Advances - Winter 2011

advances Winter 2011

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

New Research

New hope for children SPH experts work to reverse unhealthy trends and benefit the next generation

> Blood Banking in Afghanistan > CT Scans Cut Cancer Deaths > Stopping the Cycle of Street Crime > Through the Lens: Child Labor

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

advances Editor Diana Harvey Managing Editor Kristin Stouffer Contributing Writers Adam Buhr Lindsey Heffern Allison Campbell Jensen Emily Jensen Adam Overland 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.

Dear Friends, Warm greetings from our winter wonderland! 2011 ushers in new leadership at the University of Minnesota Academic Health Center (AHC), the umbrella organization that houses the School of Public Health and the U’s five other health sciences schools. Aaron Friedman has taken the reins from Frank Cerra, who provided outstanding leadership in the AHC for the past 15 years. Dr. Friedman is a pediatrician who has a strong appreciation for the role of public health. In addition, I look forward to welcoming University of Minnesota President-designate Eric Kaler to campus. Dr. Kaler is a U alum (PhD ’82). He replaces Robert Bruininks, who has served as president for the past eight years.

Dr. Kaler comes to us from Stony Brook University in New York, where he has served as provost and vice president. He will visit campus often during the next several months of transition that culminate with his inauguration July 1.

The health of U.S. children is approaching a precarious tipping point. For the first time in the nation’s history, this generation’s kids will face the distinct possibility of greater health challenges and shorter life spans than their parents. We are poised, however, to turn this around. SPH researchers are examining a host of issues to improve children’s health and set them on course for long, vital lives.

Read about their work in our cover story beginning on page 2.

Please note the special insert in this issue that provides an overview of the SPH’s finances during fiscal year 2010, which ended June 30. We continue to be a research powerhouse. For the first time in the school’s history, new research grants and contracts totaled $113 million, in terms of multiyear awards. In total research dollars, this puts the SPH in the top three units at the U, out of 19 collegiate units (behind only the Medical School and the College of Science and Engineering). In terms of grant awards per faculty member, however, we are far and away number one. More important though is the impact that SPH research has on the health of communities here and around the world. The annual report insert also includes a list of our generous financial supporters, to whom I offer my heartfelt thanks.

Together, we will continue to shape a better future for everyone.

Yours in health,

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

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

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

Photo by richard anderson

John Finnegan Dean

Winter 2011

contents

Features

Departments

2 New Research, New Hope for Children

8 Research News

From obesity to environmental hazards to health disparities, children’s wellbeing has suffered over the past few generations.

SPH experts are embarking on novel research that may help set a healthier course for kids in the 21st century.

7 Blueprint for Change

Emergency doc and SPH alum Dave Dvorak partners with city leaders to lift Minneapolis youth out of street crime and into more promising lives.

Controversy hurts backing for HPV vaccine; body size and shape linked to colon cancer; exploring surgical solutions to diabetes; and more.

16 Alumni News

Brian Osberg honored for out­standing service to the U; call for board members and alumni award nominations; and Class Notes.

10 school News

Leaders from the public and private sector debate the future of health reform; Mary Story elected to the Institute of Medicine; SPH receives funds to advance emergency pre­­pared­ness; and more.

Special Insert

Donor and financial information for the 2009-2010 fiscal year.

14 Student News 15 Before Their Time

With camera in hand, David Parker travels the world to offer an unflinching insider’s view of the harsh working conditions endured by underage laborers.

Lorna Schmidt wins FDA-sponsored contest on tobacco laws; and Sarah Stephenson helps get new children’s heart clinic underway.

1

New research

SPH experts work to reverse unhealthy

new hope for children F trends and benefit the

rom the start, children encounter threats to health. They are vulnerable to risks in an environment determined by parents, community, and society.

Some health issues have clear causes. A fetus, for example, may be affected by particulates or chemicals in the air an expectant mother breathes. And while measures of air pollution and lead levels have decreased in children since 1997, they remain higher than recommended— and noticeably higher in black children than white children.

Other issues are more complex. Researchers lack definitive answers about the causes of autism, which has increased during the last decade from one in 166 U.S. births to one in every 110 births.

With no simple solution in sight, obesity also increasingly burdens children at younger ages.

Over 30 years, the rate of obesity has tripled among those ages 6 to 11 and doubled among children 2 to 5. For ethnic minority children, the outlook is worse: one in two will develop type 2 diabetes, primarily due to obesity.

And children’s access to health care still demon­­strates gaps, despite a federal program that’s more than a decade old. Disparities in

2 University of Minnesota School of Public Health

children’s health insurance coverage can be seen in groups defined by ethnicity, income, and age.

Can we ensure a healthier future for tomorrow’s children? School of Public Health researchers are studying and tackling these daunting issues in novel ways to set a new direction for tomorrow’s children.

Comprehensive research approaches to children’s health include a seven-year, broad-based Twin Cities study to prevent obesity in preschoolers who live in low-income neighborhoods, as well as the National Children’s Study, which will start before birth and follow children to age 21.

At the same time, the National Children’s Study reaches deep, seeking links between environmental factors and individuals’ genetic profiles to improve understanding of children’s health issues. On a smaller scale, the Gopher Kids Study has started examining environmental interactions with genes in Minnesota children.

As these studies move forward, health risks will be better identified and protective factors will be promoted. Additionally, in the coming years, more children should be covered by historic health reform measures. The unhealthy trends of the late 20th century should bend back—and children’s health in the 21st century take a turn for the better.

Illustrations by Elliott Golden

next generation.

Taking the long view of America’s children The largest long-term study of child­ren’s health in the United States will examine the interactions of genes and the environment—and the SPH is involved. “It’s huge,” says Pat McGovern, an environmental health expert at the school and principal investigator for the Ramsey County study site for the National Children’s Study. Nationwide, the observational study seeks to enroll 100,000 children from before birth and follow their health through age 21.

“It’s an amazing opportunity to learn about conditions that kids and families have been struggling with the last two decades,” McGovern says. She collaborates with colleagues from the Medical School and Institute of Child Development on the Ramsey County study.

