Winter 2023 Quarterly Newsletter

Theholidayseasonisuponus,andtheMD/MPHProgramattheUniversityofMiami’sMillerSchoolofMedicinehas beenbustlingwitheducational,research,andserviceactivitiesthisFall2023semester.Wetakethismomentto welcomeyoutothenewMD/MPHnewsletterwithregularupdatesabouttheprogram,includinglocalandnational publichealthtopicsofinterest,andhighlightingtheaccomplishmentsofourfaculty,staff,students,andalumni.During thefallsemester,wealsowelcomedournewMD/MPHadministrativeteammembers,Ms.ManuelaLopez,Senior ProgramManager,andMr.BernieTamberg,SeniorProgramCoordinator.

Inthisquarterlyedition,wereflectonacontemporaryissuethatdirectlyimpactspublichealthphysiciansandthe communitiestheyserve.ChatGPTburstintopublicconsciousnessonNovember30,2022.Itwassoonfollowedby Google’sBard,Microsoft’sBing,andsomanyothergenerativeAIprogramsthatanswerquestions,drawimages, summarizeknowledge,tabulatedata,writecode,andcreatepatientnotesbasedonrecordeddoctor/patient conversations;theskyisthelimit.AIchatbotshavecapturedthepublic’sinterestandimaginationwithmanyofus dabblingwithpromptengineeringtoharnessgenerativeAI’spowertoimproveday-to-dayworkproductivity.Thetools thathavemadethesepublicfacingAImodelspossible,naturallanguageprocessing,machinelearning,andneural networkalgorithms,tomentionafew,havebeenusedbybiostatisticiansanddataanalystsforsometime.Thereare clearbenefitstousingthesenovelapproachesforsynthesizingalargeamountofhealthdatafromtraditionalandnontraditionalsources(wearables,apps,socialmedia,environmentalsensors,newsmedia,mobiledevices).CDCand institutionsacrosstheworldhaveutilizeddeeplearningmodelstoincreasethespeedandaccuracyofsurveillance byscreeningforpossibletuberculosisonchestx-rays,providebettercasedefinitionsfornoveldiseases,determine safetysignalsforvaccines,identifyindividualsatriskforsuicide,moreeffectivelytargetdiseasepreventioncampaigns, improvechronicdiseasemanagement,andprovideapersonalizedhealthcoach.Thelistofnewusesexpands weekly.Theeraofprecisionmedicineandprecisionpublichealthishere,albeitstillinitsinfancy.AIhasthepotential forreducinghealthdisparitiesthroughfocusedidentificationofriskfactorsandbettermanagementofresources. However,theuseofAIinpublichealthpresentsamyriadofchallenges,risks,andlimitations.Theseincludethe exacerbationofhealthinequities,particularlyinunderservedruralcommunitiesandwithinthedevelopingworld.In addition,poormodelinterpretability,structuralbarriersrelatedtodatasharing,inadequateinfrastructure,adeficiency inAItrainingforthepublichealthworkforce,ethical,andprivacyconcernsfurthercompoundconcernsaboutthe widespreaduseofAItoaddresstoday’spublichealthchallenges.

WeroundoutthiseditionofournewsletterwithadiscussionofthekeylegalandethicalconcernsaboutAIusein publichealthwithourpublichealthlawfaculty,Ms.MontreceRansom.

Wewishyouandyourfamilyaveryhappy,healthy,andrelaxingholidayseason!

ShirinShafazand,MD,MS DirectorMD-MPHProgram ProfessorofClinicalMedicinePulmonary, CriticalCare,andSleepMedicine

AlbertoJ.Caban-Martinez,DO,PhD,MPH DeputyDirector,MD-MPHProgram AssociateProfessor,DepartmentofPublicHealth DivisionofEnvironmentandPublicHealth

InthefirsteditionofourFacultySpotlight series,weproudlyhighlightMontrece McNeillRansom,adistinguishedfaculty memberdrivingtheUniversityofMiami (UM)MillerSchoolofMedicine/Department ofPublicHealthMD/MPHcourseinPublic HealthLaw.Ms.Ransom,anaccomplished professionalwithextensiveexperiencein publichealth,law,andleadership,servesas theDirectoroftheNationalCoordinating CenterforPublicHealthTrainingwithin NNPHI.

AnICF-certifiedexecutiveleadershipcoach andDEI-certifiedbelongingstrategist,Ms. Ransombringsauniqueblendofexpertiseto theUMMD/MPHprogram.Withnearlytwo decadesattheCDC,wheresheservedasa PresidentialManagementFellowandled effortsinpublichealthlawtrainingand workforcedevelopment,shehasaproven trackrecordofexceptionalleadershipand commitmenttopublicservice.

