Advances - Spring 2010

advances Spring 2010

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

Aging America Are We Ready? > Drop the Pop! > Grading Health Care Reform > What Haiti Can Teach Us > New Hope for School Lunch

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

Bradley Carlin Head, Division of Biostatistics Bernard Harlow Head, Division of Epidemiology and Community Health

Dear Friends, As a member of the baby boom generation, I read the “Aging America” cover story with great interest. We are a graying bunch to be sure. Yet with the strength of our numbers, we have the potential to redefine retirement and put a different shine on the golden years. SPH researchers are studying ways to make this possible. Read all about it beginning on page 2.

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

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The school continues to stay engaged with two of the biggest news stories of the past year: the passage of historic health reform legislation and the devastating earthquake in Haiti.

On page 14, SPH faculty help make sense of the new law. On page 7, two SPH students do their part to provide health care in Haiti and learn important lessons about the spirit and resiliency of the Haitian people and their own personal and professional reserves.

I offer my warmest congratulations to the graduating class of 2010 (see page 11) and welcome its members into our global community of alumni that is nearly 8,000 strong. I urge you to make connections with your fellow alumni and stay engaged with the SPH. We strive to be your best resource for lifelong learning and career development.

As we approach the end of our fiscal year, I am delighted to report that we have raised a record number of private donations in the last 12 months. Thanks for your generous support of our programs and, more importantly, our students. In the face of drastically reduced state funding of the University of Minnesota and the attendant rise in tuition, your gifts mean more than ever.

Yours in health,

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

John Finnegan Dean

Spring 2010

contents

Features 2 Aging America: Are We Ready?

8 Research News

16 Alumni News

Red, white, blue ... and gray. The boomers are about to hit retirement age, bringing big changes to our economy, health care, and home life.

Uncovering the impulses that lead to addiction; teens falling woefully short in the whole grains department; helping cancer patients get back on the job; and more.

Highlights from the Alumni and Friends Scholarship Gala; class notes; and a call for mentors.

7 Lessons From Haiti Working around the clock in a Haitian orphanage-turned-hospital, two doctors care for earthquake victims in the weeks following the disaster.

14 Health Care Reform: What Now?

Cover llustration by adam niklewicz

Departments

That 2,000 page bill became a law.

What happens next? Changes to look for in the way health care is financed, delivered, and accessed.

10 School News Big funds for training in health informatics; a $1 million scholarship bridges clinical care and community health; commencement coverage; and more.

13 Student News Ania Urban leads student senate; and an SPH team takes top honors at a national competition.

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2 University of Minnesota School of Public Health

Aging

America Are we ready?

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and colleague, SPH professor Rosalie Kane, another noted expert on aging. She, too, sees this as a time of “enormous positive changes” for long-term care.

That’s good news, considering that estimates put seniors needing some sort of long-term care in the coming years at 50 to 70 percent. Work like that of the Kanes means many of these services can be delivered in the home or in other community settings.

Robert Kane worked on the design of a Minnesota initiative that targets short-stay nursing home residents with the aim of helping them transition back home.

The program connects residents and their families to community workers who help facilitate the move. Once home, indivi­duals are tracked for health and quality of life.

The program has just been launched, and Kane’s group will be charged with evaluating its progress.

Over the past five years, Rosalie Kane has worked with several different states to shift long-term care programs to a community-care approach. Some states have adopted a “money follows the person” strategy, where residents leave institutionalized care and apply state funds to homebased services. “We used to see a top-heavy model,” says Kane, in reference to nursing home regulations about Community Living licensing and staffing. “But if money can go directly to the consumer, there’s more flexibility [to seek care outside As we prepare for an aging population, we can be grateful of institutional settings].” that the past decade has brought major gains in improving Along with SPH research associate Lois Cutler, Rosalie how older people live. “We’ve turned a corner,” says SPH Kane has led evaluations of Green professor Robert Kane. “We’re now Houses and other “small house”more committed to providing long Calling for Change style homes. These facilities term care in community settings, so to Traditional Care are built on the notion that people can live in environments that older people will thrive if their are more like home.”

Robert and Rosalie Kane are leading environment resembles their own Kane, an internationally known several initiatives that measure quality of life for nursing home residents, their home. Often located in residential expert on aging, has written more families, and the staff that care for them. neighbor­hoods, these homes feature than 30 books and 300 articles on www.sph.umn.edu/ltc private bedrooms, carpeted living the subject over the past 30 years. rooms, and green lawns. Up to 10 He often collaborates with his wife

he United States is home to 39 million people over 65, nearly 13 percent of the population. That percentage is about to get bigger very quickly.

Next year, the oldest of America’s 76 million baby boomers—those born from 1946 to 1964—will turn 65, and they’ll keep coming until 2029. By the year 2050, one in five Americans will be 65 or older. By then, the “oldest old,” those 85 and older, will have grown by 377 percent.

On top of this, the birth rate in America has been lagging behind the death rate. This means our older demographic is growing not just absolutely, but also relative to the general population.

Graying brings major implications. There will be fewer children to care for aging parents. The ratio of workers to retirees is significantly shrinking, crippling the financing of critical programs such as Medicare and Social Security.

