SPEAKER 1: As many of you know, Pete was particularly passionate about Cornell University's impact on the lives of people around the world. So it is entirely fitting that we have many faculty, students, and community partners here today who are deeply involved with the university's long tradition of public engagement. I would like now to invite Mike Kotlikoff, our provost, to introduce this morning's panel on community engagement-- Mike.
SPEAKER 2: Thanks, Bob. Good morning, Cornellians, council members, trustees. A vital part of Cornell's mission from its earliest days has been its commitment to engagement. As a regional, national, and global disseminator of knowledge, developing new knowledge through research, but also preserving and passing it on to our students and the public.
Cornell has always seen the value in applying knowledge to help solve problems in our communities, in our region, in our state, in the nation, and around the world. Thanks to the depth of faculty excellence at Cornell across an extraordinary breadth of disciplines, Cornell is able to work toward solutions to some of our world's most complex and challenging problems. This morning, we will talk with faculty who are doing exciting work on one of the most complex and challenging issues humans face-- health and health care in a world increasingly challenged by economic, environmental, and political threats.
We'll also hear from their community partners who work with them on many specific projects, critically impacting communities and at the same time, benefiting our students, who gain experience, knowledge, and skills in the process. This kind of mutual benefit happening in courses across the campus under the engaged Cornell initiative that we launched in 2014 is truly extraordinary. And I'd like to thank Cornell's Office of Engagement Initiatives and particularly Vice Provost Judith Appleton for all they do to support collaborative partnerships and especially for organizing today's panel.
Among the many dimensions of health and health care we're focusing this morning on will be health equity, including access to health care, public health, including food security, and global health, especially as addressed at the undergraduate level. I'd like to now invite the panelists up to the stage. Monika Safford and Dr. Michael Berlin. Gen Meredith and Randi Quackenbush. And David Pelletier and Cornell alumnus Justin Lee of BPC Action Please join us.
This one is going to be me, David. We'll begin with health equity and access to care with Dr. Monika Safford and Dr. Michael Berlin. I'll let all of our panelists introduce themselves and talk a little bit about their projects. Then I'll ask them a question, and we'll open it up to questions from the audience. Monika?
SPEAKER 3: Sorry about that. Welcome, everybody. It's my distinct pleasure to sketch out for you a new initiative that Cornell University is embarking on called the Cornell University Center for Health Equity. This is an initiative that we've been planning for over a year. And it is at its fundamental core a community partnership effort.
The vision that I would like to bring to this effort was formed with the experiences that I had in a very impoverished area in the southeast-- the Alabama Black Belt. When I first came to the University of Alabama at Birmingham, I was a diabetes researcher. I was very interested in pragmatic, practical research that would actually have an impact on populations. And the first person who wanted to talk to me when I got to the university was the Cancer Center director. And it was very curious because cancer and diabetes don't intersect very much.
But the reason was that they had been in the same set of communities in the Black Belt doing prevention work in cancer. And in that kind of work, you typically have community coalition meetings. And at every meeting for 10 years, the number one thing that the community wanted was diabetes programs.
Cancer researchers typically don't do diabetes research, so he was really happy when I arrived to be able to finally offer the community what they wanted. And when I did my first project there, some of you may be aware, it's very difficult and challenging to engage ethnic minorities, especially African-Americans, in research for a variety of very legitimate reasons. And we actually had to halt recruitment after we had over-recruited by 5%-- 95% of our participants were African-Americans.
And we were able to achieve this really remarkable accomplishment because of community partnership. The community wanted a diabetes program. They did the recruitment for us. We didn't recruit at all.
So the first important lesson is to listen to the community about what their priorities are. In the course of doing our first trial, we noticed some persistent observations coming from our community partners. In diabetes, it is extremely important that you get physical activity as part of your self-management program. And a lot of these participants had great difficulty meeting their physical activity goals because they were in too much pain.
I'm not a pain researcher, but our next project specifically targeted overcoming pain as a barrier to get enough physical activity. And that would not have happened had we not had this partnership model. In every scientist's trajectory of a program, there is a point at which you accumulate sufficient data to begin to plan the next project, and inevitably, there are a number of different directions that one can pursue.
The second important principle that I'd like to bring to this center is to allow community priorities to inform that decision. So if you're in a real partnership model, you know what the priorities are, and you can actually steer the research program in a direction that's more relevant for your partner. Throughout our now three programs that we had focused on diabetes, the voices from the community became louder and louder, saying, you know, Dr. Safford, it's really wonderful that you have these diabetes programs, but high blood pressure is even more common in our communities. And so our fourth trial now in the field focuses on high blood pressure with that same informed community priority model.
