UNIVERSITY OF MINNESOTA
Twin Cities Campus
Office of the Dean
School of Public Health
A302 Mayo Memorial Building
Mayo Mail Code 197
420 Delaware Street S.E.
Minneapolis, MN 55455-0381
Phone: 612-624-6669
Fax: 612-626-6931
http://www.sph.umn.edu
July 26, 2005
To: John Finnegan, Ph.D.
Interim Dean
School of Public Health
From: Judith Garrard, Ph.D.
Associate Dean for Research
Chair, SPH Futures Committee
I am pleased to submit the final report of the SPH Futures Committee. The members of the
Futures Committee have worked extensively in the discussions and in their preparation of the
written materials, as described in the report. It was a pleasure to work with these faculty on this
task. May the results of their work be useful to the School in the decisions to be made about
hiring new faculty in the future.
cc: Members of the SPH Futures Committee
Sudipto Banerjee
Robert Jeffery
Rhonda Jones-Webb
DeAnn Lazovich
James Neaton
James Pankow
Marguerite Pappaioanou
Gurumurthy Ramachandran
John Adgate
John Connett
Lynn Eberly
Roger Feldman
Aggie Leitheiser, MDH
Leslie Lytle
Betsy Wattenberg
Eyal Shahar
William Toscano
Douglas Wholey (on
sabbatical)
Beth Virnig
Sandra Potthoff
Donna McAlpine
SPH Futures Committee: Executive Summary
Purpose
The purpose of this report is to describe the background, membership, and accomplishments
of the SPH Futures Committee. The Committee was appointed in February 2005 by Interim
Dean John Finnegan with the goal of developing the next stage of planning for the future
investment in faculty research.
The Interim Dean described the future plans for 30 new faculty positions over the next five
years, and the Futures Committee was asked to identify the broad research areas in which these
new faculty were needed. The final report of this Committee was to be regarded as faculty
consultation to the next Dean of the School of Public Health.
Results
Focus Areas. Following extensive discussion over five months, the Committee identified
five broad topic areas as the Focus Areas for emphasis in new hires:
• Health Disparities
• Chronic Disease
• Infectious Disease
• Public Health Genetics
• Food Safety and Nutrition
Global Health Research. Within each of these five Focus Areas, global health research was
to be emphasized; however, the intensity of this emphasis might vary among the five areas.
Cross Cutting Expertise. In addition to the five Focus Areas, each with a global emphasis,
the Futures Committee identified five kinds of cross-cutting expertise within each Focus Area::
° Mathematical Modeling, Biostatistics, and Causal Inference
° Etiology: Biological, Sociological, Psychological, Economic, Environmental
° Policy, Finance, and Healthcare Delivery
° Prevention/Intervention/Clinical Trials
° Information Technology
Graphic Summary of Areas of Focus by SPH Futures Committee
Focus Areas
Food Safety
& Nutrition
Public Health
Genetics
Scope
Cross-cutting
Expertise
Chronic
Disease
Infectious
Disease
Health
Disparities
Global Emphasis
Etiology:
Biological
Sociological,
Psychological,
Environmental,
Economic
Mathematical
Modeling,
Biostatistics
and
Causal
Inference
Prevention/
Intervention/
Clinical Trials
Policy,
Financing,
and
Healthcare
Delivery
Information
Technology
Criteria for Prioritizing Focus Areas for New Hires
The Committee recommended that decisions about the which Focus Areas to implement first
be based on the following rank ordered criteria (1=highest; 6=lowest):
1. Serious Public Health problem with local, national, or global implications
2. Existing strengths/resources in SPH, the AHC, and the University
3. Potential for unique contribution in the area by SPH, the University, and the State
4. Potential for contributing to training/education programs
5. Interdisciplinary research potential
6. Funding potential
SPH Futures Committee Report
Page 3
SPH Futures Committee Final Report
Charge to the Committee
The SPH Futures Committee was appointed by Interim Dean John Finnegan in a memo,
February 27, 2005. The charge to the Committee was to develop specific recommendations for
investments in research areas to guide the SPH over the next five years in the creation of new
faculty positions. The Committee was asked to consider the following background materials:
•
•
•
•
•
Roundtable discussion notes from the SPH Faculty Retreat (January 13, 2005)
IOM report of November 2002;
NIH Roadmap;
CDC Futures Initiative; and
Minnesota Department of Health initiatives.
These documents were made available at the following web site:
https://my.ahc.umn.edu/metadot/index.pl?iid=260090
Interdisciplinary Role of SPH and Contribution to Educational Programs
The Committee was also asked to include in their deliberations "the School's interdisciplinary
position and role in the health sciences, the University, and the community such as those strong
relationships we have with the Cancer Center, Medical School, Veterinary Medicine, Nursing,
other AHC and University units, and the Minnesota Department of Health. In terms of investing
in faculty, proposed joint investments in appropriate interdisciplinary areas are important to our
future strength. Moreover, the Committee should consider how investments can strengthen and
build the academic and training programs in the SPH and AHC."
Assumptions
In the initial meeting with the Futures Committee, Interim Dean Finnegan met with the
Committee and provided several assumptions that would guide the Committee discussion:
•
•
•
•
•
Cluster hires -- Two or more faculty would be hired within each of the Focus Areas.
Previous experience has shown that when only one faculty member was hired in a new
area, he/she often did not have colleagues to talk to or work with. A cluster hire would
include faculty at different academic ranks and with varying areas of multidisciplinary
expertise.
Multidisciplinary capability -- New faculty hires would be expected to be capable of
multidisciplinary research individually and as a cluster. For example, one of the new hires
in the health disparities Focus Area might have a background in policy; whereas another in
the same cluster might have additional expertise in mathematical modeling.
Educational programs -- Consideration of curriculum issues in undergraduate and graduate
education areas of emphasis were beyond the scope of this Committee. The Committee
was asked to concentrate on identifying broad research areas needed in the future.
Financing of new positions -- Concern about how these new positions would be funded was
not part of the Committee's charge, although a general understanding of financing would be
provided.
Organizational structure -- Consideration of the divisional homes of new faculty hires and the
organizational structure of the School were beyond the scope of the Committee.
SPH Futures Committee Report
Page 4
Committee Membership
The Committee consisted of 21 faculty appointees, balanced by division membership,
academic rank, and gender, and one person from the Minnesota Department of Health (MDH);
the Committee was chaired by the Associate Dean for Research. Committee members included:
Sudipto Banerjee
John Adgate
Eyal Shahar
Robert Jeffery
John Connett
William Toscano
Rhonda Jones-Webb
Lynn Eberly
Douglas Wholey (on
DeAnn Lazovich
Roger Feldman
sabbatical)
James Neaton
Aggie Leitheiser, MDH
Beth Virnig
James Pankow
Leslie Lytle
Sandra Potthoff
Marguerite Pappaioanou
Betsy Wattenberg
Donna McAlpine
Gurumurthy Ramachandran
Judith Garrard, Chair
Sarah Tschida, Staff
Committee Meetings
The Futures Committee met weekly from March to June, 2005, for a total of ten
meetings, one of which included a briefing about the plan for financing 30 new faculty positions.
Committee participation and the minutes of these meetings are available at the following
website: https://my.ahc.umn.edu/metadot/index.pl?iid=260090
Following the initial meeting with the Interim Dean, the second meeting consisted of
individual and group rank ordering of topics identified during the SPH Faculty Retreat. The
method for accomplishing the ranking was the Priority Sort which is derived from the Q-sort
technique for ranking large numbers of items. The Priority Sort consisted of the following
activities by the Committee members:
Priority Sort Method. Each member of the Futures Committee was given a deck of 35 small
cards. Thirty-two cards had one topic each from the faculty retreat and SPH roundtables, and 3
were blank which each person could use to add up to 3 new topics. Each deck also included 7
priority level cards (#1=highest priority, #7=lowest priority). In the course of completing this
task, 26 new items were generated by the group, resulting in a total of 58 topics under
consideration. See Appendix I.
Individual Sort. The first task in the Priority Sort was for each individual to assign each topic
card to one of the 7 priority levels, with an equal number of cards per level. These individual
sorts were conducted without discussion or collaboration among the Committee members. If new
topics were added, then the individual was to assign each to a priority level in his/her own sort.
Blank cards were to be assigned to level #7 if no topic was added. Next, the five items within
each priority level were to be rank ordered. Any card could be re-assigned by the individual at
any time until completion of this task. This resulted in 35 rank ordered topics for each individual.
Group Sort. In the second task, each person contributed his/her seven highest ranked topics,
i.e., cards 1-5 under priority level #1 and the first two cards under level #2, to a Group Sort,
which also had 7 levels of priority. Thus, each of the 13 committee members present that day
placed his/her highest ranked topic under Group Sort #1 level, then all placed their second
highest ranked topic. The rankings were not considered final until input had been received from
people unable to attend.
The cards assigned to the 7 Group Sort priority levels were reproduced in large print and
displayed in the meeting room at all subsequent committee meetings. In the final Group Sort
rankings, there were overlaps in topics assigned to the same or among the top 7 priority levels,
suggesting similar levels of priority for some topics; see Appendix II.
