Advances - Spring/Summer 2011 by publichealthmn

advances Spring/Summer 2011

Journalist Michael Specter headlines the Alumni and Friends Scholarship Gala, Sept 22. More on page 12.

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

> An Olympian’s Take on Epi > Weight Loss: App for That! > Health Hazards of an Oil Boom > New Laws, Safer Foods?

PUBLIC HEALTH, INC. How the business of population health is changing—for better and worse

School of Public Health Leadership

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

contents

Bradley Carlin Head, Division of Biostatistics 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

Mary Ellen Nerney Assistant Dean for Education Operations

advances Editor Diana Harvey Managing Editor Kristin Stouffer Contributing Writers Nicole Endres Tricia Truninger Art Direction Cate Hubbard Design cat7hubb@gmail.com Advances is published 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.

Dear Friends, The title and focus of our cover story on the “business” of public health are sure to make some of you uncomfortable. I hope you will take the time to read and understand what it takes to run a $100 million-plus research and education enterprise, because I think you will be impressed by our ability to be entrepreneurial and thrive in the face of major economic challenges. As this magazine goes to press, the state Legislature is moving into a special session to address a multi-billiondollar budget deficit, which has significant financial implications for the University of Minnesota and the School of Public Health. The federal picture is only slightly less bleak, with proposed cuts to the National Institutes of Health and other agencies that are major sources of funding for the school. We must, I believe, adopt a philosophy of abundance whereby we look for new partners and new approaches to continue advancing our mission. If we do the opposite and adopt a scarcity mentality—raise the drawbridge and draw our arms fearfully around a shrinking set of resources—we set ourselves on a downward spiral toward mediocrity. We cannot and will not take that course. The answers we are unlocking through our research and through the leaders we are grooming in our education programs are vital to the health and well-being of the population of this state, this country, and our world.

FEATURES 2 PUBLIC HEALTH, INC: HOW THE BUSINESS OF POPULATION HEALTH IS CHANGING—FOR BETTER AND WORSE

The SPH’s history of entrepreneurial thinking has helped make it a productive powerhouse. Despite an era of growth, the school faces unprecedented threats, bringing implications for the field of public health.

We expect to expand our efforts in the realm of private philanthropy and partnerships. We will look for collaborators in new and unexpected corners of the University and beyond. We will pursue what might previously have been considered “outside the box” funding opportunities on a national and global basis. And we will look to new and existing donors to help support our students. All of this is exciting and, I must admit, a little unnerving. So, while more than ever we are operating with a strategic mentality, I can think of no better “business” to be in: creating new knowledge, ushering in a new generation of leaders, and making good on our promise to improve health. Thank you for your support of this most important cause. . Yours in health,

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

7 GOING FOR GOLD

Competing in the biathalon was “love at first shot” for Carolyn Treacy Bramante. Now the Olympian is setting her sights on an MD/MPH degree. COVER ILLUSTRATION BY PETER GRUNDY

Judith Garrard Senior Associate Dean for Research and Academic Affairs

from the dean

PHOTO BY RICHARD ANDERSON

John Finnegan Dean

Spring/Summer 2011

8 THE STATE OF FOOD SAFETY

DEPARTMENTS 10 RESEARCH NEWS

Americans ignore the dangers of indoor tanning; why your cancer doc matters; scientists track airborne viruses; and more.

16 ALUMNI NEWS

Tracy Miller discusses her ever-changing role as North Dakota’s state epidemiologist; and Class Notes.

12 SCHOOL NEWS

Commencement recap; talking trash with MnTAP; King of Hearts visits SPH; and more. 15 STUDENT NEWS

Cancer prevention goes beyond the books for doctoral student Mandy Stahre; and students awarded at Research Day.

A new law ushers in the greatest changes to America’s food safety system since 1938. But will that mean a safer experience at the dinner table? SPH experts debate the outlook.

PUBLIC HEALTH, INC. How the business of population health is changing—for better and worse

ost people don’t think of schools of public health in terms of traditional business models. But at today’s top universities, the study of population health and prevention is a complex multimillion-dollar enterprise—one that requires the strategic planning and high-stakes decision making of other industries. Researchers face pressure to think boldly about growing new and traditional research programs in an increasingly competitive grant-funding environment. Educators must keep pace with public health fields that have changed more in the past decade than perhaps at any time to date. And institutions are competing for students on a global scale in ways no one could have imagined just a few years ago. While academic public health may seem a world apart from the business sector, the challenges are strikingly similar: embrace technology, anticipate new markets, and compete globally—all in a vulnerable economy. The added threat to academic public heath is a turbulent political debate that questions the very act of publicly investing in health, education, and the well-being of populations. The changing business of educating professionals and researching population health has important implications,

THE SPH STUDENT BODY HAS NEARLY QUADRUPLED SINCE 1998. 2010

1,237

in light of public disinvestment in higher education. It means the walls between the public and private sectors will continue to come down. It means new educational opportunities must continue to develop for working professionals. And it means unprecedented threats to longstanding workforce training initiatives and new worries over federal research funding. But for those organizations willing to think entrepreneurially, it also means new opportunities. Entrepreneurial history An entrepreneurial spirit has for years been at the heart of the mission of the University of Minnesota School of Public Health. At various times throughout the school’s history it has resulted in dramatic shifts in the way the organization conducts business. In the 1980s, it meant the SPH went from being primarily an educator for preventive medicine (aimed at mainly nurses and doctors) to an organization that was also focused on research. By the late ’80s, the institution was leading some of the earliest and largest community-based health interventions— many of them still going today. But the school had not made gains in educational programing. In 1998, the student body was 362, far less than some of the SPH’s competitors. School leaders worked to add new programs

FACULTY RANKS HAVE GROWN BY 47% OVER THE PAST SIX YEARS. 2010

135 2004

2003

610

and revamp curricula in anticipation of emerging areas and to meet the needs of the practice community. By 2003, the student body had more than doubled. Today, it has nearly quadrupled, with 1,237 students. The faculty, numbering around 135, is also the largest in school history, growing by nearly 50 percent since 2004. In the process, the school’s research portfolio has grown to record highs. Sponsored research in 2010 stood at $65 million, or $113 million in terms of multi-year awards. “We’ve always had think entrepreneurially,” says Joe Weisenburger, SPH chief administrative officer and chief financial officer. “State support has historically been a small part of school funding, so finding other sources of revenue has always been an important part of how we do business.”

