Early History: The Walker Years and Legacy
The Department of Community Medicine and Health Care was established in 1971, as described in the Dean’s Advisory Committee report of May 12:
This department will have responsibility for health services research, teaching and services within its several areas of interest… and would represent for the School of Medicine a common ground for behavioral, social, and clinical scientists to pursue their interests and develop programs in research, service, and teaching which reflect the special insights of their several disciplines.
The early department, led by James E. C. Walker, M.D., M.S., developed many of the core components of the medical school including family medicine, primary care, the medical humanities, geriatrics, occupational health, and health care administration. Faculty and students were encouraged to see health and illness at the levels of both individual care and community (societal) need. “Community Health” was deemed to represent not only care of patients within the community, but the health of the population at large. Prevention included both individual health behavior and environmental measures to control hazards and develop services that reduce health risks.
During the next decade, the department guided the evolution of the Primary Care Clerkship to involve all the other departments with responsibilities for primary care. In 1977, the Burgdorf Health Center was placed under the jurisdiction of Community Medicine. The department also helped to develop new undergraduate and graduate programs in family medicine, serving as an incubator for the Division of Family Medicine, which became a department in its own right in 1975.
Out of Dr. Walker’s seminal leadership, the department developed programmatic initiatives in the medical humanities and international health. Philosophy, ethics, law, literature, and history came to be seen as key disciplines necessary to address the human and ethical issues that the physician and dentist routinely face while caring for patients and promoting ethical health care policies. The division included many of the founding members of the School of Medicine (i.e., Drs. Stuart Spicker, Robert Massey, Ralph Arcari, Stewart Hamilton). The first opportunity to teach the humanities to medical and dental students came in 1973 when the department’s new Division of Humanistic Studies in Medicine was asked to provide a seminar for the school’s “Social and Behavioral Sciences” course. The curriculum was expanded with the hiring of Joseph M. “Jay” Healy, a lawyer who joined the department in 1975. The department was one of the first in the U.S. to offer such education by means of a commitment of a full-time division. The success of this initiative was reflected in the presentation to Healy in 1980 of the Charles N. Loeser Award for excellence in teaching. Healy won the award a second time, in 1994, posthumously, following his untimely death in 1993.
Departmental initiatives in population health began in 1976 among Hartford’s African American and Puerto Rican populations. These activities included applied research to address health disparities and the development of approaches to improve health services and prevention. Stephen Schensul, Ph.D., a medical anthropologist, was the recipient of a three-year NIMH grant (1977-1980) to assess health and mental health in the Puerto Rican community. The results of this work led to the formation of the Hispanic Health Council and the Charter Oak Health Center based in a Hartford public housing project. In 1978, a Division of Community Health was formed in the department under the direction of Dr. Schensul and came to include John Glasgow, Ray Elling, Richard Lusky, Hal Mark, and Judy Lewis. Teaching and research on topics of health economics, international health, community health, and health systems research have been essential aspects of the departmen’s mission since that time.
The department’s desire to serve society assumed global proportions in the early 1980s with the formation of the Center for International Community Health Studies (CICHS). CICHS was established through a Title IV grant awarded by the U.S. Department of Education to establish a center that would serve as a local, regional, and national resource to increase access to research, and training in international community health. Under the leadership of Drs. Pelto and Schensul, it was a natural extension of concerns for underserved populations and public health.
Walker’s department fostered two graduate programs, a doctoral program in social sciences and health care and a master’s program in community health (which later became the Masters of Public Health program). The innovative doctoral program represented cross-campus collaboration between the School of Medicine and the College of Liberal Arts and Sciences, Departments of Sociology and Anthropology. Over time, this doctoral program produced more than a dozen Ph.D.s, including Tim Morse and Judith Fifield, who are currently UConn Health faculty.
The master’s program in community health, established in 1976, was initially designed to enable medical students, residents, practitioners, and other students to study community health in some depth while pursuing their other studies or employment. Over the next three years the program expanded both in the size of the student body and in the depth and breadth of the courses offered. In 1979, Holger Hansen was recruited from Columbia University School of Public Health to become the program director. The program was nationally accredited in October 1984 by the Council for Education in Public Health and the degree evolved from a Master of Science (M.S.) in Community Health to a Masters in Public Health (M.P.H.) in August 1985. The M.P.H. program currently has over 110 full- and part-time students and its graduate’s number over 700, many of whom hold leadership positions in public health in Connecticut.
