Advances - Fall 2009

advances Fall 2009

f r o m t h e U n i v e r s i t y o f M i n n e s o ta S c h o o l o f P u b l i c H e a lt h

Health

care

reform following Minnesota’s lead

>

Tracking H1N1 with Team Flu

> Vets Bring Aggressive Driving Home > What’s Lurking in Your Leafy Greens? > Heart Health Boosts Brain Power

from the dean

School of Public Health Leadership

Judith Garrard Senior Associate Dean for Research and Academic Affairs Debra Olson Associate Dean for Education William Riley Associate Dean for Strategic Partnerships and Relations Mary Story Associate Dean for Student Life and Leadership Diana Harvey Assistant Dean for External Affairs

Dear Friends,

John Connett Head, Division of Biostatistics

Welcome to Advances 2.0! We’ve redesigned our quarterly magazine to include a wider selection of research findings and school news, while at the same time providing more in-depth profiles of alumni.

We’re always looking to highlight the fascinating work of our grads, so I encourage you to share your news— or news of fellow alumni—by dropping a line to sphnews@umn.edu. And if you have thoughts on how to improve Advances, please send them our way.

Bernard Harlow Head, Division of Epidemiology and Community Health Ira Moscovice Head, Division of Health Policy and Management William Toscano Head, Division of Environmental Health Sciences Joe Weisenburger Chief Administrative Officer/Chief Financial Officer

advances Editor Diana Harvey Managing Editor Kristin Stouffer Contributing Writers Martha Coventry Lindsey Heffern Art Direction Cate Hubbard Design cat7hubb@gmail.com Advances is published four times a year by the University of Minnesota School of Public Health.

To submit comments, update your address, or request alternative formats email sphnews@umn.edu.

Printed on recycled and recyclable paper made in Minnesota with at least 10 percent postconsumer material.

© Regents of the University of Minnesota. All rights reserved. The University of Minnesota is an equal opportunity educator and employer.

We are also enhancing our online communications with a redesign of our website in the works and a monthly distribution of Alumni News, our e-newsletter that keeps you current on alumni events and networking opportunities. Sign up at www.sph.umn.edu/alumni.

With health care reform underway and H1N1 spreading virtually everywhere, public health continues to make top news. I’m proud to say we are working at the frontlines of both issues. SPH experts are embarking on a worldwide study of H1N1 (page 10) and advising the private sector on how to respond to the disease (page 12). Our students are teaming up with state-level epidemiologists to painstakingly track down critical details of H1N1 cases—a real-world experience that no doubt helps shape the next generation of public health leaders (page 9).

Our world is also changing in terms of what it means to be a “publicly funded” school. State support has never been so precarious, and expectations for private support have never been so high. We have made great strides in raising private funds that go directly toward student scholarships, but when one-time money from the federal stimulus bill runs out, we may again be faced with significant declining state support. More than ever, alumni and friends of the school will play an instrumental role in supporting our mission to provide an affordable, top-notch education. If you are interested in making your voice heard as we move forward, please read the column from our alumni society board president, Brigid Riley, on page 16.

Yours in health,

John R. Finnegan, Jr., PhD Assistant Vice President for Public Health Dean and Professor

Photo by richard anderson

John Finnegan Dean

Fall 2009

contents

Features 2 Health Care Reform: Following Minnesota’s Lead

As the great debate rages over how to overhaul the U.S. health care system, Minnesota has been quietly getting the job done.

For years, it has been a leader in delivering first-rate, affordable health care to people of the state.

8 Taking Public Health

Departments 9 Student News Disease detectives on the trail of H1N1; and a student-run clinic couples real-world experience with care where it’s needed most.

10 Research news Bad news for smoking ban critics; SPH leads worldwide H1N1 study; party colleges doing little to deter drinking; and more.

to the Hill

SPH alum Lauren Gilchrist helps Sen. Al Franken bring the Minnesota model to the nation.

12 school news U part of $185M to fight new pandemics; “Mr. Cholesterol” gets a culinary school; advancing public health in India; and more.

16 Alumni News Anna Sommers brings her perspective as a cancer survivor to health care reform; class notes; and more.

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Minnesota’s health care innovations make the state a model for change.

Health Care

Reform following Minnesota’s lead

F

or most people, public health is the “silent partner” in health care reform. They don’t realize that concepts vital to the current debate, like expanding access, cutting costs, increasing quality of care, and improving outcomes, are the very areas public health has devoted itself to for decades.

In Minnesota, the tie between health care and public health is more prominent. For years, experts in both fields have worked together to create a culture of innovation.

This partnership set the stage for the 2008 landmark legislation that brought sweeping health care change to the state and made Minnesota a touchstone for how the nation could, and some say, should, reform health care.

Illustrations by matt foster

Investing in Prevention Over the past year, the Minnesota Department of Health awarded $47 million in grants to fight the top three causes of preventable illness in the United States: tobacco use, physical inactivity, and poor nutrition. The Statewide Health Improvement Program (SHIP), which covers 86 counties and eight tribal governments, focuses on projects that make specific work, school, health care, and community environments healthier. SHIP has the potential to both improve the health of Minnesotans and curb health care costs in the state. Assuming that SHIP funding

continues, projected potential savings could be up to $1.9 billion by 2015.

In addition to the health-improvement grants, the state—with input from SPH experts—is developing rules for “health care homes” to ramp up coordination of care, particularly for people with chronic or complex conditions. The idea is that individuals would select one clinical entity to coordinate all their care. Certified health care homes will be eligible to receive “care coordination payments” from both public and private payers.

