ALUMNI PERSPECTIVES: LOOKING BACK AND MOVING FORWARD

Although no one can predict the future, we can prepare and plan for challenges and opportunities that lie ahead. An important part of planning is taking stock of past lessons to better inform our next steps. We asked several College of Public Health alumni to share their thoughts about what they view as some of the biggest public health challenges of the past quarter century, and to think ahead to what they envision for the future of their area of public health. Find additional alumni perspectives online at cph.uiowa.edu/news-items/alumni-perspectives-25-years/.

TY BORDERS (95MA, 99PHD, 01MS)

What is your current job title?

I am a professor in the College of Nursing and acting director of the Center for Health Services Research at t he University of Kentucky.

What do you think have been the top three public health challenges in the past 25 years, and why?

The most obvious public health challenge over the past 25 years is the COVID-19 pandemic. It exposed major deficiencies in the public health surveillance system and the negative consequences of disruptions in health care delivery and education will be felt for yea rs to come.

A second major public health challenge, which pertains to my own research, is substance abuse. Both drug and alcohol abuse are problems across many areas of the U.S., but many persons encounter barriers to treatment. The strongest predictor of substance use is poor mental health, which also remains under-treated.

A third major public health challenge is the cost of medical care, which continues to crowd out spending on other segments of the economy.

How has your profession/field responded to the changing public health landscape?

I started my career as a faculty member in a School of Medicine, spent most of it in a College of Public Health, and am now in a College of Nursing. I am pleased to see that Schools of Medicine and Nursing have embraced the population health perspective and have integrated many public health competencies into their curricula. For example, I teach courses on the applications of epidemiology to clinical decision-making and population health to students in the Doctor of Nursing Practice (DNP) program at Kentucky.

What are your hopes or vision for the future of your profession/field in the next 10 years?

I would like to see public health and other health professional students learn more about population health ethics, which would include multiple perspectives about balancing health, education, economic, and other individual and societal needs. This would help prepare health professionals to respond to a future pandemic and more thoughtfully inform decisions about the spending on medical and non-medical resources to benefit population health.

DANIELLE PETTIT-MAJEWSKI (10MPH)

What is your current job title?

I’m the public health director at Johnson County Public Health in Iowa.

What do you think have been the top three public health challenges in the past 25 years, and why?

I think the top three public health challenges have been political determinants of health, COVID-19, and the success of 20 th-century public health wins.

Let me explain. I didn’t realize how political public health was until I started working in the field. The political decisions on public health issues—whether it’s expanding Medicaid, providing water fluoridation in local municipalities, funding local public health, or investing in walkable communities—all have an impact on health outcomes. There’s a reason your zip code has a bigger impact on your health than your genetic code. However, as public health professionals, we need to do a better job of connecting the dots between legislation and health outcomes so we can encourage more folks to be public health voters.

COVID-19 was obviously one of our greatest challenges, and a specific example of what happens when politics take priority over public health. I think the greatest challenge we saw from COVID-19 was how the public handles uncertainty and changing guidelines during a rapidly evolving situation. [There are also big challenges] from COVID ahead of us. We have no idea what the long-term consequences will be of subsequent infections, and we’ve seen how bad faith actors have used a public health emergency to spread misinformation and disinformation. We’ve seen the public lose trust in the experts, which puts us in a very precarious position for emerging public health threats.

Lastly, we often talk about the top 10 public health wins of the 20th century, but I’m beginning to believe that those wins have also led us into a false sense of security that undermines the necessity of those wins. Some of those wins—like vaccination, safer foods, and family planning —have become politicized as legislators across the country weaken immunization requirements, legalize the sale of raw milk against public health recommendations, and limit access to reproductive care across the country.

With public health successes came a loss of institutional memory. People don’t remember when children suffered from measles and polio, for instance. This is part of the issue of public health being invisible when it works—there isn’t a good understanding of the layer of protection it brings to everyone, so legislation seems restrictive and unnecessary. As a profession, we have to continue to talk about the importance of our work all the time, not just in disasters.

GHAZI KAYALI (08PhD)

What is your current job title?

Upon earning my PhD in epidemiology and completing my postdoctoral training, I started my own organization, Human Link, a research institute based in the Middle East where I currently work as a managing partner.

I have been conducting research on emerging viral pathogens with a focus on avian influenza, MERS coronavirus, and SARS-CoV-2.

Additionally, I have been engaged in projects aimed at developing policies that enhance preparedness and response to emerging zoonotic infectious diseases in the Middle East and Africa.

What do you think have been the top three public health challenges in the past 25 years, and why?

Over the last three decades, emerging viral diseases have caused the most negative impact on public health. As we make progress towards preventing and managing chronic illnesses, we lag behind on our preparedness and capacity to control outbreaks of emerging novel viral diseases.

Additionally, vaccine hesitancy, misinformation, and conflicts led to the resurgence of previously controlled infectious diseases such as polio, measles, and mumps. A third infectious disease threat relates to antimicrobial resistance and the emergence of multi-drug resistant bacteria.

