SCHOOL OF PUBLIC HEALTH University of Virginia

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1 SCHOOL OF PUBLIC HEALTH University of Virginia Why a School of Public Health? Since 1900, the lifespan in the United States has increased by more than 30 years, 25 of those years due to advances in public health such as vaccination, healthier mothers and babies, and public health approaches to traffic safety and seatbelt use. But our life expectancy is now predicted to fall for the first time since the Civil War due to obesity and accompanying diseases, such as diabetes. Conquering a chronic disease, however, will take more than the medical treatment of individual patients; e.g. regulation of insulin levels. In fact, some suggest that medical care is the least powerful way to affect health. Enormous problems like diabetes require a public health approach such as health initiatives that empower individuals to make healthy lifestyle choices and engage communities in creating healthier places to live. The role of public health is to provide health education and improvements for the public as well as fair treatment of the disadvantaged. Schools of Public Health provide the critical integration of research, teaching, and community service leadership necessary to solve complex health problems at the societal level and then bring advances back to benefit the individual patient from society to bedside. When researchers discover diabetes genes using data from populations, individuals benefit. When we find different strains of flu present in other parts of the world, individuals abroad and at home gain access to new vaccines. Schools of Public Health are the epicenters for creative approaches to improving individual and societal health. What Will be Unique about the University of Virginia School of Public Health? U.Va. s School of Public Health will differentiate the University by its innovative approaches and step function, leading to quantum advances rather than incremental solutions to major health problems. It will emphasize innovation in science and technology, engagement with communities, and empowerment of individuals as ways to improve public health in the Commonwealth and beyond. Our mission will be not only to protect and promote the public s health, but also to extend and enrich the opportunities for health to all individuals, based on the Jeffersonian commitment to enhance human well-being through science, human rights, and public leadership. This University will create the century s leaders in Public Health. 1. Unique Structure: Health Institutes Unlike other schools of public health that are bound by the typical departmental structure of biostatistics, epidemiology, social and behavior health, environmental health, and health policy/management, U.Va. s school will use these departments as the infrastructure, upon which we will launch three multi-faceted institutes: Personal Health Responsibility, Global Health, and Health Disparities. Institutes will play the critical role of directing the attention of scholars, researchers, and students to solving problems as they occur in real-world settings. They will provide a major focus for education, with each institute providing a concentration or specialty track of courses for students enrolled in the Master of Public Health degree program. Each institute, drawing on evidence-based public health and best practices in the field, will bring the following unique perspectives to problem solving: 1

2 The Institute for Personal Health Responsibility the country s first will be dedicated to enhancing preventive care and developing individualized patient strategies in an era of consumerdirected health care. The Institute also will lay the groundwork for personalized approaches to diagnosis with information about the genetic basis for diseases such as diabetes from U.Va.'s Center for Public Health Genomics, which uses population approaches to determine individual genetic susceptibility. From participation in smoking-cessation programs to seat-belt use to the reduction in alcohol-related motor vehicle deaths, individuals have made remarkable changes in health behaviors in recent years. Epidemiologists and public health faculty will evaluate the types of programs that best provide individuals with the self-management and motivational tools needed to change their behaviors and improve their health. The Institute for Global Health will leverage the strategic initiative to internationalize the University and will become the center of the University s international health activities, as a model for education, research, and community service for the United States. The Institute will be the first in the country to send teams of undergraduate, as well as graduate, engineering, architecture, nursing, and medical students participating in joint projects, to improve the health in underserved countries. The teams would complete projects over a six- to nine-month period; eventually, the entire fourthyear School of Medicine class could participate as team members on a specific project. The Health Disparities Institute will investigate ways to reduce and eventually eliminate disparities in health, whether the disparities are due to factors such as poverty, ethnicity, or lack of insurance. Institute faculty from such diverse disciplines as anthropology, psychology, environmental science, law, and the Institute on Aging will explore ways to address health disparities that exist among groups defined by geography, disability, race, and even age. For example, diabetes deaths are about twice as high for blacks as for whites, and the death rate for African American babies is more than twice that for white babies. The uninsured have a 25 percent higher mortality rate than those with health insurance: the Institute will work to enact state and national solutions, such as health care coverage for all. 2. Unique Education to Meet the Needs of the State and Nation To address the critical need expressed in a recent Institute of Medicine report for more public health education, U.Va. s School will: Be a unique incubator that provides mentors, education, and grants for those with creative ideas for improving public health. A goal would be to engage communities and public health agencies at all levels of government in collaborative projects and participatory research, expanding the University s reach far beyond its laboratories and classrooms. As an incubator for creativity, the new School will have internal and external advisory committees to gather and vet new ideas and will award pilot grants for small innovative proposals to jumpstart the diffusion of original work into community health. Create unique models for disseminating health information that tailor information for particular individuals and communities. The Consumer Health Education Institute will assess each individual s health information needs in order to provide the appropriate level of health information to empower consumer directed care. The institute has used market segmentation to differentiate consumers into nine distinct groups based on specific characteristics, such as learning style, age, cultural background, or preferences, such as desired role in health decision-making, preferred communication channels, or comprehensiveness of information provided. The goal is to improve health care for Virginians (and eventually the entire country) by providing medical information in a format best suited to their needs and preferences, thereby creating a model for the country. The School will use this as a new model for pedagogy addressing students individual learning styles. 2

