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> Learning compassion p. 14 | Sanitize that tray table (and other travel tips) p. 18 | The price of public health p.26


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“Our presence. It’s known. We are the University of Michigan School of Public Health. We came here with a purpose. To get the best education, to work with the best faculty, so that when we leave here we can make a statement. We are oil to their water. We will not dissolve into a ready-made world and ‘find’ our niche. We will change the world and create our niche.”

Anthony Asael/Corbis

—Shama Virani, PhD ’14


Marc-Grégor Campredon

“We have converged on this great institution to tackle public health issues from differing perspectives. Some will accomplish this through initiatives to improve the built environment, some through the effective communication of health education. Others will make an impact through the creation of effective policies and the transformational leadership of health care organizations. No matter how we approach these issues, we all have the tools and undeniable ability to change the world.” —Cameron Glenn, MHSA/MBA ’14


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“We’ve been given the research skills to understand the health problems we need to address, and we’ve been given the knowledge to understand the multiplicity of factors that underlie these health problems. Above all, we’ve been taught to understand that we cannot, as public health practitioners, address the world’s problems by ourselves. We need to partner with professionals in other disciplines—because everything is interconnected. That’s key to addressing the world’s problems.”

Mario Tomba/Getty Images

—Massy Mutumba, BSN, MPH ’10, PhD ’14


Marc-Grégor Campredon

“We often talk about going out into the community, as though the world is a place somehow separate from us, as though we are gardeners who run our hands through the soil, but wash our hands of it when we go home at night. But we are not just gardeners—we are part of the garden, part of these populations we are connecting with. We are all planted in the same soil.” —Carol Gray, MPH ’14


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Center to identify social and environmental predictors of cardiovascular risk in African Americans

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Mexico: In collaboration with Dr. Tonatiuh Barrientos of the Mexico National Institute of Public Health, SPH epidemiologist Rafael Meza is examining the impact of sugary drinks taxes and other prevention strategies on diabetes rates in Mexico

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Mexico City, Mexico: Faculty in the U-M Center for Occupational Health and Safety Engineering are collaborating on a study of air pollution, inflammation, and preterm birth

W On the Web

Whenever you see this symbol, it means you can check out additional, exclusive content on this topic online at sph.umich.edu/findings.

practitioners, policymakers, and others on the use of law to protect the public’s health

Atlanta, Georgia; San Francisco, California: The U-M Kidney Epidemiology and Cost Center, in collaboration with the CDC and University of California, San Francisco, has established a Chronic Kidney Disease Surveillance System for the entire U.S.

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Guatemala; Argentina: Medellin, Colombia: Faculty in the SPH The U-M Center for ManDepartment of Epidemaging Chronic Disease, iology are partnering with in collaboration with the colleagues in the Institute University of Antioquia, of Nutrition for Central D e p a r t m e n t established s has a mobile America and Panama and health platform for the National University improving diabetes care 44 of Lanus, Aires, 6 Buenos From the Dean Our Moral Imperative to train professionals on approaches to non 7 From Our Readers communicable disease 9 On the Heights prevention in Latin 51 America

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42 Research

HBHE Genetics Research Group has conducted trials at sites at Harvard/ Brigham & Women’s Hospital, Howard University, the University of Pennsylvania, and U-M

News

Egypt: SPH environmental health scientists Da Dolinoy and Laura R and bioinformaticia Maureen Sartor are studying BPA expos in pre-adolescent females in rural ver urban populations

Colombia: In collaboration with the Industrial University of Santander, Bucaramanga, SPH epidemiologist Eduardo Villamor is studying the role of nutritional factors in severe dengue Alumni Network infection, a project 44 Report in from Zambia sponsored by the National 45 In Memoriam Institute of andService 46 Our LivesAllergy Are About Infectious Diseases

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New on the Web

The comments that appear at the bottom of pages 13–41 come from these members of the U-M SPH

derstand and can seek out that information.” “The biggest challenge is actually restructuring healt class of 2016: Jack Andrzejewski, Dan Bator, Avery Caldwell, Rachel Caty, Khalil Chedid, Becca Connect with SPH

on Facebook, Twitter, YouTube, LinkedIn, Flickr and student blogs. Links at sph.umich.edu.

Courser, Audrey Fotouhi, Boran Gao, Nick Gould, Kristin Harden, Sona Jani, Laura Johnson, Peggy Korpela, Ujwala Kulkarni, Lucia Lee, Jennifer Lerose, Jose Monzon, Christine Priori, Sonia Robinson, Ariel Saulles, Kate Sutliffe, Bei Wang, and Dongqing Wang.

How contagious is Ebola?

Can it become even more dangerous? Why is the current outbreak so severe? U-M SPH faculty experts answer these and other questions in a special video series at sph.umich.edu/ebola. You'll also find links to related articles and up-to-date information on the outbreak.


findings Volume 30, Number 1 Fall/Winter 2014 Produced by the U-M SPH Office of Marketing and Communications

36 Fe ature Articles

What Does It Take to Change the World? 1

Traits

Special Guide on pp. 26-27:

Some qualities are innate. Others need cultivation.

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Skills

It starts with the basics: reading, writing, statistics.

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The Price of public h e a lt h

Tools

You need more than money (and you definitely need money).

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Access

To make a difference, look for partners.

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S pecial S ection V i c to r s f o r m i c h i g an c ampa i g n

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am the unwitting recipient of the name of two great men in history—two individuals who did much to change the world: Martin Luther and Martin Luther King Jr. While it’s tempting to focus on the change they achieved, I believe there is another, more inspirational, side to the story, and it’s that these two exemplary human beings didn’t just foment change—they engaged with people on the wrong side of history. In his Nobel Peace Prize acceptance speech Martin Philbert in December 1964, Martin Luther King said, “There is a sort of poverty of the spirit which stands in glaring contrast to our scientific and technical abundance. The richer we have become materially, the poorer we have become morally and spiritually. We have learned to fly the air like birds and swim the sea like fish, but we have not learned the simple art of living together as brothers.” As public health professionals, our job is not merely to provide scientific and technological solutions to the pressing health issues of our time, but also to address the sociological, behavioral, political, and economic contexts that make it difficult for people to adopt those solutions. Science and technology have given us many wins, but it’s all for naught if our children don’t have access to those wins, if they fall sick or die because of a disease that can be prevented for less than a dollar. Some 500 years ago, Martin Luther said, “You are not only responsible for what you say, but also for what you do not say.” Four centuries later, Martin Luther King Jr. said, “I refuse to accept the idea that the ‘isness’ of man’s present nature makes him morally incapable of reaching up for the eternal ‘oughtness’ that forever confronts him.” Therein lies the eternal struggle—between what is (those things that we’ve inherited, either as a birthright or as the consequence of a social structure and our position within that structure) and what ought to be. King suggests it is only through active participation that we achieve change. Of course, there are those who believe we can instigate change only by stark confrontation—by seizing the moral high ground with force. I prefer the approach voiced by another activist who changed the

world. “In a gentle way,” said Mahatma Gandhi, “you can shake the world.” What binds Gandhi to the two Martins, Luther and King, is that all three hold up the mirror of the moral imperative in such a way that change becomes inevitable. “In the final analysis,” King said, “the rich must not ignore the poor, because both rich and poor are tied in a single garment of destiny. … The agony of the poor diminishes the rich, and the salvation of the poor enlarges the rich.” With the variability of access to health care and services that promote health and prevent disease, with the alarming way in which we continue to pollute our air and water and to outsource pain and suffering for the sake of a cheap coat or inexpensive coffee, we must ask ourselves the fundamental question: At what price our culture? Who must bear the cost for our standard of living? Is it the woman working 16 hours a day in a building that collapses in Bangladesh? Is it the child with no future other than to descend into a mile-deep mine? Is it our slavish adherence to our interpreted constitutional rights at the expense of innocent children slaughtered in our schools and universities? There are cases in which our inhumanity toward each other demands a swift and even vehement response: the stopping of genocide, the eradication of slavery in all its forms, systematic violence against women and children. Gandhi’s “gentle shaking of the world” is not the solution for everything. But it is the solution for much of what ails us. The restoration of justice and peace requires a firm moral and intellectual foundation, as do more basic changes like smoking cessation, violence prevention, food and water security, clean air, the primary prevention of disease. We don’t need a grand stage for these change battles to occur—we need people who can dig in at the community level. For community action is the foundation for global change, and it is ultimately through the creation of better systems and programs and opportunities that we can provide the best chance for individuals to become their best selves. That’s the genius of public health. <

“In the final analysis,” King said, “the rich must not ignore the poor, because both rich and poor are tied in a single garment of destiny.”

Martin Philbert Dean and Professor of Toxicology

Scott Lauman/theiSpot

Our Moral Imperative


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Health Organization, 2001). There are at least three compelling reasons why the ICF deserves a close look:

► It provides a uniform framework for physical and/or mental disorders and provides standard disability-related terminology;

► It goes beyond the medical model by endorsing the comprehensive biopsychosocial model, implying a holistic approach; ► It expands the definition of health by including the concept of functioning.

The Human Mind Why it’s the next frontier in public health

INSIDe > Addiction p. 40

| The case for mental health as public health p. 26 | How scientists think p. 14

Mental Health Is Public Health

>Kudos to Blake Wagner III and his work

(“Beginning the Conversation,” Findings, spring/ summer 2014). From my experience, depression can also be helped by knowing how to change our diets. Readers can find further information about this through either the Nutritional Healing Center of Ann Arbor (NHCAA) or Thrive, located in Saline (Michigan). For myself I prefer to be treated naturally rather than by medication.

Kari Dumbeck Ann Arbor, Michigan

The ICF increases our understanding of the interrelationship between health conditions and environmental and personal factors, and it can be used as a tool for the early recognition of decreased functioning. Even more useful for researchers and practitioners, the ICF has developed a core set of categories for several health conditions, including depression, with an overview of those categories most relevant for depression. The ICF can help close the gap between disciplines, strengthen the comparison of uniform data, and move the body of knowledge forward. Els R. Nieuwenhuijsen, PhD, MPH ’85 Ann Arbor, Michigan The writer is an adjunct faculty member in the U-M Department of Physical Medicine and Rehabilitation and a volunteer field test coordinator for the Unitarian Universalist Association Disability/Ability Action Certification Pilot Program.

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► Strong primary prevention services from the moment of conception, with early diagnosis and treatment in infancy, early childhood, and the subsequent developmental stages, and with active rather than passive interventions, much like the model Dr. William Beardslee proposes in Findings; ► Timely and appropriate mental health interventions that take place as much as possible in the individual’s “natural habitat,” such as home, school, or the primary care physician’s office.

One of the biggest problems in American psychiatry is that it conceptualizes and implements a rather narrow clinical approach to the treatment of mental illness. These are just two components of a public health approach that would be much more comprehensive than what the current system has to offer. Congratulations on your article, and now, take action! Carlos Salguero MD, MPH ’72 Guilford, Connecticut

The Human Mind

> Just as I accepted the position of medical

The ICF increases our understanding of the interrelationship between health conditions and environmental and personal factors, and it can be used as a tool for the early recognition of decreased functioning. It was with great interest that I read about the state of public health knowledge with regard to mental health, and in particular depression (“Mental Health Is Public Health,” Findings, spring/summer 2014). Most revealing for me was the need for a comprehensive approach that goes beyond prevention, screening, and education. I was surprised, however, that none of the experts in the article made a reference to the International Classification of Functioning, Disability and Health, also called the ICF (World

in nature and broad in scope, and which provides, among other things:

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Your article “Mental Health Is Public Health” revived my long-held opinion that one of the biggest problems in American psychiatry is that it conceptualizes and implements a rather narrow clinical approach to the treatment of mental illness, in which reimbursement by thirdparty payments encourages costly secondary intervention activities such as psychotherapy, hospitalization, and the heavy use of medication. It is incumbent on public health to develop a new model of intervention—one that is developmental

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director, Allegan County (Michigan) Community Mental Health, I received the latest Findings (“The Human Mind”). I completed my MPH in epidemiology in 1977. I retired from my career as a full-time local public health medical director in 2010. For about 14 of my years in the business, I was a public health medical director and community mental health physician for Kalamazoo County Human Services. I have continued to be a part-time public health medical director but never stopped contributing to community mental health— primarily in substance-abuse risk reduction. And now, I am doing just what Findings has featured! Richard M. Tooker MD, MPH ’77 Allegan, Michigan

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FROM OUR READERS A Highly Refined Feynman

> I enjoyed reading the essay “The Mind

of a Scientist” (Findings, spring/summer 2014) very much, particularly Eileen Pollack’s comments concerning the importance of developing physical intuition. However, I would like to point out that Feynman’s Tips on Physics is not merely “a transcript of review sessions.” Besides including other material in addition to review sessions, the book has three authors, all of whom made original contributions. In fact, Feynman did not write this book—his coauthors did so a decade after Feynman passed away, based on tape recordings and photos. The Feynman Lectures on Physics (FLP) is also a three-author work. If you ever listen to tapes of Feynman’s Lectures (especially the more advanced ones), and compare them to what is written in FLP (as I often do) you would soon realize that what you are reading in FLP is not merely Feynman. It is a highly refined Feynman, neatly packaged and delivered by two excellent physicists, Robert Leighton and Matthew Sands. Michael A. Gottlieb Playa Tamarindo, Costa Rica The writer is an editor of The Feynman Lectures on Physics and Exercises for The Feynman Lectures on Physics (New Millennium Edition), coauthor of Feynman’s Tips on Physics, and a Visitor in Physics at Caltech.

An Exemplary Leader

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I appreciated the timely article on Barney Tresnowski (“Decades Later, Still Grateful,” Findings, spring/summer 2014). Walter McNerney’s exceptional vision and foundation for Blue Cross Blue Shield’s being subscriberbased and focused is the standard that sadly is no longer. Barney Tresnowski’s subsequent leadership made a huge difference for patients (aka subscribers) and Blue Cross Blue Shield. His commitment and excellence are benchmarks for the years ahead. I enjoyed your summary of his washing hospital walls along the way. Yes, Sy Axelrod’s mentoring of Barney was timely and a key part of his leadership results. Thanks, Findings. Refreshing to read something both interesting and complimentary, let alone positive, in these times. Christopher L. Boys, MHA ’66 Lincoln, Rhode Island

continued

Findings is published twice each year by the University of Michigan School of Public Health Office of Marketing and Communications. Dean Martin Philbert

An Open Letter to the SPH Community

>As public health students and

professionals, we believe that healthy communities are characterized by selfdetermination, an environment in which to thrive, and freedom from violence perpetrated by those in power. Events in Ferguson, Missouri, and elsewhere have highlighted the need for all of us in public health to recognize that racialized violence is a public health issue that must be addressed by our field. Concerned citizens nationwide have signed a letter in solidarity underlining the importance of this issue. Please consider reading. You can find the letter in its entirety at tinyurl.com/ PHFerguson. Selam Misgano, Triana Kazaleh Sirdenis, Stephen Sullivan, Emily Pingel, Laura Jadwin-Cakmak, Viktor Cakmak, Belen Michael, Sara Blanks, Matthew Mellon, Amal Alsamawi, Lilly Fink Shapiro, and more than 325 others ...

