What is the Fellowship?


Program Overview
The Wisconsin Population Health Service Fellowship recruits and deploys early-career public health professionals to work for public health and community-based organizations throughout Wisconsin. It was started in 2004 as one of the first initiatives of the Wisconsin Partnership Program at the UW School of Medicine and Public Health (UW SMPH).  The Fellowship combines service—by tackling some of the state’s most pressing public health challenges and attracting resources to community and public health—with workforce development, by building population health skills and experience in future public health leaders.  

The program is conducted in partnership with the Wisconsin Department of Health Services’ Division of Public Health (DPH), the City of Milwaukee Health Department (MHD), and other public and private organizations across Wisconsin.  Key program leaders include Dr. Tom Oliver and Marion Ceraso at UW SMPH, Dr. Geof Swain at UW SMPH and MHD, and Dr. Jim Vergeront at DPH.


Over the past nine years, 38 Fellows have provided service to more than 25 Wisconsin organizations and community partners to:
  • Address health priorities ranging from minority health to emergency preparedness
  • Attract millions of dollars in resources for community and public health efforts across the state
  • Strengthen the public health workforce through the placement of diverse and highly skilled fellows ready to apply cutting-edge strategies for population health improvement


How to use this blog
The aims of this blog are to:
  • Keep people with ties to the Fellowship connected to one another
  • Showcase Fellow, Alumni, and faculty research and projects
  • Provide a venue for those interested in the Fellowship to get a better idea of what it’s all about
  • Share stories, insights, and lessons related to public health          
Thank you for helping to build this blog. At the top of this page are tabs linking to profiles of current Fellows, alumni Fellows, and Fellowship staff and faculty. On the left side of the page are collections of blogs, resources, and journals read by your peers.
If you have questions for current and alumni Fellows, please post a comment or send an email to wipopulationhealthfellows@gmail.com. 

How Do We Advance Health Equity?



Evelyn Sharkey, MPH, MSW
Wisconsin Population Health Service Fellow
City of Milwaukee Health Department 
Milwaukee, WI

Hester Simons, MPH
Wisconsin Population Health Service Fellow
Wisconsin Division of Public Health
Centro Hispano of Dane County 
Madison, W
I



“How can professionals dedicated to improving health continue our traditional roles of promoting healthy behaviors and delivering quality health care and also balance our repertoire by adding the skills, competencies, tools, and methods to address the socioeconomic policies, systems, and environments that so strongly influence health?” (p. 218)

Dr. Geof Swain, founding director of the Wisconsin Center for Health Equity, and former Fellows Katarina Grande (2010-2012 cohort), Carly Hood (2012-2014 cohort), and Paula Tran Inzeo (2010-2012 cohort) ask this question to frame their commentary published in the December 2014 issue of the Wisconsin Medical Journal, posing a dilemma that confronts physicians and other health care professionals on a daily basis as they care for patients. 


Determinants of health, from Dahlgren & Whitehead (1991), as cited in Exworthy (2008)
Before getting into the authors’ suggestions for overcoming this dilemma, let’s get some background on the broader issues addressed in the commentary:  health and the things that make people and communities more or less healthy.  According to the World Health Organization (WHO), health is more than just not being sick; rather, it’s “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”1  Overall health is influenced by various factors known as “health determinants,” which include not just health care, but also genetics and biology, individual behaviors, social and economic conditions, and the physical environment.2,3  Most of these determinants are “modifiable” in the sense that it’s possible to change or control them, including health care, individual behaviors, social and economic factors, and the environment.  However, it’s not yet possible to significantly alter an individual’s genetics and biology.  It’s also important to note that many of these determinants are external to an individual, including health care, social and economic factors, and the physical environment.



The Rankings model of modifiable health 
factors that impact community health 
The social, economic, and physical environment conditions that affect a person’s health are known as the “social determinants of health.”4  You can think of these determinants as “the conditions in which people are born, grown, live, work and age.”2,5,6 Examples of various social determinants of health from Healthy People 2020 include “the resources and supports available in our homes, neighborhoods, and communities; the quality of our schooling; the safety of our workplaces; the cleanliness of our water, food, and air; and the nature of our social interactions and relationships.4

As Swain et al. point out, almost all of the health-related funding in the U.S. is geared towards improving access and quality of health care services.  While health care is undoubtedly important, there is a great deal of evidence that social and economic factors and the physical environment may actually have a stronger impact on health.  This is shown by one model of the impact of health determinants developed by the County Health Rankings & Roadmaps program.  This program is a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, which created the model to estimate the relative contribution of modifiable health determinants.7  Biology and genetics are not modifiable and are therefore not included.

What does the Rankings model show?  First, 50% of the modifiable factors that influence health are social determinants of health.  If you dig deeper into this 50%, you can see that the influence of social and economic factors is especially strong, accounting for 40% of the factors that impact health.  Based on this, it’s clear that people who seek to promote health should address these social and economic influences.  However, according to Swain et al., there is limited guidance as to how physicians and other health care professionals and health systems can actually go about doing this.  This may be why more than 80% of U.S. physicians think unmet social needs negatively affect health but do not feel capable of addressing the social needs of their patients.8 

Through exploring two social determinants of health that have been studied extensively—income/employment and education—Swain et al. review evidence-based examples of both clinical and policy-level actions that health care professionals can take to address social determinants.  They conclude their commentary by providing concrete and actionable suggestions and resources for addressing income/employment, education, and other socioeconomic factors that influence individual and community health.  At the clinical level, the authors suggest health care professionals screen for socioeconomic issues like food and employment during clinical visits and coordinate their services with social workers, community health workers, and others.  At the population level, suggested strategies include advocating for social and economic policies that promote health, working collectively with peers and professional associations; and being “both patient and persistent” (p. 220).

This is a helpful article for anyone interested in promoting the health and well-being of both individuals and communities, and it was excellent foundational reading for the fellowship’s February monthly meeting on health equity.  Fellows were joined at this meeting by students from the TRIUMPH program.  TRIUMPH, which stands for Training in Urban Medicine and Public Health, is a program for 3rd and 4th year medical students at UW Madison’s School of Medicine and Public Health.  The program integrates clinical medicine with community and public health and aims to provide medical students with the knowledge and skills needed to promote health equity and reduce disparities.

During the meeting, attendees learned about The National Equity Atlas, a new policy and data tool that can be used to make the economic case for equity.  The Atlas includes data from all 50 states, Washington D.C., and the largest 150 metropolitan statistical areas in the U.S. (including the Madison and Milwaukee metropolitan areas).
A picture depicting the difference between
“equality” and “equity,” featured in the February meeting
presentation by Angela Russell and Jordan Bingham.  
Source: 
City of Portland Office of Equity and Human Rights

In the afternoon, fellows and TRIUMPH students participated in an in-depth conversation on health equity strategies for public health and medical professionals led by Dr. Geof Swain. They wrestled with the difference between equality and equity and discussed frameworks for thinking about how the social determinants of health lead to health disparities. The day ended with an engaging presentation by Angela Russell and Jordan Bingham, Health Equity Coordinators from Public Health Madison Dane County, on how to talk to policy makers about health equity. 


Sources:
1WHO Definition of Health. World Health Organization Website.  http://www.who.int/about/definition/en/print.html. Accessed February 11, 2015.
2McGovern L, Miller G, Hughes-Cromwick P. Health Policy Brief:  The Relative Contribution of Multiple Determinants to Health Outcomes.  Health Affairs. August 21, 2014. http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=123. Accessed February 11, 2015.
3The Determinants of Health. World Health Organization Web Site. http://www.who.int/hia/evidence/doh/en/. Accessed February 11, 2015.
4 Healthy People 2020. Social Determinants of Health. http://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-healthAccessed March 6, 2015.
5Braveman P, Egerter S, Williams DR.  The Social Determinants of Health:  Coming of Age.  Annu Rev Public Health.  2011;32:381-98. doi:  10.1146/annurev-publhealth-031210-101218. http://www.ncbi.nlm.nih.gov/pubmed/21091195. Accessed February 11, 2015.
6Social Determinants of Health. World Health Organization Web Site. http://www.who.int/social_determinants/en/. Accessed February 11, 2015.
7About the Program. County Health Rankings & Roadmaps Web Site. http://www.countyhealthrankings.org/about-project. Accessed February 11, 2015.
8Goldstein D, Holmes J. 2011 Physicians’ Daily Life Report. Harris Interactive.  Prepared for the Robert Wood Johnson Foundation. November 15, 2011. http://www.rwjf.org/content/dam/web-assets/2011/11/2011-physicians--daily-life-report. Accessed February 11, 2015.