SPH Futures Committee Report
Page 5
Use of Priority Sort Results. Although the group ranking results provided a basis for
discussion about the areas to be emphasized in hiring new faculty, the Committee's final choice
of Focus Areas was not simply an enumeration of top ranked items. Subsequent meetings
consisted of committee discussions about the following issues:
• Definition -- how the topics could be defined,
• Breadth -- how they differed or could be merged under broader topics,
• Specificity -- what the Focus Areas should be, including definition and specificity,
• Strengths and Weaknesses -- how the strengths and weaknesses of the School, the AHC, and
the University related to the choice of Focus Areas,
• Uniqueness -- the unique contribution of the University of Minnesota and the state to
different Focus Areas,
• Education -- how each of the areas could contribute to existing or future teaching programs,
• Cross-cutting Areas -- the differentiation between Focus Areas and cross cutting areas and a
graphic overview,
• Global Health -- the role of global health and global perspectives in the Focus Areas,
• Integration -- the Committee's choice of specific Focus Areas and Cross cutting areas, with
the agreement that a global health perspective would be important within each Focus Area,
• Criteria -- the generation of six rank-ordered criteria that could be used to guide the choice of
which Focus Areas to implement first.
Final Recommendations
Focus Areas. As the Futures Committee began to reach closure in the final meetings, there
was agreement that the final recommendation should be for five Focus Areas:
• Health Disparities
• Chronic Disease
• Infectious Disease
• Public Health Genetics
• Food Safety and Nutrition
Global Health. Within each of these five areas, there should be an emphasis on Global
Health, although it was recognized that the intensity of Global Health would vary from Area to
Area. For example, the importance of Global Health might be greater in a Focus Area such as
Infectious Diseases, and perhaps less so in the Focus Area of Chronic Disease.
Cross-cutting Expertise. The Committee also identified Cross-cutting Expertise needed for
each of the Focus Areas. These include:
•
•
•
•
•
Mathematical Modeling, Biostatistics, and Causal Inference
Etiology: Biological, Sociological, Psychological, Economic, Environmental
Policy, Finance, and Healthcare Delivery
Prevention/Intervention/Clinical Trials
Public Health Informatics
SPH Futures Committee Report
Page 6
Criteria for Prioritizing New Hires. The Committee recommended that decisions about the
which Focus Areas to implement first be based on the following rank ordered criteria (1=highest;
6=lowest):
1. Serious public health problem with local, national, and/or global implications
2. Existing strengths/resources in SPH, the AHC, and the University
3. Uniqueness of the area in SPH, the University, and the State
4. Potential for contributing to training/education programs
5. Interdisciplinary research potential
6. Funding potential.
Summary of Discussions (Appendix III)
Focus Areas. For each Focus Area, a member of the Futures Committee agreed to write a
summary of the discussion based on the following topics.
I.
II.
III.
IV.
V.
Definition
Significance of the Area
Assets Within SPH
Collaborations outside of SPH
Future Directions, including funding possibilities
Cross Cutting Expertise. Futures Committee members also prepared a summary of the
different kinds of Cross-cutting Expertise needed, using the same format:
A.
B.
C.
D.
E.
Definition
Significance of the Focus Area
Assets Within SPH
Collaborations outside of SPH
Future Directions, including funding possibilities
Recommendations for Implementation
In general, the Futures Committee recommends the hiring of new faculty in clusters with
different academic ranks (assistant, associate, and full professor). It was also agreed that a
within a new-hire cluster, faculty should have not only the expertise of the Focus Area, but also
multidisciplinary expertise in one or more of the cross cutting areas. For example, within the
Focus Area of Public Health Genetics, one of the new hires might have expertise in mathematical
modeling, whereas another within the same cluster, might be an additional expert in the
financing of public health genetics in the health care delivery system, and yet a third might have
additional expertise in information technology. It will not be possible, or sometimes even
necessary, for all of the different kinds of Cross Cutting Expertise to be represented in any one
cluster hire; however, other, existing SPH faculty or collaborators might have such expertise.
The Futures Committee discussed the need for Global Health to be a consideration by faculty
within each of the Focus Groups.
Another consideration was that new hires, regardless of the Focus Area, could not be
'dropped on barren soil' in SPH. An important part of each description was to identify other
SPH Futures Committee Report
Page 7
faculty within SPH who were already working in the Focus Area, as well as current or potential
collaborations across the AHC, the University, and the State. In a number of the descriptions of
the Focus Area, individual faculty are identified to illustrate the range of faculty already involved
in this area as well as the type of research already being conducted. There was no intent to
exclude faculty from this list. If additional faculty want to have their names included, they are
encouraged to make these additions. In general, a Focus Area was not meant to be exclusionary,
rather each is an area that needs emphasis within the School. The Committee also discussed the
possibility of research staff (e.g., Research Fellows, Research Associates, as well as Graduate
Research Assistants), or other infrastructure investments, as important inclusions in one or more
of the cluster hires.
Since the financing of new hire positions will need to be staged over time, The Futures
Committee developed criteria for choosing which Focus Area would be the first to have a cluster
hire. Implementation of the hiring process was not within the scope of the Committee. For
example, whether or not a senior faculty member would be hired first, then provide the
leadership for the search for other, perhaps more junior faculty, was not part of the Committee's
charge. Nor was the Division assignment or percent time to be shared with other Schools or
Colleges discussed.
As specified in the charge, this report is being submitted to the Interim Dean, John Finnegan,
with the goal of developing the next stage of planning for the future investment in faculty
research. The content of this report is regarded as faculty consultation to the next Dean of the
School of Public Health.
Respectfully submitted,
Judith Garrard, Ph.D.
Associate Dean for Research
Chair, SPH Futures Committee
SPH Futures Committee Report
Page 8
Acknowledgments
The written descriptions of the Focus Areas and Cross Cutting Areas in Appendix III
depended on the voluntary efforts of specific members of the Futures Committee. The time and
effort they contributed are greatly appreciated:
Focus Areas
Health Disparities -- Rhonda Jones-Webb
Chronic Disease -- Beth Virnig
Infectious Disease -- Marguerite Pappaioanou
Public Health Genetics -- James Pankow
Food Safety and Nutrition -- Robert Jeffery
Cross Cutting Expertise
Mathematical Modeling, Biostatistics, and Causal Inference -- Sudipto Banerjee
Etiology: Biological, Sociological, Psychological, Economic, Environmental -- Donna McAlpine
Policy, Finance, and Healthcare Delivery -- Sandra Potthoff
Prevention/Intervention/Clinical Trials -- John Connett
Information Technology -- Douglas Wholey (on sabbatical); edited by Sandra Potthoff
SPH Futures Committee Report
Page 9
Appendix I. Topics Considered by the SPH Futures Committee
32 Topics from the SHP Faculty Retreat and
26 Topics Added by Futures Committee Members
Topics from SPH Retreat
Advancing Public Health Genetics
Aging
Bioinformatics
Biostatistics Theory and Methods
Bioterrorism Prevention
Built Environment and Health
Children, Family, Women's Health
Chronic Disease
Clinical Research
Clinical Trials
Community-based Research
Environmental Health Sciences
Epidemiologic Theory and Methods
Evidence-based Public
Food Safety & Food Production Protection
Global Health
Health Communication
Health Disparities
Health Economics
Health Policy and Law
Health Practice
Infectious Disease
Obesity
Populations & Environmental Interaction
Public Health
Public Health Administration
Public Health and Cultural Competence
Public Health Genomics
Public Health Informatics
Social & Behavioral Approaches to
Healthy Lifestyles Promotion
Social Epidemiology
Veterinary Public Health
New Topics
Abusive Behavior
Accidents/Prevention
Addiction
Adolescent Health
Cancer
CVD
Economics & Epidemiology: A Joint
Approach
Ethics
Expert Judgment Assessment
Healthcare Delivery
Health Services Research Methods
Health Systems Improvement
Immigration/Refugee Health
Improving Health Systems
Injury Prevention
Life Stage Risk Assessment
Mathematical Modeling of Env. Systems
Mechanistic & Statistical Modeling of
Diseases
Mental Health
Public Health Leadership
Public Health Systems Biology
(Syndemics)
Social Insurance
Spatial Analysis with Geographical
Information Systems
Systems Biology
Translational Research: Healthcare and
Public Health
Violence/Gang Behavior
SPH Futures Committee Report
Page 10
Appendix II. Topics Assigned to Seven Highest Priorities
in Group Priority Sort by SPH Futures Committee
Group Sort #1 Highest Priority
*CVD
Social Epidemiology
Global Health
Environmental Health Sciences
Environmental Health Sciences
Social & Behavioral Approaches to Healthy
Lifestyle Promotion
Advancing Public Health Genetics
Bioinformatics
Infectious Disease
Infectious Disease
Clinical Research
Clinical Research
Epidemiologic Methods
Group Sort #2
Health Economics
Advancing Public Health Genetics
Global Health
Environmental Health Sciences
Public Health Genomics
Chronic Disease
Health Disparities
*Epidemiological Theory & Methods
*Cancer
Clinical Trials
Bioinformatics
Bioinformatics
Clinical Trials
Group Sort #3
Obesity
Public Health Genomics
Public Health Informatics
Populations & Environmental Interaction
Populations & Environmental Interaction
Clinical Trials
Social & Behavioral Approaches to Healthy
Lifestyle Promotion
Community-Based Research
Infectious Disease
Infectious Disease
Biostatistics Theory and Methods
Biostatistics Theory and Methods
Bioinformatics
Group Sort #4
Public Health Administration
Community-Based Research
Clinical Research
*Mathematical Modeling of Env. Systems
Social & Behavioral Approaches to Healthy
Lifestyle Promotion
Aging
Aging
Public Health Genomics
Public Health Genomics
Public Health Genomics
Public Health Genomics
Infectious Disease
*Mental Health
* New topic added by an individual Committee member
Repeat topics indicate assignment to this priority level by ≥2 Committee members
SPH Futures Committee Report
Page 11
Group Sort #5
*Health Systems Improvement
Bioinformatics
Populations & Environmental Interaction
Advancing Public Health Genetics
Social & Behavioral Approaches to Healthy
Lifestyle Promotion
Advancing Public Health Genetics
Chronic Disease
Health Economics
Health Policy and Law
Infectious Disease
Infectious Disease
*Adolescent Health
Public Health Genomics
Public Health Genomics
Group Sort #6
*Addiction
Chronic Disease
Chronic Disease
Obesity
Bioinformatics
Advancing Public Health Genetics
Obesity
Biostatistics Theory and Methods
Built Environment and Health
Environmental Health Sciences
Food Safety & Food Production Protection
Infectious Disease
*Translational Research: Healthcare and
Public Health
Group Sort #7 Lowest Priority of the Top 7 Categories
Aging
Global Health
Global Health
Social Epidemiology
Environmental Health Sciences
Obesity
Infectious Disease
Infectious Disease
Chronic Disease
Clinical Research
Public Health Genomics
Epidemiologic Methods
Built Environment and Health
SPH Futures Committee Report
Page 12
Appendix III
Focus Areas Defined
and Cross-cutting Expertise
SPH Futures Committee Report
Page 13
Focus Area: Health Disparities
I. Definition
The field of disparities research in public health broadly encompasses the study of inequities
in attaining optimum health or accessing quality health care among social groups within a
population. Overwhelmingly, current research focuses on racial and ethnic disparities, but the
theoretical and empirical models used can and have been extended to other types of social
disparities such as those involving socio-economic status, gender, sexual orientation, geographic
location, disability, age, and other stigmatizing conditions. We take this broad view of health
disparities.