R ec e n t Awar ds

The U-M SPH publication “The Face of Public Health” won a bronze award for Case Statements/General Cultivation Publications in the 2014 Circle of Excellence competition, a global awards program sponsored by the Council for the Advancement and Support of Education (CASE).

We love hearing from you! Post comments online; e-mail us at sph.findings@umich.edu; or send a letter to Findings, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109-2029; fax 734.763.5455. Comments may be edited for length and clarity. This symbol indicates the letter was originally posted to Findings online.

Director of Marketing and Communications Rhonda DeLong Editor Leslie Stainton Staff Writers Terri Mellow, Rachel Ruderman, Nora White Video Editor Brian Lillie Web Editor Beth Miller Art Direction/Design Hammond Design

Copies of Findings may be ordered from the editor. Articles that appear in Findings may be reprinted by obtaining the editor’s permission. Send correspondence to Editor, Findings, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109-2029, or phone 734.936.1246, or send an e-mail to sph.findings@umich.edu. Findings is available online at sph.umich.edu/ findings. ©2014, University of Michigan To opt out of receiving the print version of Findings and read our publication exclusively online at sph.umich.edu/findings/, e-mail us at sph.optout@umich.edu. Include Opt-Out in the subject line and your full name in the text.

Regents of the University of Michigan Mark J. Bernstein, Ann Arbor Julia Donovan Darlow, Ann Arbor Laurence B. Deitch, Bloomfield Hills Shauna Ryder Diggs, Grosse Pointe Denise Ilitch, Bingham Farms Andrea Fischer Newman, Ann Arbor Andrew C. Richner, Grosse Pointe Park Katherine E. White, Ann Arbor Mark D. Schlissel ex officio The University of Michigan, as an equal opportunity/affirmative action employer, complies with all applicable federal and state laws regarding nondiscrimination and affirmative action. The University of Michigan is committed to a policy of equal opportunity for all persons and does not discriminate on the basis of race, color, national origin, age, marital status, sex, sexual orientation, gender identity, gender expression, disability, religion, height, weight, or veteran status in employment, educational programs and activities, and admissions. Inquiries or complaints may be addressed to the Senior Director for Institutional Equity, and Title IX/Section 504/ADA Coordinator, Office of Institutional Equity, 2072 Administrative Services Building, Ann Arbor, Michigan 48109-1432, 734.763.0235, TTY 734.647.1388. For other University of Michigan information call 734.764.1817.


SPH: First in Alternative Commuting

On the Heights

The conventional ones carpooled or took a bus—but other participants in last May’s Commuter Challenge chose to walk, bike, scooter, or even pogo-stick to work. Sponsored by Ann Arbor’s getDowntown program, the annual spring challenge pits local organizations against one another in a friendly competition with a serious goal: to get Ann Arbor employees to try alternative commuting. Thanks to the efforts and energy of 177 faculty and staff participants, U-M SPH came in first among organizations with 101 to 500 employees, logging a collective 29,231 miles and avoiding 25,019 pounds of CO2—and burning an estimated 483,342 calories.

SPH Launches Research and Training Partnership with Thailand

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For Global Health Change, Adaptability Is Key

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An Interview with New U-M President Mark Schlissel

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For much of the past decade, the U-M Center for Molecular and Clinical Epidemiology (MAC-EPID) has worked to build a robust infectious-disease community at U-M, in part through its semi-annual series of symposia. Held in November, the 20th MAC-EPID symposium—on “Vaccines Past, Present, and Future”—paid tribute to the late John Maassab, professor emeritus of epidemiology at U-M SPH and developer of FluMist. The 21st symposium, scheduled for the winter term of 2015, will examine nutrition and its connections to the “2nd Epidemiologic Transition,” a phenomenon in which infectious disease remains prevalent while the burden of chronic disease grows. MAC-EPID symposia “are truly interdisciplinary events,” says center director Betsy Foxman. “We select topics that are cross-cutting and invite speakers who address different aspects of a given topic.” Last year’s winter symposium drew nearly 250 participants from a range of disciplines, including engineering, medicine, and natural resources. For more visit bit.ly/mac-epid. n

Home to assorted wildflowers, five Quaking Aspens, and one chokecherry, the newly dedicated Keeler Grove in the U-M Camp Davis Rocky Mountain Field Station in Jackson Hole, Wyoming, pays tribute to the late U-M SPH Professor Gerald J. Keeler, who died in 2011. Keeler, who conducted air-quality research worldwide, taught “Ecosystem Science in the Rockies” at Camp Davis. A plaque in the grove recalls him as “an enthusiastic, fun, and caring teacher of meteorology and atmospheric science,” who often advised students, “Don’t forget to look up.” With support from the SPH Gerald J. Keeler Fund for Scholarship in Environment and Health, U-M undergraduate student Ashley Howard attended Camp Davis last summer. n

Thailand is the thirdlargest exporter of rice in the world, and a significant part of the economy revolves around rice production.

Marc-Grégor Campredon

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On the Heights

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SPH Partners with Thailand A Memorandum of Understanding formalizes collaborative research and teaching

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n June, SPH Dean Martin Philbert, together with Laura Rozek, associate professor of environmental sciences and associate director of the SPH Office of Global Public Health, led a delegation to Thailand where they presented a two-day workshop with faculty from Thailand’s Prince of Songla University (PSU), addressing tobacco policy, population health, and cancer. Following the symposium, Philbert signed a Memorandum of Understanding with Chusak Limsakul, PSU president and dean of the faculty of medicine, formalizing ties between the two institutions. “This MOU will enhance training opportunities for students and encourage ongoing research collaborations,” said Philbert. “It really is a bi-directional collaboration—things we can learn from each other.” Rozek has been working with researchers in Thailand since 2011 and now has three major studies in the country—including a collaboration with Hutcha Sriplung, founder of the Thai Cancer Information

Network and an associate professor at PSU. Rozek has also developed a student internship program that’s entering its third year. “Thailand is going through this epidemiologic transition where they have increased life expectancy due to improved health, better treatment and control of infectious disease, and better maternal and child outcomes, but increasing chronic disease—cancer and diabetes,” says Rozek. “I’d like to see us establish population-based studies of chronic disease that take into account Thailand’s surveillance system and universal health care.” “And we definitely want students from both countries engaged in the research,” adds Philbert. “They are the future for global public health collaborations at Michigan and in Thailand.” —Terri Mellow <

Thailand is going through an epidemiologic transition.

Q: What does it take to change the world? A: Adaptability—at both the organizational and individual level. Organizations have to be adaptable in order to identify and capture nontraditional funding sources to support global health work and to carry out nontraditional projects. It’s not enough to just do research—you have to translate that research and implement it in the field. To do that, you need to be flexible. It’s true at the individual level, too. You need to be able to walk into highly fluid situations and get things done. Back in 2006, I was visiting China for the first time and had it in my head that SPH should connect with the Chinese Centers for Disease Control and Prevention. So I used my connections with the U.S. CDC to get an audience with the director of the Tianjin CDC. That meeting ultimately led to a Memorandum of Understanding between SPH and several regional Chinese CDCs as well as the central CDC in Beijing. It may sound intuitive, but to do global work, you have to be able to see—and actualize—opportunity. You have to learn to see the potential and marshall it in an organized way. Where can we build a presence?

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Who do we partner with? What is it that we do? That’s a challenge no matter where you’re working—recognizing where you can establish something meaningful, where you can build institutional broad-based platforms. You have to think about sustainable platforms that provide a durable foundation, because faculty come and go. You need critical mass of people and interest and a diversity of partnerships. —Matthew Boulton <

To do global work, you have to be able to see— and actualize— opportunity.

Matthew Boulton, MD, MPH ’91, is the senior associate dean for global public health at U-M SPH and a professor of epidemiology, health management and policy, preventive medicine, and internal medicine

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FINDINGS

“A Seamless Network of Expertise” A conversation with new U-M President Mark Schlissel

What kind of personal connection have you had to public health? The first time I was exposed to public health in any organized way was as a medical student at Johns Hopkins. The man who gave the introductory lectures to public health was the dean of the Hopkins School of Public Health, Donald Henderson, who was famous for having led the World Health Organization’s effort to eliminate smallpox from the earth. Now, if you think about having an impact—eradicating a disease from the earth? So the power of the public health concept was really driven home. I’m also a pretty data-driven, evidencebased kind of person, and during the era that I learned medicine, it was the public health practitioners who were trying to use data and mathematical models and analyses to shape medical treatment and figure out the precursors of good health and contributors to ill health. It’s that sort of quantitative, logical approach to thinking about disease that I

One of Michigan’s historic strengths is the social sciences. We also have a distinguished medical school and a top-ranked public health school. How would you deepen the connections among these disciplines? Individual faculty at Michigan are incredibly collaborative. Where I’m not sure we’re as good as we could be is strategic collaboration at a much higher level—between schools.

“Another thing I like about public health is it sits between the social sciences and medicine.” So, for example, when public health develops a plan for what it wants to invest in over the next five years, it might make sense to include folks from the Institute for Social Research and the folks from medicine or other disciplines. When we invest in new space, we do it one school at a time. Maybe we should think about space as a campus-wide asset and make investments with an awareness of one another’s strategies. That’s

something I hope to contribute—to develop ways to have our 19 schools and colleges end up being more than the sum of 19 really good parts. What might this kind of strategic collaboration accomplish in the wider world? We should have a seamless network of expertise across large problem areas. If we consider human health a problem area, for example, then each of our schools and colleges that have something to contribute should function together strategically. It’s not just public health and medicine—it’s engineering, pharmacy, nursing, public policy. There are lots of ways to combine these outstanding schools with a problem focus, as compared to a disciplinary focus. The excellence we can unleash can propel Michigan to be almost the very most important university there is. How do we make this happen? My challenge, and the provost’s challenge, will be to figure out the ways to call people together and promote their working together without having the deans of individual schools feel like they’re giving up their independence— and to do so with a light touch, where nobody knows that I did it. If I can do that, I will be sitting in my office, smiling. <

Michigan Photography

found so attractive as a student. Another thing I like about public health is it sits between the social sciences and medicine, and that’s a very interesting niche for an academic discipline to fill. Marc-Grégor Campredon

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s president of the University of Michigan, Mark Schlissel oversees 27 schools and colleges across three campuses (19 in Ann Arbor) and 100 graduate programs ranked in the nation’s top ten. Schlissel, an MD and former provost of Brown University, spoke to Findings about his vision for the university and how public health fits into the picture:


What Does It Take to Change The World?

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Ask people why

they go into public health, and you’re likely to get some version of the phrase “I want to make a difference.” But how? What combination of traits, tools, access, and skills does it take to make a dent in the world’s burden of preventable suffering?

Ken Orvidas/theiSpot.com

Each year hundreds of students come through our doors, brimming with ideas, eager to learn, ready to tackle problems that are messy and big. The students tell us they’ll find a way—they’ll secure the training and resources and connections they need to create a better world. And then they get specific. Here, and on the next 28 pages, members of the class of 2016 tell us how they plan to make a difference: “I want to change the world so that food is medicine, and prevention negates our need for treatment.” U N I V E R S I T Y

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FINDINGS

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Compassion

by Sara Talpos

’ve never considered myself a compassionate person. Helpful, yes. Reliable and fair, certainly. But I can also hold a grudge. I sometimes snap at my children. I’ve been known to get angry at drivers on the highway and argue with my husband when I should listen instead. I was surprised, then, when I recently learned that the human brain has evolved for compassion, and that compassion affects individuals on a physiological level. Like warmth from a loved one’s touch, compassion changes the heart rate and brain activity. It fosters a sense of security while putting us in a position to serve others. But what, exactly, is it? And is compassion something we can cultivate? Compassion is broadly construed as an emotion that occurs when witnessing another person’s suffering and that generates a desire to relieve that suffering. Compassion, I’ve learned, is not a sentimental response to the outside world. For it is fostered by self-efficacy, a belief in one’s own ability to cope with a given situation. This has implications for public health, which addresses large, seemingly intractable problems. SPH Senior Associate Dean Sharon Kardia explains that public health training helps us “to see new needs, opportunities, ways to be of service.” It offers real-life opportunities to make a difference and relieve suffering caused by natural disasters, poverty, and disease. Critically, compassion also has an inner dimension. It is more likely to be found in individuals who cultivate internal stability—who

direct feelings of compassion and kindness towards themselves—and are then more likely to feel compassion toward others. Perhaps cultivating compassion in one’s day-to-day life trains us for big-picture ideas and ideals.

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Can we cultivate the loving kindness that’s essential to public health?

ontemporary compassion research is multidisciplinary, drawing from neurology, physiology, and contemplative traditions. Buddhism, in particular, has a long history of training the mind for compassion, so it provides a useful starting point. In Buddhist teaching, compassion refers to the wish for all beings to be free from suffering. Suffering is understood to be universal: It does not involve pity. Instead, to cultivate compassion, practitioners are first taught to contemplate the nature of their own suffering and to develop emotional stability within themselves. Kardia believes such self-awareness and inner stability are central to public health, which has roots in a basic exchange of understanding: “I know pain; I can see you’re in pain. I know illness; I hear that you’re ill.” Some meditation practices attempt to cultivate compassion through loving-kindness exercises in which a person begins by directing feelings of compassion towards the self, then gradually extends those feelings outward to loved ones, adversaries and all beings. Though such practices draw on Buddhist tradition, they represent just a small portion of Buddhist teaching, and one need not be a Buddhist to benefit from them. I had been

“I want to bridge the gap between communities and health care centers to prevent communicable diseases.”

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meditating sporadically for two years when this particular exercise was introduced to me. I tried it with the help of a CD, a man’s voice guiding me: “May I be happy, may I be peaceful, may I be liberated.” I extended these wishes to myself and others until the guide took a difficult turn: “May my enemies be happy, may they be well, may they be peaceful.” My chest muscles tightened. As visions of “enemies” past and present entered my mind, I felt the presence of negative emotion: agitation, anger, fear. Obviously, this wasn’t compassion. I decided to back off and extend lovingkindness to myself first. Even this felt awkward. This compassionate stance served as a departure from the harshness of my usual inner dialogue, which typically began each morning when I woke to chronic foot and hip pain. I’m too young for this, I’d think. When one of my kids was having a bad morning—say my six-yearold was falling apart over the knots in her hair— I would experience a flash of self-pity, often accompanied by a vision of my husband working productively in his office. During the day, I’d offer myself “constructive” criticism: Perhaps my college writing students would liven up if I told more jokes. My e-mails should be more concise. The hole in my boots needed repair. Individually, there was nothing remarkable in these thoughts, but cumulatively, they made personal experience an arena of judgment and resistance. Loving-kindness helped to shift my orientation. For example, when I felt foot pain, the practice of loving-kindness called up images of my mother taking care of me when I was sick as a child and replaced the image of my mother with an image of myself. The acknowledgement of pain and that some things are hard for me was soothing. It was also adaptive: I could identify my emotional needs and take steps to respond to them, almost as if I were parenting myself. One morning, when

my daughter’s frustration brought her to tears, I experienced empathy and a greater sense of patience. I know pain; I can see you’re in pain. With persistent practice, this way of responding becomes easier, almost habitual. It occurs even with my adversaries. When our neighbor recently transplanted trees along the chain-link fence that divides our backyards, blocking sunlight for the vegetable garden we’ve had for years, I felt the old tightness in my chest. I ruminated the whole day, but later, out on a walk, I recalled hearing that she had been ill. May she be free from bodily strife. I passed her front yard, well-maintained, with a fairy door—surprisingly whimsical—just beside the human-sized front door. May she be happy. May she be liberated.