Care for chronic conditions such as heart disease, diabetes, and cancer will likely continue to occupy more and more of our health resources. And we still have a long way to go in providing quality long-term care for all who seek it.

All this change is prompting many to ask if we’re ready to meet the needs of an older America.

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“ We’ve turned a corner,” says SPH professor Robert Kane. “We’re now more committed to providing long-term care in community settings, so people can live in environments that are more like home.” residents live in each Green House, where they share family-style meals. Staff members are often assigned to a single house and tasked with a more holistic approach of caring for residents. Kane found that residents of these homes are happier and healthier than those in traditional facilities.

Getting Math and Priorities Right If you asked most people about U.S. life expectancy, you’d hear a number around 78. But that figure is misleading. It’s true that one’s life expectancy at birth is in the mid to late 70s. It’s a calculation that accounts for all the unexpected things that cut life short—car accidents, cancer, heart disease. But those who make it to age 70 are actually expected to live, on average, 15 more years. Eighty-year olds are expected to live eight more years. And those who make it to 90 have five more years of life expectancy. Estimating years lived from one’s current age is called conditional life expectancy, and it’s a method that’s often overlooked.

“In theory, we think someone who’s 70 is going to be dying soon. But at the same time that seems counterintuitive when we look around and see all these healthy 70-year-olds. The reason is we’re not using our math right,” says SPH professor Beth Virnig.

Short-changing the lifespan of older Americans means they’re

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often undertreated and overlooked when it comes to health care, says Virnig. Health screenings guidelines, for instance, often stop at age 70 or 75. And research has shown that the older you are, the less likely you are to receive aggressive care for cancer. Those decisions most likely are based on age, not an individual’s health status. “Health status usually predicts outcomes, but not age itself,” she explains. “A healthy 78-year-old will have different outcomes than an unhealthy 60-year-old. We need to base our decisions on health, not age alone.”

If we get the math right, perhaps better health policy will follow. But for now, says Virnig, “When it comes to health care for someone later in life we should be doing a whole lot more for a whole lot longer.”

Vitality Compass While the methods of calculating life expectancy may be off, the main question for most of us is not directed to the general population but rather, “How long am I going to live?” Having a personalized estimate of our own lifespan would certainly be a powerful tool in making healthy choices as we age. That’s the idea behind the Vitality Compass, an online longevity calculator developed by SPH professor Robert Kane and National Geographic explorer Dan Buettner.

The 35 questions of the Vitality Compass (www.

Read about how bluezones.com) are based Dan Buettner on a complex algorithm worked with SPH created by Kane and experts to add years of life designed to tell individuals to a Minnesota town. their overall life expect­ www.sph.umn.edu/albertlea ancy, their healthy life expectancy, and their Blue Zone years—the number of years one can gain or lose to current health habits. The tool is meant to be a motivator for good health.

“The results confirm what we’ve known for years,” says Kane.

“The challenge is to get people to use it to change behavior. Most of us know what we ought to do, but we have a hard time doing it.”

When Social Security was created in the 1930s most people didn’t live to be 65. It was never intended to be what it has become: the primary longterm source of retirement income.

Rethinking Retirement It’s no secret that social welfare programs like Medicare and Social Security are in financial trouble. Medicare is forecasted to be bankrupt around 2017 and Social Security in 2037. But health economist Roger Feldman says never mind the forecasts—the programs are bankrupt now.

“People have a misunderstanding about these programs [because] they focus on their trust funds, which are merely an accounting device, a place to store the money,” says the SPH professor. “Forecasting when the trust funds will run out of money is irrelevant. We should be looking at the bigger picture: the long-term income and expenses of the programs. When we do that, it’s clear that more money is going out than coming in.”

Neither raising taxes nor cutting other government programs will generate the massive funding needed to keep these programs going (see sidebar, page 6). Feldman looks at the history of the programs to offer insight into their future. When Social Security was created in the 1930s most people didn’t live to be 65. It was never intended to be what it has become: the primary long-term source of retirement income. At the least, Feldman believes we need to raise the retirement age to keep pace with life expectancy. But the changes have to run deeper than that.

“Only when we get over the idea that retirement means the cessation of work, will we be ready to make changes to these programs,” says Feldman. “We need to rethink retirement. It could mean lifelong work, education, or community service.” This means we might also have to rethink employment and work to create jobs that people will want to do in older age.

“I’m talking about re-envisioning what it means to live from age 65 to 85 in this county,” says Feldman. “It’s crystal clear, we can’t tax our way out or cut other programs. We need to redesign the programs completely and rethink the concept of retirement.”

Keys to Optimal Aging While there’s a wealth of research focused on the unhealthy aspects of aging, there is scant scientific evidence on the factors that promote optimal aging. Kristine Ensrud, a University of Minnesota professor of medicine and epidemiology, is working to change that.

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Caring for Family Members: What you Need to Know Robert Kane is one of the world’s top experts on long-term care. But when it came time to care for his ailing mother, he couldn’t get the system to work right. He penned a book to help others in similar situations, It Shouldn’t Be This Way: The Failure of Long-Term Care. He’s following it up with a caregiver’s guide, due out next year, on tools for navigating the world of long-term care.