“At the root of these reforms is a goal to achieve better health, not just better health care,” says Minnesota Commissioner of Health Sanne Magnan. “We’re working to prevent the chronic diseases that bring people into the health care system in the first place, and to improve overall population health, the patient experience, and the affordability of health care.”

States as Leaders In the 16 years since the Clinton administration failed to rework health care, there has been a lack of national leadership on reform. So states have moved ahead on their own. The progress Minnesota has made helps position it as a leader in national reform, says SPH associate professor Lynn Blewett.

3

Even before the state’s major health reforms of 2008, Minnesota has had some of the highest levels of insurance coverage in the country. The most recent estimates put coverage at around 93 percent.

As head of the State Health Access Data Assistance Center (SHADAC), Blewett works with states to increase access to health care, often determining whether Minnesota models can be used elsewhere. In the past few months, she has been invited to brief the Minnesota Legislature on national health care reform. And she is often called by federal agencies and Congressional staff to provide estimates of heath insurance coverage and the characteristics of the uninsured that may be unique to specific parts of the country.

Blewett believes that Minnesota will continue to play a leading role in national health care reform even after initial legislation is passed. At that point, federal analysts will be looking for models of payment reform that improve efficiency and financial incentives that promote quality.

“Minnesota will be at the top of their list,” she says.

In addition to the health care home model, Blewett cites quality payment incentives and “baskets of care” as successful Minnesota initiatives. Using community-based data, experts have developed a set of 29 quality measures.

The measures will be used to compare the quality of care

Lessons from the West Wing Over the past year, SPH assistant professor Jean Abraham served in Washington, D.C., as one of ten senior economists on the President’s Council of Economic Advisers. Working in a nonpartisan capacity under the Bush and Obama administrations, Abraham was tapped for her expertise in health economics and policy.

She was charged with examining the economic implications of different aspects of health care reform, such as a public option and insurance exchange. She also studied ways to pay for health care reform through changes to Medicare and Medicaid and through other revenue streams—an exercise that taught her to round dollars in billions.

What surprised you about your experience in Washington?

I learned that politics can trump good economic policy.

For example, we had some good ideas on how to change the formula the federal government uses to reimburse states for Medicaid costs as a way to reduce geographic variation and generate savings. But the political insiders rejected the idea, saying that certain senators from higher-cost states would never support it. The discussion just stopped immediately.

4 University of Minnesota School of Public Health

Did you gain any insight on the White House’s role in health care reform?

Contrary to media reports, there is a lot of communication between the administration and the Hill. The criticism that President Obama didn’t put up his own plan—that was a strategic decision. But one should not assume that the administration was sitting idle. There are actually dozens of people [in the administration] working on health care reform— on issues of [economic] modeling, budgeting, and idea formulation. Much of that work is communicated to congressional staff members on a daily basis.

What do you say to critics who say we can’t pay for health care reform?

Whether we can pay or not is a subjective answer. It’s all about what you think of the distribution of wealth in the United States. But the issues of cost and coverage are linked. If we expand coverage, we have to recognize that we must deal with cost. Even if we don’t expand coverage, as long as health care costs continue to outpace overall economic growth, we are going to face serious decisions about taxes, other government spending, and budget deficits.

for specific services at different health care systems statewide and to reward the systems that meet quality benchmarks.

Eight baskets have been identified for common services, including asthma care for children, low-back pain, obstetrics, and total knee replacement. The soup-tonuts approach bundles and prices all the costs associated with each service—from consultation to surgery to anesthesiology to prescriptions to follow-up—so consumers will be able to compare costs across the market. “Each health care system attaches a price tag to each basket,” explains Blewett. “So as a consumer, you will be able to compare apples to apples.”

Improving Access Even before the state’s major health reforms of 2008, Minnesota has had some of the highest levels of insurance coverage in the country. The most recent estimates put coverage at around 93 percent. This success can be attributed to strong public programs, extensive employersponsored coverage, and a culture that fosters innovation and quality in care delivery.

Yet still, there is room for improvement. The state is home to some of the nation’s greatest health disparities, with minority populations experiencing lower coverage rates and worse health than the overall population.Other groups most likely to be uninsured include recent immigrants, young adults, and low- and middle-income families.

“Any health reform aimed at increasing access to health insurance will have an impact on reducing health disparities in Minnesota, because we know who suffers the most due to access barriers,” says SPH associate professor Kathleen Call. “While efforts to expand coverage are a step in the right direction, attention to cost and quality will also be needed to reduce disparities.”

For the past 14 years, Call has worked with the Minnesota Department of Health to survey Minnesotans on their health insurance coverage. That work has given state leaders a clear picture of coverage and where improvements need to be made.

The survey data has, in part, led to a $9.5 million initiative to reduce health disparities among Minnesota’s populations of color and American Indians by 2010.

Florida is the only other state to enact similar legislation.

Launched in 2001, the state-funded Eliminating Health Disparities Initiative demonstrates Minnesota’s “longstanding history of trying to tackle health disparities,” says Call. “We’ve already seen some success.”

Minnesota is one of nine high-coverage states singled out for federal support with the goal of insuring the state’s entire population. First-year funds of $4.6 million—

Rural Health Care: One Size Does Not Fit All The fact that this country’s health policy is crafted in the urban setting of Washington, D.C. is both a symbolic and concrete example of how rural America can be left out of reform discussions, says SPH professor Ira Moscovice.