3 Provide unique education for the university community and public by leveraging U.Va. s proximity to Washington, D.C. The School will host a monthly Beltway Health Seminar Series that features luminaries from federal and international agencies who spend the day teaching and meeting with our students and community members in small group settings that foster in-depth personalized education. The new School will demonstrate leadership by hosting yearly national and international symposia and visiting scholars from around the globe who will spend up to two years at U.Va. Foster unique undergraduate engagement by introducing undergraduates to public health through the new undergraduate global public health minor and the five-year BA/BS-MPH program, essentially building a citizenry and workforce prepared to address society s health problems in the future. The School will create educational experiences for each student's individualized characteristics, interests, and career goals, from university research to community health education to political leadership. Why Create a New School at the University of Virginia? 1. To leverage a critical mass of investigators across disciplines U.Va. s School of Public Health will act as the focal point for new public health initiatives that involve faculty and students from across the University. As the essential link between patient care and healthy communities, U.Va. s School of Public Health will complement and partner with the School of Medicine as well as other schools in the University to marshal the creative energies of a wide range of university faculty, government public health professionals, businesses, and community groups to solve health problems that require a societal response. For example, in attacking childhood obesity though the public school system, faculty in the School of Public Health will work with faculty in the Curry School, the College, the Engineering School, and Darden to create programs that work. The School of Public Health will leverage and expand U.Va. s nationally recognized expertise in such areas as diabetes, infectious diseases, global health, law, and ethics, strengthening the University s national and international reputation in public health leadership on emerging issues such as biopreparedness. 2. To fill a need for health professionals with an outstanding education The new School of Public Health will develop training and educational opportunities to strengthen the public health workforce, a need recognized in numerous recent national reports such as the 2002 study from the Institute on Medicine, Who Will Keep the Public Healthy? Educating Public Health Professionals in the 21 st Century. Because the public health workforce includes a range of professionals from biostatisticians and epidemiologists to community health educators and experts in particular areas such as maternal and child health or sexually transmitted diseases, workforce education will draw on the five core departments of the new School of Public Health: biostatistics, epidemiology, social and behavioral health, environmental health, and health policy/management. This arrangement will allow faculty members to be part of a team of thinkers at the cutting edge of their particular disciplines, while also working with practitioners to apply and test new theories in the real world. 3. To take advantage of new funding opportunities A final reason to have a School of Public Health is that certain funds are only available to accredited schools. In 2004, for example, 36 accredited schools of public health received more than 1,000 awards totaling over $500 million from the National Institutes of Health, with funding from other federal agencies of around $275 million. Compared to the awards to the 123 accredited medical schools that year, the funding per FTE faculty member in 2004 was about $150,000 for a public health school versus approximately $99,000 for a medical school. The Pathway to a School of Public Health at the University of Virginia 3

4 The University of Virginia currently awards a Master of Public Health degree; the five-year BA-MPH begins next year. We have significant faculty depth and rigorous educational and research programs in the Department of Public Health Sciences to provide a strong foundation for a new School of Public Health. By January 2007, the department will have 31 full-time faculty members in core academic disciplines such as biostatistics, epidemiology, and health policy. This is the size of many Schools of Public Health; however, we lack required expertise in behavioral health and environmental health. By adding faculty recruits in these areas, as well as in personalized medicine, global health, and disparities, the University can create a new School of Public Health that can have a major impact on individual and population health. Metrics for success after five years will include the recognition of the School by peers around the country as providing models for the United States in at least five areas; after five years, a national ranking among the top 50 schools; and by the time of accreditation (eight years), a national ranking among the top 25. The School s impact also will be measured locally by the health of the community for example, the average weight of middle-school students. Other metrics, which will be set by the new School s leadership, will include program metrics, such as the percentage of high school students who have had treatment for tobacco and/or alcohol dependency or the number of community businesses that support employee physical education programs. A risk is that the University will not marshal the resources necessary to launch a school with the strengths to achieve these significant health improvements and that other universities in the region will become the recognized leaders in disease prevention and health promotion and capture the available public health funding. A projected timeline leading to the creation of a new School of Public Health: An endowment of $100 million is necessary to sustain a School of Public Health, generating approximately $5 million per year for recruiting and program development, as well as $30 million for dedicated space for the School: : raise the first $50 million 2010: establish the School, name a dean, hire six new faculty members, create the five SPH departments, and create the institutes 2011: establish one PhD program : raise at least another $50 million for endowment and $30 million for space 2015: School is accredited by the Council on Education for Public Health Conclusion The School of Public Health for the future of the University of Virginia The School of Public Health will bridge science, ethics, and real-world action. Public health s mission to protect and promote the health of the public, as well as its underlying core value, to ensure the fair distribution of health to individuals throughout the population and around the globe will be the fundamental principle animating the work of students and faculty in U.Va. s new institutes and School. 4