The University’s team is one of the many at 105 sites that will examine how health is influenced by environment— broadly defined to include everything from chemicals in the home to cultural factors and safety of the neighborhood.

With a multi-million dollar budget, the National Children’s Study is managed by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, in collaboration with other federal partners.

Researchers expect to discover interactions between environment and genes that contribute to the high rate of preterm births, as well as asthma, allergies, diabetes, obesity, and autism. Along with health risks, they expect to find protective factors too.

In Ramsey County, McGovern and team collaborate with community partners in clinics, hospitals, and health departments to identify women who are pregnant or may become pregnant soon.

Their vanguard study is testing methods for recruiting about 300 potential future mothers in randomly selected households.

3

Healthy at Every Age SPH experts are working to improve health among youth of all ages.

tU sing a high-tech device called a Pea Pod, researchers are studying body composition in infants to better understand how it relates to longterm health outcomes. For instance, infants who gain weight very slowly are at greater risk for poorer neurobehavioral development.

t Project EAT (Eating Among Teens) continues to publish influential findings showing, for example, that kids eat better when they have family meals, are involved in food preparation, and limit TV.

SPH professor Pat McGovern talks about the National Children’s Study. www.sph.umn.edu/ncs

The team also will assess responses to high-intensity research approaches, such as home visits during which biological or environmental samples are collected, or low-intensity methods, limited to surveys.

“It could go either way,” McGovern says of the pilot that began this winter.

“Some people may really like the personal relationship of having someone visit their home to collect more comprehensive data, while others may prefer only answering questionnaires by mail or online.” Once pilot studies at Ramsey County and selected other sites help determine study methods, the National Children’s Study expects to launch its main study in 2012.

McGovern is enthusiastic about the long-term potential for the study to make a difference in health services and policies.

“Over time,” she says, “it will influence the health of your grandchildren—and the health of future generations.”

Getting together with children at the fair

sF aculty have partnered with several elementary schools to bolster physical activity curricula and improve the nutritional value of school lunches and vending options.

s Mobile devices and GPS data are part of the technology used to track college-aged students to determine how they can make better food choices during the critical years of early adulthood.

4 University of Minnesota School of Public Health

For 10 days in late summer, families from all over the state bring their children to the Minnesota State Fair—so why not bring researchers there to study the genetic origins of obesity and differences in child growth? In 2010, that novel idea became a reality called the Gopher Kids Study, led by principal investigators Ellen Demerath, an SPH epidemiologist, and Logan Spector, an epidemiologist in the Medical School.

“We were not limited by the interest of the families coming to the fair,” says Demerath. “We were limited by the fact that we had just a part of the space.” In several shifts totaling 36 hours, faculty and 50 student volunteers staffed the study area in the University of Minnesota building at the State Fair.

“It was absolutely frenetic,” Demerath says. “There’s a lot involved, particularly with the informed consent.” Researchers

kept the study fairly straightforward, she says. “It’s very difficult to do any kind of fasting study at the fair.”

The team measured children’s height, weight, waist, and blood pressure, collected DNA samples with “spit kits,” asked parents to agree to complete a questionnaire to be mailed this winter, and requested they return to the State Fair for more study in 2011 and 2012.

Despite the time commitment, families were eager to participate. In the end, about 800 children enrolled; add their parents and the number in the study rises to about 1,500. Gopher Kids is a feasibility study funded by the University of Minnesota Academic Health Center that Demerath and Spector hope can ultimately attract funding from the National Institutes of Health.

Demerath is excited about the possibilities.

For instance, the State Fair venue means the researchers avoid transportation costs while studying a dispersed popu­ lation. In addition, they are educating the public about genetics because the Gopher Kids Study, like the National Children’s Study, looks at the interaction between genes and environmental factors. While scientists’ understanding of genetic susceptibility to obesity is increasing, Demerath says, they still don’t know how the 32 or so genes influencing obesity and body fat may be modified by healthy lifestyles. “We don’t understand how the same obesity-promoting environment produces obesity in one child and normal weight in another child.”

The outlook for the next generation, Demerath says, is not bright. It will require a “full-court press” to turn around the health threats associated with obesity, including premature puberty and potentially shorter life expectancy for future generations.

So much of a child’s environment is con­ trolled by parents, she says, that “it speaks to how important parents are in creating a home that’s healthy for their children.”

Targeting preschoolers where they live, learn, and get care The influence of family, community, and even neighborhood businesses on the health of low-income and ethnically diverse preschoolers is the focus of researchers at the new Childhood Obesity Center, a federally funded study.

“By targeting those different types of settings and wrapping it all together around parents, we’re hoping to have an impact and have it be sustainable,” says SPH childhood nutrition expert Simone French. She and fellow school faculty member Nancy Sherwood from Health Partners Research Foundation are the principal investigators.

Previous obesity-prevention efforts aimed at very young children, French

“ It’s an amazing opportunity to learn about conditions that kids and families have been struggling with the last two decades.”

Watch a Gopher Kids Study recruitment video shot

at the Minnesota State Fair. www.sph.umn.edu/gopherkids

5

“ There’s been a concerted effort in this country to provide affordable health insurance cover­age for all children, but ... there are still 9 million children without health insurance.” says. But teaching Head Start enrollees about eating fruits and vegetables had little effect. “Preschoolers don’t do the grocery shopping,” she says.

Preschoolers’ parents do the grocery shopping; they take their children to see primary care providers for well-child visits; and, in the Twin Cities, they attend Early Childhood and Family Education (ECFE) courses. These are the arenas where French and team will reach parents.

First, for the neighborhood component, French and colleagues collaborate with the Minneapolis Department of Health and Family Support and the local Institute for Agriculture and Trade Policy to connect families to farmers’ markets and community centers. They also reach those who run corner stores and groceries, to help them gain affordable access to fresh fruits and vegetables to sell. “You have to make it work for the store owners,” French says.

Second, partnering with pediatricians and other physicians who see these families is a key part of this research that hasn’t been included in previous studies, French says. Primary care physicians will talk with parents about the importance of healthy eating and physical activity.