AproudalumnaoftheUniversityofAlabama

PublicHealth,Ms.Ransom'scommitmentto continuouslearningisevidentthroughvarious certifications,includingExecutiveLeadership CoachingfromGeorgetownUniversityand DEIintheWorkplacefromtheUniversityof SouthFlorida.

Recognizedasanaward-winningcoach, speaker,andpublichealthpractitioner,Ms. Ransom'saccoladesincludebeingnamedone ofthetop5mostinfluentialcoachesof2021 byEntrepreneurMogulandreceivingthe ofDiversityandInclusionAward.Asthe

PresidentoftheAmericanSocietyforLaw, Medicine,andEthics,shecontinuesto influencethefieldthroughvariousroles, includingservingontheAdvisoryCommittee fortheGeorgiaCampaignforAdolescent PowerandPotential.

InadditiontobeingaCapstoneFaculty memberatWaldenUniversity,Ms.Ransom impartsherknowledgebyteachingpublic healthlawattheUMMD/MPHprogram.A globalpublicspeaker,publishedauthor,and Co- PublicHealth Law:ConceptsandCaseStudies contributionstothefieldareunparalleled.Ms. Ransom'sdedicationtoeducation,leadership, diversity,andinclusionmakesheran invaluableassettotheUMMD/MPH program,inspiringthenextgenerationof publichealthprofessionals.

EmpoweringCommunities:HealthierTogether'sImpactonMiami-DadeCounty

IntheheartofMiami-DadeCounty,atransformativeinitiative namedHealthierTogetherwasdeveloped.Ledbytwo compassionateindividuals,LaurenHuckoandMargaretKoester, bothstudentsintheNextGenMDMD/MPHprogramatthe UniversityofMiamiMillerSchoolofMedicine,thisprogramaimed tobringaboutpositivelifestylechangesforlow-incomeadultswith obesityandobesity-relatedhealthconcerns.

TransformingLivesThroughHealthierTogether

HealthierTogetherwasadaptedfromtheCDC-recognizedDiabetes PreventionProgram,thismedicalstudent-ledinitiativekickedoff withavisiontopromoteweightlossandwell-being.Thesix-week programdevelopedintoavariedcombinationofgroupactivities, nutritionaleducation,physicalactivitysessions,goalsetting,and reflectivemoments.

MedicalstudentsfromtheUniversityofMiamiserveasLifestyle CoachesintheHealthierTogetherprogram,whichisofferedatno costtoEnglish-andSpanish-speakingadultsinourcommunity.The closecollaborationofvariouscommunitypartners,suchasthe JacksonPopulationHealthDepartmentandGiselaAlvarez,the ambulatorydietitianatJacksonHealthSystem,workcollectivelyto helpenhanceandbroadentheHealthierTogetherprogram.This collaborationmergestheexpertiseofdieticians,nurses,social workers,andphysicians.

MD/MPHTraining:ACatalystforSuccess

HuckoandKoesterfoundthemselveswell-preparedtocarryoutthe ideaofthisinitiative.TheirMPHcurriculumwasmorethanaseries ofcourses;itwasaguidebookthatemphasizedcross-disciplinary collaboration,culturalsensitivity,andidentifyingcommunityneeds inpublichealthprojectdevelopment.Throughthelensofpublic health,theylearnedthatagencyisadriverofchange,whichlaidthe foundationforparticipantstodrafttheirownprogramgoalsand providecontinuousfeedback.

AsHuckoandKoesteradvancedintheirpublichealtheducation, theycompletedcoursesinbiostatistics,epidemiology,andresearchmethods.Thesecoursesequippedthemwith theskillstounderstandtheimpactofobesityandrelatedcomorbiditiesatthepopulationlevel,formulate researchquestions,andidentifyrelevantoutcomestoquantifytheimpactofHealthierTogether.Additionally, theirtrainingprovidedthemwiththeimportanceofincorporatingqualitativeoutcomemeasuresintoour research,recognizingthatweightstatusislargelypsychosocialandcannotbecondensedintoaquantitativedata pointwithoutlosingsomemeaning.

WhatstartedasaninitiativewithHuckoandKoester,grewintoa teamof17medicalstudentmembers.Leadershipskillsrefined throughtheirMPHcourseworkbecamethefoundation,encouraging thedevelopmentofasuccessionplantoensureHealthierTogethe continuityevenafterHuckoandKoestergraduated.

