.edu/w12/graham.

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Ancel Keys, left, and Henry Blackburn in Italy, circa the 1960s, for the Seven Countries Study.

Proving preventability SPH and the birth of cardiovascular epidemiology.

H

enry Blackburn tells the story of giving a talk in Finland in 1976 when the legendary British cardiologist Sir John McMichael was in the audience. At the end of Blackburn’s presentation, McMichael stood up and said, ”Ladies and gentlemen, what you just heard this morning is entertainment. It has nothing to do with science.” Blackburn, now SPH professor emeritus, had given a straight­ forward, data-filled report on the Seven Countries Study among cultures differing in traditional diets, one of the early forays into cardio­vascular epidemiology conceived at the University of Minnesota. “Basically, some people, such as McMicheal, were prejudiced against epidemiologic research and statistical methods,” says Blackburn. “The influence of diet and cholesterol in heart disease was also considered an ‘American’ idea and largely dismissed.”

10 University of Minnesota School of Public Health

What the body wants Blackburn is among the few remaining principal investigators of the Seven Countries Study team that focused on the relation of heart attacks to the eating and activity patterns in contrasting populations of men in strenuous occupations like farming, fishing, and logging in the United States, Finland, the Netherlands, and Japan, Greece, Italy, and Yugoslavia. The study, which began in 1958 and is now working on 50-year follow-up data, was the first to compare cardiovascular disease (CVD) rates across cultures and to follow subjects indefinitely. Its findings helped set today’s standards for healthy foods and lifestyles. The populations with the lowest rates of heart disease ate traditional diets with low saturated fat content, yet with varied amounts of total fat intake. They used meat as a condiment only, and focused on fish,


legumes, vegetable oils, whole grains, fruits and vegetables, and wine with meals. “There are whole cultures that eat very well, yet don’t have heart attacks,“ says Blackburn. “The basic contribution of the Seven Countries Study is that CVD doesn’t need to exist. Most human beings are susceptible to it, but it’s largely preventable. High rates of heart attack in the population are about lifestyle and behaviors, not DNA.”

Getting it all down Since retiring in 1995, Blackburn has devoted much of his time to writing and compiling a comprehensive archive and history of CVD epidemiology and preventive cardiology. His own and others’ documents, abstracts of early studies, oral histories of pioneering researchers, photos, videos, and audio clips are available on a wideranging website (see address at right). As a key player in establishing CVD epidemiology, Blackburn brings eyewitness accounts of the colorful and seminal Seven Countries Study, when researchers wandered the back roads of Croatia and rode ferries to island villages in Japan to explore the cultural origins of heart disease.

Watch and listen to Henry Blackburn discuss the archive he built on the history of cardiovascular disease epidemiology at advances.umn.edu/w12/blackburn. Peruse the archive’s website at advances.umn.edu/w12/archive.

Field foundations Blackburn had just finished his internal medicine residency in 1957 when University of Minnesota physiologist Ancel Keys offered him a job in his lab. Still considered a bit of an outlier in the medical community at the time, Keys had developed K-rations for WWII troops and conducted vital studies to discern how to safely begin re-feeding starved people after the war. He would go on to popularize the Mediterranean diet, make “cholesterol” part of our everyday vocabulary, and appear on the cover of Time magazine. Blackburn jumped at the chance to work with him. From the late 1940s, Keys was beginning to recognize that heart disease was becoming epidemic in America. At the same time, he was hearing rumors that heart attacks were rare in certain countries, like Italy. So, with his chemist wife, Margaret, Keys began visiting those places and returned from each trip increasingly convinced of a tie between how populations lived and their rate of heart disease. Wanting to test his hypothesis in a systematic way, he conceived of the Seven Countries Study and enlisted Blackburn to create measures to use in the field. Along with developing standardized patient history forms, Blackburn’s early assignment was to design the Minnesota Code, an objective classification system for electrocardiograms. That code and an advanced system designed by a colleague, the Novacode, remain the standards for all population-based CVD studies and prevention trials.