Finally, the existing ECFE courses already teach parenting skills, such as setting limits and using positive reinforcement as part of preparing children for school. ECFE is well accepted by families of all backgrounds and includes family advocates who understand a variety of cultures and languages.

The obesity-prevention project will piggyback on ECFE. “We’ll be engaging with parents on more than five-a-day,” says French, referring to the recommended serving of fruits and vegetables. “Limiting screen time, promoting activity, good

nutrition—it’s all about the healthy child.”

And the researchers will leverage ECFE advocates’ home visits with families.

French is excited that the project is funded for seven years because “obesity is complicated.” She is optimistic that this multi-pronged project targeting pres­ choolers will result in many of them avoiding obesity—and the concomitant lifelong health problems. She and Sherwood, with their research partners, hope they can bend the trend toward healthier habits.

Lacking health insurance, lacking access Disparities in health insurance coverage by age, household income, and race or ethnicity—as well as a surprising increase in the number of uninsured children—have been documented by recent studies carried out by the University of Minnesota’s State Health Access Data Assistance Center (SHADAC).

“The expansions to health insurance coverage, passed as part of the Affordable Care Act, will help relieve these disparities,” says Lynn Blewett, principal investigator for SHADAC, based in the School of Public Health and funded by the Robert Wood Johnson Foundation.

“For democracy to work, you need a good political debate informed by reliable and unbiased data—and that’s what we do,” Blewett says.

A recent SHADAC study found that, nation­wide, children who were more likely to lack insurance were more likely to be 14 years old or older, non-white or Hispanic, or live in the lowest income households.

Children without health insurance may lack access to care—and may be sicker when they do seek care, often resulting in higher health care costs.

6 University of Minnesota School of Public Health

“There’s been a concerted effort in this country to provide affordable health insurance coverage for all children,” Blewett says. “Both sides of the aisle sup­ ported the initial passage of the Children’s Health Insurance Program in 1997 and reauthorization passed in 2009. But despite CHIP and the Medicaid program, which cover more than 20 million children in United States, there are still 9 million children without health insurance.”

SHADAC found that in Nevada, 21 percent of children still lack health insur­ance, compared with 2 percent in Massachusetts, a state that has initiated comprehensive health insurance reform.

In Minnesota, coverage gaps are substantial.

Even though only 6 percent of Minnesota’s children are uninsured, Hispanic children in the state are five times more likely than whites to be uninsured.

Blewett also cites estimates from a recent report released by the U.S. Census Bureau, written by SPH alum Annie Mach, that found a statistically significant increase in uninsured children in Minnesota and Alaska between 2008 and 2009—while all other states have stayed steady or increased levels of coverage. This raises additional concerns for children’s coverage in Minnesota.

Blewett believes that more attention should be placed on getting children enrolled in the programs they are eligible for and in reducing the gaps in coverage.

“Numbers do drive policy,” she says, “and our goal is to drive the best outcome that we can.”

Seeking better outcomes and brighter futures for children are goals for Blewett, French, Demerath, McGovern, and their colleagues. They are working with policymakers, community members, and parents to prevent some of the health problems children face today—and to ensure a healthier future for the next generation.

Read SHADAC’s report, “State Level Variation

in Health Insurance Coverage: A Deeper Look.” www.sph.umn.edu/shadacreport

Blueprint for change

Photo by Darin Back

Emergency physician Dave Dvorak goes beyond ‘treat and street’ to stop the cycle of violence for Minneapolis kids.

A victim of child abuse who ends up in the emergency department would never be treated and sent back to a violent environment without some sort of intervention. But all too often that’s exactly what happens when young people arrive at the hospital stabbed or shot as a result of street crime.

As an emergency physician, Dave Dvorak knows this troubling reality well. As an SPH graduate, he understands the power of viewing violence as a public health issue.

A few years after the city of Minneapolis introduced Blueprint for Action, an initiative to curb violent crime among young people, Mayor R.T. Rybak asked Dvorak to help launch the program’s hospital-based component. At the time, Dvorak was working toward an MPH degree through the executive program in public health practice.

Those political and school connections helped Dvorak implement violence-prevention protocols at Hennepin County Medical Center and North Memorial Medical Center. The work—in which he partnered with Minneapolis health commissioner and fellow SPH alum Gretchen Musicant—served as the basis for his master’s project.

Now when young victims of violent crime arrive at the two trauma centers, they are connected to a social worker who evaluates them on a host of issues—anger management, chemical dependency, mental health, just to name a few. The patient is then matched to any one of 35 community organizations that can help with GED tutoring, job training, breaking from a gang, and other services to cut the chance of repeat violence.

The hospital protocol has been running for just a year, but similar efforts in Baltimore and Oakland have proved to save lives, as well as the financial costs of violent crime.

While the emergency department may seem like a questionable place for initiating big life changes, Dvorak says it’s ideal. “In the hospital, kids are out of their environment and quite often feeling vulnerable,” he explains. “It’s a perfect time to break through.”

7

research news

CT scans can cut lung cancer deaths

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Peripheral artery disease drives up heath care costs PAD, or Peripheral Artery Disease, is a common and often debili­ tat­ing condition in which blood flow to the legs is obstructed by plaque that blocks heart or brain arteries. It affects at least 8 million Americans and is considered a major, but less known, risk factor for heart attacks and stroke. As baby boomers age, rates of PAD are expected to spike.

New research, led by SPH epidemiologist and Medical School cardiologist Alan Hirsch, shows that each year the U.S. spends roughly $21 billion on PAD-related hospitalizations. The researchers also found that hospitalizations and treatment costs for what some refer to as “heart attacks below the belt” increase substantially as the disease progresses, and that many patients experience repeat hospitalizations.

For the study, researchers used data from the Reduction of Atherothrombosis for Continued Health (REACH) registry. The registry includes more than 24,000 individuals with athero­thromb­osis, the hardening or narrowing of the arteries due to plaque buildup.

“My co-investigators and I are concerned that this nation may no longer be able to sustain the high costs associated with treating a very common and preventable disease such as PAD, especially when the many invasive treatments are not always durable,” says Hirsch.

