Findings, The Ideas Issue - In praise of those who are creating a healthier tomorrow. by University of Michigan School of Public Health

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the idea s issue

INSIDE

> The art (and science) of generating breakthroughs p. 16 | Tweets, apps, and more from the public health frontlines p. 18

FINDINGS

Some ideas are like dreams. They arrive without warning, in the middle of the night or while you’re showering. You can’t always pinpoint their source. Maybe they spring from a conversation, or from something you’ve read, or from a failed experiment. Maybe you just had a hunch.

by Peggy Korpela and Nora White

Illustrations by Kate Uleman

That seems to have been the case with Dr. John Snow, a British obstetrician, who laid the foundations for modern epidemiology with his idea about a pump. A skeptic of the theory that “bad air” was responsible for spreading disease, Snow traced the source of London’s deadly 1854 Broad Street cholera outbreak to contaminated water from a community pump. Officials removed the pump handle and thus helped to halt the epidemic. Of course, dreams—like ideas—can pose problems. While engineers were pursuing their dream of a canal across Panama, workers laboring to realize that dream were falling prey to tropical diseases. Scientists eventually seized on the idea that mosquitoes transmitted malaria and yellow fever, and the U.S. government launched an integrated mosquito-control program. These measures led to the elimination of yellow fever in the region and its subsequent reduction worldwide, and contributed significantly to antimalarial efforts that continue today, at U-M SPH and elsewhere.

hile some ideas lead to treatments for disease, other ideas help prevent disease in the first place. Early attempts at variolation, or inoculating against smallpox (the Variola virus) by rubbing fluid from infected pustules into superficial scratches on uninfected individuals, occurred in Asia.

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In 1796, English physician Edward Jenner developed the first-ever smallpox vaccine—a safer and more standardized alternative to the haphazard variolation technique. U-M SPH Professor Thomas Francis Jr. made vaccine history in the 1950s by demonstrating the efficacy of the Salk polio vaccine. He was also the key figure behind the first mass influenza vaccinations in the U.S. But what if (that question beloved by children and scientists) you could prevent disease by vaccinating most, but not all, the members in a given community? That smart idea took hold in 1923, when epidemiologist A.W. Hedrich coined the term “herd immunity” to describe a phenomenon he’d observed during an outbreak of measles in Baltimore—that the spread of contagious disease is slowed or prevented when the majority of a community is vaccinated. Work by SPH Professor Arnold Monto in the landmark Tecumseh (Michigan) Community Health Study did much to establish the principle of herd immunity. Today the idea is fundamental to public health.

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n public health, one idea is rarely enough. Take, for instance, the health of mothers and babies.

In 1915, approximately 100 infants per 1,000 live births in the U.S. died before reaching the age of one. By 1997, that rate had dropped by 90 percentâ&#x20AC;&#x201D;thanks in large part to sanitation improvements, safer drinking water, and a vast expansion of prenatal care under the 1935 Social Security Act. Today the SPH Office of Public Health Practice is working to reduce infant mortality by promoting equitable care in southeastern Michigan. Sometimes, as in the case of food safety, the best ideas stem from earlier ideas. Initially, Louis Pasteurâ&#x20AC;&#x2122;s famous idea, pasteurization, was used only for wine preservation. But in 1924, the U.S. Public Health Service created a national standard for milk pasteuriza-

tionâ&#x20AC;&#x201D;thus eliminating a potential source of foodborne illness. Since then, thanks to public health surveillance work and increased scientific knowledge, researchers have identified E. coli, Listeria, and Salmonella as causes of food poisoning in many commonly eaten foods. At SPH, Professor Ernst Siegenthaler contributed significantly to 20th-century improvements in food safety. Additionally, the discovery and widespread understanding of vitamins, minerals, and basic food nutrients has led to substantial improvements in human nutrition. Among the most successful interventions are milk fortified with vitamin D to prevent rickets, niacinenriched flour to prevent pellagra, folic acid in grain products to prevent neural tube defects in infants, and iodine in table salt to prevent goiter.

any health challenges, like diabetes, are so big they require the combined talents and ideas of teams of individuals.

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Before 1921, physicians had no means of preventing the toxic effects of excess blood glucose in people who lacked an insulin-producing pancreas. The rush was on to create a â&#x20AC;&#x153;pancreatic extractâ&#x20AC;? that could serve in its place. Although several scientists worked contemporaneously on separate experiments, credit for the discovery of insulin goes to the Canadian team of Frederick Banting, J. J. R. McLeod, Charles Best, and Clark Noble, who cobbled together a purified extract that was dramatic in its ability to save lives. Today insulin remains as vital in the lives of diabetics as when it was first introduced. Recently, SPH faculty have identified over 50 genes associated with diabetesâ&#x20AC;&#x201D; offering new hope for the prevention and treatment of this life-threatening disease.

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he idea that we should reduce environmental hazards took hold in the U.S. in 1962 with the publication of Rachel Carsonâ&#x20AC;&#x2122;s Silent Spring.

The book led to a nationwide ban on pesticides and, in 1970, creation of the U.S. Environmental Protection Agency and passage of the Clean Air Act. Passage of the Clean Water Act in 1972 expanded the EPAâ&#x20AC;&#x2122;s ability to monitor and regulate environmental pollutants. Through efforts like the U-M Air Quality Laboratory, SPH researchers have furthered EPA and other efforts to ensure a clean, healthy environment worldwide. In 1964, the Advisory Committee to the U.S. Surgeon General published a landmark report stating that cigarette smoking was a cause of lung and laryngeal cancer in men, a probable cause of lung disease in women, and the leading cause of chronic bronchitis. During the 50 years since then, eight million premature deaths have been averted in the U.S. alone, thanks to the campaign to reduce tobacco use.

SPH Professor Kenneth Warner furthered these efforts with his 1985 study of the health implications of federal taxation of cigarettes and his testimony before the U.S. Senate, which helped sway Congress to extend the cigarette tax. Taxation is now one of the standard policy measures used as a disincentive to smoking. SPH faculty remain at the forefront of the ongoing fight against tobacco use. Motor vehicles, too, are a part of our environment. By 1966, car crashes were a leading cause of unintentional injury and death. That year the U.S. government launched the first systematic efforts to promote motor-vehicle safety, including creation of the National Highway Safety Bureau. New government mandates required that vehicles include seatbelts and other safety equipment. These led to a rapid decline in traffic-related injuries and fatalities. Today SPH faculty are evaluating additional lifesaving measures, including new graduated license programs.

ike dreams, some ideas go through multiple interpretations. That’s the case with health insurance, an idea that originated with ancient Greek and Roman “benevolent societies,” which paid for members’ funeral expenses and provided for their survivors.

This model informed the establishment of health insurance in the U.S. in the 19th century. Early plans offering coverage for steamboat and train accidents evolved into rudimentary group policies covering a range of benefits. In 1939, SPH Professor Nathan Sinai developed a voluntary health insurance plan that became a prototype for Blue Shield. Nearly a century later, SPH experts in health policy contributed to the development of the Affordable Care Act. These are just a smattering of the ideas that have made public health what it is today. Our field is full of dreamers who are hatching new ideas even as you read these words. Turn the pages to learn more.

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Departments

On the Web

Whenever you see this symbol, it means you can check out additional, exclusive content on this topic online at sph.umich.edu/findings.

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on Facebook, Twitter, YouTube, LinkedIn, Flickr and student blogs. Links at sph.umich.edu.

From the Dean

Growing Our Ideas

From Our Readers

On the Heights

44 Unexpected Advocate

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45 In Memoriam

End Notes

51 New on the Web

Sketches, notes, and doodlesâ&#x20AC;&#x201D;like this one by SPH Professor (and prolific doodler) Marc Zimmermanâ&#x20AC;&#x201D;can be an important part of the creative process. See more at sph.umich.edu/findings/fall2015/doodles.

Alumni Network

42 Your Health, Your Environment 43 Put Women in Charge

52 A Public Health Epidemic?

Front cover and intro pages: It seemed fitting to ask a pair of Ann Arbor artists to contribute to our ideas issue. Accordingly, artist, designer, and printmaker John Gutoskey created the front cover image, and illustrator and designer Kate Uleman created the images for the first six pages of the magazine. Back cover: The Doing a World of Good marketing campaign for SPH continues across national print and digital media. This page from the November 2015 Atlantic, one of a dozen ads currently in circulation, features Professor Goncalo Abecasis' work to find the genetic fingerprints of disease through genome sequencing. Learn more at sph.umich.edu/worldofgood.

findings Volume 31, Number 1 Fall/Winter 2015 Produced by the U-M SPH Office of Marketing and Communications

20 Fe ature Articles

The Ideas Issue 16

Where Do You Get Your Ideas?

They come in torrents, they come in dripsâ&#x20AC;&#x201D;and with luck they donâ&#x20AC;&#x2122;t dry up.

30 Public Health Ideas That Could Change the Way We Live When creative minds are free to explore, some pretty amazing things happen.

S pecial S ection V i c t o r s f o r m i c h i g a n c a m pa i g n

Idea #18 p. 32 #30 p. 41

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FROM THE DEAN

get lots and lots of ideas. And when one of those ideas is good, I bear the responsibility of nurturing it and allowing it to grow in collaboration and partnership with all sorts of people—some of whom don’t think like me and frequently don’t even speak the same language, literally or professionally, as I do. Invariably, the idea ends up better than it would have if I had pursued it alone. My experience is far from unique. Ideas drive what we do here at the School of Public Health, and most of those ideas Martin Philbert are nurtured and developed through collaborations among people, both inside and outside our school, who speak different “languages.” That’s one of the things that makes this institution one of the finest in the world—the global wealth of people, skill sets, experiences, and languages that constitutes daily life here at the University of Michigan. As scholars, our chief currency is ideas. So the challenge that any dean faces is to create a fertile environment in which the very best of those ideas can take shape and bear fruit. Among other things, this requires the constant removal of administrative obstacles and barriers that might otherwise clutter the paths of faculty, students, and staff. It also requires a deep understanding of—and sensitivity to—the often difficult and circuitous way that ideas evolve. By their very nature, ideas are ephemeral. They come and go like wind over a field of wheat. They have no structure unless we make the effort to turn them from propositions into plans or actions. But how do we do that? Not all ideas are equal, of course. Many of the ideas we hear in the public discourse are fanciful notions that melt in the heat of the noonday sun of further scrutiny. As history teaches, the most elegant of ideas— vaccination, for instance—depend on profound thought, examination, and above all, wisdom. At its core, public health is the science of ideas—but ideas with purpose and aim. That’s our challenge. As ideas become concepts, and concepts

morph into prototypes, there is an inherent danger that we will simply invent solutions for well-defined problem sets, rather than develop answers to the complex challenges of our world. In an era of big data, for example, we can all too easily categorize, measure, and massage data to address abstract problems, then throw the weight of our intellect into creating solutions for those less impactful questions. But that’s not what public health should be doing. We should be using the tools of our profession to create optimal solutions tailored to the specific needs of individuals, families, communities, regions, and nations. If we are to be successful as public health professionals, we must be relentless and disciplined in our pursuit of new ideas. We must continue to seek practical and wise solutions to the things that threaten human health. We must hold onto our ideals without yielding to idealism. And we must strike a balance between what I call “geekdom”—an obsession with numbers, percentages, standard deviations, and so on—and creative expression. Don’t get me wrong—I love being a science geek—but one thing I’ve learned as dean is that we can’t persuade people of the value of public health by inundating them with yet more facts and figures. We have to tell stories. We have to communicate our ideas in a language others can understand. Ideas are born and grow most easily and effectively in a fully integrated school like ours, where we can enjoy the breadth of individual disciplines, but can also find imaginative ways of linking those disciplines in unusual combinations. Not only do we have one of the most highly ranked schools of public health in the nation, but we’re part of a larger campus that encourages and promotes interdisciplinary research far beyond the walls of its individual schools and colleges. That’s what makes Michigan great. More than most, this institution knows how to strengthen its most important currency—our ideas. <

Most of those ideas are nurtured and developed through collaborations among people who speak different “languages.”

Martin Philbert Dean and Professor of Toxicology

Paul Giovanopoulos/iSpot.com

Growing Our Ideas

FROM OUR READERS u N I V e r S I T Y

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Becoming Detroit An inside look at a city’s metamorphosis

> I thought the most recent Findings was a fabulous issue... Addressing Detroit’s situation and the long history of partnering with U-M SPH was brilliant. It also feeds my sense of hope for the city. Having grown up in Ann Arbor when Detroit was thriving, it’s been sad to see its demise. So it’s welcome news to hear of the good things that are associated with the city and the fact that it’s beginning to turn a corner. It’s also good to hear about all the SPH connections to Detroit that have continued over the years. Thank you. The Rev. Dr. Mary Jane Francis, PhD ’70 Seattle, Washington The writer is the daughter of the late U-M SPH Professor Thomas Francis Jr.

INSIDe

> A former auto worker looks to the future p. 18 | A city grows p. 26 | The D’s healthy new food scene p. 52

Detroit Connections > As a longtime university magazine editor and a native of the Detroit area, I wanted you to know how much I am enjoying the new issue of Findings (“Becoming Detroit,” spring/ summer 2015). I have lived and worked in Texas for 31 years but still keep up daily with what is transpiring in the Motor City. Findings did a terrific job of packaging historical information and news about U-M’s contributions to public health and the revitalization of Detroit, and designing both in an attractive, engaging way. Makes me proud of the strides being made to turn things around economically, socially, and otherwise in a place I still love.

