An Insight Into Public Health
Em: I’ve had the same best friend, Jessa, since I was in 4th grade and at this point, “friend” doesn’t really do our relationship justice. We grew up practically side by side and basically, lived at each other’s houses, and just about all my adolescent memories have her in them.
I have bitched and moaned to this girl more times than I can count about not feeling well or being in pain, and she has never done anything but listen to me, comfort me, and ask what she can do to help. When I initially got sick at 17, she would come over to my house as often as she could and just lay on my bed with me and stroke my hair. Needless to say, the love I have for her is endless.
Jessa now has her PHD in Public Health and and works at a Health Institute in La Jolla as well as teaches a college class at SDSU in the little spare time she has. As we both have a big interest in the medical field for different reasons, we’re always discussing health trends and trading information we learn along the way. I asked her if she would answer a few questions about the public health in our country and give a little insight into what public health actually means. We’re usually so focused just on our immediate health and what is affecting us personally, it’s a nice shift to hear about it from a much broader perspective.
Dr. Jessa Engelberg
Jessa Engelberg, PhD, is a senior research analyst for the Gary and Mary West Health Institute. Dr. Engelberg has researched the importance of a variety of social influences on health and well-being for nearly ten years, and she has a passion for helping older adults maintain their independence and age in place. In her current role at the West Health Institute, she helps lead research efforts for the Supportive Services team, which focuses on improving the lives of older adults by considering the social determinants of health and addressing modifiable health-related social needs to ensure provision of whole-person care and supports. Dr. Engelberg holds a doctoral degree in Public Health from the Joint Doctoral Program of the University of California, San Diego and San Diego State University, with an emphasis in health behavior.
What does having a PHD in public health mean?
That’s a tough question, as I think it can mean a lot. Public Health is a broad field that includes epidemiology and biostatistics, as well as global health and health behavior (and others!). My focus and training is in Health Behavior, which means I try to understand what influences people’s behaviors, including the behavior itself and broader contextual factors. For example, physical activity is a behavior I studied extensively and would consider the neighborhood people live in (if they could walk or bike places, if it was safe, if there was a park), their age and physical capabilities, their social support and network, their self-efficacy (or confidence), transport and so on!
2. What drew you to this field to begin with?
I initially studied psychology as an undergraduate and was fascinated by what drives and motivates people, specifically related to health, but working with people on a one to one basis felt too slow. I wanted to do something that was on a more macro level, where I could have the possibility of helping a larger group of people be healthier and happier.
3. Can you explain what you do for a living?
I work as a Senior Research Analyst at the West Health Institute, a non-profit that conducts applied medical research focused on lowering the cost of healthcare and helping older adults age successfully. My specific focus is helping older adults stay in their homes and communities longer (i.e., “age in place”) and help prevent high-cost healthcare utilization (e.g., repeated hospitalizations or institutionalization) by increasing attention on the importance of addressing the social determinants of health. For example, we’ve worked to establish a “social prescribing” pilot in a geriatric-focused primary clinic, where enhanced care coordination is provided to all patients by proactively screening for unmet social needs (e.g., transportation, food insecurity, social isolation, caregiver needs) and then addressing the needs by connecting them to the community who can provide the necessary supports and services.
4. What is a trend in public health that you think we’ll be seeing in the next few years?
I think we, in the US, are already seeing greater recognition of the importance of the social determinants of health and as our healthcare system beings to shift towards a value (vs. volume) based model, these social factors will continue to gain attention. There are data that suggest that healthcare only contributes about 10-20% to premature death, but that one’s health behaviors, genetics and broader social and environmental factors contribute over 80%! These social and environmental factors will, hopefully!, start to be reimbursed or provided through our health insurance and include things like home-delivered meals, transportation to get to and from medical appointments AND social engagement opportunities, physical activity classes or gym memberships, and installing railings and ramps to reduce fall risks. Some studies show that things like the effect of loneliness or social isolation on mortality is as great as traditional clinical indicators, like high blood pressure. With the recent passing of the CHRONIC Care Act in spring 2018, there is unprecedented flexibility to allow healthcare payers and providers, including Medicare, provide some of these services as supplemental benefits because they are so clearly linked to health and well-being.
5. What is a simple thing people can do in their everyday life to be healthier?
Any step towards a healthy behavior, no matter how small, is important! I think we often forget that and think if we cannot do vigorous exercise for an hour, we may as well just do nothing. But in reality, just walking, even 10 to 20 minutes a day, is MUCH better than doing nothing!
6. What would you say is a main misconception about the public health of our country?
That our healthcare system is the best in the world—it really is not! We have a broken system right now with astronomical costs that aren’t worth the tradeoff in terms of the value and type of care one receives. There are also huge disparities, like where your zip code can be a better predictor of your life expectancy than any other single variable.
7. What is the main takeaway you hope people will take from this?
If you know you want to eat healthier or exercise more or quit smoking or get outdoors more, don’t feel you need to go to an extreme. Anything is better than nothing! And don’t forget how important the broader context is in relation to your health! The people you surround yourself with, if you live in a walkable neighborhood, if you eat every meal in front of the TV, if there are parks nearby, if you feel safe being outdoors alone, if there aren’t crosswalks or safe crossing options – these factors can all be barriers or facilitators to help you achieve your health goals! If you think of one that is a barrier to you, try to focus on it and overcome it. For example, if you really don’t like to walk alone, try plan a friend date to get a coffee and walk and talk together (instead of just sitting in a coffee shop)! Or save your favorite podcast or TV show until you’re doing physical activity (like on a treadmill)!
8. In relation to our health, with complex care needs, do you have any suggestions?
Don’t only think about your care plan in terms of the clinical plan (e.g., medications, medical procedures, physician appointments). Think about developing a comprehensive care plan that includes your health behaviors and broader social needs, such as physical activity, diet, stress-management, socialization, and mental health. And remember, you know your body best, figuring out exactly how much exercise is helpful and what types of food to avoid may require trial and error, but think of it as an experiment, like when you start a new medication. Focus on a single behavior (or type of food etc.) and then give it enough time to work up to a good “dose” and see how you feel, with ongoing monitoring!