But a third very important aspect of this community partnership is use what's there. So rather than coming in and telling people what you think the solution is, really looking around at what are existing partnerships on which you can build, and that's what brings us to our community partner here at Cayuga Medical Center. Cayuga has been a really important teaching site for our medical students.
They absolutely love the experience that they have here. It's oversubscribed. We actually have to turn a lot of students away because they love the experience so much.
So Cayuga was helping Cornell in that respect for many, many years. Last summer, there was an opportunity for Cayuga to propose a rural health residency program. There's a tremendous shortage in rural areas of primary care physicians. And so they came to us and asked whether or not we would consider helping, and of course, the answer was yes.
They're well underway under Mike Berlin's leadership here, succeeding in that proposal. And that is sort of solidifying that partnership. So now that we are focusing on the Center for Health Equity, this is one of the partnerships on which we are building to expand the projects that people are doing with Cayuga to focus on health equity.
There have been a number of Cornell-led projects that I think have been very much appreciated by Cayuga. But this is a new opportunity for us to look into a slightly different direction. So let me stop there, and let's hear from Mike.
SPEAKER 4: So I am a physician at Cayuga Medical Center. I'm also the program director and developer for our new residency program. At Cayuga Medical Center, our interaction with the community is really embedded in our mission, which is to provide the highest quality health care in partnership with our community. And we do have a long history of partnering with Cornell.
We view ourselves in that role as an extension of the classroom and a bridge back to the community. Past efforts prior to this have seen students from the College of Human Ecology help our institution expand services to geriatric population in our region. And that was very successful amongst others.
But as Monika mentioned, we see a growing shortage of primary care physicians as a looming obstacle in the equitable access and delivery of care to our region. And so we see the development of this new rural residency program is aimed at supplying a pipeline to alleviate this need in conjunction with the Weill Cornell College of Medicine and the Center for Health Equity is really highlighting Cornell's community engagement with a true purpose.
So I'll offer you this example as well. There was a medical resident at the Weill Program in Manhattan that came to Cayuga Medical Center as part of a rotation that was the predecessor to this rural residency-- the one that is oversubscribed that Dr. Safford mentioned. And upon graduation, they joined the staff at Cayuga Medical Center and then went on to forge new relationships between the two institutions. And now they are developing a new residency to help alleviate the primary care workforce shortage in our region. To be clear, that resident turned faculty turned program director and developer is myself.
And it's really an honor to be here today to share both my story and the continued work we're doing together to strengthen and expand our partnership.
SPEAKER 1: Thank you very much, Michael. A little self-promotion never hurts.
Now I'd like to turn to public health-- turn to Gen Meredith of the College of Veterinary Medicine and Randi Quackenbush of the Food Bank of the Southern Tier. Gen, would you tell us a little bit about the public health focus of your program?
SPEAKER 5: Yeah, thank you. So as President Pollack introduced, we're launching a new-- we have launched a new public health program here at Cornell that really focuses on the intersection of environmental health, human health, and animal health under the One Health paradigm. And public health is a profession that works to ensure that communities-- we-- can have access to health.
And there's two big issues that undercut our access to health right now. And Monika mentioned one of them, which is equity. And the other one is sustainability. So I'll touch on those just for a second, and then I'll talk about our partner's role.
So as Dr. Safford attested to, equity is vitally important because if we can't address the determinants of health, we can't ever achieve public health. These well-researched determinants include things like education and income, but also include things like access to safe communities, green space, transportation, food, and of course, health care. And if we unpack health and these determinants, we unfortunately see really vast disparities along racial lines, along geographic lines, along gender lines, and if I didn't say it, geographical lines. We see these globally and locally. And so we really need to find ways to address this.
Now sustainability is also really important because if the environment in which we live, our ecosystems, our world isn't healthy, we can't be healthy. In 2015, a really game-changing report came out to show that the advances that we've made in global health up until now have likely come at the expense of our future generations' health and wealth. We're using water, we're using land at unsustainable rates, and many of our natural resources are becoming polluted such that it's going to be really hard to maintain the health in the future. So this actually ties back to equity, and its equity for our future generations.
So these are these two big issues that we hope that we can address through the program. And we know that some of the best public health happens at the confluence of research, of community engagement, and then that collective innovation that can happen. And so we're trying to take a three-pronged approach to achieve that.
