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NOVEMBER 2012

UCLA

PUBLIC HEALTH The UCLA Fielding School of Public Health Magazine

What do you want to do with the U.S. health care system?

Install upgrades for a healthier future

OK

Health 3.0

Fielding School of Public Health faculty and alumni help to usher in a third era of public health.


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UCLA

PUBLIC HEALTH

Gene Block, Ph.D. Chancellor

Thomas Rice, Ph.D. InterimDean,UCLAFieldingSchool ofPublicHealth

Sarah Anderson AssistantDeanforCommunications

Carla Wohl AssistantDeanforDevelopment andAlumniAffairs

features

David Clark AssistantDeanforStudentAffairs

Dan Gordon EditorandWriter

Martha Widmann ArtDirector

E D I TO R I A L B OA R D Thomas R. Belin, Ph.D. Professor,Biostatistics

Pamina Gorbach, Dr.P.H. Professor,Epidemiology

Moira Inkelas, Ph.D. AssociateProfessor,HealthPolicy andManagement

Richard Jackson, M.D., M.P.H. ProfessorandChair, EnvironmentalHealthSciences

Michael Prelip, D.P.A. Professor, CommunityHealthSciences

May C. Wang, Dr.P.H. AssociateProfessor, CommunityHealthSciences

Lauren Harrell and Harmony Larson Co-Presidents, PublicHealthStudentAssociation

Christopher Mardesich, J.D., M.P.H. ’98

4 3.0: A New Operating System for Public Health Toward the end of his life, Dr. Lester Breslow foresaw a “third revolution” in health. Now, FSPH faculty and alumni are helping to make it a reality.

11 POLICY BY NUMBERS Fulfilling the vision of its late founding director, the UCLA Center for Health Policy Research and its California Health Interview Survey have become the authoritative source on the health and health care needs of the state’s diverse population.

PublicHealthAlumniAssociation

CORRECTION:

The Student Awards listing in the June 2012 issue inadvertently omitted the recipient of the Wayne SooHoo Memorial Scholarship: Alla Victoroff of the Department of Epidemiology. We regret the omission.


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NINEZ PONCE: Making California’s Diverse Populations Count

in every issue 23 RESEARCH

16 After fiercely advocating for hardto-reach racial and ethnic groups to be better represented in populationbased health surveys, she helped to develop the groundbreaking California Health Interview Survey, which she now heads.

18 DOUBLING DOWN: Joint/Concurrent Programs Broaden Students’ Horizons As public health becomes increasingly collaborative, combining an M.P.H. with another graduate degree on campus holds growing appeal.

PHOTOGRAPHY Reed Hutchinson / TOC: Ponce, Doubling Down; p. 2; pp. 16-19, 21-22; p. 32: Flynn Michelle Thomas / p. 20 Courtesy of Children’s Bureau / TOC: 3.0; p. 6: nutrition lecture to community members; p. 7; p. 9: parents support group; p. 10: community produce sold at the center Courtesy of Peter Long / p. 9: Long Courtesy of Pamina Gorbach / p. 26 Courtesy of Virginia Li / p. 17 Courtesy of Nicole Hoff / p. 29 Courtesy of The California Endowment / p. 33: Solis Courtesy of UCLA Volunteer Center / p. 33: UCLA Volunteer Center Courtesy of UCLA Fielding School of Public Health / p. 5: Halfon; p. 6: Inkelas; p. 10: Breslow; p. 11: Brown; pp. 32-33 iStockphoto © 2012 / cover: sky background; TOC: CHIS; pp. 4-5; p. 8; p. 10: ear exam; pp. 11-15; pp. 24-25

Opportunity cost of excessive health care spending… air quality near freeways… neighborhood unemployment and depression…health department integration and STD rates…computerassisted self-interviews in HIV prevention trials… cultivating tobacco crop alternatives in China.

28 STUDENTS 30 FACULTY 32 NEWS BRIEFS

School of Public Health Home Page: www.ph.ucla.edu E-mail for Application Requests: app-request@admin.ph.ucla.edu UCLA Public Health Magazine is published by the UCLA Fielding School of Public Health for the alumni, faculty, students, staff and friends of the school. Copyright 2012 by The Regents of the University of California. Permission to reprint any portion must be obtained from the editor. Contact Editor, UCLA Public Health Magazine, Box 951772, Los Angeles, CA 90095-1772. Phone: (310) 825-6381.


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dean’s message THIS PAST YEAR HAS BEEN one of significant transformation for the school, and I wanted to use this dean’s message to share my perspective on these important transformations with our students, alumni and friends. This past February, we announced the largest gift in the school’s 50-year history and added one of our esteemed colleagues, Dr. Jonathan Fielding and his wife Karin Fielding, to the school’s name. Their generous gift also encouraged other faculty members to create student endowments – you can read more about them on page 32. While these gifts represent a tremendous infusion of new revenue, they aren’t sufficient to shield our school from continued deep reductions to our budget caused by state cuts – cuts that are more than likely to become deeper in future years. If you have ever considered a gift to the school, I encourage you to use the envelope provided and give as generously as you are able. Not all the transitions of 2012 were happy. In April we said goodbye to two beloved faculty members, Drs. Lester Breslow and Rick Brown. We included obituaries for both in the last issue of the magazine, and in this issue we take a deeper look at the contributions that each has made to public health. While both had extraordinary individual careers, they leave behind a broader legacy that will continue to guide the field of public health and influence policy. Through his vision of a new era of health, focused not just on diseases but improving people’s capacity to enjoy life, Dr. Breslow launched a movement you’ll read more about in our cover story. The California Health Interview Survey (CHIS), launched by Dr. Brown, is the largest state survey of its kind and has had a tremendous impact on state and federal policy (read more about the continuing influence of the UCLA Center for Health Policy Research, where CHIS is based, on page 11, along with a profile of Dr. Ninez Ponce, the new director of CHIS, on page 16). While we miss them both tremendously, Drs. Breslow and Brown leave behind colleagues and students committed to

UCLAPUBLIC HEALTH

making sure their legacies live on.


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In June we thanked Dr. Linda Rosenstock for her nearly 12 years of leadership serving as dean of the school. Her tenure brought in a more diverse faculty and a focus on student recruitment that led to a doubling of student applicants, significantly raising the caliber of our student body while maintaining the Fielding School’s status as one of the most diverse in the country. Dr. Rosenstock remains on the faculty as a professor of health policy and management. Dr. Rosenstock’s departure facilitated a transition for me, as well. I was honored to be asked to step in as interim dean while we await the arrival of Dr. Jody Heymann. The experience has offered me a deeper appreciation of activities taking place in the entire school. Our enterprising and productive faculty members and a dedicated staff make the Fielding School an optimal place to receive hands-on training in public health. Our students really do represent the best and the brightest, and I am continually impressed by their enthusiasm and commitment. The future of public health is in good hands. At the end of the year I will gladly hand over the reins to incoming dean

2012-13 DEAN’S A DV I S O RY B OA R D Ira R. Alpert * Edward A. Dauer Deborah Kazenelson Deane* Samuel Downing* Robert J. Drabkin Gerald Factor (Vice Chair) Jonathan E. Fielding Dean Hansell (Chair) Stephen W. Kahane * Carolyn Katzin * Carolbeth Korn * Thomas M. Priselac Monica Salinas Arthur M. Southam* Fred W. Wasserman * Pamela K. Wasserman * Thomas R. Weinberger

*FSPH Alumni

Dr. Jody Heymann (for news of her announcement, see page 32). Dr. Heymann comes at an exciting time for the Fielding School and she has the vision and passion to help us continue to reach greater heights. I’m glad to have had the opportunity to serve as interim dean and am grateful to be on the faculty of such a first-rate institution.

Thomas Rice, Ph.D. Interim Dean

UCLAPUBLIC HEALTH


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4 T OWARD

THE

END OF HIS LIFE ,

D R . L ESTER B RESLOW SAW A

FORE -

“ THIRD

REVOLUTION ” IN HEALTH .

FSPH

N OW ,

FACULTY

AND ALUMNI ARE HELPING TO MAKE IT A REALITY.

30

: .

A New Operating System for Public Health

In a career spanning seven decades as a leading public health

UCLAPUBLIC HEALTH

practitioner and thinker, Dr. Lester Breslow gained a well-earned reputation for being ahead of his time. Breslow, who served as dean of the UCLA Fielding School of Public Health from 1972 to 1980, was an active member of the school’s faculty until not long before his death last April at the age of 97. His record of visionary thinking can be traced as far back as the 1940s, when Breslow linked tobacco use to disease in three studies that were later cited in the U.S. Surgeon General’s landmark 1964 report. Then there were Breslow’s famous Alameda County Human Population Laboratory studies, launched in the early 1960s when he was a member of the California Department of Health Services, which he would later direct. Breslow found, among other things, that a 45-year-old male who followed six of seven healthy lifestyle habits lived an average of 11 years longer than a peer who followed three or fewer. If that seems obvious today, it’s because Breslow’s work helped to usher in a new era of thinking about health promotion. So at the dawn of the 21st century, when Breslow – by now well into his 80s – began talking about a third revolution in health, he commanded a rapt audience. In a widely cited paper published in April 2004 in the Annual Review of Public Health, and in a presentation that same month at the annual UCLA Fielding School of Public Health lecture and dinner that bears his name, Breslow laid out his vision for “the third revolution in health” and the implications of the ensuing “third


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cover story

Halfon was interested in Breslow’s notion of how the role of public health might be different in this new era. He wasn’t the only one. Peter Long (Ph.D. ’08) came to the school as a graduate student in 2000 and immediately was drawn to Breslow’s ideas. Long began conducting research using Human Population Laboratory data and meeting with Breslow on a weekly basis. “My career in health policy up to then had been about health insurance and helping people better manage their chronic conditions,” says Long, who is now president and CEO of the Blue Shield of California Foundation. “It was eye-opening to think that there was this untapped area around trying to develop a system for achieving positive health. It felt like a new frontier to me – and still does.” Long and Halfon held many conversations with Breslow to flesh out how the transformation might be operationalized. Eventually, they took the baton, extended the concepts, and began to use new language to characterize the changes and their implications for the health care system. The first era became the

“Each era’s system has had its own logic. The concept for 3.0 is to move toward optimizing the health and well-being of the population.” —Dr. Neal Halfon

UCLAPUBLIC HEALTH

era” on public health. The first, starting in the 19th century, was marked by the beginning of a successful fight against infectious diseases. By the middle of the 20th century, that success was leading to longer life expectancies – and an associated rise in age-related chronic conditions such as cancer, heart disease and stroke. Breslow was among the leaders who pushed public health into what he would later call its second era, focusing not just on curbing infectious diseases but also on preventing and reducing the impact of these and other chronic diseases. The way Breslow saw it more than a decade ago, public health was poised for another revolution. The third era would cover not just acute and chronic illnesses; it would be about promoting optimal health. “Lester had been part of the transition from the first era to the second era,” says Dr. Neal Halfon, professor of health policy and management and director of the UCLA Center for Healthier Children, Families and Communities, based in the school. “He saw that people were now living into their 70s and 80s and most of them were reporting that they were in good or excellent health, and he envisioned a new focus on a more comprehensive approach to optimizing the health of all. He was ahead of his time, as always, in this thinking.”