Marisa Stanley, MPH [Preceptor, Alumni]

Marisa Stanley is the Infectious Disease Epidemiologist at the City of Milwaukee Health Department and the current preceptor for Evelyn Sharkey.  The health department’s mission is to “ensure that services are available to enhance the health of individuals and families, promote healthy neighborhoods, and safeguard the health of the Milwaukee community.”  Marisa contributes to this mission by overseeing programs that focus on preventing and controlling the spread of communicable diseases in Milwaukee. 


Marisa received a Bachelor of Science in Microbiology and a Master of Public Health in Epidemiology from the University of Minnesota.  Prior to her role at the City of Milwaukee Health Department, Marisa was herself a Wisconsin Population Health Service Fellow (2009-2011 cohort), placed at the Division of Public Health at the Department of Health Services in Madison, WI, and the Great Lakes Inter-Tribal Epidemiology Center in Lac du Flambeau, WI. 

Though Marisa’s previous background was primarily in infectious disease epidemiology, participating in the Fellowship gave her an opportunity to contribute to projects in a variety of subject areas.  These projects included writing a request for proposals for an oral health education feasibility study; serving as the interim manager and epidemiologist for a project on tobacco policy, systems, and environmental changes with Wisconsin tribal communities; and—the accomplishment she is most proud of—heading the initiative to pass and implement expedited partner therapy legislation in Wisconsin.  To Marisa, being able to explore different areas of public health that she may not have known she was interested in—effectively, to create her own job description—was the most valuable part of her Fellowship experience.

Marisa is a Wisconsin native, originally from the Eau Claire, WI, area.  She has lived in Milwaukee since 2013.  In her free time, Marisa likes hiking and otherwise enjoying the outdoors, attending music shows, and playing fetch with her cats (one of which she got while working as a Fellow in Lac du Flambeau).

                                      Tips for Attending National Public Health Conferences
 
Stephanie Kroll, MPH
Wisconsin Population Health Service Fellow
Wisconsin Division of Public Health
Public Health Madison & Dane County
Madison, WI

Bailey Murph, MPH
Wisconsin Population Health Service Fellow
United Way of Greater Milwaukee

Milwaukee, WI

 
As first-year Population Health Service Fellows, Bailey Murph and I recently attended the American Evaluation Association (AEA) conference in Denver, Colorado and the American Public Health Association (APHA) conference in New Orleans, LA.  While attending, we came up with some tips for attending these big, national conferences. 
 
Here are our top tips for attending big, national conferences:
 
1.    Use this opportunity to explore public health topic areas that you are interested in.
It is difficult to find presentations that will give you skills or a deep knowledge in a topic area that you are already working in.  Explore other topic areas of interest. Bailey and I attended a set of presentations on food waste, a topic we both are not widely familiar with, and we walked away with new and interesting knowledge.  We also found that immersing ourselves in a new topic area was quite enjoyable, and we had a desire to learn more.
 
2.    Attend state-specific events and work at an information booth.
This can give you a chance to meet others working in your state.  It is always funny how you sometimes have to travel somewhere else to meet people from your area…but sometimes this is the case!  Before you leave the exhibit hall, be sure to wander around and see who else is in the room. Reason one: there may be a free water bottle or cool pen you want from a prospective employer or university. Oh, and food. Also, food. Reason two: there are people in the room that you want to meet and you should meet. This is a perfect networking opportunity.
 
3.    Plan out the talks you are going to go to ahead of time, with considerations about time needed for travel between locations.
The sheer number of presentations at these national conferences can be overwhelming.  Start looking at the presentation topics and speakers at least a few days beforehand.  Do the research and prep work!  Make sure to look up both topics and people you are interested in.  Don’t feel like you have to book your schedule solid. You’ll soon discover that there is just too much going on, and you need to give yourself a break. Take it from two introverts.
 
4.    Don’t be afraid to walk out of a presentation.
Even after all of your research and preparation, sometimes the presentations are not what you thought what they were.  This happens, and it’s understood by conference attendees and presenters.  Don’t be afraid to walk out of a presentation if this happens.
 
5.    Wear comfortable shoes.  Comfort > Fashion.
These big national conferences require a decent amount of walking.  Bailey and I both found ourselves walking in subpar footwear and had to face the consequences. 
 
6.    Keep good notes.
Bring paper, an iPad or etc.  You can also take pictures of slides. If there are handouts, make sure you grab them! These are great resources to take home and share with your colleagues.
 
7.    Attend a data visualization presentation!
…especially those by Stephanie Evergreen (http://stephanieevergreen.com/). 
 
8.    Go to a set of rapid-fire presentations (~10 minutes each). 
You can get a lot of content in a short period of time.  These presentations are generally on “easy to digest” topic areas as well.  …which can be nice after the intense theory or data focused presentations you might attend.
 
9.    Keep your business cards on you at all times, if you don’t already.
You never know who you might run into.  I swapped cards at a restaurant while waiting for a table while at APHA. Bailey met a woman from a local Wisconsin town near where she lives, and the woman invited her to coffee anytime she’s in the area. How cool is that?
 
10.  Consider packing breakfast and/or snacks.
It can save you a lot of money and time to pack any snacks or meals. It’s expensive to eat when you travel.  However, don’t pack all your meals/snacks.  Also be sure to enjoy some of the local cuisine!
 
11.  There are some let downs…so try to go with the flow.
Not all talks will be what you hoped they would be.  You won’t network as much as you hoped.  Not as many people will look at your poster as you anticipated (even after all the hard work you put into it!).  No conference is perfect.  Try to reflect back every day on the little nuggets of knowledge that you got…or the acquaintance you got to know better.
 
12.  Have fun!! 
If you have time, make sure to take the time to look up restaurants to eat at and local sites to see!  Some things take reservations…so it is good to think ahead. J
 
Conference going can be a grueling process, but reflecting back you’ll realize how rewarding it was. Travel is difficult, crowds are frustrating and never seem to move at the pace you’d like. Be open to learning something new, plan ahead, take breaks, wear comfortable shoes and always have a snack with you. Keep those points in mind, and you’ll be on your way to an incredible conference experience.



Self-Care: A Priority During the Holidays


Colleen Moran, MPH MS
Wisconsin Population Health Service Fellow
Wisconsin Division of Public Health
Madison, WI




tobifairley.com
While as of yesterday, daylight is increasing by a few minutes each day, it sure doesn’t feel like it yet. While we’re in the midst of dark, cold, busy days, and holiday craziness, this blog post is dedicated to remembering that to be the best versions of ourselves (and consequently the best public health defenders we can be), we need to remember to practice some self-care, particularly at this time of year. Now when I say that, please know that I am not a shining example of this type of behavior: I’m dragging myself to the finish line that is New Year’s like everyone else. This blog post, in many ways, is a gentle reminder to myself to remember to slow down this time of year and take special care.

To address this topic for my blog post, I have been compiling a list of  best practices for self-care. Some are specifically meant to apply to the holiday season, but I think most carry over nicely into reminders we can use 365 days a year. Below is what I have found through my research to be the most commonly prescribed self-care practices. Enjoy!


  • Do things in moderation. “This is the time of the year where it is easy to over-indulge.  We find it easy to neglect healthy eating.  Sleeping patterns may be altered as we have more activity in our days.  We can over spend on gifts for those on our lists. The list of things that seem to trap us in extravagance may differ from person to person, however, it is common to be swept up into excessive behavior. Aristotle wisely stated, “all things in moderation.”  This is an excellent gauge for us to recall.[I]
    www.lisaferentz.com
  • Evaluate “obligations” and give yourself permission. Just because it is something you have always done or a place you have always gone to doesn’t mean you have to do it this year. It is okay to say no. “No.” can actually be a complete sentence. Consider it part of your preventative health (mental and physical) care plan.”[ii]It is natural when you begin to switch your thoughts to self-care to feel guilty, irresponsible or even selfish.  You need to give yourself permission. Allow yourself to do “whatever” it is that you want.  If you want to say “no” to a certain event, or “no” to overspending on gifts, or “no” to hosting an event, give yourself the right to do what is best for you.  This is the beginning of self-care. Learn to value the importance of setting boundaries.”[iii]
  • Family: "There is a lot of pressure (just watch any hour of tv with commercials during this time) to spend time with family, gathered around a lovely table, smiling, and sharing warm memories! Not everyone has those kinds of family experiences and it is ok. Spend time with people you enjoy. Remember that friends can be the family you choose."[iv]
  • Involve all of your senses. "When we invoke our sense, we experience things on different levels. Think of ways to include sight, smell, taste, touch and hearing into your self-care. Have a candlelight bubble bath scented with aromatic products. Sit and watch your favorite holiday movie while wrapped up in a soft blanket. Play music that is relaxing. Experiment with way to incorporate all of your sense during times of stress refreshing your body and soul." [v]

  • Give up expectations. "The holidays . . . can set us up for unrealistic expectations. It almost seems a "magical" time of year and we dream of the perfect holiday. Many people struggle with depression and high anxiety over the holidays. The crisis hotlines have an increase in calls. Domestic violence rises . . . Past experiences, the loss of loved ones, the loss of a job or financial diffuculty all seems ot heighten during this time of  year. One of the best ways to take care of yourself during this emotionally trying time, is to give up your expectations . . . As you relinquish these ideas, you are able to open  yourself up to experiencing greater joy in teh reality of the moment. Let go of false illusions and celebrate the moment. Wherever you are in your life this year, take care of yourself first. Practice self-love abdundantly." [vi]

Best wishes for a relaxing winter full of self-reflection and self-care!




