partner profile
What about the role of
academia in public health?
This is the case with everything that’s
controversial and shouldn’t be. We need
to learn better community engagement.
I think it’s a critical relationship, and
CSTE has contracts with academia.
Academic public health epidemiologists
can do the “R word”—academic research.
Government epidemiologists are not
funded to do it and sometimes are not
allowed to do it, because of institutional
review board considerations. Thus,
they have to rely on academic partners.
Epidemiology also relies on schools
of public health and related programs
for workforce development, because
they’re training the next wave of epis.
How can epidemiologists
address these challenges?
One thing is working closely with
the media. Media can be your best
friend. But it’s a hungry beast, and
if you don’t feed it, it can eat you.
One of the things we’ve learned is the
importance of good risk communication.
Risk equals hazard plus fear. Hazard
we can measure. Fear is that emotional
component. I think the hallmark of
good risk communication is recognizing
fear and embracing it. Fear should
be the first thing we address. And if
we don’t address the fear, then we’re
not doing risk communication.
As NC state health director, you
implemented a statewide ban on
smoking in restaurants and bars and
reduced the incidence of both HIV and
infant mortality. How did you do it?
How would you characterize the link
between epidemiologists and public
health laboratories (PHLs), especially
with the emergence of molecular
epidemiology?
Certainly, advanced molecular detection
(AMD) is very interesting and has
definitely led to a closer relationship.
Before AMD, the relationship between
epidemiologists and state laboratories
depended somewhat on the organization
of the state bureaucracy. In NC, the
PHL director reports to the state
epidemiologist, and the two work
arm-in-arm. But I know there are other
jurisdictions where the communication
is not as good as it should be. But I
can tell you, neither can do without
the other. They are both required.
Today, the laboratory is able to more
precisely identify complicated outbreaks,
often before the epidemiologist does,
particularly with multi-state outbreaks
involving only a couple cases in each
state. That’s exciting, and epidemiologists
have embraced this. And, yes, it’s
made the relationship even closer.
PublicHealthLabs
@APHL
When I moved from state epidemiologist
to state health director, the biggest
adjustment was the politics—and not
partisan politics, but working within
a political system. The state health
director reports to the secretary of health
in NC, but directly to the governor in
many states. Suddenly you’re in the
realm of policy. That’s a learning curve
that can be pretty challenging for a
public health scientist like me, because
politics is emotional and irrational.
It doesn’t obey the laws of science.
What led to a smoke-free policy in a
tobacco state was having a champion
in the general assembly. He was a
lung cancer survivor. And what I think
convinced him was, first, the surgeon’s
general report indicating that no amount
of secondhand smoke exposure is safe,
and second, framing the issue as one
of occupational safety for waitstaff and
bartenders and cooks, who have no choice
about their secondhand smoke exposure.
Once we started to talk about it as an
occupational health issue, it got traction.
We owe our HIV success to academia.
Dr. Myron Cohen, a physician and
researcher at the University of North
Carolina, discovered that people acutely
infected with HIV are hyper-spreaders,
and if you can get them into early
treatment, you can profoundly impact
the spread of infection. Our PHL was
APHL.org
able to implement nucleic acid testing
for HIV in high-risk sero-negative
people who hadn’t yet sero-converted.
And we sent a disease intervention
specialist to those people within a
week. It was basically applied science.
Another good example of partnership
with academia is our infant mortality
decline. The major problem was the
disparity between African-Americans and
whites. Based on that knowledge, public
health was able to employ evidence-based
interventions, such as targeting at-risk
populations with case management
and better access to prenatal care.
What is your vision for CSTE?
Our long-term vision is to ensure the
profession keeps up with science,
technology and two major changes
in the field: (1) big data and real-time
data exchange and (2) the emergence
of social media and smart phones
as major means of communication.
For example, how can public health
leverage electronic communications
to enhance epidemiology and improve
population health? CSTE is actively
involved in answering that question.
I think the laboratory community has
led the way in electronic reporting;
laboratory information management
systems are now mature in all the states.
That has paved the way to the next
iteration that we’re working on with APHL
now, which is electronic case reporting,
where you tie the lab report to the case
using the electronic health record. We’re
work