The first is that we're recognizing the absolute depth and breadth of public health across Cornell University, both in teaching, in research, and also in public engagement. I'm probably biased, but I truly think that Cornell University lives and breathes public health. And it's a really exciting space to be in right now.
The second thing that we're doing is thanks to some generous donors, we're creating an environment and providing some funding for trans-disciplinary teaching, engagement, and research, hopefully to be able to impart some real impact. The third thing that we're doing is we're trying to train both thinkers and doers-- so people who can think about our grandchildren and our great grandchildren as they're implementing programs and policies for health and public health into the future while also being able to be nimble enough to address our current and really pressing needs. And our community partners are vital in serving all of that.
We know that here at the university, we can provide top-notch public health education. We can impart knowledge, we can build skills. But the magic is going to happen when we are able to engage with our partners and be able to help students turn that knowledge and turn those skills into real competence by practicing, by doing, and by seeing the effect of their work.
So just a couple of brief examples. We have some students who are here at Cornell studying public health with an explicit focus on the prevention and control of infectious diseases. So top notch curriculum-- our students are learning a ton. We have no doubt that they're going to be able to be thought leaders in this area. But we know that some magic is going to happen when they're able to get out into the field with public health practitioners and begin to address infectious diseases at the forefront of some of these climate-driven natural disasters that Sophia earlier talked about.
We have natural disasters, we have wildfires, we have Zika outbreaks, we have Lyme disease outbreaks. And we need to be understanding through our communities how we can best help them to assess and address the needs that they're doing-- that they're facing, I'm sorry. Another group of our students are here understanding the deep complexities of food systems and how those food systems link to health.
Now, I don't know if there's a better university in the country, and maybe even the world, to learn that kind of knowledge and those kind of skills from. But I also know that there's going to be some magic that happens when these students get to get out into the field with partners like Randi and see this in action. Many of our communities, on one side of the tracks, people are struggling with diabetes and hypertension and obesity, whereas on the other side of the tracks, people can't even find enough food to keep their tummies full. This is real life in our backyard.
And we need to have the opportunities to work with our communities, not only for our students to get a deep understanding of what this means, but also to understand that public health can't happen from the top down, that it has to happen with community partners and again, bridging this deep research and great understanding with what's actually going to work in the environment. I think I'm going to stop there and ask Randi to talk a little bit about the magic that she does in this community.
SPEAKER 6: Thank you. I Might be a little bit too loud. Yeah, so Gen, I'm really honored to be here. And when Gen asked me to speak on a panel at Cornell, I said, sure. And then they're like, it's five to six hundred people, and I was like great.
This is really honored to be here. And when I met Gen a year or two ago, and I found out about the Master of Public Health program, I thought this was a perfect partnership with the Food Bank because this is an area in which we're hoping to move and put more of our attention and efforts in. So again, I'm Randi Quackenbush with the Food Bank of the Southern Tier, and we are located in Elmira, New York, but we cover six counties, including Tompkins County.
And just to give you a little bit of information, 14% of residents in Tompkins County are food insecure. And that means they may or may not know where their next meal is coming from. This is a very serious issue. There's a lot of stigma, there's a lot of shame attached to being food insecure. In our food bank, we're one of 200 food banks in the country. We source and distribute food nationally and locally, and then we get it out into communities through a network of partners, which include meal sites, soup kitchens, and food pantries.
In addition to those partnerships, we also have partners like folks at Cornell working with students, with faculty, and other community-based organizations. So in the past, we've really worked with Cornell in two ways. We engage students in volunteerism, which is kind of the most obvious and basic way you think you would get students involved in the community.
We've had students volunteer to pack backpacks for our backpack program, which is a supplement to the school meals that kids are getting during the day to help them get through the weekends. We've worked with athletic teams and other departments to come in and volunteer, even in pantries in Tompkins County and also down in our facility in Elmira. And the second way we've really worked with the students has been through education.
So I believe firmly how you view an issue is going to dictate how you actually respond to that issue. So it's really important for the community and for students as emerging leaders to have a good grasp of the issue of food insecurity because it's really complex and the solutions are not simple. So we've worked with really diverse classes.
I was actually just up in the [? Sattler's ?] School a couple weeks ago working with some hotel administration students who are in a social enterprise and nonprofit course. We've worked with business students, with political science students, with nutrition club in the public health society. So we've engaged students in simulations and presentations and things like that.
And we also work with faculty. We did a recent project on nudges, where we tried to revamp how our food pantries look and have healthier options more eye-level and more accessible when people are coming in through the line and trying to encourage healthier choices. But we, as a food bank, we really know that volunteering is obviously really important. But we know that volunteering is not going to end the issue of food insecurity.