As director of the Upper Midwest Rural Health Research Center, Moscovice has highlighted how reform measures have failed to consider the rural health care context. For instance, proposals that seek to expand coverage have not accounted for the longstanding access issues faced by those living in rural areas. And higher government reimbursements for the large, often urban-based providers who invest in robust health information technology put smaller rural-based providers at a disadvantage. Moscovice’s team released a series of reports on these issues at the request of the Health Resources and Services Administration, one of the largest agencies in the U.S. Department of Health and Human Services.

“Rural heath care shouldn’t be an afterthought,” says Moscovice. “We want to make sure the 20 to 25 percent of Americans who live in rural settings aren’t left behind.”

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“ If we can get a toehold in the process and get a bill passed, we can work on reforming the system to make it more efficient.”

with the potential for $35 million over five years— will provide preventive health care to those who are not eligible for public programs and unable to afford private insurance. “It’s that last push to get to universal coverage,” says Blewett, whose team at SHADAC will help evaluate the program.

At the national level, the outlook for universal coverage is not as promising. The proposals moving through Congress would reduce the nation’s 46 million uninsured to anywhere from 18 million to 23 million. But any proposal is better than none; if no reforms are passed, uninsured rates are estimated to hit 54 million by 2019—around 16 percent of the total population.

Plugging Away at Reform CBO Lowers the Boom On July 16, Doug Elmendorf, director of the Congressional Budget Office (CBO), said, “a large-scale expansion of insurance coverage would represent a permanent increase of roughly 10 percent” to the federal budget, which is on an “unsustainable path.”

With that declaration, the President’s end-of-summer deadline for signing a health care bill died.

CBO reached that conclusion after a thorough inhouse analysis. But the agency also regularly consults with a cadre of non-D.C.-based economists. SPH professor Roger Feldman serves on CBO’s Panel of Health Advisors. Recently, he’s been asked to weigh in on how malpractice reform would affect health care costs and the economic implications of a public option.

This isn’t Feldman’s first time at bat with health care reform or Washington politics—he served on the senior staff of the Council of Economic Advisors during Reagan’s presidency and assisted the health reform task force for the Clinton administration. Feldman says this time around a weak economy boosts CBO’s power in the reform process. “The mood in Congress and in the country is very cautious about increasing the deficit,” he says. “CBO has much more influence in this kind of environment.”

While achieving universal coverage and truly reforming the way care is delivered do not appear to be likely in this round of legislation, some sort of bill will pass.

For some experts, just moving forward is promising.

“If we can get a toehold in the process and get a bill passed, we can work on reforming the system to make it more efficient,” says Blewett. “We can continue to chip away at payment reform, cost containment, and access expansion.”

SPH assistant professor Jean Abraham agrees. She recently returned from a year in Washington where she worked on the President’s Council of Economic Advisers (see sidebar). “It’s not really about getting health care reform done this year. It’s about getting it started,” she says.

It has been a long time since health care issues have been so visible, both in Washington and across the country.

“We’ve had a good national discussion,” says Blewett.

“But people like me will continue to work on health care reform when it no longer makes front-page news.”

Web Extra SPH experts discuss health care reform at www.sph.umn.edu/reform.

Health Care Reform by the Numbers

$2.5 trillion

46 million

number of uninsured Americans

53 million estimated number of uninsured Americans in 2019 without reform 18-23 million

estimated number of uninsured Americans with reform

will be spent on health care by 2040 if we don’t slow costs

$8,160 cost per person

1 in 3 dollars

2009 U.S. health care costs

$39.7

billion

2009 projected Minnesota health care costs

14% percentage of state’s economy

$1.9 billion projected

potential savings of Minnesota’s health reform initiatives by 2015 64% p ercentage of people with employersponsored insurance in 2007

56% p ercentage of people with employersponsored insurance in 2008

Taking Public Health to the Hill SPH alum Lauren Gilchrist is Sen. Al Franken’s health policy adviser

“ Health care is not a business like every other business— it’s about taking care of people.”

L

ooking back on Lauren Gilchrist’s life, you can see her education, interests, and aspirations preparing her for a near serendipitous collision with America’s current great debate—health care reform.

Gilchrist, a 2007 MPH graduate, is Sen. Al Franken’s health policy adviser.

Before she took on that role, she helped frame, write, and mark up the present health care reform bill while serving on Sen. Edward Kennedy’s staff.

“I arrived [on the Hill] when the committee was beginning to write health reform legislation,” says Gilchrist. “I’ve been lucky enough to be involved with an issue at the top of the national agenda.”

After graduating from Wesleyan University, she worked at Planned Parenthood, with homeless youth, and at the Baraka School in Kenya. “There was always a

Working with Sen. Al Franken, Lauren Gilchrist advocates for health reform efforts that have proven successful in Minnesota.

relationship to public health [in what I did] even though, at that point, I didn’t know that’s what I would study,” she says.

Gilchrist was gaining fairly broad exposure to the problems people face because of socioeconomic disparity, and she wanted to get at the source of those problems. “That’s when I decided to go to the School of Public Health,” she says.

Gilchrist chose to get her degree in maternal and child health with an epidemiology emphasis. “I really wanted to get the quantitative epi skills,” she says. “I knew I was going to probably end up doing policy work and that it would be important for me to understand the research.”