II. Significance
Investing in health disparities research and education at the University of Minnesota SPH is
important for several reasons:
First, health disparities research is a natural fit for the SPH. Health disparities are antithetical
to our basic notions about public health. Public health is fundamentally about maximizing the
health of populations and eliminating barriers to that goal. Interest in disparities research stems
partially from the realization that increasing the health of the population has sometimes either
created or widened gaps between social groups. Health disparities research investigates the
process through which these gaps are created and sustained, and potential practice and policy
solutions for eliminating disparities.
Second, closing the gaps between population subgroups in realizing optimum health and
receiving quality health care has received recognition at the national level. It is a central goal of
Healthy People 2010 (spearheaded by the Department of Health and Human Services) and of the
National Institutes of Health’s National Center on Minority Health and Health Disparities.
Third, there is a rich funding environment for health disparities research and education.
Substantial funding from the National Institutes of Health, Centers for Disease Control,
Environmental Protection Agency, and numerous private foundations is now being directed at
this field of research.
Fourth, the topic of health disparities has been of special concern in Minnesota. Despite
Minnesota’s ranking as one of the nation’s healthiest states, minorities in Minnesota experience
shorter life spans, higher rates of infant mortality, higher incidences of diabetes, heart disease,
cancer and poorer general health than Caucasians (Minnesota Department of Health, 2004;
SHAPE, 2002). As a SPH, we need to take a key leadership role in addressing health disparities
in Minnesota and elsewhere.
Finally, health disparities is an important global issue. Health disparities are most evident in
developing countries and a number of immigrant groups (Somalis, Hmong) from developing
countries now reside in Minnesota.
SPH Futures Committee Report
Page 14
III. Existing Assets in the SPH
Faculty: There are several SPH faculty who are engaged in conducting research on health
disparities; but for a large number of these faculty, health disparities is not their primary area of
research interest. During spring 2005, faculty formed a Health Disparities Working Group to (1)
provide greater visibility to health disparities research in the SPH, (2) strengthen collaborative
efforts among SPH faculty and community-based organizations engaged in health disparities
research, and (3) ensure health disparities issues are better integrated in course curricula.
Currently, faculty in the SPH are engaged in health disparities research on range of issues
including:
Etiological Studies
Obesity (Mary Story, Simone French, Diane Neumark-Sztainer)
Cardiovascular disease (David Jacobs, Pam Schreiner, Russell Luepker, Aaron Folsom, Lyn
Steffen)
Alcohol and tobacco use (Rhonda Jones-Webb, Harry Lando, Jean Forster)
Reproductive health (Wendy Hellerstedt)
Childhood chronic health conditions (Joan Patterson)
Methods Studies
Conceptualization and measurement of SES (Michael Oakes, Rhonda Jones-Webb)
Survey methods and diverse populations (Todd Rockwood)
Biostatistical modeling, especially for spatially referenced populations and health outcomes
(Sudipto Banerjee, Brad Carlin, Melanie Wall) and longitudinal studies (Lynn Eberly)
Community-university partnerships based on community-based participatory research
(CBPR) models (Kathleen Call, Donna McAlpine, Rhonda Jones-Webb, Wendy
Hellerstedt, Jean Forster, John Adgate, Sara Axtell)
Prevention/Intervention Studies
Alcohol initiation (Kelli Komro, Cheryl Perry)
Obesity prevention (Mary Story)
Delivery/Financing/ Policy Studies
Access and barriers to health insurance and health services (Kathleen Call, Donna McAlpine,
Lynn Blewett, Rosalie Kane, Ira Moscovice, James Hart, Charles Oberg)
Discrimination and quality of health care (Michelle van Ryn)
Health care financing e.g., Medicaid and Medicare utilization (Beth Virnig, Marshall Mc
Bean)
Access to psychotropic prescription drugs (Judy Garrard)
Organ donation (David Radosevich)
Teaching Program: Other assets include our teaching program. The SPH offers several
graduate courses relevant to health disparities. These courses include
• Social Inequalities in Health (PH6055),
• Race, Class, and Family Formation (PH6628);
• Community Organizing for Public Health (PH6066);
• Medical Sociology (PH5885);
• Sociology of Health and Illness (PH8805);
• Chronic Illness and Disability in Childhood: Principles, Programs, and Policies (PH6613); •
Foundations of Maternal and Child Health Leadership (PH6630);
SPH Futures Committee Report
Page 15
•
•
Families and Health: An Ecosystems Approach (PH6645); and
Spatial Statistics (PH8472).
In addition, there are continuing education opportunities on health disparities issues through
the Public Health Institute, the Maternal Child Health Summer Institute, and Healthy
Generations.
Community Assets: Minnesota has one of the largest Hmong and Somali populations and one
of the largest urban Native American populations in the U.S. and has experienced significant
growth among Latinos (Ronningen, 2003; US Census, 2000). It also has a significant rural
population. In Spring 2001, the Minnesota Legislature passed The Eliminating Health
Disparities Initiative (EHDI) that allocated $9.5 million to the Minnesota Department of Health
to improve the health status of the American Indian community and communities of color in
Minnesota. Minnesota is only one of two states to have such legislation.
IV. Opportunities for Collaboration
Potential local collaborators at the University of Minnesota and in the Twin Cities region
include:
Rural Health Research Center, SPH
Department of Sociology’s Life Course Center
Minnesota Population Center
The Institute of Child Development
The Humphrey Institute
Hispanic Advocacy and Community Empowerment through Research, CURA
The School of Nursing
Department of Family Medicine and Community Health, UM Medical School
NorthPoint Health and Cultural Wellness Center
Powerderhorn-Phillips Cultural Wellness Center
New Americans Community Services
Chicanos Latinos Unidos En Servicio
Center for Southeast Asian Research and Education
Urban League
Minnesota Asian/American Health Coalition
Minnesota International Volunteers Association
Minnesota Department of Health
Hennepin County Medical Center
Regions Medical Center
Center for Chronic Disease Outcomes Research, Minneapolis VAMC
Health Partners Research Foundation
In addition, there are several educational institutions outside of Minnesota with which we can
collaborate, including the John Hopkins Center for Health Disparities and Emory University
Center for Research on Health Disparities.
SPH Futures Committee Report
Page 16
V. Future Directions and Recommendations for Investment
As indicated above, the SPH has faculty with expertise in a range of issues related to health
disparities. However, further investment is needed to address gaps in our current expertise and
establish the SPH as a national leader in health disparities research and training. We recommend
the following:
1. Hire senior and mid-level faculty (3) with expertise in developing interventions and policies
to reduce disparities in health and health care domestically and globally (e.g., health
promotion, health economics, health policy, and international health). We have some
knowledge about the causes of inequalities in health and access to health care, but less
knowledge about what strategies are most effective in closing current gaps. Special
consideration should be given to hiring new faculty with expertise in developing
interventions and policies on topics of interest to current SPH faculty.
2. Hire senior, mid, or junior level faculty (2) with strong methodological training (e.g., social
and behavioral sciences, biostatistics) in cutting edge methodologies to better address health
and health care disparities domestically and globally.
3. Provide resources and infrastructure to ensure success (e.g., Research Associates, Research
Fellows, and Research Assistants to work with new and current faculty; additional resources
for planning and engaging local and national stakeholders in making the SPH a national
leader in health disparities research)
4. Develop a cross-cutting area on Health Disparities in the SPH’s teaching program. We
already teach a number of courses that can provide the basis for a concentration in Health
Disparities (See Assets: Teaching Program).