Kane shares some basic tips on where to start.

•Y ou are in good company. Almost 90 percent of long-term care is provided by family members.

•L ong-term care is a long process. Pace yourself and be patient. Know how to get help.

• It’s expensive. Get a clear picture of the financial health of your parent. Know how much you’re willing to spend. Look into whether you qualify for public assistance.

•Y ou are the only true advocate. Realize that hospital-based workers aren’t necessarily there to help you. Their priority may be to the needs of the hospital.

Medicare and Social Security: How Bad is it?

If the two biggest social welfare programs in our county are bankrupt (see page 5), what would it take to get them in the black again? SPH health economist Roger Feldman offers some perspective.

• M edicare is $32 trillion in debt, an amount more than twice the GDP of the United States.

• To pay off the Medicare debt, every American worker would need to fork over his or her paycheck for the next 835 days.

• Medicare solvency could be achieved if the entire federal government—minus Medicare—shut down for 13 years.

• In 2008 there were 3.2 workers for every Social Security beneficiary. By 2030, that ratio will be 2.2 to 1, and it will continue falling until it reaches about 2 to 1 in 2040.

• The current Social Security tax rate will only pay for 74 percent of scheduled benefits.

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“ Only when we get over the idea that retirement means the cessation of work, will we be ready to make changes to these programs,” says Feldman. “We need to rethink retirement. It could mean lifelong work, education, or community service.”

For more than 20 years she’s led the Minnesota site of a national study on risk factors for osteoporotic fractures among older women.

A total of 7,760 women aged 65 and older initially enrolled in the study between 1986 and 1988. Of that group, more than 2,300 have survived. With 20 years of data on hand and access to a group whose average age is 90, the researchers have a unique vantage point to understand what helps us live long and live well.

Next year, Ensrud’s team will launch a five-year study of the group to improve our understanding of successful aging. The researchers will examine potential indicators of optimal aging such as bone density, body weight, cognitive function, physical performance, and “positive affect”— a measure of one’s optimism and resiliency. They’ll combine 20 years of study data with Medicare claims data to get a clearer picture of who’s living free of major disability or disease at ages 90 and above. Ensrud says this study is one of the few to proactively look at healthy aging.

“Most studies that have focused on successful aging have looked only at individuals who have survived to 100 or more years of age,” says Ensrud, noting that in these studies information is obtained by interviewing centen­arians about their health habits retrospectively, not actively as with Ensrud’s study.

Not surprisingly, the women in the Minnesota cohort, whose ages range from 82 to 105, paint a picture of how

many of us would like to live in our later years. Three-fourths of them live independently and have a good positive affect. About 70 percent have had no hospitalizations in the past year.

And 40 percent still walk for exercise.

Even with their high levels of engagement and optimism, Ensrud says she’s still surprised by how committed the women are to the study. She shares anecdotes of participants who have 20-year relationships with study staff members and others who come to clinic exams despite limited mobility.

But then she considers what many of them have already experienced.

“These women lived through the Great Depression and World War II. [Those experiences] probably fuel their willingness to participate and volunteer,” she says. “They’re so motivated. If they think it’s time for a follow-up, we’ll often get a call asking ‘When can I come in again?’”

Seizures in Nursing Homes: Uncovering a Troubling Reality About 13 out of every 10,000 American elders living on their own experience epileptic seizures.

U researchers have discovered that number is a 12 times higher for nursing home residents. Learn about the factors behind this startling discovery. www.sph.umn.edu/seizures

Lessons from Haiti

Photo by Paula Keller

Two physicians get back to their medical roots and bring a new perspective to their public health education.

“Lespwa fe vir” or “by hope we live” read the handwritten note tacked to a wall of the makeshift hospital where Abe Jacob and Anjali Goel worked following the earthquake that hit Haiti earlier this year.

Working with Heartline Ministries, the two doctors started serving several weeks after the January earthquake—a time when care was shifting from acute to chronic. They saw complex fractures, gangrenous wounds, malaria, typhoid fever, and pneumonia. In a country with sparse health care, they were also called to deliver babies at a moment’s notice, make HIV and cancer diagnoses with little to no medical equipment, and save lives with a handful of medicines.

Despite being overwhelmed at times with the devastation and poverty, Haiti has reminded Jacob and Goel, both pediatricians, why they chose their career. “There is something so rewarding about practicing medicine this way,” says Goel. “You use your intuition more. You sit and talk with patients. You come out of your medical role.” Says Jacob: “I didn’t look at a computer once.”

At the same time, the experience reinforced the value of a solid health care system. “The devastation is even worse because Haiti doesn’t have a public health infrastructure,” explains Jacob, a student in the Executive Master of Healthcare Administration program. “The next phase [of response] has to be workforce training to implement systems of care delivery.”

Goel agrees. “They have skilled doctors [in Haiti],” says the Maternal and Child Health MPH student. “But they don’t have effective systems.”

Both Goel and Jacob are quick to credit their colleagues for covering clinic and hospital shifts back in Minnesota. And they’re grateful to their spouses for keeping home life running smoothly— no small feat, considering Jacob’s six children and Goel’s four. “Supporting us, was their gift to Haiti,” says Jacob.