Among her most formative courses

8 University of Minnesota School of Public Health

was SPH professor Jean Forster’s twosemester class on the policy of public health prevention. “For the second semester, you work with a lobbyist, and I worked with the Children’s Defense Fund,” says Gilchrist. “It was one of the most beneficial experiences I had in grad school. Jean was my adviser, and she’s been an amazing mentor to me.”

While in graduate school, she worked at the U’s Powell Center for Women’s Health, helping the legislature design a policy that allows health care providers to expedite treatment to partners of people with an STD and creating a training program for doulas on the Mille Lacs reservation. “[With this work] I was getting involved in policy issues, and I wanted to take my career to the next level,” says Gilchrist.

So she applied “somewhat randomly” for an Association of Schools of Public Health fellowship. She got the fellowship and was placed on Sen. Kennedy’s staff.

In her work now with Sen. Franken, Gilchrist wants to take what’s working in Minnesota and use it as an example for the rest of the country. The key, she believes, is non-profit health care coverage.

“Ninety percent of Minnesotans are insured by non-profit plans,” says Gilchrist.

“That creates an environment where insurance companies and providers are more focused on patients than shareholders.

[In Minnesota], this lets them come together and collaborate on things that other states can’t even fathom. Health care is not a business like every other business—it’s about taking care of people.”

student news

Tracking H1N1 with Team Flu

Photos by Tim Rummelhoff and Paula Keller

From the moment the state confirmed its first case of H1N1 influenza in April, Minnesota Department of Health (MDH) staff have been diligently tracking the disease. Team Flu—a group of MDH epidemiologists and SPH students— has stepped up to carry out much of the legwork.

Team Flu, originally a pair of students, has grown to seven, thanks to CDC funding to develop an Emerging Infections Program site at the MDH. Led by epidemiologist Craig Morin, Team Flu members conduct statewide surveillance of seasonal and H1N1 influenza by traveling to hospitals to collect patient data used to monitor the epidemiology of severe infections.

SPH alum Richard Danila, an MDH manager and deputy state epidemiologist, explains how crucial the students are to understanding the spread of H1N1.

“They have been our lifesavers,” says Danila. “Their work has given us the data we need to track the epidemic in Minnesota, to make policy decisions, and to help the CDC and federal government make informed decisions. As with all public health, [good work] starts with the data collectors, and we are blessed with the best.”

Team Flu gives SPH students the opportunity to work with experts in the field and connect education to practice. “Being a part of Team Flu has given me realworld experience,” says SPH student Emily Hallberg. “I have been asked to perform the duties of an epidemiologist during a very exciting time in public health.”

A Student-Run Clinic Where it’s Needed Most

This year, two public health students, Liz Hackenmueller and Mac McCullough, are co-chairing the PNC board for the first time.

In Minneapolis’s Phillips neighborhood, daily life can feel unstable and unsustainable. Nearly 41 percent of children in Phillips live below the poverty line and 13 percent of adults are unemployed. Most residents have no health insurance. In these conditions, obesity, diabetes, and heart disease can flourish, and mental health issues can go unrecognized and untreated.

In 2003, the University opened the Phillips Neighborhood Clinic (PNC) to help change this dynamic. Students from five of the Academic Health Center’s six schools staff and govern the clinic, which operates out of a church basement two nights a week. University faculty members and community practitioners donate their time to oversee the students.

This year, two public health students, Liz Hackenmueller and Mac McCullough, are co-chairing the PNC board for the first time.

Hackenmueller is in her second year in the Master of Healthcare Administration program. “I come from a small town, and it is always about helping out your neighbor,” she says. “The clinic follows the same line.

[As board members], we are responsible for this clinic. If it fails, where are these people going to go?”

Students involved with PNC get an experience that would be hard to come by in another setting, and it is a critical learning opportunity for them.

“It’s one thing to volunteer at a food shelf, which I’ve done. It’s another thing entirely to figure out how to manage and provide high-quality care that’s indistinguishable from that given a few blocks away at Abbott or Children’s Hospital,” says health policy student McCullough.

Team Flu at MDH headquarters

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research news

Heart Health Linked to Dementia Heart health in middle age is linked to brain health in later life, finds a study led by SPH assistant professor Alvaro Alonso.

Researchers looked at the association between cardiovascular risk factors—smoking, high blood pressure, and diabetes—and risk of hospitalization for dementia. Data was collected from 1990 to 1992 from 11,151 participants, 46 to 70 years old. The research team tracked participants until 2004 to see how many were hospitalized for dementia.

Smokers were 70 percent more likely to develop dementia than nonsmokers; those with high blood pressure were 60 percent more likely; and those with diabetes were twice as likely as those without diabetes to develop dementia.

There was no link between midlife obesity and later dementia.

The findings add to a growing body of evidence linking cardiovascular risk factors and risk for dementia, and they

Drink Your Milk!

Global H1N1 Studies Launch

Young people aren’t getting enough calcium, according to recent SPH research.

The percentage of those failing to meet daily calcium recommendations:

Researchers have started enrolling participants in two worldwide studies of the H1N1 virus. The observational studies will be used to get a clearer picture of the prevalence of the disease and the characteristics that lead to severe cases.

Over the next several months, up to 5,000 patients with H1N1 who seek medical care will be tracked for two weeks.

And 1,000 patients who are hospitalized with severe cases will be followed for two months. The two studies will take place at up to 100 sites on six continents.

