Ana Diez Roux, MD, PhD, has looked at health from within and from above. From the patients she saw as a pediatrician in her native Argentina to her research on what factors affect health in urban areas with populations in the millions, she has learned that what determines how healthy you are is a complex stew of factors.
Now she’s seeing the world from a new angle: as the new dean of Drexel’s School of Public Health. Diez Roux started on the job in February, the same month that the school moved into its bright, vibrant new home in the remodeled Nesbitt Hall on the University City Campus.
Diez Roux, who came to the United States to study public health at Johns Hopkins University after working as a physician in Argentina, is a worldwide leader in research on what determines the health of a population. She conducted that research at the University of Michigan and Columbia University before arriving at Drexel.
DrexelNow talked with Diez Roux about what brought her to Drexel, what public health really is, and how what neighborhood you live in can be as important for your health as how often you go to the doctor.
You started your career as a pediatrician in Argentina. How does that experience inform what you do now?
I think it informs it in many ways. I don’t think you need to have a medical background to do public health. There are many terrific public health practitioners and researchers who have other backgrounds.
But having a medical background, and interacting with patients, helped me see the constraints you’re under as a practicing physician to fix a lot of the problems you see in patients. In pediatric patients, it’s particularly visible. Kids, if they have the right environment, can be really healthy. But if they’re not in the right environment, they can have a lot of problems, and you can’t really fix those problems without getting at the underlying causes.
You want to have good science, and you want to have good theories, but at the same time you want to be very practical. Being a clinician, I think, gave me that.
What in your career are you proudest of?
When I was doing my public health training at Hopkins, I became very interested in ways that we could integrate social and biological things in understanding health problems. One area I got into, by chance, was trying to understand the ways that neighborhoods affect health. Beginning with my dissertation work, a lot of my career has been studying how a lot of different aspects of neighborhood environments are related to behavioral factors and biological processes that are important to health.
That has been interesting, because it has put a little bit of a new twist on the way policymakers think about health. Community development policy is important to health. Urban planning is important to health. And much of this thinking was influenced by the research that groups like mine, and many others, have contributed to over the past few years. Having contributed to that is something that I was happy I was able to do. I’ve seen it reflected not just in policies but in the ways communities are thinking about things they could do to improve their health.
This has been a paradigm shift in health. I think most people, still today, think of health as a very biomedical thing. It’s about genes, it’s about getting the right treatments, and it’s about getting diagnosed in time. And those things are important, but they’re not enough to explain the big patterns that we see. A very simple example is if you design neighborhoods in a way that you can’t walk anywhere, then people have no choice to get in their cars and drive. It has implications for physical activity, it has implications for air pollution levels, it has implications for social interactions, and all of that has connections to health.
Why did you decide to come to Drexel?
What I liked about Drexel was the school has some themes I’ve always been very connected to and that I think are very important in public health today. Those are a focus on health in cities, a focus on the issue of health disparities and health in human rights, and a focus on connecting research to practice. The School of Public Health has a tradition of having those three prongs, and I find that really appealing.
I think I also liked the fact that Drexel is embedded in this idea of cooperative learning, and the very important goals of building a university that does top-quality research but that is also civically engaged and connected. It made me think, oh, this is a great opportunity for a school of public health to really grow and develop and be a major contributor to health in the city of Philadelphia, and to help understand health in cities around the globe.
I really think there’s a great faculty at the School of Public Health — a very diverse faculty, with research interests connected to those themes. And there’s a lot of support from the University to grow and develop the school, which is very important as well.
So far in your time here, what has surprised you the most about Drexel?
I’m not sure if it surprised me, but I would say one feature that has struck me is how dynamic the place is, and how much there is going on: the amount of energy there is around thinking about new initiatives and developing the research side as well as the educational programs in ways that are meaningful to the students and to society. The energy and the dynamism and the number of things going on, those are things that I’ve been interested to see. In other academic environments things are more established, and have been going on in a very similar fashion for a long time. Here, there’s a lot of movement and energy around building a lot of different things, which I think is terrific.
You started at Drexel right after the School of Public Health moved to its new, remodeled home in Nesbitt Hall. What has the new building done for the school?
Well, first of all, the space is very pleasant. It’s an engaging space, and it’s nice to be in it. So that, I think, has lots of influence on people’s attitudes and their willingness to spend time in it and to interact with each other.
The move has also contributed to an idea of renewal in the school, thinking about the next steps, building on the school’s strengths and having enthusiasm about the things we’ll have going forward. We’ll be recruiting new faculty and increasing our research portfolio. We’re also reviewing the educational programs we have in order to update them and launch some new ones. So it is a time of excitement and possibility.
What are some misconceptions about your field?
Public health always struggles a little bit, because sometimes people don’t really understand what public health is. They think that public health is focused on a relatively narrow set of topics that have to do with hygiene, sanitation, vaccinations or the traditional public health agency kind of work. But today, public health encompasses that and so much more. It really has to do with understanding patterns of health across populations and how many different factors can affect that, and most importantly what we can do about it. And in order to do that we need biology, medicine, psychology, sociology, economics and many other disciplines. I think making people aware of what we do is really important, in terms of connecting to other people who are also interested in health that we can collaborate with.
This is very important — in terms of the Affordable Care Act, there has been a lot of talk about population health. I think people might misinterpret that to think that population health is about groups of patients. But it’s about broader patterns of health within populations, not just people being treated by doctors. That’s really what public health is about, and why it connects to so many, many different fields.
The answers to questions about the drivers of population health are not going to be simple. Your health depends on your genes and your behaviors and the health care you get, but also what kind of environment you’re in, where you grew up, what city you live in, even what neighborhood you live in within that city. Thinking about how all that works together is intellectually super interesting, but also has many implications on what we decide to do and not to do as a society.
In the field of public health, what are the big problems or questions on the horizon right now?
I think, really, the big question is building the evidence base and increasing awareness of the fact that many things that we do as a society, many decisions that we make and policies we may implement for things that may not seem to have a lot of health impact actually have a lot of health implications. Being able to demonstrate that empirically, and being able to articulate what that means for new policies, is important — thinking about things in ways we haven’t thought about before. Creating access to quality care is important, but the evidence we have suggests that’s not going to be enough if we want to move the needle on the big population health problems.
For example, I was part of a committee last year that looked at the health of the U.S. compared to other wealthy countries, and the U.S. does very poorly in many domains: violence, drug abuse, adolescent and child health, chronic diseases. We need to understand why it is that the U.S. has these types of health outcomes despite spending so much on health care. The systemic nature of this problem forces us to think broadly about many different factors including not only health care but also environmental factors and social and economic policies. If we’re going to improve health in the U.S., or in other countries, that’s the kind of stuff that we have to be thinking about.
Also, we have to work on spreading the information we have. For example, life expectancy varies enormously across neighborhoods even within a city. Getting that type of information out causes everyone — researchers, policy makers, communities — to ask why is that and what can we do about it?
Where do you see the School of Public Health in about 10 years?
I envision it having a substantially larger externally funded research portfolio than it does today. I envision it having top-notch education programs, undergraduate, master’s and doctoral programs in public health, that teach students about rigorous methods but also about practical applications in the real world. I envision it as a very interdisciplinary kind of place that collaborates with many other units around Drexel, as well as communities and various other groups in Philadelphia . I envision it as being connected to research and action in urban health not only locally in Philadelphia but across cities worldwide. I envision it as a dynamic place that is intellectually stimulating but also committed to real action to improve health and eliminate health inequalities. Those are some of the ideas of where we want to go.
*This article first appeared in the October 2014 issue of Drexel Quarterly.