”State support has historically been a small part of school funding, so finding other sources of revenue has always been an important part of how we do business.”

Productivity powerhouse A cornerstone of the school’s growth is founded in a culture that encourages each faculty member to secure at least half of his or her annual support from extramurally funded research. The model means that the school grows at a financially manageable pace, and that research is focused on issues of strategic value to the faculty, school, and University. It has also made the school’s faculty one of the most productive groups of researchers in the country. Since 2007, the SPH has ranked first in research awards per capita from the National Institutes of Health. Among all units at the University of Minnesota, the SPH is solidly first in external support expenditures per faculty member. That means that on average the school’s 135 faculty members each carried about $840,000 in sponsored awards in fiscal year 2010. The next closest unit at the University is the College of Science and Engineering, with about $359,000 in awards per faculty member. If one considers only the full-time equivalent SPH faculty, awards become about $1 million per member. “No other unit at the University—and I dare say no other school of public health—comes close to our level of faculty

JOE WEISENBURGER, SPH CHIEF ADMINISTRATIVE AND FINANCIAL OFFICER

STATE SUPPORT OF TOTAL SPH FUNDING

1993

18%

2010

10%

2015

150

(projected)

ROI: AWARDS For every $1 the SPH receives from the state, it produces $10 in external award funding for research. Discoveries made from that research translate to improved health in Minnesota and beyond.

1998

362

SPH

$ $ $ $ $

2 University of Minnesota School of Public Health

“No other unit at the University— and I dare say no other school of public health—comes close to our level of faculty productivity.” JOHN FINNEGAN, SPH DEAN

PRODUCTIVITY The school’s 135 faculty members each carry about $840,000 in sponsored awards. Among the school’s 109 full-time equivalent faculty, awards become about $1 million per member.

All SPH faculty

$1 Million

SPH full-time equivalent faculty

TOP AWARD EARNERS PER FACULTY MEMBER AT THE U

$840,000

$359,000 $234,000

Medical School

College of Science and Engineering

SPH

4 University of Minnesota School of Public Health

Sources: Office of Institutional Research and the Office of the Vice President for Research.

$840,000

productivity,” says SPH dean John Finnegan. “Raw numbers are indicative, but you have to drill down. It’s really the scientific and public impact of our work that matters most.”

expectations, admitting 75 students since 2010, its inaugural year, and generating 10 times more inquiries than available spots for incoming classes.

E-learning takes off Another area of growth that keeps the SPH engine humming is online education. In 2002, school leaders committed several million dollars over 10 years to develop online programs. By 2006, that investment helped to bring in $20 million in workforce training grants, $10 million in online course tuition, and $11 million in tuition through the school’s Public Health Practice major, a program that blends online and on-campus learning. The overall result was about $8 returned for every $1 invested in online programs, which now accounts for more than 20 percent of the school’s annual tuition revenue. Despite state disinvestment in higher education, the SPH has managed to keep tuition at a reasonable level, compared to its chief public university competitors. Of the six highest ranked public university-based schools of public health—according to the latest U.S. News and World Report ranking—Minnesota’s resident tuition ranks fourth while its non-resident tuition ranks sixth. A large portion of e-learning courses are directed to students in Public Health Practice, a program aimed at working professionals who seek training to advance their careers. Public Health Practice became the fastest growing major at the school and is now its largest. Since 2002, the program has educated 360 students, who have earned either certificates or MPH degrees. The program has become the largest in the country for Doctor of Veterinary Medicine students (from universities nationwide) who wish to earn an MPH. Certificate programs have proven to be an important draw for professionals who may not be willing to initially commit to a degree program, with about half of those students going on to earn an MPH. The school’s latest program for working professionals—an executive MHA—has exceeded

Threats to workforce training Beyond certificates and degrees, the SPH works to meet the work force training needs of the public health practice community. That mission has been the focus of the school’s Centers for Public Health Education and Outreach (CPHEO). When CPHEO opened for business 11 years ago, it was faced with responding to the needs of a post 9/11 world. With a mission to educate professionals and encourage lifelong learning among SPH graduates, CPHEO not only met those needs but anticipated many of the emerging public health issues of the past decade—from preventing the spread of pandemic influenza to protecting our global food systems to addressing the growing influence of genomics. In the past decade, some 35,000 people have participated in face-to-face courses offered to various sectors of the workforce, including first-responders and emergency preparedness professionals throughout Minnesota and the Midwest. In the past five years, nearly 24,000 people have created accounts to participate in CPHEO online learning opportunities. Steadily, workforce training has moved beyond the region. In the past five years, CPHEO courses have reached participants in 101 countries. While these programs have been highly successful at meeting the needs of the practice community, right now they face unprecedented federal funding cuts. The federal budget debate in Washington is expected to go into the summer before decisions are reached on whether to eliminate programs that train workers in the areas of public health preparedness and occupational health and safety. “Eliminating funding in these areas will have a significant impact on our ability to protect workers and to respond to future emergencies and disasters,” says Sue Borowick, director of CPHEO. “The frightening thing is that the public may not realize the impact of these cuts until the next disaster hits.”

“Eliminating funding ... will have a significant impact on our ability to protect workers and to respond to future emergencies and disasters. The frightening thing is that the public may not realize the impact of these cuts until the next disaster hits.” SUE BOROWICK, DIRECTOR OF THE CENTERS FOR PUBLIC HEALTH EDUCATION AND OUTREACH

FOLLOW THE MONEY In fiscal year 2010 the State of Minnesota’s appropriation to the U was $623 million. Here’s how that money flows through the University to the school, and how the SPH leverages it to produce sponsored funding from federal agencies and other organizations.