The sites are part of INSIGHT, a network of researchers led by SPH professor James Neaton. Over the past eight years, INSIGHT has enrolled more than 10,000 patients in the world’s largest HIV clinical trials.

This is the first time the INSIGHT network has investigated an infectious disease other than HIV. While those who develop complications of influenza often have underlying health conditions, there are a growing number

Teens

72% 55%

of females of males

Young Adults

68% 53%

of females of males

Complete findings published in the Journal of Nutrition Education and Behavior.

10 University of Minnesota School of Public Health

of severe cases and deaths in apparently healthy individuals. By tracking the medical histories and treatments of patients worldwide, new patterns of risk factors for treatment complications may emerge.

The INSIGHT team will also create a central repository of patient specimens for virus characterization. This will allow researchers to study viral mutations and antiviral resistance that may occur with treatments for influenza.

The studies were designed in less than a month, a testament to efficiency of INSIGHT researchers and other influenza experts, including Minnesota state epidemiologist Ruth Lynfield, who is co-chairing one of the studies. Findings are expected to start rolling out in the next few months, just in time for flu season to hit the southern hemisphere.

The information gleaned from the studies will help policymakers respond to the pandemic and plan for future influenza seasons.

Illustration by matt foster

point to a need for long-term prevention efforts.

Smoking Bans Do Not Lead to Job Losses Smoking bans do not significantly affect employment in bars and restaurants, according to research from the School of Public Health and Ohio State University.

Though the economic effects of smoking bans have been studied in many individual communities, this is the first analysis to compare the economic effects of various smoking ban policies—from full bans to partial bans to no bans—in several communities.

The hospitality industry has long argued that smoking bans cause great financial difficulty for bars and restaurants because of the link between smoking and drinking, says Jean Forster, SPH professor and study coauthor. “They have used that argument to push for exemptions for bars and bar areas of restaurants. We wanted to see if their argument was valid.”

Researchers studied Minnesota employment data to track workforce changes in bars and restaurants from 2003 to 2006, the period before lawmakers passed a statewide ban.

At the time, various municipal laws existed. Some prohibited smoking within areas of bars and restaurants.

Others banned smoking completely.

Forster and her colleagues found little change in total employment in bars and restaurants over the nearly four years they tracked, once the data were adjusted for seasonal and overall time trends. “This study shows that partial smoking bans—which we know do not adequately protect employees— have no economic advantage for hospitality businesses over full bans,” says Forster. “And neither full nor partial bans have a negative impact on employment.”

Vets Bring Aggressive Driving Home

The same aggressive driving used by troops to save lives in war zones is endangering those on American roads, find University of Minnesota researchers.

Researchers surveyed 150 Minnesota National Guard members who had served in Iraq and Afghanistan. They found that within a month of returning home, 25 percent of the soldiers had driven down the middle of a road, into oncoming traffic, or past a stop sign. Ten percent drove erratically through an underpass or tunnel.

More than 90 days after their return, 20 percent were anxious during routine driving.

As a result of the study—led by Erica Stern from the U’s Center for Allied Health Programs and SPH faculty member Todd Rockwood—the Department of Defense is funding a national study of post-deployment driving behaviors.

Heavy-Drinking Colleges Show No Improvement U.S. colleges with the biggest student drinking problems have so far failed to turn the tide, according to a study from SPH assistant professor Toben Nelson.

Nelson’s team focused on 18 colleges that reported high levels of heavy drinking and related problems in a 1993 survey and found that little has changed since then. The percentage of students who reported binge drinking went from 58 percent in 1993 to 56 percent in 2005. The percentage of students who said they frequently binge went from 28 percent to 32 percent.

Nor was there progress in the behaviors that often go hand-in-hand with excessive drinking, such as physical injuries, unprotected sex, and drunk driving. For instance, in the 1993 survey 37 percent of students said they had driven after drinking. In 2005 the figure was the same.

Nelson says parents can play a key role in addressing the problem. “Not all colleges are the stereotypical heavy-drinking campus,” he says. “Parents can help their child identify a college environment that will support healthy behavior.”

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school news

Keeping the World Working During the H1N1 Pandemic While uncertainty looms large over the H1N1 influenza pandemic, there are some hard realities that businesses should keep in mind when planning for the months ahead. SPH professor Michael Osterholm shares a few lessons to come out of a recent summit that brought nearly 250 professionals together with the aim of sharing pandemic planning practices and resources. Osterholm’s Center for Infectious Disease Research and Policy (CIDRAP) organized the two-day event.

• Let sick workers stay at home. This may be the best tactic for controlling the spread of disease and holding down overall absenteeism. Consider making extra sick days available and suspending policies that require employees to bring a physician’s note to account for illness.

• Communication is key. Keep in close contact with local public health authorities.

Throw information at fear by making plans transparent, communicating to families as well as employees, using multiple communication vehicles (not just websites), and accounting for different languages and cultures.

• With supply chains, government trumps business. Border closings could put supply chains in jeopardy. Will workers have access to government-acquired vaccine in places such as India or China? What if absenteeism rises and government actions cause business delays or closings? Plans need to account for these possibilities.

Download an HR Toolkit With support from the CDC, CIDRAP has collaborated with the Society for Human Resource Management to offer an extensive kit of human resource tools, tips, and protocols useful for any sized business in pandemic planning. www.cidrapsource.com/hrtoolkit

Brad Carlin Named Head of Division of Biostatistics

The SPH has appointed Brad Carlin head of the Division of Biostatistics.