> My friend Penelope Easton loaned me her copy of Findings to read. Of course the first article to read was selections from her book, Learning to Like Muktuk (“Nutritional Sciences in Alaska, ca. 1948”). But I also enjoyed reading other parts of your journal because of my background as a health science librarian and because my brother spent his working life in Detroit. He was an electrical engineer for Detroit Edison and was loyal to Michigan to his dying day. The reporting on the ways Detroit is trying to recover made fascinating reading. I congratulate you on an alumni journal that is worth reading. Peg Lewis Durham, North Carolina

Ron Hadfield Abilene, Texas The writer is assistant vice president for university communication and editor of ACU Today, the alumni magazine of Abilene Christian University.

issue on Detroit—not only the wonderful compilation of articles and photographs depicting the history of Detroit and the immigrant settlers, but also the articles on current residents, which describe their pride in their town and communities pulling together to make Detroit a better place. I will be retaining this issue for future reading. Thank you! Irene Felicetti U-M SPH Department of Biostatistics Ann Arbor, Michigan

Paul Durance

> I was very impressed with the Findings

A Magazine’s Reach

> I really enjoyed the latest issue of Findings. Both of my parents grew up in Detroit, and the city and its fortunes strongly shaped our family. It was great to see such in-depth coverage of both the past as well as the present of the city that is the engine of our state. In July, 27,000 high school students came to Detroit as part of the Evangelical Lutheran

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Church in America Youth Gathering. They all participated in a one-day service project, which was just a taste of the kind of work undertaken by the “MFierce” program described in Findings (“Leading Detroit”). Thanks to SPH, I was able to put a copy of Findings on every bus taking these students to their projects. The students learned a great deal from the magazine about Detroit, community service, and SPH. Many of these students, along with their adult leaders, knew very little about Detroit before coming, since the gathering draws from all over the country. Findings helped open eyes, hearts, and minds to the beauty of a place and people often hidden by dire circumstances. Paul W. Durance, PhD Senior Financial Analyst, U-M Health System Faculty, U-M SPH, 1988–1996 Brighton, Michigan

My work on environmental justice brings me often to the community of West Oakland, and I have always found the parallels between Oakland and Detroit striking. > Your recent issue was of great interest to me as a former lifetime Detroiter who now works at the Environmental Protection Agency office in San Francisco. My work on environmental justice brings me often to the community of West Oakland, and I have always found the parallels between Oakland and Detroit striking. The articles in Findings capture well the texture of conflicts, challenges, and opportunities facing the city of Detroit. But nothing rang my bell so much as Lolita Hernandez’s “Writing Detroit,” with her perspective much shaped by her working at the Cadillac plant in Southwest Detroit— across the street from where I also worked, in engineering, in the late 1960s and early 1970s. I was somewhat involved in the political struggles in which she clearly was also involved. That part of the city remains quite vital, as well as quite emblematic (given the nearby Marathon refinery), of the challenges facing our country over the coming decades. The environmental justice movement runs strong and deep in Detroit, and has provided valuable guidance and education in my work over the past many years. Please stay on the story. Richard Grow Berkeley, California

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FROM OUR READERS More on SPH in Detroit > As executive director/CEO of Detroit-based Authority Health, as an SPH graduate, and as a proud member of the SPH Griffith Leadership Center Advisory Board, I appreciated the latest issue of Findings. As you note, SPH has extensive involvement in Detroit. However, you overlooked a significant SPH-Detroit partnership, including a major project with national implications: the Population Health Certification Program, which is provided to medical residents in Authority Health’s community-based teaching health center program. That program is part of the nationwide Teaching Health Center Graduate Medical Education program, an initiative created by the Affordable Care Act with the aim of increasing the number of primary care residents and dentists trained in community-based settings. Two years ago, I began talking to Phyllis Meadows, SPH associate dean for practice, about how SPH could collaborate with Authority Health’s medical training program, which shapes physician skills in community-centered medical care. Together with our graduate medical education team, Dr. Meadows and her staff created an innovative curriculum offered in the form of monthly lectures and group interactions, in addition to projects outside the seminar setting. The lectures have had an outstanding array of senior faculty from SPH as well as national experts in public and population health. No other medical training program offers this level of public health education. I don’t think it’s too strong an assertion to say that we are leading the way in training a new breed of physician for the challenging era ahead. As a public body charged with improving the health status of Detroit and Wayne County, Authority Health was also the first to establish

We love hearing from you! Post comments online; e-mail us at sph.findings@umich.edu; or send a letter to Findings, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109-2029; fax 734.763.5455. Comments may be edited for length and clarity.

Back Issues Back issues of Findings are available upon request. Visit sph.umich.edu/findings to review past issues. To request print copies, specify which issue and e-mail sph.findings@ umich.edu.

continued

a broad-based Population Health Council to redefine the public health conversation in Detroit, putting new emphasis on examining the social determinants of health and advocating for health equity. Funded by the W.K. Kellogg Foundation, the council underwrites an annual population health fellow. Nearly all of those fellows have been SPH graduates. Finally, SPH Professors John Griffith and Peter Jacobson have been an inspiration for both our population health program and for me personally, and we are honored to have them as advisors for our Population Health Council. Chris Allen, MHSA ’80 Executive Director/CEO, Authority Health Detroit, Michigan

Recent Award s

From a field of 45 entries, the fall/ winter 2014 (“What Does It Take to Change the World?”) issue of Findings won the gold award for Special Issues in the 2015 Circle of Excellence competition, a global awards program sponsored by the Council for the Advancement and Support of Education (CASE). Both the fall/winter 2014 and spring/ summer 2014 (“The Human Mind”) issues of Findings received a CASE Circle of Excellence bronze award in the category of Special Constituency Magazines, from a field of 49 entries. The spring/summer 2015 (“Becoming Detroit”) issue of Findings won an Excellence Award for magazines in the 2015 UCDA Design Show, which recognizes “the best of the exceptional design work done to promote educational institutions.”

Findings is published twice each year by the University of Michigan School of Public Health Office of Marketing and Communications. Dean Martin Philbert Director of Marketing and Communications Rhonda DeLong Editor Leslie Stainton Video Editor Brian Lillie Web Editor Beth Miller Web Administrator Patty Bradley Art Direction/Design Hammond Design Business Manager Rebecca Minch

Copies of Findings may be ordered from the editor. Articles that appear in Findings may be reprinted by obtaining the editor’s permission. Send correspondence to Editor, Findings, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109-2029, or phone 734.936.1246, or send an e-mail to sph.findings@umich.edu. Findings is available online at sph.umich.edu/ findings. ©2015, University of Michigan To opt out of receiving the print version of Findings and read our publication exclusively online at sph.umich.edu/findings/, e-mail us at sph.optout@umich.edu. Include Opt-Out in the subject line and your full name in the text.

Regents of the University of Michigan Michael J. Behm, Grand Blanc Mark J. Bernstein, Ann Arbor Laurence B. Deitch, Bloomfield Hills Shauna Ryder Diggs, Grosse Pointe Denise Ilitch, Bingham Farms Andrea Fischer Newman, Ann Arbor Andrew C. Richner, Grosse Pointe Park Katherine E. White, Ann Arbor Mark S. Schlissel, ex officio The University of Michigan, as an equal opportunity/affirmative action employer, complies with all applicable federal and state laws regarding nondiscrimination and affirmative action. The University of Michigan is committed to a policy of equal opportunity for all persons and does not discriminate on the basis of race, color, national origin, age, marital status, sex, sexual orientation, gender identity, gender expression, disability, religion, height, weight, or veteran status in employment, educational programs and activities, and admissions. Inquiries or complaints may be addressed to the Senior Director for Institutional Equity, and Title IX/Section 504/ADA Coordinator, Office of Institutional Equity, 2072 Administrative Services Building, Ann Arbor, Michigan 48109-1432, 734.763.0235, TTY 734.647.1388. For other University of Michigan information call 734.764.1817.

Saturday Afternoon in the Big House

On the Heights Undergraduate Public Health

Age of Abundance

Admissions Ambassador

Big Data

David Turnley

Football is serious business at U-M—as SPH Professor Vic Strecher was reminded when Coach Jim Harbaugh asked Strecher to be an honorary team captain for Michigan’s October 10 game against Northwestern. Duties included attending practices, meeting with players, and presiding over the coin toss (below). Strecher, who knows something about purpose (see page 41), said, “Harbaugh’s approach to working with the players—from skills training to motivation to performance— was something to behold and use in my own life and profession.”

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Ann Arbor has made Huffington Post’s list of America’s top-ten least-stressed cities. In fact, every city on the list is home to a major public university. Says HuffPo: “Universities typically provide stable employment with good wages and reasonable work hours. The cost of living in college towns is generally low, despite a relatively high quality of life.” And Midwestern towns—which account for eight of the ten cities on the list—“are generally known for their laid-back lifestyle.” n Clinical Associate Professor of Epidemiology (and SPH alumna) Eden Wells, MD, MPH, has joined the Michigan Department of Health and Human Services as chief medical executive. She’s the latest in a long line of faculty to provide service to the state of Michigan, among them Matthew Davis, professor of health management and policy and pediatrics and public policy, Wells’s predecessor as chief medical executive. Wells continues to direct the school’s Preventive Medicine Residency and to teach applied epidemiology for public health practice. n During its 20th Annual Meeting and Trade Show in May, the American Telemedicine Association (ATA) created and issued a special award, the ATA Medal–Distinguished Service Award, to SPH Professor Emeritus Rashid Bashshur, whose contributions to both medicine and telemedicine are “of historic proportions,” the association said. “We envision this to be one of the ATA’s highest awards, to be presented on occasion (not annually) to an individual for the highest level of achievement in the telemedicine and telehealth field.” n SPH Professor Richard Lichtenstein has received the 2015 Gary L. Filerman Prize for Educational Leadership from the Association of University Programs in Health Administration. Lichtenstein is founder and director of U-M’s Summer Enrichment Program (SEP), an internship program for undergraduate students interested in eliminating health disparities. n

Don Hammond

O n the H e i g h t s

Regents Approve First U-M Undergraduate Degree in Public Health

he School of Public Health will soon admit its first class of students for a new undergraduate program, leading to a BS or BA degree in public health. The U-M Board of Regents approved the new major in September. If also approved by the Presidents Council, State Universities of Michigan, SPH plans to open its doors to 50 undergraduates in the fall of 2017, and eventually build the program to serve 300 students. “Undergraduate students are increasingly engaged in the process of building a healthier world,” said SPH Dean Martin Philbert. “By integrating public health education into the undergraduate experience, we will create more informed citizens who are better prepared to address the myriad challenges that will be part of the world they inherit.” SPH leaders cite growing demand for undergraduate programs in public health, evidenced by increased numbers of students graduating into the field; the creation of similar degrees at peer institutions; calls from leading health organizations for more programs and courses; and feedback from current and prospective U-M students. The school’s addition of a handful of highly subscribed undergraduate courses since 2009 also demonstrated interest in the study of public health at this level. “Part of this is to be responsive to students’ needs and desires, and part of it is to address the Institute of Medicine call for an educated citizenry,” said Gary Harper, professor of health behavior and health education and chair of the

task force charged with leading the effort to create an undergraduate program. An additional goal is to offer classes that can be taken by nonmajors as well, Harper said. The Institute of Medicine has challenged higher education leaders to increase the number of undergraduate public health courses nationwide, both to boost the numbers of young people going into the profession and to create a citizenry that is prepared to address emerging health issues. The program emphasis will be on multidisciplinary training, with a focus on 21st-century public health problems such as antimicrobial resistance, climate impacts on food supply, and unequal access to care, leaders say. Students seeking the undergraduate degree can choose from two areas of concentration: public health sciences, and community and global public health. The major will require a field learning experience, with study abroad encouraged. Students will apply as sophomores and be admitted for their final two years as an undergraduate. One of the unique features of the U-M program is that its multidisciplinary curriculum will cross all six current departments: biostatistics, environmental health sciences, epidemiology, health behavior and health education, health management and policy, and nutritional sciences. —Laurel Thomas Gnagey < For more on the school’s new undergraduate program, visit sph.umich.edu/ undergrad.

On the Heights

Age of Abundance

SPH Admissions Ambassador

Mark Stephen/iSpot.com

More programs mean more options mean more competition mean more choices. What’s a school to do?

ith the steady rise in MPH and accredited graduate programs in public health across the U.S., prospective students now have an abundance of options, and schools like U-M SPH have big challenges. How to recruit in an age of plenty? “Be more strategic,” says SPH Director of Admissions Adam Ancira-Corrigan, whose office has introduced a number of successful new strategies in the past two years. Here’s a look:

Admissions Ambassadors Launched in 2014, this program recruits and trains volunteer ambassadors from current first- and second-year SPH students, who meet with prospective students throughout the year at both in-person and virtual recruiting events. Ambassadors also take part in virtual Meet and Greet sessions where admitted students can discuss specific SPH programs. In 2015, every admitted student who logged into a Meet and Greet session later enrolled in SPH.

Health Disparities Showcase Held in March one day before Admitted Students Day, this evening session for newly admitted students presents three different SPH faculty who give presentations on their work on health disparities in specific communities. Attendance is robust, and survey results show the showcase to be a highly successful complement to Admitted Students Day. Health Science Panel In partnership with other U-M schools and colleges, SPH goes to Atlanta each year to showcase Michigan’s many health sciences graduate programs to undergraduates from Emory and three historically black colleges and universities: Spelman College, Morehouse College, and Clark Atlanta University. The effort is key to recruiting a new and diverse generation of public health students to address the needs of underserved populations. U N I V E R S I T Y

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Public Health Power House This open-house “one-stop shop” event takes place annually in both California and Washington, D.C., in collaboration with public health schools and programs at Emory, the University of Minnesota, the University of California–Berkeley, and George Washington University. Prospective students get a chance to hear about each of the schools and about public health itself—with the aim of finding the best academic fit for them. It especially benefits students who can’t visit multiple schools. Last year’s D.C. event attracted over 80 students from the district and nine other states.

Virtual Information Sessions A year-long series of online, topical video sessions lets prospective students learn about issues like diversity and health disparities. At each session, a select SPH faculty member gives a snapshot of his or her work within a specific community, and students ask questions. Sessions draw from 50 to 80 prospective students, and Ancira-Corrigan says the series is helping SPH do a better job of recruiting prospective students from diverse populations.

Virtual Alumni Information Sessions Admitted students connect online with six to eight SPH alumni, who field questions from the students and share their perspectives on public health and SPH. Sessions attract between 75 and 100 admitted students and take place, strategically, in March—well in advance of the April 15 admissions decision deadline. For more information on U-M SPH applications and admissions, visit sph.umich.edu/prospectivestudents or e-mail sph.inquiries@umich.edu. <

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Anthony Su, a second-year MPH student in environmental health sciences, signed up to be a U-M SPH Admissions Ambassador last year largely because he wanted to give back to the A California school. His list of reasons native, Su why students even likes should pick snow, which U-M SPH is he’d never long: great experienced academics; before. friendly students; a wide variety of classes both within SPH and in other U-M schools and units; more than 100 U-M graduate programs ranked in the nation’s top ten; and Michigan’s four distinct seasons, each beautiful in its way. A California native, Su even likes snow, which he’d never experienced before. And he’s happy to know that this fall, his SPH program, toxicology, will have an even bigger class than last year—possibly as a result of his and others’ efforts. <

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B e a u t i f u l B i g D ata As ideas go, data science is as big as, well, data itself, which is shaking up disciplines across the academy, from astronomy to engineering, business, education, public health, and more. Now broadly accepted as the fourth mode of scientific discovery—along with theory, physical experimentation, and computational analysis—data science holds promise for solving any number of the world’s big problems. At SPH, researchers are mining huge data sets—some generated by social media (see page 39), others by more traditional methods—

to pioneer life-saving advances in statistical genetics, gene/environment interactions, medical and electronic health records, health services and systems, disease surveillance, chronic disease management, transportation safety, air pollution, brain imaging, and a range of other areas. So prominent is the school’s work that this fall, U-M SPH became the initial home to the brand new Michigan Institute for Data Science, a locus for U-M’s vast multidisciplinary work in this fast-changing field. <

This image of social contact patterns between individuals was created by U-M doctoral student Will Huang and SPH Assistant Professor Marisa Eisenberg as part of a collaborative project tracking disease transmission in contact networks. Also involved in the project are SPH doctoral student Ali Walsh, U-M Associate Professor Prabal Dutta, and Allison Aiello of the University of North Carolina Gillings School of Global Public Health.