5 Appendix: Diabetes and the School of Public Health Diabetes provides an illustration for the activities and approaches the health institutes will apply to a particular health problem. Diabetes as a Model: Building on the strengths of U.Va. s Division of Endocrinology and Diabetes, which is ranked fifth in the country by U.S. News & World Report rankings, all three institutes will focus on obesity and diabetes, a 21 st -century affliction that has disproportionate effects on vulnerable populations. 1) Problem solve: Institutes will seed new multidisciplinary faculty teams to work together to generate multiple and multidimensional solutions to particular problems and will provide pilot grants to teams and faculty to develop preliminary data for new projects. Diabetes as a Model: U.Va. s multidisciplinary faculty will work in the institutes to use every scientific and public health tool available to stop this growing epidemic that now includes more than 20 million Americans with diabetes, and an almost equal number of mostly obese people with impaired glucose tolerance or "pre-diabetes. The problem of diabetes will be approached from many angles. Genetic data obtained from population-based research conducted in the School of Public Health, for example, will be applied by members of the same team working in the Virginia Institute for Clinical and Translational Research to determine the actual function of those genes at the cellular level. The goal of all work will be to develop new treatments for individuals and ultimately the prevention and cure of diabetes. 2) Create community partnerships: New administrative staff community-outreach faculty will provide the on-grounds business and community-organizing skills to guarantee that new ideas and programs are developed in partnership with health providers, community groups, and citizens or patients. Diabetes as a Model: The Institute for Personal Health Responsibility will work to expand individuals opportunities to take action in their own lives and with their families and communities to prevent obesity and diabetes. Architecture school faculty in urban and environmental planning will provide innovative leadership in identifying communities with elevated biological and environmental risk through the use of Geographic Information System (GIS) mapping so that citizens have data to support the creation of jogging paths and sidewalks. Teams of health educators, psychologists, nutritionists and other public health policy faculty will work with school boards, community action organizations, parish nurses, and community leaders on community-wide interventions, such as designing, implementing, and evaluating the effectiveness of behavioral change programs, e.g., school-based healthy food initiatives and neighborhood exercise programs; implementing economic incentives such as vending machine taxes on foods with high fat content; and developing community health coalitions to finance neighborhood playgrounds and community athletic facilities. Faculty from the Institute for Global Health also will pilot these and other strategies in communities abroad, modifying them for different populations and contexts, and then bringing back new ideas to the University. 3) Maximize public impact: Education, communication, and marketing experts will provide critical support for each institute and faculty team so that the institutes become recognized as the experts and go-to resources for national and international professional organizations, and so that communities around the state and nation recognize the institutes as trusted partners to launch or evaluate new health interventions. Diabetes as a Model: Expertise in the School of Public Health would be focused on the 5

6 challenge of communicating with and educating not only the public at large but also vulnerable and special populations. The Health Disparities Institute, for example, would provide the intellectual home for faculty and students to identify the risk factors for diabetes in populations with health disparities, based on geography or other biological or social characteristics. Bringing national and international attention to the disparities embedded in the various pathways to diabetes might involve working with local and state health department communication officers and state health advisory boards, such as the Latino Advisory Board. Particular solutions might involve working with city agencies to provide new bus routes that link poor neighborhoods with better grocery stores, developing outreach programs to train peer counselors and parish nurses for community health screening programs on cardiovascular disease in high risk areas, working with school nurses on health mentoring programs for at-risk youth, and creating partnerships with businesses to provide safer working conditions and new employee-training programs. 4) Innovate and advance evidence-based public health and health information management: Scholars and experts in the application of bioinformatics and public health informatics will work with systems engineers, libraries, and others around Grounds to lead in the creation, management, and delivery of scholarly resources and research to professionals, communities, and particular patients and patient groups. Diabetes as a Model: Public health faculty will provide the important link between public health research and practices, by providing access to the latest information about effective public health interventions, such as self-management for diabetic patients discharged from hospitals or for pregnant diabetic patients who have frequent hospital emergency room visits. They also will work with community partners to evaluate new interventions in local communities, thus contributing to the knowledge base of evidence-based public health practice. In addition, public health faculty and students might work with University librarians and public health informatics specialists, for example, to create new web-based educational materials that could be made available in public libraries for different populations, based on their particular cultural, geographical, educational, or language factors. 5) Provide leadership and strategic planning: National advisory boards for each institute will bring together external advisors, such as community and corporate leaders and potential funders, with University faculty to generate new ideas, funding opportunities, and partnerships on particular health problems, such as environmental toxins, that require comprehensive, multifaceted approaches. Diabetes as a Model: To enrich and define the diabetes focus of each of the institutes, national advisory boards will include leaders from many different stakeholder groups, such as the Robert Wood Johnson Foundation s Diabetes Initiative, the American Diabetes Association, the Virginia Department of Health, major insurers in the state, corporate human resources directors, and patient advocacy groups. 6