$623M

SPH SPONSORED RESEARCH EXPENDITURE GROWTH 2010

The SPH produces

The University of

14%

Minnesota directs

of its overall state appropriation to the SPH.

of all U of M awards. SPH

$113M

U of M

$823M

$65M 1998

$ $36M 1993

$27M

$17.8M

(for central operating costs)

$11.8M SPH

$113M (sponsored, multi-year funding to SPH)

In the past five years nearly

In the last decade,

35,000 PEOPLE have participated in SPH face-to-face workforce training courses.

24,000 PEOPLE have participated in online training opportunities.

Precarious state support The school’s era of dramatic growth—in terms of research support, students, and faculty ranks—has occurred in a time of equally dramatic cuts in state support. In 1993, state support was 18 percent of total school funding. Currently, it’s about 10 percent. From fiscal year 2009 through fiscal year 2011, state support has dropped 21 percent. It’s very likely that in the next fiscal year state support will shrink to an all-time low at the SPH and, as a result, tuition will continue to rise. “We’re starting to resemble a private school housed within a larger public university,” says Weisenburger. Finnegan agrees, saying. “The very concept of ‘public’ education has changed. Our school is more state-located than state-funded.” As a result, Finnegan says the school must, more than ever, rely on private support for student scholarships, and that students have already been affected, for the worse, by the drop in state investment. “The barriers to pursuing education are

growing,” he says. “More and more of our students are taking on bigger loans to finance their education. The situation is not nearly as bad for our students as it is in most of the licensed health professions, but it is a concern nonetheless.” A global ‘common cents’ approach As federal and state-level public investments in academic public health continue to decline nationwide, it marks the beginning of a new era of collaboration. “For public health to thrive, we need to continue seeking out new partners at home and around the world,” says Finnegan. That mindset has helped usher in an era of global research, education, and outreach for the school. Many of the initiatives unite the SPH in new collaborations with the College of Veterinary Medicine, School of Nursing, and Medical School. The work touches on infectious diseases such as AIDS, pandemic influenza, and emerging zoonotic diseases that pose a threat to both animals and humans. Partners include government agencies and private-sector organizations. Other projects involve ramping up public health education and hinfrastructure in India, Africa, Thailand, and South America. While a fragile worldwide economy hampers public health funding, it also serves as the impetus for organizations to pool resources and collaborate. “Governments and businesses are realizing that preventing disease isn’t just the right thing to do, it also makes good business sense,” says Finnegan. “It’s a ‘common cents’ approach that I think will continue to become more prominent in the coming years.”

Going for gold Training for the Olympics inspired Carolyn Treacy Bramante to help others achieve better health.

ROI: E-LEARNING Every $1 invested in online education programs has returned $8 to the SPH.

PHP

2011

147

PHP

The PHP major has been the fastest growing in the school. When it began, the program had 20 students. It currently has 147 students, who are pursuing certificates or MPH degrees.

2002

6 University of Minnesota School of Public Health

SPH

$ $

$ $ PHOTO BY DARIN BACK

PUBLIC HEALTH PRACTICE

Perhaps it’s only natural that a biathlete would pursue degrees in medicine and public health. Like biathlon—a sport combining Nordic skiing with target shooting—dual degree programs require the mastery of two disciplines through focus and endurance. It’s the skillset Carolyn Treacy Bramante called on to anchor the U.S. women’s relay team at the 2006 Olympic Winter Games and bring them to their best finish ever. Now the MD/MPH student is bringing impressive results at the University of Minnesota. In just two years on campus, she has founded a 250-volunteer-strong program that delivers health care to homeless individuals. She has headed up the U’s chapter of Physicians for Human Rights, a group she represented at an AIDS summit in Washington, D.C. She has volunteered at the Phillips Neighborhood Clinic, a student-run facility serving uninsured, underserved, and undocumented patients. Those efforts have earned her the President’s Student Leadership and Service Award and the Mary A. McEvoy Award for Public Engagement and Leadership. Both honors are bestowed on U students who go well above their typical duties. Bramante’s master’s project aims to improve workplace physical activity by evaluating short videos designed to get workers away from their desks and moving. The videos are inspired by research showing that just 10 minutes of daily physical activity can bolster health. She’s invited Olympic friends like Apolo Ohno and other athletes to appear in the video series. Small businesses as well as biggies, including three Minnesota-based Fortune 500 companies, have expressed interest in providing the resources to employees. Bramante says that leaving world-class competition behind has helped her appreciate exercise in new ways. It’s a message she hopes comes across in her project. “It’s all about the excitement of reaching a new level of fitness,” she says. “That sense of accomplishment is the same, whether you’re winning a medal or biking to work.” Watch a series of 10-minute physical activity videos. advances.umn.edu/liftoff

The state of food safety

“The FoodNet data show that improvements to the food safety system of the late 1990s are still having a positive effect. But we’ve made little-to-no additional progress in the past decade.”

Will sweeping changes to our food supply translate to safer foods?

Improvements overblown The CDC made headlines with its estimate that there are 48 million cases of foodborne illnesses in the U.S. each year. The first government estimates of foodborne illness in a decade found that 15 percent of Americans get sick, 128,000 are hospitalized, and 3,000 die each year from eating tainted food. While the numbers are high—finding one in six Americans suffer from foodborne illnesses annually—SPH professor Michael Osterholm says many media outlets got the story wrong when they reported that foodborne disease rates were significantly down from the late 1990s. That misinterpretation occurred when the media compared 1999 estimates to 2011 estimates without explaining—as the CDC had—that the two sets of data had been analyzed with different methods and assumptions. Osterholm, who directs the University of Minnesota Center for Infectious Disease Research and Policy, wrote a commentary for the New England Journal of Medicine

Fifteeen percent of Americans get sick, 128,000 are hospitalized, and 3,000 die each year from eating tainted food.