Creativity is just connecting things. — s t e v e job s

Be less curious about people and more curious about ideas. —Marie Curie

to have a great idea, have a lot of them.

Rational thoughts never drive people’s creativity the way emotions do.

My ideas usually come not at my desk writing but in the midst of living. —A nais N in

An idea that is developed and put into action is more important than an idea that exists only as an idea. — Siddhartha Gautama, the Buddha

You can imprison a man, but not an idea. You can exile a man, but not an idea. You can kill a man, but not an idea. — B e n a z i r B h u t t o

order to be a wiser and more loving person, hoping to leave the world just a little better

Perhaps if I had had to slow down the ideas so that I could capture them on paper I might have stifled some of them. — J.K. Rowling

The Ideas Issue

in which we celebrate the human ingenuity that lies behind many of public health’s greatest achievements — past, present, and future.

— Neil deGrasse Tyson

—T hom a s Edi s on

letters in love with ideas in

than I found it. — Cornel West

An idea that is not dangerous is unworthy of being called an idea at all. — Oscar Wilde

A new idea is delicate. It can be killed by a sneer or a yawn; it can be stabbed to death by a quip and worried to death by a frown on the right man’s brow. —Ovid

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If you have an apple and I have an apple and we exchange these apples then you and I will still each have one apple. But if you have an idea and I have an idea and we exchange these ideas, then each of us will have two ideas. — George Bernard Shaw

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hile visiting friends this summer, I stepped into the shower and was intrigued to spot a notepad and pencil suction-cupped to the wall. I realized immediately why they were there. Don’t many people get their best ideas in the shower? And promptly forget them by the time they’re out? This friend is one of the top authors and speakers in his field; ideas are his lifeblood. No surprise that he would equip himself with the tools to capture them in their spawning ground. “How ingenious!” I gushed to him a short time later, damp-haired. He chuckled ruefully. As soon as he’d put up the notepad and pencil, he told me, ideas ceased coming to him in the shower. The only things ever written on that pad are amusing messages from guests. Ah, ideas. They come in torrents, they come in drips, and sometimes they dry up altogether, seemingly never to return. Go to a reading with a question-and-answer session, and someone is guaranteed to ask the writer: where do you get your ideas? As if there were a warehouse off some highway exit, selling ideas by the gross to those in the know. Janet Gilsdorf, MD, was once asked by a post-doctoral student where she got her research ideas. “My first reaction was, ‘I don’t know, but if you have no ideas you are toast as a scientist,’” says Gilsdorf, professor of epidemiology with a joint appointment in the medical school. She also writes books—she’s published a novel, Ten Days, and a cancer memoir, Inside, Outside—and her approach to generating literary ideas is pretty much the same as it is for medical ideas.

“In both worlds, it relies on letting your mind wander,” says Gilsdorf, “being open to the question, ‘What if?’ In the scientific world, what if this thing is related to that thing? In the fiction world, what would happen if character A did something good or bad to character B?” She also finds that she does some of her best thinking while knitting. Somehow the ingrained, repetitive motions free her mind for other musings. We are in an idea-obsessed age. Every field of human endeavor is desperate for the best ones, and small wonder. Climate change, war, terrorism, economic stagnation, poverty, disease—what hope do we have except for some heavy-duty innovation to come around and save us all? Articles, conferences, and TED talks purport to capture the secret of the creative spark. Interestingly, many of these shun the romantic image of a solitary thinker, chin in hand, struck by a lightning bolt. Rather, they argue that interconnectedness—with other people, with existing knowledge—is what most reliably results in new arrangements of information. “An idea is a network,” says Steven Johnson, author of Where Good Ideas Come From, in a TED talk on the topic. “It’s a new network of neurons firing inside your brain.” He cited the work of a Canadian researcher, Kevin Dunbar, who videotaped scientists in labs, trying to pinpoint where important ideas happened. Dunbar found that most breakthroughs took place not behind a microscope but at weekly lab meetings, when scientists shared their findings—and, crucially, their failures—with their colleagues. “Chance,” Johnson says, “favors the connected mind.”

by Mary Jean Babic

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Where Do You Get Your Ideas?

An age-old question takes on new twists. degree we all get set in our ways and laze into an acceptance of the way things are as, more or less, the way they should be, losing sight of the fact that the way things are began, like anything else, with ideas. In 2035, U-M SPH may largely be the way it is because of ideas generated during a recent visioning process to map the school’s future. “The place we began was asking, what did we really think the school would look like 20 years from now and how did we think our values—research, teaching, service, practice—would have evolved,” says Kardia, one of several leaders of the effort. The findings are now being written up; almost certainly the report will contain unsettling propositions. For example, today’s teaching methods—already in flux with online and hybrid courses, flipped classrooms, and students increasingly earning credits outside the classroom—are likely to be supplanted with even more novel methods. To remain a leader in public health, the school will have to keep up with those changes. “A lot of people get really nervous when they think the transformation will happen all at once,” Kardia says. “But if we are changing three or four of our classes every year, in 20 years most of our classes will be revolutionized without us even noticing.” This is something Johnson reiterates in his TED talk. Rather than “eureka moments,” ideas “fade into view over long periods of time.” A gradual approach will also allow the school to modify or discard ideas that don’t work. In early idea-generating sessions, Kardia said it was helpful, perhaps counterintuitively, to set some limits. “If you start brainstorming by saying, ‘Let’s just throw stuff up on the wall,’ there can be a fair amount of anxiety,” she says. Instead, conversations began with the question, “What do we really like about our school?” That reassured attendees that the school would hold on to the features it values and not throw the baby out with the bath water. “That positivity opened up people’s ability to hear things that might be frightening and not overreact.” Still, innovation will be central to the school’s future. “We’re looking to create more of a culture where people are able to build and test and fail quickly, so we can see what’s a better way to build mastery-based education,” Kardia says. “One of the goals is for us to be a little riskier.” We can beckon ideas, but in the end they will come or they won’t. All we can do is keep trying. After his failure with shower notes, my friend hit upon another way to capture his ideas: his new Apple Watch. He gets an idea, talks to his wrist, and, voilá, there it is. It wouldn’t work in the shower, but his ideas have moved on from that watery place. And like all the rest of us seekers, he’s followed. <

Open-office plans in workplaces—from tech giants Google and Facebook to New York's city hall under former Mayor Michael Bloomberg—exploded in popularity on the belief that, once the walls came down, collaboration would flow and fabulous ideas would tumble forth. (Companies also liked that such configurations cost a lot less and made it easier to keep an eye on employees.) Problem was, so many people so hated open offices that, several studies suggested, the productivity and creativity they were supposed to promote actually dropped. Frazzled, distracted employees dove for any empty conference room or quiet corner they could find for some uninterrupted work. So, what’s better, connectedness or solitude? And the answer is yes. Nothing is binary when it comes to ideas, especially not their neurochemistry. The old left-brained/rightbrained thing that we’ve all heard of has been sinking under the weight of research and neuroimaging that show all parts of the brain involved in the creative process. In a 2010 paper in the journal Trends in Cognitive Science, authors Steven L. Bresler and Vinod Menon write, “Although it has long been assumed that cognitive functions are attributable to the isolated operations of single brain areas, we demonstrate that the weight of evidence has now shifted in support of the view that cognition results from the dynamic interactions of distributed brain areas operating in largescale networks.” If it’s limiting to isolate creativity to specific parts of the brain, perhaps it’s just as limiting to isolate it to the brain itself. “It’s a trick to integrate head, and heart, and body, which is the lived experience,” says Sharon Kardia, senior associate dean for administration and professor of epidemiology at the School of Public Health. “In academia, we’re often the worst. We say, ‘Oh, we just need the head.’ The wisest among us say, ‘No, you probably need more.’” In fact, recent research has explored how moods influence creativity, with some studies claiming that “activation states” are most conducive to inspiration—regardless of whether those states are positive or negative. That is, depression or contentment can render us equally uncreative, while happiness or fear, by contrast, can galvanize us. How to reconcile this with the practice of Buddhist meditation, which holds that a calm mind is a receptive one? Maybe it’s possible to be too calm? Or too agitated? Ideas represent something other than what is, and for that reason they can threaten as much as excite. “Ideas are far more powerful than guns,” Stalin famously said, and he did not allow people to have either. But it’s not only tyrannical despots who resist new thinking. To some

Most breakthroughs

took place not behind a

microscope but at weekly lab meetings, when

scientists shared their

findings—and, crucially,

their failures—with their colleagues.

Mary Jean Babic is a writer based in Brooklyn, New York.

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public health ideas that could change the way we live

30 Public Health Ideas

Study Your Garden

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British-born Alexander Rickard loves growing plants and crafting his garden. He coordinates fruits, vegetables, herbs, and ornamentals and does his best not to overuse pesticides. “I try to go for a healthier approach to allow a decent homeostasis, to prevent different components of the garden from harming each other,” he says. One day Rickard had an idea. What if he applied the same strategies he uses in his garden to human health? In the garden, for example, he plants mint to ward off mosquitoes and has weeping willows to protect shade-loving plants. Could he do something similar with bacteria in the human body—could he effectively manipulate organisms into doing good? In particular, could Rickard, an assistant professor of epidemiology who coincidently holds a master’s degree in plant genetics and a PhD in microbiology, harness arginine (a natural amino acid that is required to make proteins) to improve oral health? The human mouth is home to hundreds of species of bacteria. “Much as in a garden,” Rickard notes, “some species can be unsightly and cause disease, while others can co-exist harmoniously and actually benefit the garden as a whole.” Rickard and his laboratory team recently discovered that high concentrations of arginine, which is commonly found in certain foods, could stop the formation of dental plaque—which can cause caries and periodontal disease. He and his team now believe that arginine could eventually replace current plaque-controlling antimicrobial substances, and they’re collaborating with colleagues at the U-M School of Dentistry and Newcastle (England) University’s School of Dental Sciences to better understand how arginine works. The research is important, Rickard says, because many existing treatments to fight caries and periodontal disease involve chemical antimicrobial agents that can stain teeth and affect the sense of taste. There is considerable debate about overuse of these agents, and scientists have sought ways to reduce their use. Dental plaque also contributes to billions of dollars of dental treatments and office visits every year in the U.S. <

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Build a Healthier Workplace As a practicing physician, Ana Baylin quickly realized that “medicine comes too late”—it’s prevention that saves lives. So she went into nutritional epidemiology, hoping to help turn the tide on obesity and unhealthy eating. But after years of watching diets fail, she concluded that even though most people know what they should eat, they don’t eat healthily, because it takes “too much willpower to go against the flow. You can’t put all the burden on individual behavior.” Her epiphany? To bring about real lifestyle change, you have to make it easier for people to adopt healthy behaviors—which means you have to change environments. Specifically, the work environment. “Sitting is killing us,” Baylin says. “We were not designed to be sedentary, to spend our days without expending energy.” Last year, at her own expense, Baylin installed a treadmill desk in her office at SPH. She spends at least two hours a day on it, gently walking while she works. She finds it helps her focus more than sitting still. (Her desk can also be lowered to a conventional height for use with a chair.) On the research front, she’s working with physician Caroline Richardson of the Ann Arbor VA to compare the impact of a treadmill desk intervention with that of an online diabetes prevention program. Treadmill desks aren’t for everyone, of course, and they aren’t the only option. Baylin notes that there are also standing desks, biking desks, and high tables with tall chairs for conference rooms—all of which address the common complaint that people “don’t have enough time” to exercise. Baylin is working as well with U-M engineers to assess the health benefits of LED skylights that mimic sunlight, because studies suggest a link between obesity and misaligned circadian rhythms. She knows it will take institutional change to enact many of the workplace improvements she envisions, and she’s looking into ways to reduce bureaucratic and financial barriers to such change. But she’s convinced she’s found an answer to our sedentary lifestyles. <

“Sitting is killing us. We were not designed to be sedentary.”

Cultivate Gratitude That’s the idea behind a biweekly series of walks through Nichols Arboretum, which had its inaugural season at SPH this year. The brainchild of the school’s Student Life Team, the 50-minute midday Gratitude Walks start in late April and run through October and are open to the entire SPH community. Between five and ten people turn out for each walk, says Chanel DeGuzman of the SPH Office of Academic Affairs, who helps coordinate the program. With no set route or agenda—just the chance to get away from the desk and enjoy the Arb—the walks are meant to foster health, well-being, and gratitude for the beauty and blessings around us. <

30 Public Health Ideas

Connect to Community The research is clear: when people feel connected to their neighborhoods, their health improves. Health also improves when people go outside and when they exercise. So Ella August—an adjunct research assistant professor in epidemiology who has spent years studying the social and physical factors that promote health—decided to “put into practice” all the numbers she’s been crunching at her computer and create an Ann Arbor Art Map to help get residents of the city outdoors, moving, and more connected to where they live.

Routes bear names like “Wonder,” “Love & Heroes,” and “Nature. August’s easy-to-use map, available in print and eventually as a mobile app, charts six themed routes that lead to and around nearly 60 works of outdoor art in downtown Ann Arbor and on U-M’s two Ann Arbor campuses. Users can walk, run, or in most cases bike the routes, which range from 1.5 to 5 miles and bear names like “Wonder,” “Love & Heroes,” and “Nature.” The mobile app will also feature spoken commentary from many of the artists. “The art in Ann Arbor is incredible, and really, unless you’re paying attention, you may not notice it,” says August, who’s already at work on special Ann Arbor art maps for kids and for the blind. <

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Adopt Clinical Nuance Up to one in four people can’t get the medical care they need, due to cost. But researchers at the U-M Center for Value-Based Insurance Design (V-BID) think that number could be sharply reduced—and health outcomes improved—by implementing what they describe as “clinically nuanced” benefit design. “By clinical nuance,” explains V-BID Center Director and SPH Professor Mark Fendrick, “we mean that medical services differ in the benefit provided, and that the clinical benefit of a specific service depends on who receives it, as well as on when and where the service is provided.” Fendrick and his V-BID team believe clinical nuance should be incorporated into both commercial health plans and Medicare—so that health-producing treatments cost consumers less, and treatments that don’t produce health hit consumers’ wallets more. That’s easier said than done. Because of anti-discrimination language in the original 1965 Medicare legislation, current regulations make it impossible to tailor Medicare benefits for specific patient populations, such as people with certain chronic diseases. Yet with the growing move toward precision medicine, “precision benefit design makes all kinds of sense,” Fendrick says. To date, V-BID’s greatest accomplishment—part of the Affordable Care Act—has been to eliminate the out-of-pocket costs for selected primary preventive services, such as vaccines for kids and colonoscopies for those over age 50, for over 137 million people. But as valuable as preventive care is, it only generates around three percent of health care spending in the U.S. and about one percent of Medicare spending. Most of the rest is spent on chronic disease services. Medicare’s “one-size-fits-all” benefit design is not set up to cover eye exams for individuals with diabetes, for example, or to reduce drug co-payments for those with specific diagnoses such as heart disease, AIDS, or depression.