Hirsch and colleagues are working to lower PAD costs and improve treatments through a national multicenter clinical study called CLEVER (Claudication: Exercise vs. Endoluminal Revascularization), sponsored by the National Heart, Lung, and Blood Institute and managed by the University of Minnesota and Brown University.

8 University of Minnesota School of Public Health

A large-scale study suggests that annual CT scans of current and former heavy smokers could reduce deaths from lung cancer by 20 percent. Screening with the high-tech images has proved so successful that researchers stopped the trial six months early.

The University of Minnesota played a major role in the National Lung Screening Trial, recruiting, screening, and tracking 6,600 participants. Total nationwide participation in the study was 53,000.

Participants received screening at enrollment and at the end of their first and second years in the trial. They were then followed for up to another five years. In that period there were 354 deaths from lung cancer among participants in the CT arm of the study and 442 lung cancer deaths among the chest X-ray group.

The study marks the first time researchers have seen clear evidence of a screening method that could reduce deaths from lung cancer, the leading cause of cancer-related deaths in the United States and one that is often diagnosed once it’s too late for treatment.

“The idea is that we can discover the cancer before it becomes inoperable,” says SPH professor Timothy Church, principal investigator.

But Church warns against making any blanket recommendations at this point, stressing that more analysis is needed on the harms and benefits of CT screening. That process could result in a change in professional guidelines for lung cancer screening.

“We have to make sure that we’re not doing more harm than good,” Church says. “Once that analysis is done, recommenda­ tions can be formulated about who to screen, how often to screen, at what ages to screen, and how long to screen them.”

Controversy hinders support for HPV vaccine laws People are less likely to support laws requiring the human papillomavirus (HPV) vaccine for young girls when they learn that there is controversy over such laws, finds SPH research.

While the vaccine that protects against the potentially cancer-causing virus is widely supported in the medical and public health com­munities, state laws requiring girls to be vaccinated for middle-school attendance have caused controversy among parents, politicians, and even medical and public health experts disagreeing about whether such laws are appropriate. News coverage about the vaccine requirements likely amplifies the controversy.

SPH assistant professor Sarah Gollust finds that the controversy, in turn, leads to diminished public support for legally mandating the HPV vaccine.

The study is among the first to examine the direct tie between controversy about a piece of health policy portrayed in the news media and public support for the policy.

“This research raises important questions about how the news media’s tendency to report on controversy shapes public opinion about health policy,” says Gollust.

Body size matters with colon cancer

Bariatric surgery: A possible treatment for type 2 diabetes?

Obesity doesn’t just raise older women’s risk of developing colon cancer, it may also increase their risk of dying from it.

That’s according to research led by SPH epidemiologist Anna Prizment. In an analysis of 1,100 postmenopausal women diagnosed with colon cancer between 1986 and 2005, her team found that women carrying excess weight in the waist and hips may be at increased risk of death.

The researchers documented each woman’s body mass index, waist-to-hip ratio, and waistline. They found that obese women were 45 percent more likely to die from all causes than their healthyweight counterparts.

Body shape appeared to have a particular link to mortality rates. Women with a high waist-to-hip ratio had a 30 to 40 percent increased chance of dying from colon cancer.

The researchers say the findings underscore the importance of women to maintain a healthy weight throughout their life, especially after menopause.

Researchers from the University of Minnesota are part of an international team investigating whether Type 2 diabetes can be effectively treated by bariatric surgery.

Obesity has long been known to be a major risk factor for Type 2 diabetes.

Randomized studies have shown that gastric banding—bariatric surgery involving implanting an adjustable band in the stomach—improves the health of diabetics by encouraging weight loss.

There is also a growing body of observational studies showing that Rouxen-Y gastric bypass—a bariatric surgery in which part of the stomach is sealed off and food is re-routed to the small intestine—often results in a return to normal levels of blood glucose. But this sort of diabetes treatment has yet to be tested, until now.

The Diabetic Surgery Study is the first randomized, controlled clinical trial to examine whether Roux-en-Y gastric bypass can effectively treat Type 2 diabetes. The trial is being conducted at clinical centers at the University of Minnesota, Mayo Clinic, Columbia University, and two sites in Taiwan. Patients are enrolling now and results are expected within two years.

Sayeed Ikramuddin, a professor of surgery in the U’s Medical School, is primary investigator of the trial. SPH faculty members include epidemiologist Robert Jeffery and biostatistician John Connett, who directs the trial’s data coordinating center.

The study also includes extensive educational sessions for participants on nutrition and exercise and rigorous medical treatment of their diabetes.

“There is intense interest and excitement regarding this bold, innovative study among diabetologists and bariatric surgeons,” says Connett.

To listen to Public Health Moment audio clips of these and other SPH research projects, go to www.sph.umn.edu/moment.

9

school news U team tackles blood banking on an international level

W

hen patients in U.S. hospitals and clinics are in need of blood, they can get it. We have a nationwide system to ensure the collection, management, and distribution of blood. We have blood drives to populate our blood banks.

And we have trained hematologists. But half a world away, this is not the reality.

In many developing countries, there is no system. If a person needs blood, he or she must find someone who is willing to donate.

And even then, it’s not a sure bet that the blood is the right type, or even safe.

Up until eight months ago, Afghanistan was one of these countries.

With a nation in need of a better health system, the Afghanistan Ministry of Public Health sought applications to develop a national blood safety and transfusion service. Establishing a safe blood supply is a critical step to building a better health system. After all, doctors cannot perform surgeries if they don’t have blood, and without surgeries, hospitals become ineffective.

The ministry chose Terri Konstenius, Jeffrey McCullough, and William Riley, a team of experts from the SPH and Medical School.

Each member plays a vital role. Konstenius, based in the SPH, leads the program and serves as project director. She is responsible for developing curriculum, as well as coordinating, planning, and implementing training programs. She also maintains contacts with the ministry and cultivates relationships between Afghanistan’s government and the U. McCullough, a world-famous transfusion expert, practices with physicians, teaching them about blood utilization and transfusion. Riley, an associate professor and associate dean in the SPH, is a recognized leader in health care

Masoud Rahmani and Terri Konstenius helped organize a blood drive at the American Embassy in Kabul. Karl Eikenberry, the U.S. ambassador to Afghanistan, also attended the drive, which collected 125 units of blood for Afghan civilians.

