For the Good of All

For those who want to make an impact on a grand scale, there are few fields that are as promising as public health. Public health workers help develop and implement policies that may ultimately touch the lives of millions.

Grinnellians have long been drawn to public health careers, and there are hundreds of alumni currently in the field. Starting in 2015, the school’s ties to public health will grow even stronger, as students begin to apply for Grinnell’s new master of public health cooperative degree program with the University of Iowa. Students enrolled in the program earn their bachelor’s degree from Grinnell and master’s degree from the University of Iowa in five years, instead of the traditional six.

According to Jim Swartz, director of Grinnell’s Center for Science in the Liberal Arts, the program is a perfect fit for the College. “Public health, as a profession, depends on the kinds of thinking and knowledge that come from humanities, social studies, and science,” he says.

To find out the impact that Grinnellians are already having in careers linked to public health, we talked to eight alumni in the field. Snapshots of their work — tackling issues from Ebola to cancer to hospital infections — are in the pages that follow.

Erich Giebelhaus ’92

Work: Helps develop emergency preparedness plans for New York City

Education: History and German majors at Grinnell; Master of Public Policy in social policy/health policy, University of Minnesota’s Humphrey School of Public Affairs

Quote: “With emergency management, you’re always trying to stay one step ahead of what’s happening. You can’t plan for the last emergency, because the next one will never look the same.”

When Hurricane Sandy hit New York City in 2012, vast multitudes of the population headed out of town to avoid the brunt of the superstorm. But for some of the most vulnerable people — like those in hospitals, for example — getting to a safe location was no easy task.

And that’s where Erich Giebelhaus stepped in. As special assistant to the deputy commissioner and interagency coordinator for the New York City Department of Health Office of Emergency Preparedness and Response, he spent two weeks after the event helping find beds for hospital, nursing home, and adult-care facility patients. He ordered emergency supplies such as power generators, blankets, flashlights, and clothing and made sure they got delivered where they were needed. “It was an intense time, and we were dealing with fragile people,” he says. “I felt responsible — it was so important to get things done in a timely fashion.” In the end, Giebelhaus and others helped place 6,000 individuals from 37 facilities.

Long before the city has to deal with an emergency — a hurricane, a deadly flu virus, a terrorist attack — Giebelhaus spends his days figuring out how the government and other organizations can best respond. More recently, for example, he’s been working on Ebola preparedness activities for the city by coordinating local, state, and national agencies. He helps build partnerships with organizations to help ensure that people get the help they need during an emergency, right when they need it. His agency helps develop plans that cover everything from bioterrorism to mold contamination for a city where more than 150 languages are spoken.

Such planning can help save hundreds — if not thousands — of lives, turning a potentially devastating event into a far more manageable one. “Nobody wants a disaster to happen,” says Giebelhaus. “But when it does, it’s gratifying to know that you’ve put together — and you can implement — the most effective response.”

Emily Parker ’95

Work: Conducts research to help doctors treat their patients more effectively

Education: Biology major at Grinnell; M.P.H. and Ph.D. in epidemiology, University of Minnesota

Quote: “There are a lot of people who think, ‘I want to do something that helps people, so I’ll be a doctor.’ But if they had exposure to [the ideas of] public health they might think, ‘I want to help populations of people, so I’ll do public health.’”

Hepatitis B is a devastating disease that, if gone untreated, can lead to chronic liver disease and liver cancer. For patients from sub-Saharan Africa and East Asia, their likelihood of having the disease is up to 10 times higher than their counterparts from North America.

For Emily Parker, a research investigator who focuses on research methods for HealthPartners Institute for Education and Research, the question was simple: How could busy doctors ferret out patients who might be at high risk for the disease to make sure they got screened — and received follow-up treatment if necessary?