Carlin, who has been a professor in the SPH since 1991, will take over as division head in May 2010. He will work with other SPH leaders to solidify the division’s ranking as one of the top biostatistics units in the nation.

“I’m looking forward to working with colleagues across the University of Minnesota,” says Carlin. “More and more, it’s critical for biostatisticians to collaborate across the health sciences. Our division has a good track record of this sort of collaboration in the broader areas of clinical trials and environmental health, as well as the study of complex chronic conditions such as cancer, heart and

12 University of Minnesota School of Public Health

lung disease, and HIV/AIDS.” Carlin takes over for SPH professor John Connett who, after serving as head of the division for nine years, is stepping down to devote more time to his own research interests, which focus on clinical trials and lung health.

“Brad’s energy and critical thinking will be an asset to the division and the entire school,” says SPH dean John Finnegan.

“I’m looking forward to working with him in this next stage of his career and in this next chapter of division leadership.”

Carlin’s research interests include statistical applications in AIDS research, clinical trial monitoring, and public health data that are geographically indexed. He is an expert in Bayes and empirical Bayes methodology, and Markov chain Monte Carlo methods.

SPH Food Safety Expert Calls for Vigilance Recent news that some of the healthiest foods may also be the most likely to cause food-borne illness underscores the need to increase food safety standards, says Craig Hedberg.

The School of Public Health professor was called to be an expert commentator for a study conducted by the Washington, D.C.-based Center for Science in the Public Interest. The group analyzed data from the Centers for Disease Control and Prevention on food illness outbreaks dating back to 1990 and came up with the top ten riskiest foods regulated by the Food and Drug Administration (FDA). (Meat is regulated by the U.S. Department of Agriculture.)

The list accounts for nearly 40 percent of all food-borne outbreaks among FDA-regulated foods:

Illustration by matt foster

SPH Professor Testifies at Hearing on Childhood Obesity Nearly one-third of children and adolescents are overweight or obese. That’s one of the troubling facts presented by SPH professor Mary Story at a Congressional hearing on children’s health issues.

Sen. Amy Klobuchar presided over the hearing as chair of the Environment and Public Works Subcommittee on Children’s Health. She called for efforts to increase access to healthy foods and opportunities for physical activity. “And that starts in our neighborhoods and schools,” she said.

As one of the four hearing witnesses, Story discussed the barriers to healthy foods and safe places for recreation faced by those in low-income communities. She also outlined a need to address school environments by creating stronger nutrition policies and increasing physical activity programs.

“We must remove the barriers to ensure that the healthy choice is Mary Story and the easy choice,” she said.

Sen. Amy Klobuchar Story directs Healthy Eating Research, a national program of the Robert Wood Johnson Foundation that supports environmental and policy strategies to reduce childhood obesity.

Both Klobuchar and Story highlighted the economic need to address the obesity epidemic. In written testimony, Story cited estimates that medical costs to treat obesity and related conditions may be as high as $147 billion per year.

1. Leafy greens 2. Eggs 3. Tuna 4. Oysters

5. Potatoes 6. Cheese 7. Ice cream 8. Tomatoes

9. Sprouts 10. Berries

The group doesn’t recommend that consumers change their eating habits, rather that Congress beefs up safety enforcement in the food industry. “We need widespread public health surveillance to detect these emerging outbreaks and a strong regulatory response to help industry develop prevention strategies,” says Hedberg.

Several bills are circulating in Congress that strive to bolster food safety by requiring food producers to develop formal safety plans and giving the FDA more power to inspect plants and enforce rules.

There is only about one food-borne illness for every 3,000 to 4,000 meals eaten in the United States. “On a relative scale, our food supply remains quite safe,” says Hedberg. “Because most people don’t experience a bad outcome, food safety standards are difficult to enforce.”

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school news

U Part of Team Awarded $185 Million to Fight Emerging Pandemics Experts from the University of Minnesota will soon be on the frontlines working to help developing countries better respond to emerging infectious diseases that pose a threat to human and animal health.

The University is part of a team that will implement a United States Agency for International Development (USAID) cooperative agreement with funding up to $185 million.

U experts will travel to global hot spots—likely located in Southeast Asia, South America, and Africa—to participate in classroom and web-based education programs with in-country partners. The

aim is to better respond to emerging zoonotic pandemics—diseases that can spread between animals and humans, such as SARS, avian flu, or the Ebola virus.

The project, known as RESPOND, is headed up by faculty in the College of Veterinary Medicine. But it also taps experts from various academic fields, including public health, nursing, medicine, education, and natural resources. SPH associate dean for education Debra Olson will serve as associate director for the project and SPH professor Bill Toscano as a regional lead. SPH faculty members Claudia Munoz-Zanzi and Randy Singer will also

contribute to the work.

“We’re proud to be a part of this initiative,” says SPH dean John Finnegan, who serves on the project’s advisory committee. “Central to our school’s mission is the notion that human, animal, and environmental health are inextricably linked and that efforts to improve health must be global in scope.”

The University is teaming up with Development Alternatives Inc. (DAI), a Washington, D.C.-based firm, and Tufts University. The team will work with U.S. government agencies, international organizations, and private industry.

Culinary School Named After U Pioneer Ancel Keys, the man who taught the world how to eat healthy, now has a culinary school in his name. It’s just a few miles from the Italian villa the pioneering U researcher and his wife, Margaret, took as a second home—a place where the couple promoted the Mediterranean diet, which they had proved to be among the healthiest in the world.

