Population Health: Creating Better Quality of Life for All

While completing her doctoral degree, Bettina Beech had an experience she’ll never forget. 

During a case competition, Beech and her team were asked to tackle the problem of breast cancer. She worked alongside — and competed against — some students whom she had never met before and many from other disciplines. The passion of her fellow future professionals was tangible, and everyone brought a unique perspective to the table.

“It was inspiring and motivating,” she says. “And it was one of the most memorable moments from my education.”

Now, Beech is having a “full-circle moment.” As the Chief Population Health Officer at the University of Houston and founder of UH Population Health, a first-of-its-kind initiative to integrate population health into academics, she is planning a case competition for UH students that will take place this fall. Graduate students from across campus will use their combined skills and intellect to tackle a major problem, and, in many ways, the contest will be the perfect showcase for what the Population Health program has brought to campus.

“We’re really trying to infuse our work across the University,” Beech says. “We’re working with several different colleges, and that was always the intention.”

UH Population Health turned two years old on January 24, and in a relatively short amount of time, the program has established a new minor, attracted millions in grants for critical research and inspired other institutions across the country.

“We’re being called upon by universities to site visit their program and talk to them about how they can do similar work,” says Beech. “That’s a huge honor in a short amount of time.”

Most importantly, the program is taking an interdisciplinary approach to some of the most significant issues the world faces at this moment and making the University of Houston a catalyst for positive change.

The How and The Why

Before one can understand the far-reaching impact of a program like UH Population Health, it’s important to understand precisely what population health is. And while Beech says it can’t be summarized with a single elevator pitch, the goal of the program is both straightforward and powerful: to improve people’s quality of life.

To achieve that goal, one must understand “the how and the why.” Why are certain populations healthy, and how can health be sustained?

All too often, as Beech explains, we are quick to associate “health” with “health care,” which conjures images of hospitals, doctors, and direct, physician-to-patient care. This association makes sense: That’s how the American health system is organized.

“It’s an ‘N’ equals one system,” Beech explains. “You go see a provider, and they take care of you as an individual.”

As a result, she says, “Our health care system is a sick care system. It’s acute care. We do a good job if you break your leg after a car accident, but trying to attain and sustain health and prevent disease, we're not so good at that.”

Population health can change things.

Research shows health care only accounts for about 20% of your health.

Acting as a bridge between health care and public health, the population health approach focuses on specific groups of people, such as veterans and older people, developing a robust understanding of all the factors that determine their quality of life. Health care is often “the least of that,” Beech says; variables such as environment, access to food and water and the presence of a positive community are all much bigger pieces of the puzzle. In fact, research shows health care only accounts for about 20% of your health.

And when you understand which factors are the most important for a given population, you can then implement the most effective interventions.

Beech will be the first to tell you it can be extremely tough to create a paradigm shift in how people view health care. Yet such a change is necessary, and, in many ways, it’s already happening. Some health care providers take a population health management approach, which means asking, “How do I take care of a group of patients who have Type 2 diabetes? How do I care for them in ways that are less expensive and more effective?”

UH Population Health is at the forefront of this change, and Beech says the timing couldn’t be more urgent.

“Taking a population approach means understanding the root of the problem. We’re so busy as a society, and we’re quick to put things in boxes. Either you’re here, or you’re there. Population health,” she says, “fits in all the boxes.”

Vital Research Initiatives

UH Population Health’s early success is vitalizing and indicative that the university-wide initiative will continue fortifying multiple areas of study and the UH student experience. Research is at the epicenter of this plan — and, of course, groundbreaking research needs funding.

In just half a year, UH has been granted tens of millions of dollars for research in fields like education, public safety and environmental sustainability. UH Population Health, which touches on all those areas of study, has received ample targeted funding, too.

For instance, the National Institutes of Health awarded the program a $50 million grant for an artificial intelligence initiative using machine learning to make more equitable health decisions. As part of the initiative, Beech has joined a consortium of leaders from universities and health science centers, all of whom are implementing AI into their respective programs in ways that are fair and accessible. This includes training staff on how best to leverage the potential of this exciting yet daunting technology while also analyzing data inputs to prevent bias from shaping algorithms.

Further, the grant will help UH recruit and equip diverse practitioners, which Beech says is a core tenet of the program’s work.

Many studies have shown that flawed AI systems and algorithms perpetuate gender and racial biases and have resulted in untoward outcomes. This is just one of the many ongoing research projects Beech and her colleagues lead.