Recently, Parker helped craft an ingenious study for HealthPartners clinics to solve that problem. With just two data points — country of birth and the language they prefer to use in the health system — from patients’ health records, she developed an algorithm to determine whether or not the patient had an increased risk of having hepatitis B. The algorithm was turned into a software tool on doctors’ computers, and if the data suggested the patient was at risk, a pop-up screen with details appeared on the computer, encouraging the doctor to order the appropriate screening. As part of the randomized trial, some clinics got a pop-up that required the doctor to order the screening (active), while others got a pop-up that didn’t require the doctor to order the screening (passive).

The results were encouraging: clinics in which the active tool was used were nearly twice as likely to help identify a patient with hepatitis B compared to clinics where the passive tool was used. That’s led to real change: “Now that HealthPartners sees that the tool works, they’re interested in implementing it into all of the clinics,” says Parker.

Russell Luepker ’64

Work: Spent a significant portion of his career doing community disease surveillance and prevention

Education: History major at Grinnell; M.D., University of Rochester; M.S. in epidemiology, Harvard University

Quote: “I’ve been encouraged to pursue ideas that I think are important at local, national, and international levels.”

In a world of speedy delivery and instant gratification, it’s easy to feel frustrated by the slower pace of change in public health. But over the course of a career, the transformation of a disease — and the culture that surrounds it — can be enormous. Few know this as well as Russell Luepker, professor of public health at the University of Minnesota, focusing on cardiology.

Luepker’s interest in studying cardiology and public health was sparked in part by his father’s sudden cardiac death at age 51, when Luepker was a senior at Grinnell. At the University of Minnesota, he has headed up vast projects, including the Minnesota Heart Health Program, an effort to reduce heart attacks and strokes in six major cities in the upper Midwest, and a National Institutes of Health trial designed to improve healthy habits of school-age children.

It’s work that truly matters. According to the Institute for Scientific Information, Luepker’s research is among the most highly cited in the world, and the lessons he’s learned are being implemented. The country’s average lifespans continue to rise in part because death rates from heart attacks and strokes have fallen and new cases of heart disease are also declining.

He attributes the change to a variety of factors, including a cultural shift in attitudes toward smoking. “The decline in cigarette smoking, for example, is dramatic in our society,” he says. “I was in Copenhagen a few months ago, and they looked at me strangely when I asked for a nonsmoking area in a restaurant,” he recalls. “But here, it’s not just restaurants that are nonsmoking. It’s almost everywhere.”

Technology to save people who have had heart attacks has also made enormous leaps forward. “At both levels — preventing heart attacks and strokes from happening, and treating them and preventing a second event — have changed in favorable ways,” he says.

It’s that trajectory of positive change, says Luepker, that makes jobs like his worthwhile. “A career in public health is gratifying because you have the opportunity to help groups of people live better and healthier,” he says.

Jeremy Youde ’99

Work: Studies global health politics as a political science professor

Education: Political science/global development studies major at Grinnell; Ph.D. in political science, University of Iowa

Quote: “Implementing public health policies, especially when dealing with multiple countries, isn’t simply about science. We can’t just drop that in place. We have to understand the politics, the history, and the context of the countries and the situation to understand why people respond in specific ways in the first place.”

When the Ebola virus outbreak started making headlines earlier this year, one of the go-to sources for the media to discuss the logistical challenges of treating the disease was Jeremy Youde, associate professor of political science at the University of Minnesota at Duluth.

Youde has spent nearly his entire academic career researching global health politics — how the international community comes together (or fails to come together) to address transborder health issues.

A public health crisis offers plenty of challenges when it’s contained to a small area, says Youde. But when a deadly, communicable disease like Ebola crosses country lines, politics can make treating it even trickier. Some countries have strong, effective policies to address health crises, while some have weak ones — or policies that run counter to those of other countries. Organizations such as the World Health Organization, Doctors Without Borders, and Samaritan’s Purse all hope to alleviate the problems, but they struggle to coordinate their efforts. “It’s like herding cats,” says Youde. “Everyone wants to do their own thing, and each has their own idea about what’s best.”

