PLACE-BASED HEALTH IN THE PANDEMIC ERA

Improving health outcomes means going beyond a one-size-fits-all framework.

For the team of educators at the Mountain Area Health Education Center (MAHEC), this philosophy was the foundation for partnering with the UNC Gillings School of Global Public Health to launch the Master of Public Health (MPH) program in Asheville, North Carolina in 2018. Recognizing that health challenges faced by populations in western N.C. often differed from other parts of the state, program founder Travis Johnson, MD, MPH, saw a need for public health education to go beyond the walls of the classroom and connect with local agencies to solve the region’s unique issues in real-time. The Asheville MPH program, with its concentration in Place-Based Health, has an administrative home in the Gillings School’s interdisciplinary Public Health Leadership Program (PHLP). “This concentration is unique within Gillings,” said Anna Schenck PhD, PHLP director and associate dean for practice. “It is available only in Asheville, and it is the only program of its kind in the country. It has been designed to celebrate and leverage the unique context of the western part of our state.” The program uses the connections that the Gillings School, the University of North Carolina at Asheville and MAHEC have in western N.C. to its advantage. Students, who are often employed in local health professions, learn to work with other providers, community leaders and regional government officials to understand the importance of place in the context of public health. The program stresses agility and adaptability, both in the curriculum’s principles and in the way it is delivered, with a hybrid model of learning that occurs both in-person and online. That ability to adjust became more critical than ever in early 2020. In February, Johnson, who was the interim director, died after an eight-year battle with cancer, and the onset of COVID-19 in the weeks that followed rocked the program. Pushing forward through turbulent times with the same resilience that Johnson had modeled, program leaders and students adapted some of their modules to emerging issues related to the pandemic. MAHEC facilitated this pivot with the understanding that it aligned with the MPH program’s case-based learning objectives. “The leadership team gathered and asked us directly how our public health students could engage with this pandemic in a way that addressed specific contextualized issues to western N.C.,” said Scott Schindler, who is the Asheville MPH program’s student manager.

We want to teach learners how to work with others, especially in an era of team-based care and population health.
—SARAH THACH

COVID-19 magnified many issues that Asheville and its surrounding communities were already facing. Staffing challenges meant that health care workers were thinly spread and had difficulty communicating critical information. This problem was exacerbated by insufficient broadband internet access. Vulnerable populations, such as those in nursing homes and members of Black and Latinx communities, were at high risk of infection outbreaks. And concerns grew around the stress of the pandemic and its impact on substance abuse and opioid death rates.

Assistant Director Sarah Thach, MPH, and Director of Academic Affairs Amy Joy Lanou, PhD, have been leading an effort to integrate place-based coursework into the local public health response to these issues. “We want to be teaching learners how to work with others, especially in an era of team-based care and population health,” Thach said. “We were able to quickly change existing plans to focus on COVID. And I think the students thought it was really helpful and appreciated, being able to work on something that was very timely.” Students have participated in a number of COVID-19-related projects, ranging from case studies, health assessments, interprofessional education and volunteer opportunities. In their practica, they have helped design strategic plans for testing, food distribution, communication and procurement of personal protective equipment. Culminating experiences have engaged vulnerable populations, such as the Latinx community, and peers within the local higher education system in health education. “Our partnership with MAHEC has been a real advantage for our team, as well as our students, in terms of being right up in the middle of the western N.C. pandemic response,” said Lanou. MAHEC’s leadership has been critical for obtaining funding and research support for MPH faculty, staff and student initiatives. Through service and circumstances, the team has forged a strong bond with western N.C., as well as within the program itself. Students and faculty work together with the knowledge that, even after graduation, they will continue to be colleagues in the public health field. In 2020, the program saw its first cohort graduate – over Zoom – and many students continue to integrate their coursework into practice today. And despite his passing, Johnson’s enduring spirit still lingers as the program evolves in the face of health challenges. “One student said she felt him on her shoulder as she helped her organization pivot to address the COVID pandemic,” Thach recalled. “This fall, as we oriented the new cohort to Travis’ legacy, we spoke of his vision, relentless optimism, deep connection with everyone he met and humility. Those are the lessons our students are reflecting on as they learn to meet the needs of the community.”

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