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“You’re not just attending to the patient in front of you; you’re trying to shift outcomes for whole populations through a lifecourse and long-term prevention orientation.”

UCLAPUBLIC HEALTH

—Dr. Moira Inkelas

1.0 health care system, the second 2.0. And now it was time for a new operating system – 3.0. “Each era’s system has had its own logic,” Halfon explains. “The first was about saving lives through acute, emergency and rescue care, and public health safety. The 2.0 system is about prolonging life and decreasing levels of disability through chronic disease management and secondary prevention. And the concept for 3.0 is to move toward optimizing the health and well-being of the population. It’s not that one usurps the next – we still need to fight infectious and chronic diseases. But we upgrade the system’s capacity so that we can do more.” The road to optimized population health and well-being, Halfon and Long believe, is through primary prevention, health promotion, and communityintegrated delivery systems. “The 3.0 era involves much more dynamic interactions between genes and the environment across the life course,” Halfon says. “We know, for example, that the mother’s health before the child is even born is going to have important implications on that child’s lifelong health trajectory.” Dr. Moira Inkelas, associate professor of health policy and management at the school, notes that unlike the earlier versions, 3.0 strives to be a fully integrated system in which all providers and com-

munity services are working toward the same goal – improved population health outcomes. “When you look at it that way, you’re not just attending to the patient in front of you; you’re trying to shift outcomes for whole populations through a life-course and longterm prevention orientation,” says Inkelas, who has been working with a model 3.0 system in Los Angeles called the Magnolia Community Initiative (see the sidebar on page 7). As an illustration of how a life-course oriented, community-integrated 3.0 system might work in practice, Inkelas offers the case of a 2-year-old child who visits a pediatrician. Noting from a routine screening that the child’s mother is depressed, the doctor might prioritize this concern for the visit, recognizing the child’s greater risk for developmental and cognitive deficits in adulthood. Although the child’s BMI is normal, the doctor notes that nutrition habits are set at a young age and that the neighborhood environment includes few fresh foods, placing the child at high risk for being overweight and developing cardiovascular disease, diabetes or other obesity-related illnesses later in life. The parent is introduced to a member of a physician-led care team who helps the mother set goals, connects her with several community programs, links her with peer social support, and follows up according to an established protocol for children with elevated risk. “In a 3.0 system you would treat the family with the goal of shifting outcomes 50 years later,” Inkelas explains.


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cover story

A Model 3.0 System

ABOVE AND OPPOSITE PAGE: The Magnolia Community Initiative, a collaboration among more than 70 government and private-sector partner organizations with significant participation from the Fielding School, embodies 3.0 with its holistic, community-integrated approach to health.

“improvement science,” including the development of metrics to determine the impact of the initiative on population health outcomes, Bowie has enlisted the support of the center’s faculty, including its assistant director, Dr. Moira Inkelas, and director, Dr. Neal Halfon. “The Magnolia initiative is demonstrating what a 3.0 system looks like,” says Inkelas. “It’s one thing to raise awareness of these concepts, but to see how such a system actually functions is important. Despite the challenges of being in an underserved community, Magnolia is putting into place the system elements of a health-optimizing philosophy and paradigm. Organizations are working in 1.0 reimbursement structures, but they are adopting 3.0 care processes and pathways. If we can show that this approach is successful in reducing costs and improving population health outcomes, this will be an excellent approach from which other systems can learn.”

UCLAPUBLIC HEALTH

As states move toward implementing community-integrated health care systems under the Center for Medicare & Medicaid Services’ State Innovation Models initiative, they would do well to study the example of the four-year-old Magnolia Community Initiative, a successful collaboration involving more than 70 government and private-sector partner organizations, with significant participation by UCLA Fielding School of Public Health alumni and faculty. The Magnolia Community Initiative was launched by the Children’s Bureau of Southern California in 2008 as a large-scale community mobilization effort to improve the health trajectory of 35,000 children living in a five-squaremile area crossing the Pico Union, West Adams and North Figueroa Corridor neighborhoods just southwest of Downtown Los Angeles. The Children’s Bureau targeted four goals shown by research to be key to creating safe and supportive environments where children can thrive: educational success, good health, economic stability and safe and nurturing parenting. “In its strategic planning, the Children’s Bureau concluded that it needed to take a more holistic approach to providing services at the scale that children and families in these neighborhoods needed,” says Patricia Bowie (M.P.H. ’92), who was brought in at the outset to help develop and design the initiative and is now supporting its implementation. “Traditional services weren’t sufficient for obtaining the outcomes they wanted to see, because they weren’t embedded in an overall wellness effort. What they were really asking for was more of a public health approach addressing the complexity of issues that contribute to overall health and well-being.” In drawing a wide variety of government and community-based groups to the effort, Bowie says, the initiative has galvanized the community and created a shared vision with the promise for much greater impact than if the groups were operating in isolation. Bowie helped to facilitate partnerships in the health care community, including several with fellow UCLA Fielding School of Public Health alumni – Shannon Whaley (Ph.D. ’98), director of research and evaluation at the Public Health Foundation Enterprises WIC program; Lynn Kersey (M.P.H. ’85), executive director of Maternal and Child Health Access; and Nancy Halpern Ibrahim (M.P.H. ’93), executive director of the Esperanza Community Housing Corporation – as well as a partnership with Vickie Kropenske, director of the Hope Street Family Center and an active member of the UCLA Center for Healthier Children, Families and Communities, based in the school. For what she calls


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8 In the 2.0 system, Halfon adds, pediatricians screen for developmental disabilities, and 4-6 percent of children might be referred to regional centers for services. A 3.0 system would focus on a significantly larger group – including children whose developmental or behavioral issues are not acutely disabling in the traditional sense but will, if not dealt with, set them on a lower health development trajectory. That means in addition to maintaining connections to hospitals, chronic disease specialists and disability programs, a 3.0 pediatrician’s office would have relationships with a variety of health promotion and prevention programs in the community. The U.S. health system was designed for the first era, Halfon notes. It was upgraded for the second, but will need a major transformation if it is to meet the needs of the third. As Long puts it, he and Halfon began “evangelizing” for the 3.0 system several years ago. Among the places where they found receptivity was the Centers for Medicare & Medicaid Services (CMS), the federal agency that administers Medicare, Medicaid and the State Children’s Health Insurance Program. The 2010 Affordable Care Act established within CMS a Center for Medicare & Medicaid Innovation (CMMI), charged with testing new models of payment and service delivery that would help to reduce program expenditures while preserving or enhancing the quality of care for beneficiaries. As the CMMI leadership began to conceptualize what the innovations should accomplish, the 1.0/2.0/3.0 model provided a framework for moving from the accountable care organizations (ACOs) that it currently supports to community-

Beyond a focus on preventing and managing diseases, the Health 3.0 system seeks to enhance people’s capacity to enjoy their lives.

The Evolving Health Care System

UCLAPUBLIC HEALTH

The three eras of health care, first outlined by Dr. Lester Breslow more than a decade ago and further developed by Dr. Neal Halfon, a faculty colleague at the school; and Peter Long (Ph.D. ’08), who worked closely with Breslow as a student and is now president and CEO of the Blue Shield of California Foundation.

1.0

2.0

3.0

The First Era (yesterday):

The Second Era (today):

The Third Era (tomorrow):

Focused on acute and infectious disease

Increased focus on chronic disease

Increased focus on achieving optimal health

Germ theory Short time frames Medical care Insurance-based financing Industrial model

Multiple risk factors Longer time frames Chronic disease management and prevention Pre-paid benefits Corporate model

Complex systems/life-course pathways Lifespan/generational Investing in population-based prevention Network model

GOAL: Reducing

GOAL: Prolonging

GOAL: Producing

Deaths

Disability-Free Life

Optimal Health for All


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cover story

he notes that increasing attention is also focused on how CMMI initiatives can help systems address more upstream determinants of health. “CMS understands that we can’t get the performance we need for our beneficiaries unless there is a fundamental change in the health care system for all Americans,” Hester says. “So we are focusing on creating transformative change that delivers three outcomes: better health care, better health for populations, and lower cost through improvement.” In addition to the SIM initiative, CMS earlier this year established the Health Care Innovation Awards – approximately $900 million in grants for awardees to implement compelling new ideas to deliver better health, improved care and lower costs to beneficiaries, particularly those with the greatest health care needs. In seeking to communicate the CMS vision across a wide variety of settings, Hester and his colleagues have found the 1.0/2.0/3.0 framework to be powerful. “People get the 3.0 framework in a way that they didn’t when we tried other approaches,” he says. “It’s been a very strong addition to our tool kit in trying to move this initiative forward.” For its presentations, Hester’s group adapted a PowerPoint slide Halfon had been using on the evolving health care system and the differences between the three eras (see page 8) – a slide that could in turn be traced to the concepts Breslow began articulating more than a decade ago.

“My career in health policy had been about health insurance and helping people better manage their chronic conditions. It was eyeopening to think that there was this untapped area around trying to develop a system for achieving positive health.” – Peter Long, Ph.D. ’08 UCLAPUBLIC HEALTH

centered accountable care systems – linking prevention-oriented population health with primary care. One of the key players in the decision-making process was a UCLA Fielding School of Public Health alum, Anthony D. Rodgers (M.P.H. ’75). Rodgers, who helped to launch CMMI and served as CMS’s deputy administrator for strategic planning and state innovation initiatives, was already thinking about how to integrate traditional population-based public health concepts into the health care system when he came across Halfon at a conference where they were both presenting. “I was talking about three levels of delivery system maturity, and Neal was talking about the 1.0/2.0/3.0 health system,” Rodgers says. “We were calling them different things, but it was the same concept. So we married the two, and began working together to better understand the component parts.” At CMS, Rodgers oversaw the development of the recently announced State Innovation Models (SIM) initiative, a $275 million funding opportunity for states to design and test new payment and delivery models. “My public health degree has always influenced how I’ve thought about the underlying determinants of health and the inefficiencies of the delivery system when it comes to keeping people healthy,” says Rodgers, who left CMS in September shortly after the SIM initiative was announced, and now plans to assist states in implementing their innovation models. “Wherever I’ve worked, I’ve tried to leverage what I learned at UCLA about the need to embed population and public health wellness concepts within the delivery system model.” Up to 25 states will receive funding from the SIM initiative to develop innovative models for accountable, community-integrated care, and approximately 10 states will receive additional funding to test their model over a three-year period; at the end of the testing period, recommendations will be sent to the Office of the Secretary of Health and Human Services on which models should be funded in the future. “It’s exciting to see states putting in their applications to start working on this issue in a real way – to start implementing the beginning of the third era of health,” says Long. California submitted a proposal for developing an innovative model in late September. Dr. Jim Hester, senior advisor to the CMMI director and acting director of CMMI’s Population Health Models Group, explains that many of the initiatives in his center’s so-called seamless care groups are focused on assisting health care systems in better coordinating care – the type of vertical integration necessary to move from 1.0 to 2.0. But


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10 The Centers for Medicare & Medicaid Services’ State Innovation Models initiative, which provides $275 million in funding for states to test and design new payment and delivery models, promotes the 3.0 framework.

UCLAPUBLIC HEALTH

The late Dr. Lester Breslow, known throughout his career for advancing ideas ahead of their time, outlined his vision for a “third revolution in health” at the Fielding School’s annual Lester Breslow Distinguished Lecture in 2004.