The location of health care administration in the purview of the department derived from physicians who had developed an awareness of “community” through a concern with the delivery of ambulatory care from the hospital base (e.g., Dr. Scott Wetstone). Sociology and anthropology were the major disciplines for research in health care delivery. During this time the major focus became medically underserved minority populations, especially those in urban areas. In the 1970s, a series of 22 population-based studies were conducted in Connecticut, including a morbidity survey of north Hartford (Elling), analyses of cardiovascular surgery (Glasgow), and a description of primary care manpower resources (Walker). Geriatrics was strengthened through the resources provided by the Travelers Center on Aging as it developed on a university-wide basis. Dr. Schensul pursued a range of research and program development projects in Hartford. In 1979, this work led to the Urban Area Health Education Center (AHEC) program, funded by federal Department of Health, Education and Welfare for $4.3 million and directed by Drs. Walker and Schensul. The award—the largest in the University’s history to that point—was one of four such programs nationwide to bring better health care to medically underserved people in urban areas.
An early initiative by the department to establish a research and teaching capacity in epidemiology began with the recruitment of Holger Hansen and continued with the hiring of David Gregorio in 1986. The development of a Public Health Research Center to address public health issues specific to Connecticut was effected through an arrangement with the State Department of Health Services, the State Department of Mental Health and the Capital Region Mental Health Center (CRMHC).
The Department of Community Medicine underwent its first review in 1980-81. At that time, the department was commended for its strengths in the social and behavioral sciences. Its research and service programs emphasized underserved and high-risk populations. It was also known for its programs in the humanities, geriatrics, epidemiology, and health care administration. Not only was the department a major contributor to preclinical medical teaching, it also was becoming a major contributor to public health workforce development in the State of Connecticut.
Continuity and Maturity (1986-1997): John Glasgow and Holger Hansen
Following Jim Walker’s retirement, the department’s leadership was assumed by John Glasgow who previously held the position of executive vice president for health affairs. During his tenure (1986-93), the department experienced little expansion of personnel or mission due to both financial and administrative constraints across the University. Nonetheless, the department’s faculty maintained its robust teaching, service, and research activities. With reorganization of several academic units, the department’s faculty grew with the movement of Joe Sheehan and Scott Wetstone from the defunct Department of Research in Health Education, and the hiring of Steve Walsh as the school’s first and only biostatistician. Upon John Glasgow’s retirement in 1993, the department remained in flux for several additional years while Holger Hansen served as interim chair (1993-1997). Overall, these 11 years were difficult for the department as institutional commitment to its mission wavered. However, there were a number of highlights in this period.
Enrollment expanded during this period and the teaching was concentrated in a small number of full-time faculty (Gregorio, Walsh, Schensul, Segal, Healy, Hansen) and a larger number of adjunct faculty recruited from the state’s public health community. In the early 1990s, education of public health professionals was added to the formal mission statement of the School of Medicine. Interdisciplinary education options with the Schools of Medicine, Dental Medicine, Social Work, Law and Nursing were introduced, and a few students in doctoral programs in other University departments, especially Anthropology and Nutritional Sciences, began to pursue the M.P.H. degree as well.
Center for International Health Studies (CICHS)
From 1986 through 1997, the Center for International Health Studies program expanded all aspects of its activities. The Title VI funding provided support for the development of research focused on international primary care and community health, including maternal and child health, childhood diseases and, beginning in 1991, HIV and sexual risk in Mauritius and Sri Lanka with grants from USAID. During this period there was expansion of international health training for M.D., D.M.D., M.P.H. and Ph.D. students and medical residents that included elective seminars, clerkships in developing country institutions, and research. The first two medical students accompanied Dr. Schensul to Lima where they served in primary care clinics in shantytown communities. By 1997, this number grew to 20 students on an annual basis. In addition to the Center for International Health Studies components of international research and education, an international training program based in Storrs was integrated into the Center for International Health Studies. From 1986 to 1997, the Center for International Health Studies conducted over 40 residential courses in basic skills (e.g., training, research, and project management) and special topics (e.g., HIV, reproductive health) for over 700 health professionals from 67 countries.
Collaboration with the State
In the early 1990s, Drs. Schensul and Glasgow conducted research on stroke and sexually transmitted infections in collaboration with the Connecticut Department of Health. This work led to changes in the way local health departments received and addressed state data. An additional contract with the DPH called for assessment of the functioning of children’s health programs in the state. A contract was developed and implemented with the federal Centers for Disease Control for the purpose of examining and evaluating HIV counseling and testing for intravenous drug users in methadone programs in the state.