SPH Futures Committee Report
Page 17
Focus Area: Chronic Disease
I. Definition
This research reflects a variety of approaches to studying the causes, prevention, treatment
and effects of chronic diseases. These conditions are not acute (that is, with a defined beginning
and end point of a relatively limited duration) such as most infectious diseases, injuries or
accidents. Chronic diseases often have a long induction period and require treatment over an
extended period of time and, in many cases, the clinical approach is management rather than
cure. They are frequently associated with disability. Some chronic diseases may experience acute
periods, but are, nonetheless, long-term in nature. Examples of chronic diseases include: cancer,
vascular diseases (including coronary, cerebral, peripheral), diabetes, chronic lung diseases and
asthma, renal failure, Alzheimer’s Disease, and arthritis.
II. Significance
With the aging of the population and the concomitant shift in epidemiology, chronic disease
has been widely recognized as the dominant disease pattern of the 21st century. Chronic diseases
account for 7 of every 10 deaths and affect the quality of life of 90 million Americans. Although
chronic diseases are among the most common and costly health problems, they are also among
the most preventable. Beyond primary prevention, secondary and tertiary prevention are essential
strategies for managing the costs and disability associated with chronic disease.
III. Assets within the SPH
The SPH has a large number of faculty who study various aspects of chronic disease. While
the list that follows may appear to be long, the scope of the topic cannot be ignored and need for
expansion remains. Notice, that many faculty study multiple chronic diseases, which necessarily
may limit the depth of available resources for any one condition. The SPH has a long track
record of establishing and maintaining population-based cohorts for the study of risk factors for
chronic disease. With an upcoming linkage of three of these cohorts to Medicare data, a group of
faculty will be working to extend this etiologic work to study treatment and outcomes. In
general, secondary databases such as the Medicare data, the SEER cancer registries and national
survey data are important tools for facilitating the study of chronic disease. In all cases, disparity
is a central problem with chronic disease.
SPH Faculty Engaged in Disease-specific Chronic Diseases:
• Vascular diseases; Folsom, Luepker, Shahar, Holtzman, Connett, Eberly, Neaton, Schreiner,
Crow, Jacobs, Blackburn, Steffen, Duval
• Diabetes and Chronic Renal Failure: McBean, Pereira, Duval
• Cancer: K. Anderson, Virnig, Folsom, Lazovich, Carlin, Church, Jacobs, Flood,
• Chronic Lung Diseases: Shahar, Connett
• Osteoporosis, Arthritis, fractures: RL Kane, Holtzman, Schreiner,
• Psychiatric and Neurologic Disorders: Garrard, McAlpine
SPH Faculty Engaged in Research that Transcends Specific Chronic Diseases:
• Epidemiology/prevention: Folsom, Lazovich, Anderson, Shahar
*this also links to genetics, nutrition
• Screening: Church, McBean, Virnig
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Treatment: McBean, Virnig, RA Kane, RL Kane
Process management: Potthoff, Wholey
Outcomes including survival: Le, McBean, Virnig, RL Kane, Holtzman, Rockwood
Randomized Trials: Neaton, Connett, Luepker
Statistical modeling: Carlin, Connett, Eberly
Long-term Care and Disability: RL Kane, RA Kane, Garrard, Nyman
IV. Collaboration outside the SPH
The Clinical Outcomes Research Center (CORC) is an example of a medical school/SPH
collaboration. Likewise, there are established SPH collaborations with the Cancer Center, several
departments in the Medical School including Orthopedics and Surgery, School of Nursing,
College of Pharmacy, and the Center for Bioethics. In addition, faculty actively collaborate with
the US Renal Dialysis System, the Mayo Clinic, Minnesota Department of Health (e.g., several
faculty members are participating in the State Cancer Plan), and the Minneapolis VAMC Center
for Chronic Disease and Outcomes Research (CCDOR).
V. Future Directions and Recommendations
As indicated above, a substantial number of SPH faculty are actively involved in the study of
chronic disease and many established collaborations. However, given the wide array of diseases
and the unique etiologic, treatment and management issues for each, additional faculty are
needed. When hiring such faculty, it will be important that they are linked to both a disease or
group of diseases as well as an aspect of disease being studied.
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Focus Area: Infectious Disease
I. Definition
Infectious disease (ID) is one of the leading causes of morbidity and mortality worldwide,
causing approximately 14 million (25%) global deaths each year, and 1 in every 2 deaths in
developing countries. HIV/AIDS, malaria, tuberculosis, maternal and perinatal conditions,
diarrheal disease, acute respiratory infections, and measles remain leading killers in the
developing world, and cause significant morbidity and mortality in the United States. At the end
of 2004, the World Health Organization estimated that almost 40 million people were living with
HIV globally, with almost two-thirds in sub-Saharan Africa and over 20% in Asia. Influenza,
causes significant morbidity and mortality worldwide annually, (between approximately 600,000
to 1.5 million deaths) and poses considerable threat to world health with its potential to cause a
large-scale pandemic.
Approximately 75% of emerging infectious diseases are transmitted from animals to humans.
The occurrence of infectious diseases will only increase in the future due to an ever increasing
human population; human encroachment into wildlife habitat; changing climates and
ecosystems; increasing global trade; globalization of food production and supply; human-made
and natural disasters; increased rapid movement of animals and international travel of humans;
and changing human behaviors—such as the consumption of bush meat, and the importation and
purchase of exotic animals for pets. With these and other factors, infectious diseases know no
boundaries, and the cluster of infectious disease positions must maintain a global view and
approach to the development of research and teaching programs.
The University of Minnesota is one of only three institutions in the United States where a
School of Public Health (SPH), School of Medicine, and College of Veterinary Medicine are
located within the same University, and within 10 miles of each other. In addition, the Academic
Health Center and its close relationship to one of the top state health departments in the country-the Minnesota Department of Health (MDH)--as well as the Board of Animal Health,
Department of Agriculture, food industry corporations, and community health organizations
further position the University of Minnesota to become one of the top SPHs in the country in ID.
The President of the University has named several high priority interdisciplinary academic
initiatives, including “Healthy Foods, Healthy Lives”, and “Translational Research in Human
Health”. A strong ID program would be an important component to each of these priority areas,
and would be well-positioned to attract University as well as external sources of funding.
The goals of an ID program in the University of Minnesota School of Public Health is to
anticipate and meet the increasing and diverse needs for research and training in infectious
diseases epidemiology, to build capacity in infectious disease expertise in Minnesota, the U.S.,
and globally, and through sound science, provide needed information for the development and
refinement of sound public policies and practices aimed at reducing illness and death due to
infectious diseases, at home and abroad.
III. Assets Within the SPH
SPH Faculty. The University of Minnesota is rich in ID expertise and experience,
particularly in clinical and laboratory sciences. However these resources are spread across the
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School of Public Health’s divisions, and other colleges and institutes on campus, posing a
challenge for collaborative research and the development of a top-ranked, coordinated, focused
teaching program. There currently is a relative lack of expertise and experience in ID
epidemiology, needed to complement the clinical and laboratory expertise available on campus.
IV. Collaboration Outside the SPH
• U of M Collaborators. A successful ID program of research and teaching depends on strong
epidemiology and laboratory science expertise and experience working together to address
important public health ID problems. Approximately 11 SPH faculty and other faculty in the
School of Medicine, College of Veterinary Medicine, and other university colleges and
institutes, teach ID courses or ID modules in courses.
In addition, there are several centers, and programs located in the Academic Health Center
(e.g., Center for Infectious Disease Research and Policy, Center for Animal Health and Food
Safety, Center for Immunology, Mucosal and Vaccine Research Center, National Center for
Food Security and Defense, Institute of Molecular Virology, Center for Infectious Diseases
and Microbiology Translational Research, etc.), with many clinical and laboratory scientists
as faculty, aimed at promoting collaborative research and information exchange.
•
Community Collaborators. Other special resources to the SPH are the Minnesota Department
of Health, Minnesota Public Health Laboratory, Veterans Administration Medical Center,
College of Veterinary Medicine Veterinary Diagnostic Laboratory. MDH staff serve as
adjunct faculty and contribute ID public health practice expertise and experience to the SPH
research and teaching programs, and provide opportunities for SPH faculty and students to
undertake research addressing ID problems at the local and state levels. The Twin Cities also
has large Hmong and Somali immigrant and refugee populations, and faculty at local medical
centers provide additional opportunity to address important ID problems arising in these
populations.
•
International Collaborators. Lastly, the SPH has launched a global health initiative, and
developed a collaborative research program with the Manipal Education and Health Group in
Manipal, India, which provides significant opportunity for faculty and students to participate
in research that addresses important ID problems in that country.
V. Future Directions
The following expertise is needed to complement existing faculty and resources to build a
strong ID program in both research and teaching:
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expertise in molecular approaches to ID epidemiology,
mathematical modeling and other quantitative methods of infectious diseases,
geographic information systems and analysis,
behavioral aspects of infectious disease prevention and control,
economic evaluation, and
medical entomology.
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The additional of faculty with experience in conducting research in resource-poor countries is
highly desirable and essential in terms of the School’s commitment to strengthening its global
health programs.
Future Collaboration. Strong potential exists for collaborative links and relationships with
each of the other clusters. It is envisioned that the proposed faculty would be appointed within
different divisions of the School of Public Health or as joint appointments with other schools.
