Change the Way We Do Business

Change the Way We Do Business

Build a Pipeline

Twenty-one-year old Morgan Williams was talking to a friend about becoming a doctor when her friend interrupted her. "You don't want to go into medicine - you want public health!"

"What's public health?" asked Williams, a senior math major at Delaware's Wesley College. Next thing she knew, Williams was exploring a career in public health - and looking at graduate schools, including U-M SPH, where she spent last summer in a ten-week program that introduces promising undergraduates to the field. Funded by the U.S. Centers for Disease Control and Prevention, the Future Public Health Leaders Program, or FPHLP, is designed to help foster a new generation of public health professionals - like Williams, who comes from an underrepresented community, wants a health-related career, and is intrigued by public health.

Dana Thomas of the SPH Practice Office, which oversees the program, calls it a "public health pipeline." With thousands of public health leaders expected to retire in the next few years, a new workforce is needed. Just as important, that workforce must be diverse. "In order to have impact in communities that tend to be most vulnerable, or have additional challenges, you need to get people from those communities in the field," Thomas says. SPH is one of four similar CDC-funded programs nationwide, all of which recruit undergraduates from throughout the country and the U.S. territories. This year SPH had 40 participants, all of them fully funded.

With a Chinese father and a Syrian-Lebanese mother, Jack Wong, who completed FPHLP in 2012 and is now a first-year SPH student, is exactly the kind of person the program is set up to attract. "I was the only one like me in the program," he laughs. "I would say everyone else was pretty much the only one like them in the program." Wong is interested in tackling chronic conditions like obesity, diabetes, and mental health, and hopes to do so in his home state of Michigan after getting his MPH.

During the ten-week program, participants work with community partners on a research project and attend talks and workshops on everything from public health principles to graduate-school applications. But first they spend three days in Atlanta, hearing CDC leaders talk about the field. That's where Williams knew she'd found her place. "It was definitely at the CDC that I said, yes, public health is for me!"

Take on All Comers

After years of mentoring graduate students - typically PhD students doing dissertation work - SPH Professor Harold "Woody" Neighbors opted last year to "throw caution to the wind and take on all comers." Friends of friends, undergraduates who'd taken the school's Intro to Public Health classes, students between degrees, siblings of current students - pretty much anyone interested in public health (and specifically ethnicity, culture, and health, Neighbors's area of expertise) was welcome to spend the summer doing an independent research study under Neighbors's guidance.

Called ENERGY (an outgrowth of "NRG," or "Neighbors Research Group"), the program is strictly informal. Neighbors volunteers his time, and the student mentees get no academic credit or funding. But it's a win-win all around. Neighbors gets to help nurture a new generation of public health scholars whose summer work informs his research agenda. The students get one-on-one mentorship, a chance to learn firsthand what it means to have an academic career in public health, and weekly meetings where they discuss current events, hear presentations, and exchange ideas.

ENERGY participant Jessica Gadsden-Gray, who holds a PhD in biochemistry and cancer biology and recently completed a master's in education from U-M, says the program gave her a vital network of professional relationships, as well as a crucial "window" through which to envision a career working to eliminate health disparities. "It's difficult to have and to hold onto strength and resilience if you don't have people around who are supportive and encouraging, and who you can access when challenges come," she says. "That's what this group has meant to me."

Partner with the Media

Frustrated by news media coverage of health issues? Find it sensationalist, slanted, naive, or just plain wrong?

Aristotle Sun knows your pain, and he's got an answer - at least a partial one. A 2015 graduate of the SPH Preventive Medicine Residency program, Sun spent last February doing an unpaid rotation with the medical news unit of ABC News. The experience convinced him that collaboration between health professionals and the media is an idea whose time is here.

During his month-long rotation, Sun and other medical resident interns helped the news team at ABC, including Chief Health and Medical Editor Richard Besser, review and summarize new health studies and vet them for accuracy. Sun and his peers also researched health information related to emerging news topics.

The experience gives the residents an inside look at how the media works - invaluable training for anyone preparing to assume a leadership role in public health, Sun says, because "what's interesting to scientists isn't necessarily interesting to the general public, and if we're going to communicate public health messaging, we have to know the difference."

For their part, ABC's medical news reporters get expert advice on the relevance, nuances, and drawbacks of individual health stories, which in turn helps them do a better job of communicating what's important. But the biggest winner, of course, is the public.

Embrace Darwin

With a background in social psychology and training in both evolutionary biology and community psychology, Daniel Kruger is something of a public health outlier - and he hopes his perspective can be a boon to the field. "So much of our morbidity and mortality is behavior-related, and we are still struggling with these so-called lifestyle diseases," says Kruger, a research assistant professor at SPH. "We've known for decades what people need to do to be healthy - eat a healthy diet, exercise, etc. But if you look at the obesity epidemic, it's obvious there's something very wrong. That's a call to rethink our strategies."

Kruger believes evolutionary theory - "the most powerful theoretical framework in the life sciences," he says - is the key to doing that. Evolutionary theory can shed light on a broad range of health issues. It can help scientists identify patterns of causality in complex health phenomena, such as why humans crave fats, salts, and sweets and tend to resist exercise, or how social and environmental factors affect birth outcomes. Kruger believes evolutionary theory is especially helpful in understanding and capitalizing on human motivation. "You can get more compliance with health messages, for example, when you tell people something will make them sexy or attractive. So far this kind of thinking hasn't been well integrated into public health."

Go Entrepreneurial

"With declining general revenue, a diminishing workforce, rising public distrust of government, and growing court-imposed restraints on regulation, governmental public health risks diminishing relevance. To survive, it must consider becoming entrepreneurial.

Think of what local health departments provide: surveillance, vaccinations, screenings, education, health promotion, disease prevention, environmental sanitation, all of it. Do we really want to risk losing these? If it's a choice between becoming marginal and changing the culture, then I think we have to recognize reality.

To be sure, entrepreneurship is not without its challenges. Even under the best of circumstances, it's hard to generate money from public health services. In a recent study of 32 local health departments in 18 states, my colleagues and I found pockets of entrepreneurial activity, mostly in the area of clinical services. But civil service restrictions pose additional barriers, and health department staff are seldom hired for their entrepreneurial skills. Our bottom-line finding was that to become entrepreneurial, governmental public health must undergo a significant culture change. It must place more emphasis on developing revenue-generating policies and programs. This may be an important strategic adaptation for staying relevant.No one should have any illusions that this is easy. How do you balance entrepreneurship against the core values that public health has always espoused - social justice, equitable access to care? But shrinking public budgets require new ways of thinking and acting." - Peter Jacobson

SPH Professor Peter Jacobson is the lead author, with Jeffrey Wasserman, Helen W. Wu, and Johanna R. Lauer, of "Assessing Entrepreneurship in Governmental Public Health," an assessment of the feasibility and desirability of public health entrepreneurship in governmental public health. The study appeared online in the American Journal of Public Health on February 17, 2015.

Change the Gloves

Last winter, U-M's Penny Stamps School of Art & Design hosted a charette - an intense and directed design "happening" - to generate innovative design solutions specific to the Ebola outbreak. More than 60 faculty, students, and staff from across the U-M campus, including SPH, convened for three days of intensive conceptualizing, designing, and fabrication. The result? A set of savvy, often deceptively simple inventions to improve procedures involving Ebola health care. Among them, Mdoff, a glove-removal device developed by experts from U-M SPH, the U-M School of Nursing, and the Stamps School of Art & Design. During trials both in West Africa and at SPH, the Mdoff team tested their concept and collected feedback to help them evaluate and refine the product. The project remains ongoing.

--Jan-Henrik Andersen