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History of PHS
Two score and ten years ago, our fore-faculty brought forth upon the UW campus a new department. Conceived as prevention as opposed to intervention, it was dedicated to the proposition that to avoid was better than to treat and it changed the way we look at health care. As we read this document describing the evolution and revolution that this department has wrought, it is good to reflect upon those whose accomplishments served as the cornerstone upon which this department was built. But, the story of the department extends back much further than its christening in 1959.
SOWING THE SEED
What would become the Department of Preventive Medicine begins with a 1903 decision of the Wisconsin State Legislature to establish a “hygienic laboratory.” The legislature established the laboratory on the university campus to “provide benefits from the university’s scientific capabilities and promote public health.” The melding of science with public health paralleled the development of academic medical centers pioneered at Johns Hopkins and championed by Abraham Flexner, where the education of physicians would have a scientific foundation to build upon their clinical skills. Various individuals headed the laboratory until 1918, in the year of the devastating Spanish flu pandemic, when Dean Bardeen appointed W.D. Stovall as director, a post he held until 1958. In 1948, in the aftermath of World War II, the Medical School recognized the efforts of Stovall and others by creating a new division within the Department of Medicine called Preventive Medicine. This new division was strongly linked not only to the laboratory but later to the Student Health Services. The Wisconsin State Laboratory of Hygiene (WSLH) building on Henry Mall was completed in 1953 with funds obtained by Stovall from a federal grant. The WSLH opened at about the same time that the Warren Grant Magnuson Clinical Center opened on the National Institutes of Health (NIH) campus in Bethesda. Both facilities were designed to bring research laboratories into close proximity with hospital wards in order to promote productive collaboration between laboratory scientists and clinicians.
When Alfred S. Evans joined the medicine faculty in 1952 from Yale, he was assigned research space and resources by Stovall in the WSLH building. Evans was trained in infectious diseases with particular interests in mononucleosis, hepatitis, and the evolving field of respiratory virology. During his time in Medicine, Evans took a sabbatical leave at the University of Michigan for training in biostatistics and epidemiology and earned an MPH degree.
Upon Evans’s return to Madison in 1959, the newly constituted Department of Preventive Medicine (now the Department of Population Health Sciences) was born and he was appointed to be the first chair as well as director of the WSLH. Evans initially staffed the department by giving faculty status to several laboratory directors within the WSLH. He also began recruiting new faculty with a research focus in microbiology. Given Evans’s interests and the expertise of the laboratory, the initial research thrust of the department was in the epidemiology of infectious diseases. He subsequently developed a strong medical student teaching program, often with intriguing lecture titles (“Sneezes, Wheezes and Other Diseases”). Courses in the medical curriculum, the Epidemiology of Infectious Diseases and the Epidemiology of Chronic Diseases in the second year became popular offerings. Between the second and third years, students carried out a survey of public health agencies in whatever community they were located.
Evans was among the first to develop and employ an effective computer program for a public health laboratory to assist in epidemiological studies. Through longitudinal observations and a collection of carefully documented stored serum specimens, he established the value of college student populations as well as other groups as close as Wisconsin and as far as the Philippines for descriptive, comparative, and serological epidemiologic studies. He also established the first comprehensive graduate summer program in epidemiology and biostatistics. The program began rotating between the UW and the universities of Minnesota and Michigan and ended at the UW when both the other universities began their own yearly programs, a harbinger of new schools of public health at the other universities and the demise of any such development at the UW. In 1966, Evans returned to Yale to become the director of the World Health Organization Regional Serum Reference Bank with a named professorship in the Department of Epidemiology and Public Health. Evans subsequently edited two widely used textbooks, Bacterial Infections of Humans and Viral Infections of Humans, which went through several editions until his death in 1996.
Following the departure of Evans in 1966, the positions of WSLH director and chair of Preventive Medicine were separated. Although the WSLH and Preventive Medicine would become administratively and financially separate, they continue to have a strong affiliation; the director of the WSLH has been a full-time faculty member of Preventive Medicine to this date. However, as units, they have had distinct trajectories.
