Advances - Winter 2013

Advances FROM THE UNIVERSITY OF MINNESOTA SCHOOL OF PUBLIC HEALTH

WINTER 2013

A Powerful Partnership Public health and the Affordable Care Act join forces

Gun violence: SPH dean issues a public health challenge Is the Affordable Care Act bad for small business?

Real food as a path to healing $1 million gift marks 50 years of gratitude

Contents

School of Public Health Leadership

Mary Story Senior Associate Dean for Academic and Student Affairs Debra Olson Associate Dean for Education William Riley Associate Dean for Strategic Partnerships and Relations Beth Virnig Associate Dean for Research Mary Ellen Nerney Assistant Dean for Education Operations

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

Since Advances launched a decade ago, I have written for the magazine only in this dean’s letter. But I am breaking tradition with this issue, and for good reason.

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 Kristin Stouffer Managing Editor Martha Coventry Contributing Writers Beth Dooley Barbara Knox Deane Morrison 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.

© Regents of the University of Minnesota.

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

WINTER 2013

Dear Friends,

Features FEATURES 2 A public health response to gun violence

In the months following the tragic shooting in Newtown, Connecticut, our country has FROM THE DEAN renewed its decades-old discussion about gun violence. As we struggle to understand this latest tragedy, we are coming to realize that gun violence is fundamentally a public health issue. At its core are the very concerns to which many of us have devoted our professional lives, including entrenched health disparities among underserved populations. On pages 2 and 3, I delve further into public health’s relationship to gun violence and challenge our field to make a lasting impact on this persistently wicked problem.

Guns take more than 30,000 lives each year in America. SPH dean John Finnegan challenges public health professionals to address the under­ lying causes of this tragedy.

4 A powerful partnership The long-term success of the Affordable Care Act depends on better health for Americans, and it gives unprecedented support to public health to make that happen.

8 More care for more Americans

We see extraordinary developments on another front: the rollout of the Patient Protection and Affordable Care Act (ACA). Never before has prevention been so intricately woven into the nation’s delivery and financing of health care. In this issue, we look at how SPH experts are helping to shape this new era. Health policy professors offer their take on Medicaid expansion (page 8) and opportunities for small businesses (page 12). SPH alum April Todd-Malmlov is charged with directing the creation of our own state-run health exchange, and we get her thoughts on page 14.

Expanding Medicaid offers the opportunity to provide health care for 17 million more people, but not all states are making the move to protect their citizens. Prof. Lynn Blewett explains why.

9 Big-picture thinking, real-world impact SPH alum Elizabeth “Issie” Karan puts her joint JD/MPH to work on the Hill to help underserved populations.

Not only are our experts guiding the implementation of the ACA, but they are benefiting from its support of their research. On pages 4-7, you can read about some of the unexpected and fascinating ways in which the ACA will shape the work of our faculty.

12 Taking care of small business Opponents of the Affordable Care Act say it’s bad for small business. But is that true? SPH faculty member Jean Abraham and alum Matthew Katz explore the facts behind the claim.

On behalf of the school, I’d like to offer my sincere thanks to Don and Janet Wegmiller for their role in creating an endowed professorship for our Master of Healthcare Administration program (page 16). Don, an MHA alum, has a career marked by innovation and accomplishment. Don’s colleagues recently inducted him into Modern Healthcare’s national Health Care Hall of Fame. It’s an honor to have his name attached to this professorship. As we move into a time of enhanced collaboration among public health and health systems, staying connected to industry leaders like Don is a key to success for all of us.

Yours in health, Yours in health,

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

Departments DEPARTMENTS 10 Findings

Doulas’ care results in fewer cesareans; Big Tobacco adds coupons to marketing practices; local food preferences lead to healthier choices; benefits of sit-stand workstations; longtime HIV prevention program moves online.

13 Finding new health in old ways

PHOTO BY RICHARD ANDERSON

John Finnegan Dean

Jason Champagne is a member of the Red Lake Band of Chippewa, a chef, and an MPH candidate.

He’s using his devotion to real food to combat chronic disease.

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R.K. Anderson remembered for his kindness and ground­ breaking work on the human-animal relationship; $1 million endowment for the Wegmiller Professorship in Healthcare Administration.

1 4 Extending Minnesota’s new health care coverage SPH alum April Todd-Malmlov is overseeing the creation of Minnesota’s new health exchange and she weighs in on its progress.

School news

17

Class notes

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A public health response to gun violence

and make it part of curricula. Out of the 50 schools of public health in America, only a handful offers advanced degrees or certificates in mental health. We must step up our efforts to make sure public health encompasses this profound challenge to individual health.

By doing what we do best, can we turn the tide?

GOING FORWARD

BY JOHN FINNEGAN

OUR PROBLEM, OUR TIME Since the Newtown shooting, gun violence has been increasingly called a “public health” issue. For the first time, the national conversation is moving beyond seeing the problem in simplistic terms—as a gun control or 2 University of Minnesota School of Public Health

By the end of 2013, more than 30,000 people will be dead from gun-related homicides and suicides. crime issue—and acknowledging the complex influences that lead to firearm deaths.

Over the past decades, our field has helped decrease tobacco use, traffic fatalities, and HIV/AIDS infections, and we are making progress in curbing the obesity epidemic. We have helped people and communities all over the world forge better, healthier futures. I have no doubt that we can bring our expertise, proven methods, and multidisciplinary approach to the intricate problem of gun violence and make a lasting difference.

WHERE TO START Public health was once a major force in addressing the issue of gun violence in America. The Centers for Disease Control and Prevention (CDC) and smaller agencies, like the Minnesota Department of Health (MDH), produced valuable statistics and research into how, when, why, and by whom guns were used to kill or injure. But in 1996, Congress passed an appropriations bill that banned government funding for any research that could be used to promote gun control.

On January 16, President Obama, by executive order, ended the freeze on gun violence investigations, calling such work

“critical public health research.” He went on to allocate $10 million to the CDC and $20 million to expand the National Violent Death Reporting System that collects detailed information and data on gun deaths.

Public health researchers can now use these federal dollars to make up for lost time, gathering information for a serious, educated look at the contributing factors to gun violence the way we have approached other public health threats. Good public policies rely on sound data, and public health researchers play a critical role in providing that information.

Office of Minority and Multicultural Health at MDH. In some areas, we’ve seen success in dealing with health disparities, but we, and the entire field of public health, have a long way to go.

We all need to do more to give underserved and poor communities the same opportunities for good prenatal health, parenting skills, sound nutrition, access to health care, and education as those in more affluent populations. We need to work with and learn from these communities to understand their environments and challenges. Giving children a good start in life, helping them stay healthy, and addressing the struggles in their families can eliminate some of the factors contributing to gun violence.

BODY, MIND, AND SPIRIT If we look at gun deaths in street and dom­estic shootings, mass killings, and suicides, two key factors emerge as major contributors—health disparities and mental health issues.