Keys first visited the area around Naples in 1952 after hearing claims that working-class men there rarely had heart attacks.

That trek launched the Seven Countries Study, the first to link the diets and health of different cultures. Keys found that heart disease was rare in Mediterranean and Asian regions where people ate mainly vegetables, grains, fruits, beans, and fish.

The findings—which landed Keys on the cover of Time magazine in 1961—prompted him and Margaret to write two bestselling cookbooks on Mediterranean cooking.

SPH professor emeritus Henry Blackburn, who collaborated with Keys as SPH faculty, spoke of his legacy at a scientific symposium in Italy that drew some 250 people from all corners of the world. The naming of the school was held in connection to the symposium.

Keys himself was a testament to the benefits of eating well.

He died at the age of 100 in 2004, having published his last paper at the age of 97.

Carrie D’Andrea, the Keyses’ daughter, traveled to Italy to dedicate the school in her father’s name. She says her parents would be pleased that the attention is focused on their work.

“It’s a ripple effect,” she says. “The students at the school will be educated on the Mediterranean diet, and they will pass that knowledge on in their careers.”

14 University of Minnesota School of Public Health

Cookbook royalties enabled Ancel and Margaret Keys to build a home in southern Italy, where they ate nourishing Mediterranean meals.

Faculty Awards and Appointments R.K. Anderson has received the George T. Angell Humanitarian Award from the Massachusetts Society for the Prevention of Cruelty to Animals.

Anderson is an expert in human-animal relationships and environments.

Julie Jacko has been appointed by Minnesota Commissioner of Health Sanne Magnan to serve on the Minnesota e-Health Advisory Committee.

The group is charged with accelerating the use of health information technology to improve health care quality and reduce costs.

William Riley has been elected vice chair of the Public Health Accreditation Board (PHAB).

PHAB is developing a national voluntary accreditation program for state, local, territorial, and tribal public health departments. The goal of the program is to advance the quality of public health departments.

Deborah Swackhamer has been reappointed

by Gov. Tim Pawlenty to Minnesota’s Clean Water Council, created by the legislature to provide advice on how to implement the state’s Clean Water Legacy Act. Swackhamer has been a member of the council since its inception in 2006.

Swackhamer has also received the Founders Award from the Society of Environmental Toxicology and Chemistry (SETAC) in recognition of outstanding career accomplishments. SETAC is a nonprofit international organization dedicated to improving the environment through science.

SPH Delegation Meets with Partners in India SPH professors Bill Toscano and Kumar Belani and assistant dean Diana Harvey were part of a University of Minnesota delegation that traveled to India earlier this fall to advance existing partnerships and forge new collaborations.

In Bangalore, the team met with leaders from Rajiv Gandhi University of Health Sciences to discuss offering an MPH degree in global public health practice. “There is an urgent need for advanced public health education in India,” says Toscano, head of the SPH’s global programs.

“We are eager to partner with colleagues in India to address this need and build public health capacity there.”

The New Delhi agenda was a full one. Alumni from many U programs celebrated the launch of the Friends of the University of Minnesota program. The delegation met with the federal-level University Grants Commission to explore ways for the University of Minnesota to offer joint degrees with institutions in India. Senior vice president for health sciences Frank Cerra co-chaired a meeting with the director-general of the Indian Council of Medical Research (ICMR) to move this partnership to the stage where it will fund research projects proposed by Indian and U.S. co-investigators in the areas of cancer and diabetes. The ICMR is equivalent to the U.S. National Institutes of Health.

The delegation wrapped up its visit with a stop in the northern state of Haryana, which enjoys a “sister state” relationship with Minnesota.

There the group explored opportunities for collaboration in veterinary medicine, higher education, and public health.

Michael Osterholm has been appointed to chair the Global Agenda Council on Pandemics, an initiative of the World Economic Forum.

Osterholm will work with other pandemic preparedness experts to create a central, global authority on the issue by looking at current pandemic patterns, preventive measures, and risk assessment.

15

alumni news Share Your Thoughts on the Future of Public Health It’s exciting to be serving as president of the SPH Alumni Society Board in an era of immense growth and equally immense challenges.

While the school has grown by record numbers in the past decade, the future is much less certain. State funds continue to dwindle, as expectations for privately sourced support continue to rise.

We’ve made a great start toward ensuring future students’ success with the Alumni and Friends Scholarship Gala, which over the past two years has raised more than $100,000 for the School of Public Health Alumni Scholarship Endowment.

The alumni society would like to build on this event’s success by engaging a broader base of SPH graduates in other ways.

We’re planning to identify the elements of an alumni society that matter most to you, in order to build a network that will benefit your own career.

To do that, we want to know how you’d like to engage with the school and fellow alumni. We’re developing an online survey where you can share your perspectives and ideas. The survey will be released in early 2010.

You can sign up to receive the survey by joining the SPH Alumni Network at www.sph.umn.edu/alumni. The network is also a great way to keep up to date on SPH events and connect with past schoolmates.

I hope you’ll join our conversation on how we can best connect with you and, at the same time, support the next generation of public health leaders.

I look forward to hearing from you.

Brigid Riley (MPH ’98)

Anna Sommers: Making

“ I’m betting that we will succeed this time around.

Even if policymakers take a few missteps, they can be sure that our nation’s well-trained health researchers and health economists will tweak it until we get it right.”

Strides Toward Health Insurance Reform When SPH alum Anna Sommers was a teenager, she was diagnosed with cancer.

