Kenneth Shine, M.D., executive vice chancellor of The University of Texas System, discusses the need for more health professionals trained as both physicians and public health specialists.
Printer Friendly Format

Graduates of M.D./M.P.H. programs will be better prepared to tackle the challenges of transforming the nation’s health care system, according to Kenneth Shine, M.D., executive vice chancellor of The University of Texas System.

Less than four years old, but with already more than 100 students enrolled, the four-year M.D./M.P.H. program offered by The University of Texas Health Science Center at San Antonio, in partnership with The University of Texas School of Public Health, is already one of the largest in the nation.

Related link: Earn continuing education credits by viewing Dr. Shine’s presentation

Dr. Shine discussed the importance of combining medical and public health education in his presentation, “Medicine and Public Health — Can They Get Together?” at the Health Science Center in August.

“The role of the graduates of a program that have both an M.D. and an M.P.H. will be particularly important, not only in terms of global health but in terms of domestic health,” Dr. Shine said.

New ways of thinking
Now that the Affordable Care Act has been passed by Congress, Dr. Shine said, “We are going to have to reorganize the way in which we provide health care and develop accountable care organization ‘health homes’ and a variety of other health strategies by which we deliver care. We’re going to have to understand the health of a population, what its health status is and how to improve it. That will include all of the techniques of epidemiology, biostatistics and related activities that are critical to public health.”

This approach is especially important in the Health Science Center’s service area of South Texas, which includes 38 counties generally south and west of San Antonio to the Mexican border, where 90 percent of the population is Hispanic and many live in poverty.

Environmental medicine in action
This is where STEER (the South Texas Environmental Education and Research program) takes medical and public health students to experience environmental and public health practices far beyond what any book or lecture can provide.

(Left to right) Fourth-year M.D./M.P.H. students Kelly Fegan, Andrew Heymann and Cameron Culver visit with School of Medicine Dean Francisco González-Scarano, M.D., following Dr. Shine’s presentation.

During the month they spend at the Texas-Mexico border, students visit colonias — settlements of low-income Hispanic families — which may lack plumbing, sewage systems or paved roads. The poverty there often resembles the living conditions in Third-World countries.

Among the possible hazards are polluted drinking water; lead-based paint on older structures and in pottery; pesticides applied for agricultural purposes and to control insects; and mold and other household exposures. These conditions can increase the potential for gastrointestinal problems, asthma and neurodevelopmental disorders.

Claudia Miller, M.D., M.S., assistant dean for the M.D./M.P.H. program and professor of occupational and environmental medicine in the Department of Family & Community Medicine, is director of STEER. She started the program 15 years ago in Laredo and then expanded it to serve the needs of the Regional Academic Health Center (RAHC) in Harlingen.

STEER: A collaborative effort
STEER became the foundation for the M.D./M.P.H program when South Texas leaders like RAHC Regional Dean Leonel Vela, M.D., M.P.H., and Joseph McCormick, M.D., M.S., recognized that a four-year dual M.D./M.P.H. degree with rich, community-based experiences could help improve the health of residents in the region. Dr. McCormick is a professor and the regional dean at the UT School of Public Health’s Brownsville Regional Campus. He also recently joined the Health Science Center part time as vice president for South Texas Programs.

Looking at the big picture
“The idea behind STEER and the M.D./M.P.H. program is to address health concerns at the population level and look for underlying causes that can be addressed in the community, going beyond the care of individual patients,” Dr. Miller said. STEER is a hands-on program that helps health professionals make the link between health and the environment. Students take water samples from the Rio Grande and analyze air samples in homes where children have asthma. They learn about traditional herbs and widely used cultural practices that play a part in patients’ lives.

Health promotion
This approach includes promoting sound nutrition and preventing chronic diseases such as diabetes and obesity, addressing environmental pollutants and controlling infectious diseases such as rabies, dengue fever and tuberculosis. “For example, at one time the Rio Grande was one of the most polluted rivers in the northern hemisphere. That’s where many people along the border get their drinking water. Although it has improved, even now the drinking water in many colonias is not treated and can be infected with bacteria that make people sick,” she said.

Program information
Most students in the M.D./M.P.H. program participate in STEER the summer between their first and second year. The four-week course is also available as an elective or practicum for medical students who are not in the dual degree program, as well as graduate students from other health professions. “More than 500 students from throughout the country have participated in STEER,” Dr. Miller said.

The M.D./M.P.H. program is especially appealing to students interested in community health, environmental health, infectious diseases, global health, preventive medicine and clinical research. Other factors that attract students to the program are the flexibility of online courses and shared credits that satisfy requirements for both degree programs. Students also appreciate the time and money saved by completing both degrees in four years instead of the five-year option offered by many other institutions.

For more information about the M.D./M.P.H program visit http://som.uthscsa.edu/Admissions/MDMPH.asp or contact Tatjana Walker at 210-564-7463.