An Ounce of Prevention Forty thousand people die of pneumonia in the United States each year, making it the leading cause of death among vaccine-preventable diseases. Yet only 46 percent of Americans over the age of 65 receive the pneumococcal vaccine. Medicine's most effective tools to fight disease in the adult population — vaccinations against flu and pneumonia, mammograms, colon cancer screening, pap tests, cholesterol and blood pressure checks — are "massively underused," according to Douglas Shenson '73, an M.D. with a master's in public health who has made a career out of uniting social issues with medicine. "We have failed so miserably in the delivery of prevention in this country because it falls between the cracks of medicine and public health," he says. "It's important to stay focused on both aspects of the challenge."
Providing the SPARC Shenson's latest venture is a non-profit organization called SPARC (Sickness Prevention Achieved Through Regional Collaboration) that the Centers for Disease Control and Prevention (CDC) has dubbed "a poster child for prevention." SPARC serves a population of 630,000 in four counties at the junction of Massachusetts, Connecticut, and New York (an area larger than the state of Rhode Island) by bringing together local agencies to coordinate the delivery of preventive care. On a fall afternoon, SPARC's steering committee for the northern Berkshire region meets at the North Adams Regional Hospital to discuss upcoming flu and pneumonia clinics and efforts to reach immigrants from Russia, Central America, and Bangladesh. Gathered around the table are SPARC staff along with a physician epidemiologist from the state department of public health, the clinical director of the local Visiting Nurses Association (VNA), and representatives from local health departments, independent agencies, and the hospital. They trade information and materials to be used in media efforts to advertise the clinics. By the end of the meeting, they have agreed that a single information number is needed for the clinics, which all of the entities represented have had a hand in organizing and publicizing. The head of a program for uninsured patients at the hospital suggests a hospital phone line be made available to ease the burden on the staff at the VNA. Afterwards Shenson says, "In most towns these different agencies don't even speak to each other. They're in competition for funding and patients and public attention. It's remarkable to see these people sit down and really work together." Shenson, who serves as the executive director of SPARC, is a soft-spoken man in his early 40s who takes a low-key approach in the steering committee meeting. A colleague describes him as an "active listener" whose engagement with key players in local health systems makes him someone they trust. In the meeting, Shenson waits to hear what others have to say before voicing his own opinion, but it is clear that beneath his gentle exterior is a man with a mission who is tenacious about seeing his vision for preventive health care become reality. Shenson grew up in London, though his parents were American, and attended Exeter for three years. He completed a joint program in medicine and public health at Tulane and a residency in social medicine at the Montefiore Medical Center in the Bronx. From the start, he says, he knew he wanted to do more than practice medicine, that he wanted to have the "widest impact" possible on improving health not just for individuals but entire communities. "Pure epidemiology suggests that those things which have the greatest impact on a person's health are outside medicine, such as poverty and education," he notes. "As a physician, where does this leave you? It's something of a dead-end. So I started thinking about what we could do that has the potential to improve health for large numbers of people. I said, let's pull out of medicine what works. To do this, you have to stop asking what can you do for people defined by their illnesses. You have to come at it from the other direction. For instance, what can we do for women over 50? We can make a real impact on their health by providing mammograms and blood pressure screening and colon cancer detection. We need to think differently about the prevention of disease than we do about disease management. Doctors on the whole are focused on treating illness. Nobody takes responsibility for prevention. Certainly no one takes responsibility for prevention for a whole community." At Montefiore, Shenson worked with AIDS patients and an inner-city population. His eyes were opened to the health implications of urban deprivation. He went on to receive a fellowship from the Social Science Council/Rockefeller Foundation and to conduct a comparative study of health and urban poverty in the United States, England, and France. In 1988, he joined the faculty of the Department of epidemiology and social medicine at the Albert Einstein College of Medicine, where he is an assistant professor and now has an appointment in the School of Medicine as well. |
|
|
|
Home | On Campus
| Exonians in Review | From Every Quarter
| Finis Origine Pendet |