Fendrick and his V-BID team believe clinical nuance should be incorporated into both commercial health plans and Medicare. The V-BID center’s goal is to create a clinically nuanced benefit design that will encourage Medicare beneficiaries to increasingly use those services that improve patient-centered outcomes. In June, the U.S. House of Representatives passed a bill—which Fendrick helped draft—to allow more precise, clinically nuanced benefit design in the Medicare Advantage Program. “It’s all part of changing the health care cost discussion from ‘how much’ to ‘how well,’” he says. < For a video interview with V-BID director Mark Fendrick visit sph.umich.edu/findings. For more on V-BID, visit vbidcenter.org.

Clinical Nuance in Practice On September 1, the U.S. Centers for Medicare and Medicaid Services (CMS) announced that it will begin testing a Value-Based Insurance Design demonstration program in 2017. The Medicare Advantage Value-Based Insurance Design Model program

is a direct application of concepts developed at the U-M V-BID Center and will be used to test and evaluate how well clinically nuanced insurance design improves care while containing costs. The program will be available through Medicare Advantage plans in Arizona, Indiana, Iowa, Massachusetts, Oregon, Pennsylvania, and Tennessee. <

Peter Smith

30 Public Health Ideas

Take on All Comers

After years of mentoring graduate students— typically PhD students doing dissertation work —SPH Professor Harold “Woody” Neighbors opted last year to “throw caution to the wind and take on all comers.” Friends of friends, undergraduates who’d taken the school’s Intro to Public Health classes, students between degrees, siblings of current students—pretty much anyone interested in public health (and specifically ethnicity, culture, and health, Neighbors’s area of expertise) was welcome to spend the summer doing an independent research study under Neighbors’s guidance. Called ENERGY (an outgrowth of “NRG,” or “Neighbors Research Group”), the program is strictly informal. Neighbors volunteers his time, and the student mentees get no academic credit or funding. But it’s a win-win all around. Neighbors gets to help nurture a new generation of public health scholars whose summer

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work informs his research agenda. The students get one-on-one mentorship, a chance to learn firsthand what it means to have an academic career in public health, and weekly meetings where they discuss current events, hear presentations, and exchange ideas. ENERGY participant Jessica GadsdenGray, who holds a PhD in biochemistry and cancer biology and recently completed a master’s in education from U-M, says the program gave her a vital network of professional relationships, as well as a crucial “window” through which to envision a career working to eliminate health disparities. “It’s difficult to have and to hold onto strength and resilience if you don’t have people around who are supportive and encouraging, and who you can access when challenges come,” she says. “That’s what this group has meant to me.”<

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Get Patients to Collaborate

Lee's six-year-old son created these illustrations showing warning signs and remedies for his food allergies. For Joyce Lee, the idea for an innovative patient-centered approach to health care came from her son, who has life-threatening allergies. Lee, who has a joint appointment in the U-M SPH Department of Nutritional Sciences and the U-M Medical School’s Department of Pediatrics, was frustrated with the complex handout patients are typically given so that they can inform caregivers about how to respond to allergic reactions. In collaboration with her then–six-year-old son, who narrated and provided illustrations, she created a YouTube video that describes warning signs and what to do in various scenarios. This became the prototype for an idea Lee calls “participatory design”—a way of transforming the health care model from one in which doctors are the experts, to a collaborative system where patients are involved in designing health care. “Design is this powerful force to bring the health care provider and patient together to collaboratively solve problems and treat each other

as equal partners,” Lee says. She’s involved in many initiatives to make this happen, including collaborative design workshops with patients and caregivers, and a diabetes emoticon app. The app will allow teens to text their parents about blood sugar levels using emoticons, a language that is more familiar to young people.

The idea came from her son, who has life-threatening allergies. “If you don’t live with the disease, you don’t understand the problems,” Lee says. “We’re trying to demonstrate to patients and caregivers that they do have knowledge and expertise,” and when joined with designers and programmers can come up with “incredible solutions that solve their problems.” Her son, now eight, has his own blog (ihavefoodallergies.tumblr. com/), and she’s teaching him how to program an app. “He’s continuing to create the tools he needs for his health and that’s what I want every patient to do.” —Julie Halpert < Joyce Lee tweets at twitter.com/joyclee and blogs at doctorasdesigner.com. To see her TED talk visit sph.umich.edu/findings.

30 Public Health Ideas

Build a Pipe line communities in the field,” Thomas says. SPH is one of four similar CDC-funded programs nationwide, all of which recruit undergraduates from throughout the country and the U.S. territories. This year SPH had 40 participants, all of them fully funded.

Next thing she knew, Williams was exploring a career in public health. With a Chinese father and a Syrian-Lebanese mother, Jack Wong, who completed FPHLP in 2012 and is now a first-year SPH student, is exactly the kind of person the program is set up to attract. “I was the only one like me in the program,” he laughs. “I would say everyone else was pretty much the only one like them in the program.” Wong is interested in tackling chronic conditions like obesity, diabetes, and mental health, and hopes to do so in his home state of Michigan after getting his MPH. During the ten-week program, participants work with community partners on a research project and attend talks and workshops on

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Twenty-one-year old Morgan Williams was talking to a friend about becoming a doctor when her friend interrupted her. “You don’t want to go into medicine—you want public health!” “What’s public health?” asked Williams, a senior math major at Delaware’s Wesley College. Next thing she knew, Williams was exploring a career in public health—and looking at graduate schools, including U-M SPH, where she spent last summer in a ten-week program that introduces promising undergraduates to the field. Funded by the U.S. Centers for Disease Control and Prevention, the Future Public Health Leaders Program, or FPHLP, is designed to help foster a new generation of public health professionals—like Williams, who comes from an underrepresented community, wants a health-related career, and is intrigued by public health. Dana Thomas of the SPH Practice Office, which oversees the program, calls it a “public health pipeline.” With thousands of public health leaders expected to retire in the next few years, a new workforce is needed. Just as important, that workforce must be diverse. “In order to have impact in communities that tend to be most vulnerable, or have additional challenges, you need to get people from those

Morgan WIlliams everything from public health principles to graduate-school applications. But first they spend three days in Atlanta, hearing CDC leaders talk about the field. That’s where Williams knew she’d found her place. “It was definitely at the CDC that I said, yes, public health is for me!” < For more information, visit fphlp.sph.umich.edu.

Take a Long Cut

Schedule a detour. Park farther away. Walk. Why? Walking boosts mood and energy, says Michelle Segar, PhD, MPH ’97, author of No Sweat: How the Simple Science of Motivation Can Bring You a Lifetime of Fitness. It’s also convenient. You can walk in any number of ways and places—safety permitting. You don’t have to change clothes or take a shower. It’s social—a great way to connect with loved ones and friends.

“Count everything you do throughout the day, and know it accumulates.” Too many people think they have to walk at a certain intensity, for a certain time, to get any health benefits, Segar says. It’s not true. “Count everything you do throughout the day, and know it accumulates.” Find ways to move. Get ice cleats for winter walking. Instead of passively sitting while waiting to pick up your kids, practice “active waiting.” Know that by walking—even if it’s only for two minutes—you’re not only giving yourself a positive gift, you’re fueling what matters most. <

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As Carrie Karvonen-Gutierrez began research on a study of women in midlife, she was surprised to learn about the burden that arthritis and musculoskeletal disease had on women ages 50 to 65, who had become afflicted with these conditions. The women were looking forward to an active retirement, but the pain, stiffness and swelling associated with their illness were hampering their ability to function. Karvonen-Gutierrez, an assistant research professor at SPH, says that while temporal trends in disability are actually remaining stable among individuals 65 to 84, and even improving among those 85 and over, “the data is worrisome” when it comes to women in midlife, with overall physical functioning worsening and disability rates increasing. With Siobán Harlow, professor of epidemiology, Karvonen-Gutierrez is working to understand the critical physiologic changes that occur in women during the midlife period just before they start late adulthood. Harlow directs the U-M Center for Midlife Science, which focuses on health-related changes in the reproductive and musculoskeletal systems, and on risk factors for cardiovascular diseases and diabetes, as women transition through their forties, fifties and sixties. The researchers hope to develop effective interventions that will help women stay on a healthier course as they age.

Aging research typically focuses on health after age 60 or 65, when it’s often too late for interventions to be helpful.

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Focus on Midlife

Aging research typically focuses on health after age 60 or 65, when it’s often too late for interventions to be helpful. A case in point, according to Karvonen-Gutierrez, is osteoarthritis, where many prevention studies don’t enroll participants until they’re 65. Dietary modifications, drug trials, and exercise interventions have proven disappointing, she says, “because by that point those who are likely to get the disease already have it, so interventions aren’t helpful.” Midlife “is a life phase that is very understudied,” Harlow notes. Until recently, a commonly held belief was that, except for menopause, the midlife was not a period of change and that women in midlife were relatively healthy and high-functioning. “What we’ve learned is that midlife is actually a period of considerable transition, both in terms of reproductive life but also in many other aspects of health,” Harlow says.

It’s important to look at the subclinical precursors of disease and disability during this life stage to better understand the trajectories of change in bone density, body size metabolism, cardiovascular health, and muscle strength. Such information can help scientists predict who is going to be at high risk as they age, Harlow explains, “and how we might facilitate healthy aging.” This type of research is particularly important at a time when life expectancy is increasing and a large proportion of the population is entering old age. As midlife research unfolds, it could form the basis for discussions on appropriate dietary activity and medical interventions, and could have implications for policy defining retirement benefit ages—insights that all can come from paying better attention to midlife health. —Julie Halpert <

30 Public Health Ideas

Go Entrepreneurial With declining general revenue, a diminishing workforce, rising public dis-

trust of government, and growing court-imposed restraints on regulation,

governmental public health risks diminishing relevance. To survive, it must consider becoming entrepreneurial. Think of what local health departments provide: surveillance, vaccinations, screenings, education, health promotion, disease prevention, environmental sanita-

Ditch the Added Sugar In 2012, Jacqueline Smith, MPH ’11, noticed a problem: she had good health habits in all areas of her life except one. She ate copious amounts of added sugar—not just by way of desserts and candy but hidden in prepackaged foods like pasta sauce, bread, and breakfast cereal. And that wasn’t good. Not only does added sugar lack nutritional value, but it contributes to inflammatory conditions like type 2 diabetes and dyslipidemia, and a growing body of evidence suggests it may be addictive as well.

tion, all of it. Do we really want to risk losing these? If it’s a choice between becoming marginal and changing the culture, then I think we have to recognize reality. To be sure, entrepreneurship is not without its challenges. Even under the best of circumstances, it’s hard to generate money from public health services. In a recent study of 32 local health departments in 18 states, my colleagues and I found pockets of entrepreneurial activity, mostly in the area of clinical services. But civil service restrictions pose additional barriers, and health department staff are seldom hired for their entrepreneurial skills. Our bottom-line finding was that to become entrepreneurial, governmental public health must undergo a significant culture change. It must place more emphasis on developing revenue-generating policies and programs. This may be an important strategic adaptation for staying relevant.

Shrinking public budgets require new ways of thinking and acting. No one should have any illusions that this is easy. How do you balance entrepreneurship against the core values that public health has always espoused— social justice, equitable access to care? But shrinking public budgets require new ways of thinking and acting. — Peter Jacobson <

SPH Professor Peter Jacobson is the lead author, with Jeffrey Wasserman, Helen W. Wu, and Johanna R. Lauer, of “Assessing Entrepreneurship in Governmental Public Health,” an assessment of the feasibility and desirability of public health entrepreneurship in governmental public health. The study appeared online in the American Journal of Public Health on February 17, 2015.

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“I get to help people prevent long-term problems on a daily basis. SPH set me up to do that.” Inspired to do something about her problem, Smith quit cold turkey—and felt more energetic, healthy, and finally free of the grip that foods with added sweeteners had had on her. With her personal success came the realization that she could help others do the same. Armed with her SPH degree and knowledge of behavior change, Smith scoured the literature and applied her previous experience as a teacher to develop Go Sugar Free, a 67-day online course designed to help adults eliminate—or at least reduce—the habit of consuming added sugars. She first gave it to 20 people in January 2013, and the course was a hit. “We’re now in our seventh round of Go Sugar Free,” says Smith, who is thrilled with both her post-SPH trajectory and her clients’ changing palates. “I get to help people prevent long-term problems on a daily basis. SPH set me up to do that.” —Nora White <

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The World Health Organization estimates that absent further progress, smoking will claim one billion lives in the current century.

30 Public Health Ideas

Pursue a Tobacco Endgame For the past few years, I’ve been involved in a fascinating discussion about a tobacco “endgame.” Credit for the initial idea goes to Neal Benowitz and Jack Henningfield, who in 1994 proposed that the federal government mandate a reduction of the nicotine content of cigarettes to levels incapable of sustaining addiction. That proposal has since blossomed into the concept of a tobacco or smoking endgame—a knockout punch, if you will, to end the pandemic of smoking once and for all. Wishful thinking? Perhaps. That hasn’t stopped many of the world’s tobacco-control scholars, strategists, and activists who share a common vision that the story of tobacco will conclude with two words: The end. Many of them met at SPH in 2012 to debate the merits of a tobacco endgame and to discuss the ways it might unfold.