Communities of color have disproportionate struggles with health, poverty, and education. And it is people from these communities who are most likely to be killed by a gun. For African-American youth, guns are the leading cause of death, and their families and neighbors know this. In a Pew Research study released on December 20, 2012, “African-Americans overwhelmingly say gun control is more important than gun rights (68 percent to 24 percent), while opinion among whites tilts in favor of gun rights (51 percent to 42 percent).” Other minority groups, such as Native American and Hispanic populations, also have above average rates of gun violence.

At our School of Public Health, we have a robust research portfolio of projects that address health disparities, including partnerships with the Medical School and the

MENTAL HEALTH AS PUBLIC HEALTH

ILLUSTRATION BY EDEL RODRIGUEZ

T

here are an estimated 310 million guns in private hands in America, that’s 88.8 per 100 people, nearly a quarter of all civilian guns in the world. Our country is awash in firearms.

As of March 15, more than 2,600 people have died of gunshot wounds since the Sandy Hook Elementary School massacre on December 14, 2012. By the end of 2013, more than 30,000 people will be dead from gunrelated homicides and suicides. No one of any class, race, or education level is immune to the tragedies related to the gun violence that cuts a wide swath across our country.

As a nation, we know the facts and up until now, they have failed to move us.

Yet 20 children and 6 adults dead in three minutes in Newtown woke up our national psyche numbed to violence. That shooting was a tipping point. If we can maintain our moral outrage, we may become a country that has seen too many gun deaths and is finally doing something to stop them.

President Obama’s wise recommendations for a new, stronger ban on assault weapons, a limit on large ammunition magazines, and an increase in background checks for gun purchases are vital steps in reducing gun deaths.

Easy access to guns contributes to homicides and suicides, but it’s not the cause. We’ll never decrease gun violence until we address why people pull the trigger in the first place, and how we can help them turn away from making that choice.

Gun homicides take lives, but suicides using guns take even more. According to the CDC, nearly two-thirds of the gun deaths in 2010 were suicides. Among people younger than age 25 who kill themselves, guns were used nearly 44 percent of the time. We must do more to protect our youth from guns, including giving them the tools to handle the despair that leads to suicide.

In general, our country has done a dismal job when it comes to screening for and helping ameliorate mental illness.

African-Americans overwhelmingly say gun control is more important than gun rights (68 percent to 24 percent).

Forty to 45 million people have untreated depression. In our state alone, according to SPH alum Sue Abderholden, executive director of the National Alliance on Mental Illness Minnesota, out of the 21 percent of children ages 9 to 17 who have mental illness or a substance abuse issue, only 1 in 5 receives treatment.

In the United States, we use a clinical model to address mental health—we wait for people with problems to walk in the door.

We need a public health approach to mental health, and we have the potential to move in that direction. Under the Affordable Care Act, heath care providers will be required to adopt population- and community-health methods that will encourage a more involved relationship with neighborhoods and lead to better care overall.

The field of public health itself now needs to add mental health to its areas of expertise

At the American Public Health Association (APHA) meeting in December, shortly after the events in Connecticut, leaders from public health schools across the country took up the issue of gun violence and what role we must play. APHA president Adewale Troutman called for a comprehensive approach to gun violence and reinvesting in research on violence in all forms.

At our school, the Newtown tragedy has refocused efforts to address gun deaths. This year, we will again try to establish a University investment in behavioral and mental health promotion from a public health and community approach. Our faculty will use their expertise to make inroads into stopping gun violence. Epidemiology professor Alan Lifson recently testified before the Minnesota State Legislature on universal background checks for all gun purchases.

And we have nominated environmental health sciences professor Susan Gerberich to a CDC committee tasked with developing a public health research agenda to reduce gun violence.

Before this day is out, another 80 people will be dead from a firearm. Tragedies as public as Newtown and as private as a suicide will continue to happen, and, as a profession, we have an obligation to make them fewer and farther between. We must take risks, stick our necks out, and work to reverse the roadblocks that the firearms lobby has put in the way of common sense measures to end gun violence.

Persistent gun violence is among our most wicked problems, the kind public health is so perfectly tuned to tackle.

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A PUBLIC HEALTH ACT

insurance marketplaces, also called exchanges, or relying on the federal government to fund and run

Public health has not always been so fortunate. According to a report from the Urban Institute Health Policy Center, during the attempt at health insurance reform in the Clinton presidency, “public health advocates were jubilant when they won a simple mention of public health in the…proposal.”

Any increase in better options for health coverage and care supports overall public health, yet the ACA goes further to incorporate the basic tenants of the field and provide the means to achieve them.

“It’s quite remarkable how the ACA is, in essence, a public health act,” says SPH dean John Finnegan. “What jumps out at you when you read the law is how the vision and mission of our field—to secure health, wellbeing, and safety for all populations—runs throughout the entire legislation.”

Nationwide, the attention to preventive care has grown steadily for the past 25 years as we’ve realized the advantages of wellbaby visits, immunizations, and screenings for such threats as breast cancer and liver disease. But serious health issues continue to plague us. It’s estimated that more than half of Americans are living with chronic diseases, most of which could have been prevented. And the specter that our children are in line to have shorter lives than their parents is an unsettling testament to our culture.

Not only do these facts signal reduced quality and quantity of life, they represent a tremendous burden to the health care and health coverage system. According to the American Public Health Association (APHA), we spend “only 3 percent of our health care dollars on preventing diseases, when 75 percent of our health care costs are related to preventable conditions.”

them. Some are still fighting to nullify the ACA. Currently, there are 270 separate bills to repeal the

HAND-IN-GLOVE

law, partially or entirely.

Each of the Affordable Care Act’s nine titles includes enhancements to prevention and public health. Title IV, Prevention of Chronic Disease and Improving Public Health, targets public health needs exclusively and groups them under four areas: community prevention; clinical prevention; public health workforce and infrastructure; and research and tracking. Addressed among these categories are such things as oral healthcare;

A Powerful Partnership Public health and the Affordable Care Act join forces

T

he scramble is on to prepare for January 1, 2014—the day that the Patient Protection and Affordable Care Act (ACA) goes fully into effect. Many of its benefits have been realized already in the three years since President Obama signed it into law on March 23, 2010, but states are still making decisions whether to expand Medicaid benefits.

It’s their choice. Others are on the fence about administering the mandatory health

country supports the health of its citizens. It will provide unparalleled opportunity for millions more Americans to get affordable health care coverage. As of March 2013, about 49 million U.S. citizens are without health insurance. In 2014, that number is expected to drop to 20 million because of the Medicaid expansion and the exchanges. And the ACA will give us the means and support to stay well. Among its provisions is unprecedented attention to and funding for public health.

4 University of Minnesota School of Public Health

ILLUSTRATION BY MARK SMITH

For now, the Affordable Care Act is moving forward and significantly transforming the way our

school-based health centers; barriers to preventive services in Medicare; health disparities; and employer-based wellness programs. Title IV also includes the National Prevention Strategy, a blueprint to create a healthier country.