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his change in my experience likely has physiological underpinnings. Loving-kindness meditations have been found to shift resting brain activity to the left frontal lobes, increasing one’s sense of well-being and social connection. A recent study headed by researchers at the Max Planck Institute for Human Cognitive and Brain Sciences in Germany asked participants to view short video sequences depicting others in distress. Some of the study participants had attended a compassion training group. The training included a six-hour course in which participants learned about and practiced loving-kindness meditation. Compared to controls, the individuals who received this compassion training reported more positive experiences and exhibited stronger activations in brain regions associated with love and affiliation. Loving affiliation is a central factor in another key element of compassion—the sense of safety. The implications for public health are significant, particularly given that practitioners are expected to work for the benefit of all, for individuals who are relative strangers, and in situ-

ations that can cause emotional distress. Kardia adds that “a sense of security doesn’t merely put us into the position to serve others, it motivates us to serve others. It opens the way.” One place to begin studying the neurology of compassion is cranial nerve X, also called the vagus nerve. Vagus comes from the Latin for “wandering.”

In an often-cited paper on the evolutionary roots of compassion, researchers at the University of California, Berkeley, cite evidence that “feeling able to cope effectively with the situation at hand is central to the elicitation of compassion.” This nerve runs from the brain stem all the way to the intestines. Along the way, it branches to the lung, heart, stomach, liver, spleen, and pancreas. Its main function is to exert a parasympathetic, or “rest and digest,” influence on our bodies. When our parasympathetic activity is high, the heart rate slows and digestive activity increases. This is accompanied by feelings of calm and safety, rather than fear and vigilance. Researchers suggest that a sense of safety supports compassionate behavior. The goal, however, is not to blunt negative emotions or create a false sense of security. Rather, “vagal flexibility” enables us to respond appropriately in a variety of contexts. In certain

“I want to develop a way to predict and prevent the evolution of microbial antibiotic resistance.” U N I V E R S I T Y

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mechanism or the reflective arc, really, between the inner ‘I know pain’ and the outer ‘I will work to reduce pain and suffering’ that our life purpose grows wings to become public health researchers, professionals, practitioners, and that changes careers into vocations.” If it’s true that feeling able to cope and act meaningfully fosters compassion, then public health may help foster a more compassionate global community. <

situations, for example, the vagus nerve can withdraw its activity—allowing us to experience bursts of fear, anger, or distress—before reactivating its parasympathetic influence and restoring a sense of calm. Negative emotions such as fear can serve a useful purpose by alerting us to danger—though it’s important that we not hold onto that fear even after the danger has passed. Researchers hypothesize that practicing compassion can help us reactivate the parasympathetic response and access feelings of security. With regard to my neighbor’s trees and my vegetable garden, I wondered if vagal flexibility was at play. Was I overusing my threat-oriented system before parasympathetic influence returned?

Sara Talpos is a writer based in Ann Arbor. She holds an MFA in creative writing from U-M. Sources Edo Shonin, Willliam Van Gordon, and Mark D. Griffiths. “The Emerging Role of Buddhism in Clinical Psychology: Toward Effective Integration.” Psychology of Religion and Spirituality. 2014. Vol. 6, No. 2, 123–137.

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n an often-cited paper on the evolutionary roots of compassion, researchers at the University of California, Berkeley, cite evidence that “feeling able to cope effectively with the situation at hand is central to the elicitation of compassion. If one does not feel able to cope—psychologically or physically—then one is more likely to feel distress and anxiety.” This rings true to my own experience. When my son was an infant, he experienced an intussusception, a condition in which part of the intestine suddenly slips—or “telescopes”— into an adjacent part of the intestine. After his life-saving surgery, my husband and I worked to soothe and calm him. This was not a happy

Jennifer L. Goetz, Dacher Keltner, Emiliana Simon-Thomas. “Compassion: An Evolutionary Analysis and Empirical Review.” Psychological Bulletin. May, 2010. 136(3):351–374.

time, but we felt connected and capable. Compassionate. This is perhaps not surprising given that the researchers from Berkeley cite multiple authors who argue for the “vulnerable offspring argument,” which posits that human compassion evolved “to help raise vulnerable offspring to the age of viability (thus ensuring that genes are more likely to be replicated).” Compassion has survival value. It motivates us to nurture our children, as well as ourselves and others. Kardia adds, “It’s in the reflective

Olga M. Klimecki, Susanne Leiberg, Claus Lamm and Tania Singer. “Functional Neural Plasticity and Associated Changes in Positive Affect After Compassion Training.” Cerebral Cortex, July 2013. 23:1552–1561. Luma Muhtadie, Katrina Koslov, Modupe Akinola, Wendy Berry Mendes. Journal of Personality and Social Psychology. In press. Paul Gilbert. “Introducing Compassion-Focused Therapy.” Advances in Psychiatric Treatment. 15:199–208.

people receive their education through their families and schools—but if they aren’t lucky enough to be brought up in a healthy

Brian Stauffer/theiSpot

One place to begin studying the neurology of compassion is cranial nerve X, also called the vagus nerve.


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Creativity & Curiosity

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or Leana May, DO, MPH ’08, creativity “is a big piece of public health.” In fact, it’s one of the things she loves best about her work in rural Rwanda, where she’s spent the past two years helping to strengthen the country’s health care delivery system as a global pediatric fellow in health service delivery, through a fellowship program run jointly by Harvard University, Boston Children’s Hospital, and Partners in Health. A pediatrician, May has partnered with policymakers and physicians in Rwanda to build capacity in general pediatrics, neonatology, and pediatric oncology in a rural district hospital in northern Rwanda and to set standards for pediatric cancer care nationwide. Thanks to the commitment of its president and minister of health, Rwanda has made enormous strides in health care and is on target to meet most of the Millennial Development goals by 2020, May notes. But challenges persist. There are only a handful of ventilators in the country, for example, and patients from May’s region who need ventilation support must travel three hours by ambulance to Kigali—“if one’s available,” May says. “Many kids die here when all they need is some ventilatory support. But we don’t have those capabilities.” May’s work requires both resilience and creativity. “In limited-resource settings you have to be creative,” she says. “You don’t have the financial ability to order lots of tests, or even the technology to get lab results or do the kind of testing we would do back at home. So you rely on basic skills—using your hands, interacting with patients, obtaining thorough medical histories.” But the payoff is huge. “This work is all about finding what fulfills you and what your passion is. It has been the most tremendously amazing experience.” <

Alyse Kennedy

A Necessary Catalyst

Leana May with Rwandan children

Marc-Grégor Campredon

The Lure of the “Why”

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hama Virani, PhD '14, recalls that she was a bit of nuisance as a child: “I used to drive my parents nuts when I was a kid because I always wanted to know ‘why?’ If I didn’t understand the reasons for doing something, then I didn’t want to do it.” Asking “why” isn’t solely the countermove of the child jousting with her parent. Asking “why?” is also one of the central questions of both the natural and social sciences. A scientist from an early age, Virani says she “wanted to know how the world worked, the Shama Virani in Bangkok science behind it. That led to all kinds of fun science experiments at home.” Her curiosity propelled her through an undergraduate education at the University of Wisconsin, where she dual-majored in neuroscience and psychology, and then to U-M SPH, where she earned a doctorate in toxicology.

As a scientist, Virani is chiefly interested in the “whys” relating to cancer. Recently, she’s been characterizing breast cancer incidence trends in southern Thailand to identify vulnerable populations and areas for intervention. “Thailand is a middle-income country in an epidemiologic transition,” Virani says. “As the country develops economically, people’s lifestyles change in terms of diet and other risk factors for breast cancer. More women enter the workforce, they have fewer children, have children later in life, and adopt a more Western lifestyle.” Economic development can change the health profile of a country. Virani found that breast cancer rates have been significantly rising for the past 20 years and will continue to do so with the current health care infrastructure, which does not incorporate mammography as a preventive measure. Virani’s parents see the link between the little girl asking “why?” and the adult using cutting-edge science to help explain some of the reasons people get cancer due to their environmental exposures. “Although they didn’t always have answers to my ‘whys’ when I was a child,” she says, “my parents continued to encourage me to find the answers so that I could one day become an advocate in global health.” —Bob Brustman <

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Stamina

by Nora White

In Transit ► Sleep when tired—but not through an

► Do what you need to refuel. Whether

entire flight if it’s nighttime at your destination. Be smart about transitioning to a new time zone— and remember that mental fortitude can help overcome physical exhaustion.

it’s exercising (in a safe place), reading, or meditating, take time for yourself.

William Rieser/theiSpot

► Get help adjusting to new time zones. Launched in April, the U-M-designed (and free!) Entrain app generates customized suggestions for periods of light and dark exposure to help expedite the process of resetting your Circadian rhythm (entrain.math.lsa. umich.edu/). ► Eat healthily, but try local foods.

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ncreasingly, public health work requires travel—and travel requires stamina. “As many more countries have developed expertise in delivering public health programs,” says Chinyere Neale, program manager for the SPH Office of Global Public Health, “fewer of our graduates will have jobs where they live abroad. More often, their jobs will require them to fly in a couple times a year to provide very specific technical support or engage with partners at the startup or assessment phase of an initiative. ”Together, Neale, SPH Dean (and million-mile flyer) Martin Philbert, and Dana Thomas, program manager for the SPH Office of Public Health Practice, offer these tips for nourishing body, mind, and soul before, during, and after a journey:

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► Avoid moving walkways at the airport. Use your feet as much as possible.

► Stay hydrated. Increase water consumption and forgo diuretics like alcohol and coffee. Once you reach your destination, consider stocking up on water—especially if the local water is contaminated or tastes strange.

► Respect personal space. No passenger enjoys a neighboring stranger’s head or arm encroaching on their space.

► Keep yourself and your area sanitized. Wash your hands nonstop, don’t tuck used tissues into seat pockets, and use airline napkins and a 3.4 ounce or less–sized Purell bottle to wipe down the top and back of your tray table.

Unless you’re in a high-risk area, aim to strike a balance. Realize, too, that your dietary habits may not make sense to others, and be prepared to explain them. In high-risk areas, it’s a good idea to eat only cooked foods.

Mind

► Prepare for your trip. Have a conver-

between personal and professional doesn’t exist. Be mindful of the fact that every moment is a public one unless you’re in the privacy of your living space.

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► Seek out depth, not breadth. Immerse yourself in the community you’re visiting and learn all you can from a variety of perspectives. (It's harder to do this if you’re visiting every other nearby city, state, or country.)

► Bring a few items that remind you of home. You’ll be more comfortable, especially if you’re feeling culture shock.

► Try journaling rather than blogging. With blogging, you’re writing to tell others; with journaling, you write for yourself. (Consider sending yourself e-mails or postcards.)

► Keep in touch with friends and family

sation with yourself about concerns and questions—then address them as well as possible before you leave.

back home, but not too much. Don’t miss out on engaging with people in your new location.

► Be choosy about airport lines. Note which travelers (such as families with children or passengers with lots of luggage) may cause delays, and avoid those lines.

► Have a plan for your destination, but be flexible. Realize that even if you’re prepared, things never work out exactly according to plan.

► Periodically get up and move. Stand,

► Remember that you’re still a student.

stretch, or even just change positions in your seat when flying.

Yes, you’re a professional, but you’re always learning.

>> otherwise do not have access to education about good life choices and habits.”

► Know that in many countries, the line

► Take in the beauty. Just because you’re working in a professional capacity doesn’t mean you shouldn’t explore the culture, music, people, and scenery around you.

► Reciprocate. Be aware of how generous people are with you—even those who have little in the way of resources—and extend the same generosity. —Nora White <

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Perseverance

An Idealist Reinvents Herself

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ver the past year, Carla Stokes, MPH ’99, PhD ’04, has flown to cities around the United States to spread her message of positive self-esteem to girls and women through educational workshops, keynote speeches, and life-coaching. Stokes says for the first time since completing a postdoctoral research fellowship at the Centers for Disease Control and Prevention in 2006, she is finally making enough money to feel financially secure. And the key to her newfound success? “I had to reinvent myself,” she explains. “I’m still an idealist. But I also had to learn how to be a businesswoman.” Over the past 13 years, Stokes has empowered thousands of teen girls to transcend the harmful social messages that can hold them back from enjoying good health and success. Stokes began this work while still a U-M student, after founding an Atlanta, Georgia–based nonprofit called Helping Our Teen Girls in Real Life Situations, Inc. (HOTGIRLS). But HOTGIRLS lost many grants and donors during the Great Recession of 2008, and both Stokes’s work and motivation began to falter. “My mom says when I was two, my daycare provider joked that my name should have been ‘Determination,’” says Stokes. “And maybe that quality kept me going when things got tough.” With help from mentors and successful entrepreneurs, Stokes has now set up a coaching and consulting business at drcarla.com that she hopes will reach even more girls and women, as well as educators, parents, and professionals who work with girls. And she is expanding her reach by helping both women and public health professionals develop business skills so they can become social entrepreneurs, too. Because of her doctoral research on the online communications of African-American

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teens, Stokes gained worldwide recognition. “I was one of the first to examine social media in a public health context,” she says, noting that her thesis shed light on “how young women navigate their sexuality in the digital age.” While enrolled as a doctoral student in health behavior and health education in 2001, Stokes founded HOTGIRLS, a peer-to-peer nonprofit that gives girls and young women leadership roles in planning and public speaking and helps them take their messages about health education, media literacy, and positive self-esteem into schools. Over the years, many HOTGIRLS have gone on to become doctors or have entered the fields of social work or public health, ready to pass on the HOTGIRLS message of self-love to the next generation of adolescent women.

“My mom says when I was two, my daycare provider joked that my name should have been ‘Determination.’” Now, as her travel schedule again fills up, and both financial and personal success come tantalizingly within reach, Stokes says she will still fit in workshops with underserved girls whenever she can. “Maybe I’m stubborn, but I have no regrets,” she says. “I gave up opportunities for jobs, including prestigious jobs in academia. But I know this is the lifestyle I want, because entrepreneurship allows me a lot of freedom and creativity. In this society, all girls face challenges—including health-related pressures—and that’s why I am dedicated to serving them.” —by Madeline Strong Diehl <

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The Basics

► Put the action in the verb. Don’t “make a comparison,” for example. Just “compare.”

hy does it matter? “Because writing is how you present yourself to other professionals in your field,” says Kirsten Herold, who works with students and others at U-M SPH to improve their writing skills. “Just as errors in your data don’t inspire confidence, errors in writing don’t inspire confidence.” Writing skills are especially important in public health, where experts need to convey complicated ideas in clear language— often to people who don’t work in the field. Herold, who holds a PhD in English and has taught writing at the university level for nearly three decades, says public health professionals need to write without grammatical mistakes and with mastery—meaning they need to develop a credible professional voice. She often advises students to “slow it down. Make it clear. Show the steps. Think of your reader and build a bridge. You have Idea A and Idea B—but the reader has no way of knowing how you got from one to the other. You need to construct a verbal bridge there. That’s a lot of what we do.”

5 Tips to Improve Your Writing: ► Keep subjects and verb as close together as possible. There’s nothing more confusing than having to look for the verb three lines down.