Path to a new discipline

As critical as the Seven Countries Study was to the founding of cardiovascular epidemiology, Blackburn’s current history project gives ample coverage to other endeavors and advances, such as the

“High rates of heart attack in the population are about lifestyle and behaviors, not DNA” Henry Blackburn

U.S. Public Health Service’s iconic Framingham Heart Study, begun in 1948 and still running. He honors the observant physicians of the past who started down the epidemiology road. Among them is Cornelis de Langen who, while stationed in the Dutch East Indies in 1914, noticed and reported on the absence of blood vessel disease among the Javanese and related it to their plant-based diet. Blackburn began this project because his students had “a few deficiencies in the history of their field,” and because so many former household names, like the once well-known cardiologist Paul Dudley White, are being forgotten. “And no one under 60 has even heard of Ancel Keys,” he says. Blackburn finds great satisfaction in the contributions of the University of Minnesota and the School of Public Health and Medical School. “The University was the earliest center of CVD epidemiology and prevention research and the first to recognize powerful social and cultural influences on the heart disease epidemic,” he says. “Minnesota work has had tremendous impact not only on science and medicine and the ultimate preventability of heart attacks, but also on the wider marketplace and how we as a people live and eat.”

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school news SPH offers unique Peace Corps experience

Elmy Wong

12 University of Minnesota School of Public Health

Watch a video of Public Health Administration and Policy student and Peace Corps recruiter, Samantha Mills, talking about her experiences at advances.umn.edu/w12/mills.

Photo BY Tim Rummelhoff

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ver since high school, Elmy Wong had thought about joining the Peace Corps. So when she graduated with a BS in nutrition science from Brooklyn College in New York City and decided to pursue a graduate degree, she looked for a school with a Peace Corps Master’s International (MI) program in nutrition. The MI program gives students the opportunity to integrate a Peace Corps experience into their graduate studies. Students must be accepted at a graduate school that has an MI program in their field, then apply and be accepted to the Peace Corps. After completing all their class work for their degree, including some aimed specifically at their upcoming Peace Corps stay, they spend the next 27 months in the field. They receive graduate credits for their time in the Peace Corps. “When these students arrive at their sites, they’re able to apply the skills they learned in the classroom and address the needs of the community,” says the University’s Peace Corps representative, Samantha Mills, herself an MPH student in Public Health Administration and Policy and a Peace Corps veteran. “With the MI program, they’re getting a graduate degree and real-world experience that is relevant to that degree, as well as the valuable international development skills gained from being a Peace Corps volunteer.” Eighty schools nationwide have created MI programs to meet their students’ needs, but when Wong began looking, there was no MI in public health nutrition anywhere in the United States. Figuring that she could join the Peace Corps after she finished her studies, she came to the University in fall 2011 on the strength of its public health nutrition (PHN) program. As Wong was searching for that non-existent MI in nutrition, PHN professor Jamie Stang was busy creating one. “From looking at applications to our program, it was very clear that there was a big interest in a global experience, but it had always been hard to find international sites and programs that were the right fit for our students,” says Stang. “That made me think of the Peace Corps.” When Stang approached the Peace Corps about starting a nutrition MI pro­g ram, she found that the organization was just realizing how much it needed one. “The Peace Corps was sending volunteers into the field to work in nutrition who just didn’t have the background they needed,” Stang says. So she determined how the PHN graduate curriculum could prepare students for a Peace Corps experience and wrote the application for the MI in nutrition. The Peace Corps accepted it, and SPH offered the country’s first such program to its students in fall 2011. Surprised to find the new program when she arrived at SPH, Wong eagerly became its first student. She goes abroad in fall 2012 to a yet unknown location. “I’m looking forward to playing a larger role in our global community, the challenge of working abroad, and putting everything I’ve learned in the past year at the U into practice,” she says. “I want to make a positive impact and show others that Americans can be partners in lasting sustainable change.”


school news Leadership and legacy New Weckwerth chair honors a beloved teacher, ensures a bright future for MHA program

Photo BY eric miller

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ive decades. Thousands of students. Five continents. That’s the teaching career of Vernon Weckwerth, PhD, in numbers. But what the numbers can’t show is Weckwerth’s impact on those who had the privilege of learning from him. Known to his students as simply “Prof,” Weckwerth has dedicated his life’s work to improving the delivery of health services. Some of his students would argue that the success of many hospitals and health systems around the world can be traced back to his critical role in educating health care administrators. Weckwerth started the first-of-its-kind interdisciplinary studies program in 1968 through the University of Minnesota School of Public Health’s Master of Health­ care Administration (MHA) program. The ISP was created to offer an executive education program for hospital administrators. When the program closed in 2008, it boasted 3,117 alumni from 45 countries, more than 1,000 of whom went on to become top-level executives. “His commitment to students is unrivaled and deserves to be honored,” says former student Richard Norling, MHA, Class of 1975, who served as past president and CEO of both Premier, Inc. and Fairview Health Services. That’s why Norling has made a lead gift of $250,000 to help fund the Vernon E. Weckwerth Chair in Healthcare Administration Leadership. So far, nearly 20 others also have contributed. The chair will be fully funded at $2 million. “Creating [this chair] is a fitting tribute to the impact he has had on our careers and health care as we know it,” says Norling. One of the most time-honored and treasured means of paying tribute to the contributions of prominent faculty leaders,

