Aabha Sharma: Dr. Stamler mentioned that you were actively involved in starting the Masters of Public Health program at Northwestern. Could you tell us how you got interested in public health and what inspired you to take the initiative?
Dr. Kathryn Andolsek: I had experiences growing up that had me look at the differences in life and opportunities that were random, such as where you were born. When I was young I lived about half the time in rural Minnesota and half the time in D.C. My father's family were immigrants from Eastern Europe who had left most of their family in the "old country;" a small subset moved here over time but the older adults kept their own language and customs. In rural Minnesota there were significant access-to-care issues and one had to travel many hours or miles to get tertiary medical care, [which] in winter [was] not easy at all. In DC there were (and remain) significant differences in access based on socioeconomic status and race/ethnicity. Today we’d include these as, “social determinants” (of health).
At Northwestern Medical School I became involved in a student-run clinic at Erie House and discovered patients' health needs expanded far beyond the chief complaint. At that time many medical school courses didn’t provide much guidance on how to deliver comprehensive care to vulnerable populations. The curriculum was very different than now, of course, but topics we would now identify as risk factors (and their modification), evidence based medicine, population health, community engaged motivational interviewing —none of that was in the curriculum.
AS: What were some of the challenges you had to face as the pioneer MPH student? Was everyone open to the idea? Were there other students with similar interests as you?
KA: There weren’t that many students at that [time] interested in [public health]. It was primarily me and someone who worked with Dr. Stamler in a research capacity who were interested in getting training in public health. I simply cannot say enough about Dr. Stamler for being so open-minded and flexible, honestly for being willing to listen and go with a crazy idea.
The biggest challenge for me was how to integrate the requirements with my medical school education, which was my “day job”. To be able to graduate from Northwestern with my medical degree and include sufficient coursework to justify this additional degree was the major challenge. Navigating academic boundaries regarding courses was another hurdle. NU offered great coursework within and outside of [the] School of Medicine so mapping [ideal courses] out a degree for the first time was exciting – there was so much potential. But the system didn’t facilitate registering participation in courses across schools. Another big challenge for me was miscalibrating the amount of work it would take me to succeed with my thesis. I was the first person to start the MPH but I wasn’t the first person to get the degree because I wasn’t able to complete my thesis until a few years later during my residency. By that time I ended up needing to take a few extra courses since there were some new requirements. As the first student, figuring out the timeline was a challenge.
At Duke one of my roles has been to work with our students (who wish) to get [an] MPH at another institution. This is a seamless opportunity for them. This type of clear pathway did not exist at Northwestern initially and was tricky to do. Of course with a brand new program, the faculty weren’t clear on the timeline and existing courses weren’t appropriately sequenced. After you have a bunch of students go through the program, then it’s possible to have a timeline, an orderly sequence, and a few cycles of improvement based on feedback.
AS: That must have been quite a challenge to figure out at the beginning with Dr. Stamler. Could you elaborate on your interactions with him?
KA: Dr. Stamler was brilliant (of course) and decades before his time with his conceptualization of increasingly identifiable and modifiable risk factors that influenced an individual’s and a population's health. He led or was involved in foundational interventional studies, many focusing on nutrition and physical activity. Those things are all so accepted now it may be difficult to understand how truly revolutionary Dr. Stamler’s ideas were at that time. In addition he led rigorous research that critically examined risk factor modification that was way ahead of the science of the time. He was inspirational as a person and the high standards to which he held himself and his team. As a non-clinician he influenced the care of more patients than most of us clinicians ever will.
He was incredibly supportive of students. He welcomed learners into his Department. He and his wife Rose went out of their way to be inclusive. They were both incredibly kind to me, both as a student and as a person. I was often overwhelmed by that interest. I still remember Dr. Stamler's Department meetings as collegial, intellectually stimulating and fun! He lived what he believed. The menu for any departmental function was always based on good nutrition. He encouraged regular exercise. I think we would categorize a lot of his characteristics today as "a good mentor". He listened well, was supportive of new ideas, and actively networked [for] me and other students.
When I felt I was lacking knowledge from "just” medical school, I surveyed existing public health curricula from other institutions. (This was before the internet so not as easy to get these types of details as it would be today.) I came to him with a very rudimentary idea of taking existing Northwestern courses and adding a few to create a Master’s degree. I thought we had all of the elements. Meeting some of his faculty, I knew we had the critically essential faculty and some terrific projects which would make worthwhile practicums and that would be essential for this new program. In fact I thought the opportunities to participate in some of his departmental work would make this program unique and exemplary among [MPH] programs nationwide. He listened to that dream and made it happen.
AS: How has an MPH degree contributed to your career as a physician and an academic?