[i] http://www.lifehack.org/articles/lifestyle/5-tips-for-self-care-during-the-holidays.html
[ii] http://www.pbs.org/thisemotionallife/blogs/grinch-prevention-self-care-during-holidays
[iii] http://www.lifehack.org/articles/lifestyle/5-tips-for-self-care-during-the-holidays.html
[iv] http://www.pbs.org/thisemotionallife/blogs/grinch-prevention-self-care-during-holidays
[v] http://www.lifehack.org/articles/lifestyle/5-tips-for-self-care-during-the-holidays.html
[vi] http://www.lifehack.org/articles/lifestyle/5-tips-for-self-care-during-the-holidays.html


The Fellowship as a Learning Community
Lauren Lamers, MPH
Menominee Tribal Clinic
Keshena, WI

One of the unique things about the Population Health Service Fellowship is that it is truly intended to be a learning community.  Earlier this year, fellows, faculty, and preceptors had the opportunity to discuss and outline exactly what we wanted our learning community to look like.  Some of the characteristics we thought were important to include as guiding principles for our community included:
·         Recognizing and valuing the different perspectives that all members of the learning community bring to the group 
·         Creating safe spaces to share questions, opinions, ideas, and constructive feedback
·         Supporting each other to take chances, celebrating each other’s strengths, and advocating for each other
·         Engaging with others in the community to enhance our own and others’ learning
·         Being committed to long-term, ongoing learning and self-improvement
The true value of the fellowship learning community, however, is that these principles are not merely words on a page - they play an integral role in our projects, meetings, and interactions with each other.  This was particularly apparent during our annual overnight retreat in Shawano and Menominee Counties earlier this month.  Other than being an exciting opportunity to show off my placement sites, one of my biggest takeaways from the meeting was just how many ways fellows, faculty, staff, and preceptors exemplified the values we set for ourselves as a learning community.    Here are just a few of those examples…
The group touring Keshena Falls, Menominee County/Reservation, WI
Our meeting, like each of our monthly meetings, started with time for fellow updates.  I was (and always am) so impressed at the fantastic work everyone is doing.  It’s truly inspiring to be part of such a passionate, talented, and dedicated group.  Having the opportunity to be inspired by each other has, for me, been one of the best parts of the fellowship learning community.
Throughout the meeting, everyone was actively engaged.  Fellows and faculty alike brought enthusiasm to learning more about our meeting topics (American Indian health and farm health).  There was great discussion and thoughtful questions for our speakers, and while the speakers themselves brought fantastic perspectives to our meeting, I think we learned just as much by engaging with each other around the topics we were discussing.
Another staple of our monthly meetings is the CALs presentation, when one fellow presents on a project they’ve done and how it helped develop their core areas of learning.  In this case, I was the one presenting.  I so appreciated the interest that everyone showed, the great questions that opened up deeper discussion and challenged me to think about my project differently, and the supportive atmosphere that helped me feel comfortable talking about not only what I thought went well, but also things I could have done better.  Having this safe space within our learning community to talk about our fellowship experiences has been so beneficial for growing both personally and professionally.
A little fellowship team building time.
Finally, one of the strongest aspects of the fellowship learning community is the varied expertise and insights that everyone brings to the table.  There were a few stellar examples of this at our retreat.  One was when second-year fellows Mallory Edgar and Crysta Jarczynski facilitated a skill building session about community readiness assessments – a topic on which they’ve developed quite bit of expertise through their fellowship projects.  They did a fantastic job not only presenting, but also developing interactive ways for us to see how readiness assessments could be useful in our own work.  Another example that really resonated with me was the insight, wisdom, and experience that my preceptor Faye Dodge, brought to our discussions around American Indian health.  For me, this exemplified the invaluable contributions that all of us – fellows, faculty, staff, and preceptors - make toward building the fellowship community.
 All of these are just a few examples of what makes our fellowship a true learning community.  What I think makes it truly special, though, is that this commitment to sharing our learning and to supporting and challenging each other to grow isn’t confined to our monthly meetings – it’s a culture we’ve built.  Being part of this community has been one of the best parts of my fellowship, and it’s an experience for which I am profoundly grateful. 


Summer lessons learned: Mentoring 101
Lauren Lamers, MPH
Menominee Tribal Clinic
Keshena, WI

Over the years, I have been incredibly fortunate to have had several mentors who truly helped me grow professionally and personally.  I would not be where I am now without the guidance of such phenomenal role models. 

This past summer, though, the tables were turned as I stepped into a mentoring role myself.  For eight weeks, I had the privilege of working with Simone Tucker, a recently graduated Menominee high school student as part of the Short-Term Research Experiences for Underrepresented Persons (STEP-UP) program.  STEP-UP is managed and funded by the Office of Minority Health Research Coordination (OMHRC) and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health (NIH).  The program seeks to increase participation in biomedical, social science, behavioral, and clinical research among students of backgrounds that are traditionally underrepresented in research fields.  STEP-UP interns work with research mentors over the course of eight weeks to complete a project that they then present to their peers and NIH researchers during the annual STEP-UP symposium at the NIH campus in Bethesda, MD. 


Apple orchard at Keshena Primary School, Keshena, WI,
planted as part of local childhood obesity prevention efforts.
Photo by Simone Tucker
For her STEP-UP project, Simone worked with me to assess childhood obesity prevalence in Menominee County.  Over the last several years, the Menominee Community Engagement Workgroup, a coalition of local community members and leaders, has been planning and implementing initiatives to prevent childhood obesity, but they have so far been unable to monitor childhood obesity prevalence or evaluate their efforts.  Simone was able to analyze screening data collected through local school physical education programs to estimate the local prevalence of childhood obesity.  She also conducted an environmental scan to better catalogue current childhood obesity prevention efforts and facilitate planning for future prevention initiatives.  Her work has played a key role in helping the community set the stage to evaluate their work in the future.      

Throughout the summer, the project enabled Simone to build research and public health skills including data collection and analysis; writing a scientific abstract; preparing oral and poster presentations; and communicating her work to various audiences including her peers, healthcare professionals, scientific researchers, and community members.   Additionally, the STEP-UP internship was a unique opportunity for her to learn about research and public health more broadly and to observe firsthand some of the efforts to improve health within her own community.  It was also very rewarding for her to see that her work would play an important role in moving those efforts forward in the future.  


Simone presenting her poster during the STEP-UP annual symposium
at the NIH campus in Bethesda, MD.
(From left: Dr. Carolee Dodge-Francis [University of Nevada - Las Vegas*],
Simone Tucker, Lauren Lamers)
What I think was the most valuable outcome of the STEP-UP program, however, was that Simone truly developed a stronger confidence in her own abilities.  One of the most rewarding parts of the summer was seeing her transform from being nervous and uncertain at the beginning of the project to seeing her confidently present her work during the STEP-UP symposium at NIH.  It was really a special opportunity for both of us to step back and take in how much she had learned and accomplished over the short space of eight weeks.    

While I knew at the beginning of the summer that there would be a lot to each over the course of the STEP-UP internship, I didn’t quite anticipate how much I would gain from being a mentor.  Although I still have plenty to learn about what it takes to be a good mentor, there are a few key points that I will take away from my experience: 

1.  Mentoring takes time, planning, and investment.  I realized pretty early on that mentoring wouldn’t be just about teaching the nuts and bolts of research or public health.  Being an effective mentor really involved strategically planning not only what I would need to teach, but also exploring how (admittedly, usually by trial and error) to teach the concepts and skills my student would need in a way that was practical and engaging.  Most importantly, though, it involved taking the time to really learn about her interests, strengths, and weaknesses and actively provide opportunities to help her grow.