Since the 1960s, smoking prevalence has declined by half or more in most developed nations—making tobacco control arguably the developed world’s single greatest public health success story of the past half century. But it’s not enough. The World Health Organization estimates that absent further progress, smoking will claim one billion lives in the current century—most of those in low-to-middleincome countries. That’s why we need a new approach. Despite the remarkable innovations of recent years—including smoke-free workplace laws, large graphic warnings on cigarette packages in dozens of countries, and plain packaging in Australia—the scourge of tobacco-produced disease is not likely to yield rapidly to current evidence-based interventions. Among the endgame proposals now under discussion are the following: administrative

mechanisms to remove the profit incentive from selling tobacco products, regulation requiring a reduction of nicotine in cigarettes to non-addicting levels, the imposition of a “sinking lid” on the supply of tobacco, a prohibition of the possession of tobacco products by all individuals born in or after the year 2000, and outright abolition of commercial tobacco product manufacture and sale. These are bold, even radical, ideas. If they seem completely impractical, consider that just a little over ten years ago, no knowledgeable public health expert would have deemed it conceivable that in 2015 we would have 30 entire countries, and half the U.S. states, in which smoking is prohibited in every workplace, including all restaurants and bars. — Kenneth Warner, Avedis Donabedian Distinguished University Professor of Public Health <

Retrofit the Bus

Air pollution is bad for you. We know this, says Sara Adar. The John Searle Assistant Professor of Public Health at SPH, Adar wants to find out what more we can do to protect people who are exposed to air pollution—like school kids. Especially school kids with asthma. One answer is to retrofit school buses with clean-air technology and run them on cleaner fuels. Adar recently completed a study of two school districts in Seattle that did just that, and her findings are revelatory. In both districts, elementary schoolchildren who rode retrofitted, cleaner-fuel buses had lower exposures to airborne particles and overall improved health. What’s more, asthmatic children—in particular severe asthmatics—had fewer missed days of school. As any parent, teacher, or employer knows, absenteeism affects not just kids but also the family and the workplace. So the potential economic impact of cleaner school buses is huge. Adar

school absences a year. More could be realized with the adoption of clean technologies. The clean air technologies Adar studied are commonly used in new school buses to meet the Environmental Protection Agency standards for new vehicles. But the agency also provides grants to school districts to

retrofit old buses, and Adar is hopeful her research will help build momentum in that direction. “For as little as $3,000, a bus can be retrofitted to emit lower amounts of particles,” she says. “We can really make a difference in kids’ health.” <

Elementary schoolchildren who rode retrofitted, cleaner-fuel buses had overall improved health.

estimates that the recent nationwide switch to cleaner fuels resulted in 14 million fewer

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Sofia Merajver (center, with several niches in hand) is joined by members of her U-M research group (left to right): Michelle Wynn, Jungsoo Chang, Julie Madden, Steven Allen, Joel Yates, and Megan Hull. U-M College of Engineering co-investigators, not shown, are Euisik Yoon and Yu-chih Chen.

Despite the fact that most breast cancers in high-income countries are diagnosed early— thus heightening the odds of successful treatment—some 30 percent of women who receive early diagnoses still die from the disease. Sofia Merajver wants to reduce that number, and she thinks she knows how.

“I want the cancer cells to tell me their story— not the other way around.” A professor of epidemiology and internal medicine, scientific director of the U-M Breast Oncology Program, and director of the U-M Breast and Ovarian Cancer Risk and Evaluation Program, Merajver is working to understand the biology of specific genomic clones in those cancers that, despite early detection and treatment, later return to cause metastasis and often death. She’s hoping to find out which clones—or genetically identical cancer cells—

are most significant in terms of metastatic potential, so that researchers can then develop personalized therapies to destroy those clones. In collaboration with multiple teams led by faculty from the U-M College of Engineering, Merajver and her research group are using a new technology—small, inexpensive, plastic devices, or “niches,” built by U-M engineers—to analyze and separate minute numbers of live cells from cancers. By observing the behavior of these cells—or, in Merajver’s words, by “listening” to the cancer cells—she and her colleagues can determine the characteristics, or phenotype, of those cells and better understand their potential to metastasize at distant organ sites. Says Merajver, “I want the cancer cells to tell me their story—not the other way around. I don’t want to tell them what I think their story is.” Each device, or niche, is the size of an adult’s thumbnail and, depending on its application, made of either rough glass or plastic. A fluid inside the device keeps cells alive and allows researchers to separate more aggressive cancer cells from less aggressive ones.

Unlike animal models, which scientists have long used to study cancers, the devices are relatively cheap and easy to reproduce and permit the quantitative measurement of cellular properties that are not accessible in animal models. And because cells can be analyzed so much more quickly in the device than in animal models, scientists can experiment quickly. Eventually, says Merajver, researchers will be able to test hundreds of different drugs and get results within a matter of days or even hours. This means that while a cancer patient is undergoing diagnosis and/or other local treatments, her cells can be tested, and personalized therapies designed to attack the deadliest clones. Merajver envisions a future in which scientists have a suite of such devices, each optimized to evaluate a particular kind of cancer or to answer a crucial biological question. Patients will be treated with targeted therapies according to the specific genomic clones found in their cancer cells. “Our overarching aim,” she says with excitement, “is to turn cancer into a manageable chronic disease.” <

30 Public Health Ideas

Lower the Income Gap (and Boost Health) With the income gap in the U.S. now higher than it’s ever been—except just before the Great Depression—Lewis Morgenstern, a U-M professor specializing in health disparities research, is exploring ways the private sector can help reduce the gap. It’s not just a question of economics, says Morgenstern, who has joint appointments in epidemiology and neurology emergency medicine and neurosurgery. It’s a matter of health. “The more money you have, the more you can afford treatments and the less catastrophic it is if you have to miss work. You also have greater access to healthy foods and neighborhoods with places to exercise. Money really makes a difference.” Dan Bejar/iSpot.com

“Part of the expectation of being at the top end of the pay scale in a corporation should be the notion that you’re going to give back to your work family.”

companies to pilot the concept, as well as others who want to work on the idea. <

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Partner with the Media Frustrated by news media coverage of health issues? Find it sensationalist, slanted, naïve, or just plain wrong? Aristotle Sun knows your pain, and he’s got an answer—at least a partial one. A 2015 graduate of the SPH Preventive Medicine Residency program, Sun spent last February doing an unpaid rotation with the medical news unit of ABC News. The experience convinced him that collaboration between health professionals and the media is an idea whose time is here.

Aristotle Sun (right) with ABC News Chief Health and Medical Editor Richard Besser (left) and fellow medical resident intern Jen Cruz.

Morgenstern’s big idea is that employers can make it possible for employees above a certain income range to voluntarily contribute a portion of their income (say, one to two percent of gross salary) to fellow employees whose earnings fall below a particular income level. He’s quick to add that he’s not talking about a salary increase, nor charity (he would not want see the program cut into charitable giving), but something closer to “leaving a tip for a restaurant server. Part of the expectation of being at the top end of the pay scale in a corporation should be the notion that you’re going to give back to your work family.” Funds would need to be distributed evenly and given anonymously, and other challenges resolved, but the fundamental idea “addresses the fact that wages have been incredibly stagnant except for people at the very top of the pay scale, and it deals with the tremendous income gap in all corporations.” He’s actively seeking

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During his month-long rotation, Sun and other medical resident interns helped the news team at ABC, including Chief Health and Medical Editor Richard Besser, review and summarize new health studies and vet them for accuracy. Sun and his peers also researched health information related to emerging news topics. The experience gives the residents an inside look at how the media works—invaluable training for anyone preparing to assume a leadership role in public health, Sun says, because “what’s interesting to scientists isn’t necessarily interesting to the general public, and if we’re going to communicate public health messaging, we have to know the difference.” For their part, ABC’s medical news reporters get expert advice on the relevance, nuances, and drawbacks of individual health stories, which in turn helps them do a better job of communicating what’s important. But the biggest winner, of course, is the public. <

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Tweet the Floods Thanks to unregulated phone service, Indonesia’s capital city of Jakarta accounts for a whopping 2.5 percent of the world’s tweets—more than any other city. Jakarta also tops the lists when it comes to flooding. Every year from November through March, this megacity of 9.6 million, which sits at sea level on the island of Java, is hard hit by monsoons. Years ago, this meant one or two floods annually. Today, with climate change, it means as many as seven or eight a year. Floods also mean gridlock, evacuations, drownings and other accidents, as well as outbreaks of waterborne diseases. And—until recently— breakdowns in emergency services. For decades it took government agencies and emergency responders 30 or more hours to identify areas of heavy flooding in the city. But now, thanks in large part to an enterprising urban planner and recent U-M research fellow named Etienne Turpin, they do it in under 30 minutes. Soon after going to Indonesia in 2012 as a postdoctoral student, Turpin had a bright idea: why not put Jakarta’s massive Twitter data to work for the public good? The result is PETAJakarta (PetaJakarta.org/banjir/ en), an open-source, community-led platform that crowd-sources Twitter data to create a mapping system that pinpoints flooded areas in Jakarta. Its impact has been revolutionary. “It’s amazing how much shooting oneself in the foot there was before this,” says SPH Associate Professor Laura Rozek, who with SPH colleague Marisa Eisenberg is now collaborating with Turpin to address flood-related health risks in Jakarta. “When it would flood, people would set up physical lines to pull themselves out, but emergency crews would cut lines as they went by in their boats. People would be stranded.” With Turpin and his team, Rozek and Eisenberg are exploring ways to use PETAJakarta to help prevent and reduce water contamination, disease outbreaks, and other health issues associated with flooding. “The idea,” says Eisenberg, “is to combine big data and PETAJakarta’s real-time mapping with our understanding of health issues like dengue fever, cholera, emergency response, and the health risks associated with garbage— all of which play out over the rainy season. So we’re looking at both immediate and long-term health planning.” Rozek says the technology they’re developing has immense potential for other megacities confronting extreme weather events and other emergencies. “This is like a modern-day John Snow,” she adds, referring to the 19th-century physician and father of epidemiology, who famously mapped his London neighborhood to identify the source of a cholera outbreak. “If John Snow had had Twitter, this is what he’d be doing.” <

“If John Snow had had Twitter, this is what he’d be doing.”

Achmad Ibrahim/AP

30 Public Health Ideas

With a background in social psychology and training in both evolutionary biology and community psychology, Daniel Kruger is something of a public health outlier—and he hopes his perspective can be a boon to the field. “So much of our morbidity and mortality is behavior-related, and we are still struggling with these so-called lifestyle diseases,” says Kruger, a research assistant professor at SPH. “We’ve known for decades what people need to do to be healthy—eat a healthy diet, exercise, etc. But if you look at the obesity epidemic, it’s obvious there’s something very wrong. That’s a call to rethink our strategies.” Kruger believes evolutionary theory—“the most powerful theoretical framework in the life sciences,” he says—is the key to doing that. Evolutionary theory can shed light on a broad range of health issues. It can help scientists identify patterns of causality in complex health phenomena, such as why humans crave fats, salts, and sweets and tend to resist exercise, or how social and environmental factors affect birth outcomes. Kruger believes evolutionary theory is especially helpful in understanding and capitalizing on human motivation. “You can get more compliance with health messages, for example, when you tell people something will make them sexy or attractive. So far this kind of thinking hasn’t been well integrated into public health.” <

“You can get more compliance with health messages when you tell people something will make them sexy or attractive.”

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Embrace Darwin

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Move Health Policy (Way) Beyond Health Care 20

Model Behavior

Computer modeling has changed any number of fields—engineering, urban planning, and lately public health, where scientists are increasingly using computer models both to predict and explain health-related phenomena, such as a recent spike in wild polio in certain Israeli communities. Although Israel has been certified polio-free for decades, two years ago the country’s routine monitoring of its sewage systems turned up evidence of a strain of wild polio in select communities. Joseph Eisenberg, SPH professor and chair of epidemiology, and a team of researchers are using computer models to try to explain the problem and develop interventions to minimize its chances of happening elsewhere.

James House believes President Obama’s initiatives to improve the socioeconomic situation of disadvantaged groups may do more to improve population health and reduce health care spending than his landmark Affordable Care Act. In his new book, Beyond Obamacare: Life, Death and Social Policy, House, a research professor of epidemiology and the Angus Campbell

Environmental pathogens don’t need humanto-human contact to spread disease. Traditionally, epidemiologists and modelers have been more interested in tracking how pathogens move among human beings than in how they move through the environment, but in this case, where the environment is an obvious factor, Eisenberg and his team are using both human-to-human and environmental-transmission models. As Eisenberg notes, environmental pathogens don’t need human-to-human contact to spread disease—witness the recent succession of outbreaks of norovirus on cruise ships, which have occurred without physical contact among humans. Computer models allow Eisenberg and his group to see patterns and chart conditions that may be related to the Israeli outbreak, and to conduct both spatial and temporal analyses of high-volume genetic and environmental data. The research is important not just because it may lead to a solution to an immediate problem, but because it may also aid in global campaigns to eradicate polio and other diseases. <

What If?

SPH Professor David Mendez has been using computer models for years to test the potential of new policies to lower tobacco use. As he explains, “with a computer you can accelerate time so you test policies that would take many years to test in real life.” Mendez uses computer models to address such questions as “what would happen to smoking rates if menthol were removed from cigarettes?” and “what would we need to do to achieve our proposed smoking-rate targets?” Mendez says, “Sometimes it’s just impossible to do these things any other way.” <

Distinguished University Professor Emeritus of Survey Research, Public Policy and Sociology at U-M, argues that we are currently on the wrong track to solve the daunting—and paradoxical—problem of burgeoning health care spending but worsening population health. He advocates moving away from a supply-side approach that focuses on improving access to health

30 Public Health Ideas

For example, “investments in early childhood education, better schools at the elementary and secondary levels, and better access to higher education have all been shown to pay off in terms of health outcomes.” House realizes his idea will be politically challenging. But he thinks the move to raise the minimum wage represents an important beginning. Politicians and corporate leaders “are starting to get the idea that if you pay better wages, you get better workers. If we also get healthier workers, we’re saving more.” House hopes his book will stimulate discussion about this fundamentally different way of approaching health policy. “It’s very complicated and hard to change the health care system, so we need to look at what we can do differently.” —Julie Halpert <

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Last winter, U-M’s Penny Stamps School of Art & Design hosted a charette—an intense and directed design “happening”—to generate innovative design solutions specific to the Ebola outbreak. More than 60 faculty, students, and staff from across the U-M campus, including SPH, convened for three days of intensive conceptualizing, designing, and fabrication. The result? A set of savvy, often deceptively simple inventions to improve procedures involving Ebola health care. Among them, Mdoff, a glove-removal device developed by experts from U-M SPH, the U-M School of Nursing, and the Stamps School of Art & Design. During trials both in West Africa and at SPH, the Mdoff team tested their concept and collected feedback to help them evaluate and refine the product. The project remains ongoing. <

Sang Hyun Lee

Population health improves more by investing in creating healthful conditions of life and work than by spending more for health care.

Change the Gloves

The fundamental concept behind Mdoff is a specially designed sticker that a user places inside disposable medical gloves before donning them.

Sang Hyun Lee

care to a demand-side strategy that improves the main drivers of people’s health—their conditions of life and work. Over the past four decades, the U.S. has increased its spending on health care to a level 50 to 100 percent more than any other country. Yet over the same decades, life expectancy and infant mortality have worsened, relative to many developed countries and some developing ones as well, House says. That’s because “we’re not taking into account the role that social determinants and disparities play in driving both levels of population health and health care expenditures.” Population health improves more by investing in creating healthful conditions of life and work than by spending more for health care, he says.