So this is why in the past few years, we've really been looking at newer partnerships with health care providers, with public health organizations, rural health networks to actually have a broader focus on food insecurity. And that's actually how I met Gen. There is a lot of work in Tompkins County using what we call a collective impact framework.
So I actually don't have any sort of public health background. But that's OK because I can meet folks like Gen who have those strengths. So how can we actually work together and address this really complex issue? And as we've been meeting with other partners, we've really been looking at the social determinants of health.
So there's a huge link between food insecurity and chronic disease and obesity and diabetes. So what can we do as we're distributing food to ensure that we're getting the best food out, that we're providing nutrition education? And then ultimately, we're looking at the root causes of food insecurity, and we're asking questions. Why are people actually hungry in Tompkins County in the southern and in the United States?
And that opens up a whole door of all sorts of other issues that traditionally food banks haven't really looked at. A lot of times we just think we're here to give out food. And that's been really transactional. So we're like here's your food, we'll see you later. So when we're engaging more with students, especially with upcoming MPH students, and we can actually try to have more transformational relationships with not only people distributing food but ultimately with the people that are accessing our food programs.
So this is a really exciting partnership. And I think we have all sorts of potential to work together, in terms of community-based research and developing relationships with people that are true food insecurity experts that people that experience every day. So I do have to mention-- I would be remiss. My boss told me to mention this. Our food bank is actually the food bank of the year across the country. So--
So Gen can tell her students, at least for the next year, you're working with the best of the best. So thank you for having me.
SPEAKER 1: Thanks, Randi. That's two for two with self-promotion.
David, so now we move to global health. David, tell us a little bit about your program.
SPEAKER 7: Sure, thank you very much. So I'm a faculty member in the Division of Nutritional Sciences. I'm actually a biological anthropologist by training. And while the others have talked about impacts in the communities where they're working, I want to sort of turn it inwards and talk a little bit about the impacts on people at Cornell, working at Cornell, or studying at Cornell, including undergraduates.
And the large frame for my comments is a paraphrase of a quote from C.S. Lewis, who said, "Experience can be a brutal teacher. But you learn. By God, you learn."
So in my own case, I got my PhD in anthropology, came here in 1984 for a one year post-doc in the Division of Nutritional Sciences. At that time, we had a project helping the New York State Department of Health to estimate the number of people who were at nutritional risk due to the cutbacks in federal programs.
This was the 1980s. This might seem like a little deja vu. But after that one year post-doc, I was then sent out-- maybe thrown out-- to the country of Malawi in central Africa to work with the University of Malawi, UNICEF there, and the government of Malawi to work on more severe forms of malnutrition. And-- this is where I learned. By God, did I learn.
Since that time-- fast forward 32 years-- now I'm one of several faculty members in the Division of Nutritional Sciences who routinely engaged with global organizations like the World Health Organization, US Agency for International Development, UNICEF, the World Bank, and governments around the world to collaborate and advise on how they can strengthen the design and the implementation of their policies and programs for under-nutrition, which is one of the leading causes of the burden of disease in the globe. So that's how coming to Cornell and being absorbed into the ethos of making a difference and applying our knowledge and engaging in the world has changed my career and those of others in my department.
And now let me talk about how in recent years, we, thanks to engaged Cornell and other parts of Cornell that are committed to engagement as a form of learning, has impacted undergraduates. So about 10 years ago, when it became obvious that this enormous burden of global health was not a flash in the pan, was not going to be a passing fad of international organizations, which sometimes we have-- that it was here to stay and that we were going to need a workforce with diverse disciplinary skills and backgrounds to address these problems.
So my department, starting with a SEED grant from the National Institutes of Health, started a global health minor program so that any student from any major across the university could get a minor in global health, taking a few core courses and most importantly, spending eight weeks in a low-income setting-- low-income country-- interning with an organization there and typically with a home-stay. And then the students come back after that experience and take a capstone course, which I teach, which helps them to integrate what they have seen and experienced in the field with the academic knowledge they've acquired previously and design a solution to some of the problems that they've seen in their experience working on teams.
We've been doing this for about 10 years. We've had about 500 students participate in this minor. And a few years ago-- four years ago-- we saw a need to deepen the training and preparation for careers in public health. So we began a major in global and public health sciences, where students have more global health courses, a greater variety of interdisciplinary courses, and again, eight weeks intensive experience in a low-income setting or a public health setting either in low-income countries or domestically.