Inkelas believes the embracing of the 3.0 framework through SIM and other initiatives speaks to CMMI’s interest in working with states to go beyond cost control measures and “move the dial” on population health. “The way accountable care organizations have been operationalized, the initial focus has been on managing the cost of people with chronic conditions,” Inkelas says. “There’s little that’s health promotion-oriented – the ACO model is only bending the cost curve. Now, the goal is to encourage states to think about shifting the cost curve, which can occur only if we focus on optimizing health and preventing more people from developing the conditions in the first place.” “As the ACO model matures, this is the next logical evolution,” agrees Rodgers. “If you change the payment model so that the ACO is incentivized to have a longer-term relationship with the beneficiary, the delivery system can evolve toward community-centeredness.” Rodgers explains that CMMI sees three areas of performance for which the delivery system should be accountable. The first is improving care – including concepts such as the quality of care, patients’ relationships with providers and their health literacy. The second is cost, which Rodgers notes is related to quality – poor care drives up costs. “The ACO model is built on these two performance dimensions,” Rodgers says. But for 3.0, a third area of accountability is added: population health. “We know that there are social and economic determinants of health, but until now the delivery system hasn’t been accountable for addressing them systematically,” Rodgers says. “As we move toward these new payment models, we want the delivery system to take a longer-term view to raise the wellness of the population by working with the public health and social services infrastructure in the community. The 3.0 system is an upgrade designed to make our delivery systems not only patient-centered, but also community-centered.” The 3.0 concept has also found resonance outside of the government. Halfon and his colleagues have consulted with the nonprofit Institute for Healthcare Improvement (founded by former CMS administrator Donald Berwick) to introduce the Health 3.0 framework into its Triple Aim Initiative. The institute is working with more than 100 partners to optimize health system performance through new designs that pursue the three dimensions of improving the patient experience of care, improving the health of populations and reducing the per capita cost of health care. One of the first grants Long awarded when he arrived at the Blue Shield of California Foundation in 2010 was for an Institute of Medicine-hosted workshop on how best to measure the Triple Aim, including positive human health. “This is catching on,” Long asserts. Dr. Jonathan Fielding, professor at the school and director of public health for Los Angeles County, had several discussions with Breslow as Breslow was first envisioning the third revolution in health more than a decade ago. Fielding was, and continues to be, editor of the Annual Review of Public Health, the journal in which Breslow’s ideas initially appeared. “Lester was saying that what’s really important is not just people’s health status, but their ability to enjoy life,” Fielding says. “That was an extremely valuable perspective from someone who had lived through almost a century of changes in public health’s orientation. This is an important way for us to look at health as we set goals and objectives, and I think it will be enduring.” “Health care is at a crossroads,” adds Halfon. “Much of the focus has been on placing short-term patches on the system to try to reduce cost. Lester was a man of great stature and vision who had a wonderful ability to see the next major change on the horizon. Sometimes it takes a sage leader to shift the narrative and point in the right direction.”


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11 THE VISION OF ITS LATE FOUND -

feature

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ING DIRECTOR , THE

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HEALTH CARE NEEDS OF THE STATE ’ S DIVERSE

Using Data to Dispel Myths and Inform Decisions

POPULATION .

Passionate. Relentless. Indefatigable. Following the death of Dr. E. Richard “Rick” Brown last April, these and similar adjectives were invariably used to describe the iconic public health leader widely admired for his intense determination to make health care services more accessible and affordable to all Americans. The late Dr. E. Richard Brown founded the UCLA Center for Health Policy Research, whose California Health Interview Survey has become a critical source of information for California and national lawmakers.

UCLAPUBLIC HEALTH

But beyond his role as a powerful and tireless advocate for health care reform who advised two U.S. presidents and three U.S. senators on the issue, Brown, a longtime professor at the UCLA Fielding School of Public Health, was a pioneer in the collection and broad dissemination of health survey data to influence policy. That legacy remains as powerful as ever through the work of the UCLA Center for Health Policy Research, which Brown founded at the Fielding School in 1994; and the California Health Interview Survey (CHIS), based in the center, which has become the nation’s largest state health survey and a critical source of information for California and national lawmakers.


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Nine out of 10 non-elderly Californians will be insured as a result of the Affordable Care Act. UCLA Center for Health Policy Research, 6/14/12

“This isn’t just a survey in which we collect data and then sit here in our office analyzing it. It’s about making that data widely available in user-friendly formats so that it can be used by policymakers and others to influence the political process.” UCLAPUBLIC HEALTH

— Dr. Gerald Kominski Director, UCLA Center for Health Policy Research

“Rick was a force of nature,” says Kim Belshé, senior policy advisor at the Public Policy Institute of California and the former director of the California Department of Health Services and secretary of the California Health and Human Services Agency. “He had this relentless pursuit of social justice and enduring commitment to informing and improving policy through independent, objective research and information. We didn’t always see eye to eye in terms of policy solutions to big problems, but we shared an interest in evidence-based decision-making.” Brown promoted the development of health data surveys “to dispel persistent myths about the uninsured and to document the devastating consequences of the chronic lack of health insurance for millions of Americans,” says Dr. Gerald Kominski, professor of health policy and management, who succeeded Brown as director of the UCLA Center for Health Policy Research last January. As an example of one pervasive myth, Kominski notes that many are surprised to learn that much of the uninsured population is employed. “When we don’t have facts in front of us, people can make ideologically driven points,” Kominski says. “Through research, we have shown that even in the best of economic times,

lack of insurance is a problem for somewhere between one-sixth and one-fifth of Californians.” Brown founded the UCLA Center for Health Policy Research with a core mission of translating academic research into practical evidence that policy audiences and community health organizations could use in their work. Central to this vision was the concept of credible and comprehensive data that would make a non-partisan case for policies and programs aimed at improving the health and well-being of Californians and the nation. Unlike many academic entities, which create knowledge for its own sake, the center aims to make information and analysis available to policymakers, advocates, journalists and others as a way of influencing the decision-making process. “The work of the center has really delivered on Rick Brown’s vision to develop a research program that meets the data and analytic needs of the policy world, as well as people in the community working at the ground level to improve health,” says Dr. Diana M. Bontá (M.P.H. ’75, Dr.P.H. ’92), president and CEO of The California Wellness Foundation. “Center researchers have kept key health issues in the public sphere, providing clarity on health behaviors and conditions in a way that wouldn’t be possible without these very enriched telephone surveys that are conducted as part of CHIS.” Early in the center’s history, Brown concluded that California policymakers needed a survey that would provide detailed information on the health and access to health care of the state’s population, broken down by geography and a host of demographic characteristics. “National surveys could produce statistically reliable statewide estimates, but didn’t have enough people in the sample to make the distinction about specific counties and populations within the state,” Kominski says. Indefatigable as ever, Brown went about raising public and private funding to establish one of the largest health surveys in the United States. “He needed a lot of money, and you didn’t know what kind of results this survey was going to get,” recalls Bontá, who has supported CHIS not only in her current role with The California Wellness Foundation, but also in her previous positions as vice president of public affairs for Kaiser Permanente Southern California and director of the California Department of Health Services. “But we trusted Rick’s vision that this was going to be very useful to communities, and the investments have paid off in allowing the type of research that, early on, we could only have dreamed about.”


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2.6 million non-elderly Californians had medical debt during the Great Recession. UCLA Center for Health Policy Research, 2/6/12

In 2001, the UCLA Center for Health Policy Research produced the first CHIS results from interviews with more than 55,000 California households, creating in the process a treasure trove of health data on the nation's most populous and diverse state. Since then, the survey has become an essential source for policymakers, advocates, researchers, members of the news media and others interested in understanding the health of Californians and that of previously under-studied ethnic, racial, disabled and sexual minority groups. CHIS data and research by the center have been at the heart of some of the state’s and nation’s most pressing health policy debates. CHIS findings were used extensively by then-Gov. Arnold Schwarzenegger and both parties in the Legislature during California’s first attempt to institute comprehensive health care

“Center researchers have kept key health issues in the public sphere, providing clarity on health behaviors and conditions in a way that wouldn’t be possible without these very enriched telephone surveys that are conducted as part of CHIS.” — Dr. Diana Bontá (M.P.H. ’75, Dr.P.H. ’92), President and CEO, The California Wellness Foundation

UCLAPUBLIC HEALTH

reform in 2007 and 2008. CHIS-based research also focused national attention in 2010 on the problem of recession-driven loss of insurance, helping to support the passage of the federal Affordable Care Act (ACA) that year. Since then, California lawmakers have used CHIS to prepare for the implementation of the ACA. CHIS data and center research have also been the cornerstone of dozens of California laws and initiatives, including efforts to increase participation in the federal food-stamp program; develop new public–private expansion programs for children ineligible for private insurance, Medi-Cal or Healthy Families; collect health data on sexual minorities; impose a fast-food restaurant moratorium in impoverished areas of Los Angeles; and remove soda and other sugar-sweetened beverages from schools and government vending machines. “CHIS has been an invaluable resource that has helped inform programs, drive policy and identify problems in new ways,” says Dr. Jonathan Fielding, professor at the school and director of public health for Los Angeles County. “It’s of incalculable benefit for health departments to have this kind of county-level data on a broad range of health determinants, and to be able to see the trends over time.”


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Californians miss 3.9 million days of work or school a year due to asthma. UCLA Center for Health Policy Research, 7/8/08 (CHIS data)

The survey has been equally vital to groups throughout the state that advocate on behalf of low-income, underserved and otherwise disadvantaged populations. “We have used CHIS data to point out to legislators the need for certain reforms or to reevaluate proposed budget cuts,” says Anthony Wright, executive director of Health Access California, a statewide health care consumer advocacy coalition. “It’s hard to make the case for policies without the data to back it up.” CHIS has become the “go-to” source for neutral, authoritative information about the health of Californians, Wright says, noting, “I don’t recall anyone ever questioning the numbers.” Belshé agrees. “From a diverse array of policymakers’ perspectives, CHIS and the work of the center are viewed as objective and of the highest quality,” she says. In that sense, adds Belshé, who worked closely with

“From a diverse array of policymakers’ perspectives, CHIS and the work of the center are viewed as objective and of the highest quality. Along the policymaking continuum…the center has always been there to provide solid information, and we’re a better state as a result.”

UCLAPUBLIC HEALTH

— Kim Belshé, Senior Policy Advisor, Public Policy Institute of California the center in California’s efforts at achieving comprehensive health reform in 2007-08, “I always thought of Rick as someone who used information to build bridges – connecting evidence with issues, data with decisionmakers. Along the policymaking continuum – defining a problem, setting a policy agenda, identifying and assessing options, informing implementation and evaluating impact – the center has always been there to provide solid information, and we’re a better state as a result.” The users of CHIS data invariably point to the survey’s granularity as one of its great strengths – the detailed picture of health it provides not just through statewide estimates, but also through county and subcounty estimates for key populations, with breakdowns by factors such as income, immigration status and racial and ethnic group. “CHIS allows us to identify where there might be significant disparities in ethnic groups or by geography on issues such as asthma or cancer screening rates,” notes Bontá. Besides helping local health officials to prioritize and develop evidence-based policies, she explains, the county breakdown shows where “hot spots” exist for everything from teen pregnancies to various chronic conditions and provides local health departments with a barometer with which to measure the success of their efforts.