But it’s with the Prevention and Public Health Fund that the ACA steps up to the plate to pay for initiatives and ongoing programs considered essential, and it marks the first time our country has enacted specific legislation to improve public health. This fund provides $15 billion between fiscal years 2010 and 2019 and $2 billion every year thereafter to give public health efforts the muscle they need to turn our country’s health care focus from illness to wellness.

According to figures gathered by the APHA, if you combine federal, state (Minnesota has received $18 million since 2010), and local programs supported by the Prevention and Public Health Fund in fiscal year 2010-2011:

• more than $385 million (31 percent) went to community-based prevention activities, such as tobacco control efforts.

• more than $220 million (18 percent) supported clinical prevention activities, such as decreasing HIV rates;

• n early $480 million (38 percent) went toward public health infrastructure and workforce development needs, such as public health training centers; and

• n early $165 million (13 percent) was spent on research and tracking activities.

Public health needs the funds, support, and clout of the Affordable Care Act to circumvent the growing health problems in our country. The Affordable Care Act needs the all-out effort of the public health field to help Americans lead better, healthier lives. Without a growing body of healthy citizens to bring down health care costs and buy into the insurance exchanges, the ACA can’t survive and its promise of robust preventive care will be deferred.

What the ACA means on the ground: SPH faculty weigh in In the paragraphs ahead, School of Public Health faculty talk about what the Affordable Care Act (ACA) will mean for the issues they tackle every day and that affect millions of Americans.

Mental health Ezra Golberstein, assistant professor, Health Policy and Management The Affordable Care Act has the potential to significantly improve health care for people with mental illness, although some challenges will remain for this vulnerable population. The core features of the ACA are the expansion of the Medicaid program to low-income individuals who were not previously elig­ible, and the establishment of insurance exchanges with significant subsidies for lowerincome individuals.

Because people with mental illness are disproportionately likely to have lower incomes, there is reason to believe that they will benefit significantly by gaining access to health care and the financial protection afforded by health insurance coverage.

The ACA also requires that mental health and substance abuse services be covered by the Medicaid expansion plans and in the health insurance exchanges, and encourages the development of “medical homes,” which may be a promising approach for coordinating the frequently fragmented health services that people with mental illness experience. However, in spite of these potential improvements, access to services may still be limited by existing shortages of mental health treatment resources.

Foodborne disease Craig Hedberg, professor, Environmental Health Sciences Reducing the number of Salmonella infections is a target of the ACA’s National Prevention Strategy and the act may help

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Because people with mental illness are dispro­portion­­ ately likely to have lower incomes, there is reason to believe that the population will benefit significantly by gaining access to health care and the financial protection afforded by health insurance coverage.

If food workers have health insurance and are diagnosed sooner, the risk of Salmonella transmission should go down.

CRAIG HEDBERG

Consumers (including those at greater risk for obesity) may benefit if the calorie-labeling mandate motivates restaurants to make changes to their menu offerings.

LISA HARNACK

Provisions in the ACA may increase children’s access to health care, support individuals with poor health, and benefit families in which either the children or the adults have substantial health care needs.

Our country needs more dental practition­ers who think along public health lines—about population health— not just about clinical dentistry.

SHEILA RIGGS

For individuals living in rural com­­munities, the questions are whether they will be able to afford the costs of having health insurance (particularly an issue for the young and healthy) and will there be social stigma related to signing up for Medicaid eligibility.

Full implementation of the ACA will offer women at or below 400 percent of the federal poverty level expanded access to coverage through state Medicaid programs, health insurance exchanges, and federal subsidies for purchasing coverage.

KATY KOZHIMANNIL

IRA MOSCOVICE

‘‘

PINAR KARACA-MANDIC

EZRA GOLBERSTEIN

accomplish this through increased health insurance coverage. For example, infected food workers contribute to transmission of Salmonella in restaurant settings. Most food workers do not get health insurance through work and may not seek care when ill. But if food workers do have health insurance and are diagnosed sooner, the risk of Salmonella transmission should go down.

The ACA is also strengthening public health surveillance systems by providing epidemiology and laboratory capacity grants to state health departments and the academic centers that assist them.

lower calorie meals. It’s not clear, though, that consumers at greatest risk for obesity and other diet-related chronic disease will be among those who will use the newly available nutrition information to make better choices. It is possible, however, that all consumers (including those at greater risk for obesity) may benefit if the calorielabeling mandate motivates restaurants to make changes to their menu offerings. For example, a restaurant may decide to eliminate some higher calorie options and increase offerings of items that are moderate or low in calorie content.

Nutrition

Children’s health care

Lisa Harnack, professor, Epidemiology and Community Health

Pinar Karaca-Mandic, assistant professor, Health Policy and Management

The ACA includes a provision that requires restaurants with 20 or more locations to list calorie content information for menu items and on menu boards. Other nutrient information (total fat, saturated fat, cholesterol, sodium, total carbohydrates, sugars, fiber, and total protein) must be available upon request. The ACA also requires vending machine operators with 20 or more machines to disclose calorie content for certain items.

Research suggests that some consumers will use the calorie information to choose

Studies done in the Division of Health Policy and Management suggest that providing insurance coverage and affordable care for the entire family is important for ensuring children’s access to health care.

Results showed that for children who do not have special health care needs, higher family out-of-pocket (OOP) expenditures were associated with higher levels of unmet or delayed medical and dental care, regardless of health insurance or socioeconomic status.

6 University of Minnesota School of Public Health

Provisions in the ACA, such as the expansion of Medicaid, premium and cost sharing (copays and deductibles) subsidies, and limits on annual OOP costs, may increase children’s access to health care, support individuals with poor health, and benefit families in which either the children or the adults have substantial health care needs.

public health infrastructure, one of the goals of Title IV, the ACA has allocated, but not yet appropriated, funding to educate mid-level dental care providers. We hope the funds are forthcoming because our country needs more dental practitioners who think along public health lines—about population health—not just about clinical dentistry.

new health insurance options.

Rural health professionals are wondering if they will be able to respond to the increased demand for their services from newly insured individuals and how they will react to the anticipated reduction in unit price reimbursement from public and private payers.

Public health dentistry

Rural populations

Health of reproductive-age women

Sheila Riggs, associate professor, Division of Dental Public Health, School of Dentistry

Ira Moscovice, Mayo Professor and division head, Health Policy and Management; Director, Rural Health Research Center

Katy Kozhimannil, assistant professor, Health Policy and Management

(Riggs is coordinating the new DDS/MPH degree that will launch fall 2013.)

The ACA did not include adult dental care among the essential benefits that must be part of certain coverage plans, and without that inclusion it’s difficult to make a real difference in our country’s dental health needs. However, health coverage under the Medicaid expansion does include dental benefits for adults. What’s more, funds have been allocated for adding dental clinics to federally qualified health centers, or what are called “safety net” clinics, and that is one way to provide access to adults.