“Even though the legislation deals with the FDA, it will undoubtedly drive changes in the overall food safety system,” says Hedberg. Minnesota model Several of the new law’s provisions are modeled on Minnesota-based practices that led to legislation introduced in 2009 by U.S. Sen. Amy Klobuchar, Minn. At a press conference announcing the bill (held at the SPH), Klobuchar spoke of collaborative food safety involving the Minnesota Department of Health, Minnesota Department of Agriculture, and University of Minnesota. That model includes Team D, (for “Team Diarrhea”) a group of investigators—including SPH students—that races into action when there are cases of foodborne illness in the state. In recent years, Team D has pinpointed the culprits behind two national salmonella outbreaks. The model was first championed years ago by Hedberg and Osterholm, who was state epidemiologist at the time. Both have since worked to keep the model active, and they served as advisors to Sen. Klobuchar in the drafting of the bill.

cautioning about misinterpreting the numbers and citing what he believes is a more reliable data source: the CDC’s Foodborne Disease Active Surveillance Network (FoodNet). “The FoodNet data show that improvements to the food safety system of the late 1990s are still having a positive effect,” says Osterholm. “But we’ve made littleto-no additional progress in the past decade.” New law, new outlook The Food Safety and Modernization Act grants the FDA the power to issue recalls, increases the frequency of factory inspections, and ramps up surveillance so outbreaks can be more quickly traced to their source. It also boosts restrictions on imported foods. SPH professor Craig Hedberg says the bill marks a fundamental change by requiring food producers to identify and prevent hazards. “For the first time, there is a clear expectation that food producers are responsible for the safety of their products,” says Hedberg. “The law creates a different climate for food safety.” While the new laws don’t affect the United States Department of Agriculture (USDA), they will help to put the FDA on par with the fellow federal agency.

ILLUSTRATION BY DAVID SENIOR

mericans have seen big news in food safety lately. At the end of last year, the Centers for Disease Control and Prevention (CDC) released a long-awaited report on foodborne disease rates. Weeks later, on Jan. 4, the president signed into law the Food Safety and Modernization Act, marking sweeping changes to America’s food safety system. The legislation gives the Food and Drug Administration (FDA) significant new powers. But will the FDA overhaul make for a safer food supply? There is debate, even among food safety experts.

Framework needs funding While the food law is expected to cost $1.4 billion over the next five years, Congress hasn’t appropriated the $326 million requested by the FDA to make initial changes. For Osterholm, this is a major concern. “The bottom line is that you need financial support,” he says. “The media coverage has overlooked a major failing of the new law—namely that it lacks sufficient funding to make it truly effective.” Hedberg says he isn’t as concerned with the initial lack

of financial backing. “Even without full funding, changes can be made to the foundation of the regulatory process,” he says. “That fundamental shift alone is worth building on and promoting.” Prevention: ROI Both Osterholm and Hedberg agree that the key to funding the law is to view any appropriation not as an expenditure but rather a sound investment. “The federal budget is obviously incredibly challenged right now. But the cost of foodborne disease far outstrips the investment of trying to prevent it,” says Osterholm. Recent salmonella outbreaks have well proved this point. For example, even though one company was responsible for the 2009 peanut contamination that led to nine deaths, hundreds of companies suffered. Kellogg’s alone, which made snacks using the tainted nuts, reported a $34 million hit. As for critics that argue the laws will be too costly for small businesses, Hedberg and Osterholm say that small producers shouldn’t be held to a different standard of safety. “Identifying and controlling your own safety issues, as a food producer, should be part of the cost of conducting business,” says Hedberg. Osterholm makes the point with an analogy to another industry: “That’s like saying ‘I have a smaller car company, can I just skip the seatbelts?’” Hedberg and Osterholm discuss implications of the new food safety law. advances.umn.edu/foodlaw

HAMBURGER VERSUS CAR The supply chain for the car you drive to the local burger joint may be simpler than the one that produced your meal. Your hamburger could be made from more than one cow, from a number of countries. Then there are the vegetables and cheese, plus the multitude of ingredients that make up the bun, ketchup, and mustard. Your meal was handled by hundreds of people during its journey over thousands of miles from several points on the globe. And all those complex supply chains converge at one place—your plate.

8 University of Minnesota School of Public Health

research news

Breast cancer patients: your doctor really matters How doctors choose to treat their breast cancer patients may play a larger role in whether the cancer returns than experts have believed. That’s according to a RAND Corp. study that looked at 994 women with pre-invasive breast cancer. Researchers found significant treatment variations from surgeon to surgeon that may account for up to 30 percent of cancer recurrences. “The study found that not all surgeons are equal,” says SPH professor Beth Virnig, who co-wrote an editorial to accompany findings in the Journal of the National Cancer Institute. ”For instance, in spite of the finding that mastectomy has lower risk of recurrence, a woman still might be better off having a more skilled surgeon doing breastconserving surgery plus radiation than a less-skilled surgeon doing a mastectomy.“ That means women need to consider not just what treatment they get, but who gives them the treatment. However, the study does not provide guidance on finding good surgeons. One solution, Virnig says in her editorial, is to develop a scoring system for breast cancer surgeons. But she acknowledges this may not be feasible. Meanwhile, she suggests women get their doctors’ views on radiation therapy after breast-conserving surgery and the importance of negative margins, both of which are associated with a lower risk of recurrence.

Tracking airborne viruses In the wake of headline-making outbreaks such as SARS, West Nile virus, and pandemic influenza, scientists have ramped up efforts to better understand how infectious agents behave and spread among us. But, remarkably, little is known as to how well many infectious diseases spread through the air. A University of Minnesota team is working to answer this question through lab simulations of six different live viruses that resemble those that cause influenza, SARS, and other diseases. The interdisciplinary team—which represents public health, veterinary medicine, and mechanical engineering—is studying how far and fast viruses travel in different airborne particles, from liquids that are drop-sized to much smaller aerosol-sized particles. Next up in the four-year National Institute of Occupational Safety and Health-funded study is to test the methods in two settings where controlling infections is critical and difficult: a swine barn and a health care clinic. Beyond that, the team hopes the study will lead to further research and recommendations on how to control the spread of disease. “The idea is if there were an outbreak, we would know how to measure the size of airborne particles that contain the virus and be able to determine how far that virus might spread by air, and how deep into the lungs it could travel,” explains SPH professor Peter Raynor. “Knowing those things could go a long way to prevent the disease from spreading.”