an endowed chair is the single greatest recognition the University can bestow. The chair in Weckwerth’s name will honor his legacy and provide resources for the chair holder to focus on furthering the body of knowledge that drives global excellence in health care administration and bringing that knowledge to the classroom. This chair also will strengthen the program’s standing—nationally and globally—by helping to attract a faculty member from inside or outside of the University who is foremost in the field. “Professor Weckwerth has shown unparalleled dedication to students throughout his career at the University,” says colleague Sandra Potthoff, PhD, an associate professor in the Division of Health Policy and Management. “This chair will help us to honor his legacy at our institution, and I find it inspiring to see so many donors stepping forward.”

“Teaching is life … and living.” Vernon E. Weckwerth

By supporting the Weckwerth Chair, you not only honor a dedicated educator but also help the University’s MHA program become a global leader in educating the best and brightest health care administrators for years to come. Our goal is to raise the majority of the funds through gifts from alumni and friends of the program. To make your gift, please contact Adam Buhr, director of development for the School of Public Health, at 612-626-2391 or a.buhr@mmf.umn.edu.

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school news

Seven new ways to learn about public health SPH now offers seven Regents Certificate Programs in public health. These non-degree programs are designed for working health and human services professionals with little or no formal public health education and who want to develop skills and knowledge in a specific area of public health. • Public Health Certificate in Clinical Research • Public Health Certificate in Core Concepts • Public Health Certificate in Food Protection •P  ublic Health Certificate in Performance Improvement— Public Health Track •P  ublic Health Certificate in Preparedness, Response and Recovery • Aging Studies Certificate • Management Fundamentals in Healthcare Organizations

Honoring the ‘Minnesota Model’ The Minnesota Model for Food Safety has made national headlines over the past several years in the search for the sources of two major Salmonella outbreaks. Based on rapid tracking of occurrences and quick investigative work, this Minnesota Department of Health (MDH) plan of action stands out as the paradigm methodology for stopping the spread of food-borne illnesses. In December, Dean John Finnegan represented SPH when the Minnesota Agri-Growth Council, an agribusiness advocacy group, presented its Distinguished Service Award to the “Minnesota Model” to honor its work for food safety in Minnesota and the nation. A group of SPH students, known as Team D, is vital to the program. MDH employs the students who work under the direction of its epidemiologists, most particularly SPH adjunct faculty member and MDH epidemiologist Carlota Medus. “The School of Public Health is especially privileged to have so many talented students provide the person-power for Team D in its unrelenting efforts to trace food-borne illnesses to their source,” Finnegan wrote in his bimonthly dean’s column. “To receive this award from the state’s food producers and processors was especially gratifying.”

Learn more about the Regents Certificate Programs at www.sph.umn.edu/programs/ certificate.

SPH faculty members Institute on the Environment fellows The University of Minnesota’s Institute on the Environment (IonE) has named Gurumurthy Ramachandran and Kim Robien as resident fellows for a three-year appointment with the institute. They join 12 other new resident fellows who will receive dedicated funding from IonE for innovative interdisciplinary projects. Fellows maintain their appointment in their own departments. With his fellowship, Ramachandran, professor of environmental health sciences, will examine the health impact of rapid industrialization in India. He will also identify infrastructure needs to manage health risks. Robien, associate professor of epidemi­ ology, will develop a research program to explore the chronic disease risk of residual pesticides, fertilizers, and other dietary contaminants in food and water.

14 University of Minnesota School of Public Health

Team D members. Back row, left to right: Alida Sorenson, Marijke Schwarz Smith, Brittany VonBank, Nicole Favata, Heidi Gusa, Dana Eikmeier. Front row, left to right: Jenny Nguyen, Steve Bennett, Steph Walczak.