Abe Jacob and Anjali Goel with a photo of a new mother and her baby girl, Nedje, one of the many patients they cared for in Haiti.

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research news

Forecasted benefits of health IT may be overstated

Soft drinks may increase cancer risk People who drink two or more sweetened soft drinks a week almost double their risk of pancreatic cancer, finds research published in the journal Cancer Epidemiology, Biomarkers, and Prevention.

Although rare, pancreatic cancer is one of the most deadly forms of the disease. Only 5 percent of people who are diagnosed survive five years later.

Researchers tracked 60,524 men and women in the Singapore Chinese Health Study for 14 years and found that soft-drinkers increased their risk of contracting the deadly cancer by 87 percent. Over the course of the study, 140 people developed pancreatic cancer.

“The high levels of sugar in soft drinks may increase insulin levels in the body, which we think contributes to pancreatic cancer cell growth,” says lead author and SPH associate professor Mark Pereira.

No such connection was found with fruit juice, which has less effect than soda on glucose and insulin levels.

The Singapore findings echo those of previous studies and are likely applicable to people in the United States, says Pereira.

Watch a Public Health Moment video of this research at www.sph.umn.edu/soda.

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While 2010 is the year of reform, those in information technology (IT) would most likely point to 2009 as health care’s big year of change. That’s when the government committed $19 billion to health IT under the federal stimulus package. With those funds set to double by 2016, IT is certain to play an evergrowing role in health care.

But how much will IT improve the way we deliver and pay for health care?

That’s the question behind a recent study led by SPH assistant professor Jeffrey McCullough.

McCullough and colleagues analyzed the effects of electronic health records and computerized physician order entry on six quality measures across academic hospitals and non-academic hospitals. They found that IT in academic hospitals raised quality measures at three times the rate of those in non-academic hospitals.

The findings expose a limitation in the research base used to project the value of health IT. Existing forecasts are often based on large academic hospitals, leaving out smaller non-academic hospitals with fewer resources. As a result, the researchers say that projected benefits of health IT are overstated.

“You can’t take findings from only the top performers and then think they can be applied to other hospitals,” says McCullough.

The researchers suggest that rather than merely subsidizing the purchase of costly health IT tools, federal policies should be crafted to help smaller, average-performing hospitals accurately track and realize the benefits of information technology.

In the meantime, we should be leery of statements exaggerating the promise of health IT. “Many projections of the returns from health IT may overstate what the real benefits will be,” says McCullough.

Young people not eating enough whole grains Teens and young adults are eating less than one serving of whole grains a day, far below the recommended minimum of three servings, according to SPH research.

While the importance of whole grains is well known—they help fight type 2 diabetes, heart disease, and weight gain—much less is known about the factors that encourage their consumption.

As part of the ongoing Project EAT study, SPH epidemi­ologists found the practice of keeping whole-grain bread available at home is associated with higher whole-grain consumption among adolescents and young adults. Conversely, consuming more fast food was related to lower whole-grain consumption.

To encourage whole grains, the researchers recommend that they be more readily available at home, school, and restaurants. And parents and adolescents should be provided with information on how to identify and prepare whole-grain foods.

Understanding the impulses behind addiction

New discoveries to help cancer patients return to work

Thanks to a four-year, $2.4 million grant from the National Institutes of Health, University of Minnesota researchers are examining the role impulsivity plays in addiction.

Research at the Center for the Study of Impulsivity in Addiction will focus on cocaine use and bingeeating disorder—addictions that share behavioral and neurobiological traits.

SPH biostatistics associate professor William Thomas is working with study lead and center director Kelvin Lim, a professor in the department of psychiatry, to analyze data taken from various behavioral and cognitive tests of those enrolled in the study. The team will be looking at whether addiction is a result of behavior, neurobiological impulses, or, most likely, a complex combination of both.

The impulsivity that U scientists and others have linked to various addictions can actually be seen in the brain’s chemistry, so the researchers are also studying MRIs and other types of brain images.

Preliminary data suggests that of the two groups being studied, there are distinct behavioral and neuro­ logical traits among the cocaine users that warrant further study.

What the research team finds could have implications for the treatment and prevention of a variety of addictions.

Cancer survivorship is growing, and with it more people are faced with the difficult task of balancing work and health. But little is known about how to help employers and patients after a cancer diagnosis.

SPH assistant professor Nancy Nachreiner is getting a clearer picture of what happens to workers in the six months following a cancer diagnosis. She tracked 110 women, surveying them on their experience, while also analyzing data regarding their treatment. Funded by the Minnesota Medical Foundation, it’s one of the first studies to combine the perspective of the worker with clinical information about their treatment.

Nachreiner found that the second month post-diagnosis was the peak time for decreasing work hours, mostly to accommodate treatment rather than to deal with symptoms of the disease. While half the women reported that fatigue and nausea hampered their ability to work, only 27 percent requested accommodations to their existing position.

A quarter of the group said they avoided changing their job altogether, due to fear of losing health insurance.

The next step will be to see whether differences exist among different types of cancers. For instance, the challenges of those with cervical cancer may differ from those who have ovarian cancer. “Getting into the details will help us to tailor programs to help employers and employees,” says Nachreiner.

