Professor Michael Stoto is an epidemiologist who likes to pose scenarios and ask questions.

Imagine it is February 2008, he said. Avian influenza has become transmittable from person to person, and there is an outbreak in Cambodia. What do you do?

A month later, a businessman who recently visited Cambodia walks into a Virginia hospital. He has symptoms of the flu. Three days later, you learn the man attended a wedding right after his trip. Now many guests are sick. What do you do?

Stoto asks these questions not only of physicians, but of a range of individuals who play a role in emergency preparedness and community affairs. They work through the answers during tabletop exercises designed to help them see the range of issues involved in a single outbreak. His students in the School of Nursing & Health Studies also will be addressing these questions during classroom simulations.

As a professor of population health and health systems administration, Stoto draws on his aptitude for statistics and data analysis as a means of solving big-picture challenges related to public health.

"The population perspective is very much rooted in social justice," he said. "We must be concerned about the whole population. We have to take care of disparities. This really fits with the university’s mission."

Dean Bette Keltner said the professor's experiences as a scholar at the Institute of Medicine and the RAND Corporation make him an asset to the school’s department of health systems administration, which he joined in August.

"Public health solutions have far-reaching impact," Keltner said. "It is an important opportunity to recognize that good preventive health efforts yield grateful patients."

While at RAND, he looked at community responses to local outbreaks of SARS, West Nile virus and monkeypox. Asking questions about their preparedness efforts, whether they followed expert advice for emergency response, how they conducted disaster drills, and what they learned from their actions.

He is currently working on "syndromic surveillance," a method to better collect and analyze data to more quickly identify when a disease outbreak is occurring.

His varied background in epidemiology, statistics and public policy is unified through his study of population health, what he said is "truly 21st-century thinking in public health and health services."

"When we're concerned about what impacts health and how to maintain the health of a community, certainly what doctors, nurses and hospitals do is important," Stoto said.

"But it is not everything. We must also understand the physical environment, the social environment, programs delivered to the whole community and behavior."

Organizations such as schools, workplaces, volunteer groups and the media all contribute to overall wellness, he said.

"If you're really concerned about improving the health of a community," he explained, "you need to think about how to intervene at the community level and harness all of these different forces."

Evaluating the overall health of a community first involves compiling data to find patterns of illness and behaviors. Then, groups must to work together to develop policies around issues such as indoor smoking or medical care access. Finally, they must ensure that members of the community are in fact receiving the services they need.

To do so is no small feat. Public health generally is a state matter, Stoto said, with services varying greatly among jurisdictions.

"The public health structure in our area -- between D.C., Virginia, and Maryland -- is tremendously diverse," he said. "The population is diverse, and so are its needs. There are also big differences in the region over political attitudes about health, and different public health systems."

During his tenure at the Institute of Medicine and RAND, he compiled data related to health indicators and access to care in the District of Columbia. His reports also included ideas for improving health in the local community, ideas that he wants to revive with his students at the School of Nursing and Health Studies.

"What impact our work on population health will have on the community will take years to see," he said. "But the first step of impact is that someone actually has to do something."

Source: Blue & Gray