From the Dean: Research IMBY

From the Dean: Research IMBY

Everyone knows the expression “NIMBY,” Not in My Back Yard. Yes, we need a new sanitary dump. . . but don’t locate it near my town. A new power plant? We have to have one. . . but keep it out of my community. A shelter for the homeless? Of course. . . but I’ll fight like hell if you try to build it across the street from my house.

How about research? Whether it’s flu prevention in University of Michigan dormitories, youth violence prevention in Flint, elimination of co-pays for diabetes drugs for UM employees, or dioxin contamination in Midland, UM School of Public Health researchers are examining critically important public health questions right here in our own back yard. The results of this research are directly relevant to the lives of university students and employees and the residents of Genesee County and the Tittabawassee River floodplain. But they’re also important to people living in New York City, as well as Mumbai, India. Somewhat paradoxically, at the same time that globalization has focused attention on public health research in other countries, research in our own back yard has implications of increasing global importance.

To illustrate, hard on the heels of the SARS scare, fears of an avian flu pandemic have awakened public interest in infectious disease. In the event of a major out- break of avian flu—still not a certainty—we may see the origins of the spreading epidemic well before we have the definitive tool, an effective vaccine, to arrest its spread. What can we do? To the extent possible, we can avoid contact with others. But the limited utility of that response is obvious in the qualifying phrase: “to the extent possible.” In a world of work, school, and commerce, avoiding human interaction for a prolonged period is virtually impossible.

So what will we do? Epidemiology Professors Arnold Monto and Allison Aiello are studying the utility of face masks, with and without careful hand hygiene, having recruited 1,000 UM students to wear masks while in their dormitories throughout two annual flu seasons. In some countries, the use of masks is commonplace. But do they reduce the incidence of influenza infection? Professors Monto and Aiello hope their research will answer that important question, while assessing the contribution of hand hygiene as well. 

A number of our faculty dedicate their work to addressing public health issues right here in our own back yard using a research approach, and philosophy, known as community-based participatory research. In CBPR, university scholars engage directly with community leaders to determine the community’s strengths and problems, as identified by the community, and then to jointly define a research protocol and carry it out with the direct involvement of community members. While posing unique challenges, this university-community research partnership can increase the relevance (and attractiveness to the community) of university research in our own back yard. As such, it helps to diminish the reputation of universities as ivory-tower elitists who know what’s best for community residents. Through our Detroit Community–Academic Urban Research Center and our Prevention Research Center, scores of faculty and students have worked with African-American, Hispanic, Arab-American, and Native American communities in Detroit, Dearborn, Flint, and the Upper Peninsula. One illustrative project, “Fathers and Sons,” strives to strengthen the bonds between non-resident African-American fathers and their 8-12-year-old sons, with the ultimate aim of promoting health. The project is directed by Health Behavior and Health Education Professor Cleo Caldwell in collaboration with Flint community leaders such as Mrs. E. Hill DeLoney, who serves as the project’s co–principal investigator.

One of the health behavior problems plaguing Flint’s children, as well as children and adults at all levels of society, is obesity and its sequela, diabetes. Through improvements in diet and use of pharmaceuticals, diabetes can often be kept under control. Could we reduce the cost and adverse health consequences of diabetes by removing the co-pays that diabetes patients pay for their medications? Would elimination of co-pays increase utilization of effective drugs? Those are the kinds of questions asked in our new Center for Value-Based Insurance Design (VBID), which is drawing the attention of everyone from insurance company executives to state and federal legislators. In our own back yard, the VBID concept has been implemented in an experiment with eliminating co-pays for diabetes drugs for UM employees and their dependents. If this experiment works, you can be sure to see it adopted far and wide, with further experimentation assessing the elimination of co-pays for other conditions.

Living in the pervasive shadow of the Dow Chemical Company, the citizens of the Tittabawassee River floodplain have long lived with a threat that is very much in their back yards: dioxin contamination. What they haven’t known, until now, was precisely how much “extra” dioxin exposure they confront (“extra” because we all are exposed to dioxins). Last August, Environmental Health Sciences Professors David Garabrant and Al Franzblau reported findings from a truly extraordinary study of dioxin exposure by source in the Midland area. Funded by an unrestricted $15-million grant from Dow, Professors Garabrant and Franzblau and their multidisciplinary research team have spent three years carefully evaluating dioxin concentrations in soil, household dust, and residents’ blood, comparing them with concentrations found in samples from Jackson and Calhoun Counties, a geographic area of comparable socioeconomic status lacking any special source of dioxins. What makes the study so remarkable is the combination of superb science with attentive and sensitive community relations. Read about the study in this magazine.

From microscopic bugs in the air to guns in kids’ hands, from prescription co-pays to man-made chemicals in our neighbors’ back yards, UM SPH faculty are working with and for the immediate communities that surround us. That their work has national and international implications just emphasizes the fact that in today’s world, our back yard is everywhere. We really are a global community. If Thailand weren’t our own back yard, why would we watch so nervously for outbreaks of bird flu in that seemingly distant land?

Dean Kenneth Warner

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