2. Remember what it was like when you were first starting out.  In many ways, mentoring helped me realize how far I’ve come even over the past year of my Fellowship.  From time to time, though, I also needed to step back and remember how overwhelming it can be to learn so many completely new concepts in a short amount of time.   Keeping this perspective helped me remember to reinforce that learning is a process that takes time and involves plenty of mistakes, but that these mistakes are often what help us grow the most.

3.  Provide clear guidance, but encourage independence.  If there is one thing I learned about myself this summer, it’s that I’m often guilty of micromanaging.  One of my biggest challenges was finding balance between providing enough guidance and direction and knowing when to step back so Simone could have the freedom and flexibility to take ownership of her own work and learning.  In many ways, it was difficult for me to let go of wanting to oversee all of the little details of the project, but once I did I think Simone was really able to test her capabilities and grow from the experience. 

4.  Mentoring is an incredibly rewarding experience.  Although mentoring presented unique challenges, it was also a lot of fun.  It really allowed me to reflect on why I love working in public health and share that with a student whose career is just beginning.  It was fantastic to go from teaching Simone about the basics of research and public health to being able to have in-depth conversations about topics ranging from the recent Ebola outbreaks to public policy aspects of obesity prevention.  I also think one of my proudest moments of my Fellowship to date was watching Simone’s presentation at the NIH a few weeks ago - it was truly a testament to all of her hard work and dedication.  Helping her grow not only in her knowledge and skills but also in her confidence has undoubtedly been the best part of my summer.

So overall, it has been a summer full of learning, growth, and hard work, but also a lot of fun.  I am so grateful for this opportunity to be a mentor, and I have an even deeper appreciation for all of the mentors I have been privileged to work with over the years.  I look forward to seeing what the future holds for Simone and to any new mentoring opportunities that may come my way.

*The University of Nevada - Las Vegas (UNLV) American Indian Research & Education Center (AIREC) is one of four NIH STEP-UP high school coordinating centers. AIREC coordinates the American Indian/Alaska Native STEP-UP students nationwide. For more information about the program contact DeeJay Chino at 702-895-4003, or email: chinoe@unlv.nevada.edu.

Matthew Landis, MS, JD, CHC [Alumni]

Matthew was a Wisconsin Population Health Service Fellow from 2005 to 2007, with a placement at the Wisconsin Division of Public Health. He is currently the Chief Compliance Officer for ActivStyle, a leading national Durable Medical Equipment (DME) supplier of urological, wound care, and incontinence products. He is happily living in St. Paul, Minnesota, with his wife, Heidi, and their two Norfolk terriers, Henry and Bailey.

Prior to the Fellowship, Matthew earned his BA in biology and chemistry from Lawrence University in 2002 and his MS in epidemiology from the University of Wisconsin School of Medicine and Public Health in 2005. Since completing the Fellowship, he has obtained a JD with a focus on Health Care Law and a certification in Health Care Compliance (CHC) from Hamline University School of Law. Matthew’s other achievements since his time as a Fellow include participation in the Health Law Moot Court Team, serving as an associate and then managing editor for the Hamline Journal of Public Law and Policy, and working as a legal researcher and policy advisor for the Minnesota Health Care Finance Committee. Since 2010, he has also been a member of the Board of Directors for the Community University Health Care Center.

In reflecting on his time in the Fellowship program, Matthew noted that it was invaluable to him in terms of the breadth and depth of the experience. The program offered him a unique opportunity to get involved with state and regional health care policymakers and legislators, culminating in the passage of a budget amendment to fund maternal and child health programming with unanimous bipartisan support at the end of his second year in the program. Ultimately, the experience opened his eyes to the notion of pursuing a law degree and how public health advocacy can create positive change. When asked if he had anything else to share about his experience in the program, Matthew simply stated, “Without question, if I could do it all over again, I would!” His advice to current or prospective Fellows is to use the opportunity to network, to develop your skill set and leadership abilities, and to have fun.

David Garcia, EdD, MPH [Alumni]


David was a Wisconsin Population Health Service Fellow from 2005 to 2007, with a placement at the City of Milwaukee Health Department. He earned his MPH in Health Policy and Management from the University of Texas Health Science Center in Houston in 2004 and completed a Doctorate in Health Education and Behavior from Teachers College, Columbia University in New York City in 2013.

Upon completing the Fellowship in 2007, David accepted a position in Seattle, Washington, working for the Fred Hutchinson Cancer Research Center, where he conducted community education for clinical trials with the Seattle HIV Vaccine Trials Unit. The desire to pursue his doctorate brought David to Columbia University in New York City. While at Columbia, David also worked as a Research Fellow for the Research Group on Health Disparities at Teachers College. In this position, he explored innovative Internet-based methods to diffuse safer sex and HIV prevention messages targeting men who have sex with men. David is looking forward to presenting the results from this study at the United States Conference on AIDS (USCA) in San Diego in October 2014.

Currently, David still resides in New York City, where he is an administrator for a community health center that advocates for and provides culturally competent health care services for underserved and vulnerable people, especially Asian and Pacific Islanders, the LGBT community, and individuals living with and affected by HIV/AIDS. In addition, he is an Adjunct Assistant Professor in Health Education for the City University of New York (CUNY) in the Bronx. His experience in the Bronx gives him the opportunity to develop his teaching skills and further fuels his passion to educate and empower young students of color. As a queer Latino, he also possesses a vested interest in serving his communities as a mentor, role model, and leader to better bridge their educational and health gaps.

In terms of personal updates, David is disappointed to report that his planned marriage to Ricky Martin did not come to fruition. He welcomes any current or former Fellows to introduce him to their gay colleagues or family members who are interested in “an educated Latino who likes long walks in the city, talks about gender politics, and science fiction.”

David’s advice for current or prospective Fellows? “Absorb everything! Do not be afraid to ask questions, and do not get tied down with bureaucratic processes or office politics. Think about a project you want to work on and make it happen. This might mean you have to get out into the community or constantly remind your mentor. Most importantly, always stay focused on the experience as a learning tool, and it will transform you as it did me.”

Wisconsin good-byes!

Carly Hood, MPA, MPH
Population Health Service Fellow 2012-2014

Wisconsin Division of Public Health
Health First Wisconsin
Wisconsin Center for Health Equity

Madison, WI


As I wrap up my final week as a Wisconsin Population Health Service Fellow, not only am I dedicating time to ensuring projects are complete and my desk(s) are clean, but I’m making time to reflect on what the last 2 years as a fellow (and 4 as a Wisconsin citizen) have meant to me. I moved here in the summer of 2010 as a reverse-culture-shocked graduate student, ready to apply what I had most recently seen in Vietnam as student of public policy at the Robert M. LaFollette School of Public Affairs. As a “fighting Bob” I took classes in public management, policy analysis, policy-making process and advanced statistics. And ate it up! I can see now, I was most definitely at a point in my life where school sounded right (boy, that ship has sailed!) But it was here that I also began seeing my lens take shape, my interests honed. I observed that the policies I chose to analyze, the experiences I brought to class to discuss, and the data I wanted to play with focused on health and access to what I had always seen as a human right: opportunity to live a healthy life. I quickly learned about the dual program with the UW School of Medicine and Public Health and added on an extra summer of epidemiology, social and behavioral health, and health policy courses to obtain my Master of Public Health and Global Health Certificate alongside my Master of Public Affairs degree.

I was fortunate to have been told about the fellowship program early enough to apply and post-application submission, waited anxiously to hear back from folks at the Population Health Institute. Finally, in late February, I received the call that helped shape my career path and joined the 4 other fellows in my cohort summer of 2012. Since my graduate research was based on food policy, I naturally found dual placement sites at the Division of Public Health in the Chronic Disease Program and at Health First Wisconsin. (I later added my tri-placement at the Wisconsin Center for Health Equity). And then…Poof! 2 years disappeared!

As my fellowship is ending soon, I was recently asked, “What do you think you’ve done as a fellow?” Wellllllllll (insert headscratch). Sometimes I want to say, “What HAVEN’T I done?!” Other times I ask myself, “Have a done ANYthing?” For most fellows, I believe it’s a difficult question to answer when there aren’t particular milestones, expectations or deliverables like those found in many other public health positions descriptions (besides the CALs of course!) The concrete products of my fellowship (which I was interested in hearing 2nd year fellows talk about as an applicant and incoming fellow so I’ll touch on here) are what I shared in my exit interview last week and include the following: I developed 2 strategic evaluations both aimed at increasing capacity for folks working with homeless, impoverished and/or jobless individuals; I designed and implemented a year-long health equity training at both placement sites; I analyzed socioeconomic data for a chapter in the 2014 Healthiest Wisconsin 2020 Baseline and Health Disparities Report; I published 1 paper (2 in the works yet!), 2 Opinion pieces and 4 Letters to the Editor in various Wisconsin media outlets; I led 2 years of discussion courses for undergraduates interested in public health; I trained local and tribal health departments around the state on the use of national community health tools; I presented on health equity/social policy in public health to community groups, students, state public health employees, and national audiences; and I developed bi-monthly resources on health equity and social policy for national partners.