The good news is that children’s dental care is covered in the essential benefits package. When it comes to improving

The ACA is likely to have significant impact on rural populations, rural employers, and the health professionals serving rural communities.

For individuals living in rural com­­ munities, the questions are whether they will be able to afford the costs of having health insurance (particularly an issue for the young and healthy) and will there be social stigma related to signing up for Medicaid eligibility.

Rural employers (many of whom are small) don’t know if they will be able to afford to offer health insurance coverage to their employees and how to best structure their employee pool (i.e. full-time versus contract workers) to take advantage of

offer women at or below 400 percent of the federal poverty level expanded access to coverage through state Medicaid programs, health insurance exchanges, and federal subsidies for purchasing coverage.

The ACA also has important implications for those reproductive-age women who do have health insurance, including expanding access to preventive care without cost sharing (copays or deductibles) and requiring that qualified health plans include certain services (such as maternity and newborn care) as essential health benefits.

State Medicaid programs finance nearly half of all births in the United States, and the ACA includes important additions to Medicaid, such as coverage for prenatal smoking cessation support and for childbirth in licensed, freestanding birth centers. New grants to states support home-visiting care programs for pregnant women and new mothers, and also provide services to women who develop postpartum depression.

The ACA also establishes new workplace protections for breastfeeding mothers, requiring employers with 50 or more employ­ees to provide workers with a private place to express breast milk and ample break time to do so.

Twenty-five percent of all reproductiveage women were uninsured at some point in 2009, the year before the ACA was signed into law. Full implementation of the ACA will

Looking west for health care reform Andrew McCulloch, SPH alum and president of Kaiser Permanente Northwest, is helping Oregon reduce costs for Medicaid patients through local coordinated care organizations. The model is rooted in preventive health practices that Kaiser Permanente has been using for more than 65 years. Read McCulloch’s article, “Oregon paving the way for innovative care transformation” at advances. umn.edu/w13/mcculloch.

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If every state were to participate in the expansion. . . approximately 17 million more Americans would eventually get health care benefits.

SPH professor Lynn Blewett explains the Medicaid expansion

O

n June 28, 2012, the Supreme Court upheld the constitutionality of the Patient Protection and Affordable Care Act (ACA) and the mandate that all individuals must have health insurance coverage. But the court ruled that the ACA Medicaid expansion was optional and that governors and state leaders could choose whether or not to increase their state’s Medicaid coverage.

The expansion is designed to provide health care coverage for more low-income families and individuals and is vital to the ACA’s vision of insuring every American. If every state were to participate in the expansion— due to go into effect on January 1, 2014—approximately 17 million more Americans would eventually get health care benefits through Medicaid and the Children’s Health Insurance Program (CHIP), which is the Medicaid program for children. As of March 2013, 24 states have committed to the expansion.

Lynn Blewett, SPH professor in the Division of Health Policy and Management, has been carefully tracking expansion developments. Blewett directs the State Health Access Data Assistance Center (SHADAC). SHADAC supports states in monitoring and evaluating programs to increase health care access and coverage. She shed some light on the Medicaid expansion and what it means.

ADVANCES: First of all, how does Medicaid currently work?

BLEWETT: It’s a combined federal and state program, with each entity paying a percentage of health care costs for people with low incomes who qualify for the program. States run the program and decide who they will cover and how, within federal guidelines.

Between Medicaid and CHIP, about 60 million Americans have health care coverage [out of a U.S. population of about 314 million].

ADVANCES: What does it cost states to participate in the Medicaid expansion?

BLEWETT: The Medicaid expansion will add little to what states spend on Medicaid now. The federal government will pay 100 percent of expansion costs, and that will eventually be reduced to 90 percent. Because the expansion will reduce state and local government costs for uncompensated care and other services they provide the

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.

Big-picture thinking, real-world impact

uninsured, it is actually a good deal for the states.

This is especially the case for a state like Minnesota that has financed simi­lar programs, like Minnesota­Care, with no federal financial support.

SPH alum Issie Karan links law and public health on the Hill

ADVANCES: Why then would a state opt out of the expansion?

BLEWETT: There are a lot of politics involved in the choices states are making. And after a few years, states will need to fund 10 percent of the costs of expansion. Many states feel that even 10 percent is too much of a burden for taxpayers.

ADVANCES: When states opt out, what are the consequences for the overall success of the ACA?

BLEWETT: The goal of universal and standardized coverage for the poor will not be achieved, and we will continue to have great variation across states on programs to support access to affordable health care.

ADVANCES: Given the difficulties of the Medicaid expansion, do you still think it was a wise move?

BLEWETT: I would have preferred that it had been simplified and streamlined, and written in a way so that states couldn’t opt out. But the good news is that the law now requires that Medicaid coverage be extended based on income, not based on a cate­ gory (e.g. pregnant women or the elderly) and the ruling has mandated simplified enrollment procedures. Even so, it’s a complex system and having states opt out adds another layer of complication.

But if we waited to figure this all out, nothing might have changed. This is a step in the right direction.

PHOTO BY DARIN BACK

More care for more Americans

“I loved walking across the Mississippi from the Law School to the School of Public Health and taking on a whole new set of challenges,” says Elizabeth Karan (aka Issie) of her years in graduate school earning an MPH in Public Health Administration and Policy and a JD through the University’s Joint Degree Program in Law, Health, and the Life Sciences.

As one of last year’s recipients of the national David A. Winston Health Policy Fellowship, Karan works in Washington, D.C., with the health team of the majority staff of the U. S. Senate Finance Committee. Day-to-day, she’s engaged in Medicaid and Children’s Health Insurance Program (CHIP) issues, thinking about big-picture policy concerns and minute programmatic details.

“Both levels present unique analytical challenges,” Karan says.

“I wanted to work on programs that provide medical assistance to some of the neediest and most vulnerable members of society. The committee staff interacts regularly with stakeholder groups who provide insight into programmatic areas, and these sessions are an important reminder of the real-world impacts of policy.”

Karan credits her time with the Minnesota Department of Human Services for launching her career in public service. She worked there initially through her SPH field experience and then as an Executive Pathways intern, which gave her the chance to learn about large government systems and be part of policy-making decisions.

SPH faculty members Anne Barry, Donna McAlpine, Beth Virnig, and Lynn Blewett, and former faculty member Sharon Long, guided her course selections and volunteer opportunities. The career services office helped her prepare applications, gather materials, and practice interviewing.

“My current work is motivated by opportunities I had as a graduate student to help people,” says Karan. “Whether it was a paper on the inadequate number of mental health providers in rural areas or assisting with applications for asylum, getting my MPH and JD helped me under­ stand the diverse characteristics and needs of underserved populations.”