Discussions are underway to determine the most effective way to bring ID faculty together from
across the University and the MDH to promote collaborative, interdisciplinary research that will
link epidemiologic and laboratory sciences to address priority infectious disease public health
problems at local, state, national, and international levels, and a comprehensive teaching
program.
Scope of an ID Cluster. An ID program at the University of Minnesota would focus research
and teaching around the following areas: the etiology, epidemiology (including molecular
approaches) and ecology of infectious diseases, mechanisms of disease transmission,
pathogenesis and immunologic responses, methods of disease surveillance, development of
biologic and behavioral interventions and strategies for prevention and control, emergency
preparedness, ethical approaches to ID research, risk communication and health education, and
policy.
Given trends in globalization and existing resources, there are three general areas where
investments by the SPH would be necessary and strategic to build a strong program in ID
epidemiology:
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the HIV/AIDS-tuberculosis-sexually transmitted infection (STIs) complex;
other emerging, zoonotic infectious diseases; and
immigrant/refugee health.
Research program goals and objectives would range in addressing local, state, national, and
international ID problems. Emphasis will be placed on integrating research and teaching
programs to provide excellent training opportunities for PhD candidates and Masters degree
students.
Funding Opportunities. HIV/AIDS remains an important funding priority for the National
Institutes of Health (NIH) and the Centers for Disease Control and Prevention. This includes
funding for projects of international significance. Several of many recent examples from NIH
include the following grant announcements:
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"AIDS International Training and Research Program" from the Fogarty International Center,
"International Studies of AIDS-Associated Co-Infections" from NIAID,
"Alcohol Abuse and HIV/AIDS in Resource-Poor Societies" from NIAAA, and
"International Initiatives To Prevent HIV/STD Infection" from NIMH
In addition, major funding is available through organizations such as the Bill and Melinda Gates
Foundation, as well as many other public and private funders.
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In 2003, the Institute of Medicine recommended that interdisciplinary infectious disease
centers should be developed to promote a multidisciplinary approach to addressing microbial
threats to health, and that these centers should be based within academic institutions and link the
relevant disciplines necessary to support such an approach. Their vision of these centers
emphasized collaboration with the larger network of public agencies addressing emerging
infectious diseases, interested foundations, private organizations, and industry. In addition, the
NIH has increased its funding of interdisciplinary approaches to solving ID research questions of
importance as a component of the NIH Roadmap. Given the special strengths of the University
of Minnesota described above, the University is well positioned to become a national leader in
emerging infectious diseases, including zoonotic diseases such as avian influenza and others, and
immigrant and refugee health.
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Focus Area: Food Safety and Nutrition
I. Definition
Food and food safety are two of the most enduring themes of Public Health. Providing
reliable supplies and equitable distribution of food has been and continues to be a challenge for
many human populations. In geographic areas in which the problem has been for the most part
solved, having an adequate and varied food supply is arguably the number one factor responsible
for reductions in population disease and increases in life expectancy. Ironically, in the last few
decades food supply and distribution systems in some parts of the globe have become so efficient
that over-nutrition and consequent obesity is now competing with under-nutrition as a health
issue and is threatening to reverse historical nutrition related Public Health gains.
II. Significance
In addition to its importance in energy balance, food is also a significant contributor to many
other health issues in human populations. Food is a major conduit for exposure to infectious
disease agents in human populations. Food is also one of the most important modifiable
contributors to chronic diseases, e.g. dietary fat is a significant causal contributor to
Cardiovascular Disease and some cancers.
At this point in time, enhanced research on food and health and its safety in our society is in
great demand by public and private funding agencies, by the Health Care Delivery System and
by Public Health policy makers. The impact of nutrition on obesity, cancer, cardiovascular
disease, diabetes, and food-borne infections are among the hottest specific topical areas.
Improved knowledge about the biological and social etiology of food related health conditions
and about methods and policies that would contribute to the prevention of these conditions are
much needed.
III. Assets Within the SPH
The University of Minnesota and its School of Public Health are in a unique position to
assume a position of national and international leadership in Nutrition and Health.
•
SPH Faculty. The School of Pubic Health is particularly well suited to taking a leadership
role in the area of food and heath area because of its long history of pioneering efforts in
studying the etiology of diet related diseases and its well earned reputation as a major
contributor to the evolving research literature on preventive nutrition interventions in
individuals, communities and through public health policy.
IV. Collaboration Outside the SPH
• Interdisciplinary Research. We have an excellent situation with respect to interdisciplinary
capability, in that we have Schools of Medicine, Public Health, Veterinary Medicine,
Agriculture and Food Science in close proximity.
•
Centers. We have four already established University-wide Centers whose focus includes
food and health; University of Minnesota Cancer Center, University of Minnesota Obesity
Prevention Center, Center for Infectious Disease Research and Policy and the Center for
Animal Health. In the food safety, we have the University Center for Post-Harvest Food
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Protection and Defense, based in the College of Veterinary Medicine, with joint leadership
(Mike Osterholm) in SPH. This Center is funded by the Department of Homeland Security.
•
Center Grants. We also have or are soon to have three Center Grants, from NCI, NIDDK and
the Robert Wood Johnson Foundation, that focus on this topic.
•
President's Initiatives. Finally, food and health is one of the major foci of President
Bruinink’s University-wide initiatives.
V. Future Directions and Recommendations
To develop the School of Public Health capacity to contribute to and lead the development of
research on Food and Health, it is believed that a cluster faculty hire in this area would have
great upside potential. Specific areas in which additional research strength are desirable include:
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nutritional epidemiology (with special emphasis on studies of the effects of food exposures in
free living populations on disease risk markers),
agricultural economics,
health economics,
nutritional intervention (with special emphasis on applications in the Health Care and Public
Health delivery systems),
food policy,
food safety (defined broadly to include food composition and marketing),
underserved populations, and
food production technology.
Added strengths in cutting edge areas of methodological development are also desirable.
These include skills in multilevel causal modeling and analysis, community intervention research
designs and survey research methods (especially those focusing on assessment of food intake in
human populations).
It is envisioned that the 3 to 5 new faculty be recruited in a “cluster” hire with collaborative
involvement of all SPH Divisions and other collaborators in other fields as appropriate. In
additional to their primary departmental homes, it is suggested that a Nutrition and Health
Interest Group be formed that includes these faculty and existing faculty collaborators. This
group will have the explicit charge of articulating a nutrition and health agenda for the School of
Public Health that includes specific research and teaching goals.
Summary. Overall, it is believed that a food safety and nutrition cluster hire in the School of
Public Health has the potential for achieving dramatic gains in scientific productivity and
extramural funding for the School of Public Health at relatively modest cost, which in turn will
enhance the School’s reputation in the area locally, nationally and internationally as a leader in
the field.
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Focus Area: Public Health Genetics
I. Definition
This research area reflects several inter-related fields that defy easy classification. This
presents a challenge in developing an operational definition, as terminology continues to evolve
and is not used consistently, even by experts working in these fields. For clarity, the term public
health genetics is used in this report which encompasses the following:
•
Public health genetics has been defined as the “application of advances in human genetics
and genomic sciences to improve public health and prevent disease.” Other faculty within
and outside the SPH prefer the term, public health genomics, which reflects a more global
view of the interaction of many genes and gene products in biological pathways, networks
and physiology.
•
Related fields. The application of mathematical modeling and computer science to analyze
complex biological phenomena and high-dimensional datasets has given rise to fields such as
bioinformatics and systems biology that intersect with genetics research.
Bioinformatics uses techniques from applied mathematics, informatics, statistics, and
computer science to solve biological problems. The terms bioinformatics and computational
biology are often used interchangeably.
Systems biology integrates biological data as an attempt to understand how biological
systems function. By studying the relationships and interactions between various parts of a
biological system (e.g. genes, proteins, cells, physiological systems, whole organisms,
environment, etc.) it is hoped that an understandable model of the whole system can be
developed.
II. Significance
Advances in molecular biotechnology and computer technology are rapidly transforming
research in academia, government, and industry and have begun to significantly impact public
health research and practice. Public health and genetics have much in common. Both intersect
and interact with many, if not most, departments and specialties found elsewhere in the
Academic Health Center. Both focus on populations in research, practice, and policy. Both are
interested in prevention of environmental and behavioral risks. Both share a concern for ethical,
legal and social issues. And both would gain from growth in public health genetics in the SPH.
Although growth in genetics research is having a significant impact in many, if not most,
health disciplines, faculty with a public health perspective have an important role to play in
helping to guide the research agenda. The emphasis in public health should be on large-scale,
population-based studies of diseases that are common and complex, such as CVD, cancer,
respiratory diseases, and obesity. Special attention should be given to the interaction of
modifiable environmental factors and genes in disease etiology. Furthermore, public health
scientists are needed to help in the translation of genetic discoveries to public health practice and
policy.
The importance of public health genetics has been recognized by agencies and organizations
such as the NIH, the Institute of Medicine (IOM), the CDC, and the American Society of Human
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Genetics. A recent (2002) IOM report noted that “with the arrival of the era in which we will
have the ability to understand gene-environment interactions comes not only the era of genomic
medicine, but of genomics-based public health.” As mentioned above, several competitor
institutions have developed formal training programs in public health genetics. Explosive
growth in the field has created a demand for researchers and practitioners with expertise in the
application, interpretation, and communication of genetics research within the context of public
health.