A place for pets in disaster relief

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hen Hurricane Katrina slammed New Orleans in 2005, 44 percent of the people who refused to evacuate didn’t want to abandon their pets. “Addressing animals in an emergency is a public health issue,” says Arnold Goldman, who recently completed his MPH through the Executive Program in Public Health Practice. “If people don’t leave their homes because of concern for their animals, they can put themselves [and those who try to help them] in danger.” Along with struggling to get people with pets to evacuate, dealing with those animals if their owners bring them to shelters is also a problem. When a disaster hits and emergency shelter is needed, there may be 40 pets involved for every 100 people. Goldman is a practicing veterinarian in Connecticut. As a leader in the Connecticut Veterinary Medical Association (CVMA), he spoke to various groups, including firefighters, to address the issue of animals in a disaster. After one of his talks, Goldman was asked to build an animal management plan for one of Connecticut’s five emergency response regions. His biggest challenge was creating a plan that would work in Connecticut, a “home rule” state that has no county government. “Towns make their own rules,” Goldman says. “They prefer to shelter their citizens in their gyms or community centers rather than in a regional shelter. Animal care equipment is often beyond the budget and off the radar for these towns.” Unable to provide animal care to every municipality in a disaster, Goldman aligned his program with existing regional collaborations. He helped train a volunteer animal response team and outfitted three mobile emergency trailers with animal care equipment. If a disaster occurs that communities can’t manage, they decide where a mass care shelter will be, and Goldman’s team deploys nearby as part of a region-wide coordinated response. As his emergency response work took more of his professional time, Goldman realized he might want to make it a

Arnie Goldman with his Boston Terrier Hap.

career one day. Knowing he’d need public health credentials to do that, he explored the Executive Program in Public Health Practice. It was a perfect fit. “My coursework was mostly online, and I also attended the summer Public Health Institute three times,” he says. “It was great fun to be back on campus.” His regional emergency animal response plan later became his MPH thesis. Connecticut’s four other emergency response regions now have programs modeled on Goldman’s. In 2008, CVMA named Goldman Veterinarian of the Year for initiating the legislation mandating “the evacuation and mass care of household pets along with their owners in every Connecticut municipality.”

“Addressing animals in an emergency is a public health issue. If people don’t evacuate because of concern for their animals, they can put themselves [and those who try to help them] in danger.”

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alumni news

Join the SPH Alumni Society Board The SPH Alumni Society Board is looking for alumni to share their expertise and interests by serving as board members. The mission of the society is to work in collaboration with SPH to promote excellence in the school’s programs, be of service to alumni, and advance the development of public health in the community and world. A slate of candidates is being developed for a vote this spring. Board members serve threeyear terms and meet every two months. The board encour­ages alumni from around the country and world to apply by April 16. New terms begin in August. Nomi­ nate yourself or someone else. Meet the current members, learn more about the alumni society, and access an application at advances.umn.edu/alumni/board.

Get Advances anywhere, anytime Our online magazine features videos, the latest school news, and ways to connect with fellow SPHers through social media. advances.umn.edu.

Class notes Sue Abderholden (MPH ’80) was appointed by Gov. Mark Dayton to the Minnesota Health Insurance Exchange Advisory Task Force. Abderholden is executive director of the National Alliance on Mental Illness of Minnesota. Paola Brigneti (MPH ’10) won the United Nations Volunteers Online Volunteering Award in recognition of her work with the Nigerian NGO Delta Women. Brigneti developed advocacy strategies and educa­ tional materials to prevent sexual harassment in institutions of higher education in Delta State, Nigeria. Craig Bryan (MHA ’04) was named among the top 30 ambulatory surgery center industry leaders under age 40 by the publication Becker’s ASC Review. Bryan is the administrator at Gateway Surgery Center in Concord, N.C. Nicole Brys (MPH ’10), Mary Navara (MPH ‘07), and Abigail Rotari Franklin (MPH ’09) received the Better Govern­ ment for a Better Minnesota team award from Gov. Mark Dayton. The award recognizes state employees who build collaborations and a culture of continuous improve­ ment. At the time of the award, the three SPH alums were all part of the Minnesota Department of Health’s (MDH) Newborn Screening Long Term Follow-up Unit. Navara has since taken a position in MDH’s environ­ mental health X-ray unit. James Fett (MPH ’63) is co-director of the Peripartum Cardiomyopathy Network (PCN) and Investigations in Pregnancy Associated Cardio­ myopathy (IPAC) at the University of Pittsburgh. The work involves some 30 clinical sites across North America.