10 University of Minnesota School of Public Health

Despite risks, indoor tanning remains popular Too many Americans are ignoring the dangers of indoor tanning, or they are unaware of the dangers, finds SPH researcher Kelvin Choi. In a nationwide study of nearly 2,900 people, Choi found that 18 percent of women use indoor tanning facilities, yet only 13 percent believe people should avoid tanning salons to prevent skin cancer. About 6 percent of men reported tanning indoors. Age was a significant factor, with 36 percent of women and 12 percent of men between the ages of 18 and 24 tanning indoors. “There’s a knowledge gap out there,” says Choi. “People are still not recognizing that tanning beds actually cause cancer. We found that, alarmingly, the use of indoor tanning among young women is actually higher than smoking.” The research showed that women who tanned indoors were more likely to be from the Midwest and the South. They were also more likely to use spray-tan products. “Avoiding indoor tanning booths and beds is the simplest way to reduce the risk of getting skin cancer,” says Choi.

Clinical trial to study best time to begin HIV treatment A major new clinical trial seeks to determine whether HIV-infected individuals with no symptoms have less risk of developing AIDS or related illnesses if they begin taking treatments sooner rather than later. SPH professor Jim Neaton will lead the trial, which involves 4,000 HIV-infected participants at more than 250 clinical sites in 36 countries. Participants will be followed for up to five years. The trial is the latest from the International Network for Strategic Initiatives in Global HIV Trials (INSIGHT), the world’s largest HIV/AIDS clinical trial network, funded by the NIH’s National Institute of Allergy and Infectious Diseases. “There are different recommendations about when to treat HIV because the evidence is not robust,” says Neaton. “That’s why you need a very strong study design with randomization and a lot of people with long-term follow-up to really get the answer about risk versus benefit.”

“A year of antiretroviral treatment and monitoring [in the U.S.] averages about $25,000 for a patient who is doing well. So having really good data about which groups of patients most benefit is crucial.”

Take off two inches and call me in the morning Watch a profile of Barbershop Conversations, a program in which Twin Cities-based African-American barbers engage clients in discussions about their health. advances.umn.edu/barbershop

Using technology to stay healthy A new clinical trial aims to combat obesity by capitalizing on technology and social media’s influence on young adults. In the new CHOICES trial (Choosing Healthy Options in College Environments and Settings), an SPH team will test a forcredit course and web-based social networking as a way to prevent unhealthy weight gain in 440 student participants attending three community colleges in Minnesota. The trial is one of seven nationwide to test the role of technologybased weight management approaches—such as cell phone applications, text messaging, web-based social networking, and Bluetooth-enabled weight monitors—targeted to at-risk young adults. SPH professor Leslie Lytle chairs the steering committee of the trials and is the principal investigator for CHOICES. All will be supported by $36 million in funding over five years by the NIH’s National Heart, Lung, and Blood Institute, with support from the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

INSIGHT investigator Keith Henry, director of HIV clinical research at the Hennepin County Medical Center, says that risks include side effects, which, in rare instances, can be deadly. He says that cost is another factor to consider. “A year of antiretroviral treatment and monitoring [in the U.S.] averages about $25,000 for a patient who is doing well. Forty years of that adds up to one million dollars,” says Henry. “So having really good data about which groups of patients most benefit is crucial.” Listen to an extended interview with INSIGHT investigators Jim Neaton and Keith Henry. advances.umn.edu/start

school news Journalist Michael Specter to headline SPH gala New Yorker staff writer Michael Specter will keynote the annual Alumni and Friends Scholarship Gala, Thursday evening, Sept. 22. The event celebrates SPH alumni and raises scholarship funds for SPH students. Since joining The New Yorker, Specter has written several articles on critical health issues, including the global AIDS epidemic, avian influenza, and the world’s diminishing freshwater resources. His most recent book is Denialism: How Irrational Thinking Hinders Scientific Progress, Harms the Planet, and Threatens Our Lives. “We are excited to have Michael Specter speak on a very timely topic,” says Angie Lillehei (MPH ’84), who, along with fellow

SPH alum Deborah Lasher (MPH ’98), is serving as gala co-chair. “We hope alumni and friends of the school will join us for an evening of socializing, supporting public health education, and learning more about what denialism and the anti-science movement means to us personally, to public health, and to our culture at large.” Through annual giving and previous galas, the SPH Alumni Scholarship Endowment has reached a value of more than $200,000. The impact of the endowment is magnified by the University of Minnesota President’s Scholarship Match, which doubles the student awards of the scholarship. All proceeds from gala

Rothenberger Institute launches

ticket sales support SPH scholarships. This year’s gala will take place at the TCF Bank Stadium’s DQ Club Room at 5:30 p.m. Tickets are $60 but attendees are encouraged to donate more. Those who are unable to attend can still donate gala tickets to SPH students or make a gift to the scholarship endowment. For questions about donations, contact Adam Buhr, director of development, at 612-626-2391. To learn more about the gala go to advances.umn.edu/gala11.

The SPH announces the launch of the Rothenberger Institute, an organization dedicated to improving the health of students through online courses developed by top public health experts. The Rothenberger Institute will build on successful existing courses— Alcohol and College Life and Sleep, Eat, and Exercise—conceived by its namesake, the late James Rothenberger, who was a national health expert and an early champion of web-based education. Rothenberger, a beloved SPH instructor, taught some 100,000 students during his 35 years at the University of Minnesota. “The strength of the curriculum that Jim began is that it offers flexible content students can learn through various

The SPH Alumni Book Club will discuss Specter’s book, Denialism, on Sept. 24 at 11 a.m. Participate in person or by phone. More at advances.umn.edu/bookclub.

media,” says institute director Jolynn Gardner. “Students can listen to or read content at their computer, print lessons, or download audio files to an iPod.” Research has shown that students who successfully manage health issues—avoid excessive drinking, get adequate sleep, exercise—perform better academically, build positive peer relationships, and more smoothly transition into adulthood. The institute will soon launch a new course, SOS: Success Over Stress, to meet the great demand for stress-management skills among students. Last year, 4,500 students took Rothenberger Institute courses. Some 2,900 of those students were on University of Minnesota campuses. The remainder were at other colleges. Soon, college-bound high school students will be able to take the courses for college credit. “In this economy, sharing resources is more important than ever,” says Gardner. “I hope that University instructors and colleagues beyond the U will seek us out if they are in need of health curriculum.”