III. Assets with the SPH
SPH Faculty. An existing asset in the SPH is a nucleus of faculty with methodological
expertise in genetics and bioinformatics. In the Division of Biostatistics, Cavan Reilly, Wei Pan,
and Baolin Wu are conducting research in bioinformatics, particularly with respect to analysis
and interpretation of microarray experiments that evaluate gene expression profiles. Na
(Michael) Li is developing statistical methods for population-based genetic studies, and another
statistical geneticist (Saoli Basu) has recently been hired. Mike Miller in Epidemiology and
Community Health also provides expertise in genetic epidemiologic methods.
The number of SPH faculty applying these methods to specific research areas is small but
growing. Jim Pankow (EpiCH) conducts genetic epidemiologic research on cardiovascular
disease and type 2 diabetes. Lisa Peterson, Betsy Wattenberg and Bill Toscano (Environmental
Health Sciences) study interactions of genes with toxins in cancer and development. Dr.
Toscano recently submitted a proposal to establish within the UMN-SPH a CDC-funded Center
for Genomics and Public Health (see the CDC reference in the Addendum for more information).
Many other faculty across the school are beginning to collect and analyze genetic information in
their research projects. To our knowledge, there are no SPH faculty or other faculty focusing on
interventions in public health genetics or conducting research on policy, financing,
communication, education, or ethical, legal, or social implications of genetics.
IV. Collaboration Outside the SPH
There are outstanding opportunities for collaboration across the university and Twin Cities
region. The University of Minnesota has major laboratory, computing, and faculty resources in
genetics and bioinformatics. Potential collaborators can be found in the
• Institute of Human Genetics
• Department of GeneticS, Cell Biology and Development
• Department of Laboratory Medicine and Pathology
• Department of Medicine
• Center for Computational Genetics and Bioinformatics
• Digital Technology Center
• Minnesota Supercomputing Institute
• Cancer Center.
Other units within the University or region that provide potential for collaboration in genetics
and bioinformatics. These include the
• Advanced Genetic Analysis Center
• Beckman Center for Transposon Research
• Department of Psychology (behavioral genetics)
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College of Pharmacy, Biomedical Genomics Center
Lillihei Heart Institute
Center for Microbial Genomics
Developmental Biology Center
Minnesota Center for Community Genetics
Plant Molecular Genetics Institute
Stem Cell Institute
Minnesota Department of Health.
V. Future Directions and Recommendations
Although the SPH has developed a substantial nucleus of faculty with methodological
expertise in bioinformatics and statistical genetics, further investment is needed to build
excellence and innovation in public health genetics/genomics and bioinformatics. The following
are examples of faculty who should be considered for a genetics cluster:
•
Senior-level and mid-level faculty with content area expertise who can integrate genetics and
the latest advances in biotechnology in their research armamentarium, including genetic
epidemiology, proteomics, and systems biology.
• Faculty with an interest in translation of genetic discoveries to public health practice, such as
evaluation of genetic testing and population-based genetic screening, pharmacogenetics,
development, implementation, and evaluation of population-based genetic services delivery,
and health communication.
•
Faculty with expertise in bioinformatics and statistical genetics who will further expand the
existing nucleus in those areas.
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Cross Cutting Area of Expertise:
Mathematical Modeling, Biostatistics, and Causal Inference
A. Definition
Mathematical modeling is an ensemble of methods that employ formal mathematical
equations and algorithms to model scientific phenomena. Such modeling can be broadly
classified as deterministic or stochastic. Deterministic modeling (nowadays often referred to as
computer modeling) formulates equations based upon scientific laws that explain a phenomenon
in theoretically perfect settings. Examples range from the equations we see in high school
physics to highly complex environmental or ecological systems. Experimental or field data,
however, do not arise in theoretically perfect settings and are contaminated with measurement
error and other external disturbances. In such cases stochastic or statistical models are required to
filter out noise, enhance the accuracy of predictions and help validate an underlying
deterministic system.
B Significance
The existing literature offers an immensely rich body of knowledge on the subject. A simple
Google search on the web reveals several conferences and meetings that deal with mathematical
modeling with public health emphasis. Several high quality research articles have been published
that feature mathematical modeling of population dynamics (where “population” is used in a
broad sense), outbreak and spread of diseases (recently much interest has been devoted to
outbreak of SARS), human physiological processes, environmental systems, mechanisms of
metastasis of cancer cells (clonogens) and many other areas. Methodological research in such
modeling has direct application in some of the core areas proposed by the committee. For
instance, modeling epidemics has direct relationship to “infectious diseases” and modeling
metastasis of cancer applies to “chronic diseases”.
C. Assets Within SPH
Many of the current SPH faculty spanning many of the divisions conduct active research in
developing computer-intensive methods to model scientific phenomenon. For instance, most of
the faculty in Biostatistics needs to carry out mathematical simulations as a part of their research.
These include, but are not limited to, designing and implementing
clinical trials, surveys, and epidemiological studies, developing methods that add statistical
formalism to Geographical Information Systems, methods that help answer deeper questions in
bioinformatics, modeling of environmental data and various other
phenomena. The Division of Biostatistics has considerable strengths in the areas of clinical
trials, bioinformatics and statistical genomics, Bayesian statistics and spatial data analysis,
survival analysis, and other areas, and there are biostatisticians with strong research records in
the Division of Environmental Health Sciences and the Division of Epidemiology and
Community Health. Biostatisticians will continue to be essential members of research teams and
advisors of PhD and Master’s students.
D. Collaboration Outside of SPH
SPH faculty involved in mathematical modeling, often collaborate with departments and
schools outside of the SPH. These include the Medical School, Department of Computer Science
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(Information Technology), School of Statistics, Department of Geography and the Department of
Agronomy and Plant Genetics, to name a few.
E. Future Directions
While external collaborations with departments such as those mentioned above enhance
research impact, the SPH might be better served by expanding its current faculty pool. It is likely
that recruitment of additional people with biostatistical training and experience will be required
as collaborators for most of the research priority areas identified elsewhere in this document.
Other recruitments might include experts in differential equations and modelers who specialize
in simulating biological phenomenon. Such a person could hold an advanced degree in Applied
Mathematics, Engineering, Comp Sci or Statistics/Biostatistics. The role of such experts would
have to be collaborative and, importantly, such collaborations would involve public health
researchers as well as biostatisticians.
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Cross Cutting Area of Expertise:
Etiology
A. Definition:
Etiology is the study of the causes of disease or illness. Etiological research may adopt
various perspectives, from emphasizing biological agents to focusing on social factors as
fundamental causes of illness. The most common example is etiological studies based in
biology, beginning with germ theory. But it has also long been recognized that the etiology of
illness goes beyond biology or genetics. The social origins of disease are fundamental to
medical sociology and social epidemiology. Economists may contribute to our understanding of
the causes of disease by examining, for example, the relationship between the consumption of
health care resources and health. Psychological models may emphasize cognitive processes and
structures. Factors in the physical environment that cause disease are central to the study of the
etiology of illness from the perspective of environmental sciences Most of these perspectives,
however, recognize that illness is not randomly distributed; instead, risk is shaped by the
interplay of two or more risk factors in these areas.
While this cross-cutting area could focus on each of these factors separately, the hiring
cluster might also be enhanced by the presence of a faculty member with two or more of these
areas of expertise, for example, someone with expertise the biological and social etiology of
foodborne disease.
B Significance
Understanding the causes of disease is important for public health prevention efforts.
Moreover, etiological studies naturally lend themselves to cross-disciplinary research. Rarely
are the origins of a particular disease traced to one causal factor. Thus, there is often the need to
bring together scientists with varying perspectives; for example, research on the causes of
depression often focuses on the interaction of biologically and social factors. Research
investigating multiple causes may help public health efforts to identify population based
prevention strategies.
C. Assets within the School
There is a wide variety of faculty expertise exploring the etiology of disease or illness from
different perspectives. The illnesses that are the focus of this work are also diverse, from mental
disorders and obesity to cancer and heart disease. However, until there is a more intensive
survey of existing faculty about their specialty areas, we cannot say with certainty that expertise
in any of these combinations of etiology currently exist. The particular disciplinary perspective
one might want to consider in a new hire, depends on the focus area. For example, sociological
perspectives might be more relevant for understanding the causes of health disparities; while
biological perspectives might be more relevant for food safety.
D. Collaboration Outside of SPH
The potential for collaboration outside of SPH for new faculty with expertise in this cross cutting
area is difficult until the specific focus area is identified. However, as mentioned earlier,
etiological studies are by nature often cross-disciplinary. We currently have faculty from each
division working on etiology studies.
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E. Future Directions
The specific faculty needed, depend upon the focus area for new hires. Faculty with interest
and experience working across academic disciplines would be an asset. Funding agencies, such
as NIH, commonly encourage cross disciplinary work. This would also develop the School’s
expertise in understanding how risk factors interact to cause disease and illness.
