Built to Serve
Working in Diverse Communities to Address 21st Century Public Health Challenges
At the heart of public health is a commitment to prevention and sustainably protecting and improving the health of entire communities.
The Herbert Wertheim School of Public Health and Human Longevity Science at UC San Diego has been serving the community by working in diverse populations to improve determinants of health, develop collaborative community-based programs and foster innovation.
“Public health is about reaching the community so that no matter where you live, learn, work, play, or pray you have the opportunity to experience the longest possible healthy life,” said Cheryl A.M. Anderson, Ph.D., M.P.H., founding dean of the Herbert Wertheim School of Public Health and Human Longevity Science and Hood Family Endowed Dean’s Chair in Public Health.
“The idea was to take the technology developed at UC San Diego and deploy it at the service of students and communities that need it the most around the county,” said Fielding-Miller. “We’ve heard from a lot of our school partners that the program makes them feel good and safe because there is this extra level of monitoring on their campus.”
The success of the program led to a second year of funding from the county and the Safer at School Early Alert system was expanded to more schools for the 2021-2022 academic year.
Pandemic Response
When the establishment of the school was approved on September 19, 2019, public health professionals were focused on addressing health behaviors — like tobacco use, physical inactivity, and poor nutrition — that are responsible for the most common modern day chronic diseases: cardiovascular disease, cancer, lung disease and hypertension.
But in 2020, as the school was being primed for its first academic year, Herbert Wertheim School of Public Health quickly pivoted to help overwhelmed communities disproportionately impacted by the COVID-19 pandemic.
In an effort to reduce the risk of COVID-19 outbreaks in San Diego-area TK-8 schools and child care centers as they resumed in-person instruction, Rebecca Fielding-Miller, Ph.D., M.S.P.H., assistant professor, led a community-based pilot program using wastewater and surface monitoring to detect the presence of SARS-CoV-2.
Called the Safer at School Early Alert system, the program is a collaboration with San Diego County Health and Human Services Agency. The program incorporates elements of risk mitigation, viral monitoring and a strong focus on public health interventions that work for each community.
“Public health is about reaching the community so that no matter where you stand in our society you have the opportunity to experience the longest possible healthy life that we’re all hoping for.”
– Cheryl A.M. Anderson, Ph.D., M.P.H., founding dean of the Herbert Wertheim School of Public Health and Human Longevity Science.
Beyond Borders
Linda Hill, M.D., M.P.H., Distinguished Professor and interim assistant dean for community border health partnerships, began supporting government agencies with health screenings for asylum seekers entering the United States in 2018, using a congregate sheltering model. With the onset of the pandemic, sheltering was moved to separate hotel-room housing.
Hill and her team of community health workers and medical providers screen for COVID-19 and other health problems and conduct house calls for approximately 200 to 400 asylum seekers per day, checking on pregnant women, providing hypertension medicine and other medications, and caring for acute illnesses.
It’s a labor of love made up of a community of students from UC San Diego, San Diego State University and University of San Diego; community health workers; medical residents from UC San Diego Health, Kaiser Health and Scripps Health; and clinicians from UC San Diego Health and the community.
In 2021, Hill and other UC San Diego colleagues, including Timothy Rodwell, M.D., Ph.D., M.P.H.; Richard Garfein, Ph.D., M.P.H.; and Steffanie Strathdee, Ph.D., joined the Consulate General of Mexico in San Diego and various health agencies and universities in Baja California to conduct a survey of the prevalence of COVID-19 in the Mexican cities of Tijuana, Mexicali and Ensenada.
“We are building future public health professionals who will understand and care for displaced populations, who will be committed to providing culturally competent care and who will address diversity and equity,” said Hill.
“This project is an example of binational cooperation and collaboration government, academia and non-governmental organizations coming together to design public policies for the prevention, management and eventual eradication of COVID-19,” said Hill.
Population Health
Working in collaboration with public health officials, health and human services agencies and community health centers ensures that programs and messages are appropriately adapted to different communities and fill gaps in health services.
Jesse Nodora, Dr.P.H., associate professor, investigated human papillomavirus (HPV) vaccination knowledge, awareness and practices by health providers, pharmacists and school or university providers in San Diego County to help stakeholders identify opportunities to increase HPV vaccination.
The findings were presented in February 2021 at the San Diego HPV Vaccination Call to Action Summit. It created the basis for an academic community workgroup called San Diego Protecting Against HPV (SD PATH).
“While the work to increase HPV vaccination rates in our county has been challenged by the realities of the COVID-19 pandemic, these immunizations have never been more important,” said Nodora.