The sticker allows the user to grab each glove firmly and safely without tearing the glove material or touching the skin with the other contaminated hand. Mdoff team members include Ann Verhey-Henke, Marisa Eisenberg, Michelle Munro, Eden Wells, and others from U-M SPH; Sue Ann Bell (U-M School of Nursing); Sang Hyun Lee and Jan-Henrik Andersen (Stamps School of Art & Design).

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Learn from Flint

Peter Smith

â&#x20AC;&#x153;After a while the kids start to build this correlation between fun and community awareness.â&#x20AC;?

What Does It Take30 to Public ChangeHealth The World? Ideas

Green the Streets

Say Yes to YES

A counterpoint to “broken windows theory,” the idea of “busy streets” builds on the notion that safe neighborhoods with engaged residents are healthier all-around. It can start with something as simple as a street beautification project, says SPH Professor Marc Zimmerman, founding director of the U-M Prevention Research Center, which has been partnering with community organizations in Flint and Genesee County since 1998 to improve health outcomes in the city and county. A related idea is the notion of “greening”—environmental design that encourages people to engage in their community and with each other. Zimmerman and his PRC colleagues are now evaluating a three-year community initiative, Youth Violence Prevention Through Environmental

Seven years ago, Jerimiah Neyland took part in Youth Empowerment Solutions (YES), a partnership between SPH and the Flint (Michigan) community to help prevent violence among kids and teens by encouraging community involvement. Neyland spent two years as a YES participant. Now 19, and a sophomore at U-M Flint, Neyland spoke to Findings about his experience with YES: YES is designed to help young people navigate the tricky transition from childhood to adolescence. Did it do that for you?

Peter Smith

In my neighborhood in Flint, there weren’t really a lot of options for kids growing up in what was considered the ’hood. So if you didn’t find a sport

Gardens along Flint's University Avenue help foster a healthier, more engaged community, as do programs like YES, which encourages young people to be a positive force for change. Design, aimed at improving a two-to-three mile stretch along Flint’s University Avenue through such means as replacing a liquor store with a restaurant, converting an abandoned lot into a mini-park, planting a produce garden, and holding community social events. So far, Zimmerman says, findings suggest this kind of “greening” has a positive effect on health.

or a hobby, you’d just be out to explore the streets and do God knows what. YES gave me a safe haven, a fun place to go, and a group of people to be with. Some of the things that I picked up at YES still help me today—talking to people, working with other people, planning things—skills I’ve really honed. YES laid a foundation for us to go out and find other positive groups that were looking for people like us, and other places where we belong.

Empower Youth

What’s the secret to YES?

That’s the idea behind YES, or Youth Empowerment Solutions, an evidence-based violence-prevention program launched in 2004 by the Flint-based U-M Prevention Research Center. The overarching goal of YES is to prevent youth violence in at-risk populations by creating opportunities and structures through which young people can “be a positive force for change in their communities,” says PRC Director Marc Zimmerman. Recently, through a new violence-prevention program sponsored by the U.S. Centers for Disease Control, four U.S. cities—Boston, Massachusetts; Houston, Texas; Portland, Oregon; and Salinas, California— have adapted YES for use in their communities.

Facing page: Former YES participant Jerimiah Neyland.

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Two things. A focus on fun, and a focus on freedom. So the adults in the program will say, “Here’s three things that we can do.” But they don’t pick one—instead they listen to the kids. Normally the kids will take the idea and turn it into something that will be really fun for them. After a while the kids start to build this correlation between fun and community awareness and community advocacy, and before you know it you’ve got 25 community advocates. Did YES make you feel differently about Flint? It wasn’t until I became a part of YES that I started to take a step back and see the world around me. I said, “Wow, this is really not cool! This guy’s selling crack to children.” So it changed my perspective. And once you start to invest in the community—peace parks, murals, and things like that—you get attached. After moving away from YES, I couldn’t help but find myself wanting to contribute more. A lot of us in the program, we branched out, we found other ways to give back to our communities. < For a video about SPH activities in Flint, go to sph.umich.edu/findings.

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Enroll Now

Navigate the System

Now that the Affordable Care Act is up and running, most Americans who have been uninsured can get coverage—but the process can be daunting, especially to lowincome and immigrant populations. Why do I need insurance? What does the term “copay” mean? What’s a “deductible,” and how much does it cost? What’s an “exchange”? These are the kinds of questions that keep people from getting insurance and prevent navigators—hired by federally qualified health centers and social service agencies to help walk people through the process of getting health insurance—from providing the most effective enrollment assistance, say SPH faculty members Minal Patel and Richard Lichtenstein. In a project funded by the National Institute of Healthcare Reform, Patel and Lichtenstein are partnering with eight community-based organizations to develop a website to address these issues. The website will contain engaging videos aimed at educating and empowering vulnerable members of Detroit’s African-American, Latino, and Arab-American communities—with the goal of helping them enroll in Medicaid or private health insurance plans and using their insurance effectively.

Why do I need insurance? What does the term “copay” mean? What’s a “deductible,” and how much does it cost? What’s an “exchange”? To date, the team has identified key issues facing Detroiters, both with and without health insurance, and the group is now developing content. Topics include “enrolling in the right plan for you,” “how to identify a plan whose network includes your preferred provider,” and “what documents to bring when you visit a navigator.” The group will begin disseminating and evaluating their website next year and eventually hope to see it used nationwide. <

The original idea—an app to help people with HIV manage their health and well-being—won first place in last year’s SPH Innovation in Action (IIA) competition. But follow-up research showed that people living with HIV, as well as the case managers and community organizations who serve them, were in greater need of assistance navigating the health system at large—not just hospitals and clinics but “all those underlying things that go into good health, that people often take for granted until they actually need them or struggle to get them,” says Ryan Gourley, one of three members of the winning IIA team. Welcome to LivWel, the new web app under development by Gourley, a recent U-M; Ryan Sanii, a recent SPH graduate; and Maria Gosur, a graduate student in the U-M School of Information. Still in the early stages of development, LivWel is designed to provide a personalized, interactive way for people living with (or at risk for) HIV—and eventually others—to find and engage the social services they need. Web- and mobile-friendly, LivWel aims to reduce health disparities by being free and accessible to as many people as possible. For more visit www.livwel.co. <

LivWel is designed to provide a personalized, interactive way for people living with (or at risk for) HIV—and eventually others—to find and engage the social services they need.

Connect Online Daniel Eisenberg, associate professor of health management and policy at SPH and faculty associate at the Population Studies Center in the U-M Institute for Social Research, is exploring use of online video in confronting mental health issues. Two of his projects, Tinyshifts and Athletes Connected, employ brief videos as a means of engaging students and student athletes on mental health topics. “I’m interested in large-scale, low-cost, population-level approaches to improving mental health,” Eisenberg explains. “Online video seemed like a great way to reach large numbers of young people.” While not a replacement for a full intervention, the videos help normalize the discussion of mental health topics, and ideally, guide individuals toward seeking more serious assistance. —Beth Miller <

30 Public Health Ideas

Test your genes Has genetic testing ever interested you, but you shied away from doing it because of the price? Well, now you can do it for free. By participating in Genes for Good, a U-M SPH–sponsored research study that uses Facebook, you can find out about your DNA—and help scientists better understand how genes cause diseases like diabetes, addiction, obesity, heart disease, macular degeneration, and psoriasis, among others. The goal of the study, says Gonçalo Abecasis, chair of the SPH biostatistics department and project director, is to get insights into the biological causes of common diseases, so that scientists can find cures and treatments and improve prevention efforts. It’s the first study of its kind to take advantage of social media in this way. “Facebook makes it easy for us to capture what is missing in traditional studies—like being able to question someone’s environment, which can change daily,” Abecasis notes. “It’s also helpful in attracting enough people so that we can ask these interesting questions of large groups.”

It’s the first study of its kind to take advantage of social media in this way. As a user, you first log into the study on Facebook, where you’re prompted to complete Health History Surveys and Complementary Health Tracking Surveys, which chart your diet, exercise, mood, and other characteristics to see how your health changes over time. Facebook then lets you know “you have filled enough surveys to qualify for a spit kit.” Within

weeks, a plastic tube arrives by mail, which you spit into and mail back for analysis by the Genes for Good team. Once your DNA is extracted and genotyped, you can view and download both your genotype and ancestral history on Facebook, free of cost. The data is yours to keep. More than 6,600 people—representing every state in America—have joined the study since it went live in January 2015. But to make the biggest advances, the researchers need tens of thousands of participants. To sign up, go to apps.facebook.com/genesforgood. —Nora White <

Embrace the Unexpected

Thirty years ago, at the start of her career as a toxicologist, Rita Loch-Caruso wanted to study cell biology, with an eye toward addressing birth defects. But the molecular tools and techniques she needed did not yet exist, so she turned to researching the effects of environmental chemicals on uterine contractions during childbirth. One day, as she and a graduate student were testing the effects of polychlorinated biphenyl, or PCB, on uterine muscle, they decided to see what would happen if they separated the uterine lining from the muscle. The result was stunning: the muscle tissue proved far less responsive without the lining. It was a classic “eureka” moment, says Loch-Caruso, now a professor of environmen-

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tal health sciences at SPH. “I thought, ‘Maybe I’m studying the wrong thing.’” She switched her research agenda and is today a global expert on the effects of environmental toxicants on the placenta and other gestational tissues necessary for a

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healthy pregnancy and delivery. These highly sensitive membranes, says Loch-Caruso, play a critical role in a woman’s risk for preterm birth—in part by serving as a protective mechanism against potentially devastating microbial infections. Loch-Caruso hopes her work can lead to policy changes aimed at lowering women’s risk for preterm birth—one of the leading causes of infant death, impaired cognition, blindness, and lung afflictions. She’d also like to see her research contribute to the development of better interventions to prevent microbial infections associated with preterm birth. Her story, Loch-Caruso says, is a prime example “of the fortune that can be found when things don’t work the way you anticipated.” <

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Build on a Great Idea By his own admission, SPH toxicologist Rudy Richardson “kind of fell out of my chair” when early last year he stumbled on a Japanese research study showing that chlorine dioxide, a chemical compound commonly used in water treatment and bleaching, oxidizes a specific amino acid in the hemagglutinin protein of the human influenza virus H1N1. “It was one of those ah, ha! moments,” Richardson says eagerly. That’s because the findings were unexpected. Scientists have long known that disinfectants like chlorine dioxide can inactivate viruses, “but we thought it was indiscriminate,” he says. “And we knew little about how it happened.” The Japanese study—which Richardson found by chance while searching for material to help one of his students with her work—showed that chlorine dioxide is actually highly selective in this case. It inactivates hemagglutinin, which is found on the surface of influenza viruses, “probably by disrupting the protein’s binding to recognition sites on human cells.” The findings alter “our fundamental understanding of protein oxidation,” Richardson explains, and could have far-reaching implications for both infectiousdisease prevention and oxidative stress, a process scientists have yet to understand at the molecular level. Oxidative stress is implicated in many diseases associated with aging, among them Alzheimer’s and Parkinson’s.

Richardson is now using computational approaches to model protein oxidation in an effort to discover how and why this “selectivity happens with chlorine dioxide. If we can figure that out, we may be able to design other ways of inactivating viruses.” He thinks his research could lead to new anti-influenza drugs, which could in turn lead to the development of other antivirals, including drugs to combat norovirus and the common cold. “Virology is not my thing,” he admits, “but I find myself more excited about this than any other area of my research.” He credits the Japanese study with having “unlocked the door. It’s an example of how, by looking at the same thing other scientists have observed, but in a different way, you can come up with something completely new.” Richardson is collaborating with Christian Lastoskie, an associate professor in the U-M Department of Civil and Environmental Engineering, and U-M engineering doctoral student Margaret Reuter. <

Peter Smith

“By looking at the same thing other scientists have observed, but in a different way, you can come up with something completely new.”

30 Public Health Ideas

Think of Yourself as a Boat The name sounds like “jewel,” and that’s intentional, says Vic Strecher, SPH Director for Innovation and Social Entrepreneurship, professor of health behavior and health education, and founder and CEO of the new startup JOOLHealth. JOOL was also the nickname of Strecher’s daughter Julia, who died in 2010, and that connection, too, is intentional. “This is her legacy,” Strecher says of the app, called JOOL, he’s developing through his new company. Strecher compares JOOL to a “personal weather report,” or “coach,” that helps users track their health, well-being, values, and goals, with the aim of boosting energy and willpower. The app uses the metaphor of the human body as a boat, piloted by the winds of energy and a rudder of willpower. The company’s new office space (left) in downtown Ann Arbor is a prime example of health and well-being in action. It’s got a yoga room, seating and tables designed to foster collaborative work, lots of whiteboards, and a quiet room for meditation and naps. (Strecher notes that each minute of a power nap “can replace up to five times the amount of sleep deprivation.”) There’s even a playroom. Strecher, who previously founded HealthMedia Inc., a company later acquired by Johnson & Johnson, launched JOOLHealth last spring. It’s an outgrowth of his 2013 book and app On Purpose, which recounts Strecher's journey from grief, in the aftermath of his daughter’s death, to a new understanding of health. JOOL carries that understanding to a more nuanced level, harnessing sophisticated technologies so that users can better achieve their purpose and values and deepen daily reserves of energy and willpower. Initially, the app will be tested and used by large employers, including health insurers, but Strecher hopes it will ultimately be available to the general public. “It’s the first app I’ve ever built that I can’t wait to use myself,” he says. <

“It’s the first app I’ve ever built that I can’t wait to use myself.”

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ALUMNI NET WORK CL A SS N O TES

1960s

Your Health, Your Environment

f you live in a residentially segregated area with comparatively high rates of crime and violence, limited access to healthy foods, and inadequate health care, it’s going to affect your health. Public health professionals who ignore this reality do so at our peril, Carl V. Hill says. Hill, PhD ’05, believes that to address health disparities in the U.S., new steps—and an interdisciplinary team approach—are needed, “because these disparities are created and sustained at environmental, sociocultural, behavioral, and biological levels.” As he and co-authors Timothy A. Akers (a behavioral scientist) and Roberto H. Potter (a criminologist) argue in their new book, Epidemiological Criminology: A Public Health Approach to Crime and Violence, various disciplines can inform and strengthen efforts to address health disparities. Epidemiologic tools can provide quantitative research methods to help criminologists understand population phenomena, while criminology can shed light on behavioral choices such as gang membership and violence, which may serve as coping strategies for individuals facing harsh circumstances. With homicide a leading cause of death among young African-American men, criminalization is “without a doubt” a health disparities issue, Hill says. By “criminalization” he means not just criminal activity or criminal justice, but physical environments where crime and violence may be products of high unemployment, restricted social mobility, and structural racism. Even if people have no direct interaction with the criminal justice system, residents of neighborhoods where violence is prevalent experience the negative health impacts of criminalization. “While public health has given

criminalization some attention in terms of violent-behavior prevention,” Hill says, “there’s a broader landscape for thinking about this.” Because events that happen to us throughout the lifespan help determine health status, life expectancy, and quality of life, health-disparities research has broad implications for aging. As director of the Office of Special Populations at the National Institute on Aging, Hill has worked with colleagues to develop a framework to motivate health-disparities research related to aging—research that takes into account not just health behaviors and socioeconomic factors, but also the implications of racial discrimination, and how biological pathways and markers such as telomere attrition, epigenetic alteration, and chronic inflammation are affected to produce health disparities.