10 University of Minnesota School of Public Health

administration and is principal investigator of the project.

“We want to help [Afghanistan] build and strengthen their national blood supply,” says McCullough. “Not only does this include strengthening screening and collection procedures, but it also means improving lab processing systems, recruitment of donors, and blood utilization methods in hospitals.”

The group hosts weeklong training seminars for roughly 60 Afghan physicians, ministry staff, and hospital administrators.

Depending on the designated curriculum, other national experts travel overseas with the team.

“ We’re really privileged to be able to support the Afghanistan program and improve the safety and availability of their blood supply.”

–Terri Konstenius

“We have a vast interdisciplinary pool of experts to assist us,” says Konstenius. Adds Riley, “Because of their own extensive reputations, Terri and Jeff know top experts, and we bring those people with us to the training sessions so they can share their expertise.”

Eight months into the two-and-a-half year project, the team remains grateful for the opportunity to partner with the Afghanistan Ministry of Public Health.

“We’re really privileged to be able to support the Afghanistan program and improve the safety and availability of their blood supply,” says Konstenius. “Everyone in the training sessions is extremely eager to improve, and that’s really gratifying.”

While most of the instruction has been in Afghanistan, Masoud Rahmani, the national director of the National Blood Safety and Transfusion Service, recently came to the United States for a fellowship. He completed rounds in the U’s acute care units and blood bank. He also met with Congressman Keith Ellison and leaders from the American Red Cross and Centers for Disease Control and Prevention (CDC).

While the group has already accomplished a tremendous amount, it is only the beginning. The team will soon hire a Kabulbased employee to help manage the work. And the program will soon expand to other countries.

The CDC recently selected the University of Minnesota as one of three organizations for task orders to work on blood banking in 42 nations around the world.

“This is a great opportunity to become a center of excellence for developing nations,” says Konstenius, “and it’s really special that we’re a part of it.”

Health care reform: Where do we go from here?

Experts discuss issue at SPH roundtable

H

ealth care needs to change, and it will, one way or another.

That’s the uncomplicated fact agreed upon by a panel of experts at the most recent School of Public Health Roundtable, “Leadership Essentials in the Era of Health Reform.”

The roundtable kicked off with a keynote address delivered by George Halvorson, chairman and chief executive officer of Kaiser Permanente, the nation’s largest nonprofit health plan and hospital system.

Halvorson spoke of the need to change processes in health care delivery.

He noted that 1.7 million people get sick each year—or sicker—as a result George Halvorson of hospital-associated infections. The outcome of this irony is billions of dollars in treatment and tens of thousands of deaths annually.

Some other startling statements from Halvorson: • People diagnosed in the late stages of cancer who go on to receive standard treatment such as chemo or radiation live 29 days fewer than people who simply enter hospice.

• We treat diabetes correctly only 8 percent of the time.

• We treat asthma correctly only about half the time—and we don’t know which half we’ve treated correctly.

• If people walked 30 minutes, four days per week, diabetes would be cut by 40 percent—and by 60 percent if a person also lost 10 pounds. The Medicare system, which is on course for insolvency, could be saved by this action alone.

SPH associate professor Daniel Zismer echoed that last thought in a panel discussion following the lecture, saying that health care is geared not toward keeping people healthy, but to help them once they’re sick. The issue, said Zismer, is “will patients do their part [to keep healthy]?”

Halvorson said the health care system will be moving toward team care (with, say, a nutritionist sitting alongside a cardiologist), preventive measures, patient focus, and a universal medical database for tracking treatment and outcomes.

As for health care reform legislation itself, SPH professor Lynn Blewett said it will likely go up for a “repeal all” vote in the House.

While that probably won’t pass the Senate, Congress will start to look at specific pieces to take out of the bill. “The question is,” said Blewett, “what components will they pull and what are the costs associated with them?”

Watch a video presentation of “Leadership Essentials in the Era of Health Reform.” www.sph.umn.edu/roundtable

“ Federal health reform is focused in large part on access, but what are we doing about the cost and delivery challenges we face? That’s what we’re focused on at the state level.”

“ We are on a trend line where we will bankrupt the country in 20 or 30 years if we don’t radically address the way care is delivered and paid for in the United States.”

David Tilford, president and CEO, Medica

Carol backstrom, assistant to the commis­sioner for health reform, Minnesota Department of Health

“ Most [providers] realize that reform is inevitable. Reform is going to come whether it’s legislated or not—market forces are telling all providers that change is afoot. Frankly, if you talk to them honestly and behind closed doors, most of them will tell you change is absolutely required.”

Photos by Paula Keller

Daniel Zismer, SPH associate professor

“ [For states moving ahead on reform] it’s this tension of ‘hurry up, get things done’ and then at the same time ‘what’s going to happen and what [parts of reform] will they peel off in the next Congress?’”

Lynn Blewett, SPH professor

“ What is at risk in the whole issue of health care reform is whether the new culture of mandate can survive— mandating states to do what they are asked to do through medical assistance enrollment or whether the individual mandate of federal health care reform can survive in and of itself. If that unravels much of federal health care reform—the exchanges and the federal subsidies for those to get coverage—is threatened as well.”

Cal Ludeman, commissioner, Minnesota Department of Human Services

11

school news

SPH receives $12.4 million for emergency preparedness initiatives The University of Minnesota School of Public Health is the recipient of two multi-million dollar preparedness grants that will position the school to conduct and translate preparedness research into training opportunities for the workforce. The work will be carried out under the University of Minnesota Simulations, Exercises, and Effective Education (U-SEEE) project.

The Centers for Disease Control and Prevention (CDC) recently awarded nearly $5 million to the SPH to establish a Preparedness and Emergency Response Learning Center, which develops prepared­ ness and response competency-based training. The center will support best practices and participate in a national network of preparedness and emergency response learning centers.

What sets the Minnesota center apart is its connection to research. The learning center will work in tandem with the SPH’s Preparedness and Emergency Response Research Center, which was funded at $7.4 million by the CDC in 2008. The aim is to conduct research on which preparedness training strategies work best.

