November 16th - Community Based Model for Cancer Prevention Speaker on Campus

Dr. Karen Patricia Williams will visit our campus on Thursday, November 16th to deliver the inaugural presentation for our Cutting Edge research series.  Dr. Williams is the Distinguished Professor of Women's Health, and Director of the Center for Women, Children, and Youth at the College of Nursing, The Ohio State University.  She has developed the  Kin Keeper^SM  Model for cancer prevention, a health advocacy model that involves community, family, and health care providers working together.  Dr. Williams currently serves as a member of the Nursing initial review group (IRG) of the National Institutes of Heath.

DEPUTY DIRECTOR OF PUBLIC HEALTH PROGRAMS

Please see the following announcement for the Deputy Director position at the Cook County Health & Hospitals System.

Lifestyle and Non-Communicable Disease

By Jasmine Swyningan

As humans, we are bombarded with choices on a daily basis.

• Do I go on a diet or maintain my current eating habits? 
• Should I go to work today or play sick and watch movies all day? 
• Should I get the chocolate chip cookie or oatmeal raisin cookie? 
• Should I go for a run or go to a kickboxing class? 
• Should I call my grandmother or aunt? 

You get the idea. 

These choices, when looking beyond this week (or this month, or this year), can have a significant impact on our long-term health. Here’s one way to think about this phenomenon: we are lucky to live in a time where our own lives literally make us sick. We are familiar with the endless amount of diet and fitness fads in the United States (like Beachbody, or Herbalife, or Shakeology, or encouraging a “Gluten Free” or “low carb” or “high fiber” diet), and efforts by political leaders and celebrities to encourage exercise (like Play60, or Worldwide Day of Play, or Let’s Move). Why do so many people obsess over diet and exercise? Because our “Western” lifestyle is, well, in many cases, a synonym for the term “sedentary.” And there has been a significant increase in the prevalence of non-communicable disease–particularly hypertension (high blood pressure) and type II diabetes–over the past 3 decades, not only in the US, but globally. 

Of course, this is a major problem in the US, having lasting impact on people’s quality of life, and also changes the way we need to approach the debate on healthcare. Hypertension and type II diabetes are examples of diseases requiring ongoing care and potentially complex medication regimens. When we think about these issues on a global level, the effect is even more complicated.

The Imperial College London completed and published findings from their 30-year-long project to track diabetes rates globally. What they found was a stark increase in the prevalence of type II diabetes, particularly in countries in sub-Saharan Africa and the Pacific Islands. Especially problematic about the increase in non-communicable diseases in these areas is a clear lack of infrastructure to treat these diseases. Additionally, researchers believe that this issue of non-communicable disease (or NCD) morbidity (having a disease) and mortality (dying from a disease) isn’t going away anytime soon. In fact, NCD rates are expected to surpass those of infectious diseases (like HIV/AIDS, tuberculosis, or malaria) in lower and middle-income countries by the year 2035. 

Why is this happening? Are there more doctors with the ability to diagnose the disease? 

Maybe. 

What research is telling us, however, is lifestyle may be more to blame than we’d like to admit. As countries in Africa continue to globalize and urbanize, their citizens begin to adopt a lifestyle that accommodates accommodations. People are: 

• Walking less and driving more.
• Not traveling as far to access clean water.
• Eating more processed foods.
• Smoking and drinking more often. 

When these changes happen in a short amount of time, say, over the span of one person’s lifetime, their metabolism comes to a screeching halt, and anticipated weight gain due to moving less often and eating more often (and eating lower-quality foods) is exacerbated as a result. Further, myths around health and wealth, unfortunately, encourage this type of lifestyle in lower and middle-income countries. The ability to smoke, drink alcohol, drive, and eat processed food is a sign of wealth; also, weight loss is a symptom of many infectious diseases. Therefore, ailments such as hypertension or type II diabetes are known as the “rich person’s disease.” Infrastructure to manage these types of diseases are scarce, and motivation for patients to make lifestyle changes reminiscent of a time before accommodations were in place (or to take medication that won’t heal, but will only treat their disease) is lacking.

In my own travels, I have witnessed public health efforts to combat obesity and spread awareness about non-communicable disease. Sometimes people don’t believe these diseases exist because they take years to develop. Other times people know about the disease but simply do not care. Most intriguing, though, is working with people who both know about long-term problems associated with eating processed foods and not exercising, but who also respond to calls for lifestyle change with something like, “I don’t live in an area that sells produce.” Or they live in an area where beer is cheaper than water. Or (in the US) where dialysis centers are more plentiful than grocery stores.

The choices we make about our own lifestyle has a domino effect on our health, and research is telling us that such choices are changing the face of disease, both in the US and globally.

