From the Classroom to the County Council: A Public Health Success Story

A professor, a student and a community make a difference in the world as a writing assignment turns into a real-world policy.

Assignment

 

‘Intentional’ is the word Dr. Kimberly Enard uses.

Kimberly R. Enard, Ph.D., MBA, MSHA, is assistant professor of health management and policy at SLU and has taught at the University for the last two years. When one of the classes she teaches led to a student advocating for the enactment of a new tobacco policy in St. Louis County that will save lives and dollars, she reflected on one of the lessons she tried to teach her students.  

“I believe in being intentional,” Enard said. “You can teach health policy from a theoretical standpoint, but my goal is to inspire students do real work in the real world. You can learn concepts but until you try them, you don’t know how those theories will play out.”

Enard teaches a health policy course for students in SLU’s executive master of health administration track, the highly ranked and regarded degree program in the College for Public Health and Social Justice designed for professionals who already are working in their fields. The hybrid format of the course blends distance learning with monthly face-to-face classes.

An M.H.A. degree prepares graduates to lead, manage and administer health systems at health care systems. Saint Louis University's master of health administration program is ranked among the top 10 graduate programs for health care management by U.S. News & World Report.

“While an understanding of policy is important for everyone who works in this field, there is probably one student in every class who takes it a step further and would like to do more to be involved in policy advocacy. In my spring class, this was Phil.”

Philip Abraham, M.D., is a pediatric hospitalist at St. Louis Children’s Hospital and is pursuing a M.H.A. degree at SLU.

“I’m pursuing this degree to help understand the business side of things,” Abraham said. “We don’t get enough exposure to how hospitals work in medical school, in terms of how medicine functions in our society and how it is delivered to our society.”

For Abraham, the classroom assignment wasn’t just an exercise; it was an opportunity to advocate for a policy that would benefit his young patients a few years down the road, as they hit an age when lifetime smoking habits frequently take hold.

Kimberly R. Enard, Ph.D., MBA, MSHA

Kimberly R. Enard, Ph.D., MBA, MSHA, is assistant professor of health management and policy at SLU.

Enard’s Class

Enard assigned her spring class a writing assignment: Draft a policy analysis memo.   

“I asked students to identify a public health problem that is significant, urgent and has not yet been solved, to research one to two policies that may address the problem, and to determine the feasibility of each policy by examining data, thinking through reasonable goals and metrics, and assessing constraints to advancing the policies, such as political or economic factors in the current environment,” Enard said. “Students pull all of this together to recommend a policy solution to a pressing public health problem.

“But, we don’t stop there. We start to think through what to do next. What are the steps that will move this idea forward through the policy-making process?”

The spring class had around 20 students from different fields, including publishers, analysts, insurance industry workers, physicians and people from other areas of health care.

“One of my goals is to get students to think about issues in a different way, and especially to think across the political spectrum,” Enard said. “We all have to be respectful. We want to actually have a conversation so you can understand what other people are thinking. Part of the exercise is to look at issues from many sides.”

Students researched and proposed policy solutions to difficult and complicated issues, including the opioid crisis and gun violence. One benefit of the class was the opportunity to receive input from classmates who brought different perspectives, politics and experiences to the discussion.

Abraham honed in on an issue that had the potential both to improve patient health and to reduce health system costs: He wanted to advocate raising the legal age to purchase tobacco and smoking products from 18 to 21 in order to stop young people from developing a life-long addiction to a dangerous habit.

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Philip Abraham, M.D., is a pediatric hospitalist at St. Louis Children’s Hospital and is pursuing a M.H.A. degree at SLU. 

Abraham’s Policy

As a pediatrician, Abraham was concerned about his young patients who were taking up smoking in an era in which the deadly health risks of tobacco are firmly established. In addition to tobacco’s known cancer risk, e-cigarettes had begun to concern physicians, with studies showing that teenagers who used e-cigarettes were more likely than peers to switch to tobacco products.

“I’m working with kids all of the time, and this issue was so applicable. Kids receive their smoking products from their peers. Nicotine is so addictive. The majority of kids who smoke are addicted before they turn 21," he said.

“In a way, this policy is an easy solution, a known way to reduce costs and improve health.”

Abraham got to work on his proposal.

“From the beginning, Phil was very determined,” Enard said. “He called for clarification. He asked, ‘Am I on the right track?’ He researched existing policies and he found an ally: Dr. Sam Page, a member of the St. Louis County Council. He was on top of things, and he made it happen. He sent emails and he built coalitions. It was clear that, to him, this wasn’t just an exercise.”

Bringing in Allies

Embracing Enard’s primary lesson, Abraham approached his project with intention. He built a coalition in the St. Louis region, called T21, or Tobacco 21.

As Abraham’s proposal gained traction, he turned to allies to build support for the policy, including many from SLU. Assistant professor of health management and policy Kevin Broom, Ph.D., and SLUCare pediatrician Matt Broom, M.D., attended St. Louis County Council meetings, voicing support for the proposal.

Chair of behavioral science and health education Ricardo Wray Ph.D., proposed that SLU officially support the policy, and brought the idea to President Fred P. Pestello, Ph.D., who in turn endorsed the position.

SLUCare surgeon Theresa Schwartz, M.D., signed on to lead a similar effort for the City of St. Louis, already underway.

On Sept. 6, St. Louis County Council passed the bill, restricting sales of tobacco products and e-cigarettes to those 21 or older. The new rule will take effect on Dec. 1.

“As a faculty member, it’s really rewarding to see a class you organized and taught lead to real-world change,” Enard said. “To see the work in action is very exciting and very inspirational.”

Abraham credits Enard’s guidance as a professor and Page’s sponsorship of the bill as two keys to the success of the policy push.

“Finding a councilman to sponsor the bill and push it forward was key,” Abraham said. “Dr. Sam Page was very instrumental in making this happen.

“A lot of people want to do good, but it’s hard to navigate if you don’t have some sort of baseline understanding of the process, which is what Dr. Kimberly Enard shared with our class.” 

As a professor, Enard hopes that other students will be inspired by Abraham’s success.

“I want to let students know they can make a difference, maybe even more quickly than they might think,” Enard said.  


Kimberly R. Enard, Ph.D., MBA, MSHA

Kimberly R. Enard, Ph.D., MBA, MSHA, is an assistant professor of health management and policy in SLU’s College for Public Health and Social Justice. Her overarching research goal is to address health disparities using community-engaged, patient-centered approaches that recognize the complex, multilevel factors that influence each person's health and well-being over their life course.

Saint Louis University's Master of Health Administration (M.H.A.)

Saint Louis University's master of health administration (M.H.A.) program is ranked among the top 10 graduate programs for health care management by U.S. News & World Report. An M.H.A. degree prepares graduates to lead, manage and administer health systems at health care systems.

SLU’s competency model is nationally known for its rigor in ensuring our students gain the knowledge and skills required by health care organizations today and in the future. The SLU model is comprised of 60 competencies grouped into six domains: communication, critical thinking, leadership, management, political and community development, and science and analysis.

College for Public Health and Social Justice

The Saint Louis University College for Public Health and Social Justice is the only academic unit of its kind among the nearly 250 Catholic institutions of higher education in the United States.

With a focus on finding innovative and collaborative solutions for complex global health problems, the College offers nationally recognized programs in global public health, social work, health management and health policy, epidemiology, biostatistics, environmental and occupational health, behavioral science and health education, emergency management, biosecurity and disaster preparedness, and criminology and criminal justice.