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Cross Cutting Area of Expertise:
Policy, Finance and Healthcare Delivery
A. Definition
National health expenditures are projected to rise from $1.67 trillion in 2003, consuming
15.34% of the GDP, to $3.36 trillion in 2013, consuming 18.4% of the GDP.i These increasing
costs are straining the public healthcare financing systems, with public dollars spent rising from
$759 billion in 2003 to $1.55 trillion by 2013.1 States now spend more on Medicaid, a combined
federal-state funding program for the poor, than on education.2 Missouri has formed a
commission whose mandate is to dismantle the Medicaid program by June 30, 2008.2 Healthcare
costs borne by the private sector are also increasing. General Motors cites healthcare costs of
$5.6 billion to cover its 1.1 million workers, retirees, and dependents, representing a cost of
$1,525 for every car it produces.2
B. Significance
An aging population in and of itself has not been found to be a large driver of healthcare
expenditure growth.2,3 Rather, factors that increase expenditures for all groups, such as per
capita income, costly new medical technology, workforce shortages, and delivery system
variability are cited as primary drivers (Reinhardt, 2003; Wennberg and Cooper, 1999). Studies
focusing on the microsystem of healthcare delivery document large gaps between known best
practices for proven prevention and treatment protocols and technologies and their successful
implementation. Patients receive only about 55 % of those services from which they would
likely have benefited (McGlynn, 2003). Likewise, numerous studies support the contention that
poor patient safety and medical injuries are a serious epidemic facing the American health care
system. The Institute of Medicine concluded that up to 98,000 hospitalized patients die annually
as a result of errors (Institute of Medicine, 1999). Clearly, better coordination between
healthcare financing, policy, and delivery systems are needed to promote a healthcare system
that helps people stay well, and provides care to them after they become ill, in a manner that is
equitable, efficient, safe and effective.
C. Assets Within the SPH
• School of Public Health. The University of Minnesota School of Public Health has a strong
reputation for its health economics faculty in the Division of Health Services Research, and
Policy (HSRP). In addition, there are a number of faculty members across the school,
including Environmental and Occupational Health, Epidemiology, and HSRP, with strong
research and teaching interests in aspects of health policy (Blewett, Foote, Forster,
Humphrey, Bob Kane, McGovern, Oberg, Toomey, among others). These faculty members
not only conduct policy research, but are very visible in the community through activities
that assist policy makers at the state local and federal level or inform the public through
media appearances. HSRP also has faculty with extensive research expertise in leveraging
large data sets to analyze policy, including McBean, Blewett, Virnig and Davern. The
addition of the healthcare administration faculty to HSRP brings research strengths in
healthcare strategy and manpower, quality improvement, safety, technology implementation,
chronic disease management, insurance, and payment mechanisms.
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D. Collaboration Outside the SPH
• Academic Health Center. Within the Academic Health Center, the presence of the Health
Informatics department complements the public health informatics capabilities of HSRP with
that of clinical informatics. The presence of the Medical School and Nursing School within
the AHC provides opportunities for research collaboration that spans policy, financing,
administration, and clinical delivery.
•
University. Within the broader University, the Juran Center for Quality Leadership in the
Carlson School of Management has a track record of supporting research in quality
management and patient safety in healthcare and in partnering with the healthcare industry to
offer executive training in emerging quality management methods. Finally, the presence of
the Humphrey Institute offers opportunities for collaborative research in policy.
•
Community. The Minnesota Department of Health is a recognized leader in public health
informatics, and there are strong working collaborations with SPH.
E. Future Directions and Recommendations
With over half of the faculty in HSRP over the age of 50, there is clearly a need for
succession planning. Cluster hires should focus on faculty who:
Create new knowledge that informs both policy and delivery through merging public health
data sources and delivery system data. Healthcare systems are implementing computerized
electronic medical records that span inpatient and outpatient settings and systems that capture
electronically time stamped patient flow data in the hospital. These data sources provide patientlevel detail to better understand both micro and macro issues around variability in utilization,
costs, access, and quality. As technology around genomics diffuses into the public health and
delivery setting, the implementation and use of such technologies to improve delivery and policy
analysis will need to be leveraged. Producing master’s students with these skill sets would
uniquely position them for what will be current and emerging informatics and knowledge
management career opportunities in the delivery, insurance, and biotechnology fields.
Study healthcare finance at the macro policy and health economics level, such as pay for
performance and health savings accounts, develop new methods needed at the delivery level to
understand true costs of providing care and price it using a rational methodology, and test and
implement process redesign methods in healthcare delivery to eliminate waste, rework and errors
at the micro and macro system levels. Policy level financing innovations must be coupled with
true knowledge of production costs at the institutional level. Because of the inherent process
problems in healthcare delivery, cost analysis should be coupled with process redesign to drive
waste out of the system concurrent to developing cost and pricing models.
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Cross Cutting Area of Expertise:
Prevention, Behavior Modification, and Clinical Trials
A. Definition and B. Significance
Research in public health frequently centers around efforts to reduce risk in large populations
which have high levels of risk associated with certain behavior patterns (e.g., smoking, use of
drugs and alcohol, avoidance of exercise, poor eating habits, and others). Such research may
take the form of clinical trials which test whether efforts to change behavior can reduce risk and
result in improved health, quality of life, and longevity. Epidemiologic studies, including casecontrol studies, of the causes of risks in certain populations may be needed also. Such research
is genuinely collaborative, requiring the concerted efforts of epidemiologists, behavioral
scientists, statisticians, and often clinician-specialists.
C. Assets Within the SPH and D. Collaboration Outside the SPH
The School of Public Health has a long and distinguished record in carrying out clinical trials
and community trials in which risk reduction is accomplished by education and behavioral
intervention. Primary prevention trials in cardiovascular disease, cancer, or other chronic
diseases are typically large, multicenter studies involving hundreds or thousands of participants.
The Multiple Risk Factor Intervention Trial (MRFIT) was an outstanding example.
Conducted from 1972 to 1982, the MRFIT included 12866 participants in 22 clinical centers.
The objective of the MRFIT was to test whether smoking intervention, dietary intervention, and
intervention to reduce blood pressure could reduce the risk of coronary heart disease death. One
of the clinical centers was here in the Division of Epidemiology (originally the Laboratory for
Physiological Hygiene). Clinical center staff included epidemiologists, psychologists,
sociologists, nutritionists, and experts in smoking intervention, as well as physicians who
specialized in cardiovascular diseases. The Data Coordinating Center (DCC) for the MRFIT was
operated by the Division of Biostatistics. DCC staff included statisticians, programmers,
database management programmers, and data entry and quality control personnel, as well as
experts in nutrition, smoking intervention, and sociology.
Many of the same individuals who worked on the MRFIT project continued with later studies
of primary prevention for cardiovascular disease, lung disease, cancer, HIV/AIDS, and other
chronic diseases whose risks can be reduced on a large scale by changes in behavior. The
Division of Environmental Health Sciences, which has conducted large screening trials on colon
cancer, lung cancer, and other cancers, also includes biostatisticians with expertise in the design,
conduct, and analysis of large-scale clinical trials.
E. Future Directions and Recommendations
Prevention is the heart and soul of public health. The expertise in epidemiology,
biostatistics, behavioral modification, and clinical sciences which is needed to conduct largescale primary prevention trials is essential to any school of public health. The University of
Minnesota’s SPH has a wealth of expertise in these areas which must be maintained and which
may need to be strengthened if important research related to behavior change in large
populations is to be carried out in the future. In addition, the participation of specialists in
certain areas – e.g., sleep apnea, depression, abusive behaviors, addiction, obesity, diabetes
SPH Futures Committee Report
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prevention and control, sexual behavior, and other areas – may be required for future research
thrusts within the School, and may be the target of cluster hires designed to assemble teams to
carry out preventive studies.
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Cross Cutting Area of Expertise:
Public Health Informatics
A. Definition
Public health informatics “is the systematic application of information, computer science,
and technology to public health practice and learning” (Page 63, Who Will Keep The Public
Healthy: Educating Public Health Professionals for the 21st Century, IOM). Public health
informatics is a bridge between the Information sciences and the practice of public health. Public
health informatics emphasizes “Understanding and being able to apply information and computer
science technology to public health practice and learning (i.e., public health informatics) are
necessary competencies for public health professionals in this information age in which we are
vitally dependent upon data” (Institute of Medicine Report – 2003 – Who Will Keep the Public
Health: Educating Public Health Professionals for the 21st Century).
Public health informaticians occupy the bridge between computer science and information
system use. Their knowledge spans computer science, information systems, public health,
organizations, systems analysis, and management. They use systems analysis to develop logical
description of systems which can be implemented and evaluated under their guidance by
programmers. A good analogy for an informatician is an architect, an individual who can
understand and translate user needs so that they can be built and implemented effectively.
In contrast to computer science, public health informatics focuses on the design and
implementation of systems to fit organizational environments rather than on more technical
operating system, programming, and database issues. In contrast to bio-informatics, which
concentrates on topics very close to core computer science and statistics topics, public health
informatics and health informatics concentrate on how information systems are used within
organizations and social settings. Public health informatics, which concentrates on surveillance
and use of information systems in a public health setting, complements health informatics which
focuses on information systems use in clinical settings.
B. Significance
Public health informatics is important from both a research and pedagogical perspective.
Research issues are summarized in Public Health Informatics and Systems (O’Carroll, Yasnoff,
Ward, Ripp, and Martin, eds, Springer, 2003): “In view of the promise of information
technology, the public health has certain systems development challenges that are apparently
straightforward (e.g., immunization registries) but in fact are enormously challenging. … [There
are] several important areas of opportunity afforded by modern information technology, such as
new means of data collection and new means of increasing data accessibility. … key information
technology challenges with which the public health communication is currently grappling …
[include] geographic information systems, expert systems for public health, and the use of
information technology to promote the delivery of preventive medicine and primary care.”