Minnesota health commissioner addresses 2011 grads

Brownell: Do we have the will to change the American diet?

“Six months ago I could never have imagined that I would be here today giving this address,” said Ed Ehlinger in his remarks at the school’s commencement ceremony. Ehlinger was referring to his recent appointment as Minnesota Commissioner of Health. Prior to that, he served for 16 years as director and chief health officer for Boynton Health Service at the University of Minnesota. “The opportunity to be health commissioner at this point in my career should be a reminder to you, at the beginning of your public health careers, to always be ready to seize a promising, unexpected opportunity,” Ehlinger said to the 227 graduates. The SPH adjunct professor also stressed the importance of addressing health disparities in the coming years. “I challenge you to make social justice part of your public health portfolio by constantly redefining the unacceptable,” he said.

Is there the political will to change the American diet? That was the question posed by Yale University professor Kelly Brownell at the school’s annual Gaylord Anderson lecture. Brownell noted that the Robert Wood Johnson Foundation has committed $100 million a year over five years to combat childhood obesity. Yet the food industry spends more than that per week, marketing junk food to children. Brownell called for a penny-per-ounce tax on sugar-sweetened drinks as a way to combat obesity, cut health care costs, and raise revenue for debt-burdened government agencies. “Economists estimate that this would decrease consumption of sugar-sweetened beverages by up to 23 percent,” he said. “The Congressional Budget Office estimates that such a decrease could reduce health care costs by $50 million over 10 years, and it would generate an awful lot of money.”

Listen to Ehlinger’s remarks and see commencement photos. advances.umn.edu/commencement2011

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Watch Brownell’s lecture. advances.umn.edu/brownell

COMMENCEMENT PHOTO BY ERIC MILLER, BROWNELL PHOTO BY PAULA KELLER

MnTAP helps businesses save $1.3 million in 2010 The pollution prevention and energy efficiency efforts of the Minnesota Technical Assistance Program (MnTAP) helped state businesses save more than $1.3 million in 2010, reports the agency. MnTAP’s experts worked with 120 Minnesota businesses on cost-saving solutions in the past year. The organizations that made changes based on MnTAP’s recommendations realized environmental reductions of 163,000 pounds of waste, 17 million gallons of water, 3.5 million kilowatt hours, and 307,000 therms of energy. Over the past five years, MnTAP—which is housed in the SPH and funded primarily by the Minnesota Pollution Control Agency— has helped new partners achieve more than $8 million in first-year savings. MnTAP offers assistance at no cost to state businesses. “When we help Minnesota businesses reduce waste and cost, they save money that can be invested back into their organization. This helps them retain jobs, and improve the state’s overall economy, all while improving our environment,” says Laura Babcock, MnTAP director. In 2010, MnTAP staff members conducted more than 330 site visits and eight student interns were placed with companies. The interns spent months researching pollution prevention and energy efficiency projects that are projected to save $1.7 million annually. MnTAP’s materials exchange program diverted some 82,000 pounds of waste from landfills in the past year. Read MnTAP’s 2010 environmental benefits report. advances.umn.edu/mntapreport.

A MnTAP intern identifies energy-saving solutions for the exhaust system at a metal casting facility.

student news

school news Health visionary Devi Shetty receives honorary degree from the U of M He’s known as the King of Hearts, Mother Theresa’s cardiologist, the founder of one of the word’s largest hospitals, and a champion of health care for the poor, young, and most vulnerable. Devi Shetty has no intention of slowing down. This spring, the world-renowned cardiac surgeon traveled to the Twin Cities to receive an honorary Doctor of Laws degree from the University of Minnesota. The Indian physician and U health care experts have forged close ties over the years in a common pursuit to improve health care access worldwide. As founder and chair of Narayana Hrudayalaya, a 1,500-bed hospital near Bangalore, India, Shetty oversees an average of 40 adult heart surgeries a day and 16 pediatric heart surgeries. The “health city” operates on economies of scale that afford care to those who would otherwise go without. Beyond hospital walls, this access is expanded through a government-sponsored micro-insurance program that Shetty pioneered. Now hundreds of thousands of Indians have health care by paying a monthly fee of about 20 cents. To reach those in remote areas, Shetty

“Technology gives rich people the heath care they always had, but a bit better. But it gives poor people what they could otherwise never dream about.”

partners with the Indian Space Research Organization. To date, he and his colleagues have used telemedicine to treat 70,000 patients throughout Africa and India. “Technology gives rich people the heath care they always had, but a bit better,” says Shetty. “But it gives poor people what they could otherwise never dream about.”

Research on display

Shetty believes the economy of the 21st century will be driven by health care, and he intends to lead that drive. He plans to add 30,000 hospital beds across India, build a 2,000-bed hospital in the Cayman Islands, and bring 5,000 African and Afghan children to his facilities for care in the next five years. “I believe health care should become a fundamental right for every citizen of this world,” he says. “I also believe India will become the first country to disassociate health care from affluence—and we’ll do it in the next 10 years.”

Prevention gets personal for Mandy Stahre

SPH alum gives back to his ‘calling’ through scholarship

14 University of Minnesota School of Public Health

The huge network of Minnesota MHA alumni leaders throughout the country also has impressed him over the years. So to show his gratitude for being set up for success, Hays has created a scholarship for current MHA students. He gave $25,000 in 2009 to establish the Patrick G. Hays Leadership Scholarship and has set aside another $500,000 in his estate plans for it. Hays also has supported students and alumni by serving as a preceptor, adviser, and mentor throughout his career. “In my day, we were inculcated with the notion of health service administration as a profession and a calling—not a business,” he says. “Part of being a professional was [giving] back.”