Capstone 2017 – Jasmine Swyningan

Presented May 4, 2017, Jasmine Swyningan offered a look into the lifestyle factors that influence hypertension specifically as they are effecting countries in East and West Africa. As noted in Jasmine’s research, along with other non-communicable diseases (NCDs), researchers have documented a significant increase in hypertension and type 2 diabetes over the past 35 years. The lack of research documenting the contributing factors and gaps in treatment and prevention knowledge are limiting elements to the mounting burden of these types of diseases in Sub-Saharan African countries.

Comparing data gathered on non-pregnant women in Kenya and Ghana, Jasmine was able to support some key public health predictions within these areas. Her findings replicated the positive relationship between age/BMI and hypertension. Additionally, as the wealth index increases, so does the prevalence of hypertension. An individual living in an urban environment, having a higher education and being covered by health insurance is more likely to be diagnosed as hypertensive. While all of these factors are a result of movement toward economic development and increased wealth, these are also causing changes in the environment and behaviors that influence the health of the population.

As lifestyle continues to change at varying rates between and even within, countries must look to prepare themselves for the health impact of NCDs. Unfortunately, it may be outside financial reach to install effective prevention efforts that combat the effects of lifestyle changes. However, work could be done to leverage the existing healthcare networks—targeting clinician and patient education—to help curve the long-term effects of NCDs.

Jasmine joined Loyola University’s Master of Health Program with a BS in Economics from Iowa State University and MA in International Relations from the University of Chicago.

Learn more about Jasmine’s capstone experience.

Why did you choose to pursue an MPH? 
My desire to pursue an MPH and specialize in Epidemiology was organic in nature. I was brought to the University of Chicago for a few reasons that have remained unchanged throughout my academic career at Loyola: I am fascinated by economic development, and its intersection with other facets of society (e.g., education, health, gender, culture); I have a passion for enhancing my surroundings in a holistic manner; I love learning and engaging in both sides of an argument. I felt that an MPH at Loyola would allow me to grow in all of these areas.

What led you to your topic? 
Lifestyle and type II diabetes among women in sub-Saharan Africa was the focus of my MA thesis back in 2011, shortly after Imperial College London completed and published findings from their 30-year-long project to track diabetes rates globally. What they found was a stark increase in the prevalence of type II diabetes, particularly in countries in sub-Saharan Africa and the Pacific Islands. Before I even began studying public health, I became obsessed with understanding the social, economic, and cultural forces at play in these low-and-middle-income countries that are influencing the increase in NCD prevalence. After I completed my MA thesis in 2012, I presented my observations at African Studies conferences at Michigan State University Stanford University. At both conferences, people encouraged me to continue pursuing this topic and to look at everything from a public health lens. The transformation of this project has been an interesting challenge that I have come to greatly appreciate.

What personal skills helped you the most in completing your project? 
Time management! I spread out my capstone over two semesters which allowed me to do most of the background during the first semester, and then run the data (and rerun, and rerun, and RERUN the data...) during the second semester. Over the duration of my project, I also worked full-time (sometimes on weekends), completed 2-3 other courses, and started planning my wedding! Time management and an open dialog with my faculty advisers were key to completing this project. I also think that a genuine interest in the topic helped quite a bit.

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A student’s Capstone project is a professional presentation, which demonstrates his/her ability to apply the program learning to a specific public health topic. Selected by the student, the project reflects a culmination of the course curriculum, field experience and independent study. This experience helps students explore their academic passions while preparing them for a competitive job market.

Capstone 2017 – Madeline Ruhl

Presented May 4, 2017, Madeline Ruhl explored the realities of individuals entering the U.S. via the U.S.-Mexico border from Mexico and other Latin American countries. Examining migration trends can uncover important insights that can help public health officials and human rights advocates on both sides of the movement. However, while this topic has garnered much political attention over the past 50 years, Madeline’s research focused on a specific reality—the use of smugglers (called coyotajes in Mexican-Spanish)—that is not as well researched.

Coyotajes are routinely recruited or hired by individuals to assist them in traveling from Mexico to the U.S. They are paid a fee for their service. The increased use of coyotajes since the mid-1960s is associated with a complex web of political, economic, and social factors, along with increased surveillance along the U.S.-Mexico border. The number of visas extended by the U.S. has also fluctuated significantly over the 20th century through legislation including the Immigration and Nationality Act, which additionally contributes to the rate of undocumented immigration.

Madeline’s research aimed to uncover whether the fee paid to coyotajes could uncover important patterns in other life effects. Utilizing data obtained from Princeton University’s Mexican Migration Project (MMP), Madeline’s research yielded some interesting results.

• The average fee paid to a coyotaje is as high as $1,929 in some regions. 
• The majority of individuals traveling are male.
• Group sizes tend to be small averaging two individuals.
• Fees paid by women are approximately 18% greater.
• Those in better health paid less.
• Acculturation contributed to lower later self-reported health.

While research in this area may be difficult to gather, Madeline’s project reminds us of its continuing importance. Investigating relationships like those between fluctuating coyotaje fees paid and associated life effects or health outcomes can reveal important information about at-risk populations. This information could then lead to the development of more effective health initiatives, and a better understanding of a path forward for health officials and human rights advocates on both sides of the border.