► Start sentences with what’s known and end with what’s not known. Instead of “We conducted this study because of this problem …,” try: “Because of this problem [already established], we conducted this study. And here’s what we did.”

► Avoid needless repetition. See example below. ► Put the meaning into your nouns and verbs. Use adjectives and adverbs sparingly. Strunk and White (The Elements of Style) say there’s no adverb that can prop up a weak verb. International students, in particular, need to concentrate on finding the right verb. If you can find the precise verb, the rest of the sentence more or less falls into place. You don’t need all the prepositional phrases and whatnot that get in the way. Example, with in-text edits:

Public health professionals need to write without grammatical mistakes and with mastery— meaning they need to develop a credible professional voice.

“Due to limited resources and funding, the NRDC has been unable to perform further studies in order to characterize the MDR cases and isolates. However, the NRDC with a visionary approach, the NRDC has been collecting and storing resistant isolates found during years in which of national evaluations of resistant tuberculosis have been performed. Their overarching purpose was to perform a molecular epidemiology analysis in the near future to understand the genetic basis of resistant Mtb in the area. <

Recommended Reading: George Gopen and Judith Swan, “The Science of Scientific Writing,” American Scientist (November-December 1990): americanscientist.org/issues/pub/ the-science-of-scientific-writing.

“My master plan is to try to reduce the negative and harmful effects U.S. food production has on health disparity.”

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Skills • The Basics

Statistics

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iostatistics, one of the key requirements of the SPH curriculum, is also one of the courses SPH students most dread. But when well-taught, with a “focus on applications, the subject can be more interesting and rewarding than you might expect,” says Rod Little, the Richard D. Remington Distinguished University Professor of Biostatistics. The discipline of statistics—and its broad application to public health—is a critical underlying component of more visible discoveries and newsworthy policy developments. Little notes that without the hard, meticulous work of biostatisticians, none of these groundbreaking findings would be possible—nor would they stand the test of time. In his work as a biostatistician, Little helps researchers differentiate fact from belief or opinion—and thus maintain the highest standard of scientific excellence. He stresses that for progress to continue in public health, rigorous statistical design and analysis are essential. Every facet of public health—from behavior change to environmental impact, epidemiological analysis, and policy development—relies on the strength of causal relationships that can only be safely inferred through a sound application of statistics. —Rachel Ruderman

4 Things to Know About Statistics: ► Math isn’t the same as statistics. Accord-

► Statistics is critical to the public health community. Without it, new developments are rendered meaningless—and potentially harmful—in the face of scrutiny. Consider, for example, the supposed relationship between vaccines and autism, largely based on a statistically weak and now discredited study. (For one discussion see webmd.com/brain/autism/searchingfor-answers/vaccines-autism.)

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According to a recent National Research Council study, the biostatistics department at U-M SPH is the country’s top-rated biostatistics program.

In his work as a biostatistician, Little helps researchers differentiate fact from belief or opinion.

► You can find statistics wherever you look—the good, the bad, and the ugly. Apply your basic statistics knowledge and critical-thinking skills to scrutinize news reports and recent developments in the public health world.

► Not everyone is a statistical mastermind. Nevertheless, Little recommends that all public health professionals understand the importance of measuring uncertainty, summarizing data, and designing studies that avoid hidden biases and lead to real knowledge. <

“I want to make potable water safer.” U N I V E R S I T Y

Michigan Statistics Resources

ing to Rod Little, a mathematics theorem essentially boils down to “if A, then A,” but statistics says, “if A, then maybe A!”

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U-M also has other resources for sharpening your statistical edge. The Center for Statistical Consulting and Research provides pro bono statistical consulting to U-M students (cscar.research.umich.edu/). You can also re-explore the no-cost introductory statistics course at Open.Michigan, U-M’s effort to maximize the impact and reach of faculty research and teaching (open.umich.edu/education/ lsa/statistics250/fall2011).

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Political Savvy

Big Decisions at Small Tables Peter Smith

to create a new advisory position for her in Detroit’s Department of Health and Wellness Promotion. Royan’s chief task—critical in a city with an above-average chronic-disease burden—is to produce a health impact assessment and advise officials on health issues associated

Regina Royan

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hen Regina Royan, MPH ’12, first learned of Detroit’s plans to tear down roughly 40,000 abandoned houses—part of the city’s long-term redevelopment plans— she saw a “powerful opportunity” for public health to take on an advisory role. “In early conversations, there were experts in land use and environmental concerns weighing in, but no voice to bring those factors together in the context of health,” she says. Having spent three years as a research associate for Matthew Davis, professor of medicine and public policy at U-M and chief medical executive for the state of Michigan, Royan knew something about persuading policymakers to take an interest in health issues. She got in touch with city officials, secured seed money to write a health impact assessment, and convinced the Detroit Building Authority

with blight removal, from lead exposure and pest management to clean fill and public notification. “It took a lot of pitching to get people to start thinking about health in this process,” says Royan, who is continuing her Detroit work while starting medical school at U-M this fall. “But the fact that they established—and are utilizing—this new position speaks to their desire to make a long-term positive impact.” Royan’s advice to those who want to make a difference is to “first get yourself to the table. Sometimes these are very small tables—but more often than not, big decisions get made at small tables.” Good communication skills are

indispensable. “Most of my job is synthesizing health concerns for people with no public health background—so writing well and knowing your audience are key.”

“It took a lot of pitching to get people to start thinking about health in this process.” Just as Davis taught her how to use the political system to advance public health, Royan is now passing those lessons on to secondyear SPH epidemiology student Doug Strane, who interned with Royan at the Department of Health and Wellness in 2014. Royan says he’s been a tremendous asset. “When you establish a strong voice for health, you have to teach others how to fill that role after you.” <

Blight removal can generate toxic lead dust and release animal pests.

>> about sex and sexual health—topics that are taboo in our society right now.”

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Entrepreneurship

Why Not?

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efore he and his friend Jeff Sorensen launched optiMize—a U-M student organization that funds student-run nonprofits—Tim Pituch had little experience with social innovation or entrepreneurship. But he asked himself the question he thinks every potential entrepreneur should ask: “Why not me?”

Tips for Entrepreneurial Success

Pituch, a second- year student in the joint U-M SPH/School of Information graduate program in health informatics, believes entrepreneurship is a skill “you can develop.” As undergrads, he and Sorensen created optiMize in 2012 after seeing too many good student ideas come to naught. Through its Social Innovation Challenge, optiMize raises money ($85,000 in its first year) to fund student-run nonprofits like the Michigan Urban Farming Initiative, which harvests produce from Detroit’s north side.

1. Talk to everyone. A lot of potential entrepreneurs fear that if they tell someone about their idea, they’ll steal it. That’s not going to happen. The only way to really develop your idea is to talk about it and learn from others.

Tim Pituch—whom the Michigan Daily selected as one of its 2013–2014 students of the year for his social entrepreneurship work—offers these tips for would-be entrepreneurs:

2. Learn how to work on an interdisciplinary team. Recognize that other people’s perspectives may be just as valid as your own—and that a combination of perspectives will result in something better than any individual could come up with.

“Go out and do something, test as much as you can, validate any assumptions you might have. It really helps you move forward.”

3. Think about problems before you think about ideas. Talk to people who are experiencing the problems you want to solve and to other organizations that may be working to solve those problems. 4. Look to different contexts to try to identify solutions. Maybe something that’s worked well in a clinical setting, for example, can be adapted for use in a more rural setting.

Early on, Pituch and Sorensen received key support from Victor Strecher, SPH Director for Innovation and Entrepreneurship, who advised them to “just go out and do it. You’ll learn a lot more than if you plan for six months.” Strecher directs the school’s new annual competition for student entrepreneurs, Innovation in Action: Solutions to Public Health Challenges—a program Pituch says “makes it easy for student entrepreneurs to find what they really need.” Pituch and Sorensen now give the same advice to other U-M students working to develop start-ups: “Go out and do something, test as much as you can, validate any assumptions you might have. It really helps you move forward.”

5. Keep your eyes open. Be observant. 6. Go to as many open events as you can—tech meet-ups, social entrepreneurship meet-ups, open-to-the public events. It’s probably the best way to find resources. 7. Be persistent. Entrepreneurship isn’t rocket science. But it’s a roller coaster, and if you’re not convinced that what you’re trying to do is something you really want to devote a lot of time and effort to, it’s not going to happen. <

Volunteers at the optiMize-funded Michigan Urban Farming Initiative harvest produce from Detroit’s north side.

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See a video interview with Tim Pituch at sph.umich.edu/findings.

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n working with diverse groups of people, public health practitioners should be aware that notions of health and disease differ across cultures, and that to do effective cross-cultural work they must understand those differences, says SPH Professor Gary Harper, who collaborates with communities in both downtown Chicago and rural Kenya. “We always have to be thinking about our viewpoints and perspectives on the communities we work with, how we understand them and connect to them—or not.” Toward that end, schools like U-M SPH have long included “cultural competence” training as a key part of their curricula. But Harper, like many others, finds the term limiting because “it tends to promote stereotyped notions— the idea, for example, that most Latinos are Catholic, or that family is important to African-American

communities. You come away saying, ‘I’m now competent to work with Latinos,’ but how do you define ‘Latino’? What type of Latino? What context?” Harper prefers the more nuanced term “cultural humility,” coined in 1998 by physicians Melanie Tervalon and Jann Gary Harper Murray-García. As they define it, “cultural humility” entails both a lifelong commitment to self-evaluation and self-critique and “the ability to recognize our

box you check off. But with cultural humility you have to think about it 24/7. You’re constantly engaging in this self-reflexive process of challenging your notions. It’s more work, but it’s how we do better work.” He adds that “cultural humility” also incorporates the notion of “intersectionality, the idea that we all have multiple identities, and they come together in a variety of different ways and contexts.”

“With cultural humility… you’re constantly engaging in this self-reflexive process of challenging your notions. It’s more work, but it’s how we do better work.” own beliefs and assumptions and to break through commonly held assumptions and stereotypes that can get in the way of being ‘competent’ or ‘sensitive’ in another’s culture.” “It gets us to think about our preconceived notions of other people,” says Harper, who includes some discussion of cultural humility in all of his SPH classes. “I get really frustrated with how people approach cultural competence—it’s a

W >> it’ll be McDonald’s for everybody.”

For SPH Professor Barbara Israel, cultural humility is a reminder “to show humility and mutual respect within the context of someone else’s culture. It’s the idea of listening—and not always having the answers. We as researchers have a lot of training, skills, and competencies, but we have to also recognize what we don’t know. That’s the part of cultural humility that I think is so important.” <

See a video interview with Gary Harper and his intervention team at sph.umich.edu/findings.

“I want to change public restrooms so that exit doors push out, not in.

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A 24/7 Process


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hree years ago, SPH Professor Gary Harper began working with a group of young black gay and bisexual men in Chicago to develop an HIV-prevention intervention. The young men were primarily from the city’s South and West sides—home to Chicago’s largest AfricanAmerican communities—and came from a range of backgrounds. One was a professional classical and contemporary ballet dancer. Another was homeless. Most had experienced discrimination. One had been attacked because of his sexual orientation and nearly died. Together, the young men were committed to becoming social change agents by promoting healthy behaviors among young gay and bisexual black men. As part of that work, they would confront the social stigmas and media stereotypes that can lead young black gay men to engage in substance abuse, eating disorders, suicidal ideation, and risky sexual behaviors. And they would change hundreds of lives—including their own. Today, as cofacilitators of Harper’s ongoing intervention, Guys Like Us—Educated, Empowered, Everywhere (GLU-E3), these young men are working to prevent the spread of HIV among teenaged black gay and bisexual men—the population most at risk for HIV in the U.S. Additionally, several members of the group have enrolled in college and one is in graduate school. Together they spoke to Findings about the importance of cultural humility to their efforts:

“Young people can really tell when somebody is not culturally competent. They can tell when somebody is not relatable, and if they feel it’s fake, they’re not going to go for it. So my advice is to do your research on whatever you’re trying to accomplish. If it’s a certain race or type of people that you’re not a part of, it doesn’t mean that you can’t do the work, but do your research and make sure you know your facts. Reach out to the appropriate people. Give credit where credit is due. If your heart’s really in it, and you really mean to help, then you definitely can make a difference.” —Anthony Singleton, Program Coordinator, LGBT Center, Halsted; Co-facilitator, GLU-E3 “When we think about working with communities, we have to take the pulse of the communities. We can’t just say, ‘I know all this, I have this many years of experience.’ That’s great, but they also have experience, and they live that. I don’t live on the south side of Chicago. I don’t know what it’s like to experience chronic long-term

oppression like they have, because I have economic privilege. I have resources to remove myself from some of that. So my experience is different. The key is to appreciate those differences.” —Omar Jamil, Project Director, GLU-E3 “I find it helpful to check my educational experience and my public health background and really just be in the space—learn from members of the community and have them learn from me, and realize that everyone may not come to the same decision or agreement. It’s really important to allow space for everyone to state their position—especially in these young age groups. They’re learning a lot about life, and things go so much further when they can determine for themselves what it is they want to do, versus me being some old person telling them how they should think.” —Alan D. Johnson, Linkage to Care Coordinator, AIDS Foundation of Chicago; Co-facilitator, GLU-E3 “For me, cultural humility is about meeting people where they are. What is their background? What neighborhood, what region do they come from? Getting a sense for their current understanding of the issues that we’re going to talk

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about and remembering that I am separate from this specific community, that these folks really are the experts of their own lives.” —Kylon Hooks, Drop-In Manager, Broadway Youth Center, Chicago; Co-facilitator, GLU-E3

Photos by Leslie Stainton

The Community Perspective

“Dr. Harper is very intentional about seeking out people in the community and not just saying, ‘This is what I’ve found,’ but saying, ‘This is what I’m interested in doing. How can I learn from and serve this community?’ My colleagues and I actually see our ideas and words in the finished product of this collaborative process. It shows us that he cares about our opinions, is serious about the work, and wants to make a difference. He ‘steps up by stepping back,’ as I’ve heard other members of the community say, because in order to serve a community you need to give its members a voice and due recognition.” —Dion Rice, Senior Behavioral Research Associate, Ann & Robert H. Lurie Children’s Hospital of Chicago; Co-facilitator, GLU-E3 <

“I want to change what >> S P H . U M I C H . E D U


$150-$200: Average cost of a seatbelt $69 billion: Savings in medical care, lost productivity, and other injury-related costs as a result of seatbelt use in U.S. (2010)

$20: LifeStraw® personal water filter $770 million: Cost of 1991 cholera outbreak in Peru from lost trade and travel revenue

$12: Cost of a TB skin test $12 billion: Annual global economic burden of TB (including lost earnings due to illness or death)

$5–$30: Average cost of a seasonal flu shot $30.4 billion: Cost to U.S. employers from lost work days due to flu in 2012–2013 flu season

$5: Average cost of insect repellent $37.8 million: Annual financial burden inflicted on Puerto Rico by dengue fever

$5: Average cost of one malaria bed net $12 billion per year: Estimated direct global costs of malaria (e.g., illness, treatment, premature death)

$2: Cost per 1,000 gallons of potable water in a Detroit home $500+ million: Annual cost of hospitalizations in U.S. from three common waterborne diseases (Legionnaire’s, cryptosporidiosis, giardiasis) (2010)

Approximately $1.50: Additional daily cost of eating healthily instead of eating unhealthily $245 billion: Annual cost of diagnosed diabetes in U.S. (2012), including direct medical costs and lost productivity

$.20–$2.50: Cost of a condom $29.7 billion: Annual federal funding for domestic and global HIV/AIDS efforts, including mandatory domestic care and treatment programs (2014)

$ .10–$28 Cost of a dose of combined measles, mumps, and rubella vaccine $142,452: Estimated direct cost to the public health infrastructure of containing one case of vaccine-preventable measles (2004)

Prevention isn’t free—but it’s cheaper than the alternative.

