In 1854, cholera struck the city of London. Hundreds of people died in just a few weeks, yet no one knew where the disease originated.
Was it an airborne virus? Physician John Snow didn’t think so. He suspected cholera was carried through contaminated water, and he was right. To prove it, he began tracing, on a map, all of the cases within walking distance of a particular water pump in the center of Soho.
Snow’s groundbreaking discoveries about the source and spread of cholera — and how to curb it by removing the contaminated water pump’s handle – earned him the title “father of epidemiology,” the study of diseases and their spread through populations.
Now, 166 years later, everyone’s an armchair epidemiologist thanks to the coronavirus pandemic. Like Snow, we’re studying maps and data of COVID-19 cases worldwide, and we’re changing our behavior to prevent its spread: washing our hands more, sneezing into our elbows, and practicing social distancing.
We are also developing a new, amplified relationship to UNLV’s School of Public Health, whose experts are helping guide Nevada through the crisis and shaping public discourse worldwide. Members of the media, elected officials, and even donors are seeking out the school’s experts and empowering them to lead.
“If you asked people four or five months ago what public health is, and what we do, most people just didn’t know,” said Shawn Gerstenberger, dean of the school.
But that’s not the case now.
Prepared for take off
Public Health has been quietly building its preparedness to respond to an emergency of this scale, though the school’s growth has been anything but slow and steady.
In 2004, there was no public health training of any kind in Nevada. UNLV administrators tapped Gerstenberger to write a plan for the first school. Then the recession hit in 2008, and there was talk of suspending or even folding the fledgling program to cut costs. But Gerstenberger – along with the school’s founding dean, professor and epidemiologist Mary Guinan – remained steadfast in their vision and forged ahead.
Public Health is still a small school, but mighty in research productivity and community partnerships. Last November, it became one of only 66 public health programs in the world – and the first in Nevada – to receive accreditation through the Council on Education for Public Health.
Today, the school also secures some of the most research dollars of any at UNLV – $7 million currently – and was among the first at UNLV to land a National Institutes of Health research grant in 2005. Since the pandemic hit, the school has submitted $35 million in grant proposals to potential funders.
If that weren’t enough, epidemiologist Brian Labus, an assistant professor in the school, has become a sought-out expert on the coronavirus. In March, Labus was selected by Gov. Steve Sisolak to serve on a five-member task force to help advise on the scientific aspects of the COVID-19 pandemic statewide.
Labus has been on the job around the clock since the pandemic hit, but it doesn’t faze him.
“This is what I train for. This is what I do,” he said.
As an expert on communicable disease surveillance and outbreak investigation, Labus has given more than 250 media interviews since March. Compare that to a typical four-month period, when reporters may call him only a handful of times.
Meanwhile, Gerstenberger quickly marshalled resources to respond to the city’s urgent need for help with contact tracing, or the process of identifying persons who may have come in contact with an infected person. He helped organize a team of 20 students, including two doctoral candidates, to assist the southern Nevada health department with collecting data on COVID-19 cases, working in laboratories, and assisting with the media. For burgeoning public health professionals, it was a once-in-a-lifetime opportunity to work in the field at an historical moment.
What is public health?
At its core, public health is about prevention. Gerstenberger describes it as “not what I can do to protect me, but what I can do to protect us.” Noteworthy success stories from the field include initiatives that led to people correctly installing children’s car seats, eliminating lead-based paint from children’s toys, and reducing exposure to second-hand smoke in public buildings.
“It might not always be the first to come to mind, but public health can have the biggest impact on the overall health of our community,” said Interim Provost Chris Heavey. “The best way to keep people healthy is to help them before they get sick rather than to treat them afterwards.”
Public health researchers work with sets of real-time data – from sources like lakes or streams, emergency rooms, or even social media – to begin unpacking community health problems. For instance, a researcher could cull from Twitter every mention of the word “coronavirus” and create a massive data set. But the skill in the work, Labus said, is then identifying meaningful questions to render the data useful. What do we want to know, and what solutions can we recommend?
The field has always been positioned at the intersection of science and politics. Its practitioners must be trained in epidemiology and biostatistics – the basic science of public health – but they also must know public policy, environmental health, and behavioral health. UNLV’s master’s and doctoral students in public health take classes such as Racial and Ethnic Disparities in Public Health, Pollution and Health, and Public Health Law.
It’s an interdisciplinary field, and also an applied science, meaning it is rooted in practical application. Public health researchers are deeply embedded in the community and its health problems.
The keys to success: partnerships
UNLV administrators believed enough in public health to establish the school initially. Today, they speak proudly of its community partnerships, which include the state and county health departments, all of the area hospitals, health-related organizations such as lung and heart associations, Three Square, Immunize Nevada, and Green Our Planet, to name just a few.
Sue DiBella, executive director of UNLV’s Office of Community Engagement, whose daughter is also earning a doctorate in epidemiology, said that in terms of partnerships, the school is “one of the most active entities in our community, state, and beyond.”
UNLV’s public health efforts are hugely valuable to Nevada because more than 75 percent of the state’s population lives in Clark County. As a result, researchers have ample access to work that can impact the entire state’s health statistics and improve health prosperity for all.
A public health project in Las Vegas, for example, may look at food insecurity in a defined geographic area. The next step is to pinpoint the reasons why: Is there a food bank nearby? Does the available food match the residents’ cultural preferences and what they know how to prepare? Do they have transportation to get to the food bank?
Ideally, in this work, the collaboration between the university and agency partners will result in additional grant funding that can be directly applied to solutions.
The school’s next big frontier, Gerstenberger said, is securing partnerships of another kind in philanthropic donors. One of his top goals is to create endowed scholarships for students, and especially graduate students gaining valuable research and field experience. The second long-term goal is to find a donor to name the school one day.
During the Great Recession, Gerstenberger and Guinan together established two endowed scholarships that provide support annually for graduate students studying epidemiology or environmental health and interning at local community agencies. Students need assistance to continue their training as academicians – or to land jobs in the government, nonprofits, and hospitals, he said. Scholarships help ensure they can participate without worrying about making ends meet.
Gerstenberger is a donor himself. “It’s very hard for me to ask people for money if I’m not giving too,” he said.
Leadership at the helm
Growing up in Wisconsin, Gerstenberger loved all things outdoors and spent time fishing, camping, and hunting. As an undergraduate, he studied aquatic reclamation and biology, which led to an interest in how contaminants in the water impact health.
He earned a doctorate in toxicology from the University of Illinois Urbana-Champaign, and in 1997 landed a tenure-track position in the environmental studies department in the Greenspun College of Urban Affairs. In 2014, he was promoted to dean of the then-named School of Community Health Sciences, which after accreditation changed its name to the School of Public Health.
Colleagues describe him as a can-do, innovative leader who is driven to support research. Since the pandemic hit, they say he’s been working to keep everyone positive and optimistic.
“I think that’s my job,” he said, “to try to get all of the distractions out of the way so faculty and staff can do good work.”
Guinan exalted her partnership with Gerstenberger. She was the public health expert; he was the academician. “Neither of us were hotheads,” she said. “We didn’t get angry or make demands. We tried to figure out how we could build our school and support our faculty.”
Pandemic or not, Gerstenberger says he likes to keep focused on why public health matters.
“It’s always about people, and I think that’s probably a pretty good way to look at it,” he said. “It takes resources, and it takes meetings, and it takes all sorts of things. But when we forget that we are working for the health of people, we have lost our way.”