University Times

Researchers and practitioners need to go beyond the science of their work to address the cultural aspects of dealing with public health problems.

In her March 31 lecture, “Achieving the Promise of Public Health,” Noreen Clark stressed the importance of transdisciplinary research that links the cultural and scientific dynamics of a health issue.

Clark, dean of the University of Michigan School of Public Health, was the featured speaker for the Graduate School of Public Health’s annual Thomas Parran Lecture. Clark’s academic interests include systems, policies and programs that promote health, prevent illness and enable individuals to manage disease.

Clark focused on challenges faced by schools and institutions of public health and the nature of transdisciplinary work.

Laying the foundation of public health challenges today, Clark stressed that there are not only many public health problems, but also a wide range of them:

• By 2025, 20 percent of the population will be elderly. By mid-century, the groups traditionally considered minority populations will become the majority. According to Clark, this demographic shift underscores the importance of problems concerning repressed cultures, race and ethnicity and brings a diverse set of perspectives to the table.

• Chronic diseases continue to be a major cause of death worldwide. Additionally, the World Health Organization has reported that depression is one of the major concerns for the 21st century, according to Clark.

• Infectious diseases such as HIV, tuberculosis and malaria account for significant portions of morbidity and mortality around the world.

• The impacts of emerging diseases such as SARS (Severe Acute Respiratory Syndrome) are still not fully known.

• Individual behavior plays an important role in obesity and smoking. About two-thirds of the American population is overweight and smoking is the No. 1 preventable cause of death around the world.

• Drug and alcohol abuse remain a serious concern.

• The continued degradation of air and water is pitting progress against environmental health.

• The disparities in heath status between the rich and poor are evidenced by 45 million uninsured Americans.

“And the economic disparity of cross-racial and ethnic groups in this country is a major factor in the disparities in health status,” Clark said.

These health challenges are both helped and complicated by globalization and changes in transportation and communication, according to Clark. The Internet allows quick transmission of medical records. Changes in research equipment and other devices dramatically is increasing the ability to address this wide range of very difficult public health problems, she said.

On the other hand, the increased mobility of people exacerbates public health problems. “Transportation has brought a variety of diseases to everyone’s doorstep,” Clark said.

Although technological tools such as the Internet and scientific discoveries present more possibilities for interventions, there also are social and behavioral aspects of health issues that need to be addressed.

According to Clark, younger scientists are working on the transdisciplinary needs of public health problems. “For example, our team of molecular epidemiologists started out very interested in infections, but after having looked at viral and bacterial infections, they are very interested in other factors associated with infection transmission such as socio and demographic characteristics, social context and behavioral characteristics.”

To foster this type of expanded study, schools of public health should seek to develop partnerships across disciplines, develop new disciplines and infuse teaching with research that crosses disciplinary lines. She added, “Schools of public health really have to think about the ultimate outcome of their research, ‘How does the word go out?’”

—Mary Ann Thomas