“The goal of PATH is to bring together area immunization champions to increase HPV vaccination in our region. The only way we will be able to make San Diego free of HPV-related cancers is by working in partnership.”
The workgroup is currently focused on capacity building and inventory projects, curating continuing education for local providers, facilitating learning opportunities for the community, investigating pilot research projects and increasing cancer prevention awareness. Its goal is to raise HPV vaccination rates to 80% by 2026.
Andrea LaCroix, Ph.D., M.P.H., Distinguished Professor and chief of the Division of Epidemiology, is also involved in a multi-institution cancer prevention program called the WISDOM Study. The aim is to uncover whether annual mammograms are the best way to screen for breast cancer, or whether a more personalized approach — driven by the data attached to each woman’s genetic makeup, family history and risk factors — could deliver better results.
Women live longer and as a result have more comorbidities and disabilities, said LaCroix. So in addition to cancer risk programs, her work focuses on identifying effective interventions for heart disease and disability in postmenopausal women.
“I work with collaborators across the country on ways to create a world in which older people are able to walk and take care of themselves, live independently, and be cognitively intact enough to do the things that you need to do every day,” said LaCroix.
“Older people get the same advice as younger people: Exercise. And if they can’t exercise, then they should do whatever they can do. Our studies indicate that just standing or doing light physical activity is associated with reduced mortality, reduced cardiovascular disease and a greater chance of maintaining mobility.”
Surprisingly, physical activity has not historically been a routine discussion during primary care visits, said Sarah Linke, Ph.D., M.P.H, associate professor and assistant interim dean for community UC San Diego campus partnerships.
“Your doctor may never talk to you about physical activity, despite the fact that you have high blood pressure, diabetes, cardiovascular disease or are overweight,” said Linke.
She’s trying to change the paradigm and incorporate an assessment of physical activity at every primary care visit and, if necessary, prescribe physical activity to patients who are not doing enough physical activity. Already, Linke has implemented the “Exercise is Medicine” program into four UC San Diego Health primary care clinics and has reached more than 21,000 unique patients.
Healthier Future
Solving contemporary public health problems requires a 21st century approach.
“Whenever we have different views of a problem, we also have diverse ideas for solutions. If we can put our heads together, using our unique lenses from each of our disciplines, then ideally, we can come up with more creative solutions,” said Linke.
The Safer at School Early Alert system used this approach. The program is modeled after UC San Diego’s Return to Learn, a first-of-its-kind approach to safely resume to teaching, learning and research at a university.
A robot installed at each school site collects daily wastewater samples that were then tested at the laboratory of Rob Knight, Ph.D., professor at UC San Diego School of Medicine, enabling researchers to detect SARS-CoV-2 three to five days ahead of individual tests.
For surface monitoring, teachers or staff used a swab to sample a one-square-foot section of the center of the floor in a classroom, which is where aerosols settle. These samples were tested daily at the Expedited COVID IdenTification Environment (EXCITE) lab at UC San Diego.
Digital tools and strategies — such as wearable and remote sensors, and social media platforms — used in health research produce volumes of granular data that can provide important health indicators. These tools also introduce new and unique ethical challenges around privacy, risk assessment, data management and informed consent.
Camille Nebeker, Ed.D., associate professor, leads the multidisciplinary and trans-sector Research Center for Optimal Digital Ethics Health (ReCODE Health), which conducts research and provides education to support ethical digital health study practices.
Several members of ReCODE Health contributed to the design and implementation of CA Notify, California’s COVID-19 exposure notification system. Users who active CA Notify on their smartphone will be notified if they have been in proximity to someone who tested positive for COVID-19. It will be a critical tool in preventing the spread of COVID-19, but only if used by a majority of Californians.
UC San Diego partnered with the California Department of Public Health to design and test CA Notify. By working closely with the university campus and local community, they learned what would make CA Notify an acceptable and useful tool. Several community “design” workshops were convened, three of which were conducted in Spanish. Insights obtained from workshop participants focused on language and images used to communicate key CA Notify features including privacy protections and accuracy.
“We have taken a community-engaged approach to design CA Notify. By taking the time to listen to community members, we were able to identify improvements and areas of concerns that influence acceptability and subsequent adoption. Technology will only be useful in preventing the spread of COVID-19 and other infectious diseases if it is trusted,” said Nebeker.
Whether through campus partnerships, collaborations with government agencies or community health centers, the Herbert Wertheim School of Public Health is on a mission to create and promote public health innovations to advance equity, justice and wellbeing on a local, national and global scale.