For the last two years, the research center has investigated the way public health organizations conduct preparedness and

An actor receives makeup for her role as a victim in “Disaster 101,” an emergency prepared­ ness and response simulation developed by SPH experts.

emergency response education. The findings will help establish a model of best practices in preparedness training.

“The SPH is one of only five schools nation­a lly that received grants from the CDC for both types of centers—learning and research—and the only one conducting research on teaching and learning strate­ gies,” says Debra Olson, SPH associate dean for education and lead investigator for the projects.

“This means that the SPH is positioned to be a national leader to ensure that the public health workforce is better prepared to respond to emergencies and that funding for preparedness training is used in the most effective way,” says Olson.

A bomb explodes and responders rush to the scene to help injured victims.

Watch “Disaster 101” in action. www.sph.umn.edu/disaster101

The SPH received its highest level of gift support on record in fiscal year 2010, which ended on June 30. More than 650 donors made gifts and pledges totaling $2,724,939, with most of those gifts going to endowed scholarships. With support from University scholarship matching programs, gifts to scholarship endowments will have their awards doubled on an annual basis.

“This is a challenging time for everyone, and I know that donors must make careful decisions about giving. I am proud that our alumni and friends continue to value public health education by showing such generosity,” says SPH dean John Finnegan.

“I appreciate the support shown to our students.”

With help from the SPH Alumni Society board, the third annual Alumni and Friends Scholarship Gala raised more than $33,000, bringing the Alumni Scholarship Endowment to more than $160,000.

12 University of Minnesota School of Public Health

The year was especially notable for significant gifts made by alumni. Lowell (MHA ’67) and Leslie Kruse made the largest gift ever given by an SPH alum for a scholarship to build healthy communities. Patrick Hays (MHA ’71) made a major commitment toward an MHA leadership scholarship, and Richard Norling (MHA ’75) made a key leadership gift toward an endowed chair that will honor a retiring faculty member.

Friends of the school Leon and Nancy Robertson gave a substantial gift to support the Leon S. Robertson Professorship in Injury Prevention. In all, alumni and friends have stepped forward to make the fiscal year a success in garnering new support for the school and its students.

For more information about ways to support the SPH, call Adam Buhr at 612-626-2391.

Photo by Jack McTigue

SPH receives highest level of giving in FY10

Mary Story elected to Institute of Medicine School of Public Health professor Mary Story has been elected to the Institute of Medicine (IOM). IOM membership is a status considered to be one of the highest honors in the field of health sciences.

“My academic career has been devoted to improving the nut­­ri­­­­ tional health of children and adolescents, and it is an honor to be elected to the Institute of Medicine,” says Story.

New members are elected by current active members through a highly selective process that considers an individual’s profes­sional achievement and commitment to service. The IOM is

unique in its structure as both an honorific membership organ­ization and advisory organization.

In addition to being a professor, Story is SPH associate dean for student life and leadership. She directs the national program office for the Robert Wood Johnson Foundation’s Healthy Eating Research, an initiative that supports research on environmental and policy strategies to prevent childhood obesity. She has conducted numerous school and communitybased obesity prevention studies, and several of them have focused on low-income communities and minority populations.

Story was elected with 65 other professionals, raising the IOM’s membership to 1,649 and the number of foreign associates to 96.

Watch a photo slideshow of Mary Story’s IOM celebration. www.sph.umn.edu/storyiom

Photos by paula keller

School honors community partners More than 200 community members came together with School of Public Health leaders to recognize the partner­ships that advance the education, research, and outreach efforts aimed at improving population health locally.

“We all know that public health has always been a discipline that has valued the concept of collaboration. That is what sets us apart from other areas of scientific study,” said SPH dean John Finnegan in his welcoming remarks at the seventh annual Community Partners event. “It is the commitment we all share for making an impact on improving health and pre­venting disease at the community level.”

In addition to 24 individuals who received awards for their work as mentors, research colleagues, and other key partners, two organizations were singled out for exceptional community engagement.

Clear Channel was honored for helping to educate the public about the 2009 H1N1 pandemic. In the weeks when H1N1 was rapidly spreading worldwide, the media conglom­ erate invited public health experts to appear across its family of radio stations to discuss ways in which people could protect themselves and their communities.

The Health Economics Program at the Minnesota Department of Health was recognized for collaborating with SPH colleagues to provide data on levels of insurance coverage across the state.

This work was critical in advancing state-level health reform efforts over the past several years, and it will play a vital role in assessing national health reform efforts as they take effect in the coming years.

“ We all know that public health has always been a discipline that has valued the concept of collaboration. That is what sets us apart from other areas of scientific study.”

–john Finnegan

See photos and a list of Com­ Partner Star winners. munity

www.sph.umn.edu/cp2010

(Top) SPH professor Ira Moscovice heads the Division of Health Policy and Manage­ ment, which collaborates with Health Economics Program director April ToddMalmlov and assistant director Stefan Gildemeister. (Bottom) SPH dean John Finnegan presents a Community Partner Award to Mike Crusham, president and market manager of Clear Channel Radio, Minneapolis and St. Paul.

13

student news

MHA student helps get heart clinic underway at Children’s Hospital Sarah Stephenson realized she had an interest in children’s health at a dance marathon.

At the time, the University of Iowa student was helping to raise funds for young cancer patients and their families.

“At the end of the marathon, all the kids who you raised money for come to the dance,” explains Stephenson. “When I saw the kids and their families arriving, I realized I had an interest in helping them beyond just this event.”

After graduating Stephenson, who com­

bined a degree in bio­medical engineering with a certificate in entrepreneurship, worked as a lab director for a year while she planned her next move. “I knew I liked health care settings, and I’ve always been interested in the organizational side of things, so the MHA program was a perfect fit,” she says.

Now just a few months from graduating, Stephenson is wrapping up her work as coordinator for a new heart clinic at Children’s Hospital in Minneapolis. The clinic diagnoses

and treats children who are experiencing dev­el­opmental delays that are likely related to their heart condition. All the children who come to the clinic have had heart surgery at the hospital, often within hours or weeks of their birth.