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The inclusiveness of the CHIS survey when it comes to racial and ethnic sub-populations has been widely lauded. CHIS is conducted in English, Spanish, Chinese (Cantonese and Mandarin dialects), Korean and Vietnamese. By ensuring sufficient-sized subsamples, the survey is able to produce statistically meaningful data on groups that have been underrepresented in most other health surveys, including Latinos and Latino ethnic sub-groups, African Americans, American Indian/Alaska Natives, and a number of Asian sub-populations. Bontá points out that the center has also made concerted efforts to make the CHIS data accessible to non-Englishspeaking California residents.

feature

One in four California Children have never seen a dentist. UCLA Center for Health Policy Research, 7/7/10 (CHIS data)

Californians,” says California State Assemblyman Gilbert Cedillo, who has consulted with Brown and the center on a number of health issues. “Whether it was attending a meeting of the L.A. County Board of Supervisors, a health meeting in East L.A., or a meeting in Sacramento, he was always willing and available to share his knowledge about public health and health policy. As a policymaker I found his work impeccable, his research stellar and his advocacy work exceptional. He was also a great personal friend who left us too soon." Kominski joined the center as associate director when it was established in 1994, in large part because he shared Brown’s vision, dating to his pre-UCLA work as a staff member for the agency now called the Medicare Payment Advisory Commission (MedPAC). “I’ve believed throughout my professional career that it’s important to make information available to policymakers so that decisions can be based on the best evidence,” he says. Brown is sorely missed, but his vision continues to be fulfilled by Kominski and the rest of the center’s leadership and staff. “Rick remains an inspiration and a high ideal to all of us,” Kominski says. “I am confident that his memory will be honored for many years to come through the important work of CHIS and the UCLA Center for Health Policy Research.”

“CHIS has been an invaluable resource that has helped inform programs, drive policy and identify problems in new ways. It’s of incalculable benefit for health departments to have this kind of county-level data, and to be able to see the trends over time.” — Dr. Jonathan Fielding Los Angeles County Director of Public Health

UCLAPUBLIC HEALTH

From the beginning, Brown and the center’s leadership viewed the dissemination of the CHIS data to be as important as the survey itself. “This isn’t just a survey in which we collect data and then sit here in our office analyzing it,” says Kominski. “It’s about making that data widely available in user-friendly formats so that it can be used by policymakers and others to influence the political process.” At the heart of what the center refers to as “the democratization of data” is AskCHIS, an online interface that allows users to quickly and easily generate customized health statistics from the CHIS data. “There have been times when we’ve had discussions in which a question came up about a particular statistic,” says Wright. “Even if it’s after hours, we can just go on the site and create our own crosstab charts for a variety of scenarios. For most other surveys you have to accept what’s in the printed report.” AskCHIS, which fields approximately 10,000 queries a month, has served as an invaluable resource for members of the news media as well. “It’s a rare week when I don’t say to a reporter, ‘You should really check out the CHIS data’ to get the authoritative number on whatever it is that he or she is looking for,” Wright says. The center has also held numerous training courses, in-person and online workshops and technical assistance sessions as a way to build the capacity of advocates, organizations and coalitions to use the data to address public health issues important to the communities they serve. Much of this is done through the center’s Health DATA program, which tailors the lessons to different groups’ skill levels and health issues of interest. Whomever the audience – news media, academics, community-based advocates, public health professionals or legislators – the center has promoted the dissemination of data to influence policy in a way that few can match, fulfilling the vision Brown had from the start. “Rick contributed so much of himself to improving the health of

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16 A FTER

FIERCELY

ADVOCATING FOR HARD - TO REACH RACIAL AND ETHNIC GROUPS TO BE BETTER REPRESENTED IN POPULATION - BASED HEALTH SURVEYS , SHE HELPED TO DEVELOP THE GROUNDBREAKING

C ALIFORNIA H EALTH I NTERVIEW S URVEY,

WHICH

SHE NOW HEADS .

Ninez Ponce:

Making California’s Diverse Populations Count For Dr. Ninez Ponce,

the opportunity to participate in developing a

groundbreaking state health survey shortly after earning her Ph.D. in 1998 was “a dream come true.” More than a decade later, Ponce, an associate professor in the UCLA Fielding School of Public Health and associate director of UCLA’s Asian American Studies Center, is the new principal investigator of the same California Health Interview Survey (CHIS), now the nation’s largest state health survey and widely admired for the detailed picture it provides of the health and health care needs of California’s diverse population (for more

UCLAPUBLIC HEALTH

on CHIS, see the article on page 11). Ponce’s path to the UCLA Fielding School of Public Health faculty – and specifically the school’s Center for Health Policy Research, where CHIS is based – can be traced to the frustrations she experienced with health surveys when she was starting her career as an advocate. After earning a Master of Public Policy degree from Harvard’s Kennedy School of Government in 1988, Ponce spent three years as deputy director of the Asian & Pacific Islander American Health Forum, a nonprofit advocacy and policy research organization aiming to advance the health of Asian and Pacific Islanders in the United States. In that role, she became a strong proponent for population-based health surveys that would collect data better representing the diversity of Asian American/Pacific Islanders and other populations.


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“After years of working as an advocate and hearing that it was too expensive to oversample Asian subgroups, I was suddenly at the drawing board. After being told it was too confusing to survey in all of these different Asian languages, I was on the other side.” —Dr. Ninez Ponce

UCLAPUBLIC HEALTH

When she isn’t involved in survey research, Ponce is focused on racial/ethnic disparities in health, including work that sheds light on the “transaction costs” of

care for certain populations. “These are social determinants of health that aren’t necessarily reflected in most analyses of health care,” she explains. Examples include not only the cost of care and access to health insurance, but also rules that can exclude individuals from receiving health benefits based on their citizenship or sexual orientation (such as when same-sex spouses fail to qualify for coverage on their partner’s plan); and limits to the effectiveness of care based on language barriers and lack of interpreter services. “It can take a long time to learn another language – if you’re an adult coming to this country, it might be 10-15 years before you feel comfortable communicating with your doctor in English – and in that time, a tumor could grow, undetected,” notes Ponce. “Yes, there are individual responsibilities, but there are also structural barriers that individuals can’t easily overcome, yet societies can.” Born in the Philippines to a father who was an accountant and a mother who was a schoolteacher, Ponce was 7 when her family immigrated to San Francisco. Her parents were adamant about raising her biculturally, making sure their daughter maintained her Filipino roots. As a teacher, Ponce’s mother embraced the linguistic and cultural diversity of her students. “She would stay up all night writing proposals to fund different cultural programs for the schools,” Ponce recalls. “At one point she came home and said, ‘I’ve got to learn Russian! I’m getting more and more Russian students.’ ” Ponce inherited that interest in cultures and languages, as well as her mother’s love of teaching. She was voted Outstanding Professor by the UCLA Public Health Student Association in 2008, and the following year she received the Dean’s Distinguished Teaching award. “So much of academia involves delayed gratification – you write a grant, eventually it’s funded, then you work on it, submit articles to journals, and the end product comes many years after you started,” Ponce says. “With teaching, you can convey something in a way that resonates with students and immediately see the reward. And it’s gratifying to continue my mom’s legacy.” Ponce is also pleased to have become the principal investigator of CHIS, a survey that has adopted much of what she advocated more than two decades ago. “I’m very honored to uphold Rick Brown’s legacy with CHIS,” says Ponce of her mentor, who died in April. “I’m happy to say that the principles we laid out in 1999 are still in place. This is a large public health survey that depicts the diversity of the population, and informs policies for the state and local communities that can improve health and reduce racial/ethnic disparities. I’m excited to continue that vision.”

faculty profile

“The Asian and Pacific Islander population was lumped together in surveys, despite the fact that we knew there were significant differences when you broke it down into subgroups,” Ponce says. “Because of that, it was very difficult to use data to demonstrate needs we knew existed but weren’t being met because of the ‘model minority’ myth, which depicted Asian American/Pacific Islanders as not having the same problems as other racial/ethnic minorities.” Ever since, one of Ponce’s major interests has been in promoting and developing surveys that represent hard-to-reach populations, both by oversampling certain subgroups whose numbers would otherwise be too small to be significant, and by designing surveys that are culturally and linguistically appropriate to ensure participation of groups whose health needs might otherwise go unrecognized. After years of working to effect change at the National Center for Health Statistics and through presentations at meetings of statisticians, Ponce decided to obtain research and statistical skills of her own by enrolling in the UCLA Fielding School of Public Health’s Ph.D. program. In 1999, shortly after Ponce completed her Ph.D., she was hired as an assistant professor in the school’s Department of Health Policy and Management and a senior research scientist at the Center for Health Policy Research. The fulfillment of a dream came that year when Ponce was invited by Dr. E. Richard Brown, the center’s founding director, to sit at the table during the initial discussions of an ambitious new project, the California Health Interview Survey. “After years of working as an advocate and hearing that it was too expensive to oversample Asian subgroups, I was suddenly at the drawing board,” Ponce recalls. “After being told it was too confusing to survey in all of these different Asian languages, I was on the other side.” For the first CHIS survey in 2001, Ponce led the efforts on the measurement of race/ethnicity, acculturation, physician-patient communication and discrimination. In doing so, she devised the rationale for Asian subgroup oversamples, as well as the cultural and linguistic adaptation of the survey. The importance of oversampling can be seen in the issue of cancer screening, one of Ponce’s major areas of research. Overall, Asian Americans and Pacific Islanders have lower screening rates for breast, cervical and colorectal cancers than other U.S. racial/ ethnic groups, but the rates among specific Asian subgroups vary widely. “Having that level of detail makes it possible to target the right groups in efforts to overcome barriers to screening,” Ponce says.


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DOUBLING DOWN GREG FLAXMAN “I’ve taken some macro classes in the social work program, and you can see the similarities to public health. There’s a shared vision between the two programs. As a dual degree student I have been able to pursue both tracks.”

Joint/Concurrent Programs Broaden Students’ Horizons After five years working in the health care field in a variety of AS

PUBLIC HEALTH

BECOMES INCREASINGLY COLLABORATIVE , COMBINING AN

M.P.H.

WITH ANOTHER

GRADUATE DEGREE ON CAMPUS

UCLAPUBLIC HEALTH

HOLDS GROWING APPEAL .

positions, Paige Hosler was looking to boost her career prospects with a graduate degree. The question for Hosler, who was interested in health care management or hospital administration, was which degree to pursue: M.P.H. or M.B.A.? “I thought the M.B.A. would give me more of an in-depth background in finance and entrepreneurship than a public health program would offer,” Hosler says. “But on the flip side, most of the M.B.A. programs I looked at didn’t have a strong focus in health care.” At UCLA, Hosler found the best of both worlds – the opportunity to enter a three-year program ending in an M.B.A. from the UCLA Anderson School of Management and an M.P.H. from the UCLA Fielding School of Public Health. “I was really impressed with the strength of the two programs and the achievements of the faculty from both schools,” says Hosler. She graduated in June with two degrees and no regrets. “I got a strong foundation in both health care and management that will serve as the springboard for the next several years of my career,” she says.