Karan’s coursework for her degrees was highly interdisciplinary and she broadened her education with a semester studying international law in the Netherlands and traveling through Turkey and Liberia. “It’s tempting in graduate school to stay in a single department and bang away at required coursework, but the reality is that real-world problems and solutions cut across different disciplines, different agencies, different populations,” she says. “It’s important to begin the collaborative process in graduate school. The University has so many opportunities for joint degrees; I feel lucky every day that I stumbled into such a perfect program.”

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FINDINGS

Sit-stand workstations may boost energy, health

Tobacco industry uses coupons to keep people addicted SPH researchers find that tobacco companies are using coupon-based marketing tactics that cut down on the likelihood that a current smoker will break the habit.

The study, published in Tobacco Control, is the first of its kind to illustrate that cigarette coupons have a negative association on smoking cessation.

“We know that raising the price of cigarettes encourages smokers to quit,” says Kelvin Choi, SPH assistant professor.

“Coupons are a way to bring the price down, and keep people smoking.”

Choi’s team analyzed data from 2,436 smokers and recent quitters and found:

· · · ·

Nearly half of smokers reported receiving cigarette coupons.

Eighty percent of those who received coupons redeemed them.

·

SPH epidemiologists have conducted a pilot study examining the benefits of sit-stand workstations.

SPH associate professor Mark Pereira, graduate student Nirjhar Dutta, and colleagues followed a group of people who used sit-stand desks for a month and compared their experiences to a month at their regular desks.

During the experimental month, the vol­ unteers not only spent a lot more of their workday on their feet, but—surprisingly—they reported being less hungry and ate about 200 fewer calories every day.

“That [finding] could be really interesting if it holds up,” says Pereira, who calls for more research on this issue. “By using the desks, people increased the time spent standing by a couple hours a day, and through measures of activity monitors on hips, we saw they were moving around the office more.”

Access the full study at advances.umn.edu/ w13/stand.

Smokers who redeem coupons are 84 percent less likely to quit smoking.

Watch a video about the study at advances.umn.edu/w13/coupons.

Women, younger smokers, and heavier smokers are disproportionately targeted by coupons.

Smokers who use coupons are more likely to believe that tobacco companies care about their health, do their best to make cigarettes safe, and tell the truth.

Young adults who prefer local foods likely to make healthier choices

Doula care could increase safety, savings

10 University of Minnesota School of Public Health

something we should pay attention to and ensure that this investment produces the highest possible value and quality of care,” Kozhimannil says. “Medicaid reimbursement for birth doulas could be a case where adding coverage could result in improved outcomes as well as real dollars saved.”

Support during childbirth may be especially important for women with low health literacy or patients whose first language is not English and who may not fully understand all their clinical options during childbirth.

“All mothers—but especially those from low-income communities, communities of color, and immigrant communities—stand to benefit from support during childbirth,” Kozhimannil says. “The doula group we studied made a concerted effort to recruit and train diverse doulas and to match doulas with clients based on language, culture, and community.”

Kozhimannil discusses her work at advances.umn.edu/w13/doula.

Pioneering HIV prevention program moves online

LITTLENY / SHUTTERSTOCK.COM

Providing a doula to low-income women during childbirth could lead to healthier babies and save taxpayers money.

The finding comes from a study led

by SPH assistant professor Katy Backes Kozhimannil. She looked at births among a group of Minnesota Medicaid beneficiaries with and without doula care and compared them to a sample of national Medicaid births. Her team found the odds of needing a cesarean delivery were 40 percent lower when women had support from a doula.

Unlike physicians, midwives, and obstetrical nurses who provide medical care, a doula provides maternal support in the nonmedical aspects of labor and delivery. Medicaid does not typically offer coverage for doula care.

In 2009, Minnesota’s Medicaid program spent about $54 million on childbirths. One in four was a cesarean, which, at a cost of $13,600, is nearly 50 percent more expensive than a vaginal birth ($9,100).

“In 2009, we paid almost $7 billion for cesarean deliveries in this country. That’s

Public health researchers recently retired the Man-to-Man Sexual Health Seminars, an inperson education and support program that ran for nearly 20 years. The move was made to make way for more online-based HIV/STD prevention interventions for men seeking men (MSM).

Man-to-Man played a critical role in HIV/ AIDS education, prevention, and support, much of it offered in a time when homosexuality was misunderstood or considered unacceptable.

Now efforts need to be focused online, says B.R. Simon Rosser, SPH professor and director of the HIV/STI Intervention and Prevention Studies (HIPS) program.

“We live in an online world,” says Rosser. “And it isn’t just the homosexual or MSM community, everyone is online. It’s also where people now go to gather health-related information. Online is where we now need to be, and that’s the direction we’re taking our research.”

Rosser and SPH dean John Finnegan discuss the impact of online public health interventions at advances.umn.edu/w13/m2m.

Young people who prefer organic, local, and sustainable foods are more likely to make healthier food choices—a link that holds up regardless of socioeconomic or demographic status.

That’s according to research led by SPH research assistant and PhD student Jennifer Pelletier. Her team examined the characteristics and dietary behaviors of 1,201 students at a two-year community college and a four-year public university in the Twin Cities.

“Almost half of the young adults placed moderate to high importance on alternative production practices of food,” says Pelletier. “And no differences were found by race, ethnicity, or socioeconomic status in this sample.”

Women, people 25 years and older, vegetarians, and those living outside their family’s home reported the highest importance on alternative food production practices. Those who placed high importance also consumed: • • • •

1.3 more servings of fruits and vegetables more dietary fiber, fewer added sugars and less fat breakfast approximately 1 more day per week fast food half as often

“Registered dietitians and other nutrition educators should start incorporating these topics into health-promotion efforts or college health courses,” says Pelletier. “We have an opportunity to encourage healthy eating without talking about nutrition directly, but rather by emphasizing alternative production practices to improve overall dietary quality.”

Access the full study at advances.umn.edu/w13/food.

advances.umn.edu/w13 11

Taking care of small business The Affordable Care Act aims to help insure more American workers

T

here are nearly 6 million businesses in the United States with 50 or fewer full-time equivalent employees, the Patient Protection and Affordable Care Act’s (ACA) definition of a “small” business. This group represents most firms in the United States and employs nearly 34 million workers. In 2012, 98 percent of firms with 200+ workers provided health insurance, while only 61 percent of firms with 3 to 199 employees offered coverage.

The United States has about 49 million people without health insurance, and if the goal of the ACA is to drastically reduce that number—which it is—then small businesses are a good place to start.

CHANGING THE NUMBERS The ACA has several provisions to help small businesses provide health insurance, according to Jean Abraham, SPH associate professor in the Division of Health Policy and Management. One is the medical loss ratio regulation. Under this rule, health insurers must spend at least 80 percent of small group or individual premiums on clinical benefits, not administrative costs or profits. If they don’t, they must issue rebates to the policyholders. This will help small businesses whose premiums, according to the White House, have up to three times as much administrative cost built into them as plans in the large group market.