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school news

$5.2 million grant will help train professionals in health informatics Julie Jacko, SPH professor of environmental health sciences, is the lead investigator of a $5.2 million grant to train health professionals in the field of health informatics.

She says that the demand for professionals with health informatics expertise is growing as health care systems transition from paper to digital records, such as patients’ electronic health records and prescriptions.

“Health informatics really matters right now because the workforce is in dire need of people who have expertise in getting technologies in places where it matters to do a better job, a more efficient job, a more cost-effective job of delivering care,” says Jacko.

The grant is part of the American Recovery and Reinvestment Act and was awarded by the Office of National Coordinator for Health Information Technology.

The University Partnership for Health Informatics—a consortium that includes the U of M, University of Minnesota-Crookston, and the College of St. Scholastica—will develop the program and provide the training. Jacko says that it will be running by fall 2010.

She adds that most of the program will be avail­able online.

“The bulk of the funds in this grant are aimed at the trainees in the program,” she says. “It provides them with tuition and with stipends.”

Other University of Minnesota faculty with key roles in the grant include: SPH associate professor Sandy Potthoff; Terrence Adam, College of Pharmacy; Bonnie Westra, School of Nursing; Layne Johnson, Health Science Library; and Rui Kang, Department of Computer Science and Engineering.

Julie Jacko discusses the growth of health informatics: www.sph.umn. edu/ihi. For more on informatics at the U of M go to www.ihi.umn.edu.

Senate considers a $4.5 billion bill to improve school lunches The U.S. Senate is considering a bill that would provide $4.5 billion in new child nutrition program funding over 10 years. The aim of the Healthy, Hunger-Free Kids Act of 2010 is to improve school lunches by providing funding for more nutritious foods and by mandating higher nutrition standards.

SPH professor Mary Story, an expert on nutrition and childhood obesity, provided input to Sen. Amy Klobuchar on the proposed legislation.

The two recently visited a Twin Cities-area school to hear from students and administrators.

“The bill would increase the reimbursement rate for school meals so that schools could serve more fruits, vegetables, and whole grains. And the bill would also strengthen the local schools’ wellness policies,” says Story.

“Very importantly, the bill would establish national nutrition standards for all food sold on the school campus throughout the day.”

Story says the bill would provide needed investment in the fight against childhood obesity.

“Investing in these programs is a down payment on education and the fight against obesity and other serious diet-related diseases.”

To hear a Public Health Moment about this initiative, go to www.sph.umn/edu/lunch.

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Benjamin to grads: ‘You are your neighbor’s keeper’ “You now carry the responsibility for improving the health of your community,” said Georges Benjamin to the SPH class of 2010. “In short, you are indeed your neighbor’s keeper.”

The executive director of the American Public Health Association said public health practitioners must ensure the integration between community health and individual responsibility.

“While it’s important for the individual to improve their nutrition and exercise regularly, it is very difficult to do so if the streets aren’t safe or if there are no stores carrying fruits and vegetables,” he said to an audience at the University’s historic Northrop Auditorium.

Benjamin challenged the 190 graduates to imagine how the health of this country could be improved in the 21st century. He singled out the $15 billion health care reform dollars dedicated to public health efforts as new hope.

But he noted that the field still faces a significant workforce shortage.

Retirement rates in the next five years hover around 50 percent, and some state agencies already have a 20 percent job vacancy rate. “We have gone from 220 workers for every 100,000 Americans in 1980 to 158 workers per 100,000 today,” said Benjamin.

Then he stressed what is perhaps the best news for a graduate to hear: “What this means is public health is a growth industry, and we have jobs for you.”

Commencement photos by Eric Miller, photo of rick norling by paula keller

To hear Benjamin’s commencement address, go to www.sph.umn.edu/lectures/benjamin.

First Premier Richard Norling Scholarships awarded The first round of Premier Richard Norling Scho­lar­ ships was awarded to winners of the CLARION National Case Competition, which recognizes interprofessional efforts among health care teams.

Richard Norling, a 1975 graduate of the Master of Health­care Administration (MHA) program, served as one of the judges for the competition. Norling is now retired after 12 years as president and CEO of the San Diego-based health care alli­ance Premier, Inc. To honor his contributions to the company and to care improvement, Premier made a gift—$15,000 per year for 10 years—to name the Premier Richard Norling Scholarship.

Nine teams from around the country participated in this year’s CLARION competition. Each team includes up to four students and two must be from at least two different health disciplines.

The teams are charged with finding the root cause of a sentinel event and recommending solutions.

CLARION—a University of Minnesota interprofessional student organization in the Academic Health Center’s Center for Health Interprofessional Programs—is designed to give students a “360-degree” look at how collaboration across the health professions can improve patient safety.

“I am very proud to be associated with the CLARION National Case Competition,” says Norling. “This kind of interprofes­ sional education is very promising for our field. It is clear that these students have the potential to make great improvements in health care.”

SPH students process to Northrop Memorial Auditorium.

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school news “ As health care leaders, we have a moral obligation to run the best organization we can. But we have an even larger moral obligation to use our leadership capacity to look after the overall health and well-being of the people in our community.”