While most of these have a tangible item attached to them (a pdf report, a powerpoint presentation, a word document newsletter), some of them do not. And in my eyes, the more important outcomes of all of these projects have very little to do with the items one can see and touch. I have found much more value in the relationships I’ve developed, the heightened understanding of how public health & policy works at a State Health Department AND an advocacy organization, and the confidence that my perspective is a valued and impactful one.

I don’t believe in fate. I don’t think my career ‘required’ this 2-year experience or that I couldn’t also have been happy and successful in another position (there are certainly positives and negatives to this position). But I do believe that this experience gave me the flexibility and time to explore the many facets of public health, the plethora of partners who are involved, and the varied organizations that support the field of public health. I believe I was fortunate to be given the opportunity to hone the skills I wanted and dump those I wasn’t interested in. And as an academically funded staff person working in the field, I had access to more resources and training alternatives that helped me sharpen a sort of ‘field of expertise.’

The fellowship was a great opportunity. And—like everything else—it came with a fair share of challenges. I dealt with a loss of preceptors (2 of mine left in the middle of my fellowship). I was conflicted with 2 placement sites and not feeling 100% a part of either. I was challenged to assert the understanding that ‘fellow’ does not mean ‘student’ or ‘administrative assistant’—we are in fact highly trained professionals seeking mentorship and experience early in our careers. And lastly, I struggled with evolving interests, being originally interested in food policy my interests broadened from issues of healthy food access to more upstream equity associated with income, education and housing. That made projects at my particular placement sites hard to find at times…but my preceptors were flexible and encouraging and I was able to develop my own projects that focused on equity and increasing capacity within my placement institutions. I was also able to expand many of my projects to the Wisconsin Center for Health Equity, where I revamped the website and built several partnership that results in facilitation and keynote speaking engagements.

In this way, the fellowship demanded innovativeness and honesty. I had to be cognizant of the skills and abilities I wanted to develop, I had to be honest and open about those, and then look for ways to infuse that work where I & my organizations were. In contrast to many other positions, I had to speak up louder than I might otherwise and was forced to be my own advocate. While this can be challenging at first, it ultimately helped me learn who I was, what I wanted, and encouraged me to think outside of the box. Today I feel lucky to have had the chance to say, “Hey! This is what I want to work on. How do we make that happen?”

In looking back over the last 4 years—and the fellowship in general—Wisconsin has provided a safe space for me to overcome my reverse-culture shock, make new friends and professional connections, and build on the amazing efforts of places like the policy school (3rd in the country for Social Policy!), the Institute for Research on Poverty, the Population Health Institute, and the School of Medicine & Public Health. Due to its size and approachability (plus people’s lovely Midwestern demeanor!) Wisconsin is a ripe place for networking and building connections. I will miss those that I’ve made as I move on to a new position as Clinic & Public Health Director for a small clinic—in a new country! But I feel more equipped to deal with the challenges I will likely face in the developing world, and look forward to contrasting the public health system in Belize with that of the United States and Wisconsin. Thank you to the fellowship community for the support and learning you’ve provided me!!!! I do hope you’ll keep in touch.


Storytelling and Public Health


Christina R. Hanna, MPH
Wisconsin Population Health Fellow
AIDS/HIV Program, Wisconsin Division of Public Health
Wisconsin Alliance for Women's Health
Madison, Wisconsin



I have known for a long time that I was interested in women’s health, specifically reproductive and sexual health. As part of my graduate school experience at the University of Michigan School of Public Health, I was an HIV Test Counselor, a volunteer at the University of Michigan Women’s Health Resource Center,  and completed my summer internship with Planned Parenthood, but I didn’t want to be pigeon-holed so early in my career as the “condoms and birth control” woman. I remained open to engaging in other topics and as I began the Fellowship two years ago was open to learning about other topics in public health. I had the opportunity to explore many other public health topics through networking with staff in the Wisconsin Division of Public Health and through Fellowship Monthly Meetings. While I have discovered new passion for other topics that affect and are affected by health (incarceration, education, and health disparities/social determinants), my brain always leads me back to the question, “How does this affect women and girls?” After two years in the Fellowship, I gained the confidence to own that women’s health is my passion. Beginning to think about the many roles I can play in women’s health is what makes me excited about my future. And while some may still pigeon-hole me as the “condoms and birth control” woman, the story has really opened up for me. I think about the roles I can play in public health, from helping families to have age-appropriate discussions about sex and our bodies, to pre-conception health for young girls, to safe and healthy sexuality and sex, to supporting pregnant women prenatally and during childbirth, as a doula (I’m a newly DONA-trained doula).

The theme of storytelling has kept reappearing for me throughout the Fellowship. I place high value on communication and have paid attention to when storytelling has crossed my path. One of the main projects I worked on during the Fellowship was a qualitative evaluation of a patient navigation program for people living with HIV/AIDS. Throughout the process, I found that I really enjoy qualitative evaluation and I think one of the main reasons was that I love listening to stories. As part of the evaluation, I was able to interview program participants, sit down face-to-face with them, and give them the space to tell their story. Interviewing participants was my favorite part of the evaluation. I think being able to share one’s own experience, and if it’s received positively, can be really empowering and help validate an individual’s experience.

Sharing one’s experience can also be motivating for others. During the 2014 WisconsinWomen’s Health Policy Summit, stories were shared by keynote speakers and in individual conversations. The first keynote, Ms. Bylle Avery, shared her story and the history of working in women’s health, especially her work focusing on black women’s health. Another keynote, Mr. Anton Gunn, shared the power of storytelling with examples from his personal life, as well as his professional work with President Barack Obama and the Department of Health and Human Services. A Summit attendee shared with me her motivation to attend the summit and do her work is to honor the memory of her son who died soon after his birth. Moments from this Summit have also been told as a story to motivate others. One that was repeated numerous times after the Summit was when Wisconsin Alliance for Women’s Health Executive Director, Sara Finger, demonstrated how simple it is to advocate, by calling Governor Walker’s office during her talk in front of over 250+ summit attendees. That simple action made an impact on a lot of people and that story was shared with many others after the Summit. All of these stories stuck with me, motivate me, and help me to understand what motivates others.  

I have also seen powerful stories told through pictures and video. Photovoice is great tool for public health that can be used to help tell a person’s or a community’s story. Another powerful tool for storytelling is video. The Wisconsin Alliance for Women’s Health used a video to tell their story and celebrate their 10 year anniversary. The Wisconsin Clearinghouse for Prevention Resources also uses video to help communities tell their stories. No matter how they are told, stories are a powerful way for individuals, communities, and public health professionals to tell the story of the improving health in the places they live.  

To my fellow Fellows, future Fellows, and all other public health practitioners, I challenge you to think about your story and the stories you want others to tell about the important work you will do and the communities you will serve.

Image courtesy of: http://kryschendo.com/uploads/storytell_image_web.jpg


'In Closing'

Lindsay Menard, MPH

La Crosse, Wisconsin

As my final weeks of being a Wisconsin Population Health Service Fellow draw near, I have had the opportunity to reflect upon the past 22 months and recognize how much I have grown and how fortunate I am to have been part of such compassionate, innovative, and inclusive communities.  I want to use this blog post to focus on one of those communities, the La Crosse County Health Department, by highlighting one particular project I helped advance, the accreditation process.The accreditation journey has fostered my professional and personal development during my time as a Wisconsin Population Health Service Fellow.

Getting Started
Almost two years ago, the only thing I knew about national voluntary public health accreditation was that the Public Health Accreditation Board (PHAB) had released a set of standards and measures in 2011 to help state, local, and tribal health departments ensure the three core functions of public health and the ten essential health services were being met.   I had to quickly get myself up to speed on the purpose of accreditation (with the use of resources such as: the PHAB Online Orientation, Embracing Quality in Public Health: A Practitioner’s Performance Management Primer, and Developing a Local Health Department Strategic Plan: A How-To Guide), the reasons the La Crosse County Health Department was pursuing it, and how I could add value to the process. 