Epidemiologic tools can provide quantitative research methods to help criminologists understand population phenomena. Ultimately, the goal is to intervene at critical points to change not only individual behaviors but also environmental factors, like housing and school quality, which affect health. Many times people don’t choose to live in under-resourced, violent places, says Hill, who became interested in interdisciplinary health-disparities research as a doctoral student in the U-M Center for Research on Ethnicity, Culture, and Health. His experience at SPH, he adds, “has really informed and sustained my work.” <

Fifty-five years after receiving his MD from Howard University, James P. Comer, MD, MPH ’64, returned to his alma mater in May to give the keynote address at Howard’s School of Education Honors and Awards ceremony. Comer is also the recipient of the 2015 Mary Utne O’Brien Award for Excellence in Expanding the Evidence-Based Practice of Social and Emotional Learning.

1970s

Looking back on her long career in medicine and public health, Nigerian physician Florence Abinola Adeniran, MPH ’72, says she has learned “to accommodate people and take them for who they are. … In my 85 years of existence I have realized that no human being is perfect, and there is always a good side to each individual.”  Formerly associate vice president for development at Buffalo (NY) State College, Jane Armbruster, MPH ’79, is now vice president of foundation and community relations at Niagara Falls Memorial Medical Center.  Peter Butler, MHSA ’76, and William Leaver, MHSA ’76, were among 25 individuals nationwide to receive a Becker’s Healthcare 2015 leadership award. Butler is president and chief strategy officer of Rush University Medical Center (Chicago) and associate chair and professor of Rush University’s Department of Health Systems Management. Leaver is president and CEO of UnityPoint Health (West Des Moines, Iowa), and a past president and CEO of Rock Island, Illinois–based Trinity Regional Health System.  Sally Calef-Gebronwas, MPH ’74, a long-term health care representative for Genworth Insurance and former president of the Sausalito (California) Chamber of Commerce, has been named Spirit of Marin for 2015. The award honors businesses or individuals in Marin County who have made a difference in their community.  A board-certified hospice and palliative-care physician, Lewis Hays, MD, MPH ’72, was instrumental in developing palliative-care services on Boston’s North Shore and is currently medical director of All Care Hospice in Lynn, Massachusetts.

Alumni Network

 Alan M. Jette, MPH ’75, PhD ’79, is editorin-chief of Physical Therapy, the monthly scientific journal of the American Physical Therapy Association. Jette is professor of health policy and management at the Boston University School of Public Health, where he directs the Health and Disability Research Institute, and professor in the Rehabilitation Sciences Program at the Massachusetts General Hospital Institute of Health Professions.  President Obama has reappointed Barbara Rimer, MPH ’73, as chair of the President’s Cancer Panel. Rimer is dean and Alumni Distinguished Professor at the Gillings School of Public Health, University of North Carolina.  Barbara Schoenbrun-Glickman, MHSA ’78, who worked in health care administration for 20 years, has published two books: Maryland’s Public Gardens & Parks (2015) and Capital Splendor-Gardens & Parks of Washington, D.C. (2012).

Hays was instrumental in developing palliative-care services on Boston’s North Shore.

1980s

St. Joseph Mercy Health System has appointed David Brooks, MHSA ’85, president of St. Joseph Mercy Ann Arbor and St. Joseph Mercy Livingston. Brooks was previously with St. John Providence Health System, where he was president of St. John Hospital and Medical Center in Detroit and senior vice president of the system’s east region.

Now retired, Ullian says despite the progress she and others have made, too few women hold top jobs today. While in Ann Arbor last winter for a colloquium sponsored by the U-M SPH Griffith Leadership Center, Ullian spoke to Findings about the need for women leaders in health care: Why is it so important to have women at the top?

Peter Smith

“In my 85 years of existence I have realized that no human being is perfect, and there is always a good side to each individual.”

Put Women in Charge

laine Ullian came to Michigan in 1972 thinking she’d pick up the skills she needed to run a small feminist health center in a poor community somewhere in Boston. She left convinced there was a “much bigger world I could play in.” Ullian, MPH ‘73, went on to make health care history—and a name for herself—as one of the first women in the U.S. to become CEO of a major academic medical center. In the mid-1980s, at a time when just one of Boston’s 60+ hospitals was run by a woman, Ullian and a dozen or so other women—all in their 30s, all health care professionals in senior management, most of them married with children—began meeting regularly with one goal in mind: to rupture the old boys’ network that seemed to dictate their career paths. As Ullian later told the New York Times, “We were all working for new CEOs. We could be CEOs. But none of us was.” They called themselves Women in Health Care Management, and they took a “one-forall” approach—working the phones, advocating for each other, talking up headhunters and politicians. By the late ‘80s, nearly half of them had scored top positions in health care management. Ullian herself became CEO of Boston’s Faulkner Hospital in 1987. In 1994 she clinched the top job at Boston University Medical Center Hospital.

Without getting into stereotypes, I think women bring a very deep sense of purpose to their work. I think it’s the way we’re socialized. So when women come into the health care setting, I think they are there deliberately—there is a deep connection to sense of purpose and making a difference. They’re there because they believe that’s a place where they can shine and contribute. My other observation is that they have a strong spirit of team, maybe because so many women in health care have been part of care teams, and nursing and ancillary support services are all about the team delivering exceptional care. My experience of women working in health care is they celebrate the results of the team. It’s not about, “I have to win, so therefore you need to lose.” It’s about, “What do we do for these patients, what do we do for this community today?” And that’s very powerful—it’s magical. For women who want to go into health care leadership, what are the challenges? Multiple. First of all, you have to shine in every arena. Secondly, you have to be very clear about your ambition, and I have seen a lot of women being a little apologetic for being ambitious, and a little tentative as they go after jobs or promotions or raises. We’ve got to lose that behavior—you have to come in confident and sure of yourself and believe you’re just as good as any other candidate (if not better than the other candidates), regardless of their gender. I’m still very frustrated as a feminist that we haven’t done enough of that. < For a video of Elaine Ullian discussing women in health care and the impact of U-M SPH on her career, go to sph.umich. edu/.findings.

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Melanie Maxwell/MLive

Unexpected Advocate

Members of Michigan Open Carry were present at a meeting of the Ann Arbor school board last spring.

s a psychiatrist and mother of two, Sonya Lewis, MPH ’15, was used to being a “nontraditional” student. Now she’s a nontraditional graduate. Two months before finishing her degree at U-M SPH last May, Lewis found herself taking on a new and unexpected role, as a gun-safety advocate. It started when Lewis attended her daughter’s spring choral concert at Ann Arbor’s Pioneer High School. In the audience that evening was a man with a gun—and a license to carry it. As Lewis and many others in the crowd would soon learn, under Michigan law it’s legal to carry an unconcealed weapon, with ammunition, in schools and certain other public venues as long as you’ve got a concealed pistol license.

In the audience that evening was a man with a gun— and a license to carry it. The episode made local headlines—and galvanized parents like Lewis, who became the de facto leader of a movement to ban firearms in Michigan schools. “I never knew much about politics,” says Lewis, a practicing psychiatrist who went into public health hoping to help prevent depression and other mental health maladies. Now she finds herself tackling what she views as a critical public health issue. “Even if we take out intentional shootings, accidental discharges occur with alarming frequency and result in tragedies for individuals and communities,” Lewis says. Although she concedes that the issue “is a lot more complicated than I thought,” and the political system at times confounding, Lewis embraces her new role. With other supporters she’s working to close the legislative loophole that permits firearms to be carried in Michigan schools, and to heighten public understanding of the issue. Whatever the outcome, Lewis says, “it’s getting a conversation going.” <

President Obama has nominated Kristen Sarra, MPH ’97, as Assistant Secretary for Policy, Management and Budget in the U.S. Interior Department.  Neysa Dillon-Brown, MHSA ’83, has joined the Atlanta office of Diversified Search, an executive search firm, as managing director in the Healthcare Practice. Dillon-Brown was most recently president, executive search practice, with the Desir Group LLC.  After four decades in health care, long-time arts patron Robert Johnson, MPH ’84, has become executive director of the Paramount Theatre and Visual Arts Center in St. Cloud, Minnesota. Johnson was previously executive director of the CentraCare Heart & Vascular Center and a St. Cloud city council member.  At the end of 2015, Deborah Szmuszkovicz Devaux, MHSA ’83, will become COO of Blue Cross Blue Shield of Massachusetts. She is also an adjunct faculty member at the Harvard School of Public Health and Tufts Medical School.  Sharon Legette-Sobers, MHSA ’84, is senior program officer for opportunity grants for the Greater Rochester (New York) Health Foundation.  Valerie Powell-Stafford, MHSA ’89, has been elected to the board of governors of the American College of Healthcare Executives. She is the COO of Blake Medical Center in Bradenton, Florida, and the former COO of Doctors Hospital in Sarasota, Florida.

1990s

Nevada Business Magazine has chosen Vance Farrow, MPH ’94, as its 2015 Community Partner Healthcare Hero for southern Nevada. Farrow is the industry specialist for health care in the Nevada Governor’s Office of Economic Development.  In addition to being director and CEO of the Centre for Infectious Disease Research in Zambia, Charles B. Holmes, MD, MPH ’94, is a faculty member at the Center for

Alumni Network

IN MEMORIAM

AIDS Research in the Johns Hopkins School of Medicine Division of Infectious Diseases.  In June, Sridhar P. Reddy, MPH ’95, became chief medical officer at St. Joseph Mercy Port Huron (Michigan).  President Obama has nominated Kristen Sarra, MPH ’97, as Assistant Secretary for Policy, Management and Budget in the U.S. Interior Department. Previously the department’s principal deputy secretary for policy, management and budget, Sarra has also worked in various senior roles at the White House Office of Management and Budget, the Commerce Department, and Democratic offices in the Senate.

2000s

After nearly a decade of service, Anand Parekh, MD, MPH ’02, has stepped down from his position as Deputy Assistant Secretary for Health (Science & Medicine) with the U.S. Department of Health and Human Services.  A faculty member in the Department of Urologic Oncology and Office of Cancer Health Disparities Research at Roswell Park Cancer Institute (Buffalo, New York), Willie Underwood III, MPH ’04, focuses on methods to improve the early detection and treatment of prostate cancer.

Deborah Szmuszkovicz Devaux, MHSA ’83, will become COO of Blue Cross Blue Shield of Massachusetts.

2010s

As associate director of the board of directors of the American College of Epidemiology, Shervin Assari, MD, MPH ’14, chairs the Associate Members Committee and serves on the Career Mentoring Committee.  James Keller, MD, MHSA ’14, is vice president, medical management, for Chicago’s Advocate Trinity Hospital.

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1970s

Abram B. Stavitsky, MSPH ’40  August 2, 2015 Harry B. Nelson, MSPH ’42  December 2, 2007 A. Louise Behrends, MPH ’45  February 17, 2015 Alfhild J. Johnson, MPH ’46  October 8, 1998 Henry J. Kruska, MPH ’47  June 28, 2015 Clarence L. Brumback, MPH ’48  January 12, 2012 Leah R. Heslop, BSPHN ’48  July 1, 1978 Edith C. Oakes, MPH ’49  August 21, 2007

Peter W. Rekshan, MPH ’70  March 3, 2011 Charles R. Snyder, MPH ’71; PhD ’90  March 19, 2015 Alice J. Grant, MPH ’72  March 14, 2008 John A. Hopewell, MPH ’72  July 24, 2014 Grace I. Luckscheiter, MPH ’74  March 6, 2011 Rebecca A. Head, MS ’75; PhD ’83  June 23, 2015 Mary A. Michalak, MS ’79  April 4, 2015

1950s

Sharon M. Evenden, MPH ’82  December 7, 2014 Roberta A. Purdon, MPH ’82  January 12, 2015 David M. Dunn, MPH ’86  November 4, 2014

Glenn E. Spurlock, MPH ’51  May 22, 2008 Delmar R. Stone, MPH ’51  January 6, 2015 Elizabeth Warner Waggener, MPH ’51  April 10, 2015 Raymond M. Taylor, MPH ’54  May 21, 2015 Robert W. McKinney, PhD ’57  July 16, 2015 Russell F. Whaley, MPH ’58  August 1, 2009

1980s

1990s Alexandra A. Bowers, MPH ’99



July 31, 2015

1960s John R. Mitchell, MPH ’60; DPH ’63  March 20, 2015 John C. Booth, MHA ’61  October 10, 2010 Ruth E. Smith, MPH ’61  March 3, 2015 Henry J. Suroviec, MPH ’62  February 14, 2015 John L. Dietemann, MPH ’63  July 1, 2015 Angela F. Mullins, MPH ’63  July 15, 2015 L. W. True, MPH ’63  August 17, 2013 Mammo Beshah, MPH ’64  March 1, 2015 Phyllis Standen, MPH ’64  February 21, 2012 Shirley A. VanZetta, MPH ’64  May 28, 2013 Jesse E. Trow, MPH ’65  May 30, 2015 nn Wallace, MPH ’65  August 2, 2015 Ruth M. Ward, MPH ’65  April 26, 2010 Bruce B. Dicey, MPH ’66; MS ’69  August 13, 2015 John D. Phaup, PhD ’66  March 17, 2013 Barbara A. Taylor, MPH ’66  June 25, 2015 Janet A. Ryan, MPH ’67  April 25, 2015 Girard Veenschoten, MPH ’67  March 7, 2015 Tomiko Shimada, MS ’68; PhD ’75  November 15, 2014 Thomas P. Webber, MPH ’68  February 26, 2015 Bernard E. Harrell, MPH ’69  June 15, 2008 David A. Stewart, MS ’69  November 20, 2005

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contact info at leadersandbest.umich. edu/alumni_update/. Or indicate changes on the address label and mail to the address on the back cover. H E A L T H

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FINDINGS

IN MEMORIAM

John H. Romani John H. Romani, professor emeritus of public health administration at U-M SPH, died in Ann Arbor on July 8, 2015. He was 90. Born in Milan, Italy, in 1925, Romani was raised in Milford, New Hampshire, and after military service in World War II, received his BA and MA degrees in government from the University of New Hampshire in 1949. He earned his PhD in political science in 1955 from U-M. He was a postdoctoral fellow at the Brookings Institution in Washington, D.C.; then worked at the Cleveland Metropolitan Services Commission and taught at Western Michigan University and the University of Pittsburgh before joining the U-M SPH faculty in 1961. Throughout his 30-plus years at SPH, he served in a variety of administrative capacities, including assistant dean (1962–1966), associate dean (1966–1969), first chair of the Department of Health Planning and Administration (1975–1980), and interim chair of the same department in 1991. He also served briefly (1969–1971) as vice chancellor of the University of Wisconsin–Milwaukee. “Simply put, John Romani had a constant desire to get things working well and he used his public administration skills to advance the academy, government, and countless organizations,” said U-M SPH Dean Martin Philbert. “John was more interested in seeing good ideas put into practice than in having his name out front, a concept that he imparted to his students.” Known statewide and nationally for his many contributions to public health, Romani consulted frequently with local, state, national, and international health organizations, and played a key role in the development of Michigan’s first and current Public Health Code in the late 1970s. He chaired the working group that laid out the organizational structure of state and local public health, clarifying responsibilities and funding sources and creating a structure that became a model for health departments nationally.