“Policymakers have been concerned about the small group market for health insurance for quite some time,” Abraham says.

12 University of Minnesota School of Public Health

“This market segment has much higher administrative expenses per dollar of benefits than coverage obtained by large employers.”

Abraham served as the senior economist on health issues with the President’s Council of Economic Advisers in Washington, D.C., and she and her colleagues are currently exploring the impact that the ACA will have on employers’ decisions to offer coverage.

If employers do choose to buy insurance for their workers, those premium contributions are tax exempt, as they always have been. But now businesses with up to 25 employees that pay average annual wages below $50,000 may qualify for a small business tax credit of up to 35 percent of the employer’s premium contribution. In 2014, that credit increases to 50 percent and is available for two years.

Finding good, affordable health insurance policies to offer employees is one of the hardest chores of a small business. To address that barrier to coverage, the ACA established exchanges, virtual state marketplaces where individuals and businesses with 100 or fewer employees can choose the best options among a selection of health insurance plans.

Matthew Katz is an SPH alum and executive vice president and CEO of the Connecticut State Medical Society. He’s on the committee of his state’s Small Business Health Options Program (SHOP). SHOP sets many of the parameters and requirements that interested health insurance companies must meet in order to offer plans in the new exchanges.

“In many locations, there were few insurance options for small employers,” Katz says. “They were very expensive or offered such varying and often confusing benefit designs that employers had a hard time selecting options for their employees. SHOP is designed to reduce complexity, reduce confusion, and provide a clear avenue for employers and employees to make the best choices.”

INTO THE UNKNOWN The hope is that, with the exchanges and other ACA provisions, employees in small businesses will have the opportunity to obtain affordable health insurance, whether they buy it as individuals or obtain it through their employer’s plan. With tax credits to offset some premium costs, policymakers hope that more small employers will offer health insurance.

But Katz worries that perhaps not enough small businesses will access the exchanges to make them profitable enough for insurance company participation. “The biggest challenge is going to be getting small business owners to use the exchanges,” he says. Among Abraham’s concerns is whether the small business tax credit will be enough of a carrot to get small business owners to offer insurance. “[Since the law went into effect in 2010], relatively few small businesses have taken advantage of the tax credit benefits,” she says.

The Affordable Care Act is an enormous piece of groundbreaking legislation and it will take time for everyone, including small business owners, to understand the law. It may be several years before the country can judge the ACA’s success in bringing better and affordable coverage to more people.

Finding new health in old ways Public health nutrition student and chef Jason Champagne harnesses the healing power of food.

“H

ealing is the most important ingredient in Native American cooking,” says chef Jason Champagne, a member of the Red Lake Band of Chippewa and current MPH candidate in public health nutrition. “Indigenous foods are a path to health and a way for us to recover our communities.”

At age seven, Champagne taught himself to cook by watching TV chefs after school.

By age eight, he would prepare a full dinner and set the table before his parents returned from work. After high school, Champagne started working in construction and saved enough to go to Le Cordon Bleu culinary arts program in Minneapolis. He landed a plum job after graduation with Walt Disney World and was quickly promoted.

“But one night, after a successful 3,000 person steak and lobster dinner, I realized I’d had enough,” Champagne says. “My work was focused on quantity and production, and I realized I’d lost sight of why I’d entered a culinary career— to cook and connect with people. So I decided to finish my education and work in a field where I could do both.”

Champagne was awarded a scholarship to the University of North Dakota and graduated with a degree in nutrition and Native American studies.

“Throughout the research I did for my nutrition degree, I kept coming across papers

authored by Dr. Mary Story and was captivated by her work in obesity and diabetes,” he says. “So I emailed her and she encouraged me to apply for an MPH.” Champagne began his MPH studies at the School of Public Health in fall 2011. He is a Shakopee Mdewakanton Sioux Scholar and is a candidate for a Centers for Disease Control and Prevention grant that will help fund his work in diabetes and obesity prevention. This past summer his field experience included an internship with the Chickasaw Nation in Ada, Oklahoma. He consulted with participants of the Special Sup­­ ple­mental Nutrition Program for Women, Infants, and Child­ren (WIC), taught nutrition classes, and developed healthy recipes for the Chickasaw Medical Center Cafe.

In November 2012, Champagne was a presenter at the Native American Culinary Association Indigenous Food Culture Confer­ ence. “Five-hundred years ago, we Natives were expert farmers, hunters, gatherers, fishermen, and cooks,” Champagne says.

“These activities will make us healthy again.”

Champagne is currently teaching nutrition and cooking classes at several Native American outreach organizations and is a volunteer cook for homeless Native Americans at the Minneapolis American Indian Center. “I focus on portion size and whole foods,

12 University of Minnesota School of Public Health

showing how to make healthy food taste good and look good within a tight budget,” he says.

And this summer, he’ll head the cooking program and work with youth at Dream of Wild Health, a 10 acre, Native-owned organic farm in Hugo, Minnesota.

“I hope that traditional foods will become the everyday foods for Native Americans,” Champagne says. “I dream of having a traditional Native American food truck that serves our ancestors’ food, not the fry-bread and tacos at today’s powows. Why not serve rack bread—a flat bread cooked over an open fire,— bison burgers, wild rice, fresh fried fish? Real foods. Real fun.” .

“ Five-hundred years ago, we Natives were expert farmers, hunters, gatherers, fishermen, and cooks.

These activities will make us healthy again.”

advances.umn.edu/w13 13

ALUMNI NEWS SCHOOL NEWS

Gearing up the exchange

A legendary leader

SPH alum April Todd-Malmlov helps Minnesotans access more health care coverage

The late R.K. Anderson continuously broke new ground exploring the tie between animals and humans

“G

government establish one for it, or form one in partnership with the federal government.

14 University of Minnesota School of Public Health

PHOTO BY TIM RUMMELHOFF

N

ext fall, most Americans and many small business people will sit at their computers searching for the right health care insurance policy. If all goes well, they should be getting more choices in an easy-to-understand format called a health insurance exchange.

“We are planning for [health insurance selection] to be a pro­­cess that takes less than an hour to complete,” says April ToddMalmlov, executive director for the Minnesota Health Insurance Exchange and a School of Public Health alum.

The exchanges are meant to be virtual marketplaces where people can comparison shop for health coverage among a variety of insurance plans. There will also be exchanges where businesses with up to 100 employees can buy group coverage.

Insurance exchanges are compulsory for all states and are the lynch pin of the Affordable Care Act (ACA). Whether or not the ACA lives up to its promise of health insurance reform depends in large part on the success of the exchanges.

Each state can decide whether it will establish its own ex­­ change (referred to as “opting in”), step back and let the federal

DOUBLE DEADLINES FOR MINNESOTA Minnesota has spent more than $100 million to create its own exchange and hopes to have 1.3 million people buying coverage by 2016. Todd-Malmlov has been working feverishly at the legislative level to make sure the plan is in place by October 2013 when enrollment opens.