Youde first got interested in global health politics at Grinnell, when he traveled to Zimbabwe and ended up doing an independent study project that examined the potential political and economic effects of an HIV epidemic in the country. “That was what first got me thinking about the intersection of public health and politics,” he says, a topic he ended up pursuing more systematically once he entered graduate school.

While Youde has had a chance to share his views in the media — he had an op-ed on The Washington Post website in August — much of his work will happen after the crisis has subsided. “My job is to step back and see what we can learn from a crisis. We want to find out how we can use these insights for future emergencies and outbreaks that occur.”

Debbie Gottschalk ’90

Work: Includes developing and refining public health-linked legislation

Education: American studies major at Grinnell; J.D., State University of New York-Buffalo School of Law

Quote: “We want to create the structures for people to be supported in their communities, no matter what kind of support they need.”

For most people, a vision of public health focuses primarily on the body — vaccinations and prenatal care, clean water, and healthy foods. But for Debbie Gottschalk, chief policy adviser to the secretary of the Delaware Department of Health and Social Services, a critical part of her job is working on policy that provides guidance and assistance to foster better mental health, too.

Recently, for example, she and others have been working to update the state’s civil mental health laws in ways that make it easier for people to get help — and less likely for them to be involuntarily committed. “Our emphasis has been on encouraging people to receive treatment voluntarily and to make it feasible for people to receive treatment in the community, rather than in institutions,” she says.

Gottschalk has also been instrumental in developing legislation for Delaware’s new aging and disability resource center. The program is designed to help older adults and those with disabilities maintain their independence by helping them find and fund everything from transportation to food delivery services to home health care options. Often, Gottschalk says, individuals can stay at home with just a few thousand dollars’ worth of help, compared to a six-figure price tag for some types of nursing home care. “Staying in their own homes is not just healthier for the patients,” says Gottschalk. “It’s also one of those rare times when what people want is actually more cost-effective than the alternative. It’s much less expensive to support people in their communities than to pay for them to move into a state institution.”

For Gottschalk, it’s work that leads to stronger communities, where loved ones can stay together when they have the resources they need.

Maia Olsen ’11

Work: Helping provide critical information on fighting noncommunicable diseases in resource-poor nations.

Education: Anthropology major and global development studies concentration at Grinnell; M.P.H. in international public health, Boston University

Quote: “We want to keep pushing the boundaries of global health. We want to say ‘Yes, we have to treat chronic diseases like cancer, asthma, and heart disease in places like Africa. It’s not too expensive. It’s not too difficult. We have to make it happen.’ ”

For years, treating HIV/AIDS in Africa seemed impossibly daunting; the affected population was enormous, treatments were expensive, resources were slim. But in recent years, thanks to efforts from scientists, governments, and public health officials, universal coverage seems tantalizingly within reach.

But now there are new challenges on the horizon. In many parts of Africa, rates of noncommunicable diseases including cancer, asthma, and heart disease are on the rise. Treatments are expensive. Resources remain modest. For Maia Olsen, a program associate at the global health organization Partners in Health, the excuses are as unsatisfactory as they were decades ago. “It’s the same place we were at with HIV,” she says, “and we want to push against that.”

Large-scale efforts to fight noncommunicable diseases in countries with poor populations are relatively new, and her program at Partners in Health is beginning to ramp up its efforts in countries including Rwanda, Lesotho, and Kenya. For Olsen, that means helping develop a website that promises to be the “connective tissue on policy and advocacy, planning resources, and telling the stories of what chronic diseases look like in really poor settings.”

The site will include training material for health care workers, information about policies, and a database of key planning tools and research. It will also include stories to illustrate why the problem is so critical to address — and why the tactics that have worked elsewhere may not be effective everywhere.

For example, while the United States was able to slash the incidence of lung disease by concerted efforts to discourage smoking, the same approach won’t necessarily be sufficient in other countries. “In some settings, people are getting lung disease because of the cooking stoves in their huts, but they might not have the money to buy something else,” she says.