Building healthy communities Lowell and Leslie Kruse create a $1 million scholarship fund

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owell Kruse was the youngest student in the Master of Healthcare Administration (MHA) program when he came to the School of Public Health in 1965. He was 21 and had just graduated from Augustana College in Sioux Falls, South Dakota. His wife, Leslie, was 19. They drove to Minnesota in Lowell’s father’s cattle truck with their furniture and six-weekold baby. “We were absolutely clueless,” says Leslie. “We looked like the Clampetts.”

Today, the Kruses are older, wiser, and grateful to have accomplished so much. They share a common goal to raise Americans’ economic, educational, and social well-being to create healthier citizens and healthier communities.

“Our country spends about 17.5 percent of our GDP on health care, and our population just keeps getting sicker,” says Lowell, recently retired CEO of Heartland Health, an integrated health system in St. Joseph, Miss.

The Kruses believe health care administrators must provide the leadership to help reverse that trend, so they created the $1 million Lowell and Leslie Kruse Scholarship to Build Healthy Communities, a gift to the MHA program. The Kruses have given half of their gift, and the other half will come to the University after their deaths. The first installment alone, together with the University’s President’s Scholarship Match, will annually make $50,000 available to MHA students.

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Before Lowell came to Heartland Health in 1984, he had witnessed how poverty and a lack of education can influence health. Then, while developing a first-rate hospital, he saw how little correlation there was between having an outstanding hospital and healthy people. So the Heartland Foundation changed its focus from raising money for the hospital to creating healthy communities. In 2009, Heartland Health received the coveted Malcolm Baldrige National Quality Award and was the single recipient of the American Hospital Association’s Foster G. McGaw Prize recognizing excellence in community service.

“As health care leaders, we have a moral obligation to run the best organization we can. But we have an even larger moral obligation to use our leadership capacity to look after the overall health and well-being of the people in our community,” Lowell says.

As Lowell neared retirement, he and Leslie considered funding a scholarship for the MHA program. Their friend and director of the MHA program, associate professor Sandy Potthoff, worked with Lowell when he was president of the program’s alumni association. She sees a clear need for the scholarship.

“Every year we get students whose hearts are more around keeping people healthy than leading a health care organization,” she says. “But it can’t be either/or. With this scholarship, we can help those students be successful CEOs and engage in the type of leadership that will help create communities strong in education, health, capacity building, and economic vitality.”

A newly designated SPH Distinguished Fellow, Lowell will teach MHA students to forge partnerships with leaders in other sectors to develop collective responsibility for building a healthy community.

“Leslie and I are issuing nothing less than a call to action to figure out a new strategy for health and prosperity in our country,” says Lowell. “It’s going to be harder than putting a man on the moon, and it’ll be a complicated son-of-a-gun, but I’m glad we’re doing it here.”

Photo by TIM RUMMELHOFF

– Lowell Kruse

student news

Ania Urban: Lab scientist and student leader

Ania Urban Photo by Paula Keller

MHA students win national competition A student team representing the Master in Healthcare Administration (MHA) program placed first in the UAB Health Administration Case Competition, held earlier this year at the University of Alabama-Birmingham.

Liz Hackenmueller, David Henriksen, and Rob Sabina presented recommendations for a real-life case in which the organization they analyzed faced financial, organizational, and clinical challenges.

Their presentation, “Positioning Baptist Memorial Hospital for the Future,” recommended a physician partnership and patient-centered model.

“The recommendations that we made in this case were really spot on to what happened in the actual case,” Hackenmueller says. All three credited the faculty and alumni of the MHA program with helping them prepare the case.

The case compe­ tition provides health adminis­tration grad­uate students an opportunity to put knowledge into practice with a real-life, real-time case. This year, 26 programs participated in the competition.

Watch a video of the winners at sph.umn.edu/uab.

Ania Urban is only half joking when she says she pursued leadership in the School of Public Health’s student senate as a way to socialize away from her research lab. It’s true that the doctoral student racks up major time there, studying cancer-causing chemicals. But Urban’s success as senate president suggests that her connection with fellow classmates is fueled by something deeper. She’s working to make the student experience better for not just herself but all who come to the school.

Urban’s efforts were recently recognized with a University of Minnesota President’s Student Leadership and Service Award. The award is given to only one-half of one percent of the University’s entire student body. Soon after that, she received another vote of confidence: a second term as senate president.

Urban says she hopes to build on her first year as president. Along

“ Cancer is such a scientific challenge because it’s unique to each individual.

Why do some people get cancer while others don’t?” with the senate, she’s been working with school administrators to deliver student messages. “It’s so important that students know their voices are heard,” she says.

She also led an effort to establish scholarship funds to support student travel to the annual meeting of the American Public Health Association, a key event for resume building and networking.

Her doctoral work centers on how a tobacco carcinogen (known as NNK) damages DNA, and how that process may lead to cancer. “Cancer is such a scientific challenge because it’s unique to each individual,” she says. “Why do some people get cancer while others don’t? It’s such a complex process.”