The same issue of making the promise of apparently straightforward information technology
work in other health related settings is common. While the technology may be available, fitting
the technology to a complicated organizational world, making it work effectively is problematic,
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and determining how to use data to produce information that is organizationally useful is a major
research challenge.
Informatics has been identified as key to managing population health. Surveillance systems
are rapidly moving to technologies as the world-wide-web. Examples include immunization
registries, automated lab reporting, GIS and other systems. Experts are required to do the
analysis and management of systems development.
Informatics is an infrastructure area that can be applied to may substantive areas. Over the
past thirty years, developing, implementing and managing information systems have become a
core feature of all organizations. Information systems are used to support surveillance, research,
decision-making, work-flow management and many other activities. Individuals skilled in
information system design, implementation, and management can address a wide range of
substantive problems issues, such as chronic health management.
The Occupational Outlook Handbook, 2004-05 Edition from the Bureau of Labor Statistics
(http://www.bls.gov/oco/home.htm) states that the information management sector is among the
fastest growing sectors in the economy and is likely to remain a strongly growing sector. This
translates into well-paying jobs being available for graduates. Professional and related
occupations will grow the fastest and add more new jobs than any other major occupational
group. Over the 2002-12 period, a 23.3-percent increase in the number of professional and
related jobs is projected, a gain of 6.5 million. Professional and related workers perform a wide
variety of duties, and are employed throughout private industry and government. About threequarters of the job growth will come from three groups of professional occupations—computer
and mathematical occupations, healthcare practitioners and technical occupations, and education,
training, and library occupations—which will add 4.9 million jobs combined.
(http://www.bls.gov/oco/oco2003.htm)
C. Assets Within the SPH
Within SPH, public health informatics complements a number of areas. Informatics and
information systems development and management is a key managerial skill. A strong
informatics program will complement and strengthen existing management programs. A strong
information systems program will provide a competitive advantage for the MHA, PHAP, and
other educational programs. Informatics complements interests in data mining. Existing HSRP
faculty with backgrounds and interests in management applications of informatics include Doug
Wholey, and Sandy Potthoff. In Biostatistics, Wei Pan and Baolin Wu are interested in data
mining. In HSRP, Beth Virnig and Marshall McBean work extensively with Medicare claims
data. The informatics area of GIS complements work in spatial biostatistics by faculty such as
Brad Carlin.
D. Collaboration Outside the SPH
Within the Academic Health Center, the presence of the Health Informatics program
focusing on clinical informatics in the Medical School’s Department of Laboratory Medicine and
Pathology complements the public health informatics capabilities of HSRP. The informatics
area of GIS also complements work on GIS in Geography. Collaborating with Health
Informatics will provide complementary emphasis on informatics applications such as decision
support systems. Within Minnesota, the Minnesota Department of Health is a national leader in
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implementing public health informatics. Marty LaVenture, PhD, Public Health Informatics
Advisor, to the Minnesota Department of Health has expressed interest in collaborating in the
development of a public health informatics program.
E. Future Directions and Recommendations
The addition of informaticians would provide the focus for existing informatics related
activities within the school and would result in attracting research and training funding, as well
as attracting a new category of students. SPH has strong assets that can be built on. The key
investment required is four faculty positions. A cluster of four faculty will allow us to develop a
highly visible public health informatics program and provide specialization areas for students. It
will also facilitate recruiting. This will signal a strong interest by the School of Public Health and
the opportunity to create an exciting collegial environment. Collaborating with MDH, a national
leader in public health informatics, and Health Informatics should also increase the likelihood of
successfully recruiting faculty. That collegial environment combined with excellent collaborative
research opportunities with organizations such as MDH should provide the foundation for
success.
There is significant funding available to address this challenge in using information
technology effectively. The Agency for Health Research and Quality has had major initiatives
funding studies of information technology. In October 2004, it awarded $139 million in
contracts and grants to promote the use of health information technology (health IT or HIT)
through the development of networks for sharing clinical data as well as projects for planning,
implementing, and demonstrating the value of health IT.”
(http://www.ahrq.gov/research/hitfact.htm) Agencies are also funding work on using medical
claims data to identify bioterrorism events. The National Library of Medicine also funds
informatics research, as well as training grants for students.
1
Heffler, S, Smith, S, et al (2004). Health spending projections through 2013. Health Affairs:Web Exclusives
Supplement, January-June.
2
Robert Wood Johnson Foundation, (November, 2004). St@teside, issue 6:
http://www.statecoverage.net/stateside1104.htm#6.
3
Morris, F. (May 11, 2005). 2005Debating Medicaid and Morality in Missouri. National Public Radio:
http://www.npr.org/templates/story/story.php?storyId=4647327).
4
Will G. (May 1, 2005). Health care costs taxing GM. George Will Chicago Sun-Times:
http://www.suntimes.com/output/will/cst-edt-geo01.html).
5
Bodenheimer, T. (2005). High and rising health care costs. Part 1. seeking an explanation. Annals of Internal
Medicine142:10:847-854.
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Appendix I. Topics Considered by the SPH Futures Committee
32 Topics from the SHP Faculty Retreat and
26 Topics Added by Futures Committee Members
Topics from SPH Retreat
Advancing Public Health Genetics
Aging
Bioinformatics
Biostatistics Theory and Methods
Bioterrorism Prevention
Built Environment and Health
Children, Family, Women's Health
Chronic Disease
Clinical Research
Clinical Trials
Community-based Research
Environmental Health Sciences
Epidemiologic Theory and Methods
Evidence-based Public
Food Safety & Food Production Protection
Global Health
Health Communication
Health Disparities
Health Economics
Health Policy and Law
Health Practice
Infectious Disease
Obesity
Populations & Environmental Interaction
Public Health
Public Health Administration
Public Health and Cultural Competence
Public Health Genomics
Public Health Informatics
Social & Behavioral Approaches to
Healthy Lifestyles Promotion
Social Epidemiology
Veterinary Public Health
New Topics
Abusive Behavior
Accidents/Prevention
Addiction
Adolescent Health
Cancer
CVD
Economics & Epidemiology: A Joint
Approach
Ethics
Expert Judgment Assessment
Healthcare Delivery
Health Services Research Methods
Health Systems Improvement
Immigration/Refugee Health
Improving Health Systems
Injury Prevention
Life Stage Risk Assessment
Mathematical Modeling of Env. Systems
Mechanistic & Statistical Modeling of
Diseases
Mental Health
Public Health Leadership
Public Health Systems Biology
(Syndemics)
Social Insurance
Spatial Analysis with Geographical
Information Systems
Systems Biology
Translational Research: Healthcare and
Public Health
Violence/Gang Behavior
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Appendix II. Topics Assigned to Seven Highest Priorities
in Group Priority Sort by SPH Futures Committee
Group Sort #1 Highest Priority
*CVD
Social Epidemiology
Global Health
Environmental Health Sciences
Environmental Health Sciences
Social & Behavioral Approaches to Healthy
Lifestyle Promotion
Advancing Public Health Genetics
Bioinformatics
Infectious Disease
Infectious Disease
Clinical Research
Clinical Research
Epidemiologic Methods
Group Sort #2
Health Economics
Advancing Public Health Genetics
Global Health
Environmental Health Sciences
Public Health Genomics
Chronic Disease
Health Disparities
*Epidemiological Theory & Methods
*Cancer
Clinical Trials
Bioinformatics
Bioinformatics
Clinical Trials
Group Sort #3
Obesity
Public Health Genomics
Public Health Informatics
Populations & Environmental Interaction
Populations & Environmental Interaction
Clinical Trials
Social & Behavioral Approaches to Healthy
Lifestyle Promotion
Community-Based Research
Infectious Disease
Infectious Disease
Biostatistics Theory and Methods
Biostatistics Theory and Methods
Bioinformatics
Group Sort #4
Public Health Administration
Community-Based Research
Clinical Research
*Mathematical Modeling of Env. Systems
Social & Behavioral Approaches to Healthy
Lifestyle Promotion
Aging
Aging
Public Health Genomics
Public Health Genomics
Public Health Genomics
Public Health Genomics
Infectious Disease
*Mental Health
* New topic added by an individual Committee member
Repeat topics indicate assignment to this priority level by ≥2 Committee members
SPH Futures Committee Report
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Group Sort #5
*Health Systems Improvement
Bioinformatics
Populations & Environmental Interaction
Advancing Public Health Genetics
Social & Behavioral Approaches to Healthy
Lifestyle Promotion
Advancing Public Health Genetics
Chronic Disease
Health Economics
Health Policy and Law
Infectious Disease
Infectious Disease
*Adolescent Health
Public Health Genomics
Public Health Genomics
Group Sort #6
*Addiction
Chronic Disease
Chronic Disease
Obesity
Bioinformatics
Advancing Public Health Genetics
Obesity
Biostatistics Theory and Methods
Built Environment and Health
Environmental Health Sciences
Food Safety & Food Production Protection
Infectious Disease
*Translational Research: Healthcare and
Public Health
Group Sort #7 Lowest Priority of the Top 7 Categories
Aging
Global Health
Global Health
Social Epidemiology
Environmental Health Sciences
Obesity
Infectious Disease
Infectious Disease
Chronic Disease
Clinical Research
Public Health Genomics
Epidemiologic Methods
Built Environment and Health