Learn more about Madeline’s capstone experience.

What led you to your topic?
In 2015, I received an email blast from Loyola’s Public Health department about a volunteer opportunity with an organization called Community for Children, located in the Rio Grande Valley. I applied and attended their January 2016 program. That opportunity not only changed my life, but it fundamentally shaped my career. It sparked my passion for immigration health.

Why was the content or theme important to you?
When I returned from Texas, I dove into studying immigration law, health, and the factors and outcomes associated with the movement of people. I joined organizations like the Migration Policy Institute to help me further my understanding of global immigration legislation. I focused closely on movement into the U.S. from Mexico and the Northern Triangle countries—with a special interest in the movement of unaccompanied children. 

Did you encounter any challenges during your project?
There are always challenges associated with obtaining the data we need as Public Health scientists, and even more so when what those data are extraordinarily sensitive, both ethically and politically.

Where are you headed with your career?
My practicum and capstone projects at Loyola led me to continue my career in immigration health. I currently work as a program evaluator with an organization providing support to unaccompanied migrant children. This summer, I will also be participating in a one-month research project through the American Anthropological Association doing fieldwork in pediatric clinics in Antigua, Guatemala. 

What coursework did you apply to completing your project?
Biostatistics and epidemiology were at the technical core of my project, but I believe that Loyola’s well-rounded curriculum gave me the opportunity to explore the undeniable humanity of my work as well. Fields such as bioethics and research ethics, human behavior and health policies all strongly informed my project. 

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A student’s Capstone project is a professional presentation, which demonstrates his/her ability to apply the program learning to a specific public health topic. Selected by the student, the project reflects a culmination of the course curriculum, field experience and independent study. This experience helps students explore their academic passions while preparing them for a competitive job market.

Capstone 2017 – Ashley Hess

Presented May 4, 2017, Ashley Hess took the opportunity to explore the relationship between access to legal services and health outcomes. In her presentation, Ashley reminded us of some of the key social determinants of health. These include, but are not limited to, access to quality housing, education and healthcare as well as employment/income, legal status and even family responsibilities. It should be no surprise that access to legal services is subject to many, if not all, the same limitations as good health.

Ashley’s project centered around examining how medical legal partnerships (MLP)—collaborations among medical and legal services with the aim of addressing legal, social and health related issues for vulnerable patients or those underserved in a clinical setting—have been applied to address the social determinants of health. The Erie Family Health Center, a partner of Loyola’s School of Law and the Beazley Institute for Health Law and Policy, regularly refers patients that meet a list of criteria to the Health Justice Project. By probing the open and closed case data—available since the program’s 2010 inception—Ashley was able to extrapolate the data to the city of Chicago as a whole. The case data revealed case outcomes included enrollment in Medicaid, receipt of SNAP benefits, abatement of substandard housing conditions and eviction defenses provided. Cases were often closed due to immigration status, employment or other family law issues.

Overall, the MLP examined is making a positive impact in this community, however, there is much work to be done to further its effectiveness. Besides increasing staffing, Ashley’s research suggests that MLPs could benefit by expanding their education and legal education offerings, developing a more open communication process between participating entities as well as establishing a more holistic approach to addressing social justice.

Learn more about Ashley’s capstone experience.

Why did you choose to pursue an MPH?
I participated in two public health trips to Honduras through Global Brigades during my undergraduate career. While there, our group was responsible for building a latrine, stove, water storage unit and shower as well as installed concrete floors in the homes of the families we worked with. We were also responsible for preparing an educational program about proper hygiene and hypertension for children at the local school. After having this experience and working with community members, I knew I wanted to do more with public health and empower those around me to better their circumstances. 

What led you to your topic?
I worked with the Health Justice Project during my practicum in the fall of 2016. During this time, I helped research health outcomes related to lead and arsenic exposure through contaminated dust and soil. Through our work, we were able to change HUD’s requirements for blood lead levels to warrant intervention. The legal side of health was something I did not know much about at the time, but as I immersed myself more into the work, I wanted to make sure I incorporated it into my capstone.

Why was the content or theme important to you?
Legal services are not a right for individuals pursuing civil cases but are a right for those involved in criminal ones. When first researching my topic, I was very surprised to see what a difference legal aid has on health outcomes. By simply addressing legal needs in a medical setting, vulnerable populations can gain imperative services such as Medicaid, Social Security, WIC, and receive assistance for paying utility bills.

Where are you headed with your career?
I am currently looking for a job that utilizes my degree and incorporates the legal aspects of policy development. 

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A student’s Capstone project is a professional presentation, which demonstrates his/her ability to apply the program learning to a specific public health topic. Selected by the student, the project reflects a culmination of the course curriculum, field experience and independent study. This experience helps students explore their academic passions while preparing them for a competitive job market.

The Affordable Care Act: A Brief Review

A great new article from LUC MPH professor, Dr. Talar Markossian.