In a 1993 report to Interim Dean Peter Deckers by a departmental task force, it was recommended that “natural colleagues” be encouraged to transfer from elsewhere at UConn Health into the Department of Community Medicine for the purpose of consolidating “the currently splintered activities and resources of extramurally funded researchers in behavioral sciences and epidemiology throughout.” That initiative was begun in 1996 by the movement of health psychologists Howard Tennen and Glenn Affleck from the Department of Psychiatry which added significantly to the department’s intellectual climate. Unfortunately, there was no further attention by the administration to this initiative, which has maintained the distribution of social and behavioral scientists across the school’s departments.
Additional recommendations stemming from that report called for re-designation of the department as a basic science unit and for the department to serve as an academic home of population-based health agencies in order to encourage cooperative research relationships with the State Department of Health and other appropriate state agencies.
During this time there also was an expansion of the department’s contributions to the medical school curriculum and the School of Medicine’s innovative Community Based Education Program, under the direction of Judy Lewis. The medical humanities were also expanded with the recruitment of health lawyers Barbara Blechner, Nancy Williams and Giles Scofield (replacing Jay Healy).
Renewal and Re-orientation: Thomas Babor (1997- present)
The most recent chapter of the department’s history begins with the selection of Thomas F. Babor, Ph.D., M.P.H., as chairman in late 1996. At that time Dr. Babor was interim chair of the Department of Psychiatry and he managed both departments for an entire year until the current Chair of Psychiatry was recruited into that position. When Dr. Babor moved into the department, the M.P.H. program and some faculty were located on the ground floor of the L building, the Center for International Health Studies was in The Exchange, and the remaining faculty had offices in Dowling North. In 2001, the department was given office space in The Exchange, which allowed the eventual consolidation of most of our research and teaching programs in one location. The main changes to the department in the past 10 years can be summarized as follows: 1) refinement of the department’s mission and purpose; 2) expansion of faculty research programs through new recruitments; 3) diversification of funding streams for research, teaching and service; 4) strengthening the M.P.H. program; 5) development of academic partnerships with state agencies and other entities; 6) strengthening the medical humanities, health law, and ethics.
In 1996, there was no NIH extramural funding for research, and other research and service programs were funded at approximately $400,000. Faculty members were primarily supported by the general fund for teaching (undergraduate medical education and M.P.H.) and service activities. Babor’s mandate from the dean was to develop epidemiology and biostatistics in the department, and to recruit five new faculty under the new UConn Health research strategic plan. In order to mobilize the faculty, he developed a strategic plan for the department and hired a grants administrator, who actively worked with faculty to promote extramural funding opportunities from state, foundation, and federal sources.
The Strategic Plan recommended that the designation of the department be changed from clinical to basic science, based on the recognition that the department was primarily involved in teaching and research. This was done in 1998. Other changes implemented according to the plan include:
- Formation of core faculty groups in the areas of epidemiology, biostatistics, health services research, behavioral medicine, community health sciences, and health law and ethics.
- Expansion of the graduate program in public health to include a Ph.D. degree.
- Expansion of the medical humanities throughout the undergraduate medical education curriculum.
- Development of academic partnership agreements with key state agencies.
Faculty recruitments proceeded in three directions. First, it was decided that the tenure track strategic plan positions would begin with a focus on biostatistics. Accordingly, Martin Kulldorff, Ph.D., a promising young specialist in spatial statistics, was recruited in 1999 from the National Cancer Institute. A second biostatistician, Charles Hall, trained at the Johns Hopkins School of Public Health and appointed to the Statistics Department on the Storrs campus, was recruited that same year to work with Kulldorff in building an academic program as well as capabilities in statistical collaboration and consultation. Additional recruitments in 1999 included Richard Stevens, a cancer epidemiologist, and Zita Lazzarini, a health law and policy specialist. In addition, several “in residence” faculty supported on extramural grant funds were transferred from other departments (Ungemack, Higgins-Biddle, Burleson). Howard Bailit, D.M.D., Ph.D., returned to the University in order to set up a Type II Center (Primary Care and Health Policy), which was a welcome addition to the department, where office space and administrative support were provided. The infusion of new faculty into the department and the incorporation of Tom Babor’s grants during this period resulted in a dramatic increase in the extramural funding portfolio. The department’s funding from grants and contracts increased steadily until it peaked in 2000/01. The subsequent decline in funding during the next two years was the consequence of a combination of circumstances, including the departure of the recently recruited biostatistics faculty (Hall and Kulldorff), retirement without replacement of several other member of the faculty (Higgins-Biddle, Affleck, Sheehan, Mark, Hansen), and the transfer of Steve Walsh’s responsibilities to the new Type II Biostatistics Center.