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In the process of looking into M.P.H. programs, UCLA’s – which would allow her to concurrently earn a master’s degree in African Studies – stood out. Farah Abdi felt the same way. “I knew that in the places where I hope to one day work, the problems extend well beyond the individual,” she explains, “and I felt an M.A. in African Studies alongside my M.P.H. would give me invaluable context for the health and social issues I would be working to ameliorate.”

Since Greg Flaxman knew he would be gaining a population perspective in his M.P.H. program, he chose to pursue the clinical focus in his M.S.W. studies.

CHRISTINA BATTEATE “It allowed me to tailor the tools I was obtaining in public health to fit the region where I was interested in working.”

With that in mind, the UCLA Fielding School of Public Health has increased the number of joint and concurrent degree programs available to students. “This is an increasingly attractive option,” says David Clark, the school’s assistant dean for student affairs. “It gives students with varied interests and skills the chance to dive deeply into two fields, and broadens their opportunities after they leave.” Public health

Combining an M.P.H. with an M.A. in Latin American Studies enabled Christina Batteate to explore aspects of Latin American society, where she would like to practice public health, in greater depth.

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Eli Tomar’s original plan was to pursue a law degree. But as someone interested in helping to shape health policy in Washington, D.C., Tomar reasoned that adding an M.P.H. would give him more credibility, whether it was with health care clients of his law firm or with future employers if he chose to pursue a position with a health-related company. So Tomar enrolled in UCLA’s M.P.H./J.D. program, the first of its kind west of the Mississippi River. “I felt public health would be interesting to study, and it was,” says Tomar, who completed the four-year program in June. “I learned about the American health care system on a much more academic level than I would have ever gotten in law school. But I gained a great deal besides the knowledge.” For Farah and Ridwa Abdi, an M.P.H. was part of the initial plan. The twin sisters, who were born in Somalia but had lived in the United States since they were 6, harbored ambitions of returning to East Africa after their education to tackle communitylevel health issues. But at some point, both concluded that they also wanted to learn more about their place of birth. “When I was an undergraduate I took an African history class and began to realize I was lacking knowledge about the history and politics that would help me do the most meaningful work there,” says Ridwa Abdi.

By its very nature, public health has always had close ties with other professions. That is arguably more the case today than ever before, with a growing recognition of the importance of social and physical conditions in influencing health – factors such as education, socioeconomic status, and both the built and natural environment. In addition, a burgeoning “Health in All Policies” movement calls for health consequences to be factored into policy decisions made by non-health agencies.


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20 can now be combined with degrees in any of 10 programs on the UCLA campus: law, medicine, business administration, urban and regional planning, social welfare, public policy, Asian American studies, African studies, Islamic studies and Latin American studies. Last fall, Clark says, 35 students enrolled in one of the joint-degree programs.

with older adults that summer, and decided that the clinical skills he could obtain from the social work program would provide the ideal complement to his public health education. Students pursuing an M.S.W. choose between a macro population focus and a micro clinical focus. Since Flaxman knew he would be getting the population perspective in his M.P.H. program, he chose to pursue the clinical focus in his M.S.W. studies. “I’ve taken some macro classes in the social work

“Often, students gain skills that allow them to participate in their field very differently. For example, we will get medical students and when they begin taking courses in public health their horizons expand dramatically.”

DR. DIANA HILBERMAN, director, M.P.H. in Health Policy and Management Program, UCLA FSPH

“The additional coursework and interactions with students in the other departments and schools enriches the depth and breadth of our students’ knowledge, and enhances their perspectives and contributions in their future efforts as public health professionals,” says Dr. Marjorie Kagawa-Singer, a professor in the school’s Department of Community Health Sciences and in UCLA’s Asian American Studies Department, and director of the concurrent degree program between the two. “As someone who has had many students from multiple programs in my own courses, I have seen this in action.”

ELI TOMAR

UCLAPUBLIC HEALTH

“Lawyers tend to be as mystified by health care as health-minded people are mystified by the law. It’s important for more of us to learn about these areas where health and the law intersect.” His original plan was to pursue a law degree, but Eli Tomar reasoned that adding an M.P.H. would give him more credibility in his efforts to shape health policy in Washington, D.C.

For many students, the joint/concurrent programs help to establish a distinct career path. Greg Flaxman was preparing to enter the UCLA Fielding School of Public Health in the fall of 2010 when he learned about the dual program with the Department of Social Welfare in the UCLA Luskin School of Public Affairs. Flaxman had enjoyed working as a volunteer

program, and you can see the similarities to public health,” says Flaxman, who will complete the threeyear program in June. “There’s a shared vision between the two programs. So in a sense, as a dual degree student I have been able to pursue both tracks.” While he is currently planning a career working with older adults as a clinical social worker, Flaxman believes the M.P.H. will enhance his ability to participate in program planning, and will give him the flexibility to work in administration should he ever choose that direction. “Often, students in these programs gain skills that allow them to participate in their field very differently,” observes Dr. Diana Hilberman, an adjunct professor of health policy and management at the UCLA Fielding School of Public Health who, as director of the school’s M.P.H. in Health Policy and Management Program, is closely involved with a number of joint/concurrent degree students. “For example, we will get medical students who have been learning about anatomy and treating individuals, and when they begin taking courses in public health their horizons expand dramatically. Now they’re learning about the context in which they’re practicing medicine and the environmental factors that are contributing to successes or frustrations they have in providing good patient care.” Hilberman notes that some M.P.H./M.D. students come to the school as part of UCLA PRIME, a federally funded dual-degree program focusing on developing leaders addressing issues pertaining to underserved populations. Others are considering careers in hospital administration, research or policy. Hilberman says she has seen increased interest in the M.P.H./M.B.A. program as well as the M.P.H./ M.D. program. “There’s a greater recognition of the importance of business skills in a field as complex as health care,” she says. “But even if you go through an


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M.B.A. program with a health care emphasis, you get significantly less depth on the health care side. We provide the health wraparound to the management skills students get in the business school, and our close ties with the medical school, hospital and health care field add considerably to the experience.” Christina Batteate knew she was interested in practicing public health in Latin America, where she has worked in the past and hopes to return in the future. Concurrently pursuing an M.A. in the interdepartmental Latin American Studies program enabled her to explore aspects of Latin American society in greater depth, including concentrations in Portuguese and urban planning. “It allowed me to tailor the tools I was obtaining in public health to fit the region where I was interested in working,” says Batteate, who graduated in June. “It was a great balance and opportunity to connect with professionals and professors who are working in that area.”

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feature

RIDWA ABDI

FARAH ABDI

“Learning how other fields go about it allows you to gain a unique vantage point to conduct what you want to do in the region in the most meaningful way.”

“I felt an M.A. in African Studies alongside my M.P.H. would give me invaluable context for the health and social issues I would be working to ameliorate.” Twin sisters born in Somalia, Farah and Ridwa Abdi hope to return to East Africa after their education to tackle community-level health issues.

UCLAPUBLIC HEALTH

Ridwa Abdi says engaging with students and professors who have worked in Africa in non-health disciplines has helped to stretch her thinking about ways to attack public health problems. “We have many of the same challenges,” she explains. “Whether you’re doing urban development or public health, you still have to work within the same societal framework and the same cultural boundaries. Stepping outside of your specialty and learning how people in other fields go about it allows you to analyze the problems from different points of view and gain a unique vantage point to conduct what you want to do in the region in the most meaningful way.” Where there is overlap, having a foot in two programs can help students appreciate the disparate perspectives different professions bring to the same issues – and the need for professionals skilled in both worlds. “I think lawyers tend to be as mystified by health care as health-minded people are mystified by the law,” says recent M.P.H./J.D. graduate Eli Tomar. “There are very few people who are experts in both. I certainly don’t profess to be one, but it’s important for more of us to learn about these areas where health and the law intersect.” Experiencing the different approaches to health care in the UCLA Fielding School of Public Health and UCLA Anderson School of Management reinforced Paige Hosler’s decision to pursue degrees in both. “I felt I was bringing a broader health care perspective to my M.B.A. classes, as well as a deeper understanding of business concepts to the team interactions and classroom discussions in my public health courses, than if I were only in one program,” she says.


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PAIGE HOSLER

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“I got a strong foundation in both health care and management that will serve as the springboard for the next several years of my career.”

After earning her M.P.H. and M.B.A. degrees, Paige Hosler accepted a position in the leadership development program of DaVita, a leading provider of kidney care in the United States. Not that it was easy. “Either program by itself is rigorous, so combining the two is that much more challenging,” Hosler says. She notes that an important part of any graduate program is the time spent outside the classroom networking and forging relationships with other students; being part of two programs at once doubled those time commitments. But Hosler, who recently accepted a position in the leadership development program of DaVita, a leading provider of kidney care in the United States, believes these relationships – combined with the ability to tap into both schools’ alumni networks – will serve her well as she advances in her career. Tomar has returned to Washington, D.C. and Patton Boggs LLP, the law firm where he served as a policy analyst prior to entering UCLA’s M.P.H./J.D. program; he is now working as an attorney in the firm’s health policy practice group. Like Hosler, he expects to benefit from an expanded alumni network, as well as from like-minded public health students he met at a weeklong symposium in Washington, D.C.,

one master’s degree, because it shows ambition and points to a more diverse experience,” she says. “With the background in Latin American studies as well as public health, I feel I have many good options.” Farah and Ridwa Abdi are on track to have completed both of their degrees by June, and have begun applying to medical schools. Ultimately, they hope to start a clinic together in their native Somalia or elsewhere in the East African region. Ridwa Abdi says the tools she and her sister take with them from the Department of Epidemiology and elsewhere in the school will enable them to go beyond one-onone patient care to conduct needs assessments and implement community health education programs. “But instead of having to walk into the community blind, we will be able to hit the ground running with our knowledge of the history, politics and culture of the region,” she notes. Kagawa-Singer believes that as public health becomes more of a collaborative process, professionals such as those who graduate from the school’s

”The additional coursework and interactions with students in the other departments and schools enriches the depth and breadth of our students’ knowledge, and enhances their perspectives and contributions in their future efforts as public health professionals.“

UCLAPUBLIC HEALTH

DR. MARJORIE KAGAWA-SINGER, professor, FSPH and Department of Asian American Studies that Tomar attended as a recipient of the school’s David A. Winston Health Policy Scholarship. Batteate is still weighing her options, which range from working in a Latin American region through the United Nations, World Health Organization, or a ministry of health, or working with the large Latino community in Los Angeles. “Right off the bat, people are impressed by someone who takes on more than

joint/concurrent programs will be increasingly valuable. “The problems public health professionals face are complex and wide-ranging,” she says. “We need professionals who have a breadth of experience and a solid foundation of knowledge and expertise from multiple disciplines to make the difference that’s needed. Our students who go through the joint/concurrent programs are uniquely prepared to do that.”


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research highlights Windfall from Eliminating Excessive Health Care Spending Could Transform America How the $750 Billion Saved from Eliminating Wasteful and Excessive Health Care Spending Could Be Used to Benefit Americans*

*All figures are in billions (2012 $) **Includes nurse home visits for high-risk pregnancies, improved water treatment, crime and violence prevention programs, Safe Routes to School expansion, teenage pregnancy prevention program, rural development grants, school-based smoking prevention program, and urban greening programs.