While heart health and neuro­logical dev­­el­ op­ment in children are linked, the relation­ship is complex and still some­what mysterious. But it is known that when neuro­­­­logical issues are addressed early, children are much more likely to be on track devel­opmentally by the time they begin school.

Stephenson gets to put the operations and strategy skills she’s learned to use when overseeing clinic operations, which includes recruiting families, collecting data, and liaising with hospital admin­istration. The clinic specialists range from occupational therapists to neuropsychologists to genetic counselors to pediatricians.

The experience will serve her well as she soon embarks on a yearlong fellowship with Bon Secours, a health system based in Richmond, Va. Stephenson says the new chapter will give her a different perspective on health care, but that she sees herself returning to children’s health.

“It’s such a powerful thing to know you’ve helped a child,” she says. “Nothing else can make you feel that way.”

When Lorna Schmidt signed up to receive text message updates from the Food and Drug Administration (FDA), she had no idea she would one day win a contest sponsored by the federal agency.

But that’s just what happened when the Community Health Education student participated in a text message-based quiz on new tobacco regulations. As one of four winners across the country, Schmidt was profiled in a FDA-produced video on her own efforts in the area of tobacco prevention.

Schmidt has been working inside and outside of the classroom on various obesity and tobacco prevention projects. She’s currently implementing school-based wellness policies with the Minneapolis Department of Health and Family Support.

Before that, she worked on tobacco-free workplace initiatives for the Vitality Project, a first-of-its-kind endeavor to improve the longevity of residents of Albert Lea, Minn.

When the Tobacco Control Act legis­lation of 2009 began to

14 University of Minnesota School of Public Health

go into effect this year, Schmidt looked for resources on key provisions of the law, which gives the FDA the power to regulate the tobacco industry. She was pleased to learn that the FDA was using Twitter and other social media, especially considering that teens and adolescents are key audiences in the battle over tobacco.

“The tobacco industry has always been on the cutting edge of marketing—it’s hard to fight that,” she explains. “It’s great to see that the government is trying to sell health in new ways. It’s a great way to reach youth.”

Lorna Schmidt discusses tobacco prevention in a video produced by the FDA. www.sph.umn.edu/schmidt

Photo at top by Paula Keller

FDA recognition for MPH student Lorna Schmidt

Before their time

Photo byby David Parker Photo Darin Back

SPH faculty member David Parker brings a human face to the tragic world of child labor.

David Parker remembers the moment he first en­ count­­­­ered child labor. It was the early 1990s and the occupational health physician was in Nepal invest­igating what was at the time a greatly unknown issue.

“I walked into a factory, and there were about forty kids sitting on a cold, damp floor hand knotting carpets in a cramped room,” he recalls. “I thought, ‘My God, this is what people think of when they talk about child labor.’”

That trip led to many similar ones over the next two decades. Armed with a Leica camera, Parker documented young cotton pickers in Turkey, metal workers in Morocco, prostitutes in Thailand, leather tanners in Bangladesh, garbage pickers in Nicaragua, and many others. He often had to pose as a businessman (complete with falsified business cards) to gain access to work sites.

Along the way, he published books of his photo­ graphs and edited a collection of essays. He won a Minnesota Book Award, a McKnight photography grant, and a Christopher Award “for literature affirming the highest values of the human spirit.” His photographs were displayed in the U.S. Senate rotunda, at the Department of Labor, and in traveling exhibitions throughout Canada and Nicaragua.

In that time, the visibility of child labor rose and governments began acting to stop it. Yet today more than 320 million kids under the age of 16 work at jobs where they’re often underpaid, underfed, and exposed to abuse and dangerous working conditions.

When faced with questions about trying to remedy a centuries-old problem—one that is inextricable from cycles of poverty and lack of education—Parker says people should simply “do what they can.”

To illustrate the point, Parker goes full circle, back to Nepal, where he first saw children toiling in the carpet factory. Since that visit, he has forged connections that helped the Minnesota Advocates for Human Rights start a school in Kathmandu valley, serving the very children who used to have no alternative to working. “We started with eight kids,” says Parker. “Now we have about 280.”

Brick worker, India, 1994.

Watch a slideshow of more photos from David Parker. www.sph.umn.edu/parker

15 13

alumni news

Class notes Christine Bakke (MHA ’01) received the Up and Comers Award from Modern Healthcare Magazine. She is an administrator for the Gorecki Care Center at St. Benedict’s Senior Community, CentraCare Health System in St. Cloud, Minn.

Nancy Goldstein (MPH ’76) has been named chair-elect of the Cancer Patient Education Network, an organization affiliated with the National Cancer Institute. Goldstein is a patient education program manager at the University of Minnesota Medical Center, Fairview, and the University of Minnesota Amplatz Children’s Hospital.

Verna (Raisanen) Hames (MPH ’46), Denver, Colo., died Jan. 1, 2010, at age 86. She worked in public health nursing for the entirety of her career, including posts at Minneapolis General Hospital, the Mayo Clinic in Rochester, Minn., and Children’s Hospital in Denver, Colo.

Linda Olson Keller (MS ’80) has been named Distinguished Nurse of the Year in Minnesota by the March of Dimes. She was honored for significant professional contributions in public health nursing and leadership. She also received the Distinguished Alumni Award from St. Olaf College. Keller is a faculty member in the U’s School of Nursing.

Annie Mach (MPH ’09) is a Presidential Management Fellow (PMF) with the U.S. Census Bureau. As a survey statistician, she produces estimates of health insurance coverage nationally.

Prior to her current position, she served as a PMF for the Congressional Research Service, the public policy research arm of the U.S. Congress.

Kristina McElroy (MPH ‘09) is serving in Afghanistan as a veterinary public health officer in the U.S. Army Veterinary Corps. In addition to managing food safety and defense activities for the armed services, McElroy provides medical, surgical, and dental care for military working dogs.

William Santulli (MHA ’84) and Tom Lubotsky (MHA ’81) are on the senior leadership team of Advocate Health Care, which received the Malcolm Baldrige National Quality Award. The award is given to a cadre of organ­ izations annually by the President of the United States and is the nation’s highest honor for quality.