Stanley Inhorn, who served as assistant laboratory director with Evans for six years, became laboratory director. Under Inhorn, the WSLH greatly expanded testing for infectious diseases, drugs of abuse, and environmental contaminants.1 Newborn screening, prenatal screening, and screening for tuberculosis, hypertension, diabetes, and cervical cancer enhanced the role of the WSLH in preventing diseases in Wisconsin. Inhorn became chair of the Department of Pathology and Laboratory Medicine in 1978 and was succeeded as director of the WSLH by Ronald Laessig in 1980. Laessig, a clinical chemist, expanded newborn screening to more than 40 conditions, and consolidated all environmental, occupational health, and forensic toxicology testing in a new 76,000 square foot laboratory.2 During Laessig's tenure, the WSLH established testing for HIV/AIDS, hantavirus and West Nile infections, SARS, and agents of biological and chemical terrorism. The WSLH provided support for many high profile epidemiologic investigations of toxic shock syndrome (1980), cryptosporidium (1993), monkeypox (2003), and contamination of Great Lakes fisheries. Laessig became an Emeritus Professor in Population Health Sciences upon his retirement in 2006. Laessig was succeeded by Charles Brokopp, who currently serves as the director of the WSLH.
DEPARTMENT OF PREVENTIVE MEDICINE (NOW POPULATION HEALTH SCIENCES) 1966-2009
The recruitment that began in 1966 for the chair of the department of Preventive Medicine culminated in 1968 with John Rankin’s appointment from his position as professor of medicine and head of the Pulmonary Disease Section in the Department of Medicine. He retained his Medicine appointment and continued in clinical practice throughout his career.
Rankin was a native of Glasgow, Scotland. His early publications in the 1950s produced the Rankin (or Glasgow) scale for stroke diagnosis and prognosis, which is still used in clinical trials throughout the world. Rankin’s research interest at UW was in occupationally-related pulmonary disease. With his colleague, Helen Dickie, he provided the first description of farmer’s lung as a hypersensitivity pneumonitis.
Rankin’s vision for the Department of Preventive Medicine included interdisciplinary integration of biology, medicine, epidemiology, and health policy. He began development of a health services research/administration program that led in 1972 to the initiation of a Masters of Arts (MA) degree program in Health Services Administration jointly with the Business School. The degree program was organized and led by Rockwell Schulz. This program also had tracks through which students in the Industrial Engineering Department and Lafollette Institute for Public Policy (now called the LaFollette School of Public Affairs) could develop a health administration emphasis.
In 1978, based on the recruitment of additional epidemiology and biostatistics faculty and their attendant research programs, a Master of Science (MS) degree program in Epidemiology was begun. The program emphasized epidemiologic research methods and required a thesis for the degree. The students who achieved this MS were a highly motivated group who were served well by the program’s limited size, research orientation, and rigor. Alumni of this program hold positions in academic institutions and national, state, and local health agencies. In 1979, as an outgrowth of the health services administration program, a residential MS degree program in Administrative Medicine for physicians and other clinician managers was begun, organized, and directed by David Kindig and Jay Noreen. The program was later reorganized into an innovative non-residential, distance-learning format that enabled the training of mid-career clinicians nationwide and the campus-based program was discontinued. There are more than 250 alumni of this program throughout the US, most occupying leadership positions in a variety of health care organizations.
Under Rankin’s leadership, the department grew to reflect his and the faculty’s diverse interests. It soon included not only the “laboratorians” at the State Lab, but also pulmonary physiologists, occupational medicine physicians, health care administrators, and epidemiologists. Modern epidemiology and public health continued to be the common factors linking the Department’s varied interests. Rankin fostered strong links to the State of Wisconsin Departments of Health and Family Services and Natural Resources that last to this date. In addition, he and colleagues in the Department of Medicine undertook a series of studies of pulmonary disease in grain elevator and rubber industry workers.
During his almost three decades of service to UW-Madison, Rankin was honored as a Rockefeller and Markle Scholar, awarded a Rennebohm Professorship in Medicine, and made an honorary member of the Royal College of Physicians. He was an extraordinary mentor to many young scientists and physicians in the department and at the UW. A visiting professorship and travel award stipends to research trainees in Rankin’s name have been awarded annually since 1984.
Upon John Rankin’s untimely death in 1981, Donn D’Alessio was appointed chair. D’Alessio had been vice-chair of the department, director of the epidemiology graduate program, and a member of the Infectious Disease Section of the Department of Medicine. Like Rankin, he maintained his appointment and clinical activity in Medicine throughout his career. D'Alessio was trained in internal medicine and infectious diseases and spent two years in the Epidemic Intelligence Service at the Centers for Disease Control before coming to the University of Wisconsin.
With this change in leadership the work in occupationally-related lung disease came to an end and the emphasis shifted to enlarging the faculty numbers in epidemiology, biostatistics, and health services research, and to focus research and training in those areas. The group of pulmonary physiologists who were brought to the department in Rankin’s tenure continued a strong research and training program in the control of breathing and sleep apnea. The State Laboratory continued to provide faculty members and training opportunities to the department’s students.