So with the major, we recognized that many students may want a career domestically rather than internationally. So we've developed partnerships with the Skorton Health Center, with Cornell Cooperative Extension in Tompkins County, and with Cornell in Washington so that students can intern in those programmatic settings. This is in addition to the international partnerships that we had when we developed the minor, which is in Tanzania, Zambia, India, and the Dominican Republic.
So this program began only about three years ago. We had our first cohort enrolled, and it's turned out to be a very popular major. The third program that I want to describe that gives students this very upfront, sometimes brutal learning relates to Cornell in Washington. I was invited to become the director of Cornell in Washington last year and gladly accepted it.
This program, many of you may know, has been here for about 35 years. It was begun by Ted Loewy, primarily for government majors and history majors way back when. But over the years, it's become more and more attractive and popular with students across the university.
Cornell has a building in Washington DC in Dupont Circle area, which has classrooms on the main floor and apartments in the three stories above where students can do a halftime internship for a semester and take courses at the same time from Cornell faculty and faculty from the DC area and work in an organization of their choosing. We help them to find the internships, but they do most of the legwork themselves. And there's several hundred organizations that have hosted Cornell undergraduates over the years and many, many hundreds of students that have taken part in this program.
So that doesn't focus only on global or public health. It's actually across the board. You can imagine the opportunities in government and non-government organizations in the Washington DC area.
So in thinking about what community partners to invite to this panel, my first thought-- maybe some of the partners from low-income countries where we've worked. But then I thought, no, let's bring someone who's experienced Cornell in Washington as a student and now is one of our partners in DC, which is Justin Lee. Thank you, Justin.
SPEAKER 8: Well good morning, everybody. First let me say thank you for letting me address you today and being a member of this panel. I have said it before, but it is an honor that I do not deserve.
But regardless, my name is Justin Lee. I was class of 2015. And I now am a research assistant at BPC Action, which is the legislative affairs shop for the Bipartisan Policy Center, which is the premier center for bipartisan solutions for the nation's most pressing challenges-- policy challenges. Among our areas of interest are health care, immigration, taxes, budget, and a couple of easier issues like energy innovation and North American trade.
But in any case, I think what the most important thing I can contribute to the discussion today is how what I do everyday in Washington can be traced directly to my experience as a CIW. Student back in the fall of 2013. That was a great inspiration and I think very informative of where I've taken my career so far. But when I was in CIW, I had the opportunity, one that I would not have had without the CIW program, to intern with the White House Office of Legislative Affairs.
And when I was there, I was able to see firsthand some of those pivotal moments of the Obama administration. The Syrian chemical weapons crisis happened in my first week in the office. And the government shut down as well as the less than OK rollout of healthcare.gov also happened during my term there.
And I think it was an amazing experience. And it allowed me to take what I've learned in the classroom here at Cornell and bring that to a setting where people were working on these solutions every day. And I think it's really important to say that my experience is not unique at CIW.
I think you can say that every student has had a similar experience. Just in my cohort alone, we had students who had interned with major non-profits like Amnesty International, with many of the federal bureaucracies, including the State Department. We had interns who were walking the halls of Congress and interns who were also lobbying Congress with the big k-street firms. Students were interning with nonprofits that were more local to DC, particularly.
And I think the great thing about CIW is that all of these students are a close, cohesive group, and they get to learn about all of these issues together, be it talking about what they did at the office, talking about what they do in their research papers there, or know going to the many events that happen around DC, like the think-tank talks and things like that. And I think it's a really important way for students to come down from Ithaca and see what people are doing every in the kind of policy areas that they are looking to study and understand here in Ithaca. And really, it's a way for them to engage their Cornell experience.
And I think as an alumnus and as a partner, I think I and other people like me have a great role to play in making sure that students have more opportunities in the CIW program to really broaden that experience-- to bring in to the CIW community connections to other communities that we have in Washington and beyond, whether that be helping secure internships. For example, I helped a colleague of mine secure a Cornell intern. And she spent a very productive semester working on freedom of press issues in China.
And I have to give a shout-out to my own intern. She is Victoria Lopez. She is a CIW student now. And as a testament to how hard CIW students work, here I am taking a vacation day, and she is back at the office working on finding us some members of Congress to meet with on Deferred Action for Childhood Arrivals. So she has her work cut out for her, and she's learning a lot and applying a lot of what she has learned here at Cornell.
And so yes, I think that alumni and partners have a lot to contribute to the CIW experience. And yeah, that's me.