Lessons Learned
The first lesson I learned is that people and organizations always have room for improvement, and that it is important to introduce quality improvement efforts in a way that does not threaten staff or the good work they were already doing.  I framed this concept in many different ways.  For example, when discussing performance management and quality improvement ideas (Domain 9 in the standards and measures established by PHAB) with public health nursing staff I highlighted the fact that we are already reaching a large proportion of the community with seasonal influenza vaccinations, and then asked them to think about how we could reach even more people and improve upon the structure of community influenza clinics.

I have also learned to be open to change, to document change, and to encourage change (even if I am hesitant about it myself).  Change does not come easily to most people, including me.  Learning how to maneuver change, address change resistors, and embrace change has been important throughout the accreditation process.  We, the La Crosse County Health Department, had to overhaul and develop new systems.  Changing the infrastructure of an organization is no easy task.  It took time, patience, and various forms of training to get new or changed systems to “stick.”  And as a new employee and  Wisconsin Population Health Service Fellow, I was essentially charged with testing the status quo.  I had to learn to build rapport and earn the trust of staff.  There was a period during the transition when everyone (including me) had to adjust to the shift in the organizational structure. 

The third lesson I learned was how important communication is at all levels of an organization, not just at a local health department.  It is important for leaders to communicate on a regular basis with all staff members and it is equally important for leadership to explicitly reach out to staff for feedback.  Communicating thoughts, ideas, improvements, and questions can be extremely difficult.  Encouraging a safe environment for all to communicate is essential.  Otherwise, trust and morale break down. To communicate with staff about the new systems, plans, and policies and procedures (P&Ps) that were created, adopted, and implemented a department newsletter was created (Figures 1 and 2).  The newsletter highlights the accreditation process, discusses the twelve domains developed by PHAB, states new changes, and captures health department news.   Through the accreditation process, I have learned to develop newsletters and frame messages for staff and the media in a meaningful and concrete way. 

Figure 1:                                                  Figure 2: 

Final Thoughts
In closing, the accreditation process has increased the capacity of the La Crosse County Health Department to deliver the ten essential services AND it has made me a better public health professional.  I have increased my knowledge of public health, fostered many professional skills, learned to manage change, and recognized the value of communication throughout an organization.   I will carry the many lessons and skills I have learned throughout the Fellowship program with me for the rest of my career.  Fellowship faculty and staff explain it best, “Through this intensive process, academic health departments and their UW School of Medicine and Public Health—based partners have developed a way to take talented and highly motivated early-career professionals and transform them into confident, emerging leaders, with cutting-edge skills, competencies, and connections to improve population health outcomes and advance health equity in Wisconsin and beyond.”[i] I am proof.  I have been transformed.



[i] Ceraso, M., Swain, G.R., Vergeront, J.M., Oliver, T.O., & Remington, P.L. (2014). Academic Health Departments as Training Sites for Future Public Health Leaders: A Partnership Model in Wisconsin.  Journal of Public Health Management and Practice, 20 (3), 324-329.

Morgen Alexander-Young [Alumni]

Morgen Alexander-Young was a Population Health Service Fellow from 2006 through 2008, placed at the City of Milwaukee Health Department. Prior to the Fellowship, she received a degree in Government from Smith College and an MPH in Health Behavior and Health Education from the University of Michigan. She became certified in Public Health through the National Board of Public Health Examiners in 2008 and also completed the Clinical Trial Management and Regulatory Compliance certificate program through the University of Chicago Graham School in 2011.

Morgen is currently the Associate Director for Protocol Operations for the Alliance for Clinical Trials in Oncology, a part of the National Cancer Institute’s National Clinical Trials Network. In this position, she leads a team that develops cancer clinical trials and implements these trials in a nationwide network of community and academic cancer centers. Morgen is proud to have worked with University of Chicago researchers on an article published in the Journal of Pediatrics on the topic of health disparities in children’s health. She is also lucky to have worked with the Robert Wood Johnson Foundation and University of Chicago researchers to administer research grants for health disparities research in chronic disease care all over the country. Since completing the Fellowship, Morgen has also become a mother to two boys who are now 4 years old and 1 year old.

Morgen shared that the Fellowship program gave her confidence in her ability to lead and complete projects to help answer very important public health questions. The respect given to her by her mentors demonstrated that she had valuable skills and experience to contribute. Morgen’s words of wisdom for prospective Fellows: “The experience of a Fellowship is a once in a career opportunity to jump on. There may not be many other opportunities in your career when you will be paid to learn, explore, make mistakes, and focus on what you love to do (or figure out what it is that you love to do). I loved the mix of no-pressure academic learning coupled with professional exploration.” As for current Fellows, Morgen explains, “The professional network of connections that you are currently building is immensely valuable. If you are considering where to go next, staying in Wisconsin and in the area you are working is an important consideration, as you’ve had a jump start in building crucial professional connections.” 

Amanda Schultz, MPH [Alumni]


Amanda was a Population Health Service Fellow from 2007 to 2009. During her Fellowship, she participated in a dual placement with the City of Milwaukee Health Department and CORE/El Centro, a nonprofit working to improve the health of Milwaukee’s Latino community. Prior to the Fellowship, she earned her MPH in Community Health Sciences with a focus on Maternal and Child Health Leadership from the University of Illinois at Chicago and a BA in Psychology and Spanish from Lake Forest College.

Since her time in the Fellowship, Amanda has worked both internationally and domestically to provide public health perspectives in nontraditional settings. For two years, she worked in Central America, offering technical assistance to a local nonprofit focused on developing communities through female leadership development, micro-financing, food security, and environmental conservation. She currently provides leadership on domestic food security as the CalFresh (SNAP) Outreach Director for the San Diego HungerCoalition. Amanda is passionate about her role at the Coalition, bridging the anti-hunger and public health communities to develop pathways to food and health through program development and state and federal policy change. As a part of her work, she is currently spearheading a partnership with the UC-San Diego School of Medicine to develop curriculum focused on food security as a social determinant of health. Amanda also recently received state-level recognition for her use of GIS mapping to improve SNAP outreach efforts.

Outside of work, Amanda loves taking advantage of “Sunny San Diego,” and the opportunity to be outdoors. She practices yoga, bikes, and looks forward to any excuse to “dust off the old backpack.”

Amanda’s time in the Fellowship helped solidify her interest in multi-disciplinary approaches to community health. As she explains, “The experience of developing the Milwaukee Latino Health Coalition and working on the City of Milwaukee’s Community Health Assessment allowed me to see firsthand the power of bringing together leaders from various sectors, and instilled a belief in collaboration to create sustainable change.” The Fellowship also planted the seeds of policy as a vehicle to systemic change. She continues to fine-tune this skill, identifying the best areas to influence and improve systems to create pathways to health. 

Her advice for future Fellows is to take advantage of every opportunity the Fellowship offers and to utilize this experience as a space to explore new areas, build new skills sets, and further develop areas of interest. She notes that the Fellowship is a unique opportunity for reflection, experimentation, and supported development. Amanda’s hope for all current and future Fellows is that they “are able to fully appreciate and take advantage of all the program has to offer!”   


Public Health: Moving Forward




Colleen Moran, MPH MS
Wisconsin Population Health Service Fellow
Wisconsin Division of Public Health
Madison, WI




Public Health is cool, right? Well, I suppose it depends upon whom you ask. This became a topic of discussion the other day - how do we "rebrand" public health? How do we communicate what it is and how cool it is? Most of the time when I tell people I work in public health, they ask me something regarding primary care, something clinical. I have to gently let them know that I'm not in, "that kind of health," that, "I work in prevention - I try to change the environments we live, work, learn and play in, and incorporate health into policies, to make the healthy choice the easy choice, so that fewer people have to visit the clinic," I'm usually met with a blank stare and the inevitable followup question: "so what is it exactly that you do?"


That question, a good one I might add, is what I dedicate my blog post to today. I'd like to answer that question of "what is it that I do" and in the process, try to explain just how amazingly cool public health really is. So in recognition of National Public Health Week, this blog post is dedicated to celebrating the great successes public health has accomplished so far, while also focusing on where the future lies for the world of public health. And hopefully along the way I'll answer that nagging question.


How Far We've Come . . .

First, let's take a moment to remember how far we've come. Back in the early days of public health, contaminated water was causing disease outbreaks such as cholera (remember Dr. Jon Snow and the Broad St. pump?), overcrowding was leading to transmission of infectious diseases, workplaces were unsafe, and family planning was unheard of. Just a few generations ago mothers and father worried about their children contracting polio, measles and mumps, and many did with devastating effects
We've come a very long way. Listed below are 10 of the greatest public health achievements of the 20th century. To many, the achievements listed below are so basic that they virtually go unnoticed. However, I think it's time to pause and recognize how far we've come, thanks to public health.