Another challenge was the decline in general fund support. Between 2000-01 and 2003-04, support for the tenured- or tenure-track faculty plus administrative staff, decreased from approximately $1.8 million to about $900,000 per year. This decline in general fund support was attributable, in part, to budgetary constraints experienced across UConn Health, and was compensated, in part, by increasing per capita productivity within the department, with fewer faculty being supported on the general fund and more salary coverage on grants. Another factor contributing to the department’s difficulty sustaining its prior level of funding was the pregnancy leave and subsequent departure (without replacement) of Denise Parris Smith, the department’s administrator. We were unable to replace the position for several years because of the hiring freezes, which also made it impossible to replace departing faculty or recruit new strategic plan positions.
After the hiring freeze of 2002 and subsequent budgetary constraints, it was not until 2006 that the department was allowed to recruit new faculty. At that time the Department recruited Audrey Chapman, Ph.D., into the newly created Joseph M. Healy, Jr. Endowed Chair in the Medical Humanities and Ethics. A social scientist and ethicist by background, her interests include health and human rights, ethical issues related to stem cells and genetic developments, spirituality and healing, and the impact of intellectual property on the health field. To replace the position vacated by David Gregorio when he assumed Holger Hansen’s responsibilities as M.P.H. program director, we also recruited Assistant Professor Helen Swede, Ph.D., into a vacated tenure-track position. An epidemiologist by education, her research interests include biomarkers in cancer survival, precursor lesions, and chemoprevention; molecular epidemiology applied to health disparities in cancer; and cancer epidemiology and surveillance.
In the area of education, a major responsibility of the department since its inception in 1984 has been the support of the M.P.H. program. Although the program’s accreditation was renewed in 2001 for seven years, the review suggested that the program should reduce its dependence on adjunct faculty by shifting more teaching and advising to the department’s growing number of full-time faculty. Working with David Gregorio, the new M.P.H. director, all department faculty were requested to teach and advise within the program. Such commitments were achieved within the first year of the program’s new leadership. In 2006, the dean decided to shift administrative responsibilities of the program to the Center for Public Health and Health Policy. Nevertheless, the department continued to provide over 90 percent (11/12) of the primary M.P.H. faculty and 42 percent (10/24) of secondary faculty, and the program’s administration continued to operate within departmental space and facilities located at The Exchange. As the Ph.D. program in public health within the Center for Public Health and Health Policy took shape, the department, yet again, played a major role in sponsoring new graduate students and in curriculum planning. In 2010, the dean decided to shift administrative responsibilities for both the M.P.H. and Ph.D. programs to the department to facilitate integration of the two programs under the administrative unit accredited by the Council on Education in Public Health.
In addition to its teaching and research programs, during the last decade the department expanded its academic partnership agreements with the State Department of Public Health, the Department of Children and Families and the State Department of Mental Health and Addiction Services (DMHAS). Working relationships with state agencies have followed a successful formula that joins the faculty’s research capabilities with the state’s service needs and federal contracting potential. Examples of such collaborative funding include:
- A series of epidemiological surveys for DMHAS in both the school age and adult populations, providing the first statewide estimates of alcohol and drug abuse.
- Needs assessment studies for alcohol and drug treatment and prevention services, As well as evaluation research on innovative state programs funded through federal grants.
- Assessments of statewide need for breast screening services.
- Surveillance strategies for monitoring fetal and infant death.
- Participation with DMHAS in the national SBIRT Program (Screening, Brief Intervention and Referral to Treatment) for alcohol, drugs, and tobacco misuse.
Of particular note, DMHAS has worked with UConn Health as well as several other academic partners (Yale University, UCONN Storrs) during the past decade. These have helped DMHAS leverage over $100 million in federal grants and contracts. Typically, the department is a subcontractor for the evaluation or training components of the grant or contract.
In summary, the department over the past 15 years has expanded somewhat in size and scope, and has redefined its mission to operate as a “basic science” department in areas related to the social, behavioral, and population health sciences. Despite some success in building capabilities in epidemiology and biostatistics, the goal of having a strong concentration in these areas to service the growing need for consultation throughout UConn Health has been only partially achieved because of hiring freezes and departures. The department has provided a nurturing home for the M.P.H. program, and its research portfolio has, with some fluctuations, increased dramatically in comparison with 1996 levels. The department has also developed a successful formula for collaboration with state agencies, which helps to leverage funding for both the State and the University. Most importantly, during a period of decreasing general fund support, declining NIH funding and increasing competition for extramural funds, the department has expanded its research programs in cancer epidemiology, international health, bioethics, health psychology, HIV infection, and health services research, to the point where it administers the largest portfolio of social, behavioral, and population research projects at UConn Health.