KA: I think the MPH has been invaluable to me. It helps me think outside the room, outside the person in front of me to try to take a more comprehensive view of all factors impacting my patient's health. It emphasizes the importance of the community on health and illness. Fortunately we are now getting more people insured (if not all people) through the Affordable Care Act, but we are just beginning to radically reform the health care system (not just the reimbursement system). Take smoking: responsible for 1 in 5 deaths, of which around 10% are due to second-hand smoke. Smokers die a decade earlier than non-smokers. Tobacco use costs $200 billion yearly. In 2013, states collected over $25 billion from tobacco taxes and legal settlements while spending less than 2% on its prevention and cessation. Chronic disease is responsible for 75% of health care costs and most related to tobacco use, inadequate physical activity, poor nutrition, and excessive alcohol use. You can't simply tell people to exercise more without attending to community violence. You can't adequately impact alcohol and other substance abuse without addressing mental health.
When I finished residency, I worked with the National Health Service corps in inner-city Chicago and put my MPH to work every day. I was able to use it when I joined an academic health center, initially working with at risk populations such as frail low income older adults, and later through work in our community trying to understand their priorities and identify stakeholders. As more of my career turned to education, I found many of the MPH principles equally applicable: what do we already know about how people learn and how learning can be assessed? How do we measure the outcome and impact of educational interventions?
AS: As the first MPH student at Northwestern University and as a successful individual in the realm of medical education, would you mind sharing a few words of advice with the current MPH students?
KA: Follow your passion. Hone your critical thinking skills! Think broadly and creatively! I am actually extremely envious of the new tools your generation has: geomapping, smart phones, apps and e-medicine. I think you will make bigger differences, especially in resource-constrained settings.
Reading Dr. Stamler's article I think he would consider me a failure. I did not follow his advice to develop tremendous expertise in one area. I respect that path immensely. However, I am a generalist by nature and by training, and I have found the MPH skill set tremendously useful across different populations, health conditions and research questions.
AS: The importance of mentorship is invaluable in any academic setting. Could you tell us about mentors you have had and how they helped you through your career?
KA: I think your generation talks a lot more about mentorship than mine. Whether we didn’t have it or didn’t see it in the same way, I don’t know. One of the things I felt fortunate about was that maybe because there were relatively few women in medicine when I started medical school, I didn’t necessarily see myself in one individual. I kind of felt like I had the opportunity to mix and match and select attributable features from different people to create a composite mentorship from them. I would have to say that I owe Dr. Stamler a lot. I probably had a sense of public health but I learned from him a commitment to not just implement changes but to evaluate and measure impact; also the whole excitement of the possibility of doing it as a career—I don’t think I knew that existed before Dr. Stamler helped me realize it. He and his wife Rose were the kindest people. They were genuinely interested in students and made time to take us to dinner or swimming. They were real human beings who got me involved in the affairs of the department. I felt like I had a home there, which was nice as a medical student since you are working [on] so many things and in so many directions.
Mentorship is really important. Sometimes you need to seek more than one person. Through different stages of life, you will need a team of mentors for support and guidance. The types of people you look for mentorship might change as you continue to develop throughout your professional career so it’s not something you would only do once. What you need from a mentor evolves too.
AS: Now, shall we wrap up our conversation? As much as I would love to talk about issues related to women in science and health careers, I don’t want to take too much of your time.
KA: Okay, I would like to add one more thing to mentorship as my advice to students. As I have gotten older, I have realized this and have gotten more explicit about telling my mentors what great and important mentors they were to me. In the context of women in medicine, one of the people who did a lot for the few women who were in my class was Dr. Sandra Olson. She was a bright and articulate faculty member who had a husband and kids and represented a way of life that no other faculty member did—that maybe we as women could combine a lot of elements in our career, professionally and personally, and not have to sacrifice one or the other. She was a very impressive person. It dawned on me a couple years ago that although I had told many people about the huge impact she had on me, I had never told her about it. A couple years ago, I wrote her a letter and took her for a drink when I was in Chicago. I think it’s important to thank people who have impacted your life and let them know they were an inspiration to you.
AS: Wow that’s true. Now I am thinking of all the teachers from high school that I never thanked personally.
KA: There’s still time and it’s never too late.
AS: Thank you so much for your time! It was great talking to you.
KA: Good luck to you!
The companion piece to this article, our interview with Dr. Stamler on the founding of the MPH program here at Northwestern, can be found online in our Fall 2014 edition at nphr.org.
Dr. Kathryn E. Andolsek is Professor of Community and Family Medicine at the Duke University School of Medicine. As a medical student, she initiated the creation of the Program in Public Health at Northwestern University. Her current research interests include work on medical education, geriatrics, and healthcare delivery.
Aabha Sharma is a PhD/MPH student at The Graduate School of Northwestern University.