The Price of Public Health

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Rachel Ruderman and Elise Tolbert contributed to this article. For sources visit sph.umich.edu/findings.

$9.6 billion: Annual cost to implement EPA Mercury and Air Toxic Standards (MATS), which helps prevent an estimated 540,000 asthma attacks per year $150–$380 billion: Estimated annual health care savings from implementation of EPA MATS

$5.5 billion: Cost to implement the Global Polio Eradication Initiative’s (GPEI) Polio Eradication and Endgame Strategic Plan, 2013–2018 $25 billion: Expected net benefits over next 20 years from implementation of GPEI’s Polio Eradication and Endgame Strategic Plan

$1.019 billion: Annual U.S. Department of Agriculture food safety budget (2014) $14.6–$16.3 billion: Annual cost of U.S. illnesses and deaths caused by the 14 major foodborne pathogens (2012)

$300 million: World Health Organization smallpox eradication campaign (1967–1980) Over $1 billion: Annual savings from WHO’s smallpox eradication campaign

$50 million: Annual federal contribution to EPA Emergency Fund for oil-spill planning and support functions $1 billion and counting: Cost of Enbridge Kalamazoo oil-spill cleanup (2010–present)

$26 million: Annual amount spent on public policy by Planned Parenthood (2012–2013) $9.4 billion: Annual cost of teen pregnancies to U.S. taxpayers (2011)

$3.3 million: Cost of 5-year federally funded study by U-M KECC on Medicare payments for dialysis, medications, and tests $225 million: Annual savings to Medicare from implementation of new dialysis-payment system based on federally funded research by U-M KECC

$2,000: Average cost of prenatal care throughout a typical pregnancy in the U.S. $26 billion: Estimated total annual economic burden of preterm births in U.S. (2008)

$1,700: One complete hazmat suit $10,000–$100,000+: Average cost (including safety shower, ambulance transport, hospitalization, & potential long-term care) to treat an accidental chemical exposure

$1,185: Average cost of a colonoscopy in the U.S. (2013) $24,000–$40,000: Lifetime treatment costs for colorectal cancer in average-risk adults in U.S. (2011)

$183; $366-$410: Program costs (including pharmacotherapy, counseling, and outreach) and net annual savings per Medicaid participant in a comprehensive tobacco-cessation program implemented by the state of Massachusetts in 2007-2009 $289 billion: Annual costs attributable to smoking and exposure to tobacco smoke in U.S. (at least $133 billion in direct medical costs; more than $156 billion in productivity losses)

$175: Cost of a pulmicort (steroidal inhaler) for asthma $56 billion: Estimated annual cost of asthma in the U.S., including millions of potentially avoidable hospital visits and over 3,300 deaths, many involving patients who skimped on medicines or did without

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rofessor Linda Chatters has long understood that religion and spirituality affect both physical and mental health. Last winter she turned that understanding into a course, HBHE 710: Religion, Spirituality, and Health. Chatters spoke to Findings about what she learned from the course and why she thinks it’s so important for public health students and practitioners to be aware of religion and spirituality. Why a class in religion and spirituality at U-M SPH? Religion and spirituality are important social determinants of health for many, many people. Faith shapes health Linda Chatters behaviors and beliefs. And in our increasingly multicultural society, we need to understand how we differ and how we are similar in terms of faith traditions and their role in our lives. How might such an understanding affect the practice of public health? One way is the extent to which people seeking help for health problems will use faith measures —like prayer or consulting with clergy—as opposed to seeking medical care. Another is the extent to which clients will find health

interventions acceptable or unacceptable because of what their faith dictates. Some faith communities do not welcome conversations about sexuality, for example, and that has implications for interventions focused on sexual health.

Many of them said their faith traditions gave them their passion, their energy, and their commitment to social justice and to serving others. What challenges did you face in designing the course? The United States is still predominantly Christian, and the students and I struggled with the lack of a good body of knowledge of other faith traditions and their connections to health. The average American is functionally illiterate when it comes to other faith traditions—and even the diversity within the Christian faith. Minority faith traditions are even less known in the U.S. and are often discriminated against and stigmatized—both in general and within public health and care settings. I saw this course as a

way to encourage students to begin thinking both about how their own religious and spiritual background influences their role as public health practitioners and what it means to be a Muslim or Catholic or Hindu client seeking services. What did you learn from the students? In the context of two assignments—one a religious/spiritual history and the second an examination of students’ religious and spiritual autobiographies and professional roles—they homed in on their own conceptions of religion and spirituality. Several students went to Catholic schools and felt this had informed their present beliefs. Students who came from minority traditions (Muslim, Hindu) similarly cited their faith as a formative influence. Other students eschewed a formal faith tradition and identified as agnostic or atheist and felt they were more “spiritual” than “religious.” Many students talked about a spiritual journey—how they’d been raised, how those values and traditions had re-emerged in young adulthood. I specifically asked them to talk about the tension between their professional roles and their religion/spirituality. Many of them said their faith traditions gave them their passion, their energy, and their commitment to social justice and to serving others. It was really inspiring—and a privilege—to read these accounts. <

>> people think of as normal health—the amount of supplements they take, the number of pills, what’s normal—with the goal


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—Nashia Choudhury, MPH candidate (’15); President, Muslim Graduate Student Association

I grew up in a Hindu household. Hindu allows you a lot of freedom with what you want to believe—it’s more of an ethical than a faith-based framework, which is why I like the faith. The way I understand it, when you’re doing good, then you’re doing what you’re supposed to be doing in your life. If you’re helping people in a positive way, then you’re serving your faith. I’m going to medical school after getting my MPH, and one of the questions I know I’ll face is what to do as a clinician when people bring religion into the conversation. I think it helps to have a framework. That’s the main thing I got from Professor Chatters’s class—it let me get comfortable with religion and spirituality. I knew it was important for some people, but I didn’t know how important it was.”

Peter Smith

Islam teaches us, basically, the first saying of the Prophet is to love for your brother what you love for yourself. This is universal. It doesn’t matter whether the other person is of a different faith, or they practice their faith more (or less) than you do, or they’re your enemy. The understanding is that if you can do something to help someone, regardless of how you view them or they view you, you do what you can. That’s always stuck with me. This is one of the greatest things about public health. We’re collectively tied together in our need to give back and better society as a whole. Public health is one of those fields where we’re always thinking about people in greater terms—as opposed to individuals. My faith helps me carry on doing the work I want to do. ”

Shreya Sharman

Eric Bronson/Michigan Photography

How Does Your Faith Tradition Inform Your Public Health Work?

—Shreya Sharman, MPH ’14; Student, Michigan State University College of Human Medicine

We learned in class that 77 percent of people in the United States are affiliated with a religion, so religion and spirituality are unavoidable topics. I was raised Catholic and went to a Catholic school from first through eighth grade. As a nurse at Seattle Children’s Hospital, I saw how the large life events that you witness in hospital settings have religious and spiritual meaning to people. And I saw that the more you know about someone’s culture, the more willing they are to let you in and trust you. Trust is a big part of providing care to people. People who are able to get outside their own beliefs and respect others make the best practitioners and providers. Even if you’re the same religion as someone else, it doesn’t mean you know what they’re experiencing. Religion and spirituality are so much more complex than that. We all need to do more to understand people’s individual beliefs.” —Jacqueline Dufek, MPH candidate (’15)

The comments above are from students in HBHE 710: Religion, Spirituality, and Health.

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hat do faith leaders have to say to the medical community? How can religious communities help disseminate public health messages? Questions like these are a routine part of the fare at a monthly breakfast meeting hosted during the academic year by U-M SPH faculty and staff and attended by a range of spiritual and health care leaders. The breakfast gatherings are a place “to look at issues of spirituality, science, and genetics,” says Susan King, associate director of the U-M Life Sciences and Society Program, who helped launch the series in 2004. Conversations are far-ranging and touch on issues where science, ethics, and spiritual values overlap and sometimes conflict—such as in vitro fertilization, genetic counseling, and end-of-life care. By wrestling with these issues, and by assembling a collection of ethical guidelines from the major religious traditions, the group has become a valued resource for both the medical and spiritual communities in the region. King says she looks forward to many more years of spirited discussion around topics like compassion, dignity, health, and community relations. <

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Communication

by Richard Besser

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ommunication is a critical arm of public health, not an afterthought. Many times we do all we can to avoid talking about our work. We fear that we might say the wrong thing, or that it’s a distraction to what our work really is. And that’s a big mistake—for a couple of reasons.

Communication puts a face on public health so people understand what it is you do.

First, communication is an important tool for making sure that your findings lead to true improvements in public health. Second, communication puts a face on public health so people understand what it is you do. That’s going to do a number of things. It’s going to ensure that you have the resources to get the job done—and that’s a critically important thing in the current economy. If you don’t do that, the only time people are going to think about public health is when these systems fail. There’s a truism in public health, and it’s that you can do every single thing right during a response, but if the public doesn’t know what you’re doing, and doesn’t trust you, you’ve failed. And to gain that trust, you need to communicate. I was acting director of the Centers for Disease Control and Prevention in 2009 when the swine flu pandemic hit, and we decided that in addition to everything else we did at CDC—case investigations, hospital infection control, laboratory support, border policy—we were going to make communication a central part of our response. We told people what we knew when we knew it. We told them what we didn’t know and what we were doing to get answers. And every

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Going Retail morning and evening I took to the airways for the news shows. Every afternoon I hosted a press conference. We made sure that CDC experts were available to any news outlet that wanted to know anything about the response. And the efforts paid off. Increasing numbers of people said that if they got sick, they would stay home. They understood that hand-washing was a critical part of preventing flu transmission. And the trust in government was as high as it’d ever been seen for a health crisis in the U.S. ABC News had been participating and watching the news conferences, and they liked what they saw, and they offered me a job. It struck me that if I really cared about impact, I needed to go retail. This is something that public health has to take seriously. We look at Richard Besser populations. We aggregate data. But often we forget about those people that we’re serving, whose lives we’re trying to improve. We forget to tell those stories about them and their lives and the impact that what we do has on their lives. And that’s what I’m trying to do. These remarks are adapted from Richard Besser’s graduation address to the U-M SPH Class of 2014. Besser, MD, is the chief health and medical editor for ABC News and a past acting director (2009) of the U.S. Centers for Disease Control and Prevention.

>> care for elders in China, because their children are just going out to work and they have little time to help their parents.


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tibe Effiong’s efforts to change the world date back to childhood, when he became class representative in his grade school in Lagos, Nigeria. He knew then he “wanted to speak for people who couldn’t speak for themselves, or were too shy or too afraid to do so.”

development discussion.” During his fellowship year, Effiong and 11 other New Voices fellows got extensive training on how to speak at major events, write op-eds and think pieces for major news outlets, and create galvanizing social media platforms. In between training sessions they received weekly writing prompts and coaching. By mid-May, Effiong had published his first opinion piece, “Why Ebola isn’t just Africa’s problem,” in the Detroit Free Press.

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A New Voice

Fellows get extensive training on how to speak at major events, write op-eds and think pieces for major news outlets, and create galvanizing social media platforms.

Utibe Effiong Effiong, MD, MPH ’14, now dreams of being a health minister or a senator for the Federal Republic of Nigeria or even an ambassador to the United Nations. He’d like to work with the Centers for Disease Control and Prevention or the World Health Organization at what he calls “the intersection of infectious disease and environmental health.” But first he wants to hone his communi- cation skills. Last year he applied for—and won —an Aspen Institute New Voices Fellowship, designed to bring greater numbers of expert voices from the developing world into the “global

Supported by the Bill & Melinda Gates Foundation, the New Voices Fellowship program aims to identify and nurture a new generation of global development “champions” able to share their stories, insights, and research on multiple media platforms. The hope is that the insights and experiences of these experts will help guide policy in such key areas as public health, education, agriculture, and the environment. Effiong says the fellowship taught him the importance of using his own experience to illustrate larger issues. “When you tie something to your real-life story, people can feel. You more or less step off your academic pedestal and become one of the people.” < For more on the Aspen Institute New Voices Fellowship see aspennewvoices.org/#fellows.

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And Don’t Forget the Power of Stories … Screenwriter and director Monte Montgomery, who works with SPH faculty to incorporate storytelling into their presentations, says a story “can make you a more effective presenter. Stories, unlike lists of facts, make it easier for listeners to engage—and a protagonist makes it easier for audiences to get invested emotionally.” It’s our human nature, he adds. “Stories are how we remember. We’re not built to memorize facts or lists—we’re built to remember narrative.” Montgomery advises researchers to think of themselves not as scientists or teachers but as performers, and to ask, “What does my audience want to see and hear?” <

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Dreams Come True

“I hope to connect young people with the resources I lacked growing up.”

Peter Smith

Although critical to the health and well-being of billions, public health is not always a lucrative field—which makes the case for scholarship support all the more urgent.

Rebecca Ahmad

Summer Enrichment Program (’13) MPH/MSW candidate (‘16) Dean’s Scholarship

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ronx-born Rebecca Ahmad realized early on that “school was one of the places I could go where adults would actually pay some attention to me.” Ahmad’s mother died when she was born,

and Ahmad herself entered kinship care at age five, after her father went to prison. She bounced around from one troubled family member to the next, all the while dreaming of an escape—and working hard to make that dream come true. Her efforts paid off. A prestigious scholarship enabled her to attend Swarthmore College, where she studied psychology, education, and biology.

Hoping to add health care management skills to her portfolio, she enrolled in U-M’s Summer Enrichment Program, which gave her the chance to complete an eight-week paid health care internship in southeastern Michigan. Ahmad discovered she was less interested in health care management than in aspects of health care that harkened back to her upbringing. With combined scholarships from SPH and the School of Social Work, she became a dual-degree student at Michigan. “Without this support, I would not have gone to grad school at all,” she says. “A lot of circumstances have to come together for a person like me to make it to a place like this. Much of that support is financial.” Ultimately Ahmad wants to get a doctorate in education and run a national nonprofit to provide sexual and mental health and educational resources to urban African-American and Latino adolescents. Her mission? “I hope to connect young people with the resources I lacked growing up.” —Nora White

“Without this support, I would not have gone to grad school at all.” >> providers to provide incentives for consumers that will allow them to make better choices on their own.”

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MPH candidate (’15) Hunein F. Maassab Scholarship

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Muhoza recalls the deadly outbreaks of cholera and dysentery that plagued the refugee camp.