UCLAPUBLIC HEALTH

The InsTITuTe of MedIcIne estimates that $750 billion is lost each year to wasteful or excessive health care spending – dollars that add minimal value to health and well being. In a paper published in the American Journal of Preventive Medicine, researchers from the ucLA fielding school of Public health and Los Angeles county department of Public health calculate that this spending comes at a substantial cost. “If cut from the medical enterprise, these funds could provide businesses and households with a huge windfall, with enough money left over to fund deficit reduction on the order of the most ambitious plans in Washington,” says dr. frederick Zimmerman, professor and chair of the department of health Policy and Management and one of the study’s authors. “These funds could also cover needed investments in transportation infrastructure, early childhood education, human capital programs, rural development, job retraining programs and much more.” The research group – which also included graduate student Mac Mccullough; dr. Jonathan fielding, professor at the school and director of the Los Angeles county department of Public health; and dr. steven Teutsch of the department – conducted a detailed review of the literature before presenting one of the myriad ways the $750 billion might benefit Americans. under the group’s scenario, more than $410 billion per year (55 percent of the total, approximately the public-private split for all health care expenditures) would be returned to the private sector for individuals and companies to use as they please. Twenty-seven percent ($202 billion) of the savings would go to deficit reduction, yielding a greater reduction than the congressional “super committee” sought and failed to achieve. fourteen percent ($104 billion) would support additional investments in human capital, urban and rural quality of life, and physical infrastructure. for example, head start could be doubled in size and universal preschool could be provided; average class size could be reduced from 22-25 to 13-17 students; and trained nurses could conduct regular home visits for high-risk pregnancies. Two percent of the savings, amounting to $18 billion, would promote urban and rural quality of life by improving the built environment surrounding schools, expanding and modernizing public libraries, improving wastewater treatment, providing rural development grants to every small town in the nation, and providing job training opportunities to nearly 50,000 unemployed persons. And under the research group’s scenario, the remaining 2 percent would be devoted to fully funding an extensive wish list of transportation projects to alleviate road congestion and promote mass transit alternatives. “By no means will it be easy to liberate the wasted health care expenditures,” Zimmerman notes. “But we believe reconceptualizing our excess health care spending by looking at its opportunity cost to society is an important first step. eliminating wasteful health care spending could transform America with little to no reduction in the quality of, or access to, health care actually provided.”


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Studies Raise Concerns About Exposure to Vehicle-Related Pollution Near Freeways

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UCLAPUBLIC HEALTH

In dense urban areas such as Southern California, as much as half of the population lives within 1.5 kilometers of a freeway; more than 10 percent of U.S. households are located within 100 meters of four-line highways.

TWo sePArATe sTudIes by ucLA fielding school of Public health research groups raise concerns about the potential health effects of exposure to vehiclerelated pollution near freeways. In dense urban areas such as southern california, as much as half of the population lives within 1.5 kilometers of a freeway; more than 10 percent of u.s. households are located within 100 meters of four-lane highways. A joint study by researchers at the fsPh, the ucLA department of Atmospheric and oceanic sciences (Aos) and the california Air resources Board has confirmed an earlier fsPh study showing that in the pre-sunrise hours – with stable, nocturnal meteorological conditions – vehicle-related pollution from a freeway in southern california extends more than 2 kilometers downwind, well beyond what previous research had shown. The new study, published in the journal Atmospheric Environment, reports that this large downwind pollutant impact zone during the pre-sunrise hours was observed for four additional freeways across the Los Angeles Basin, making it clear that heavily trafficked roadways potentially have a much greater impact on downwind populations than was previously understood. “our findings have significant implications for more extensive human exposures to vehicle-related pollutants than previously indicated based on daytime measurements of roadway plumes,” says dr. Arthur Winer, professor emeritus of environmental health sciences at the school, who headed the study along with dr. suzanne Paulson of Aos. “If your home is within about 2 km downwind of a freeway, you may want to close your windows in the early morning hours and not run or otherwise heavily exercise within the 2 km impact zone until a few hours after sunrise.” In a separate study, which was also published in Atmospheric Environment, a team led by dr. Yifang Zhu found that ultrafine particles on and near freeways carry more electrical charges than ultrafine particles in the background air. Very high concentrations of toxic ultrafine particles have been reported on and immediately downwind of major roadways. The presence of the charges on these ultrafine particles substantially affects their transport mechanisms, which influence population exposure. Zhu’s group found that concentrations of charged particles were approximately 10-fold higher on southern california’s Interstate 405 than in the background air. “Because the number of charges on particles affect their aerodynamic behavior, this finding is important in understanding the near-roadway and traffic emission-related health effects,” says Zhu, associate professor of environmental health sciences at the school. “These data will help to better estimate population exposure to ultrafine particles on and near roadways.”

Living in Neighborhoods with History of High Jobless Rates Increases Depression Risk MIddLe-Age And oLder AduLTs living in neighborhoods with historically high rates of unemployment are more likely to experience symptoms of depression than those whose neighborhoods have lower jobless rates, regardless of whether they are employed themselves, according to a ucLA fielding school of Public health study headed by drs. richard g. Wight and carol s. Aneshensel


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of the department of community health sciences. The findings also suggest that residing in a high-unemployment neighborhood earlier in life takes a toll on an individual’s mental health later in life. Published in the Journal of Epidemiology and Community Health, the paper is the latest to come out of Aneshensel’s national Institute on Aging-funded study “neighborhood ses and emotional distress in old Age.” “our study highlights the importance of considering historical conditions when examining the mental health impact of urban neighborhood context, especially those that are tied to period effects such as climbing unemployment rates due to the current u.s. recession,” says Aneshensel. other studies have found significant associations between neighborhood jobless rates and a variety of health measures, but little was known about the impact of past neighborhood unemployment on the current and future mental health of residents. using four waves of data from the nationally representative u.s. health and retirement study between 2000 and 2006, along with data on unemployment by u.s. census tracts between 1990 and 2000, the researchers examined how an urban neighborhood’s unemployment level, as well as changes in unemployment rates over time, influenced emotional well-being among residentially stable late-middle-age and older adults. even when taking into account an individual’s employment status and other socioeconomic factors, the researchers found that symptoms of depression in 2000 were most likely to be found among those living in neighborhoods with high unemployment between 1990 and 2000, and whose neighborhood jobless rates rose between 1990 and 2000. The study found no evidence that the harmful effects of having lived in a high-unemployment neighborhood worsened between 2000 and 2006, suggesting that individuals in these neighborhoods take an emotional “hit” from the unemployment history of the neighborhood, but that it doesn’t accelerate with time. “Job growth interventions targeting urban neighborhoods entrenched in high unemployment may help to alleviate emotional distress due to prolonged exposure to job insecurity and fear of job loss, especially among those in late middle age, who often face age discrimination in hiring practices," says Wight, the study’s lead author.

Even when taking into account an individual’s employment status and other socioeconomic factors, symptoms of depression in 2000 were most likely to be found among those living in neighborhoods with high unemployment between 1990 and 2000, and whose neighborhood jobless rates rose between 1990 and 2000.

STD Rates Lowest Where Local Health Departments Are Integrated

UCLAPUBLIC HEALTH

The occurrence of sexuALLY TrAnsMITTed dIseAses within a population appears to be lowest in communities where core public health activities are shared by many partners, according to a study by a group headed by dr. hector P. rodriguez, associate professor of health policy and management at the ucLA fielding school of Public health. The study, published in the American Journal of Public Health, found, conversely, that public health systems where the local health department shoulders much of the effort and offers comprehensive services are likely to have higher sTd rates. rodriguez and colleagues linked countywide incidence rates of sTds – specifically chlamydia and gonorrhea – to the organization and governance of local public health systems and health departments. The 307 counties included in the study were separated into six categories of local health systems determined by size, financial allotments and number of services offered. Local boards of health deemed by the researchers to be independent and comprehensive – meaning that the departments individually offered a wide range of health serv-


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ices – produced the highest sTd rates. When local health boards shared public health activities with many working partners, the number of annual cases dropped substantially. The study also found that counties with higher concentrations of AfricanAmerican residents were more likely to have independent and comprehensive local public health services – and higher sTd incidence. sTd incidence rates in the united states have remained steady in recent years despite improved surveillance and prevention strategies. untreated, sTds can have serious long-term health effects, including cervical cancer, infertility, and pregnancy complications. racial disparities in sTd rates are among the widest of any health disparities, and are largely influenced by area-level sociodemographic factors. “Interventions for the modifiable local public health system correlates of sTd incidence, including the involvement of public health system partners in core activities, might improve the reach and effectiveness of surveillance and control activities and reduce racial disparities in the burden of sTds,” the study authors concluded. “To improve public health system effectiveness, clarifying how to build and maintain effective community health partnerships should be a high priority for researchers and public health practitioners.”

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Women in Malawi HIV Prevention Trial More Forthcoming in Computer-Assisted Self-Interview Audio Computer-Assisted Self-Interview in Malawi HIV Prevention Trial Involving LowLiteracy Women

UCLAPUBLIC HEALTH

Note: Images change as participant selects more partners; computer audio reads the number shown.

WoMen In An hIV PreVenTIon TrIAL in Malawi were more likely to reveal information about sensitive behaviors when undertaking an audio computerassisted self-interview than when asked the same questions face-to-face by a human interviewer, a ucLA fielding school of Public health study has found. The study, conducted during the course of a clinical trial testing the safety and effectiveness of two topical hIV microbicides, showed significant differences in responses to questions on sexual behavior and gel use in the computer-assisted interview, which even non-numerically literate women were able to use, than when the study subject was interacting with an interviewer. The computer-assisted interviews used images in addition to audio to enhance comprehension for the low-literacy women. “our findings suggest that the use of audio computer-assisted self-interviews in international hIV prevention trials among low-literacy study populations may result in slightly lower – but presumably more accurate – reporting of adherence to use of study products such as microbicides, but certainly higher reporting of other sensitive and highly relevant behaviors such as anal intercourse,” says dr. Pamina gorbach, professor of epidemiology and principal investigator of the study, which was published in the journal AIDS and Behavior. “given that sexual behaviors are known to be under-reported and adherence over-reported, the differences when using these computer interviews support the assumption that they can improve the accuracy of the data.” significantly, gorbach notes, the women participating in the trial found the computer-assisted interviews preferable to face-to-face interviewing. In the study, 585 women completed the same questionnaire through a faceto-face interview and in an audio computer-assisted self-interview. In the group receiving the microbicide, nearly 30 percent of the women provided inconsistent responses on questions regarding total sex acts and sex acts in which condom and gel were used; overall, the women were more likely to report lack of adherence to gel and condom use, as well as sexual behaviors such as anal intercourse, when interacting with the computer.


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The study also demonstrated that consistency or edit checks can be programmed into the computer interview and may reduce, although not necessarily eliminate, internally discrepant responses. “When considered in the context of the mixed findings reported in other studies that used biomarkers to validate reporting by interview mode, the audio computer-assisted self-interview is clearly not a cure-all for over-reporting of adherence,” gorbach cautions. “further research and new approaches to collection of data on self-reported adherence may be necessary to reduce the significant over-reporting that remains a challenge for hIV prevention trials.”

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Curbing Tobacco Use in China by Making Substitute Crops Profitable

Assisted by the local bureau, farmers in the tobacco-growing Yuxi municipality of Yunnan Province, China organized cooperatives through which they acquired the necessary skills to successfully substitute food crops for tobacco.