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Holly Heisler (MPH ’04) is a senior associate at ICF International in Atlanta, where she works on public health research and evaluation projects in the Health, Education, and Social Programs Group. Mary Larson (MPH ’96) received a Bush Fellowship Award to address health disparities in Moorhead, Minn. As a Bush Fellow, she will work with community partners to integrate lifestyle medicine into primary health care settings and to create healthier living environments. Larson is a life­ style medicine provider at the Family HealthCare Center in Fargo, N.D. Desmond Runyan (MPH ’75) was appointed the Jack and Viki Thompson Professor of Pediatrics and executive director of the Kempe Center for the Prevention and Treatment of Child Abuse and Neglect at the University of Colorado. He is also the national program director for the Robert Wood Johnson Foundation Clinical Scholars Program. Stephen Williams (MHA ’79) is president and chief executive officer of Norton Healthcare, which received the 2011 National Quality Healthcare Award from the National Quality Forum. The Kentucky-based Norton was recognized for continual improve­ ment in the quality and safety of patient care.

Share your news Submit your own class note or read about classmates at advances.umn. edu/w12/classnotes.


MHA grad and U students design a child friendly IV pole

Photo by Tim Rummelhoff

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hen Tom Duncan completed his Master of Healthcare Admin­ istration (MHA) program in 2004, he set out for a yearlong fellowship at the Arkansas Children’s Hospital. While there, he learned something profound by watching the young patients. “I found myself unable to take my eyes off their IV poles,” says Duncan. “I saw how the children struggled to walk down the hall with them, how the wheels got stuck getting on and off elevators, and how they served as a constant reminder of the children’s sickness.” Those images stuck with Duncan, even after he wrapped up his fellowship and went on to work outside of health care. When his son fell a year ago, Duncan found himself back at a children’s hospital, confronted once more with the stainless steel poles. “I thought, it’s time to do something about this,” says Duncan. His first step was to reconnect with in­ struct­ors of the University of Minnesota’s New Product Design and Business Devel­opment course. Bringing together students from business, engineering, and health care, the class was one he valued as an MHA student. Duncan worked with a student team to design an IV pole that would make life easier—and cheerier—for children and their caregivers. The new poles had better wheels, a support ring that doubled as a walker, and rounded tops that sported colorful artwork. Duncan also tapped into the Minnesota MHA network—one he refers to as “the best there is”—to bring his product to market. For caregiver and patient input on pole design, he worked with leaders at the University of Minnesota Amplatz Children’s Hospital, including Russ Williams (MHA ’98) and Cari Worner (MHA ’00), and with Tom Kmetz (’87) from Kentucky-based Kosair Children’s Hospital. Don Black (MHA ’77), the president of the Child Health Corporation of America, helped Duncan navigate the daunting hospital purchasing industry and invited the student design team to Kansas City to present its product. During the entire process, SPH professor emeritus Vern Weckwerth offered his expertise.

A new IV pole design from MHA graduate Tom Duncan helps brighten Carter’s stay at the University of Minnesota Amplatz Children’s Hospital.

With the patient friendly poles now in use at several hospitals, Duncan is hearing positive feedback from children and hospital staff. He also has the U team readied to design other tools to help young patients, including an upgrade to the wagons used to transport children throughout hospitals. Duncan says it’s gratifying to be working with U students and MHA alums. He notes that everyone involved has been a proud

contributor to a project aimed at improving children’s lives. “There’s something special about helping kids in need,” he says. “Everyone responds to that call and wants to do their best.” Learn about child friendly IV poles at treehousemedical.com.

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Upcoming Events SPH Research Day Poster Competition April 2, 10 a.m.-1 p.m. Coffman Memorial Union Great Hall

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SPH Roundtable “The Economy and Health: What is the Role of Public Health?” April 27, 9 a.m.-noon Coffman Memorial Union Theater

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SPH Commencement May 14, 5 p.m. Mariucci Arena Public Health Institute May 21–June 8 Minneapolis, Minn. Industrial Hygiene Reunion June 18, 5:30 p.m. Harry and Izzy’s, Indianapolis, Ind. Epidemiology Reunion June 29, 6 p.m. Brit’s Pub, Minneapolis Event details at advances.umn.edu/events. Sign up for Alumni E-News to receive monthly news about events and SPH alumni. advances.umn.edu/involved.

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Advances - Winter 2012