While Urban is hoping for a post-doctoral fellowship, she says she would ultimately like a job that combines her knowledge of biological science with public health strategies. “I would love to have a role in translating discoveries,” she says, noting that the senate tenure will serve her well in her career.

“It really shows you what kind of leader you are.”

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Health care reform: What now?

Now that heath care reform is law, what can we expect to see? Three SPH health policy experts weigh in on three major areas of reform.

Financing

Delivery

SPH professor Roger Feldman is a health economist who is a member of the Panel of Heath Advisors for the Congressional Budget Office. He assisted the health reform task force for the Clinton administration and served on the President’s Council of Economic Advisers under Ronald Reagan.

SPH associate professor Daniel Zismer is director of the Executive Master of Healthcare Admin­­istration and Executive Studies programs. Most of his career has been on the provider side of health care, including service on the leadership team of Essentia Health.

Reform’s 10-year $1.1 trillion price tag will be paid for with a near equal mix of new taxes and spending cuts to existing programs, with the biggest cuts being made to Medicare. Feldman says to watch out for impending cuts to Medicare Advantage, a plan available through private insurance that offers more robust benefits than traditional Medicare. “The government used to reimburse Medicare Advantage plans at 15 percent higher rates than traditional Medical,” he explains. “[Once the cuts hit,] some seniors will lose benefits in these plans.”

On the tax side, households with income of more than $200,000 will face new taxes. “This is a major flaw in the design of [reform],” says Feldman, who contends that new taxes should have been used to address the failings of the existing “incredibly in debt” Medicare program. Worse yet, he says, is that taxes won’t kick in until 2014 or 2018, which makes them vulnerable to rescission by a future administration: “I’m afraid the tax increases won’t stick when they come due.”

Changes to financial incentives will result in more mergers of hospitals and clinics, predicts Zismer, as providers move toward creating large, integrated health systems.

It’s a trend the Twin Cities market has experienced for some time now.

This new era will bring a “transfer of risk” from payers to providers, meaning the providers that manage illness and cut down on waste will benefit. “If [providers] can save money, they get to keep it,” he explains. Zismer believes delivery will focus more on teamwork, prevention, home-based care, and online care. Large, resource-rich systems will be able to best make these changes, resulting, Zismer hopes, in improved quality of care.

For consumers, that means fewer independent doctors. There’s also the chance that systems will provide services they can’t do well, in an attempt to retain patients. “But the trend toward transparency will help,” says Zismer.

“We’re not far from electronic consumer tools that compare [the quality of] services across systems.”

Finance Grade:

Delivery Grade:

“ If I knew the taxes would stick, I’d give it a B. But I think they’ll be repealed, so I’m giving a C.”

14 University of Minnesota School of Public Health

“ There are too many unknowns at this point to give a grade.”

Access SPH professor Lynn Blewett directs the State Health Access Data Assistance Center (SHADAC), which helps states monitor and understand trends in rates of health insurance coverage. SHADAC research is often used to shape public policy at the state and federal level.

A key component of the new expansion is that all low-income households (about $29,000 or less for a family of four) will have access to health care coverage through Medicaid. The federal govern­ ment will pay for the expansion for the first few years, starting in 2014. “This is a significant shift in policy to provide a uniform floor for coverage across all states. Currently, only 10 states provide such coverage for low-income adults,” says Blewett. Middle-income households (around $29,000 to $88,000 for a family of four) will receive subsidies to purchase insurance in the private market. The idea is that these families will spend no more than 9.5 percent of their total income on health coverage.

Access expansion also targets specific age groups. Young adults can now be covered—whether they’re in school or not—under their parents’ insurance plan until age 26. Health plans that insure older Americans (55- to 64-year olds) will have access to government-sponsored reinsur­ ance to offset the cost of health care needed in a catastrophic event. “This helps insurance companies keep premiums down, because they will have a cap on their risk for the most costly enrollees,” says Blewett.

Access Grade:

photo by paula keller

Overall Grade:

“ Instead of cutting complexity to the health care system, we just added new layers.”

Franken: History will vindicate reform Sen. Al Franken outlined a defense of the new health care law at a recent SPH roundtable. Reform’s focus on prevention, he argued, will ultimately result in savings. His remarks were followed by a response from several health care experts, including SPH faculty members and community partners. Speaking to a packed auditorium, Franken stressed that it will take time to realize reform’s benefits. “Ten years from now, hopefully, we can look at this moment and say the tide started to change,” he said.

“This got the ball rolling. We’re better off because of it.” atch a video of Franken’s remarks at W www.sph.umn.edu/franken.

“ Ten years from now, hope­fully, we can look at this moment and say the tide started to change. This got the ball rolling. We’re better off because of it.”

1515

alumni news

Gala proceeds double previous year’s The school’s third annual Alumni and Friends Scholarship Gala raised more than $33,000, and donors made additional gifts of nearly $10,000 to the Alumni Scholarship Endowment during the Gala-related fundraising drive.

The total endowment now stands at more than $150,000, and annual awards to students are doubled by the University of Minnesota President’s Scholarship Match.

“The steady growth of the scholarship endowment shows that our public health community understands the importance of investing in the future of our field,” says SPH dean John Finnegan. “These funds will have a direct impact on our ability to attract and train the best and brightest students and to usher more professionals into practice.”