PHOTOS BY PAULA KELLER

“In my day, we were inculcated with the notion of health service administration as a profession and a calling—not a business.”

PHOTO OF DEVI SHETTY BY TIM RUMMELHOFF

Patrick Hays has had plenty of career success. A 1971 alum of the Master of Healthcare Administration (MHA) program, Hays founded Sutter Health in Sacramento, California. Today the organization is recognized as one of the country’s top integrated health systems. Hays also has served as president and CEO of the Blue Cross Blue Shield (BCBS) Association, the national coordinating body for the nation’s then 49 independent BCBS plans. And in 2003, he received the American College of Healthcare Executives’ Gold Medal Award. Though his own personal determination and drive surely cannot be discounted, Hays is quick to credit his education for those achievements. “If I’ve had any professional success, Minnesota is the reason,” he says. “I believe that the program gave me the grounding to go ahead and do this stuff.”

On April 29 Mandy Stahre boarded a plane for Washington, D.C. As an advocate for the National Breast Cancer Coalition, she was traveling to meet with members of the Minnesota Congressional delegation. It was a big day by any account, but the departure date on Stahre’s boarding pass carried extra significance. It marked exactly one year since she had been diagnosed with breast cancer. On that day a year ago, Stahre became one of several women in her immediate family, in four consecutive generations, to receive a breast cancer diagnosis. After undergoing surgery, she had to decide whether to begin chemotherapy. The treatment guidelines for her type of cancer weren’t clear-cut and the chemo could mean more complications than benefits. The epidemiology student called on all of her research skills to investigate. “I spent weeks scouring the literature,” she says. “Even with my training, it wasn’t easy to find good information pertaining to women my age with breast cancer.” She ultimately chose not to pursue chemo but also came to another realization: “That’s when I knew I wanted to become involved in efforts to improve cancer detection, treatment, and prevention.” That decision culminated in Stahre’s service to help determine how $150 million in Congressional appropriations will be spent on researching the disease in the coming years. Stahre’s role as a consumer reviewer is

to call on her own experience with cancer to determine which research proposals will have the greatest impact on patients and survivors. All the while, Stahre has been writing her dissertation, which investigates the links between tobacco use and binge drinking. She has kept ties with her former employer, the Centers for Disease Control and Prevention, doing contract work for the agency. And she continues to serve on the U’s Council of Graduate Students, a group she led as president from 2009 to 2010.

Stahre is working toward another significant date: Jan. 1, 2020. That’s the deadline the coalition has set to end breast cancer. Last year, Stahre’s contributions were recognized with the President’s Student Leadership and Service Award, given to about one-half of one percent of the U’s student body.

Forty-seven SPH students participated in the school’s annual Research Day poster presentation. Six students took home awards for posters outlining research on a host of issues, including cervical cancer trends, maternal health in Ghana, barriers to oral health care for kids, nutrition standards for childcare settings, financial barriers to health care, and drug-testing effectiveness. Award winners, from left to right: Meghann Reetz, Sarah Atunah-Jay, Sung Choi, Olusola Adegoke, Jaime Preussler, and Katherine Schofield.

Make My Life a part of your life

Check out the My Life video series and learn what it’s like to be an SPH student. The latest episodes follow students as they visit a senator at the Minnesota State Capitol, prepare for the National Public Health Week Film Festival, and share the personal story that inspired new partnerships in a Kenyan village. advances.umn.edu/mylife

While Stahre doesn’t see herself researching breast cancer in her own career, she does intend to continue service roles with the Young Survival Coalition—the group she represented while in Washington, D.C.—and the National Breast Cancer Coalition. In partnering with the network of advocates (which counts Bill Clinton among its supporters) Stahre is working toward another significant date: Jan. 1, 2020. That’s the deadline the coalition has set to end breast cancer.

alumni news Outbreaks and oil booms

Class notes

Ilina Chaudhuri (MPH ’09) is analyzing Medicare Part D issues at the Centers for Medicare and Medicaid Services in Baltimore, Maryland. Among the issues she studies are subsidies for low-income beneficiaries and closing the Medicare “doughnut hole” coverage gap. Chaudhuri is a graduate of the U’s joint degree program in law and health policy. Angie Larson Ficek (MPH ’07) is a program evaluator at the Minnesota Institute of Public Health, a nonprofit group that bridges research and practice. She provides quantitative and qualitative evaluation services to clients participating in the Statewide Health Improvement Program. Susan McCormick Hadley (MPH ’89) received the Ann Bancroft Dream Maker Award for her pioneering work in domestic violence prevention and intervention. In 1986, she founded WomanKind, a program that established health system-based support and services for abused women. The

WomanKind concept has become a national model of 24-hour health response to domestic violence. Hadley is an adjunct faculty member of the U’s Medical School. Laura Hatfield (MS ’08, PhD ’11) will begin a position this fall as assistant professor of biostatistics in the Department of Health Care Policy at the Harvard School of Medicine. She will be developing statistical methodology to conduct health policy research with colleagues who have clinical and economic expertise. Marilyn Kaufmann (MPH ’88) has been named to the board of directors of Shady Lane Nursing Care Center in Manitowoc, Wis. Shady Lane is a private, not-for-profit citizen-directed care center. Kaufmann is chair of the nursing program at Lakeshore Technical College. Thomas Klassen (MHA ’88) has been appointed executive vice president and chief operating officer of the Emergency Physicians Professional Association, which provides physician staffing for six hospital emergency departments in the Twin Cities. Rachel Kossover (MPH ’05) has completed a CDC fellowship, which included a two-year field assignment with the Alaska Division of Public Health. She has since taken a position in Atlanta at CDC headquarters, where she is a public health analyst in the Division of Healthcare Quality Promotion, working on injection safety and other outpatient care issues. Amy Becker LaFrance (MPH ’06) has taken a position with Development Media International, based in London.

