Living well

It takes a village of experts to make one great health school

Waterloo’s new School of Public Health and Health Systems doesn’t look or work like any other public health school in Canada.

That’s part of the plan. It teaches by tackling contemporary problems. After the SARS crisis in 2003, Waterloo’s academics and scientists took up the call for greater collaboration, and began talking about expanding the scope of public-health education.

It was a big challenge, but they could build on a tradition of solid scholarship: From obesity to aging, smoking to fitness, applied health sciences at Waterloo continues to explore issues that are important to the lives people lead.

“Our strategic plan said that to have as much impact as we wanted, we needed to do it differently,” says Paul McDonald, director of the new school.

Public-health training hadn’t changed much in 100 years, he says. Graduates tended to work in nutrition, child and maternal health, occupational health and epidemiology. The world had fundamentally changed, but little attention was being paid, for example, to the social impact of aging.

“We want to look for the next best idea,” McDonald says. “The majority of academic papers describe problems, the rest offer solutions. We decided to commit to that – to organizing around solving problems, not just describing them.

“Let’s train students to be agents of constructive social change.”

Waterloo’s health studies program dates back to 1978. That’s when the university created one of North America’s first multidisciplinary departments dedicated to advancing health promotion rather than traditional, medically oriented treatment.

The early focus on gerontology, which brought together care providers and academics, remains as strong today as it was 35 years ago.

George Heckman, a geriatrician, internist and Schlegel Research Chair at Waterloo, maintains a clinical practice while carrying out research and advocating for better long-term care for seniors.

Heckman believes that frailty and chronic diseases can be proactively managed, with the goal of keeping seniors as functional as possible wherever they live, decreasing the need for hospitalization, and ultimately reducing pressures on long-term care.

His work involves assembling an inventory of services and identifying barriers to seniors’ care.

“Many seniors end up in alternate levels of care because of preventable problems such as falls, fractures and complications associated with heart disease,” says Heckman. “The solution is to prevent it from happening in the first place.”

Breaking down barriers

Susan Elliott joined the University of Waterloo two years ago as the new dean of applied health sciences. She had just completed her first term as dean of social sciences at McMaster University when the position at Waterloo became available.

A multi-disciplinary faculty such as applied health sciences seemed a natural fit, given her profession as a medical geographer.

Elliott knew there was an intention to transform an existing department into a school, but as the scope of planning grew, it became much more than a simple transition and name change.

She liked what she was hearing about cross-faculty co-operation. “My job is to facilitate those dreams – to get rid of barriers,” she says.

Susan Elliot

Public health is both an art and a science, says Susan Elliot, dean of the Faculty of Applied Health Sciences.

A number of collaborations are already underway. Professors specializing in occupational and environmental health are working with experts in engineering to investigate the potential influence of wind turbines on human health.

Others teach public health courses as part of the country’s first health-focused, online Master of Social Work (MSW) program, a collaboration between Renison University College and the Faculty of Applied Health Sciences.

Public health and health systems faculty members themselves contribute expertise from a cross-section of disciplines.

Health researcher John Hirdes, who develops clinical decision-making tools to improve health-care services, has a doctorate in sociology, which Elliott sees as a vital component of improving health.

“Public health is both an art and a science,’’ Elliott says. “We need to understand biological mechanisms, but also the art of changing human behaviour. For example, how can we motivate people to get up at 5 a.m. to exercise?”

“That has less to do with biology and much more to do with changing behaviour. We need to understand what is important to people.”

New ways of thinking

Changing attitudes about public health begins with the men and women who enroll in Waterloo’s program.

“We find that the majority of students interested in health sciences want to be physicians,” McDonald says. “We introduce them to a new way of thinking about health.

“Many are not aware of public health, not aware that policy is far more effective than a pill or surgery in bringing about change at a population level.”

Better health care, in Waterloo’s view, combines good medical treatment, timely information and sound social planning.

In times of fiscal restraint, cuts to transportation, education and environmental protection can adversely affect mental and physical well-being. Cuts to health care come with their own set of challenges as an aging population raises the demand for service.

One area that shows promise as both a money-saver and tool for better health care is informatics – the electronic management of information across different platforms among different experts. Waterloo’s
public-health researchers are deeply involved, examining ways in which informatics might be used, for example, to share a rehabilitation plan for an injured elderly person, or bring a social worker up to date as a patient moves from one facility to another.

“Right now we can’t follow people through the system, which is fundamental,” McDonald says. “It may take several providers to get to the type of care a person really needs. That’s a systems problem.

“We want students to excel at systems thinking. We build it into assignments. They need to think, assess, analyze differently. We are all interconnected. We need a whole new generation of thinkers who look at social systems to develop solutions.”

As an example of systems thinking, Elliott points out that older persons are among the primary users of acute-care hospital beds. With a strong network of supports, more of these people can avoid hospital stays.