And as a young adult, she couldn’t get insurance on the individual market for three years because of that preexisting condition. “[This experience] opened my eyes to the problems the uninsured face every day, especially the stigma of asking for care without the means to pay for it,” says Sommers.

After the failed health care reform efforts in the 1990s, Sommers wanted to be ready to play a role when legislators considered reform again. So she came to the SPH to get her doctorate in health policy and now works at the Hilltop Institute at the University of Maryland, evaluating public health insurance expansions. Currently, she’s leading a study evaluating the State Coverage Insurance program in New Mexico, which provides coverage for low-income adults.

“At Hilltop I receive direct feedback from policymakers about what’s useful in our evaluation, how they’re interpreting it, and how they’re going to translate it into program changes,” says Sommers.

SPH faculty instills in students that “sound policy requires sound research,”

16 University of Minnesota School of Public Health

says Sommers. “It’s my job now to make sure the data and research I’m conveying is as accurate and close to the truth as it can be.”

Sommers has high hopes for reform.

“I’m betting that we will succeed this time around,” she says. “Even if policymakers take a few missteps, they can be sure that our nation’s well-trained health researchers and health economists will tweak it until we get it right.”

Donna Anderson:

Class Notes Megan Alavi (MPH ’07) is a public health analyst in the Office of Rural Health Policy, part of the Health Resources and Services Administration (HRSA). She took the position after serving as a HRSA Scholar for two years.

James Anderson (MHA ’68) was elected to the board of trustees for the Minnesota Medical Foundation. Anderson, who is chief administrative officer emeritus of the Mayo Clinic in Arizona, will serve a fouryear term. He joins fellow alum Mark Eustis (MHA ’79) on the board.

Andrea Johnson (MPH ’07) is a health and wellness coordinator at Aramark. She provides support to students and nutritional guidance for the University of Minnesota’s dining services.

Pamela Jo Johnson (MPH ’99, PhD ’04) is a senior statistician in the Research Consulting Unit at the Center for Healthcare Innovation.

The center supports clinical and health services researchers across Allina Hospitals and Clinics.

Bridging Community and Classroom Tiffany Radcliff (PhD ’00) has been promoted to associate professor in the School of Medicine at the University of Colorado Denver. Her research interests include access to care, market forces on health care delivery, and quality of care.

Erin Roche (MPH ’09) has earned the Certified Public Health credential after successfully completing the exam administered by the National Board of Public Health Examiners.

Adam Atherly (PhD ’98) has been appointed chair of the new Health Systems, Management and Policy department at the University of Colorado Denver School of Public Health. Atherly is an expert in health economics.

Kathleen Harriman (MPH ’04) is chief of the Vaccine Preventable Disease Epidemiology Section of the California Department of Public Health.

Elizabeth Hutchinson (MPH ’09) is a monitoring and evaluation specialist at Minnesota-based Land O’Lakes. She supports a field staff working in 20 countries on projects that improve health and alleviate poverty.

Traci Mouw (MPH ’05), center, is joined by Amy Subar (MPH ’79) and Akira Fujiyoshi (MPH ’07) at a nutritional epidemiology course hosted by Imperial College London. Mouw is a research officer at Imperial College; Fujiyoshi, a doctoral student at Shiga University of Medical Science in Japan; and Subar, a research nutritionist at the National Cancer Institute in Washington, D.C. The three alumni, who had never met before, realized over dinner that they had each attended the SPH. Says Mouw, summing up the experience: “[We represented] three continents, one table, and one very good graduate school.”

Donna Anderson’s (MPH ’71) alumni service to the SPH began modestly—with a guest lecture in the early 1970s. Though no one could have guessed at the time, that lecture would launch a career-spanning endeavor to connect public health practice to the school. Nearly four decades later, Anderson received the University of Minnesota Alumni Service Award in recognition of her efforts. She was one of 13 alumni presented with the prestigious award during the U’s homecoming events in early October.

Anderson has served in virtually every alumni role for the SPH—a mentor to students, an adviser to faculty, and the school’s first alumni society president, to name a few. Outside of the school, she has been a top administrator in local public health agencies for nearly 40 years.

Connect with the SPH! Connect with classmates, learn about SPH events, and share your news at www.sph.umn. edu/alumni.

Don’t forget to sign up for Alumni News, a monthly e-publication.

17

420 Delaware Street SE Minneapolis, MN 55455 www.sph.umn.edu

Is coffee bad for you?

Here’s a perk: it may be good for you. SPH researchers have found that drinking four or more cups per day may lower the risk of Type 2 diabetes by 22 percent—or 33 percent for decaf drinkers.

A healthy diet and exercise are still key to preventing diabetes.

But it may be time to rethink the notion that coffee does more harm than good. So drink that Joe!

Non-profit U.S. Postage PAID Permit No. 155 Minneapolis, MN

Make Your Public Health Statement: Create a PSA

Create a 30-second health message and win $500. www.sph.umn.edu/psa

SPH Experts Discuss Health Care Reform at Minne-College

Join friends and alumni of the U at this networking and educational event.

January 23 Naples, Florida www.sph.umn.edu/naples

Former Justice Department Prosecutor Talks Big Tobacco

Sharon Eubanks, the lead trial lawyer in the government’s lawsuit against the tobacco industry, delivers the school’s annual Gaylord Anderson Lecture.

February 19, 10 a.m.

Weisman Art Museum www.sph.umn.edu/gaylord