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She is the country director in Burkina Faso, where she oversees the Health Media Project, measuring the ability of media campaigns to save young children’s lives. The scientific trial is being done in partnership with the London School of Hygiene and Tropical Medicine. Carl Platou (MHA ’51) appeared on public television’s The Mary Hanson Show, as part of Hanson’s annual Minnesota Leaders series. Platou is president emeritus of Fairview Health Services, where he was president and CEO for 36 years. Shelly Feaver Shaw (MPH ’01) is an epidemiologist and climate change program manager at the Wisconsin Division of Public Health, where she investigates the impact of rainfall on water quality and rates of gastrointestinal illnesses. She also serves on a team that trains local public health officials and community organizations to conduct health impact assessments.

Congratulations to the following SPH alumni who have been inducted to the Pi Chapter of the Delta Omega Honorary Society in Public Health. Amy Brugh (MPH ’99) Kathleen Ferguson Carlson (MS ’03, PhD ’06) David Dvorak (MPH ’10) Lindsey Fabian (MPH ’00) Elaine Hernandez (MPH ’04) Julia Johnsen (MPH ’07) Rachel Kossover (MPH ’05) Nicholas Wold (MS ’08)

PHOTOS BY MIKE MCCLEARY

Anne Bunde-Birouste (MPH ’86) is the subject of a film that received the Australian National Human Rights Award. The documentary, Football United: Passport to Hope, tells the story of Bunde-Birouste’s passionate work to form a team of Australian refugees from Africa and the Middle East to represent Australia at the World Cup in South Africa. Bunde-Birouste is a senior lecturer at the School of Public Health and Community Medicine of the University of New South Wales in Sydney.

Tracy Miller doesn’t like to be boxed in, whether it’s on the road or on the job. While the Montana native enjoyed her time in the Twin Cities as an SPH student and staffer at the Minnesota Department of Health, she says she was happy to leave the city traffic behind for a position as a field epidemiologist at the North Dakota Department of Health. In the next dozen years, Miller worked her way up through the state agency, always looking to expand her duties along the way. Last November she was appointed state epidemiologist. It’s a position that allows her to combine traditional skills with projects that wouldn’t necessarily be available to her at a larger health department. For instance, Miller is tracking the health implications of the state’s incredible oil boom. North Dakota’s oil supply now accounts for about 6 percent of total U.S. crude oil production, up from 1 percent less than three years ago. Experts believe the state’s crude oil production will double within the decade, putting it second only to Texas. The boom is attracting tens of thousands of people, many of them living in makeshift trailer towns dubbed by locals as “man camps.” While the business is great for the state economy, Miller says there are concerns about maintaining safe roads, water supplies, and jobs. She’s proposed a project—with the University of Minnesota as a partner—to track the occupational safety of not just oil workers but also hotel, restaurant, and road workers. “The sheer volume of people coming to the state has resulted in an increase in injuries in several occupational fields,” she says. Since earning an MPH in 1999, Miller has experienced what she calls “a reemergence of public health,” ushered in by 9/11 and sustained by an era of bioterrorism fears, emerging diseases, and pandemic influenza. “In my work, it used to be mainly just doctors and nurses who understood public health. Now my contacts include police, firefighters, veterinarians, emergency responders,

Congratulations to the SPH graduates who have been appointed to high-ranking health positions in Minnesota. • Paul Aasen (MS ‘86), commissioner of the Minnesota Pollution Control Agency • Jeanne Ayers (MPH ‘85), assistant commissioner for the Community and Family Health Promotion Bureau at the Minnesota Department of Health (MDH) • Ellen Benavides (MHA ‘84), assistant commissioner for the Policy, Quality, and Compliance Bureau at MDH • Lauren Gilchrist (MPH ‘07), assistant commissioner for health policy and reform at the Minnesota Department of Human Services

“In my work, it used to be mainly just doctors and nurses who understood public health. Now my contacts include police, firefighters, veterinarians, emergency responders, and others. It’s an array of fields that goes way beyond clinical medicine.” and others. It’s an array of fields that goes way beyond clinical medicine.” Whether it’s her contacts or her responsibilities, Miller is grateful for the scope of her professional purview. “Every day brings something different —surveillance, budget discussions, grant proposals, learning new technologies, connecting with people in the community,” she says. “It’s a great mix.”

Thanks to the alumni and friends who have served for at least 10 years in the school’s mentor program. The program connects public health professionals to current SPH students. Karen Adamson (MPH ’00) Carol Berg Janny Brust (MPH ’87) Gail Gentling (MPH ’86) Sarah Kogut Ann O’Fallon Patricia Ohmans (MPH ’91) Christopher Reif (MPH ’84) Ellie Zuehlke (MPH ’99)

Stay connected, stay involved Submit a class note, sign up for monthly e-updates, connect with fellow alumni, and learn about events. advances.umn.edu/involved

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Upcoming Events

public health is global health.

SPH Alumni and Friends Scholarship Gala Keynote address from New Yorker staff writer Michael Specter, author of Denialism: How Irrational Thinking Hinders Scientific Progress, Harms the Planet, and Threatens Our Lives. Sept. 22, 5:30 p.m. TCF Bank Stadium Event details on page 12. SPH Alumni Book Club Sept. 24, 11 a.m. Participate in person or by phone. Book selection on page 12. U of M Homecoming Parade Oct. 21, 7 p.m. Join the SPH team walking in the parade. Sign up to mentor an SPH student and attend the SPH Mentor Kickoff Oct. 28, 8 a.m. McNamara Alumni Center Memorial Hall Learn more about the mentor program at advances.umn.edu/mentor.

Follow the adventures of the SPH students working on international field experiences this summer. They’ll be taking on the world’s greatest health challenges in a range of se!ings, from remote African villages to the headquarters of the World Health Organization. Read their updates, live from the field, at advances.umn.edu/notes11. © 2011 Regents of the University of Minnesota. All rights reserved.

SPH alumni and friends reception at the annual meeting of the American Public Health Association. Oct. 31, 6:30 p.m. Washington, D.C. Event details at advances.umn.edu/events. Sign up for event notices, including alumni reunions, at advances.umn.edu/involved.