SPEAKER 2: Thanks very much, Justin. I have one specific question and then one general question. Perhaps I'll start with the general. I'm hearing four entities, really, here in these programs. University and faculty is one. A community partner is the second. The population that we impact is a third. And the fourth is, of course, our students.
I wonder. These seem like very challenging partnerships to construct and maintain. And I'm wondering if anyone can really speak to how you really developed those partnerships and what barriers you find in creating these institutions. Monica, do you want to start with that? I know you're starting with a new center.
SPEAKER 3: That's a really-- you're absolutely right. It is a very, very challenging thing, especially when you're coming into a community that you're not that familiar with. So I'll use my own experiences. An example, I inherited a community coordinator from a CDC Prevention Center at the School of Public Health who was a known quantity. And we sort of knew what her stature was in the community.
But there were several people from the community who sought me out once it became clear that we were doing programs. And several of them, when I inquired with my community partners, were people who, if we had chosen them to partner with, we wouldn't have gotten very far because they were not people of stature in the community. So there are minefields, without a doubt.
And I don't think there's a formula for how to do this. But in health, a terrific partner is often the Department of Health because they are out in the field, they have offices everywhere. There are some tips that you can take. They have a better sense for which are the stable community partners.
We have right now-- this is another problem that you have-- is that some of these nonprofits come and go. It's very hard to keep a nonprofit going, especially in a state-- New York state, I think, is a little bit more mindful of the safety net and has more opportunities. But several states in the country do not. And often, they are the states where the need is the greatest.
So one of our community partners, we were hoping to house our community health workers there. She's actually dissolving the nonprofit as we speak. So that creates all kinds of problems.
In terms of Cayuga Medical Center, is the duration of how long the partner has been established. And Cayuga has been here for how long?
SPEAKER 4: 100 years.
SPEAKER 3: 100 years. So that's a good partner.
SPEAKER 2: Gen, I'm imagining that in the partnerships you're working on developing, you run into issues of agricultural practices, environmental issues. Are there concerns about interfacing with specific communities and trying to educate and develop an impact?
SPEAKER 5: That's a great question. So I had the privilege of working out in the field in developing countries for 10 years before coming to Cornell. And I actually was the recipient of some Cornell interns in that time. And so I had the opportunity to learn a lot about the skills that students can bring.
But I also got to be on the other side to understand what I, as a partner, needed to make sure that my projects and my needs could be fulfilled. So I sort of bring that to the table now. And I don't think that we've run into any challenges yet in developing partnerships.
In fact, it seems that people are really excited that Cornell is doing public health and that Cornell is taking a broader approach to public health to look at the intersection of animal health and environmental health and human health. But what I keep trying to remember are three things-- patience, trust, and adaptability. And I know that we're going to have to be patient, and our partners are going to have to be patient as we get the program up and running, and we really begin to understand what the mutual and bidirectional needs are.
We have to do, and we can, thankfully, use that time to develop trust. And I think really strong partnerships are built on this long-term trust. One of the other great values of this program is there is a long, long, long history of partnerships through the Cooperative Extension, through the Public Service Center, and now through Engaged Cornell. And so we already have some of that trust being laid, and now it's a part of continuing to foster that.
But then the third thing is adaptability. And I think as a faculty member, I can go in, or we can go in, with clear ideas of the types of research that we want done. But our community partners might not be open to that. And our community partners might have some very pressing needs that they want to address, but are at some roadblocks. And if we can remember to be adaptive, and if we can remember to really draw on bi-directional communication and create space where we can co-asses and co-address, I think that there's real opportunities for impact.
And you may have mentioned it. And I think one of the values of the global health major now that I was able to see as a recipient was the programs and the projects that students were engaged in continued over time. And one class or one cohort passed the torch on to the next cohort. And that's something that we're going to really try to do in our public health program-- not to dissuade students from doing something independently on their own. But I think the real value is going to come when we can see 10 years down the road the fruit of some very strong collaborative relationships.
SPEAKER 2: Terrific. My last question. David, can you give us an example of transformation that in this period of time that you've worked in global health? Can you give us some examples of something that you look back on and say, I've made a difference?
SPEAKER 7: Yes. It's because there's so many choices.
SPEAKER 2: I'm sorry.
SPEAKER 7: No, no the reason I pause is that I think, without a doubt, the biggest impact that I personally have had in my career here did not involve engagement. But it triggered a whole cascade of changes out there in the world. So to be specific, back in the early 90s, I and some colleagues in my department published a paper documenting with evidence for the first time that the percent of children in developing countries who died due to malnutrition is not the 3% to 5% that the World Health Organization and others were estimating. It was more than 50% because we took into account the mild to moderate forms of malnutrition, not just the visibly obvious, severe forms of malnutrition.
