‘We’re here to serve the public’

Three UND Master of Public Health program grads discuss serving North Dakota by creating solutions to improve health outcomes

It’s become a common thought of late among public health professionals, said Rachel Goebel: “We didn’t think we would have to deal with this.”

This sentiment was shared by several North Dakota Health and Human Services-based UND Master of Public Health (MPH) graduates who recently spoke with North Dakota Medicine. The trio – Goebel, Amy Hanson, and Lakin Kath – are working on everything from infectious disease to sexually transmitted infections (STI) to public safety across North Dakota these days. And things are only getting more challenging, they said.

“Would I ever have seen that coming up? No,” acknowledged Hanson of the H5N1 respiratory virus. “But were we prepared to handle it? Yes.”

Long distance race

As the trio put it, although public health work was always a challenge, several factors have made it even more of an endurance race over the past decade. From declines in immunization rates and unpredictable state or federal budgets dedicated to public health to the emergence of new viruses and vectors of transmission, public health feels more volatile these days.

“I work in the northeast region and with the Turtle Mountain Tribe as a field epidemiologist,” explained Goebel, who graduated from UND’s MPH program in 2018. “I do a lot of what we recognize as ‘contact tracing’ from COVID.”

That means, she said, working with communities on the reporting and containment of a variety of outbreaks: West Nile, Lyme disease, tuberculosis, syphilis.

“I’m working with people to see where they traveled, where they might have been exposed to these bugs, and who they’ve been in contact with,” she said. “That way, we can help counties with their mosquito surveillance programming, for example, or the quality of their food and water – where they were, where they ate, what they drank, who they were around when they got sick.”

To hear Goebel tell it, today’s public health is very different from what it was when she graduated from UND in 2018. “When I first started a few years ago, we did all the syphilis training, but I was kind of led to believe I’d maybe have a case or two every year or so,” she said. “Now, I’m always working syphilis – and I never thought I would see measles.”

Nodding in agreement, Kath added that upon graduating from UND in 2022, she expected to be working primarily with COVID and its effects in the state. “COVID helped teach us that we need to be prepared, so we’re working to strengthen our disease surveillance system and other preparedness activities,” said the electronic surveillance systems manager. “Amy talked about some of the emerging viruses that we’re watching, like H5N1. Even without a human case yet, we still need to be ready.”

Preventive medicine

And they are prepared, said the North Dakota Health and Human Services (NDHHS) crew. For now. Part of the irony is that when public health programs work well, they can seem to disappear into the background. It can be easy to assume, in other words, that public health programs are inessential when children and the elderly, women and men, are not missing work or dying young of preventable diseases.

But the reverse is true. “Public health is working when you don’t hear about problems,” Kath reasoned, echoing Hanson’s quip that “public health is everywhere, and I wish more people realized that it affects the water you drink and your daily coffee. When you drive to work, what do you do? You buckle your seat belt.”

This paradox, the team said, affects how and where public health programs are resourced. “I recently read an article that really stuck with me – it said that public health funding rises and falls with disease trends,” Kath continued, explaining how prior to COVID many public health teams across the U.S. scrounged for resources. “Then COVID came and funding poured in. But now that the pandemic has eased, that support is starting to decline again.”

The research suggests, though, that for every $1 invested in public health, $14 are saved on community care over the long term. That is to say, financing public health programs can often prevent public outbreaks of disease – or at least reduce their severity – in advance.

And prevention, in the end, saves money. Just look at the recent measles outbreaks across the U.S. said Hanson, who serves as emerging diseases and outbreaks manager for NDHHS.

“Our Measles example is obviously a pretty good success story,” she said of this past summer’s relatively minor flare up. “We just had that larger outbreak in the state, and I feel like it was handled well overall. We don’t have any more cases right now.”

In the end, the UND grads suggest, a community’s public health isn’t simply about dollars and cents. It’s about communities working together to stay healthy: educating each other about the benefits of routine vaccinations and smoking cessation, reminding each other to wear seat belts or eliminate spaces that can breed insects carrying infection.

“We work for the public – that’s what we do,” stated Kath. “And while we’re in a stressful time, right now is a really important time for public health communication. Having good people in public health can help make sure we’re getting the right information out to people. Because like Amy said, we’re here to serve the public, even if the public doesn’t always realize that.”