For that to work, hospitals, community-care access centres, primary-care physicians and support staff need to collaborate. Urban planners could also be part of the discussion to ensure future communities are more senior-friendly.

Research involving Waterloo’s Faculty of Applied Health Sciences and the School of Planning is already looking at neighbourhood designs that make walking a convenient, healthy alternative to quick trips in a car. 

Masters of collaboration

A review of Canada’s SARS outbreak, which killed 43 and sickened more than 200 others, found gaps in the public-health skill set.

At Waterloo, applicants to the Master of Public Health (MPH) program must have at least one year of experience in a relevant position. The program was established in 2006 almost entirely online. Students established in jobs and communities don’t have to leave home or uproot their families.

It also attracts international students who bring different experiences and approaches to promoting and protecting the health of populations.

MPH students start on campus for two weeks. They connect, develop an understanding of the methods and goals of the courses, and learn the technology.

Five terms and a practicum later, they return for two final weeks of assessment and evaluation. At any given time, MPH enrolment totals about 160.

“We are attracting phenomenal applicants,” McDonald says. Despite distances separating them and primarily online communication, “the cohort bond in the public health program is unlike any other. They elicit feedback from each other: it’s a network with unrivalled power.”

Open to different perspectives

The words “partnership” and “real-world” pop up again and again in conversations with faculty at the new public health school.

Assistant Professor Shannon Majowicz joined Waterloo last spring after a decade researching food- and water-borne diseases for the Public Health Agency of Canada.

Shannon Majowicz

Waterloo's approach to public health problems is strengthened by a willingness to share knowledge and openness to different perspectives, says Shannon Majowicz.

“It’s a point of pride that what they do (at Waterloo) matters to the real world,” Majowicz says. “They’re very open to different perspectives.”

The Public Health Agency of Canada talked about “surge capacity”– including tapping into the expertise universities have to help manage a crisis.

“During the H1N1 pandemic (in 2009), there was a lot of informal connectivity that happened,’’ Majowicz says. “Folks who had something to offer stepped forward. Regardless of where you’re sitting, you want what you do to make a difference.

“There is a lot of sharing,” Majowicz says. “It’s a fine example of systems thinking. My ideal is a multi-pronged approach to problems.”

Building trust

Associate Professor Rhona Hanning has had a diverse career in nutrition research. From her early career as a dietitian, through clinical research with kidney disease patients and preterm babies, she has focused on nutrition and dietary assessment.

Since joining Waterloo 12 years ago, her prime areas of investigation have focused on public and population health issues. These have included dietary surveillance of school children and adolescents, including First Nations students, obesity prevention, and evaluating school-based food and nutrition program and policy interventions.

Rhona Hanning

Rhona Hanning works to improve nutrition and health among youth in First Nations communities.

Currently, her research group is evaluating physical activity programs and breakfast-and-snack programs in First Nation schools. In Fort Albany, Ont., a new greenhouse will help the children learn about gardening as they grow fresh food for their own school snacks. A web-based eating behavior questionnaire developed by Hanning while at Waterloo (WEB-Q), has been used to assess the food intake and physical activity of 250 Cree schoolchildren in grades six to 10.

One challenge she sees is getting the research findings back to First Nations communities.

“We use numerous channels to disseminate research findings – radio, newspaper articles” Hanning says, “but where we’re having more success is with organizing healthy community feasts.”

“Celebration feasts are part of native culture and they draw people who might not ordinarily be interested in what we’re doing. Raffling off prizes such as bags of milk, which are difficult for them to access, is very popular.”

The look of the future

Involvement with outside agencies will help ensure the School of Public Health and Health Systems fulfills its mandate of leading thoughtful, informed change, McDonald says.

He regularly gets calls from health organizations seeking analysis or research in a particular area. Typically, they want the material in a hurry because funding may evaporate with the next budget.

“Currently, we’re not prepared to respond to immediate requests, but we are setting up practice centres that will have the capacity to respond quickly,” he says. “Students will be closely supervised as they work with researchers on real-life problems, getting experience in analytics, designing and conducting evaluations, devising and testing new technologies.”

Waterloo’s long tradition of co-op education also makes the health-sciences program stand out.

Elliott, the dean, says the faculty’s students are serious and focused, committed to future success, and well-suited to the type of real-life health research that shows well on their resumés.

A proponent of international research, Elliott is actively seeking more links like the one established with the Uganda Christian University in 2010 to build health research and education capacity. She also supports more collaboration with experts in health informatics and evaluation.

“Good things happen when techies and health people are in the same room,” she says.

The goal, McDonald says, is to become one of the world’s top 10 public-health programs.

“Our expertise is to build capacity for national and international health systems,” he says. “It is do-able. We have a five-year plan and the university is completely supportive. We intend to add five new degree programs. With them, we should have sufficient resources to meet and exceed expectations.”