UCLAPUBLIC HEALTH

In chInA, 350 million people smoke. each year, 1 million die from smoking-related disease, and many more become disabled. Approximately 20 million chinese farmers produce the world’s largest share of tobacco, nearly 40 percent of the global supply. What is the key to cutting the number of deaths and smoking-related health problems? convince chinese farmers to grow some other crop. dr. Virginia Li, professor emeritus of community health sciences at the ucLA fielding school of Public health, set out to do just that. she contacted local chinese agriculture officials in Yunnan Province, where Asia’s largest cigarette manufacturer is located. Li and her local partners designed a tobacco crop-substitution project, the core of which is a farmer-led, for-profit enterprise. The farmers, many of whom are not formally educated, were able to acquire the knowledge and skills necessary to substitute food crops, including fruits and vegetables, for tobacco. By doing that, their annual income increased between 21 percent and 110 percent per acre of land, and the amount of tobacco being grown was reduced. A report on the project appeared in the American Journal of Public Health. Tobacco farming and promotion are the twin forces driving the demand for tobacco. “for china to reduce tobacco use, public anti-smoking campaigns are not sufficient,” Li says. “The key is to show that income from crop substitutions can exceed that from tobacco growth. That's essential to persuading farm families to stop planting tobacco, which is their livelihood.” so in the tobacco-growing Yuxi municipality of Yunnan Province, Li and her collaborators from the Yuxi Bureau of Agriculture designed and initiated a tobacco crop-substitution project. The agriculture bureau worked with village heads to recruit farm families through announcements at village meetings and word of mouth. At three sites, 458 farm families volunteered to participate in a new for-profit cooperative model. Assisted by the local bureau, farmers organized cooperatives through which they acquired the necessary skills for accounting, producing the highest possible crop yield, conducting market research, and storing and selling their produce. They elected their own officers, and participating farmers wrote the charter and bylaws. each cooperative’s responsibilities to its members included supplying seeds, pesticides and needed materials at the lowest possible cost through bulk purchasing. The project successfully demonstrated an approach that engaged farmers in cooperatives to substitute food crops for tobacco. “This was a remarkable accomplishment,” Li says. “The Yuxi pilot demonstrated that farmers, many of whom do not read or write, are able to learn the knowledge and skills necessary to operate an enterprise that gives them an income superior to tobacco farming.”


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student profiles Using Statistics to Solve Problems

“I get to work on problems that are very tangible, that affect entire populations at a very basic level – health. The possibilities are endless and I like that.”

UCLAPUBLIC HEALTH

— Shemra Rizzo

For as long as she can remember, SHEMRA RIZZO has loved math for its ability to make a difference in people’s lives. “While some people – like my husband who is a mathematician – love math for its intrinsic beauty, I like math as a tool to solve problems,” she says. as a college undergraduate, rizzo majored in physics. “but eventually I realized that the applications were not connected to my life experience; I couldn’t really relate to them,” she recalls. “In physics, math is used to understand how our universe works. It was too abstract for me. I decided to narrow my focus to more earthly problems – things you can see and experience.” rizzo found the ideal fit for her interests in biostatistics. “biostatistics feels perfect to me because it is the intersection of the part of math I like best and the fields that I enjoy the most,” rizzo explains. “I get to work on problems that are very tangible, that affect entire populations at a very basic level – health. I find myself immersed in different things over time: antibodies, infections, nutrition, stents, etc. The level of focus also changes: We could be working at the cellular level in a project now, and at the population level tomorrow. The possibilities are endless and I like that.” born in mexico city, rizzo was raised in the small mountain community of orizaba in the mexican state of Veracruz. While an undergraduate physics student at the monterrey Institute of Technology in mexico, she spent a semester studying abroad at the University of colorado at boulder and a summer at Ucla’s Institute for Pure and applied mathematics. later, while studying for her master’s in statistics and operations research at the University of north carolina at chapel hill, rizzo found her niche in health, focusing in her thesis on mathematical models for breast cancer screening. of her decision to continue with her doctoral studies at the Fielding school, rizzo explains: “a master’s degree in biostatistics provides you with the skills to solve problems using existing statistical methodologies. a Ph.D. allows you to develop new methodologies to deal with challenging data. It is like getting a doubleedged sword.” For her dissertation, rizzo is developing methods in the area of meta analysis – using the findings of multiple studies to provide stronger evidence of the efficacy of a treatment. rizzo is also applying her statistical know-how as a graduate student researcher in the methods core of the Ucla-Usc center for Population health and health Disparities. she is part of a project that aims to change eating behaviors and improve health measures in the east los angeles latino community through education and an overhaul of corner stores to increase the accessibility of healthy foods. “as a latina who is passionate about my own health and nutrition, I am connected to this study at a very personal level,” says rizzo, one of two winners of the Fielding school’s 2012 student writing competition for her essay on using biostatistics to address health disparities. “I find the idea of helping to lower other people’s risk of disease, and contributing to eradicating health disparities, immensely satisfying.”


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Improving Disease Surveillance Capacity in the Democratic Republic of Congo

“It was everything I had been interested in – getting to see the world and combining biology with working in the field in a way that has major implications on people’s lives.” — Nicole Hoff

UCLAPUBLIC HEALTH

NICOLE HOFF Was In The FIrsT Week of her m.P.h. program at Tulane University school of Public health and Tropical medicine when she received something her mother thought she would find interesting – a National Geographic article on monkeypox in the Democratic republic of congo (Drc). among the work highlighted in the piece was that of Dr. anne rimoin, a member of the Ucla Fielding school of Public health epidemiology faculty. Working closely with Drc government and academic collaborators, rimoin’s group has helped to improve the disease surveillance capacity in a nation that is one of the world’s poorest – and one that remains devastated by the effects of civil war. “at the time, I didn’t know where I saw myself going with epidemiology,” says hoff, currently a Ph.D. student at the Fielding school. “but after reading that article I thought, ‘That’s exactly what I’m going to do.’ It was everything I had been interested in – getting to see the world and combining biology with working in the field to collect and analyze data in a way that has major implications on people’s lives.” although she kept the article, hoff mostly forgot about it until it came time to apply to doctoral programs. although she had attractive scholarship offers from other programs, when the opportunity arose to enroll at the Fielding school and work in the Drc as part of rimoin’s group, it was an easy decision. Thanks to fellowship funding from the Faucett Family Foundation, hoff has spent most of her time since august 2011 in kinshasa, Drc, where rimoin’s team is based. hoff is assisting rimoin on a number of projects, including data management of monkeypox surveillance; the UsaID-funded PreDIcT, which works with hunter cohorts and conservation organizations to track viral pathogen emergence in animals and the potential for crossing over to humans; and the building of a large-scale network of conservation organizations working in remote Drc locations to collect animal tissue samples for public health research. hoff is also assisting in vaccination campaigns through funding received by rimoin’s group from the bill and melinda gates Foundation. That and other work have taken hoff to some of the Drc’s most remote, difficult-to-reach areas. as part of the vaccine program, she has accompanied groups that have gone to villages with no electricity or means of outside communication. getting to these villages can take a full day, including river crossings and long walks through marshes. In conversations with local health workers once her group has arrived, hoff has learned of the harsh realities they face. “They know they’re supposed to vaccinate regularly, they know the vaccine is supposed to be kept cold, and they know they’re supposed to report diseases regularly,” hoff says. “They know so much, but they have so little. Without the most basic resources they do the best they can.” beyond her on-the-job lessons in international field epidemiology, hoff has gained a remarkable set of life experiences. “I had never ridden in the cockpit of a plane, or on the back of a motorcycle through the jungle,” she says. “I had never met with a minster of health. I’m around incredible people and am learning a lot more than just about my field. It’s been an amazing experience.”


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contracts & grants 2011-12 This section includes new contracts and grants awarded in fiscal year 2011-12. Due to space limitations, only funds of $50,000 or more are listed, by principal investigator.

SUSAN BABEY Examining the Effects of Water Policy Changes in California Public Schools Using the California Health Interview Survey (CHIS) (National Center on Minority Health and Health Disparities & RAND Corporation, $103,740) ROSHAN BASTANI Increasing HPV Vaccine Uptake in a Low Income Ethnic Minority Population (National Cancer Institute, $2,800,709 for 5 years) RONALD BROOKMEYER Laboratory and Statistical Development of Cross-Sectional HIV Incidence Assays (National Institute of Allergy and Infectious Diseases & Johns Hopkins University, $1,688,771 for 5 years) E. RICHARD BROWN California Health Interview Survey (CHIS) (California Department of Managed Health Care, $409,921 for 2 years; California Children and Families Commission, $1,500,000); National Network of State and Local Health Surveys (Robert Wood Johnson Foundation, $387,651 for 2 years) ARTHUR CHO Development of Quantitative Cellular Assays for Use in Understanding the Chemical Basis of Air Pollutant Toxicity (South Coast Air Quality Management District, $368,457 for 2 years); Determining the Physical and Chemical Composition and Associated Health Effects of Tailpipe PM Emissions (South Coast Air Quality Management District & University of California, Riverside, $53,253); Characterization of the Physical, Chemical, and Biological Properties of PM Emissions, VOCs, and Carbonyl Groups from Commercial Cooking Operations (South Coast Air Quality Management District & University of California, Riverside, $53,975) CLAIRE DILLAVOU AND JOHN CLEMENS Compostable or More Vaccination, Less Debris: Developing Compostable Vaccine Packaging (Bill and Melinda Gates Foundation, $100,000 for 1.5 years) JONATHAN FIELDING Health Impact Assessment (HIA) of State Tax Alternative: Demonstration, Outreach and Training to Increase Understanding of HIA among State Policy Analysts (Robert Wood Johnson Foundation, $209,963 for 2 years)

UCLAPUBLIC HEALTH

JOHN FROINES AND TIMOTHY MALLOY Risk and Decision: Evaluating Pesticide Approval in California (Clarence E. Heller Charitable Foundation, $61,102) PATRICIA GANZ Enhancing Outcomes in Young Breast Cancer Survivors: A Program of the UCLA-Livestrong Survivorship Center of Excellence (DHHS/Centers for Disease Control, $690,000 for 3 years); National Surgical Adjuvant Breast and Bowel Project (NSABP) Community Clinical Oncology Program Research Base (NIH & NSABP, $1,542,899 for 5 years)