FutureImpact:ApplyingMPHSkillSet

AsHuckoandKoesterlooktowardtheirfuturecareers,theycarry withthemtheinvaluablelessonsfromHealthierTogether.Hucko, withherbackgroundinAnthropologyandSpanish,recognizesthe influenceofsociodemographicandenvironmentalfactorsonhealth outcomes.Asafutureophthalmologist,sheplanstoleverageher publichealthtrainingtoobtaindetailedsocialhistories,ensuring patientshaveaccesstonecessarytreatmentandfollow-upcare. Huckoenvisionsacareerinacademicophthalmology,withafocusonservingunder-resourcedpatient populationsbyprovidingcounselingandaddressingpreventablemetabolicdiseasesassociatedwithocular pathologies.

Equippedwithastrongfoundationinepidemiologyandprevention science,KoesterenvisionsapplyingherMPHskillsettoprovide comprehensivepatientcarethatconsiderssociodemographic backgrounds.EngagingwithHealthierTogetherparticipantshas deepenedherunderstandingofcommunitychallenges,emphasizing theimportanceofmodifyingtreatmentplanstoalignwithpatients' goals.Beyonddirectpatientcare,Koesteraimstocontributeto researchandacademicworkthatbridgesthegapbetweenindividual patientcareandthelargerhealthlandscape.

IntheongoingdevelopmentofHealthierTogether,theimportanceof collaboration,theimpactofpublichealthtraining,andthe unwaveringcommitmenttobuildingahealthier,happiercommunity echo.HuckoandKoester,intheirrespectivejourneys,serveas inspiringfigures,demonstratingthetransformativepotentialof MD/MPHtraininginshapingthefutureofhealthcare.

Dr.JoycelynLawrence:PavingtheWayforImprovedCommunityHealth

Dr.JoycelynLawrence,ChiefMedicalOfficeratJessieTriceCommunity HealthSystem,Inc.(JTCHS)since2016,ismakingwavesincommunity health.Herfocusonstrategicdiseasemanagementandinnovative primaryandbehavioralhealthprogramsalignswithJTCHS'smissionto improvequalityoflifeandhealthequity.

Dr.Lawrenceandherdedicatedteam,includingLeonBain,haveplayeda pivotalroleintheimplementationoftheMD/MPHPatientNavigation Program.IncollaborationwiththeUniversityofMiami(UM),JTCHS hasbeenthedrivingforcebehindthisinitiative.Theprogramaimsto empowerpatients,enhancecommunicationandcoordination,and ultimatelyreducehealthcaredisparitiesandimproveoverallpatient outcomesfordiabeticindividualsunderthecareofJTCHS.Thisholistic approach,rootedinaddressingSocialDeterminantsofHealth(SDOH) andpromotingpatient-centeredcare,isachievedthroughaprocess involvingcomprehensiveassessment,goalsetting,andongoingsupportfordiabeticpatients.

GrowingupinthesamecommunityservedbyJTCHSaddsapersonal touchtoDr.Lawrence'scommitment.Herresponsibilitiesgobeyond administration,extendingtodirectpatientcareandadvocacyfor improvedcommunityhealthoutcomes.

BeforeJTCHS,Dr.Lawrencespentover17yearsattheUniversityof Miami'sDepartmentofFamilyMedicine.Shedirectedschool-based healthcenters,securinggrantsliketheCentersforMedicareand MedicaidHealthCareInnovationAward.Thisinitiativeshowcased cost-basedsavingsinprovidingcomprehensivecaretoover9,000 students.

SincejoiningJTCHS,Dr.Lawrencehascontinuedherresearchefforts throughcollaborationswithHealthChoiceNetworkandtheUniversityofMiami.Additionally,sheservesasa boardmemberoftheEarlyLearningCoalition,demonstratinghercommitmenttoholisticcommunityhealth.

Dr.Lawrence'sgoalsextendbeyondadministrativeduties;sheaimstoimprovecommunityhealthoutcomesby addressingsystemicissuesthroughadvocacyanddirectpatientcare.AnativeMiamian,shecreditsher accomplishmentstoasolidfamilyfoundationandisaproudmotherandwifetoafamilyofseven.

Beyondherprofessionalaccomplishments,Dr.Lawrenceisamotherandwifetoafamilyofseven.Hersolid familyfoundation,rootedinthevaluesofhardworkanddevotion,hasbeenadrivingforcebehindhersuccess. AproudgraduateofSpelmanCollegewithamajorinPre-MedBiology,shecompletedhermedicaleducation attheUniversityofArizonaSchoolofMedicineandherresidencyattheUniversityofMiami/Jackson MemorialHospitalinFamilyMedicine.