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n 1994, Pierre Muhoza and his family spent three months living in a refugee camp in Zaire (present-day eastern Congo) to escape the civil war and genocide taking place in their native country, Rwanda. Muhoza recalls the deadly outbreaks of cholera and dysentery that plagued the camp—and Doctors without Borders’ subsequent missions to contain them. He and his family ultimately settled in Kenya, but memories of his time in the camp stuck with him. He eventually went to the U.S. and studied biotechnology and biochemistry at Rutgers, with the aim of helping to prevent the spread of lifethreatening infectious diseases. Today Muhoza is pursuing an MPH in hospital and molecular epidemiology

at U-M SPH—a program deeply aligned with his professional interests. “I wouldn’t have had the courage to transfer into this program and pursue my real passion had I not had U-M’s funding,” he says. Muhoza’s story comes full circle, as he hopes to establish himself with Doctors without Borders, or a similar international public health organization. “My goal,” he says, “is to assist underserved populations and reincorporate the human element back into my work to improve human health.” —Nora White

Peter Smith

Pierre Muhoza

Heather Boyd MPH candidate (’15) Dean’s Scholarship

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y her own account, second-year SPH student Heather Boyd grew up “very poor.” In her teens she effectively became homeless and spent a number of years living on friends’ couches and at one point spending nights in unlocked cars in a parking lot. “I’m an anomaly,” she admits. “Especially at the University of Michigan.” But even as a small child, Boyd saw that education was the key to escaping poverty. With scholarship aid, she attended Eastern Michigan University, where she majored in biology and anthropology. She trained as a doula and began working with low-income mothers. The experience taught Boyd that while she could help women through labor and delivery, if they lacked the resources to care properly for their babies—and themselves—the odds were against

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them. So Boyd started her own nonprofit, Students for Midwifery, which collects household goods for new mothers and their infants. Boyd’s focus at U-M SPH is maternal and child health in global settings. She recently completed a summer internship in Kenya. Without a Dean’s Scholarship, she says, it would be nearly impossible to pursue an MPH. She’s been supporting herself since she was 14 and still carries undergraduate debt. At times she worries that her good luck will unravel. But at her most optimistic, Boyd is exuberant. “I think I’m going to change the world,” she laughs. “One person at a time.” <

Even as a small child, Boyd saw that education was the key to escaping poverty.

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by Peter Song

10 Ways “Big Data” Is Changing the Way We Do Public Health

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The growing availability of big and complex data sets means new opportunities for interdisciplinary research in public health.

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Instead of examining just one type of data, such as physiological outcomes, researchers now assess and integrate multiple kinds of data, such as imaging and behavioral data and environmental exposures. This kind of rich, subject-level information can help scientists develop personalized interventions to improve quality of life.

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Biologists once studied individual genes through conventional laboratory experiments . Today, using high-throughput microarray, sequencing, and other technologies, they collaborate with statisticians to measure and analyze gene expressions across the entire genome.

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Digital health records yield vast amounts of information on conditions like asthma and diabetes and allow researchers to do a better job of tracking both compliance with and the efficacy of medications.

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The vast amounts of data generated by new technologies allow scientists to better understand the relationships among genetic variants as well as geneenvironment interactions— crucial factors in understanding complex diseases.

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Instead of conducting costly and time-consuming conventional clinical trials with specific groups of people under certain exclusion criteria, scientists can use digital health records to streamline clinical trials—and save both money and time.

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Because of the increased capacity of computer storage and cloud-computing facilities, scientists have access to—and are able to process—more variables than ever before.

Previously, scientists looked at data that was often collected at a single point in time. Today they follow people’s life-course trajectories and measure data at multiple points, making it easier to track the progression of chronic diseases and the mechanisms of human growth and development.

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By combining data from national disease registries, insurance companies, hospitals, and

individual patients, scientists are better able to evaluate the quality of health care—and people in need of treatment can make better choices about facilities and treatments.

Conditions like childhood obesity have very complex pre- and postnatal exposure patterns. Big data enables researchers to measure a wide span of environmental exposures, from pesticides to food intake to neighborhoods. This high-dimensional data can yield critical insights into childhood growth and development and help lead to effective interventions to prevent obesity. <

Peter Song, professor of biostatistics, is engaged in several projects involving big data, including studies of renal disease using registry data from the U.S. Renal Data System and from the NIH and EPA–co-funded study Lifecourse Exposures & Diet: Epigenetics, Maturation & Metabolic Syndrome. He hopes this research will provide relevant knowledge and better evidence for policymakers.

>> money we spend on pharmaceuticals and medicine and government intervention.”

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Real-Life Data Public health students don’t always get the chance to work with real-life data in the classroom, so field experience is critical, says Dana Thomas of the U-M SPH Office of Public Health Practice.

Data collection has been a key component of the practice experience at SPH since 2006. Field work teaches students how data is actually collected and lets them see the faces behind the data. It helps them understand why questions need to be worded in certain ways and why questions need to be asked the same way with each respondent. “Sometimes data comes from focus groups,” Thomas notes. “Sometimes it comes from going to the market and having conversations.” Wherever it comes from, the context matters because it influences how students interpret the data they gather.

Back in the Day … … researchers like Thomas Francis Jr. stored big data in file cabinets—more than a million records of children who participated in the Salk polio vaccine trials. No one had ever conducted a study of that size, and it’s not likely to be repeated. As epidemiologist William Foege, the first recipient of U-M’s Thomas Francis Jr. Medal in Global Health, noted on the 50th anniversary of the conclusion of the Salk vaccine trials, a century from now people will still marvel “at the audacity of a field trial that kept track of 1.8 million children before the age of computers.” <

Since 2006, when Thomas’s office sent a group of SPH students to the Gulf Coast to help collect data in the wake of Hurricane Katrina, data collection has been a key component of the practice experience at SPH. In partnership with health departments and community organizations, students on the school’s interdisciplinary Public Health Action Support Team, or PHAST, have worked on projects both in the U.S. and overseas. It’s a win-win arrangement, Thomas says,

because students get indispensable handson experience, and health departments and community organizations—who often lack the capacity to undertake significant data collection—get the data they need to launch new initiatives, determine programmatic direction, and identify areas of need. Specific PHAST projects include: Mississippi Gulf Coast and Delta: Since 2006, SPH students have helped assess post-Katrina needs and quality of life in communities in Mississippi and Louisiana, with the aim of informing community and economic development. Texas: Since 2010, PHAST teams have worked in the border region near Brownsville to gather information on food security, electronic medical records, and implementation of the Affordable Care Act.

Grenada: PHAST students have conducted focus groups on workplace wellness and worked with the Sickle Cell Association of Grenada to assess caregiver needs. Kentucky: In collaboration with the CDC’s Community Assessment for Public Health Emergency Response, or CASPER, program, a PHAST team conducted a door-to-door community assessment in the wake of tornado strikes in 2012. <

This notebook is part of the Thomas Francis Jr. archives at U-M’s Bentley Historical Library.

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Tim Roberton

hen Kevin Kamis participated in a U-M SPH program in Texas, he was struck by how those who successfully settle along the U.S./Mexico border still have difficulty gaining access to healthy food. The field experience, where he surveyed individuals at food banks, reinforced his desire to pursue public health. In March 2013, Kamis, a dual-degree student in epidemiology and health behavior and health education, was part of the Public Health Action Support Team (PHAST), a voluntary enrichment program intended to provide students with opportunities to experience public health practice in a range of field settings. It is run out of the SPH Office of Public

Practice

Into the Field Health Practice, founded in 2005 to “create multiple inoculating experiences for students in public health,” says Matthew Boulton, its founding director and the school’s senior associate dean for global health. The office exemplifies the school’s commitment to giving students real-life skills in the field. PHAST is a fundamental part of that effort. Students also get field experience in internships. Every MPH and MHSA student is required by the Council on Education for Public Health to complete one. And the vast majority of students participate, says Phyllis Meadows, associate dean for practice since 2010, who has successfully pushed to increase opportunities for internships

in governmental public health. In 2014, 68 percent of SPH internships were paid by the organization where students interned and 24 percent of interns received funding from SPH or other university sources.

Real-World Experience Boulton says at many schools of public health, students can receive their MPH without ever actually experiencing public health practice—even though practice is integral to the educational experience. So “we’re trying to change that,” he says. Roughly 26 percent of all SPH students head to work in international fields, not-

for-profits, and the government sector— areas with a strong practice focus. PHAST is now being viewed as a model for incorporating student field experiences into the public health curriculum, says Eden Wells, a clinical associate professor of epidemiology at U-M SPH, who has been participating in PHAST since 2008. Wells says practice at SPH works because it builds upon rigorous classroom training that students receive the first year. PHAST has become so integral to this process it is now being offered as a two-credit course, with classes in both domestic and international health practice. Meadows says practice experiences are designed to provide students with tools

Her student work as a member of the SPH Public Health Action Support Team (PHAST) proved indispensable to Clementine Fu, ’13, when she went to Guinea in July to conduct real-time research on the Ebola outbreak response for the International Federation of Red Cross. Despite prior experience in West Africa, solid briefings on the Ebola crisis, and a full understanding of past outbreak history, Fu says that without her PHAST training, she would have been ill-prepared to function in Guinea, “where virtually all that’s going on is action and movement, 24/7.” But through PHAST, she’d learned to work quickly on the ground in an international setting—Grenada—and to undertake an effective evaluation without having the leisure to design a comprehensive study. “Although the scale is different,” Fu says, “the skill set is the same.”

>> food waste, eat greener, and live sustainable, healthy lives.”

“I want everyone to be empowered to learn about


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Access • Practice

they can apply to public health problems, allowing them to “transfer theory into reality.” She adds that a big driver of practice programs is accreditation criteria: a requirement to engage students in active practice experiences before graduation is viewed as a core responsibility for an accredited school. There’s an expectation that universities should be partners with those in the public health community, she says. The SPH practice office has spearheaded long-term partnerships, like working with the Sickle Cell Association in Grenada, as well as experiences where students are called in to respond to emergency situations following natural disasters.

Student Opportunities Dana Thomas graduated from U-M SPH in 2005, before there was a practice office, and didn’t learn about the role of local health departments while she was in school. She’s now program manager for the Office

Eric Bronson/Michigan Photography

Marc-Grégor Campredon

Iqra Nasir

Whether it’s a summer-long internship or a one-day encounter with a local health department, practice teaches students to translate public health theory into reality.

Public Health Practice where the goal is to provide students with exposure to applied public health, that is rare,” says Jennifer Vahora, MPH ’14, who participated in PHAST programs in Texas and Mississippi. The practice office also oversees the school’s annual Practice Plunge, a program that is now mandatory for all incoming students. During orientation week, students are bused to one of six different health departments in southeastern Michigan, where they learn about the department’s mission and then participate in community service. Meadows says the idea holds such appeal that other public health schools, including the University of North Carolina, have adopted it.

Roughly 26 percent of all SPH students head to work in international fields, notfor-profits, and the government sector—areas with a strong practice focus. of Public Health Practice and is a strong advocate for introducing students to health departments early on. Whether students pursue a practice-related field or not, the experience is important, she says, since they’ll undoubtedly have to interact with the public health system at some point. “There are great schools of public health, but having one with an Office of

Life after Graduation Wells says field experiences provide students with knowledge about the infrastructure they’re entering and introductions to jobs they might want to pursue. They may even meet future employers, she adds.

Former PHAST member Tiffany Huang, MPH ’14, had the opportunity to present her research findings from a survey on a smoke-free ordinance she conducted in Brownsville, Texas, at last year’s National Association of County and City Health Officials’ annual conference. A month after she graduated, she got a job as a program analyst for health equity and community engagement with that organization. “My experience in public health and with local health departments definitely helped in getting me this job,” she says. Meadows is continuing to expand the focus of the practice office, this fall beginning exploratory work to build partnerships in St. Lucia, a place where she says there’s a huge need for services. Practice will remain a priority, “interwoven into everything” students do, she says. < Julie Halpert is a writer based in Ann Arbor.

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Networks

SPH graduates worldwide: Algeria 1 Argentina 1 Australia 13 Bahamas 1 Bangladesh 7 Barbados 3 Belgium 3 Botswana 2 Brazil 5 Bulgaria 1 Burkina Faso 1 Canada 76 Chile 3 China 77 Colombia 6 Costa Rica 3 Denmark 1 Dominica 1 Ecuador 2 Egypt 20 Ethiopia 4 Finland 3 France 4 Germany 3 Ghana 13 Greece 3 Grenada 2 Guatemala 3 Haiti 2 Honduras 2 Hong Kong 3 Iceland 1 India 31 Indonesia 37 Iran 4 Israel 7 Jamaica 1 Japan 22 Jordan 2 Kazakhstan 1 Kenya 4 Kuwait 1 Lebanon 4 Malawi 1

Where We Connect Sacramento, California: The U-M Center for Law, Ethics, and Health has worked with Sacramento County to develop an intervention program for second offenders of driving under the influence of alcohol

Mexico: In collaboration with Dr. Tonatiuh Barrientos of the Mexico National Institute of Public Health, SPH epidemiologist Rafael Meza is examining the impact of sugary drinks taxes and other prevention strategies on diabetes rates in Mexico

Mexico City, Mexico: Faculty in the U-M Center for Occupational Health and Safety Engineering are collaborating on a study of air pollution, inflammation, and preterm birth

Mississippi: The U-M Center for Integrative Approaches to Health Disparities is collaborating with the Jackson Heart Study, Jackson State University, and the University of Mississippi Medical Center to identify social and environmental predictors of cardiovascular risk in African Americans

Illinois, Indiana, Kansas, Kentucky, Michigan, Missouri, Nebraska, Ohio, Pennsylvania: The U-M Network for Public Health Law (Mid-States Region) provides support to public health attorneys, practitioners, policymakers, and others on the use of law to protect the public’s health

Boston, Massachusetts; Washington, D.C.; Philadelphia, Pennsylvania; Ann Arbor, Michigan: The REVEAL (Risk Evaluation & Education for Alzheimer’s Disease) study from the U-M SPH HBHE Genetics Research Group has conducted trials at sites at Harvard/ Brigham & Women’s Hospital, Howard University, the University of Pennsylvania, and U-M Atlanta, Georgia; San Francisco, California: The U-M Kidney Epidemiology and Cost Center, in collaboration with the CDC and University of California, San Francisco, has established a Chronic Kidney Disease Surveillance System for the entire U.S.

Guatemala; Argentina: Faculty in the SPH Department of Epidemiology are partnering with colleagues in the Institute of Nutrition for Central America and Panama and the National University of Lanus, Buenos Aires, to train professionals on approaches to noncommunicable disease prevention in Latin America

>> understand and can seek out that information.”

