Public health is a growing and innovative field in the United States, bringing together all sectors of the medical community to address problems on a macro scale. In Kentucky — which has some of the worst health statistics of any state — public health is especially important as the platform by which physicians, nurses, administrators, researchers, and other stakeholders work together to develop programs that attend to the state’s pressing health needs.
In this episode of Kentucky Health, host Dr. Wayne Tuckson welcomes the deans of the public health colleges at the University of Kentucky and the University of Louisville to learn about the schools’ missions of service, their programs, and how they educate and train the next generation of public health workers.
Dr. Donna Arnett, PhD, MSPH, is a professor of epidemiology and the dean of the University of Kentucky College of Public Health. Dr. Craig Blakely, PhD, MPH, is the dean of the University of Louisville School of Public Health and Information Sciences.
“Public Health is really about dealing with populations,” Arnett says. “We look at policy, and we look at studies themselves to investigate what causes diseases in populations. It’s a very broad field, all the way from basic toxicology and poison control, vaccinations, all the way through creating policies that impact Medicare delivery and spending.”
Different Service Missions, Equal Commitment
Arnett describes the mission of UK’s College of Public Health: “We’re really ‘boots on the ground’ in our college with the real public health infrastructure in the state.”
That public health infrastructure encompasses Kentucky’s primarily rural counties, and Arnett says that the College of Public Health has a mission to serve Appalachia, which has the highest rates of cancer in the nation. The college works with county public health departments in developing needs assessments for the local population, in strategic planning, in health education, and many other areas.
Blakely explains that the University of Louisville School of Public Health and Information Science has traditionally concentrated on serving the urban population in metro Louisville. “We’re joined at the hip with the city health department across from our campus,” he says, but adds that “we’re both (colleges), of course, very much interested in ‘big picture’ state policy issues.”
Both UK and U of L schools are working on important research projects. Arnett says that UK has been collecting health data on Kentucky for 20 years as part of a grant-funded study by the Robert Wood Johnson Foundation. The study examines how integrated and connected communities in Kentucky are, and how the community’s togetherness impacts the lifespan of its citizens. “We know from research that the more connected and engaged a community is, the better the life expectancy will be,” she says.
UK is also working with state government agencies in studying the commonwealth’s opioids crisis and has created a 24-hour Web portal for people to locate drug treatment options through a grant from the Centers for Disease Control and Prevention.
Blakely says that U of L is currently working on an environmental health study that measures the impact of coal ash on the learning ability of grade-school children.
“The thing that is really exciting is that we’re developing new analytics tools all the time,” Blakely says, “and so massive data sets are now things we can handle, whereas 15 years ago, the computing capabilities were challenged by the kinds of data sets that we can now play with.”
Arnett says that there is a growing trend of public health schools working in collaboration with health insurers on major policy projects. This is done for financial reasons – grant dollars – but also because more insurance companies are recognizing the value of improving public health metrics and how that can benefit their own bottom line.
“Right now, we are partnering with a major insurer to see if there are ways we can build the model for a community network that builds in sustainability,” Arnett says.
Blakely agrees that this collaboration between public health entities and insurers is a positive change, and cites the current Bold Goal initiative spearheaded by Humana Inc. in Louisville as an example.
What’s Needed to Improve Kentucky’s Poor Health
Sustainable community models are necessary to fully address Kentucky’s myriad health needs, both guests contend. These models should include all social service organizations, not just medical providers and public health offices, Arnett explains, because the health problems that pervade Kentucky’s population are primarily caused by social factors such as housing, (un)employment, family structure, education, and so on.
“Eighty percent of the disease in our populations is caused by social determinants of health,” Arnett says. “It’s lack of health literacy, it’s the lack of a good diet and physical activity, it’s smoking. And then if you take all of those physical attributes, it’s whether or not you have transportation to your doctor appointment if you have hypertension, it’s whether you can get your prescription filled, it’s whether or not you have the knowledge of taking that pill regularly.”
Blakely agrees and says that “If I drew my Venn diagram of what public health is, medicine is just a little corner. It all fits in there – I don’t care if you’re talking about housing or violence or transportation or jobs or education or income, it’s all population-related issues.”
Arnett and Blakely both praise the talent and drive found in many of the state’s public health agencies and social service organizations, but feel that more progress in terms of working together and adopting a broader vision is needed. They are both optimistic, but Arnett cautions that improvements made by the 2010 Affordable Care Act in emphasizing “value-based” outcomes and community health policies in general may be in jeopardy as the law is rolled back. To that end, Blakely aspires to spread the public health message more widely within Kentucky’s state legislature and in Congress to gain more converts among lawmakers.
As for the future of public health education in Kentucky, Arnett and Blakely are excited about enrollment and curricula at each of their respective schools. Arnett says that UK’s College of Public Health has an undergraduate program that is the fastest-growing program in the university, with over 300 students this year. She recommends that all medical professionals take at least basic courses in public health policy, and get a certificate if they can.
Blakely agrees and says that he believes public health is a wonderful pre-med major. He adds that U of L’s Master’s Degree program in Clinical Investigative Sciences has a lot of physicians enrolled. “I think that the fusion of clinical medicine and public health is something that needs to happen more heavily,” he concludes.