So we pulled epidemiologic data from eight studies and were able to demonstrate this. The world took it up. And that was one of the things that put nutrition onto the global policy agenda of international organizations, including the World Bank, World Health Organization, the Bill and Melinda Gates Foundation, as well as national governments. So that, by itself, did not involve engaged research. It was strong epidemiologic research. But now that that cascade is happening, I and my many colleagues in the department are engaged in trying to design and implement effective policies to deal with this major issue.
SPEAKER 2: Terrific. Thank you. Why don't we open it up to the audience for any question for our panelists? Cornellians always have questions, in my experience. And administrators are very patient. Greg?
AUDIENCE: Thank you for the opportunity and interesting panel discussion. Your last comments about the nutritional needs of the world, to me, brings to mind the need for genetic engineering for our food stuffs. And I wonder if this plays into your dialogue at all. Thank you.
SPEAKER 2: So the question is around, really, I think, the efficiency and capability of producing food for an expanding population and addressing food insecurity, food inequity, which leads, of course, to health inequity through technology, I think, most generally. Any comments? On that, David, you may be the close--
SPEAKER 7: Yeah, I'd be happy to comment. Actually, when the Food and Drug Administration issued its policy statement on foods modified through modern methods, I did some research on that myself because I could see it was a pretty major issue. It was already controversial. I wanted to educate myself.
So I actually did a sabbatical and stayed in the Cornell in Washington building back in 2002 or so, interviewed people at FDA and nonprofit organizations, had enough background in biology myself to understand what was going on. And I was most impressed by the uncertainties about possible unintended changes due to the insertion of genes into the genome. Because at that time, the insertions were kind of random, multiple, and uncontrolled.
And actually there's well-known principles of molecular genetics that would lead you to believe that could create all sorts of unintended consequences downstream. So I published three papers on that. I'm not saying that it's dangerous, but just that there's a lot we still don't know, biologically, about what's going on with transgenic foods.
Since then, very interestingly, further innovations in genetic transformation, including the CRISPR gene, which allows very precise insertions to take place, to my mind, eases those concerns. So through continued work at the molecular level with genetic engineering, to me, it puts it to rest.
And there's no doubt that we need much more application of this technology for drought resistance, pest resistance, for all sorts of problems in the agricultural systems of high-income countries as well as especially low-income countries. Thank you.
SPEAKER 2: To me, maybe I'll just make a comment as well. It's getting a little closer to my area. To me, there are two areas here that have a potential impact. One, as David said, is how you do the germ-line transformation-- what other bits of DNA you leave when you transform a species, whether it's a plant or an animal. And that has largely been solved.
What is still not known is the complexity, the environmental interactions, the impacts that can occur when you have a change that results in monoclonal expansion of species, et cetera, and the downstream impact. So the only thing I would add to your terrific comment is that our ecology is so complicated that we have to be very, very careful, still. Even though we can genetically transform species very specifically, the impact of that, in terms of the overall ecosystem, is quite unknown.
SPEAKER 3: I'd like to also comment that there's another dimension that we haven't really talked about, which is that there is a large segment of the public is very adamantly against any kind of genetic modification of foods. And there are a host of similar misperceptions on the part of the public-- vaccines come to mind-- where we, as scientists and especially as health care professionals, I think, have largely ignored public health-- effective public health messaging-- and how to counteract these tidal waves that are based on misinformation.
And I think that's a huge need. We need to do a much better job of figuring out how to communicate the latest research findings so that people can make informed decisions.
SPEAKER 2: Terrific point.
AUDIENCE: Please, thank you very much for this terrific panel. All of us here have always been inspired by what a special place Cornell University is. And today's panel, I think, opens up a highlight that I hadn't really considered very much before. The stories of your engagement with communities around Ithaca and around the world truly are a different kind of a paradigm.
And I have a lot of experience dealing with other universities as well. In many of those, the faculty eschew the practical application of the knowledge they've been developing. And here, you're telling us such inspirational stories about how you embrace that and the application of it.
What do you see as a provost, as faculty, as those around in the community that are impacted by this wonderful partnership that makes Cornell such an attractive place. And indeed, do you select faculty here based on their willingness and enthusiasm in sharing what they develop here with the broader world.
SPEAKER 2: Well maybe I'll take that one really quickly. I personally think this is Cornell's secret sauce. And its secret sauce from the very beginning.
