February 2019, Volume XXXIII, No 11
Shaping our health and well-being
John R. Finnegan Jr., PhD
University of Minnesota School of Public Health
MNA has successfully grown and adapted to the needs of its members as health care What do you want people to think when they hear the term “public health”?
Public health is about the forces and factors that combine to shape the health and well-being of population groups. Core to public health is disease prevention and health promotion, and the partnerships it takes to make these efforts effective. Just a few examples of the variety of public health work from our school: We’ve developed apps for just-in-time interventions to stop HIV transmission; we help keep farm children safe from injuries; and we design and run some of the largest clinical trials in the world in infectious and communicable diseases. Public health has a full dance card!
What are some of the common misperceptions people have about the field?
First, a lot of people think of public health in medical terms, such as treating patients. There is a strong complementary connection between medicine and public health, to be sure, but the focus and the tools are different. Public health’s focus on the population contrasts with medicine’s focus on the individual, for example.
And second, some think public health efforts lead to “a nanny state,” though most public health professionals, including our school’s graduates (master’s and doctorates), work in the private sector. Regardless of that fact, public health relies on education, technology, and community partners to disseminate what it learns through evidence-based research that explores what is hurting or helping our collective health.
What can you tell us about gun violence as a public health issue?
Some 100 people die every single day from guns in the U.S., and suicide accounts for 63 percent of those deaths. What’s more, a 2018 study in Health Affairs found that U.S. children ages 15–19 were 82 times more likely to die from gun homicides than those in our peer nations. We look at the problem through multiple interventions. I know that some people are deeply afraid that preventing gun violence means taking away people’s guns, but that’s not a public health approach. For us, it’s about realistic, achievable ways to reduce the carnage.
How can public health initiatives address social disparities in health care?
One approach we take is to shine a light on health care disparities, then follow up whenever possible with solutions that often lie in public policy and system changes. Two examples:
Associate professor Katy Kozhimannil, PhD, found that birth doulas improve birth outcomes for low-income women, among whom women of color and American Indians are over-represented. Her research had direct impact on the 2013 passage of Minnesota’s “Doula Bill” that permitted Medicaid coverage of services provided by a certified doula.
SPH’s Upper Midwest Agricultural Safety and Health Center is addressing the well-being of immigrant farm workers. Co-director professor Jeff Bender, DVM, says, “Accessing health care is difficult if you’re poor; it’s harder if you’re poor and a person of color; and even harder if you’re poor, a person of color, and an immigrant.”
Public health’s focus on the population contrasts with medicine’s focus on the individual.
Let me single out three: aging populations, climate change, and the need for further federal investment in U.S. public health.
Today, 8.5 percent of people in the world are 65 and older; by 2050, that will likely reach 17 percent. This means a greater burden of chronic disease, rising health and long-term care costs, strains on health infrastructures, and an even more urgent need for prevention and health promotion at younger ages.
Climate change exacerbates a host of public health concerns, such as the emergence and re-emergence of infectious diseases, respiratory illness, water pollution, and excessive heat affecting aging adults and other vulnerable populations.
As for federal funding, we’re not spending enough as a nation on prevention and health promotion. Some 90 percent of our nation’s health dollars go to health care, a system which many studies have shown is the most expensive and least efficient on the planet. We need a rebalancing!
The media can play a positive role to further public health, especially through advertising and television programming. The recent Merck ad (www.tinyurl.com/mp-merck) for HPV vaccine is extremely effective. On the other hand, with the explosion of social media there is potential for negative impact. Witness the anti-vaccine movement that promotes the falsehood that childhood vaccines cause autism. I also believe that scientists and journalists need to communicate research better to the public.
The grant supports a collaboration among SPH, Mayo Clinic, and Hennepin Healthcare. With a $4 million, five-year award, we’ll train researchers in a game-changing approach to health care and health care research called learning health systems (LHS). In LHS, researchers embed in a health care system, bringing continuous and real-time learning into the relationship between researchers and clinicians to improve the quality of patient care.
Fairview Health Services, Minneapolis VA Health Care System, Children’s Minnesota, Ebenezer, Essentia Health, and HealthPartners will partner with the program (Minnesota Learning Health System Mentored Career Development Program) to train the scholars, offering diverse patient populations and dynamic learning laboratories.
Like it or not, consolidation is the rule today and the question is whether or not it will reduce costs and keep quality high. Many experts believe that this trend is actually raising health care costs, shifting costs to consumers, but not improving patient care.
We know that the consolidation of certain services leaves many in rural areas with reduced access to health care. A recent study from our school (www.tinyurl.com/mp-SPH-study) found that rural U.S. counties that lost hospital-based obstetric services and were not adjacent to urban areas had significant increases in out-of-hospital births, births in a hospital without an obstetric unit, and preterm births in the first year.
Public health research provides data and evidence for health care legislation and helps guide policy decisions. Health policy and management are major parts of many schools of public health, like ours, and our research shapes the design of public programs, such as Medicare and Medicaid.
For public health to be truly effective, though, we need legislators to pay more attention to research. We also need to make our findings easier to understand and apply. Our school did a study with the University of Minnesota Medical School and found that only 41 percent of all formal legislative discussions on childhood obesity-related bills in Minnesota from 2007–2011 cited some form of research-based evidence.
Physicians are our best partners when it comes to protecting people from disease and fostering good health and well-being. We have physician-researchers on our faculty as well as physician-students who seek an MPH or PhD. Often they discover public health after they have spent many hours treating people with chronic diseases that could have been prevented. Those of us in public health and primary care have an important opportunity to form strong partnerships with communities to promote disease prevention and a culture of health. A good example of this is the Practical Playbook (www.tinyurl.com/mp-playbook).
John R. Finnegan Jr., PhD, has been dean and professor at the University of Minnesota School of Public Health since 2005. With a doctorate in journalism and training in mass communication, he developed public health campaigns and a research and education program in health communication. He serves on several health-related local, national, and international boards.