Stephen Hopper (MHA ’74) retired as president and CEO of McDonough District Hospital after 26 years as the chief executive officer and longest serving administrator in the hospital’s history. Located in Macomb, Ill., McDonough is a not-for-profit 113-bed hospital with more than 550 part- and full-time employees.

Chris Karam (MHA ’92) is CEO of the Christus St. Michael Health System, ranked second in the nation in Modern Healthcare Magazine’s Best Places to Work for 2010. The program recognizes outstanding employers in the health care industry. The Christus St. Michael Health System, located in Texarkana, Texas, ranked third in 2009.

Mindy Rostal (MPH ‘07) is field veterinarian with EcoHealth Alliance, where she detects emerging zoonotic diseases. She has taken samples and conducted surveillance of wild animals—as well as trained vets, biologists, and lab workers on surveillance methods—throughout Asia, South America, and Central America. She also works with local conservation partners to collect samples in the field, as pictured in this photograph of Rostal holding a flying fox bat in Bangladesh.

16 University of Minnesota School of Public Health

Brian Osberg awarded for decades of alumni service

Tricia Todd (MPH ’94) is an instructor for the Public Health Practice program and director of the North Central Public Health Leadership Institute at the SPH. She will continue to serve as assistant director for the Health Careers Center at the University of Minnesota.

Melissa Bachman Ugland (MPH ’98) authored the report “Toward a Coordinated Sexual Assault Advocacy Response in Milwaukee: A Needs Assessment of Sexual Assault Advocacy Services” for the Wisconsin Office of Justice Assistance. The report analyzed the circumstances that led to Milwaukee being singled out in a U.S. Senate hear­ing about the mishandling of rape cases.

Gita Uppal (MPH ’99) received the Rising Star Award from the health administration section of American Public Health Association. The award recognizes those new to the field of health administration who show great promise. Uppal is director of policy analysis at the U.S. Department of Veterans Affairs.

Perry Witkin (MHA ‘81) received the Humanitarian of the Year Award from National Distribution and Contracting, a medical distributors association, in recognition of his work with disaster response. He serves on the boards of the American Refugee Committee and Nechama. Witkin is the owner and CEO of the Twin Cities-based health IT company STAT Technologies.

Send your class notes news to SPHnews@umn.edu.

Join the SPH Alumni Network at www.sph.umn.edu/alumni.

Brian Osberg has been awarded the prestigious University of Minnesota Alumni Service Award in recognition of his dedication to the institution.

Osberg’s relationship to the University is one marked by his ability not only to strategically envision next steps but also a commitment to do the work to get there.

This combination became evident soon after Osberg graduated from the School of Public Health with an MPH in 1986. At the time, he was a vice president at Group Health (now HealthPartners), where he was working to usher in new health care models. Knowing that the SPH would soon be sending out alumni with a knowledge deficit in this area, Osberg took it upon himself to design and teach a class on emerging health systems. The class is still offered today.

As a volunteer for the SPH alumni society, Osberg continued to infuse practice-based concepts into the school’s curriculum. His belief in the strength of the education compelled him to make the lead gift to the school’s alumni scholarship fund, which now stands at more than $160,000.

While a new Gopher football stadium was just a dream for most people, Osberg

was serving on the University of Minnesota Alumni Assoc­ iation’s national advocacy board, analyzing policy and legislative issues pertaining to the sports venue.

One of his top achievements was securing the association’s $1 million gifts to the President’s Scholarship Match and the new TCF Bank stadium.

Outside of his leadership at the U, Osberg has championed the health of Minnesotans. From 2002 to 2009, he served as assistant commissioner of health care for the Minnesota Department of Human Services. For the past two years, he has worked as state Medicaid director at the agency.

“My volunteer service to the University, especially to the School of Public Health, is a natural extension of the great experience I had there as a student, and it is an expression of my gratitude for all it afforded me,” says Osberg. “I owe my professional success and personal development to the education I received at the U.”

Alumni award and service opportunities • The SPH Alumni Society Board seeks nominations for the Gaylord W. Anderson Leadership Award.

The award—named after the school’s first leader—will be presented to an outstanding alum who is (or has been) engaged in public health. Nominations will be accepted until June 1. See the award criteria at www.sph.umn.edu/ andersonaward.

• The SPH Alumni Society Board seeks applications for new members to serve three-years terms. Applications are being accepted until March 15 for terms that begin in August.

Members attend bi-monthly meetings and serve on a board committee.

They are also encouraged to mentor current SPH students. Learn more and access an application at www.sph.umn.edu/alumniboard.

17

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

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MAKE PLANS TO ATTEND THE

--------------------------NATIONAL PUBLIC

HEALTH WEEK

Upcoming Events Gaylord Anderson Lecture Kelly Brownell, Yale University, presents “Is there the Courage to Change the American Diet?”

Feb. 11, 10 a.m.-noon Coffman Memorial Union Theater Register by Feb. 4 at www.sph.umn.edu/gaylord.

SPH Alumni and Friends Reception ENAR International Biometric Society March 22, 6:30-8:30 p.m.

Miami, Fla.

APRIL 4-8, 2011 FREE & OPEN TO THE PUBLIC

5PM | DOORS OPEN Grab a snack and visit with representatives from public health organizations and businesses.

5:30PM | SHOW TIME Expert film introductions and films to follow.

Q&A post-films daily.

SPH Student Research Day Celebrate the research endeavors of public health students at this poster presentation.

April 4, 10 a.m.-1 p.m.

Coffman Memorial Union Great Hall

Health Disparities Roundtable April 19, time TBD Coffman Memorial Union Theater Register by April 12 at www.sph.umn.edu/ce/ roundtable.

SPH Commencement May 16, 5-6:30 p.m.

Northrop Memorial Auditorium MHA Third Annual Golf Tournament June 6, noon-8 p.m.

White Bear Yacht Club Register at www.sph. umn.edu/mhagolf.

Sign up for event notices, in­cluding alumni reunions, at www.sph.umn.edu/ alumniinvolved.

Event details at www.sph.umn.edu/events.

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