The mid-1980s saw a number of changes in the department’s teaching programs. The department’s course in the second year medical school curriculum was combined with two other courses to form a course focused on the preparation for medical practice. This change occurred concurrently with major changes in the department’s graduate training program.
Although the department had three different master’s programs, there was no formal doctoral program. After a prolonged planning effort led by D’Alessio and involving the entire faculty, a unique MS/PhD program was developed that combined core training in epidemiologic, biostatistical, and health services research methodology prior to students completing an emphasis in one of these areas. The proposal for this new integrated degree program was approved by the Graduate School and an MS/PhD degree program in Population Health was initiated in March 1997. The first cohort of 11 students entered the new graduate program in the fall of 1997. Between 1997 and 2000, the number of entering students fluctuated between 15 and 20 annually.
To launch the new degree program D’Alessio prevailed on the Medical School administration to geographically unify the departmental faculty who would be most directly involved in teaching and mentoring in the Population Health Graduate Program. In November 1998, the health services research and epidemiology/biostatics groups were geographically united for the first time in thirty years in the Wisconsin Alumni Research Foundation (WARF) Building, which remains the department’s home. By necessity, the State Laboratory of Hygiene faculty remain separated to this day as do the Pulmonary Physiology group and one epidemiology research group that require wet laboratory space not available in the WARF Building.
During the 1980s and 1990s, the department continued active research programs and consistently ranked in the upper echelon among the school’s departments in total extramural grant funds obtained as well as in extramural grant dollars per faculty member. In addition to individual research programs in the late 80s and early 90s, four NIH-funded population-based cohort studies were begun that studied low birthweight infants (Mari Palta, principal investigator [PI]), sleep apnea (Terry Young, PI) hearing (Karen Cruickshanks, PI) and type 1 diabetes (Donn D’Alessio, PI). These studies continue federally-funded follow-up of these populations through twenty plus years.
D’Alessio retired in 2000, ending thirty-three years at the university, nineteen as chair. John Mullahy served as interim chair of the department while a national search was conducted to find a permanent chair. During Mullahy’s tenure, the department officially changed its name to the Department of Population Health Sciences in July 2001.
As we entered the new millennium, under Dean Philip Farrell’s initiative, the medical school was set on a course for embracing the public health mission and transforming itself to a school of medicine and public health. Several faculty from the department worked closely with Dean Farrell on major public health efforts, including the development of plans for the Wisconsin Partnership Program (created from interest income on a $300 million gift from Blue Cross Blue Shield), a new Master of Public Health Program, and changing of the name of the medical school to the first in the nation "School of Medicine and Public Health" (SMPH). The recruitment of a new departmental chair was part of the vision and planning for this eventuality.
F. Javier Nieto arrived in Madison as the new department chair in January 2002 after a successful national search. A native of Spain and with training in medicine and public health in Spain, Cuba, and the US, Nieto was on the faculty of the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health at the time of his recruitment. He is a nationally and internationally known cardiovascular disease epidemiologist with significant research in emerging cardiovascular risk factors including chronic infections, psychosocial factors, and sleep disorders. Owing to the combination of his epidemiology expertise, public health background, original training as a family physician, and experience in health care services organization, Nieto was uniquely poised to lead the multidisciplinary DPHS.
With Nieto's arrival, a combination of meeting standing needs and the new chair's recruitment package initiated a wave of faculty hiring and new initiatives. A retreat held in the fall of 2002 led to priorities in hiring for areas of: infectious diseases, behavioral sciences, chronic disease epidemiology, health services research, health outcomes research, health economics, and health policy. As a result of new hires and retirements, as of June 2009, the department’s faculty ranks had changed dramatically from being mostly tenured professors to being comprised of 10 assistant professors, 3 associate professors and 12 professors.
Research and Extramurally Funded Programs
In the Nieto era, the breadth and scope of research and extramurally funded programs have greatly expanded. Department faculty and staff were instrumental in the successful effort in 2007 to win an NIH Clinical & Translational Sciences Award (CTSA) worth over $40M and the subsequent creation of the UW Institute for Clinical & Translational Research (UW-ICTR), with matching funds provided by the Wisconsin Partnership Program. Maureen Smith directs UW ICTR’s Community-Academic Partnerships core, which aims to support collaborative, multidisciplinary research that solves problems in translating new and existing knowledge into improvements in clinical practice and community health (“Type 2” translational research). ICTR-CAP’s infrastructure leverages and links a network of more than ten organizations from across the UW and the State of Wisconsin. This multi-pronged approach, in which unique translational research resources and funding mechanisms are integrated with educational and community engagement activities, has been nationally recognized as a model for building and supporting translational research that engages communities and clinical practices. Smith also directs the Health Innovation Program, which supports innovative health services research focused on improvements in local and statewide health care delivery. The Health Innovation Program has been successful in engaging trainees, recruiting faculty, and supporting a diversity of projects. In addition to Smith, Nieto and D. Paul Moberg also have leadership roles in ICTR programs as assistant directors for population-based research and evaluation, respectively.