Ten Great Public Health Achievements in the 20th Century
  1. Immunizations*
  2. Motor-Vehicle Safety
  3. Workplace Safety
  4. Control of Infectious Diseases
  5. Declines in Deaths from Heart Disease and Stroke
  6. Safer and Healthier Foods
  7. Healthier Mothers and Babies
  8. Family Planning*
  9. Fluoridation of Drinking Water*
  10. Tobacco as a Health Hazard

While  most of us take these advances for granted, there a few of the achievements on the list that create controversy and I would feel remiss if I did not make note of that (the * above denote these controversial public health practices). However, I do not want to spend time refuting the arguments people make against these public health achievements. Rather, I would like to use this blog post to acknowledge the fact that we've largely moved from the focus of the 20th century on infectious diseases and injury prevention to a 21st century focus on chronic diseases and the environments, systems and policies that must be changed to create a healthier world. There is so much more to be done in public health. It's time to move forward. 


So What IS Public Health . . . ?

So what do we mean when we say "environmental, systems and policy level changes"? Well, think about your daily routine: 
  • How do you get to work? 
  • How do your kids get to school and are they safe and happy there?
  • Where do you purchase your groceries? 
  • Where do your kids play outside?  
http://healthsciences.curtin.edu.au/teaching/soph_whatis.cfm
If you said you drive to work, is this because there is no public transportation? The research demonstrates that if you use public transportation you get more exercise simply getting to and from the transit stop than if you drove yourself, thereby helping you reach your recommended levels of physical activity. Not to mention the environmental benefits of using public transit which lead to improved respiratory health outcomes from cleaner air. We must change your environment so that you can access public transit but this must be done at a systems and policy level. This is public health. 

https://www.safeschoolscoalition.org/
RG-posters.html
If you said, "I drive my kids to school because it's too far for them to walk," or, "I don't feel safe letting my kids take the bus," that is public health. If you said, "my child is bullied at school," or,"the lunch they are fed is not healthful" - that too is public health. Where we site our schools, if our kids can incorporate physical activity into their daily routine by walking to and from school, if you feel that the neighborhood is safe enough for your children to walk in - this is your environment and changes to the systems and policies that create this environment must be made. This is public health. 


https://www.flickr.com/photos/35586421@N03/
3331755112/in/pool-683857@N21
If you said, "I drive 30 minutes to the nearest full service grocery store to purchase my groceries," this is a public health issue. What about the folks that don't have access to a grocery store because they don't have a car, can't drive, and/or there is no public transportation? How do we feed ourselves healthy foods if we can't access them, can't afford them, or have to spend hours per week simply in transport to retrieve them? What type of zoning we create, where we site our grocery stores, and what types of foods we sell in them create our environment and at the systems and policy level, we must make changes. This is public health. 



http://www1.ochca.com/ochealthinfo.com/docs/newsletters/whatsup/2013/13-04.htm
If you said, "my kids don't play outside," why is this? Is there no park in your neighborhood? Are there no sidewalks for your children to walk, bike or play on? Is there a  park but you don't feel safe sending your children there? Do the cars drive too fast to allow you to feel safe letting your kids walk anywhere? This is your environment and we can make systems and policy level changes to make it healthier. We can change the zoning regulations to allow for urban agriculture in empty lots and front yards, we can create "road diets" to slow down traffic, we can increase the pedestrian and biking infrastructure, plant shade trees, and create community centers. This is public health. 


So Where Do We Go From Here?

The new face of public health focuses on these upstream social determinants of health. Where you live, work, learn and play are the biggest factors in your health and well being. An example of such public health work in action is an op ed recently posted by my friend and fellow Fellow, Carly Hood, on How to improve the health of Wisconsin families.

County Health Rankings Model
University of Wisconsin Population Health Institute
County Health Rankings and Roadmaps 2014. www.countyhealthrankings.org
"In short, when people don't have access to education, healthy food options, safe and active living environments or transportation to and from a decent-paying job, their health suffers."


In short, EVERYTHING is public health. As public health professionals today, we work to create healthier environments in which to live, work, learn and play tomorrow.










Moving Beyond #72


Moving Beyond #72:  Improving Health in Menominee County
Lauren Lamers, MPH
Wisconsin Population Health Service Fellow
Menominee Tribal Clinic
Shawano-Menominee Counties Health Department
Keshena, WI 

On March 26, the Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute released the 2014 County Health Rankings.  Within each state in the U.S., the Rankings rank counties from most to least healthy based on heath outcomes as well as the environmental, clinical, social, and behavioral factors that influence health.  For many counties, the release of the Rankings is an opportunity to see how their community’s health measures up to other counties in their state, identify successes in improving community health, and hone in on areas that still need improvement.  For Menominee County, however, the Rankings tend to be all too predictable. 

County Health Rankings Model
University of Wisconsin Population Health Institute. 
County Health Rankings and Roadmaps 2014.  www.countyhealthrankings.org

Every year since the Rankings have been released nationally, Menominee County has ranked 72nd of Wisconsin’s 72 counties for both health outcomes and the factors that influence health.  Perusing the data behind Menominee County’s ranking, several factors driving the low ranking quickly become apparent: unemployment and child poverty rates more than double the state average, high rates of teen pregnancy, and a high prevalence of health risks such as smoking and obesity just to name a few.  Furthermore, considering the wide disparities in health outcomes and health determinants between Menominee County and other counties in Wisconsin, the #72 ranking is unlikely to change any time soon.

Although consistently being ranked last in the Health Rankings can paint a rather grim and defeating picture, when I began my fellowship with the Menominee Tribal Clinic I quickly realized how much the Health Rankings, while not necessarily inaccurate, do not capture.  In many ways, it is the factors that the Rankings cannot directly measure that tell a much richer and more inspiring story about the health of this community.

First, there are a host of historical factors not directly captured in the County Health Rankings that nonetheless underlie the Rankings’ measures of heath outcomes and health determinants.  As a predominantly Native American community, the historical trauma experienced by the Menominee Tribe, including forced relocation to the present reservation, boarding school educational policies intended to destroy Menominee culture, and termination of the Menominees’ status as a federally recognized tribe in the mid-twentieth century, continues to dramatically affect the health of the community.  Many of the indicators captured in the Rankings, such as high rates of poverty, substance abuse, and premature death, are direct reflections of this legacy of historical trauma.

Many efforts are currently underway, however, to address and move beyond this trauma and improve the physical, social, emotional, and spiritual wellbeing of the Menominee people.  Through Fostering Futures, an initiative to promote trauma-informed care across tribal and county agencies, community leaders have joined together to discuss the impact of historical and intergenerational trauma and discuss how to build resilience among families and children.  Additionally, in response to the county’s health ranking, a Community Engagement Workgroup of stakeholders across a variety of sectors has been meeting for several years to implement initiatives aimed at reducing youth obesity and teen pregnancy and improving school readiness.  Other local coalitions and programs are actively addressing issues such as substance abuse and are promoting healthy youth development through the teaching of the Menominee language and traditional cultural practices.  Through this work, community members have identified how a variety of social, environmental, and behavioral factors interact to influence health, and their collaboration has enabled them to take a multifaceted approach to improving community wellbeing.

While the engagement, collaboration, and resilience of the Menominee community are not necessarily quantifiable factors that can be incorporated to a Health Rankings model, they are crucial for eventually making changes to improve community health.  It will take years for small improvements in health to be manifest in the overall health ranking, but there are already some indicators of the fantastic work that this community is doing.  For instance, in the 2010 Rankings, the percentage of Menominee County ninth grade students who graduated in four years was 68% – the lowest in Wisconsin.  In the 2014 Rankings, that number has increased to 93% - above state average.  Violent crime has decreased, and Menominee County is currently ranked 45th for clinical care and 15th for environmental factors. 

According to the Robert Wood Johnson Foundation and UW Population Health Institute, the County Health Rankings are intended to “serve as a call to action for communities to understand the health problems in their community, get more people involved in improving the health of communities, and recognize that factors outside medical care influence health.”1  The community members in Menominee County have certainly embraced this call to action wholeheartedly.  While it may not be reflected in the #72 health ranking, their fantastic work to improve health and wellbeing is an exemplary model for other communities to follow.