“Beyond health care, AI has been used in areas from facial recognition to self-driving cars and beyond, but there is an extreme lack of diversity among the developers of AI [and machine learning] tools,” she said in the official statement announcing the grant and her consortium role. “Many studies have shown that flawed AI systems and algorithms perpetuate gender and racial biases and have resulted in untoward outcomes.”

This is just one of the many ongoing research projects Beech and her colleagues lead. She is also spearheading the University’s Obesity Health Disparities program — one of just nine programs in the U.S. currently being funded by the NIH — which trains and mentors early career faculty from underrepresented backgrounds in the biomedical and behavioral sciences. In turn, these faculty become subject matter experts in obesity-related cardiovascular disease, meaning the program advances both diversity and quality of life at the same time.

This is a recurring theme for UH Population Health: The program’s impact is multilayered and far-reaching, addressing multiple issues at once (or fitting in multiple boxes, as Beech puts it).

It helps that the program is part of a holistic research community at UH. Elsewhere on campus, the Energy Transition Institute recently received a $100,000 grant from the Baker Hughes Foundation. The funding will support the institute’s workforce development programs and help implement energy transition programs in areas most affected by global warming. Other recent grants include an American Cancer Society-sponsored project aimed at reducing tobacco-related health disparities, specifically mental health afflictions. Further, UH researchers in education recently received a $1.6 million grant from the National Science Foundation. The grant will help UH roll out culturally responsive STEM experiences for underserved high school students in Houston and provide scholarships for dozens of high schoolers and STEM undergraduates.

“This program is about instilling confidence, resilience, and a sense of belonging in students,” says Mariam Manuel, a clinical assistant professor for teachHOUSTON, a UH program dedicated to producing secondary STEM teachers. “By giving them opportunities through mentorship and research lab experiences, we are paving the way for a more diverse and inclusive STEM workforce, which will benefit society as a whole.”

“The field of population health is very interdisciplinary,” Beech notes. “In order to make changes society-wide, from architecture to engineering to policy change, we need to embed skills and knowledge when students are undergraduates.”

That’s why the program has started giving back in the form of the Outstanding Population Health Publication Award, as well as a minigrant initiative that recently supported students’ efforts to conduct much-needed research into disability law.

Additionally, the University has also added a population health minor available to all students. As of this writing, students majoring in fields as diverse as biology, nursing, sociology and public health have all chosen to minor in population health, and the first of those students will graduate at the end of this semester.

This is a particular point of pride for Beech, who points out that creating a new, formalized minor in less than two years’ time is a feat in and of itself.

“There is no singular way to study population health,” she says, “and that’s a big reason we’re able to address the deep needs of so many populations.”

Of course, that includes populations in Texas. When asked which factors are most important to sub-populations within the broader state, Beech immediately rattles off several key variables:

Global warming is a major focus for her program, as are food supply and infrastructure challenges like clean water accessibility. Another critical factor is social isolation, best defined as the proximity to neighbors and other community sources.

“If the surgeon general of the U.S. takes it on with a reporter, as he did with loneliness, best believe it is a health issue,” she says.

All of these issues are complex and gravely serious. Yet Beech talks about each with equal parts hope and steely resolve. This optimistic determination is precisely what’s needed for a program as intricate as UH Population Health.

Experienced Leadership

After earning both a bachelor’s in sociology and a master’s in public health from Temple University, Beech enrolled in the public health doctoral program at the UT Health Science Center of Houston. As if that wasn’t impressive enough, Beech also completed a postdoc fellowship in cancer prevention and control at M.D. Anderson Cancer Center.

Looking back, she can see how each of these experiences paved the path to her role at UH.

“My public health background, combined with working in academic medical centers, was the perfect brew,” she says.

Plus, this isn’t her first rodeo with population health. Before returning to Houston, Beech was the founding dean at the University of Mississippi Medical Center’s John D. Bower School of Population Health.

“To be able to birth a graduate school — and do it in the name of someone who was doing population health before it was called population health — was a tremendous honor,” she says. “We spent a lot of time addressing the deep needs of the state, just as we are now. Coming to UH, I was able to pivot and look at how to incorporate the same kind of opportunities for undergraduates.”

One such opportunity is the forthcoming case competition, which is sure to send Beech’s mind back in time to when she was a student eager to tackle the greatest challenges in the world. The competition is still being developed, and while Beech remains mum on details, she can’t hide her excitement.

“Undergraduates will be able to partner with graduate students and take on real-world topics that need their creative problem-solving skills,” she says. “It’ll be a special event.”

It’ll also mark another key milestone in her program’s momentous progress, though you won’t find Beech and her team taking their feet off the gas.

“We’re in this for the long haul,” she says. “And while we’re proud of what we’ve done, we’re really just getting started.”