AsanativeMiamianwhogrewupinLibertyCity,Dr.Lawrence'sdedicationtoprovidingcaretounderserved populationsisnotjustaprofessionalcommitmentbutadeeplyingrainedpartofheridentity.Herjourneyfrom LibertyCitytobecomingtheChiefMedicalOfficeratJTCHSisnotjustatestamenttoherachievementsbut alsoaninspirationforothersstrivingtomakeameaningfulimpactoncommunityhealth.Dr.Joycelyn Lawrencestandsasarolemodel,showingthatwithdetermination,compassion,andasteadfastcommitmentto healthequity,transformativechangeispossible.

AninterviewwithMontreceMcNeillRansom,adistinguishedfacultymemberattheUniversityofMiami MillerSchoolofMedicine/DepartmentofPublicHealth,providedinsightintothelegalandethicallandscape surroundingtheintegrationofArtificialIntelligence(AI)inpublichealth.

1.WhatarethelegalandethicalramificationsofusingAItoolsinpublichealth?

Fromoutbreakpredictionandpreventiontoclinicaldecision-making,theuseofAIhasthepotentialto transformpublichealthandhealthcare.However,thepromiseofAIcomeswithnumerousriskstohumanhealth andraisesaplethoraoflegalandethicalconcerns.Primaryamongtheseisdataprivacy.AInecessarily processesenormousamountsofpatientdata,raisingconcernsabouttheprivacyofthatdata.Forexample, accordingtoDupreeandWillet,whenanAIalgorithmsuccessfullyreidentifiespreviouslydeidentifiedor anonymousdata,thereisaheightenedriskthatprivacyprotectionswillbeinvalidated.AsweembraceAIin publichealth,itisessentialtoensurepatientprivacyandtheprotectionofsensitiveinformation.Healthcare practitioners,clinicians,hospitals,healthcarefacilities,andothercustodiansofpatientdatamustembedclear guardrailsacrosstheorganization,continuallyadapttoevolvingdataprivacyrisks,andrigorouslyenforce existingandemergingprivacylaws.

2.InyouropinionwillAI,atleastinthenearfuture,improveorworsendisparities?

AIoffersthepromisetohelpreducehealthdisparities,butonlyifbiasinAIalgorithmsis addressed.Algorithmicbiasinpublichealthandhealthcaretechnologyisacriticalethicalconcern,particularly whenitcomestoAI.Algorithmicbiasoccurswhenanalgorithmamplifiesexistinginequitiesrelatedto socioeconomicstatus,race,ethnicity,religion,gender,disability,orsexualorientationwithinhealthsystems. Studiesshowwhenbiasedresultsareappliedtohealthinterventions,existinginequitiescanbefurther perpetuated.Forexample,a2019AIstudyusedalgorithmssuggestingBlackpatientsmustbesickerthan Whitepatientstobereferredforadditionalhealthcare.Thesefindingspointtohowimportantitistocarefully examineAIsystemsforbias.InSeptember,SenatorRonWydenofOregonintroducedtheAlgorithmic AccountabilityActof2023.Ifpassed,thisfederallawwouldrequirecertainbusinessesthatuseautomated decisionsystemstomakesignificanteffectsonthecostofhealthcare,housing,oreducationalopportunitiesto studyandreportabouttheimpactofthosesystemsonconsumers.Suchlawsareimportantbecause,without intervention,thesesystemsmayfurtherdisadvantageunder-representedandmarginalizedgroups,further wideningexistinghealthinequities.

3.WhatcanbedonetohelpthelegalsystemcatchupwiththepaceofAIanditsuseinhealth,public health,andindustry?

Describingtherelationshipbetweenlawandtechnologyasakintothetortoiseandthehare,McNeillRansom emphasizestheneedforlegalsystemstocatchupwiththerapidevolutionofAIinhealthandpublichealth. AdvocatingfornewlegalframeworkstailoredtoAIapplicationsinhealthcare,shepointsoutthecurrentlackof legislationspecificallyaddressingpublichealth.DrawingattentiontofederalbillsfocusedonAI,national security,andhealth,sheunderscoresthenecessityofregularreviewsandupdatestokeeppacewithAI advancements.Cross-disciplinarytrainingandcollaborationamonglegal,publichealth,andAIprofessionals areidentifiedascrucialstepsinbridgingtheunderstandinggapandensuringtheethicalintegrationofAIinthe field.

AsAIcontinuestoreshapethelandscapeofpublichealth,theinsightsprovidedbyMontreceMcNeillRansom shedlightonthedelicatebalancebetweenharnessingthepotentialbenefitsandnavigatingthecomplexlegal andethicalterrain.