BETH GLENN Improving Cancer Screening among Breast and Colorectal Cancer Survivors and their Relatives (SIP) (Centers for Disease Control, $900,000 for 3 years) GILBERT GEE Effects of Criminal Justice System (Kean University & National Institute on Drug Abuse, $64,055 for 3 years) DEBORAH GLIK AND MICHAEL PRELIP Measuring Health, Media, Computer & Digital Literacy Among Senegalese Youth (Fogarty International Center, $190,500 for 3 years) JESSICA GIPSON Social Context and Fertility: A Mixed-Methods Approach to Survey Development (National Institute of Child Health and Human Development, $635,399 for 5 years) PAMINA GORBACH Microbicide Trials Network (Magee-Womens Hospital, Research Institute and Foundation, $187,246); Adult Film Performers Transmission Behavior & STI Prevalence (UC California HIV/AIDS Research Program [CHRP], $200,000 for 2 years) DAVID GRANT CHIS Building Healthy Communities Oversample: Follow-Up Activities (The California Endowment, $616,000) GAIL HARRISON WIC Infant and Toddler Feeding Study (USDA Food and Nutrition Service & Westat, Inc, $990,881 for 5 years) JULIA HECK AND BEATE RITZ Parental Occupation and Childhood Cancers (National Institute of Environmental Health Sciences, $154,000 for 2 years) PETER KERNDT Men Who Have Sex With Men Human Papillomavirus (HPV) Prevalence Study (Centers for Disease Control & University of Kentucky, $104,775) LEEKA KHEIFETS Exploring the Feasibility of Novel Approaches to the Investigation of Elf & Childhood Leukemia (Electric Power Research Institute, $357,547 for 2 years); Asthma and EMF (Electric Power Research Institute, $209,806 for 1.5 years); Assessing Occupational Electric Shocks, Magnetic Fields and ALS (Centers for Disease Control, $402,145 for 2 years) GERALD KOMINSKI California Health Policy Research Program (The California Endowment & University of California, Berkeley, $238,284 for 2 years); Low Income Health Program (LIHP) Evaluation (Blue Shield of California Research and Education Foundation, $1,201,019 for 4 years) MICHAEL LU AND GAIL HARRISON Establish University-Based Grants to Assess WIC Impacts on Periconceptional Nutrition (USDA Food and Nutrition Service, $997,759 for 5 years)


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YING-YING MENG Air Pollution and Type 2 Diabetes Prevalence, Control and Risk Factors (British Petroleum Group & South Coast Air Quality Management District, $299,937) DONALD MORISKY Social Network and Sexual Risk for HIV Among Older Female Sex Workers (National Institute of Child Health and Human Development & Virginia Commonwealth University, $274,682 for 4 years) JORN OLSEN Health of Children Born by Mothers with Rheumatoid Arthritis (National Institute of Arthritis & Musculoskeletal & Skin Diseases, $333,336 for 2 years) ANNE PEBLEY Does School Readiness Improve Academic Achievement for Low Income and Immigrant Children in Los Angeles? (John Randolph Haynes & Dora Haynes Foundation, $136,421 for 2 years) NINEZ PONCE Disparities in Utilization of Gene Expression Profiling and Subsequent Chemotherapy Decisions (Aetna Life Insurance, $325,433 for 2 years) NADEREH POURAT Assessing Costs of Maternal Hypertension and Maternal Hemorrhage (California Department of Public Health, $52,541) MICHAEL PRELIP Corner Store Makeover in East Los Angeles/Boyle Heights (The California Endowment, $416,364 for 2 years) DYLAN ROBY Low Income Health Program (LIHP) to Medi-Cal Transition Plan (Blue Shield of California Research and Education Foundation, $92,000) HECTOR RODRIGUEZ AND ROSHAN BASTANI Implementing Patient Reported Outcomes Among Diverse Primary Care Patients (DHHS/Centers for Disease Control & Harvard University, $183,486) DAMLA SENTURK Effective Semiparametric Models for Ultra-Sparse, Unsynchronized, Imprecise Data (National Institute of Diabetes, Digestive and Kidney Disease, $609,480 for 3 years)

STEVEN WALLACE Community-based Interventions to Increase Clinical Preventive Service Use by Older Adults (SIP) (Centers for Disease Control, $200,000 for 2 years); Enhancing the Delivery of Clinical Preventative Services in Community Settings (National Association of Chronic Disease Directors & Michigan Public Health Institute, $56,400); The Elder Economic Security Standard Index for Use in California (California Wellness Foundation, $125,000); Undocumented Immigrants and Health Care Reform (Commonwealth Fund, $56,203)

faculty

WILLIAM MCCARTHY LAUSD Menu and Plate Waste Evaluation (County of Los Angeles & Public Health Foundation Enterprises, Inc., $75,000)

RICHARD WIGHT Aging, Stress & Health Among Gay-Identified Men: Linking Past and Present (National Institute on Aging, $410,920 for 2 years) ELIZABETH YANO AND FREDERICK ZIMMERMAN Women’s Health Research Consortium/Practice – Based Research (Veterans Affairs, $125,000) YIFANG ZHU Reducing Air Pollution Exposure in Passenger Vehicles and School Buses (CA/EPA Air Resources Board, $150,000 for 2 years)

$20M CDC Grant to Fight Obesity Researchers at the UCLA Fielding School of Public Health and UCLA’s Jonsson Comprehensive Cancer Center have been awarded a $20 million federal grant to further their innovative efforts to curb obesity. The UCLA project, rather than requiring busy, stressed individuals in low-resource neighborhoods to seek out physical activity and nutrient-rich foods, will engage them as “captive” audiences in settings they already frequent – including schools, offices and churches – making healthier options a default that can be avoided only with effort or by “opting out.” The five-year grant from the Centers for Disease Control and Prevention is intended to address health disparities among racial and ethnic groups across the country and is part of the agency’s Racial and Ethnic Approaches to Community Health (REACH) initiative. The UCLA project will be led by Drs. Antronette Yancey and Roshan Bastani, professors of health policy and management at the Fielding School and co-directors of the school’s UCLA Kaiser Permanente Center for Health Equity. Other faculty members on the team include Assistant Professor Beth Glenn, Professor Annette Maxwell and Professor William J. McCarthy, all of the school’s Department of Health Policy and Management.

KIMBERLEY SHOAF Hazard Risk Assessment for the Bay Area MSA Health Departments (Department of Public Health, $200,000)

DAWN UPCHURCH A Biopsychosocial Investigation of Women’s Health at Midlife (National Institute on Aging, $200,000)

UCLAPUBLIC HEALTH

PETER SINSHEIMER California Environmental Garment Care Demonstration Project: Non-Toxic Dry Cleaning Incentive Program (AB998) Phase 3 (CA/EPA Air Resources Board, $367,994)


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news briefs

faculty support FSPH students Following a naming gift from faculty member Dr. Jonathan Fielding and his wife Karin Fielding, other faculty members have made significant contributions to the school. Drs. Charlotte and Alfred Neumann, emeriti professors in the Department of Community Health Sciences, donated $100,000 to establish the Drabkin/Neumann Global Public Health Field Experience Endowment. The fund will support students who travel abroad to do field work, especially in the areas of nutrition and family, child and maternal health. Dr. Ron Andersen, professor emeritus in the Department of Health Policy and Management, and his wife Diane Andersen donated $150,000 to establish the Department of Health Policy and Management Community Partner Fellowship Endowment, which will support fellowships for M.P.H. and Ph.D. students. These generous gifts will help the Fielding School continue to recruit and train the best and brightest students in public health.

heymann appointed dean Dr. Jody Heymann has been appointed dean of the Fielding School, effective January 1. A professor of epidemiology and political science at McGill University, Heymann is founding director of McGill’s Institute of Health and Social Policy and holds a Canada Research Chair in Global Health and Social Policy. As founding director of the WORLD Global Data Center, she leads the first global initiative to examine how health and social policies in all 193 United Nations member countries affect the ability of individuals, families and communities to meet their health, educational, economic and other needs. An internationally renowned researcher on health and social policy, Heymann holds a B.A. in history and physics from Yale University and an M.D., M.P.P., and Ph.D. in public policy from Harvard University.

UCLAPUBLIC HEALTH

FLYNN NEW DEVELOPMENT DIRECTOR – Anthony Flynn has joined the school as director of development and will focus on securing major gifts. Flynn has a distinguished background with more than 25 years of fundraising experience. He worked most recently as the deputy director general for development and communications at the International Vaccine Institute in Seoul, South Korea. Much of Flynn’s development experience has been in global health, including working for the International AIDS Society in Geneva and the International AIDS Vaccine Initiative in New York and Amsterdam.

jackson receives heinz medal Teresa Heinz and the Heinz Family Foundation honored Dr. Richard Jackson, professor and chair of the Department of Environmental Health Sciences, as a recipient of one of five prestigious Heinz Awards. Jackson was honored for sparking a national conversation about the relationship between the physical design of communities and rising health risks. As the award winner in the Environment category, Jackson receives an unrestricted cash prize of $250,000.

INTERACT WITH US! You can learn about happenings at the school, participate in discussions on public health topics of the day or reconnect with former classmates and favorite faculty members through the school’s Facebook page, and follow UCLASPH on Twitter for important updates. In addition, alumni are invited to join the UCLA Jonathan and Karin Fielding School of Public Health Alumni Network on the professional networking site Linkedin.


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faculty honored at APHA

IOM honors rosenstock, elects needleman

DID YOU KNOW?

winter institute launched The Fielding School has launched the Winter Institute, an exciting three-week program for health professionals. The Winter Institute features a dynamic series of course offerings taught by faculty at UCLA and other top institutions – a way to help those who wish to remain competitive in the fields of medicine, public health, nursing and other health-related professions. The program presents a continuing education opportunity for professionals working in the health care arena around the world. The first Winter Institute will take place on the UCLA campus December 9-22 and January 2-5. For more information, visit http://ph.ucla.edu/wi.

You are a lifetime member of the UCLA Fielding School of Public Health Alumni Association if you are a graduate of the Fielding School and its executive programs. If you would like more information about the activities of the Public Health Alumni Association, please call (310) 825-6464 or email phaa@support.ucla.edu.

NEW ALUMNI ASSOCIATION PRESIDENT – Dr. Beatriz Solis (M.P.H. ’96, Ph.D. ’07), director of community health at The California Endowment, has been elected president of the Public Health Alumni Association (PHAA), succeeding Rosa Pechersky (Dr.P.H. ’83). The board now includes alumni representatives from all five of the Fielding School’s departments. PHAA is engaged in many activities to support both students and the more than 10,000 FSPH alumni. Anyone interested in helping with PHAA’s mentorship, career networking, community and young alumni engagement programs is encouraged to contact Karin Shaw, director of alumni affairs, at (310) 825-5119 or kshaw@support.ucla.edu.

UCLA VOLUNTEER CENTER – FSPH students join with 7,000 fellow Bruins in volunteer activities throughout the greater Los Angeles region.

UCLAPUBLIC HEALTH

Dr. Linda Rosenstock, dean emeritus and professor of health policy and management, was awarded the Institute of Medicine’s David Rall Medal for her distinguished leadership as chair of the Committee on Preventive Services for Women. The committee’s recommendations, combined with the Affordable Care Act, provide women with historic access to preventive health services. Dr. Jack Needleman, professor of health policy and management, was elected to the prestigious institute.

news briefs

During the fall annual meeting of the American Public Health Association (APHA), several Fielding School faculty members were honored: Dr. Jonathan Fielding received the Fries Prize for Improving Health from the James F. and Sarah T. Fries Foundation, and was named 2012 Honorary Fellow of the Society for Public Health Education for his visionary leadership and lifetime of contributions to public health. Dr. Deborah Glik received the Everett Rogers Award from the Public Health Education and Health Promotion Section of APHA for outstanding contributions to advancing the study and/or practice of health communication. Dr. Richard Jackson was awarded the APHA Sedgwick Memorial Medal for distinguished service and advancement of public health knowledge and practice. Dr. Toni Yancey received the APHA Award for Excellence in recognition of her exceptionally meritorious contributions to the improvement of population health.

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FSPH Magazine Autumn/Winter 2012