Medellin, Colombia: The U-M Center for Managing Chronic Disease, in collaboration with the University of Antioquia, has established a mobile health platform for improving diabetes care

Colombia: In collaboration with the Industrial University of Santander, Bucaramanga, SPH epidemiologist Eduardo Villamor is studying the role of nutritional factors in severe dengue infection, in a project sponsored by the National Institute of Allergy and Infectious Diseases

United Kingdom: Associate Professor Scott Greer of the SPH Department of Health Management and Policy is helping to assess and develop health policy in the context of European integration

Egypt: SPH environmental health scientists Dana Dolinoy and Laura Rozek and bioinformatician Maureen Sartor are studying BPA exposure in pre-adolescent females in rural versus urban populations

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Access • Networks

Point to almost any area of the globe, and someone from the U-M SPH community is working to improve health and expand access to care. Here’s a (very partial) glimpse. Finland: SPH biostatistician Michael Boehnke directs FUSION, a genetic study of type 2 diabetes and related traits

Sweden: In partnership with the University of Gothenburg, Richard Neitzel of the U-M Risk Science Center is studying the risk of cardiovascular disease associated with exposures to noise, paper dust, and shift work Russia: In partnership with investigators in Russia, SPH environmental health scientist Rudy Richardson is developing medical countermeasures against toxic chemical agents

China: SPH epidemiologist Matthew Boulton is partnering with CDC health officials in Beijing, Tianjin, and Shanghai to control the spread of measles and other vaccinepreventable diseases

Beijing, China: U-M SPH has a memorandum of understanding with China’s CDC for research collaboration, joint publication, and training exchanges

Thailand-Burma border: SPH epidemiologists Rafael Meza and Marisa Eisenberg are examining cholera transmission in a refugee camp

Western Kenya: In a project funded through the U-M SPH Office of Global Public Health and the African Studies Center, SPH Professor Gary Harper is studying risk and resilience factors among young gay/bisexual men and other men who have sex with men

Israel: U-M SPH has a memorandum of understanding with the Clalit Research Institute and is engaged in research collaborations with Ben Gurion University of the Negev and Israel’s Ministry of Health

India: Ten U-M SPH researchers are pursuing joint research, training, and educational initiatives in partnership with the Public Health Foundation of India and seven other public health institutions across the country

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Australia: SPH Professor Ken Resnicow is collaborating on harm-reduction and bully-prevention programs

than just creating well-intentioned policies that just uphold the status quo.” U N I V E R S I T Y

Sydney, Australia, and Detroit, Michigan: The U-M Center for Managing Chronic Disease has worked with colleagues at Westmead Hospital on a peer-teaching program for school students with asthma, which has since been adapted and assessed in Detroit, Michigan

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Malaysia 16 Mali 4 Mexico 9 Myanmar 1 Nepal 1 Netherlands 1 New Zealand 2 Nicaragua 1 Nigeria 9 Pakistan 9 Panama 1 Paraguay 1 Peru 3 Philippines 11 South Korea 39 Romania 1 Rwanda 1 Saudi Arabia 9 Senegal 2 Singapore 3 South Africa 5 Spain 6 Sri Lanka 2 Sudan 1 Sweden 1 Switzerland 5 Taiwan 85 Tanzania 2 Thailand 32 Trinidad & Tobago 2 Turkey 1 United Arab Emirates 3 United Kingdom 5 United States 12,486 Uruguay 1 Venezuela 13 Vietnam 6 Yemen 1 Zambia 2 Zimbabwe 3

Figures on global distribution of U-M SPH alumni (as of July 2014) courtesy of U-M SPH Office of Development and Alumni Relations.

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Community Partners

De Loney believes a successful academiccommunity partnership depends above all on three factors:

legend in her adopted city, Flint, Michigan, Mrs. E. Hill De Loney has spent nearly 60 years working to change the lives of the city’s African Americans—especially its young people. “My parents told us that we always had to give back,” she says. “Regardless of what we accomplished, we had to give back to our community. It did become very ingrained in me.” Growing up in the Jim Crow South, De Loney was particularly aware of the debt she owed her enslaved forebears—“because of the hardships they went through, the psychological trauma. I was taught that we were all connected.”

Trust

“The African-American community is not going to accept a partnership unless it’s someone you trust. Until I know you, observe you, see what kinds of feedback you offer, what kinds of words come out of your mouth, how you look at me, how you approach me—trust can’t happen. Trust is difficult to come by, and it can dissipate quickly.”

Communication

“Communication is one of the hardest skills in a partnership. It’s very, very important to be clear. You have to ask questions. If I explain something to you, but our definition of the same word is different, then we’ll fail to communicate. So if you’re in a meeting, find out what each partner heard, and make sure the interpretation is accurate.”

“Research was a dirty word to our community.” Aware, too, of the persistent legacy of racism in the United States, De Loney hesitated when members of the U-M SPH faculty approached her about becoming a community partner in the early 1990s. Tuskegee—the infamous 20th-century study in which the U.S. Public Health Service withheld treatment from poor African-American men in order to study the natural progression of untreated syphilis—“was on us,” she remembers. “Research was a dirty word to our community.”

>> where I can influence public policy.”

But something drove De Loney to say yes to SPH, and she has since become one of the school’s most loyal partners—a key player in collaborative, community-based initiatives to improve adolescent health, lower infant mortality, strengthen parent-child ties, and prevent youth violence in Flint.

Listening

“Hand in hand with clear communication is listening—mindful listening, active listening, positive listening. When you’re truly listening to a person, you’re not just hearing words, you’re comprehending, and you know what questions you need to ask. But if you’re halfway listening, you’re not even in the conversation.” <

“I want to inspire children to be the next ones to help other people.”

Peter Horjus/theiSpot

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A Level Playing Field Peter Smith

Corporate Partnerships

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orporations team up with SPH researchers for a variety of reasons. Some, for example, hope the collaboration will result in a profitable consumer product, and others seek SPH expertise in conducting risk assessments.

“We want to get our research out into communities.”

Barbara Israel and Ricardo Guzman

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wenty years ago, Ricardo Guzman, MPH ’97, and his colleagues in Detroit’s Hispanic community and the city’s predominantly African-American east side community were worried. They’d seen researchers come into the city before and conduct what one community member called “drive-by research.” “They’d essentially shoot in, take information, and leave,” says Guzman, the CEO of southwest Detroit’s Community Health and Social Services Center (CHASS). On one occasion, Guzman didn’t know he and his fellow Detroiters were part of a research study until he stumbled on findings from the study in a peer-reviewed journal. So when SPH faculty members Barbara Israel, Rich Lichtenstein, and their colleagues asked Guzman and other community organizations in Detroit to partner with U-M researchers in a new venture focused on health equity, the

ognition and understanding that community partners have a knowledge and experience base that we as outside researchers just don’t have,” says Israel. “As a consequence, the research itself, and the nature of the questions we ask, are much more relevant and valid to the community context.” Since its inception in 1995, the Detroit URC and its affiliated partnerships have launched over 30 community-based participatory research projects in Detroit— including air-quality assessments, walking groups, and a domestic violence–prevention project. The partnership has also helped bring more Latinos into SPH, among them Guzman himself, who earned an MPH in 1997 through the school’s executive master’s program. “Twenty to 25 years ago, U-M was not welcomed in Detroit,” Guzman says. “That has significantly changed. I believe the Detroit URC helped pave the way for the larger U-M involvement you see today in Detroit.” <

Detroit Community–Academic Urban Research Center (URC), “there was a lot of apprehension,” Guzman remembers. But he’d met Israel and several SPH faculty members, and sensed “that at the heart of it there was something that probably would be worthwhile.” So he and his peers decided to give it a try. Trust was critical. So was an 18-month period when all of the partners—faculty from throughout U-M and more than eight community organizations in Detroit—met to “set down a level playing field that we all understood and agreed to and talked about,” says Guzman. Among the principles they agreed on: ► Equal data-sharing ► Collective action ► Mutual respect ► Equal participation “One of the really critical things about a collaborative research process is the rec-

While every research project is individual, certain basics apply to all such partnerships, says SPH Associate Dean for Research John Meeker. Academic integrity is a given, and projects are ideally investigator-initiated and maintain intellectual property within U-M. Meeker knows firsthand what he’s talking about— he’s partnering with NSF International on a study of the reproductive and childhood-development impacts of exposures to everyday chemicals. “One of the main reasons we embrace these partnerships is that we want to get our research out into communities,” Meeker adds. “If an SPH researcher has discovered something that can improve public health, we want to get that out there in the form of a product or as information. Many times it’s much more effective to do that in a strategic partnership than on our own.” <

“I think to change the world we should take small steps at a time and be consistent, and you will reach your goal.” U N I V E R S I T Y

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The University of Michigan Injury Center

New Certificate in Injury Science at SPH

The Teenage Brain on Wheels: Things Every Parent Should Know

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njury is the leading cause of death for people ages one to 44 in the U.S. Recognizing the importance of this critical public health issue, SPH now offers a Certificate in Injury Science through the U-M Injury Center. Open to all SPH students, the new certificate program incorporates courses in epidemiology, health behavior and health education, health management and policy, biostatistics, and psychology, and includes a practicum component. For more information: injurycenter.umich.edu/academic-training/certificate-injury-

hink you know all there is to know about teen driving? Think again. SPH Research Professor (and U-M Injury Center researcher) Ray Bingham uses fMRI imaging to study the teenage brain and its influence on driving. His findings may surprise you:

1. Male teens have a much higher crash risk than females.

2. Having a peer passenger causes more fatal accidents for teens—period.

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By the Numbers: The Public Health Impact of Michigan’s Helmet-Repeal Law

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he Michigan state legislature repealed the state’s universal helmet law for motorcycle riders in the spring of 2012. In an effort to assess the public health implications of this policy change, researchers with the U-M Transportation Research Institute and U-M Injury Center conducted a study of motorcycle accidents in 2012. Their findings may make

drivers think twice about leaving home without a helmet:

► 26: Additional deaths attributed to helmet non-use after the repeal ►

36: Percentage decrease in helmet use among drunk riders who crashed

49: Serious injuries that could have been avoided by helmet use ►

60: Percentage

increase in risk of injury caused by not wearing a helmet <

3. Peer passengers can up the odds of accidents not only through direct interference (distraction), but through more subtle cues as well, meaning that even when they’re not talking or gesturing, risky driving behaviors may increase from the mere presence of fellow teens.

4. Teens who are more likely to feel socially excluded are more strongly influenced by a risk-seeking peer passenger.

5. Teens with greater cognitive control (higher executive functioning) are not influenced by high-risk passengers, and when accompanied by low-risk passengers actually drive more safely than they would without low-risk passengers. —Rachel Ruderman <


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by Rachel Ruderman

20 Years after Cairo: A Health and Human Rights Report Card As the lead U.N. author and analyst for the 20-year review of ICPD, SPH Associate Professor Rachel Snow spent the 2013-2014 academic year in New York synthesizing a vast range of research. She and her team found that, in the aggregate, achievements over the last 20 years have been remarkable—and include gains in women’s equality and education, population health and life expectancy (with a 47 percent decline in maternal mortality), and the achievement of near universal access to primary education for both girls and boys. “The elaboration of human rights protection systems has been significant, if deeply uneven in focus,” Snow said. And the growing participation of young women in the labor force, especially in Asia, has contributed to an estimated one billion people moving out of poverty.

The growing participation of young women in the labor force, especially in Asia, has contributed to an estimated one billion people moving out of poverty.

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e take it for granted today that all people matter, but this was not always the case. In fact, the rights of women to earn an equitable education and pay—and to assert their reproductive and sexual freedom—were not formally recognized until the groundbreaking 1994 International Conference on Population and Development (ICPD) in Cairo, and the Programme of Action that resulted from that conference. The 1994 ICPD Programme of Action represented an unprecedented consensus among 179 governments that individual human rights, capabilities, and dignity throughout the life-course—including the equal rights of women and girls, and universal access to sexual and reproductive health and rights—are a necessary precondition for sustainable development. The Programme set forth goals and objectives to accelerate development in the next two decades. Twenty years later, in light of new challenges and a changing development environment, the U.N. General Assembly called for a review of progress on the 1994 Programme of Action. With the U.N. Millennium Development Goals approaching their target date of 2015, it was essential to identify whether we’d made global and Snow regional progress in education, pay, and reproductive health and rights. What were the outstanding shortfalls of ICPD, and were we equipped to deal with the health and human rights consequences of increased urbanization and climate change? And were things truly better for women worldwide?

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But the findings are not all positive. Snow and her colleagues noted that in no country are women equal to men in political or economic power. One in three women worldwide experiences sexual and/or physical abuse, and recent U.N. data from Asia found that nearly a quarter of men surveyed said they had perpetrated rape, many without fear of consequences. While gains in women’s education have been substantial, women continue to be over-represented in “vulnerable employment”—they work with lower pay and have less job security and decision-making power and fewer benefits. Additionally, unequal wealth distribution between and within countries is a growing concern. “Eight percent of the adult population controls 80 percent of global wealth,” Snow said. And while there is “impressive commitment to women, young people, and older persons” in many countries, “there are far fewer commitments that address persons with disabilities and indigenous people, or ensure that human rights protections extend to all persons.” Snow presented the ICPD Beyond 2014 review and recommendations to the U.N. General Assembly in February. In September, during a special session of the U.N. General Assembly, 90 presidents, heads of government, ministers, and high officials from around the world endorsed the Beyond 2014 review and its recommendations.

W The full ICPD Beyond 2014 report is available at icpdbeyond2014. org/uploads/browser/files/93632_unfpa_eng_web.pdf.

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Report from Zambia: A s CEO of the Centre for Infectious Disease Research in Zambia and associate professor of medicine at the University of North Carolina, Chapel Hill, Charles Holmes, MD, MPH ’94, devotes much of his time and energy to protecting the next generation of Zambians against HIV/AIDS and other health threats. Through the work Holmes he and his team are conducting in collaboration with the government of Zambia, hundreds of thousands of people are now receiving lifesaving therapy, among them tens of thousands of women who have

been treated for HIV during pregnancy to prevent children from contracting the disease— work Holmes says is critical if Africa is to avoid an epidemic rebound of HIV/AIDS. Holmes, who previously worked in Malawi and with the President’s Emergency Plan for AIDS Relief (PEPFAR) in Washington, D.C., stresses the importance of continued commitment and funding from national governments and donor institutions like PEPFAR, as well as the Global Fund to Fight AIDS, Tuberculosis and Malaria. “We are working hard to scale

up innovative and more efficient models of service delivery to ensure greater efficiency, quality, and reach, but consistent funding is needed to make the transition,” says Holmes. How can SPH students best prepare for the ever-changing world of global health? Holmes suggests they get solid grounding and expertise in technical and quantitative skills. “The ability to critically appraise data and to use both qualitative and quantitative data to improve programs is extraordinarily important,” he says. He adds that the impact of problem-based learning cannot be overstated. Experience dealing with actual public health problems—whether domestic or global —is paramount. —Rachel Ruderman <

Stewart Reid

HIV/AIDS Prevention


Alumni Network

C L A SS N O T ES

IN MEMORIAM

1950s

Having retired in 2012, at age 90, from his post as director of the Fritz Beske Institute for Health Systems Research Kiel, Fritz Beske, MD, MPH ’55, has published two books: one on the future of the health care system in Germany, Gesundheitsversorgung von morgen (Tomorrow’s Health Care), and a second on aging, Bewusst älter werden (Mindful Aging).

1960s

Speaking at the Achieving the Dream Annual Institute on Student Success last February, James P. Comer, MD, MPH ’64, said that community colleges are a key to upward mobility in the U.S. because they serve so many low-income students. Comer, 79, is the Maurice Falk Professor of Child Psychiatry at the Yale Child Study Center.

Community colleges are a key to upward mobility in the U.S. because they serve so many low-income students.

1970s

A former U.S. Assistant Surgeon General, Roscoe M. Moore Jr., MPH ’70, DVM, is a senior advisor to Cannabis Science, a U.S. company specializing in cannabis formulation-based drug development and related consulting. Moore also leads the company’s initiative in Africa and is a senior member of its scientific advisory board.