“We are one of four states out of the 18 that have opted in that does not have legislation or an executive order to run our own exchange,” says Todd-Malmlov. “We need to pass a law giving Minnesota that power by the end of March.”

The bill has to gone through the House and Senate, and is in the hands of conference committees. The final destination is Governor Dayton’s desk.

Three big issues have been up for debate: 1) which carriers may participate in the exchange, 2) how the exchange will be financed, and 3) who is qualified to sit on the exchange board, which will govern the exchange.

In recent votes, the Minnesota House decided to allow 88 insurance providers into the exchange, with minimum requirements.

The Senate chose the active-purchaser model, which means that the state must follow strict guidelines and carefully select the providers that can compete.

“When it comes to deciding which providers may participate, some legislators believe there is value in allowing all companies to compete, others say that the state should be involved in selection,” Todd-Malmlov says. “There are strong feelings on both sides.”

Federal grants will fund the exchange for 2014 and the financing going forward has come down to two choices in Minnesota: withholding 3.5 percent from insurance premium fees or using money from the “health impact fee,” also known as the cigarette tax.

When it comes to the powerful exchange board, who should be allowed to participate? Should a position in the health care industry disqualify a potential candidate, or does that make him or her more attractive?

“It’s a big issue,” says Todd-Malmlov. “Some argue that a person’s involvement in the health care industry makes him or her more conversant in the complex issues, others say that individual won’t be able to stay neutral.”

Although the bill is moving swiftly through the legislative process, the provider, funding, and board issues remain unresolved as of March 15. But Minnesota has always been a leader when it comes to health care coverage, so chances are that the exchange will be up and running in October with first-rate choices for consumers.

rowing up on a dairy farm, we had con­sider­ able contact with live­­stock and wildlife,” wrote R.K. Anderson. “Even though we understood, or perhaps because we understood the primary role of animals in our lives, we were often in a close relationship that gave us a perspective of our inter­ dependence and the nature of life and death in our ecosystem.”

Considered a gentle giant by his colleagues, Anderson died on October 18, 2012. He was the founding director of the veterinary public health pro­­ gram in the School of Public Health, which provided the first opportunity in the country for people to earn an MPH degree in the same four years as their DVM degree.

SPH dean John Finnegan says that Anderson “understood the breadth and depth of public

health and its connection to biologic, economic, and social systems. He was so far ahead of his time in recognizing the interplay of animals and the environment in human health.”

That interplay was a vital concern for Anderson, as he taught public health and veterinary students about such things as zoonotic diseases and how to keep the food supply safe. His belief that we can’t look at animals, humans, and the environment in isolation is an idea we now call “One Health.”

Anderson simply said of this relationship, “We are here as one family.”

human-animal bond. Early in his career as director of the Denver Department of Health and Hospitals, responsible for the city’s animal control facility, Anderson used rewards to modify dog behavior, a method that seemed “soft” at the time.

A DEEP UNDERSTANDING “I saw that we’d use these harsh methods and the dogs Anderson, called R.K. by his would get worse, becoming friends, fundamentally changed more anxious and more afraid,” our collective understanding he said in a 2003 interview. of animal “I decided to try and emotions NECK STRAP: motivate with food.” and the PRESSURE ON Among his THE BACK OF THE NOSELOOP: PRESSURE HERE NECK INDUCES many initiatives, COMMUNICATES RELAXATION Anderson YOUR NATURAL LEADERSHIP co-founded the Calming control Center to Study Anderson drew on his experience, research, Human Animal QUICK and intuition to create the Gentle Leader RELEASE Rela­tion­ships and BUCKLE ADJUSTABLE with colleague Ruth Foster (then president Environments CLAMP FOR A of the National Association of Dog Obedience PERFECT FIT (CENSHARE) at NORMAL Instructors). Unlike a traditional collar that puts LEAD the University. By pressure on a dog’s throat, the Gentle Leader touches studying and encouraging the calming points on a dog’s head, removing its natural companion animals in care tendency to pull the leash or engage in anxiety-based behaviors. The environ­ments and animalSmithsonian has named it among of the world’s best 100 inventions. assisted therapy, for example, “We didn’t use choke chains on horses and cattle, why not use halters Anderson believed CENSHARE on dogs?” wrote Anderson. “I believe we can do a great job of teaching could improve the quality of life the dog whatever we need to without inflicting pain. After all, don’t they for both humans and animals. deserve that? We’re supposed to be talking about our best friends.”

He also helped found the Delta

Society (renamed Pet Partners), an internationally known nonprofit that encour­ages the human-animal bond.

LEAVING A LEGACY “I can’t begin to explain how important R.K. was to me in my career,” says Michael Osterholm, SPH professor and director of the Center for Infectious Disease Research and Policy (CIDRAP).

“He was one of the greatest teachers. His most profound lesson to me was that nothing matters if you don’t have good science behind it.”

Osterholm shared a friend­ ship as well with Anderson.

Every year, they had a compet­ ition to see who would be the first to call the other at Christmas. Anderson, often travelling somewhere in another time zone, usually got the jump on Osterholm, maybe calling in the middle of the night.

Osterholm visited Anderson shortly before his death: “The last thing he said to me was, ‘Merry Christmas, forever.’”

Finnegan says of Anderson, “He was a Renaissance man.

He was completely focused outside himself and one of the most genuine humans I’ve ever encountered.”

advances.umn.edu/w13 15

ALUMNI NEWS CLASS NOTES

SCHOOL NEWS

Fifty years of gratitude Don and Janet Wegmiller support the program that has supported them by creating an endowed professorship

I

f it’s true, as philanthropist Andrew Carnegie once said, that “it’s more difficult to give money away intel­ “ Don has been ligently than to earn it in the first an innovator in place,” then Don and Janet Wegmiller’s recent gift to the School of Public health care for the Health’s Master of Healthcare Admin­ last four decades, istration (MHA) program would score high with Carnegie. and this is his The couple’s decision to endow way of helping $1 million to establish the Wegmiller the program that Professorship in Healthcare Admin­ istration, which will be awarded to each helped him.” director of the MHA program, came from a deep understanding of not only how the program educates, but how it shapes lives.

With their endowment, they want to publicly support what Don Wegmiller calls “the best health care administration pro­gram in the country.” will have access to discretionary “The MHA program formed not funds to help with such things just the basis of our professional lives, as supporting emerging research Don Wegmiller and his wife, Janet, have endowed but also of our personal lives,” says priorities and recruiting top-notch $1 million for a healthcare administration professorship.

Wegmiller, who earned his MHA in students and faculty.

