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CLASS SYMPOSIUM Grads of '75 Mix Medicine and Public HealthDuring a panel in the Class Symposium on June 8, four members of the HMS Class of '75 discussed the population perspective they have taken toward health care delivery. The speakers considered population-based approaches on the federal, state, and community levels to form policies and practices based on evidence rather than anecdote.
In a speech to her former classmates, Claire Broome, HMS '75, talked about how observational data analysis can help bring science into policy decisions. The panel was moderated by Claire Broome, a senior adviser to the director of integrated health information systems at the Centers for Disease Control and Prevention. Broome said her position at the CDC has allowed her to answer questions about population-based health care that medical school had not addressed. For instance, concern about lead poisoning in children in the 1980s sparked a need to decide if universal lead screening was necessary. The CDC found, however, that lead levels in most children had dropped dramatically, except in certain high-risk populations. The data helped shape a more effective policy that targeted these populations. Ulder Tillman, Delaware's director of public health, reviewed some state-level concerns in public health, such as environmental contamination, infectious diseases, natural disasters, and access to care. Tillman also praised recent studies that explore racial disparities in health care, adding that state life expectancies showed gaps of several years between blacks and whites. "One now must look at the impacts of cultural, historical racism on health care in society," she said, such as stressful effects of racial discrimination on health. Focusing on health at the city level, David Bor, HMS associate professor of medicine at Cambridge Hospital, used Cambridge as an example of how academia can engage in community health promotion. Bor helped coordinate an effort using students at the School of Public Health to develop priorities to curb teen pregnancy in the area. The students interviewed adolescent mothers and found that they were generally well informed about sex and contraception, but lacked access to contraceptives. The data the students collected was brought to the school board, resulting in a decision to dispense birth control pills in schools for the first time. Diana Petitti, director of research at Kaiser Permanente Southern California, talked about the "silent revolution" of evidence in health care, which has made quality measurement possible and allowed the development of quality standards and guidelines. "Without measurement, it's impossible to hold people accountable," Petitti said. Publicly reported comparisons of managed care organizations, for example, help raise overall standards among all of these organizations. All of the panelists mentioned that a lack of public trust is a barrier to developing effective health policies but that population-based data and evidence can give meaning and credibility to support health care policy decisions. —Courtney Humphries |