Top left, clockwise: SPH students Thuy Doan and Eunice Abiemo; SPH dean John Finnegan, Shannon Fitzpatrick, SPH professor Bernard Harlow (MPH ’78), Paige Anderson Bowen (MPH ’05), and James Anderson (MHA ’68); SPH students Siddharth Jain and Lamesha Melton; Shelly (MPH ’99) and Mitch Espinosa; Rebeca and Gizaw (MPH ’06) Tsehai; Kimberly and Brian (PhD ’07) Brosdahl; Mary Kay (MPH ’83) and Vincent Hunt.

16 University of Minnesota School of Public Health

Class notes Kenneth Bence (MHA ’92) was elected president of the Minnesota Public Health Association. He is director of community health initiatives for Medica Health Plans, based in Minnetonka, Minn., and holds appointed positions on the Minnesota Department of Health’s Maternal and Child Health Advisory Task Force and Health Care Disparities Task Force. He takes over as president from SPH assistant professor James Hart.

Kelsey Brodsho (MS ’08) is working at the Minneapolis-based law and consulting firm Halleland Habicht in the area of health care law. Previously, she worked as a patient safety officer for St. Peter’s Hospital in Helena, Mont., where she lives. She is a graduate of the U’s Joint Degree Program in Law, Health, and the Life Sciences.

Lara Jones Jaskiewicz (MPH ’95) received a PhD in health policy and administration from the University of Illinois at Chicago School of Public Health. She is a project manager at the Consortium to Lower Obesity in Chicago Children.

Carrie Klumb (MPH ’09) is at the Minnesota Department of Health as a fellow of the Council of State and Territorial Epidemiologists and the Centers for Disease Control and Prevention. She is working in the Zoonotic Diseases Unit, where she has contributed to H1N1 response, led an outbreak investigation of canine blastomycosis, and evaluated a rabies surveillance system.

Angie Lillehei (MPH ‘85) and Lisa Pogoff (MPH ‘85) were elected to the SPH Alumni Society Board. Lillehei

is chief clinical officer at Sage Health Management Solutions. Pogoff is a continuing education specialist in the SPH. Kim Milbrath (MPH ’06) has taken a position as project manager with the Center for Prevention at Blue Cross and Blue Shield of Minnesota. The center was established in 1998 following Blue Cross’ historic lawsuit against the tobacco industry. Milbrath is working to reduce rates of Minnesota’s leading killers: tobacco use, physical inactivity, and unhealthy eating.

Michael Osterholm (MS ’77, MPH ’78, PhD ’80) received the Thomas F. Waters Stewardship Award sponsored by the Great Waters Fly Fishing Expo and Midwest Fly Fishing magazine. He was recognized for his work on coldwater stream and tall grass prairie restoration.

He also received the University of Minnesota Council of Graduate Students Outstanding Faculty Award for his efforts as professor in the SPH. Janet Porter (PhD ’93) co-authored the book Managing Public Health Enterprise. She is executive vice president and chief operating officer of the Dana-Farber Cancer Institute and an instructor at the Harvard School of Public Health. She serves on the board of the Commission of Accreditation for Health Management Education.

Lorene Wedeking (MS ’72) was awarded a Fulbright Scholar grant to lecture at the University of Pecs in Hungary. She is serving there during the current academic year as an expert on strengthening public health services.

Wedeking is a professor in the College of Nursing and Health Sciences at

Metropolitan State University in St. Paul, Minn.

The following SPH alumni have been inducted to the Delta Omega Honorary Society in Public Health, Pi Chapter.

Lauren Gilchrist (MPH ‘08) Katherine Huppler Hullsiek (MS ’96 , PhD ’99) David Johnson (MPH ’00) Maurice Mazzarella (MPH ’05) Brigid Riley (MPH ’98) Have news to share? Submit class notes to SPHnews@umn.edu.

Mentors Needed Tap into a large professional network while helping to prepare the next generation of public health leaders.

You are invited to join the SPH mentor program for the upcoming academic year.

Through a new online tool, mentors will be matched with SPH students based on shared interests and skills.

While mentors and students decide how often to meet, and what activities to engage in, the average level of commitment is two hours per month. The school will host mentor program events throughout the year. Mentors are encouraged to sign up

by Sept.1.

Learn more at www.sph.umn. edu/alumni/mentor.

17

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

What does public health on five continents look like?

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

Global Health Institute: Uganda

Aug. 1-15 Take a four-credit course on One Health concepts on the historic campus of Makerere University in Kampala. The course includes a three-day immersion experience through rural Uganda.

Instructors include faculty from the University of Minnesota Schools of Public Health and Nursing and the College of Veterinary Medicine, as well as Makerere University, Tufts University, and the USAID RESPOND Project.

Learn more at www.sph. umn.edu/uganda.

Packing a thirst for adventure, more than a dozen SPH students are embarking on international field experiences this summer. They’ll be taking on pressing public health challenges like HIV prevention, clean water, and community health. In the process, they’ll learn about themselves in ways that no classroom course could teach.

Follow their journeys at www.sph.umn.edu/notes10.