By Nate Hinkel
Throughout history the role of public health in the overall health care model has been one of great discovery, evolution and varying degrees of emphasis.
In Arkansas, which faces the challenges of great disparity and rural populations, it’s clear that an approach integrating public health efforts and the overall health care system is the ticket to better serving the state’s unique needs.
“What’s happening now, and increasingly has been for a couple decades now, is that state leadership and those molding health institutions like UAMS are all on the same page as far as the realization of how crucial it is to take responsibility of the health of Arkansans,” said Jim Raczynski, Ph.D., dean of the UAMS Fay W. Boozman College of Public Health. “Those in the health professions see the importance of not only treating people who come to them with diseases, but also figuring out ways to prevent problems, diseases and poor health.”
Last year, the College of Public Health celebrated a decade of researching the needs of Arkansans while working toward enacting initiatives and crafting policies to meet them. The college began in July 2001, but it was forward-thinking leadership several years before that set it in motion after Arkansas was awarded more than $50 million a year in a national legal settlement with the tobacco industry. In 2000 the people of Arkansas voted to become the only state to dedicate all of its settlement money to improve the health of its residents, 5 percent of which went to establish the College of Public Health.
“That was a landmark effort that really paved the way for enhancing public health in our state,” said UAMS Chancellor Dan Rahn, M.D. “You really can’t say enough about the leadership it took to direct all of the state’s tobacco settlement money and put it toward this vision that was at the time on the leading edge of innovation nationally. With the creation of this new public health hub at UAMS, it opened the gates for collaborations and a more streamlined approach with what the Arkansas Department of Health and other entities and institutions were doing for the betterment of the state.”
Finding Its Place
And while the role of public health in Arkansas is currently flourishing within its overall health care model, that was not always the case.
Raczynski said at the roots of public health were physicians looking into the causes of diseases, where the field of epidemiology developed. Even before the 18th century, the fields of medicine and public health were closely aligned, and still are in most countries throughout the world. But Americans tended to separate the two in the early 20th century. The major cause of disease in those times was infectious diseases rooted largely in unsanitary conditions and unsafe water and food supplies.
“A lot of the people involved in those issues were scientists or human rights activists or social workers,” Raczynski said. “Hookworm disease, malaria and yellow fever were a huge problem in Arkansas and throughout the South.”
In the early 20th century, medicine became focused on viruses and bacteria. The Flexner Report, roundly known as the landmark directive for medical education and care in the United States and Canada, generally recommended for medicine to continue going its separate direction while leaving the cleanup of unsanitary conditions to social advocates, which became known as public health.
“And so public health has sort of grown up as a secondary field,” Raczynski said. “The renaissance that we’re enjoying now with public health reemerging as part of the overall picture has not always been that way.”
Raczynski’s idea of public health is more in line with helping create policies to improve health and using evidence from research to change the behavior of people, which the College of Public Health has done successfully.
A recent flagship effort, Raczynski said, is a study done at UAMS that showed that a Community Connector Program developed and implemented by Tri-County Rural Health Network to enhance access to home and community-based health care services to the disabled and elderly can save millions in the Arkansas Medicaid program. The study’s key finding shows that the state’s Medicaid system had a net savings of more than $2.6 million over three years when Medicaid-eligible elderly and disabled adults with unmet long-term care needs in a three-county area were sought out and connected to home and community-based long-term care services.
“The intervention resulted in a more than 23 percent reduction in annual Medicaid spending per participant, demonstrating a savings of $3 for every $1 invested,” Raczynski said. “The bigger picture is that it proves that getting out into communities with these health workers and connecting with Arkansans makes sense medically and financially. That’s where I feel we can make the difference, in projects like this.”
Paul Halverson, Dr.P.H., Health Department director, believes the department’s aim is to control epidemics, ensure safe food and water, and improve maternal and child health services, among many other public health activities looking to improve the quality of life of Arkansans. Those bellwether successes include influenza immunization programs and hometown health initiatives at the community level.
“Many of our services are provided at the local level through a statewide service network. Our public health workforce is working every day to promote prevention services and to defend against threats to the public’s health,” Halverson said. “Our strategic objectives include decreasing infant mortality, reducing hypertension, increasing physical activity and reducing disparities.”
On the Same Page
Many of the successful public health initiatives in the state are the result of the Health Department and UAMS joining forces along with other state institutions and organizations.
The College of Public Health and Health Department are intertwined in many ways. Halverson himself is a full-time UAMS faculty member, with several other Health Department employees having appointments to teach at UAMS. The two entities share many research projects.
A number of Health Department employees from various disciplines are enrolled in the College of Public Health for advanced training. Since 2004, more than thirty have completed a Master of Public Health or a Post-Baccalaureate Certificate in Public Health. Before the college was established, Health Department personnel pursuing advanced training had to go out of state, with many receiving degrees from Tulane University’s School of Public Health and Tropical Medicine.
The relationship with the UAMS College of Public Health has provided Health Department employees a rigorous program while allowing them to work full time and balance other responsibilities. Their enhanced knowledge and abilities have benefited all Arkansans.
UAMS is also committed to using state-ofthe- art technologies, Rahn said, to provide rural communities with its nationally recognized ANGELS (Antenatal and Neonatal Guidelines, Education and Learning System) program. This program uses communications technology to provide long-distance care to rural Arkansas women and their newborns. UAMS also leads the Arkansas SAVES (Stroke Assistance Through Virtual Emergency Support) program, which links rural hospitals 24 hours a day to stroke specialists.
“Every day Arkansas is making strides to be a healthier place to live,” Rahn said. “I see it as essential that public health continues to be a cohesive force in transforming the way we look at health care in the state.”
Halverson agrees it’ll take an integrative effort moving forward.
“At the end of the day we want to bring public health and medicine back together,” Halverson said. “Now more than any time in our history we’re seamlessly integrating medicine and public health in innovative ways to keep Arkansans healthy.”