1980s

Eugenio D. Beltran, DMD, MPH ’87, MS, DrPH ’96, is senior director of the American Dental Association’s Center for Scientific Strategies and Information.  Stanford University’s Haas Center for Public Service has awarded its 2014 U N I V E R S I T Y

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Miriam Aaron Roland Volunteer Service Prize to Catherine Heaney, MPH ’85, PhD ’88. An associate professor, Heaney teaches in the Stanford Prevention Research Center, the Department of Psychology, and the interdisciplinary Program in Human Biology.  Blake Medical Center in Bradenton, Florida, has appointed Valerie Powell-Stafford, MHSA ’89, as its new chief operating officer.

1990s

As a managing director and executive medical director at FTI Consulting, Michigan-based William Allen, MD, MHSA ’98, is part of the company’s Health Solutions segment and a leader in its Convergence group.  David Janotha, MHSA ’90, has joined Axiom EPA as Industry Vice President of Healthcare. Previously, Janotha held leadership roles at Loyola University of Chicago Medical Center, Transition Systems Inc., Eclipsys, and Deloitte Consulting LLP.  A health care quality expert with experience in both the public and private sectors, Maulik S. Joshi, MHSA ’92, DrPH ’00, is president of the Health Research and Educational Trust and senior vice president of research at the American Hospital Association.  Edmundo Muniz, MS ’90, PhD ’92, is the new CEO of Certara, a global technology-enabled drug-development and drug-safety consultancy. Muniz was previously president and CEO of the Kirax Corporation.  In August, Leigh A. Neumayer, MD, MS ’93, became the first-ever female head of surgery at the University of Arizona (UA). She is also the Margaret E. and Fenton L. Maynard Endowed Chair in breast cancer research at the UA Cancer Center.  In his new book, Surgeon General’s Warning: How Politics Crippled the Nation’s Doctor (University of California Press), Mike Stobbe, MPH ’94, tells the history and current political struggles of the Office of the U.S. Surgeon General. Stobbe interviewed Michigan’s Kenneth Warner and Howard Markel, among many others, as part of his research.  After 35 years in the legislative and executive branches of the Centers for Disease Control and Prevention, Richard Weston, DrPH ’94, has retired. continued on page 46

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1940s Beatrice W. Greenbaum, MSPH ’43  April 5, 2014 Helen L. Scheibner, MPH ’45  April 18, 2014

1950s Lauralee S. Boyd, BSPHN ’50; MPH ’51  January 1, 2012 John E. McAllister, MPH ’52  July 20, 2014 Philip C. Loh, MPH ’54; PhD ’59  September 17, 2013 Eugene H. Guthrie, MPH ’55  August 6, 2014 Marjorie J. Cole, BSPHN ’56  March 20, 2014 Samuel L. Ettman, MPH ’56  March 13, 2011 Grace A. Heath, BSPHN ’56  May 3, 2014 Alyce Bowman-Hartzler, BSPHN ’57  April 9, 2014 Barbara I. Stone, BSPHN ’57  June 28, 2014 Nancy J. Russell, MPH ’58  May 25, 2014 Henry V. Walkowiak, MPH ’58  June 21, 2014

1960s Merlyn B. Johnson, MPH ’64  April 5, 2014 Julia L. Stipe, BSPHN ’64  November 19, 2009 Kathryn A. Sullivan, BSPHN ’64  March 15, 2014 Mary S. Freliga, MPH ’66  May 1, 2014 James L. Ash, MHA ’68  June 19, 2014 Jean C. Chabut, MPH ’68  July 27, 2014 Harvey Pine, MPH ’68  June 11, 2014

1970s A. Stephen Coburn, MPH ’71  March 19, 2014 Walter F. Meyers, MPH ’72  June 18, 2014 Lawrence H. Bois, MHA ’73  June 13, 2014 Hilde M. Lehmann, MPH ’73  June 24, 2014 Michael Glanz, MPH ’74  May 17, 2014 John R. Balch, MHSA ’77  April 8, 2014

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FINDINGS

C L A SS N O T ES continued from page 45

Quote/Unquote

Our Lives Are About Service

M

Peter Smith

ary Kelly’s classmates at U-M SPH found out pretty quickly that she was a nun when, as a doctoral student in the school’s On Job/On Campus program—which then met on-campus one weekend a month—Kelly, DrPH ’01, skipped eight a.m. classes on Sunday mornings. Her colleagues took notes for her. This August marked Kelly’s 50th anniversary as a member of the Catholic order the Religious Sisters of Mercy. While the combination of a public health career and life in a religious community may strike some as odd, Kelly sees her life as a spiritual whole. Her order is, after all, a group of practical women who work to reduce disparities in health and education, particularly for women and children. Kelly earned an MBA when the Sisters of Mercy asked her to oversee the order’s finances; she sought a degree in public health when asked to help govern the order’s health system (now Trinity Health) and she realized she needed health policy expertise. Today, Kelly, a tenured associate professor, teaches health policy at University of Detroit Mercy. She’s also an active member of her order who meets regularly with her community members for meals and prayer, flies to Guyana several times a year to volunteer at St. Joseph Mercy Hospital in Georgetown, and is researching the role of Catholic nuns in the development of U.S. hospitals— with an eye toward correcting the historical record. (Recent findings appear in the fall 2014 issue of American Catholic Studies.) “There was a point at which nuns ran 50 percent of the U.S. hospitals,” Kelly says. “It irks me that history doesn’t recognize that.”

“We have thousands of collaborators in our ministries.”

On the overlap between her life in public health and her life with the Sisters of Mercy, Kelly told Findings: “There’s a quote in scripture that says ‘in God we live and move and have our being.’ So whatever I do, or whatever I collaborate with other public health professionals in doing, it all seems to be related. My absolute favorite thing is channeling resources from those who have them to those who need them. Those things feel spiritual to me because I understand that my life is about making the mercy of God real today. Here and now on earth.” And to those who question the relevance of nuns today, Kelly said: “Being a nun is a privilege, because our whole lives are about service. The invitation I would extend is: Work with us. And lots of people do—we have thousands of collaborators in our ministries. The number of nuns is decreasing dramatically every year, and our average age is going up, but the works are growing. It’s marvelous. We started hospitals, we started schools, we advocate for the poor, especially women and children, and the reason the work is continuing today is because there are these great people with good hearts and generous spirits who understand Mercy ministry and carry it forward.” <

W

See a video interview with Mary Kelly at sph.umich.edu/findings.

In Surgeon General’s Warning: How Politics Crippled the Nation’s Doctor, Mike Stobbe, MPH ’94, tells the history and current political struggles of the Office of the U.S. Surgeon General.

2000s

Ikenna “Ike” Mmeje, MHSA ’07, is chief operating officer at Sierra Vista Regional Medical Center, the largest medical center in San Luis Obispo County, California.  After nine years of working for The Carter Center on issues such as guinea worm and malaria, Aryc W. Mosher, ’00, has joined the Neglected Infectious Diseases team at the Bill & Melinda Gates Foundation. He credits his success to date to “the strong foundation of education that I received at U-M.”  Kristen Schweighoefer, MPH ’00, is the new environmental health director for the Washtenaw County (Michigan) Public Health Department. A registered sanitarian, Schweighoefer received the 2010 Michigan Environmental Health Association’s Distinguished Member Service Award.

2010s

As an ORISE fellow in the U.S. Department of Health and Human Services, Yasi Mazloomdoost, MPH/MSW ’13, is a member of Assistant Secretary Howard Koh’s tobacco control policy staff. Her portfolio includes the Tobacco-Free College Campus Initiative, which originated at U-M.  In addition to serving as president of the Spectrum Health Medical Group, Seth W. Wolk, MD, MHSA ’10, recently became the organization’s chief medical officer. <


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As you have seen in this issue of Findings, our students are the

change agents

of tomorrow. They will make the discoveries, devise the policies, and develop the systems to solve the great public health problems of our time. They will change the way we think about health. We are extremely proud of the education our students receive here at the School of Public Health. But many of our students can’t afford that education without your support. The path to their future is paved with intelligence, drive, creativity—and scholarship funding. What better investment could you make than to help develop the minds and hearts of tomorrow’s public health leaders? Be a victor for Michigan through a scholarship contribution today.

Victors for Michigan.

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Tenacity and Imagination Belen Michael wants to change the

their children. Because the HIV rate in

To make real change, “you have to be

world for women and children who

Ethiopia is low—just 1.5 percent—it’s

mindful that not everyone thinks the

lack access to health care. “It’s always

critical to find ways for HIV-positive

way you think,” she says. “Public health

seemed to me,” she says, “that the

individuals to live healthy lives, Michael

needs people who are passionate about

health of women and children is not a

says. That includes the ability to safely

their work but who also understand that

priority in society.”

conceive and bear children.

it’s going to take time, and work, and

This year, Michael took a step toward

Scholarships from the SPH Office

realizing her dream during a ten-week

of Global Public Health and U-M’s

summer internship at St. Paul’s Hospital

International Institute made it possible

in Addis Ababa, Ethiopia, where she

for Michael to go to Addis Ababa. A

collected data for a study to help stop

second-year MPH student, she says

the spread of HIV from partner to

the internship opened her eyes to the

partner and from infected parents to

realities of work in under-resourced

it’s going to be hard. That was the big takeaway for me this summer.” Above: Belen Michael, in front of the Church of St. George in Lalibela, Ethiopia. Carved from solid rock in the 12th-century, the structure is emblematic of the tenacity and imagination it takes to achieve significant change, Michael says. “I’m just in awe that people could build these gorgeous structures without modern technology.”

settings and gave her vital hands-on training and cultural grounding.

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Women

and Children

By t h e n um b e r s

First

$12.2 million

Annual amount of financial aid awarded to U-M SPH students

$67.7 million

Lynn Buchholz Singer, MPH ’72, could not have attended U-M SPH without a U.S. Public Health

Annual amount of research dollars to fund U-M SPH research, including training grants for doctoral students

Service Traineeship, which paid for her tuition and living expenses. So she is sensitive to the issue of economic access. She’s also determined to improve the health and well-being of children and their mothers. After receiving her BA in history and a teaching certificate from U-M in 1970, Singer got a job at a preschool in Ann Arbor, Michigan, for at-risk kids. “When I taught there, the mothers for the most part were very young,” she remembers. “They didn’t understand not to send their children to school with

$1,000

a high fever. And the families had no access to health care. I went there with a

Cost to help offset the expense of a single U-M SPH student summer internship

passionate desire to improve education. But my experience helped me see that health care management—and ensuring access to health care—was the right way for me to try to make a difference.”

$25,000

Since graduating from U-M SPH, Singer has held key administrative positions in government agencies, a university hospital, and as president of her own

Cost to create a named scholarship fund at U-M SPH

consulting firm. And now she has made another significant contribution to her underlying passion. The new Lynn B. Singer Endowed Scholarship will help fund

$600,000

an SPH education for “high-achieving, low-income students who have a particular concern for women’s issues in the health care field.”

Cost of an endowment to fund one full-year scholarship for an in-state master’s degree student at U-M SPH

Four decades ago, a lack of resources could have meant the end of Singer’s public health dream. But a scholarship made a U-M education possible. Now it’s her turn to make sure income doesn’t end the story for today’s dreamers.

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A single scholarship can lead to

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global change.

Help make the difference by giving now. “A lot of circumstances had to

The University of Michigan

come together for a person like

will match qualifying student

me to make it to a place like this.

support gifts at one dollar

Much of that support is financial.”

to every four dollars you

—Rebecca Ahmad, MPH/MSW

contribute.

candidate (’16), Dean’s Scholar

sph.umich.edu/giving

Read about Rebecca Ahmad and other U-M SPH scholarship recipients on pages 32–33.


New on the web online

at

51

July 12–31, 2015

Graduate Summer Session in Epidemiology

sph . umich . edu

Now in its 50th year, this internationally recognized program provides instruction in the principles, methods, and applications of epidemiology. A certificate program as well as online and e-learning courses are available. For more information visit SummerEpi.org.

> Ebola

As the number of Ebola cases climbs globally, SPH experts discuss the disease, its transmission, the likelihood of further spread, and more in a new video series that answers some of the most common questions about the outbreak of Ebola. sph.umich.edu/ebola.

> 2014 Public Health Symposium

November 15–19, 2014

The biennial SPH symposium took place on October 6, providing an opportunity for the SPH community to examine an important public health issue from multiple disciplinary perspectives. The 2014 symposium honored the work of the late Noreen M. Clark by examining the challenges of chronic disease and its management. Details and video are online at sph.umich.edu/symposium/2014/.

APHA Annual Meeting New Orleans, LA

Even if you’re not registered for APHA, alumni and their guests are invited to Michigan’s KeepIn-Touch reception, Monday,

> Summer Internship

November 17, 6:30 to 8 pm.

Student Blogs

For more information contact sphkeepintouch@umich.edu

SPH students took their classroom knowledge to public health frontlines around the world this summer, from Thailand and Mongolia to Mexico and Peru. Read their first-hand accounts of the experience on the SPH Frontlines blog: umsphfrontlines. wordpress.com.

or 734.764.8093.

K EE P I N T O U C H Want to share your real-world knowledge and experience with current or prospective students? Need a job or have one to fill?

> Findings

is on Issuu

You can now read Findings online via the digital publishing platform Issuu. issuu.com/umsph.

> SPH Career Connection matches SPH students and grads with companies and agencies. Check out umsphjobs.org or e-mail sph.jobs@umich.edu.

> Something to Say?

Comment online on any story in this magazine and learn what other readers have to say at sph.umich.edu/findings.

> If you would like to be part of

Are you attending a conference, professional meeting, or other event where prospective students could learn about the University of Michigan School of Public Health? If so, complete our Alumni Materials Request Form at sph.umich.edu/scr/alumni/recruit.cfm, and the SPH admissions team will get you the items you need.

U N I V E R S I T Y

O F

M I C H I G A N

S C H O O L

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P U B L I C

Ask an Alum, please send an email to sph.inquiries@umich.edu.

> Update your SPH contact info from our home page at sph. umich.edu. Or indicate changes on the address label and mail to the address on the back cover.

H E A L T H

S P H . U M I C H . E D U


52

“Entrepreneurship and innovation go hand and hand with public health— this is something I learned from the U-M SPH Innovation in Action competition. As a result of that competition, I co-founded LiquidGoldConcept to improve breastfeeding promotion, education, and support. We are four graduate students from all over the University of Michigan—engineering, social work, health behavior and health education, and nutrition—working together to translate current problems in maternal and child health into creative, efficient, scalable, and sustainable technologies.” —Anna Sadovnikova, MPH/MA student ’15; CEO, LiquidGold Concept LLC. LiquidGoldConcept was the winner of the “Empowering the Underserved” category of the 2014 U-M SPH competition Innovation in Action: Solutions to

Per-Anders Pettersson/Corbis

Public Health Challenges (sph.umich.edu/iia).


Mike Savitski

“As a first-year health informatics student, I’m working as a research assistant on a project aimed at developing an online suicide-intervention program for college students. It’s a federally funded study that’s designed to screen students for suicide risk and link those who test positive with online mental health counselors. After living in South Korea for ten years, I became deeply interested in how mental health resources can be developed for people who don’t have access to them—either because of cultural stigma or because they lack financial resources.” —Lucia Lee, MHI student ’16


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Findings, What Does it Take to Change the World, Fall 2014  

Findings is published twice a year by University of Michigan School of Public Health Office of Marketing and Communications.

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