'Radical' Transformation

Innovation chair Jim McMahon views nursing as uniquelypositioned to lead a disruptive revolution in health care

The following is an excerpt of Jim McMahon’s speech delivered Oct. 15 at his installation as Chair for Innovation in Health Care.

I’d like to thank Dean [Kathy] Rideout for supporting me as the inaugural Chair for Innovation in Health Care. It’s such a great honor. And I’d especially like to thank Marilyn Fiske for her generous donation that made the chair possible. The endowment has had a huge impact on how I am able to conduct my research, and especially the ability to devote more time to mentor junior investigators in the school.

In thinking about delivering this speech tonight, and what I would say about innovation in health care, I thought, why stop at innovation? Why not go bold, why not talk about something even more radical than innovation – the health care equivalent to a Mars landing or reversing global warming?

As some of you know, I earned my doctorate in biological and medical anthropology from the City University of New York, where I completed my dissertation and began working in the field of bone biology. Then a somewhat fortuitous event changed the course of my career.

In order to make ends meet, I took a job as a data analyst for a study investigating the spread of HIV among women in East Harlem. I spent time working in affected communities doing community outreach and interviews, and I began to see firsthand how forces like discrimination, violence, and poverty restricted and shaped people’s choices and behaviors leading to increased exposure to HIV and other diseases.

I found this work so eye-opening, so compelling, that I decided to switch my area of research to HIV prevention and epidemiology.

Like HIV/AIDS, the diseases that account for the vast majority of premature morbidity and mortality in the U.S. – such as cardiovascular disease, stroke, hypertension, diabetes, obesity, and even some cancers – are preventable through behavioral, social and environmental changes, such as improved diet and nutrition, adequate exercise, high quality sleep, social integration, safe sex and healthy relationships, and reduced exposure to addictive or toxic substances. But we also know that these factors are shaped by more distal structural factors like discrimination, violence, and poverty.

Jim McMahon, center, celebrated his installation as Chair for Innovation in Health Care with some of his colleagues from the School of Nursing Interdisciplinary Sexual Health and HIV Research group (from left to right): LaRon Nelson, Chen Zhang, Amy Braksmajer, and Natalie Leblanc.

Jim McMahon poses with Marilyn Fiske, whose support helped to make possible McMahon's appointment as Chair for Innovation in Health Care at the School of Nursing.

Given this evidence, the “radical” question is: Should we, as a nation, be doing more to prevent people from getting sick in the first place, rather than waiting until they get sick to treat them? This is not an innovative idea. Right here at the UR, we have the Center for Community Health and Prevention, whose mission and programs emphasize disease prevention, health equity, and community engagement. Yet, recent reports estimate that only about 3 percent of total health care spending is devoted to community health and prevention, and only 7 to 9 percent of NIH spending is devoted to research to prevent chronic illness.

I‘ve witnessed firsthand how medication, surgery, medical devices and other treatments can not only improve quality of life but save the lives of those who are sick. So, I understand on a personal level the importance of treatment. But to me that doesn’t diminish the question: Can we do better? Can we envision more than just innovation, but a “disruptive transformation” in health care? A national, coordinated plan to gradually and strategically shift resources to health promotion and disease prevention?

This is already happening in my field of HIV/AIDS, with a massive investment and prioritization of prevention. In fact, New York state leads the nation with its campaign to End the Epidemic. This is a strategic plan to reduce the number of new HIV cases to sub-epidemic levels. So, if this can not only be envisioned, but strategically planned and implemented for one chronic condition, it can be done for others.

Such a transformation will not be without challenges. It’s not easy to change health behaviors, social norms, and environments, not to mention things like poverty. It will mean working more closely with professions traditionally not included in the medical model of health care, such as elected officials, city planners, the business community, and community organizations.

My colleagues and I in the School of Nursing Interdisciplinary Sexual Health and HIV Research group just published an article in the Journal of Clinical Nursing, in which we argued that key historical trends and characteristics of the nursing profession ideally position nurses to play a leading role in HIV prevention efforts to end the epidemic.

In our article, we note that, historically, nurses have been on the frontlines of caring for vulnerable and marginalized populations; nurses have placed more emphasis on health education, prevention and community engagement; the nursing profession has embraced a holistic approach, integrating clinical, biopsychosocial and ecological methods; nurses also have unique skills in leading care coordination; and as often the first to encounter health care delivery gaps and problems, nurses have also been at the forefront of innovation and entrepreneurship; and finally, I would argue that nursing is more flexible, adaptive, and able to respond to change more readily than most other health professions.

For these reasons, I believe that nursing is uniquely positioned to take a leading role in transforming health care. Indeed, our own School of Nursing is already leading the way, with its Center for Employee Wellness and Passport Health programs, school-based prevention initiatives, and educational programs that emphasize health promotion and prevention.

In closing, I’d like to reference another major event that had a profound impact on my career. Eleven years ago, I joined the School of Nursing family. That turned out to be a smart decision. I could have increased my clinical knowledge by joining a school of medicine; I could have improved my understanding of community health and engagement by joining a school of public health; or stimulated my sense of caring and compassion in a school of social work; or even advanced my methodological skills by going into epidemiology. But what I’ve come to realize is that there’s only one place that combines all of these attributes under a single academic home, and that’s our School of Nursing. And my decision to join the school has greatly accelerated my growth both as a scholar and as a person. I only hope I’ve contributed and given back to the school even a small part of what I’ve received.

James M. McMahon, PhD, is an associate professor, Chair for Innovation in Health Care, and co-founder and chair of the SON Interdisciplinary Sexual Health and HIV Research group at the School of Nursing.