In the end, she says, her organization’s work is part of a much larger effort to increase awareness of the problem of noncommunicable diseases in countries with poor populations. “For us,” she says, “that [growing awareness] will be a measure of success.”

Tim Johnson-Aramaki ’99

Work: Helps employers design workforce health programs to help workers get and stay healthy

Education: Fine art major at Grinnell; M.B.A. and M.P.H., University of Michigan

Quote: “Wellness requires a longer-term commitment because it’s about change, and usually people don’t change quickly. However, as large and critical as the issue is, we have to start with baby steps to bring about that change.”

As health care costs have skyrocketed, the companies covering their workers’ costs have tried minimizing their bills by raising deductibles and limiting coverage. But these days, they’re also layering on another tactic: helping employees get healthier through wellness programs.

For Tim Johnson-Aramaki, a workforce health consultant for Kaiser Permanente, the goal is both daunting and critical. He’s charged with helping employers get their employees healthier within a larger culture that has seen nearly unabated increases in obesity and diabetes, thanks in part to fast-food restaurants on nearly every street corner and increasingly sedentary jobs for employees. “We’ve developed the problems that we’re facing today over the past 50 years,” he says. “I can’t just go in and wave a wellness wand and change it.”

Johnson-Aramaki works with more than 30 organizations, including the University of California, which want to encourage their employees to get healthier. Efforts to jump-start that process can include premium reductions for things like getting a physical/preventive screening, participating in a 5K walk, or joining a smoking-cessation program.

But Johnson-Aramaki says that experts in this rapidly developing field are also approaching the problem more holistically. It’s not enough to participate in a 5K if workplaces offer vending machine candy bars in every breakroom and host regular pizza parties. And it’s not enough to tell an overweight employee to “work out more” if the weight gain is tangled up in a mental health issue such as depression.

In the end, he says, the real goal for wellness programs is to help create an environment that encourages people to adopt healthier habits for life. “Wellness isn’t really about ‘activities,’” he says. “It’s about changing the culture at workplaces, in families, in the larger society. The activities, though, are the things that help us start to change that culture.”

Scott Fridkin ’86

Work: Develops policies to prevent antibiotic resistant infections in healthcare settings

Education: Chemistry major at Grinnell; M.D., Loyola University Stritch School of Medicine

Quote: “I believe my efforts have directly affected the way the federal government is measuring the impact of its investments in health care-associated infection prevention. And it’s working.”

Hospitals are designed to help us get well, not make us get sick. But perhaps it’s no surprise that in an environment that by definition contains a stew of germs and bacteria, patients can end up with an illness they didn’t bargain for. Indeed, Centers for Disease Control and Prevention (CDC) estimates suggest that almost three quarters of a million of people get sick every year as a result of hospital-acquired infections.

It is Scott Fridkin’s job to help bring that number down. As senior adviser for antibiotic resistance in healthcare at the CDC, Fridkin helps develop smarter strategies to prevent antibiotic resistant infections, a critical subset of those hospital-acquired infections.

You’ve probably heard of “superbugs,” the strains of bacteria that have evolved to resist today’s antibiotics. Such superbugs are among the baddies Fridkin is charged to track and fight.

In 2005, Fridkin was able to calculate the first national estimate of people in the United States who developed the potentially deadly methicillin-resistant Staphylococcus aureus infection (MRSA) — it was an astonishing 110,000 people a year. “I believe that information sparked a public debate about how unacceptable infections with MRSA were,” he says.

The discussion ultimately involved patient advocacy groups, elected officials, scientists, and professional organizations and led to 25 states passing laws regarding the reporting of either healthcare-associated infections or MRSA specifically. These policy changes eventually led to federal policy changes in the Affordable Care Act. As of 2011, the number of serious MRSA infections has dropped to 75,000 cases per year.

The trajectory has been so successful, says Fridkin, that they’re using the work as a template to move forward. “We’re just beginning to put the same efforts in place for other antibiotic-resistant infections encountered in hospitals,” he says. “The lessons we learned from MRSA should be helpful.”