Nieto led at team of faculty who successfully obtained a grant from the Wisconsin Partnership Program to plan for and then initiate the Survey of the Health of Wisconsin (SHOW), a statewide annual survey of the health of residents of Wisconsin. Modeled after the National Health and Nutrition Examination Survey, SHOW was launched in June 2008 as the only such survey in the nation with a state focus. Because of its annual and modular character, SHOW is designed to serve as a core infrastructure for ancillary studies to be added; these could include the addition of exam components, community specific studies (including the evaluation of community wide interventions), and prospective follow-up studies.
In collaboration with the Medical College of Wisconsin, we were one of the first wave recipients of a Vanguard Center for the National Children’s Study that is located in Waukesha County (Maureen Durkin, director). The extremely successful long-term studies begun under D’Alessio’s leadership also continue to flourish. This includes Mari Palta’s Newborn Lung Project and the type 1 diabetes study that is still underway (with Palta replacing D'Alessio as PI). Likewise, Terry Young’s and Paul Peppard’s Wisconsin Sleep cohort recently received renewed NIH funding to complete what will be the longest population-based cohort study of sleep disorders in the world. Karen Cruickshanks’ sensory/aging research has expanded dramatically to include the Epidemiology of Hearing Loss Study in Beaver Dam, WI, Beaver Dam Offspring Study, and the EpiSense Audiometry Reading Center for the Hispanic Community Health Study, a multicenter national study of 16,000 Latinos.
The department’s recent hires provide us with even greater capability to meet the needs of the University, state, national and international communities. The successful 2006 recruitment of Jonathan Patz, an internationally known researcher in global health, provides us not only with a more solid link with the Center for Global Environmental Health and an expanded capability for research and teaching in global health, but with a window of visibility that transcends academia. Together with emerging research by our faculty in such areas as: disease clusters and hospitalizations (Ronald Gangnon), community interventions (Ana Martinez-Donate), infectious disease epidemiology (Ajay Sethi), prostate and breast cancer (Halcyon Skinner, Amy Trentham-Dietz), hypertension epidemiology and treatment (Leonelo Bautista), caregiver and family initiatives (Whitney Witt), health economics (Thomas Deleire, John Mullahy, Bobbi Wolfe), health care provider practice change modeling (Mark Albanese), environmental contamination (Marty Kanarek), health policy (Thomas Oliver), genetic epidemiology (Corinne Engelman), epidemiology of childhood disabilities (Maureen Durkin) and translational research (Maureen Smith); we have a strong foundation for building into the future.
The nature of the graduate program has also evolved to reflect the growth of the department. In 2007, the department completed the approval process for granting an emphasis on epidemiology that is noted on the transcript and a concentration in Clinical Research was added to the existing concentrations in Epidemiology and Health Services Research. In 2008, a fourth concentration was added in Social and Behavioral Health Sciences. At the beginning of Nieto’s era, the graduate program had an entering class of 14 in 2002 that saw rapid growth to 25 in the fall of 2003. Since then it has ranged between 18 and 26. As of summer 2009, the program will have produced a total of 121 masters and 32 PhD graduates. Graduates of our program have assumed academic positions (professor and scientist positions) at universities such as Yale, Duke, Illinois, Chicago, Michigan, Michigan State, Johns Hopkins, and Harvard. We have had others become epidemiologists for the state of Wisconsin and the Centers for Disease Control. Still other graduates work for profit and non-profit corporations such as the American Cancer Society, Mayo Clinic, Eli Lilly and Company, Merck and Company, Moffitt Cancer Center and the Center for Urban Population. Our graduates have been very successful in becoming contributing members of the population health professions.
In 2004, a new interdisciplinary Master of Public Health (MPH) program was approved with Patrick Remington as its founding director. Administratively, the MPH is housed in the DPHS, but the eight core and 50 program faculty come from throughout campus including the departments of: Biostatistics and Medical Informatics, and Family and Community Medicine; schools of: Nursing, Veterinary Medicine, and Pharmacy; and the Nelson and La Follette Institutes. The first class of 20 students matriculated in the fall of 2005. The program has steadily increased both in applicants and enrollments. As of spring 2009, it has almost 70 students enrolled and 50 graduates. In June 2009, the MPH received national accreditation by the Council on Education for Public Health.