Together, those threats bring public health to an era we thought was long over with very slow progress towards solving those issues. Global capacities to prevent, detect, control, and recover from infectious disease threats are far from where they need to be.

How has your profession/field responded to the changing public health landscape?

Infectious disease researchers have been engaged in finding solutions to those problems and answers to the research and public health questions surrounding those pathogens. For instance, our ability to characterize emerging and re-emerging pathogens shortly after they are detected has significantly improved. Adapting novel technologies for collecting and analyzing field samples has similarly improved with the adaption of, for example, environmental sampling equipment and drones for collecting samples and using genomics and metagenomics for laboratory analysis.

The global infrastructure for developing, testing, manufacturing, and distributing vaccines has benefited from experiences gained over the last decades. Researchers and public health professionals in my field continue to develop and implement the One Health concept [the interconnectedness of people, animals, and the environment] and create evidence-based policies supporting it.

What are your hopes or vision for the future of your profession/field in the next 10 years?

It is imperative that, in the next 10 years, we invest more in field research to enable us to better understand what pathogens are circulating and assess their potential risks to human and animal health. Additionally, we should be working harder to reduce vaccine hesitancy and misinformation while improving our capacity to equitably produce and distribute vaccines. This should be in tandem with work dedicated to making One Health mainstream in public health practice and research.

DWIGHT FERGUSON (06MS, 12PHD)

What is your current job title?

Regional Emergency Coordinator with the Administration for Strategic Preparedness and Response and a Commander in the Commissioned Corps of the U.S. Public Health Service.

What do you think have been the top three public health challenges in the past 25 years, and why?

1. An aging/retiring workforce with difficulty recruiting and maintaining the next generation of professionals. The lack of a vibrant public health workforce is partially due to people retiring or moving on for various reasons and a lack of qualified candidates. To increase post-graduate opportunities for students, graduate public health programs should encourage students to build their experiences and networks through internships and mentorships while in school.

2. The COVID-19 pandemic created numerous moral dilemmas and, unfortunately, hostile situations between the public and public health. Inadequately addressing moral dilemmas within the public health workforce may have led to moral distress, moral injury, and burnout. Therefore, the pandemic may have led to an accelerated exodus of public health workers from the profession.

3. The political environment is creating difficult situations for public health workers. With a politically polarized populace, public health workers are currently at a deficit when it comes to trust. Additionally, public health workers, for good or bad, may be seen as the faces of political groups and receive pushback for it. However, public health requires the populace and the public health workforce to continue building a partnership, which enables the social contract to flourish.

Some challenges in this type of environment are communicating timely what is known and unknown about the problem, identifying misinformation/ disinformation appropriately, and providing sufficient transparency. Building partnerships and coalitions with the general public can improve trust and mitigate some of these challenges through a deliberative democracy process. Hence, when a crisis occurs, there are trusted coalitions from the populace, private sector, and public health sector who work together in a transparent forum to enhance trust with the public.

What are your hopes or vision for the future of your profession/field in the next 10 years?

1. Recruit and retain a competent public health workforce. Graduate public health programs should develop public health workers who have the experience and capabilities to work in the government (local, state, and federal) and the private sector.

2. Incorporate/embed bioethics into public health to help identify and address moral dilemmas faced by both the public and public health workforce to mitigate negative outcomes.

3. Advocate for risk management, risk communication, and communicating uncertainty to be included in didactic learning for public health students and professionals.

All statements made are my own and are not official or endorsed statements of my employer.

STEPHANIE KLIETHERMES (09MS, 13PHD)

What is your current job title?

I am the research director for the American Medical Society for Sports Medicine and an associate research professor in the Department of Orthopedics & Rehabilitation at the University of Wisconsin-Madison.

What do you think have been the top three public health challenges in the past 25 years, and why?

Three issues that come to mind include the growing burden of mental health challenges, the spread of non-communicable disease and its contributing factors (e.g. obesity, substance abuse, diet), and climate change, all of which are relevant personally and professionally.

How has your profession/field responded to the changing public health landscape?

The field of sports medicine strives to improve the health and well-being of active individuals and athletes throughout their lifespans. Sports medicine clinicians rely on a wellness-based model (as opposed to disease-based) and strive to help sedentary populations incorporate exercise and movement into their lives while preventing illness and injury in active individuals and athletes. This approach to health naturally permeates many of the public health challenges we currently face given the significant benefit of physical activity and movement to overall health and well-being.

When COVID-19 hit the U.S., our cardiac researchers immediately began assessing the risk of myocarditis in collegiate athletes—an area of major concern and unknown in the early days of the pandemic. We also looked closely at the drastic mental health and physical activity declines in youth during this time when sports and other activities ground to a halt.

As we learned about and began to comprehend the pervasiveness of abuse in sport, sports medicine leaders initiated the development of needed education and support resources, implemented essential policies for athlete safety, and developed research studies to identify best practices in responding to and preventing instances of interpersonal violence in sport.