Robin Barlow Among his other professional activities, Romani was president of the American Public Health Association and chaired the committee that led to the formation of the public health school accrediting body, the Council for Education in Public Health. A committed classroom teacher, he continued, after his formal retirement from U-M in 1993, to teach both at SPH and in the U-M Program in the Environment. His post-retirement years were also taken up with research on issues of population and health in South Africa, where he and his wife, U-M Professor Barbara Anderson, spent time each year from 1999 on, working with colleagues there.

Romani consulted frequently with local, state, national, and international health organizations, and played a key role in the development of Michigan’s first and current Public Health Code in the late 1970s. “John was a leader in the field of public health administration, but in many ways it was his second act—his post-retirement career— that gave him his most pleasure, and clearly his greatest productivity as a scholar,” said Professor Kenneth Warner, a colleague and friend. “With Barbara, he delved into research and writing in a way he never had earlier in his career.” Romani is survived by his wife, Barbara Anderson; his sons, David (Betty) of Durham, North Carolina, and Paul (Theresa) of Beltsville, Maryland; a stepdaughter, Theresa (Arun Rajmohan) of Arlington, Virginia; and three grandchildren. He was predeceased by his parents, Henry A. and B. Hazel Pettengill Romani; his sister, Cynthia; and his former wife, Nina. <

Robin Barlow, professor emeritus of epidemiology in the School of Public Health, died at home in Augusta, Michigan, on August 23 after a long illness. He was 81. Born in Blackburn, England, Barlow received his AB degree from Oxford University in 1954. After college, he served in the British Army and then emigrated to the United States, earning his MBA and PhD degrees from the University of Michigan. He joined the U-M faculty as a lecturer, then assistant professor of economics and faculty associate in the Center for Middle Eastern and North African Studies in 1961. He later served as director of the center as well as director of the Center for Research on Economic Development and director of the Seminaire sur l’Economie du Developpement. From 1988 to 1995, he was a professor in the SPH Department of Population Planning and International Health. When that department was integrated into the Department of Epidemiology in 1995, Barlow became a professor of epidemiology, serving until his retirement in 2000. He played a key role in the U-M SPH international health program, working closely with students to identify and help secure funding for their overseas internships. “Robin Barlow was the classic professor, full of ideas, willing to share, open to suggestions, yet never acting as if he was above others,” said Mark Wilson, U-M professor of epidemiology and a close colleague. “He insisted on rigor, yet did so with gentle firmness and quiet encouragement.” Barlow published widely on the relationship between public health and development and consulted frequently with the World Bank, the World Health Organization, the U.S. Agency for International Development, and other international agencies. He was also a gifted actor, performing in 50 local theater productions, often in a leading role. Barlow is survived by his wife, Betsy; children Jim, Jennifer (Ed Gibbs), and Rebecca (Michael Cooper); eight grandchildren and several nieces and nephews. His daughter Gwendolyn Barlow predeceased him. <

Marc-Grégor Campredon

We invite you to be a

victor for Michigan.

Our students strive to advance public health through innovation and collaboration. They want to make a lasting and positive impact on the world. Through the creativity of their ideas and the passion, intelligence, and commitment they bring to their work, they are changing the way we think about health—and shaping a promising future for countless individuals and communities across the globe. But many of our students can’t afford a public health education without support. That’s where you can help. The following pages highlight examples of creative giving. We invite you to be an innovator, together with our students. Consider the many ways you can support the University of Michigan School of Public Health—by honoring a friend, including us in your will, making an annual gift. And these are just some of the ways our friends and alumni have offered their support. Your contribution makes a lasting impact.

Victors for Michigan.

Honor a

Friend

When it came to promoting water quality and water access, Hillel Shuval, MPH ’52, HSCD ’03, was ahead of his time. With a degree in water/sanitary engineering from Cornell University, the U.S.–born Shuval moved to Israel in 1948, knowing the region would face Hillel Shuval water shortages in the years ahead. He undertook major projects in water reuse and recycling while helping to establish the Environmental Health Division within Israel’s Ministry of Health. Thanks in part to Shuval’s farsighted efforts, today Israel is a world leader in water conservation.

He served on the World Health Organization’s expert advisory panel on Environmental Health (1965–2001) and was a consultant on environmental health and engineering for the World Bank, the United Nations, and the European Union. Among his many awards, Shuval received an honorary doctorate from U-M in 2003. “He was always a great source of unbiased information,” recalls SPH alumnus Charles Gelman, MPH ’58. During one of Shuval’s stays in Ann Arbor, he rented a house in the Gelmans’ neighborhood. Gelman and Shuval became friends, as did their Charles and Rita Gelman teenage daughters. The families maintained a connection over time, and Charles and his wife, Rita Gelman, visited Shuval in Israel a few years before his death in 2013.

Shuval returned to the United States to earn a degree in environmental health engineering from U-M SPH, where he also served as a visiting associate professor in 1962 and 1967. While at SPH, Shuval began collaborating with Khalil H. Mancy, now professor emeritus of environmental health sciences. “He, an Egyptian, and I, an Israeli, became fast friends,” Shuval later recalled, “despite the fact that our two countries were still formally at war.”

Shuval believed water is a basic human right and throughout his career worked to develop approaches for resolving water conflicts between Israel and its neighbors.

Palestinian colleagues initiated the First Israeli/Palestinian International Academic Conference on Water. Recognizing that Palestinians historically have experienced water shortages, Shuval worked to increase their share of water in the region.

To honor their friend’s legacy, the Gelmans have awarded SPH a gift to support student internships in Israel, where SPH researchers are now collaborating with Israeli scientists in a number of areas, including water quality and environmental health. Thanks to the Gelmans’ generous gift, SPH students now have the opportunity to follow in Hillel Shuval’s footsteps—solving public health problems through international collaboration.

Shuval believed water is a basic human right and throughout his career worked to develop approaches for resolving water conflicts between Israel and its neighbors. In 1992, he and his

l t

What Does It Take to Change The World?

Create a

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“Our public health infrastructure needs strong communityoriented leaders. While there are departments of population medicine or population health in various medical schools, they don’t train public health leaders. It’s only in schools of public health where true, community-oriented, population health is the predominant focus. Public health tends to be the stepchild of the health care system. It needs a financial base. We have to get creative. I would encourage everyone to offer their support.”

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Progress Toward $100 Million SPH Campaign Goal goal remaining:

$35.7 million

SPH Campaign Priorities For student support:

Before Waggener died this past spring, she designated 25 percent of her trust to SPH. Among other things, the assets will be used for student grants, global public health, and projects devoted to improving access to health care. By generously providing educational opportunities for SPH students now and in the future, Waggener will continue to advance the field she loved so dearly.

What motivates you to give to SPH?

Waggener “always had a soft spot in her heart” for the University of Michigan, recalls Julie Pokorny, Waggener’s trust officer at Union Bank. And she was a strong proponent for the principles of public health. “She admired the people who knew what good public health entails.”

Halley Faust, MD, MPH ’78, MA (philosophy), began his career at U-M as an assistant professor of epidemiology while also serving as medical director of the Livingston County Halley and Ruth Anne Faust (Michigan) Health Department. After leaving Ann Arbor, Faust worked as a senior manager, first in staff model HMOs, and later in health insurance. For the past 25 years, Faust has run two venture-capital funds, investing in high-technology medical companies. He is a professor of family and community medicine at the University of New Mexico; a managing member of Jerome Capital, LLC; and a past president of the American College of Preventive Medicine. Faust has been giving annual gifts to SPH since 1982.

Elizabeth “Betty” Warner Waggener (BS ’45, Dental Hygiene; MPH ’51) had a lifelong devotion to public health. Born in Holland, Michigan, she graduated from SPH and spent several years with the U.S. Public Health Service in Washington, D.C. She was eventually recruited to the University of Elizabeth Waggener Nebraska, where she established a dental hygiene program that opened in 1964. When she arrived on campus, she discovered there wasn’t enough room in the building that had been designated for the program. So, in addition to organizing the curriculum, selecting students, and buying equipment, Waggener contended with a dirt floor in the basement of the building that provided temporary housing for the program. She adapted, and the program graduated its first class of students on schedule in 1966. Today, the dental hygiene program continues to educate students within the University of Nebraska’s College of Dentistry.

Give Annually

Legacy

U N I V E R S I T Y

For Faculty support:

$28 million

contributions pledged to date:

$38 million

for Program support:

$64.3 million

$34 million

P U B L I C

H E A L T H

l t

S P H . U M I C H . E D U

One day. 24

hours. That’s 1,440 minutes to support what you love about

Michigan. This December 1st, U-M is once again

turning Giving Tuesday—the national movement to kick off the giving season—into Giving Blueday. You can help transform lives, shape the world, and make great things happen. On this special day, from midnight through 11:59 p.m. EST, you can be a victor for Michigan by making a donation to any area of your choice at the university. Gifts of every size will make a difference, and your gift could go even further by attracting additional funds through matching gifts and challenges you can participate in throughout the day. Be sure to mark your calendar now so you can come back on Giving Blueday for interactive social media content, challenges, and real-time updates.

Join us. Be a victor for Michigan. sph.umich.edu/giving

New on the web online at sph . u m ich . e d u

> Giving Blueday

Last year, SPH colleagues, friends, and alumni raised $42,412 online in just 24 hours during Giving Blueday, U-M’s first universitywide day of giving. On December 1, 2015, you can once again be a victor for public health by making a gift to SPH. Every donation makes a difference, and on Giving Blueday, your gift has the potential to go even further, through online challenges and matching gift programs. sph.umich.edu/givingblueday

> Innovation

in Action

The Innovation in Action competition harnesses the talents of Michigan students to address real-world problems. Now in its third year, the competition has expanded from its original public health focus to include a new education track. The program equips students with an innovator's toolkit in a supportive environment where they combine these skills with their creativity and passion to make an impact. InnovationInAction.umich.edu

> New Online Alumni Directory

On October 15, 2015, U-M SPH launched a new online alumni directory! The directory is available to all alumni, and settings can be adjusted to determine what portions of your information are visible to other SPH alumni. If you have not updated your settings, please visit leadersandbest.umich.edu/directory-sph.

> Something to Say?

pay it

forward Want to share your real-world knowledge and experience with current or prospective students? Need a job or have one to fill?

> SPH Career Connection matches SPH students and grads with companies and agencies. Check out umsphjobs.org or e-mail sph.jobs@umich.edu.

> If you would like to be part of Ask an Alum or mentor a

student, please send an email to sph.inquiries@umich.edu.

O F

M I C H I G A N

S C H O O L

SPH turns 75 in 2016. Our alumni hold many of the memories that make our history real. Maybe it’s a milestone moment, or a personal epiphany, or a particular place or faculty member or classroom experience you cherish. Whatever it is, we want to hear about it! We’ll publish your answers online and in a special 75th-anniversary edition of Findings next fall. To submit your story visit sph.umich.edu/75 or e-mail sph.findings@umich.edu.

J uly 10–29, 2016

Comment online on any story in this magazine and learn what other readers have to say at sph.umich.edu/findings.

U N I V E R S I T Y

What do you love about U-M SPH?

O F

Graduate Summer Session in Epidemiology Now in its 51st year, this internationally recognized program provides instruction in the principles, methods, and applications of epidemiology. A certificate program as well as online courses are available. For more information visit SummerEpi.org.

P U B L I C

H E A L T H

S P H . U M I C H . E D U

FINDINGS

A Public Health Epidemic? Now there’s an idea! With dazzling speed, wit, rhythm, and rhyme, the 2015 U-M SPH commencement speaker—poetic voice and storyteller Sekou Andrews—offered a new take on the practice of public health during the school’s May 2 graduation ceremonies in Ann Arbor. Andrews brought a crowd of 2000+ (among them over 300 members of the SPH Class of 2015) to its feet with his bold idea: that public health is its own outbreak. Here’s how he began: Ladies and gentlemen, Faculty and staff, Parents, and grandparents and friends And play sisters, And 3rd cousins on the father’s side And little babies who have no idea why they’re here And the graduating class of 2015 I welcome you I am here today for one reason To update you on the status of the public health outbreak that is spreading across this nation at an alarming rate. It is fierce, and quiet, and it is reaching epidemic proportions faster than we can keep up

In Washington, the outbreak has apparently gone airborne, where a policymaker is mutating the strain of health care costs on the country A local college professor is reportedly using an app to spread pathogens of purpose to entire digital populations The damage these cases are doing to blight and affliction is staggering There is a husband and wife team casting a net of safety over sub-Saharan Africa and completely undoing all the hard work that malaria has put into infecting people in the region

Reports are still coming in, daily, from every state

Everywhere we look, we are finding cases of these infectious agents of public health

Like the recent reports of a woman in Santa Ana, CA

whose impact on local and global communities

who is transmitting chronic illness education door to door throughout her local neighborhoods

is somehow managing to go more viral than cat videos and Kardashian clips.

To watch Sekou Andrews’s speech in its entirety, go to sph.umich.edu/findings.

Peter Smith

What Does It Take to Change The World?

U NI V ERSIT Y

MICHIGAN

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1415 Washington Heights, Ann Arbor, MI 48109-2029

Gonçalo Abecasis Professor

In mapping the human genome

we never forget the human. For nearly a decade, Prof. Gonçalo Abecasis has been mapping genome sequences around the globe. But his work goes beyond data alone. He is searching for genetic fingerprints of diseases, such as heart disease and diabetes—with the ultimate goal of curing and preventing them.

Global health challenges are multiplying every day. We at the University of Michigan School of Public Health work passionately beyond the classroom to bring viable solutions to the world’s most pressing problems. Because the only way to ensure the health of our world is to protect the people who live in it. sph.umich.edu