1962. “When something like that has “But the professorship is about been so important to you for over five decades, it becomes a very much more than dollars,” Zismer says. “It adds a status to the easy decision to say, ‘This is where we should allocate some of program that shows the marketplace that we are supported by our resources.’” top industry professionals like Don.” Wegmiller, chairman of two health care organizations— Wegmiller praises Zismer’s work, believing that he has C-Suite Resources and the Scottsdale Institute—and a recent reenergized and improved an already outstanding program inductee into the Health Care Hall of Fame, says that Minnesota since he was appointed director in early 2010. Wegmiller cites has long been acknowledged as a leader in producing successful the success of the recently launched Executive MHA program— health care executives. designed for professionals already working in the health care “Alumni of the University’s MHA program are actually field—as just one example of Zismer’s contributions so far. known in the industry as ‘the Minnesota Mafia,’ because we’re “Today’s MHA students will face daunting challenges as the such a closeknit group,” says Wegmiller, laughing. “The MHA industry changes from a volume-based to a value-based system, alumni association takes care of itself as a family and supports and the program will continue to need support from all of one another professionally and personally.” its alumni,” Wegmiller says. “Janet and I hope that one of the Daniel Zismer, the MHA program’s current director, will results of our gift will be to stimulate others, who’ve had the be the first person to hold the new professorship. same benefits we’ve had, to say, ‘Maybe we should do something “Don has been an innovator in health care for the last four like this, too.’” decades, and this is his way of helping the program that helped Carnegie would applaud the thought. After all, he was him,” Zismer says. “That’s a longstanding tradition of our the man who also said, “The best means of benefitting the MHA program.” community with your wealth is to place within its reach the From a strictly pragmatic viewpoint, the endowment ladders upon which the aspiring can rise.” means that Zismer, and those who succeed him as director,

16 University of Minnesota School of Public Health

Justin Doheny

(MHA ’75) is project director for the Northern New Jersey Health Profes­ sions Consortium. This group of 10 community colleges and a health system is partnering on a $24 million five-year grant initiated by the Affordable Care Act to train 5,000 low-income residents and recipients of state assistance programs for entrylevel health occupations. The project is in its third year.

Katarina Grande

(MPH ’10) joined the Global Health Corps as a pro­ gram manager on a USAIDfunded project, “Strengthening Decentral­ization for Sustain­ ability,” in Kampala, Uganda.

The project aims to improve health in Uganda by strengthen­ ing the capacity, coordination, and management of local government. “My mind is challenged every day to see global health in systems and structures rather than single diseases or issues,” says Grande, who has enjoyed visits from fellow SPH alums Samuel Lee (MPH ’11) and Tyler Weber (MPH ’11).

Kathleen Harriman (PhD

’04) was appointed by the U.S. Health and Human Services Secretary to be a member of the federal Advisory Committee on Immunization Practices. The committee is a group of medical and public health experts that develops recommendations on how to use vaccines to control diseases in the United States. She is chief of the

Vaccine-Preventable Disease Epidemiology Section at the California Department of Public Health.

Evan Henke (MPH ’11,

PhD ’12) began work as a food­ borne disease epidemiologist at the Arizona Department of Health Services.

Kate Downing Khaled

(MPH ’07) is engagement and development manager for the Charities Review Council in the Twin Cities.

Hema Khanchandani

(MPH ’03, MA ’05) works with the Washington, D.C.-based Campaign for Tobacco-Free Kids, where she has accepted a one-year assignment in India.

She is in Delhi partnering with several NGOs to implement Indian tobacco control laws at the local level. Campaign for Tobacco-Free Kids works globally in middle- and low-income countries, with special priority given to 15 countries where tobacco consumption is the highest. India has the world’s second largest number of consumers, after China.

Vladmir Makatsaria (MHA ’96)

was appointed company group chairman for the Global Surgery Group in Asia Pacific at Johnson & Johnson. He previously served as global integration leader for the group and was responsible for incorporating three medical device and diagnostics groups into a global structure.

Susan McClernon (MHA ’87) was awarded the Presidential

Scholarship for AcademyHealth Institute on Advocacy and Public Policy. She will participate in a national conference with AcademyHealth leadership and join in legislative advocacy efforts on behalf of the organization in Washington, D.C. McClernon is a PhD candidate in SPH’s Health Services Research, Policy, and Administration program.

Erik Olson (MHA ’00) joined Allina Health’s United Hospital as vice president of operations.

Olson comes to the St. Paul-based hospital from Wellington Regional Medical Center in Wellington, Fla., where he had served as chief operating officer since 2007.

Jake Rosenberg (MHA ’05) received the Early Career Executive Regent’s Award from the American College of Healthcare Executives.

He is assistant administrator for support services at Kaiser Foundation Hospitals Sacramento Medical Center.

Brianna Routh (MPH ’12) completed the registered dietitian exam and started work as an assistant extension professor at the University of Minnesota.

Her program areas are family relations, health, and nutrition.

Gretchen Sampson

(MPH ’99) received the Milton and Ruth Roemer Prize for Creative Local Public Health Work from the American Public Health Association. She was

recognized for her achievements as a health officer in Wisconsin’s Polk County, where she has led efforts to improve quality, preparedness, telemedicine, and workforce training.

Chris Steffen

(MPH ’03) took a position as operations administrator with the Mayo Clinic Health System, Southwest Minnesota Region, where he will use a population health focus to increase access to health care services for Mankato, Minn., and surrounding rural communities.

Virginia (Ginny) Zawistowski

(MPH ’09) was promoted to research and data analysis manager in the division of Performance Measurement and Quality Improvement at the Minnesota Department of Human Services (DHS). Her division is responsible for data analysis and research for policy and program development, quality measurement, and required reporting for state health care programs. She previously worked as a maternal and child health researcher and then as supervisor of the data analysis unit at DHS. Create your own class note or read about classmates at advances.umn.edu/ w13/ classnotes.

Sign up for monthly alumni updates from the school at advances.umn.edu/w13/ alumni.

advances.umn.edu/w13 17

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UPCOMING EVENTS Research Day

SPH Commencement

SPH student poster

Address from Lois Quam,

competition

special advisor,

April 5, 11 a.m.-1 p.m.

U.S. Department of State

Coffman Memorial

May 20, 5 p.m.

Union Great Hall

Mariucci Arena

Martinson Lecture

Public Health Institute

Keynote from Michelle

May 28-June 14

Williams, Harvard School

Minneapolis

of Public Health April 19, 10 a.m.-2 p.m.

Walk & Talk:

Coffman Memorial

Presented by the

Union Theater

SPH Alumni Society May 30, 6-8:30 p.m.

SPH Celebration

Urban Organics,

of Giving

Minneapolis

April 25, 5-7 p.m.

McNamara Alumni Center

Industrial Hygiene

Presentation of the

Alumni Gathering

Gaylord Anderson Award

May 20, 5 p.m.

to Susan Abderholden,

Montreal, Canada

MPH ’80 Health Disparities Roundtable “Engaging Communities in Public Health Research, Practice, and Policy” April 26, 9 a.m.-noon Coffman Memorial Union Theater

Registration requested for some events. Details at sph.umn.edu or by emailing sphnews@ umn.edu.