In collaboration with the emergent UW Center for Global Health, directed by Cynthia Haq and with participation of faculty from Nursing, Veterinary Medicine, Pharmacy, the Nelson Institute, and the Division of International Studies, a new Certificate in Global Health was approved in 2008. Available as a Graduate Certificate to professional students in the health sciences, to graduate students in health-related fields, and as a Capstone Certificate to individuals with a minimum of a BA or BS in a health-related field, the Certificate in Global Health program is based in the DPHS and is administered by the Center for Global Health at UW-Madison.
The education portfolio of the department has also expanded beyond the graduate and professional programs. Denny Fryback and Terry Young began an introductory survey course for undergraduates. This course has been an important means to showcase the department in the larger campus and to recruit new graduate students. Moreover, under Nieto’s leadership as course director, the department has returned to teaching a required course in the medical students’ curriculum. In 2006, “Principles of Population Medicine and Epidemiology” became a required course in the first year curriculum. The combination of lectures and faculty-facilitated small group case analyses makes it a full department as well as affiliated faculty effort. This new course is just a first step in the introduction to the “basic science” of epidemiology and public health for the “new medical student” in an integrated SMPH. The department faculty is currently working with the SMPH curriculum office and faculty from other departments to develop a new public and community health curriculum thread that will be integrated into all four years of the medical school curriculum.
Affiliated Institutes and Programs
The department continues to house major institutes and programs. The Population Health Institute serves as a focal point for public health and health policy within the SMPH by bringing together faculty, staff, and students interested in applying their skills and experience to answer 'real-world' questions. First established by David Kindig in 1984, the Institute serves as the bridge to public health and health policy practitioners in the state, through an active citizen board, frequent issue briefs and reports, and periodic conferences and educational programs. Under Pat Remington’s leadership, the Institute has grown to include nearly 40 staff, with nationally recognized programs such as the Healthy Wisconsin Leadership Institute, the Population Health Fellowship Program, Evidence-Based Health Policy Program, and the Wisconsin County Health Rankings. The Institute has just received funding from the Robert Wood Johnson Foundation to extend the county health rankings program to the nation to facilitate the use of population health data to engage communities in evidence-based programs and policies.
Under the leadership of David Kindig, John Mullahy and Stephanie Robert, UW-Madison was designated as one of six program sites of the Robert Wood Johnson Health & Society Scholars Program (the other five sites are University of California-Berkeley, University of Michigan, Penn State University, Columbia University, and Harvard University). The program, administered and housed in the DPHS, admits three post-doctoral fellows each year who spend two years engaged in interdisciplinary mentored research. As of fall 2009, the program has 15 graduates.
The John Rankin Laboratory of Pulmonary Medicine (named after the former department chairman in 1981) enters its 47th year in 2009, having been funded continuously by NIH and having been responsible for the research training of over 65 pre- and post-doctoral scientists and over 50 undergraduate students and the classroom teaching of basic and applied physiology to medical, graduate, and undergraduate science majors.
In embracing a broad determinants of health model3 and through these research and education programs, DPHS engages faculty from departments and programs from across the UW-Madison campus as well as other academic, private, and government institutions statewide. Faculty from 39 UW departments have an affiliate appointment or are part of the graduate program faculty; the department also counts on the participation of 20 adjunct faculty from state agencies and other academic institutions including UW-Milwaukee and the Center for Urban Population Health, the Medical College of Wisconsin, Marshfield Clinic, US Geological Survey, and the Wisconsin Collaborative for Healthcare Quality, among others.
With this significant anchoring in interdisciplinary partnerships across campus and the state, the DPHS is poised to be a pivotal force in the transformation of the school of medicine to a school of medicine and public health. Recently, Patrick Remington was named to be the first Associate Dean for Public Health, in charge of coordinating school-wide efforts to make our school a model of integration. Under Remington and Dean Robert Golden’s leadership, this process of interdisciplinary transformation is likely to continue to be a work in progress for many years.4 The role of the DPHS in this transformation continues to evolve, but we anticipate being a critical component in some key areas, including but not limited to: (1) supporting innovative and collaborative research, including population, basic, and clinical sciences; (2) continuing the growth and integration of graduate and professional programs; (3) increasing presence in both UW undergraduate programs and medical school curriculum, potentially including the development of new undergraduate public health certificates; and (4) developing partnerships and collaborations with researchers, clinicians, communities, and institutions to improve understanding of health and translate population health research findings into policy and practice.
Building on the successes of our past we look forward to a bright future.