In 2020, during an intense time of racial and civil unrest in the U.S., our field began to look critically at our own weaknesses and biases to understand the ways in which health inequities impact the health and well-being of individuals within our circles. We have made great strides in better understanding, drawing attention to, and addressing health inequities within the field through education, policy, and research.

What are your hopes or vision for the future of your profession/field in the next 10 years?

My hope is sports medicine can continue to make meaningful and lasting strides in keeping individuals healthy in body, mind, and spirit. I hope we continue to use research to assess and implement emerging technologies to advance the care we provide. And I hope we continue to focus on making sports medicine for all—by listening to and responding to the needs of vulnerable and marginalized communities.

TINA FREESE DECKER (02MHA)

What is your current job title?

President & CEO of Corewell Health, a leading integrated health system.

What do you think have been the top three public health challenges in the past 25 years, and why?

The public health landscape is always changing, but here are a few that come to mind:

Health equity: There are very real inequities when it comes to care. We have inequities in how we are listened to, understood, and cared for. And we need to address those. We need to make health accessible and equitable for all. One of the areas where inequities can be seen is in infant and maternal mortality. Black women are three times more likely to die from a pregnancy-related cause than white women, according to the CDC.And Black newborns are more than twice as likely to die in their first year of life than white newborns, per the Office of Minority Health.

At Corewell Health, we stepped up to combat this issue alongside seven community partners. We invested in an evidence-based Maternal Infant Home Visiting Program and added a community health worker to the model. We call it Strong Beginnings. We serve moms, dads, and babies who have the greatest challenges and needs, connecting families with medical, educational, and social support. We’ve also increased the rates of adequate prenatal care and postpartum visits, and this is improving birth outcomes. The latest data show that the infant mortality rate has been cut in half while there is still much work to do, this is significant.

COVID-19 pandemic: Around the world, we had to figure out new ways of operating, providing care, and keeping people safe. It brought to light several underlying issues in public health, from health equity to caregiver burnout to violence against health care workers. It also uncovered some of the best in us the unwavering commitment and compassion to the health of our communities, the collaboration across systems, and the innovation in care and technology, from drive-through testing to curbside vaccinations to virtual primary care to groundbreaking research.

Behavioral health: As we tackle the stigma and complexity of mental health issues, we recognize the steady increase in the incidence of mental health conditions nationwide. The most concerning trend is the alarming rates of mental illness, loneliness, and suicidality, especially in children and adolescents. Mental health affects everyone; however, it disproportionately impacts marginalized communities. The intricate connection between mind and body highlights that mental health and addictions can predispose people to various chronic conditions and thus decrease the ability to live a healthy, high-quality life. It’s our collective responsibility to reduce stigma and inequities in mental health care and prevent every loss of life to mental illness.

TALA AL-ROUSAN (15MPH)

What is your current job title?

I am an assistant professor and founding faculty at the Herbert Wertheim School of Public Health at the University of California San Diego.

What do you think have been the top three public health challenges in the past 25 years, and why?

Pandemics: Pandemics have brought public health to the forefront of public discourse, especially in light of the COVID-19 pandemic. This crisis has highlighted how inadequately prepared our societies are for such events. Emerging or re-emerging infectious diseases can instantly alter how people live, work, travel, shop, and receive education. Addressing pandemics involves preventing outbreaks, controlling the spread of diseases, and tackling the growing threat of antibiotic resistance.

Chronic and Mental Health Conditions: The rapid integration of technology and social media into our daily lives over the past 20 years has introduced significant mental health challenges. These include rising rates of chronic diseases, depression, eating disorders, anxiety, and substance abuse. Stigma, lack of access to mental health care, and insufficient funding exacerbate these issues, making it crucial to address them comprehensively.

Mass displacement: Mass displacement is a defining yet often neglected issue of our time. Factors such as global inequality, wars, economic hardship, and climate change have increased the scale, scope, and geographic diversity of displacement, making them highly interdependent. Currently, 120 million people worldwide are forcibly displaced from their homes—the highest number on record. Unlike migration, which is a normal human behavior and is, in fact, great for public health, innovation, and society’s prosperity in general, displacement is not and poses a public health catastrophe if not addressed carefully. It leads to generational trauma and cycles of health disparities and societal unrest.

What are your hopes or vision for the future of your profession/field in the next 10 years?

In the next 10 years, I envision significant advancements in the public health field, particularly in research and advocacy. I want to see an increased focus on addressing the multifaceted issue of displacement, recognizing it as a human experience that impacts millions globally. By integrating the perspectives of displaced individuals into our research and advocacy efforts, we can develop more effective and inclusive solutions.

As global challenges such as natural disasters, wars, and climate change intensify, I am optimistic that the scientific community will rise to the occasion. I envision more researchers from other disciplines, such as the arts, engineering, design, political sciences, and others, communicating more with public health researchers to innovate collectively.

Ultimately, my hope is that our collective efforts will lead to a more equitable and resilient world, where public health challenges are met with innovative, compassionate, and effective solutions.