 
1.  County Health Rankings and Roadmaps.  Frequently Asked Questions.  http://www.countyhealthrankings.org/faq-page#t82n12072       

Suzanne Gaulocher, MA, MPH, PhD [Alumni]



Suzanne was a Population Health Service Fellow from 2007 through 2009, placed with Public Health – Madison & Dane County in the Health Promotion Program. Prior to the Fellowship, she received an MPH from the University of Wisconsin School of Medicine and Public Health, an MA in medical anthropology from Oregon State University, and a BS in cultural anthropology. Suzanne combines approaches from all of these disciplines into her research and practice in the US and abroad. Her work thus far has centered on increasing knowledge that supports the intersection between health and place research, with a focus on community engagement and equity. She earned her PhD in Environment and Resources from the UW-Madison’s Nelson Institute for Environmental Studies.

Suzanne recently relocated to the San Francisco Bay Area of California, where she works at Stanford University as the Director of Community Engaged Learning, specifically leading the health thematic area of the program. Together with her colleagues, she provides support to students, faculty, and community partners in community engaged learning opportunities on and off campus. Before taking this position at Stanford, Suzanne worked at the University of Wisconsin’s University Health Services as a researcher and evaluation specialist. Most recently, she worked on the Centers for Disease Control and Prevention’s Community Transformation Grant (CTG). Prior to CTG, she was part of a team providing national technical support and evaluation services for the Communities Putting Prevention to Work Program, in which storytelling was used as a tool to improve health policy and communication at the local level.

In her work, Suzanne builds upon a framework that addresses interconnected human and non-human systems to positively impact human health outcomes. She uses community-based participatory research (CBPR) techniques to engage with community members, academics, stakeholders, and professionals to learn how people use places and how health supports and barriers to health are assessed, addressed, and translated into action. 

For fun, Suzanne loves to spend time with her two boys, practice yoga, run, knit, love as deeply as possible, and visit the ocean and the mountains as often as she can. She enjoys exploring the beautiful cityscapes and landscapes across the state of California and she is about to embark on a stairway-seeking adventure in San Francisco.


What advice does Suzanne have for current and prospective Fellows? “This is a wonderful gift, both to you and to the community in which you are working. My advice is to understand the complex mechanisms that make up our directive in public health and to think strategically about engaging diverse disciplines in your work. How can we crosscut disciplinary thinking in order to effectively improve population health outcomes across the board? Be creative, think big, challenge yourself, and, most importantly, don't be afraid to step out of your comfort zone. That is where learning happens. In the words of Pete Seeger, There is something about participating; it is almost my religion. If the world is still here in 100 years, people will know the importance of participating, not just being spectators.’"


"W" for Wisconsin. Suzanne Gaulocher leading a Service Learning Trip through the Global Health Institute in Sri Lanka, pictured with UW students, John Beck, Hasan Nadeem, and Tudor Byas at the Botanical Gardens in Kandy, Sri Lanka. Most of the students who took part in this trip were part of the global health certificate program.  

Kristen Audet, MPH, JD [Alumni]



Kristen Audet was a Population Health Service Fellow from 2011 until 2013, with a dual placement at the Wisconsin Division of Public Health in Madison and the Rural Wisconsin Health Cooperative  in Sauk City. During the Fellowship, she received specialized communication training at the Centers for Disease Control and Prevention (CDC) and the Federal Emergency Management Agency (FEMA). Prior to the Fellowship, Kristen earned a B.A. in English, a Master of Public Health (MPH), and a Juris Doctor (J.D.).

As a Fellow, Kristen gained experience that has helped her to be more effective in her current position as the Life Safety Coordinator at the University of Wisconsin Hospital and Clinics. She works under hospital administration, ensuring compliance with state and federal regulatory authorities regarding the environment of care, life safety, and emergency management, with a specific focus on emergency management preparedness and response.

Kristen recently bought a house in Madison and added a puppy to her family, increasing her “pet count” to 4!



A Major Achievement: The Healthiest Wisconsin 2020 Baseline and Health Disparities Report

                                     
 
  e.shor, MPH and Christina R. Hanna, MPH
  Population Health Service Fellows
  HIV/AIDS Program, Division of Public Health
  Madison, Wisconsin

Over the past few years, many Fellows and staff at the Wisconsin Department of Health Services (DHS) have been working to put together the Healthiest Wisconsin 2020 Baseline and Health Disparities Report. The report serves both as a baseline report for Healthiest Wisconsin (HW) 2020, Wisconsin's state health plan, and as a report on health disparities in Wisconsin. Users can orient themselves to this large report by reviewing the text on the web page and the Executive Summary.

The report is organized into health focus areas, an infrastructure focus area focusing on access to high-quality health services, and data summaries by population. The health focus areas include:
  • Alcohol and other drug use
  • Chronic disease prevention and management
  • Communicable disease prevention and control
  • Environmental and occupational health
  • Healthy growth and development
  • Injury and violence
  • Mental health
  • Nutrition
  • Oral health
  • Physical activity
  • Reproductive and sexual health
  • Tobacco use and exposure

The data summaries by population highlight demographic and socioeconomic data for each population and emphasizes health risk behaviors and outcomes where that population experiences disparities compared to other groups. The populations highlighted in this report include:
  • Blacks/African Americans
  • American Indians
  • Asians
  • Hispanics/Latinos
  • Lower socioeconomic status populations
  • People with disabilities
  • Lesbian, gay, bisexual, transgender populations
  • Geography (rural, suburban, urban)

Fellows worked on many pieces of the report including writing SAS codes, running data, analyzing data, putting together the PowerPoint, and writing some of the chapters, editing, and evaluation. It was truly a team effort with over 60 contributors. The current and former Fellows that have contributed to this important report include Akbar Husain, Anneke Mohr, Erica LeCounte, Christina Hanna, Carly Hood, Lindsay Menard, Melissa Olson, Kelli Stader, and e.shor.

This report is unique is that it brings together a rich set of data on a diverse range of populations. Within the Wisconsin Division of Public Health, program areas have epidemiologists that collect, analyze, and present data specific to that area. For example, the HIV Program has staff members who collect and compile data and publish reports on HIV in Wisconsin. There is no one epidemiologist that is charged to compile data about racial and ethnic populations, LGBT people, and other marginalized communities and the health disparities that these communities face. A large number of people stepped out of their usual responsibilities to help put this report together. Another unique aspect of this report is that it highlights communities that are often left behind and do not get enough attention, especially given the extreme health disparities in Wisconsin. All of these factors make it incredibly important to get this report out to people working on these issues and working in these communities. If you think of someone who could benefit from the information in this report please send them the link and do your part in getting the word out!


Samantha J. Perry, MPH [Alumni]



Pictured:  (left) Samantha J. Perry, Project Manager and 
(right) Kimberly Seals Allers, of MochaManual.com

Samantha J. Perry has a BS in Biological Sciences from Illinois State University and an MPH in Community Health from Southern Illinois University-Carbondale. She was a Population Health Service Fellow from 2008 through 2010 with the City of Milwaukee Health Department and the March of Dimes.

Samantha is currently a Project Manager at the Racine Kenosha Community Action Agency in Racine, WI.  She is responsible for managing the Racine Lifecourse Initiative for Healthy Families (LIHF), an initiative of the University of Wisconsin-Madison Wisconsin Partnership Program. The goal of LIHF is to reduce African American infant mortality in one of four counties in Southeastern Wisconsin. Samantha also manages a stakeholders group as part of the Personal Responsibility Education Program (PREP). PREP is designed as a community-wide effort to reduce the STI and teen pregnancy rates of adolescents, ages 10 to 18 years old.

In 2012, Samantha was elected to serve on the Board of Directors for the Wisconsin Association for Perinatal Care (WAPC) as a Consumer/Member-at-Large Representative. She was also appointed as the Regional Stork’s Nest Coordinator within her sorority, Zeta Phi Beta Sorority, Inc. In this position, she oversees the progress and evaluation of 26 Nests that provide prenatal education and incentives for at-risk women.

The practical experience and mentorship she obtained in the Fellowship had a huge impact on Samantha’s career trajectory. She worked with inspiring African American female administrators who provided her with real opportunities to learn and grow. She also had excellent experiences with other public health professionals that provided her with wonderful opportunities, such as serving as a guest speaker for college courses and working on aspects of city needs assessments. All of her experiences, coupled with support from Fellowship program staff, helped to shape her strengths and interests as a public health professional.

Samantha’s advice for current and prospective Fellows: “The experience as a Fellow is very important, especially if you don’t have work experience that relates to public health. It really opens your eyes to office culture and all sides of public health, from the grassroots level to administration. It is important to gain experience on each level, if you can, because you never know what your next adventure will be.”