It was Andrew Dickson White and Ezra Cornell. It was an individual that was interested in knowledge and the most-- the highest level of academic achievement and an individual that wanted to-- that essentially said, that's great, but it's not good enough. We need to utilize that information in a way that helps society.
And that's what's led the breadth of Cornell, which you don't see in any other Ivy League institution. And this combination of absolute excellence and a commitment to impact is what really makes Cornell what Cornell is.
SPEAKER 4: I certainly can't speak to the hiring of faculty. But I wanted to expand a little bit because Dean Pollack brought it up as well. There's not only--
SPEAKER 2: President Pollack. Sorry.
SPEAKER 4: See me as a partner, displaying my ignorance. But what she mentioned, in addition to pursuing the highest level of scientific exploration and excellence, is that Cornell University doesn't view itself as a separate entity. There's not Ithaca and Cornell. And they're really engaged together and synergistic.
And so particularly in the application of health equity, there's the blurring of the lines between university and faculty and students and community because everybody is involved. And that's that mentality that we are the community, and the community is Cornell that really helps, I think, break down those barriers.
SPEAKER 2: We'll stated.
SPEAKER 5: Could I just add one little piece to that. Is I think Cornell-- I'm a new faculty member here-- and I think Cornell really is putting their money where their mouth is in this example. The Engaged Cornell initiative, which has been around since 2014, is investing heavily in faculty development. . So those of us who want to learn how to teach this way and learn how to engage partnerships, there's really great resources to support us in this, as well as the new Center for Teaching Innovation, right?
SPEAKER 2: Yes.
SPEAKER 5: Teaching Innovation-- used to be excellence, now it's innovation. And it is also helping us to learn how to bring the communities and bring impact into our classrooms-- I'm sorry-- so that our students are even better equipped to know how to go out and apply this in the communities.
SPEAKER 2: Please.
AUDIENCE: Yes again, thank you for all your contributions to a wonderful panel. I want to ask a question about the end game. In the same spirit as we have come close to eradicating polio, for example, and smallpox, maybe getting there in cholera, and Gates hope they can get there on malaria, I think. For each of you, can you give us an idea of can you see an end game here?
For example, is there a time and a way soon, within any of our lifetimes, when there will be no people in Tompkins County who are food deprived? Can you see a way that there will be no time when there are children around the world who die from lack of nutrition? All of you, in your own domain, what is the smallpox-type end game that you can see, or do these problems go on essentially forever?
SPEAKER 3: Well let me just respond to that. Is poverty ever going to go away is essentially what you're asking. I don't think poverty is ever going to go away, unless there's a fundamental change in humans and in societies.
But that doesn't mean that we can't continue to do a much better job of enriching and giving individuals who are at the very poorest level of our society opportunities. So I think it's a journey. It's an ongoing attempt.
I don't we can eradicate it. It's a great thing to aspire to eradicate poverty. But there are a lot of things that we could be doing to meet basic needs of people who are the most vulnerable in our society. There are some-- from my perspective, from a health perspective-- one of the most stubborn health disparities is hypertension control in African-Americans.
The Kaiser Health System is eradicating that disparity. They are modeling that you can do that through outstanding quality of health care. So certainly, I think it's a worthy goal to aspire to. And even small differences make a big impact to the people who benefit.
AUDIENCE: Any of the rest of you?
SPEAKER 5: Yeah, I'd love to complement-- to build on that. And I think poverty or equity or disparity is really at the core. And until we find ways to begin to address that, it's going to be really complicated to have those endgames.
I think what we've really realized in public health is that public health can't come from the top down. Public health has to emerge from the communities up, with support from the top down. And so I think in finding ways to both translate the research that we know to the communities, like both David and Monica said, helping our communities to understand what the best knowledge is out there and finding ways to adapt it to make sense to them. But then also providing them the ability to achieve that-- to access that.
And so that means spending time with the community, and it means building leadership within the community. It means building advocacy skills within the community so that they're able to be the collective voice that tells us up here what needs to happen. And so when we're thinking about climate change and the impact on public health, ecological sustainability, and the impact on public health and poverty on the public health, we know that we have to be getting to the legislators with the best research. But we know that we also have to invest in our communities, so that they can be the ones to demand this as well.
SPEAKER 2: One last quick question. Thank you very much.
AUDIENCE: So thanks very much. This is truly a unique partnership-- as Mike said, among four constituencies. So there's the university and its faculty, the community programs, the community itself, and then really importantly, the students. But three of those groups are more stable and permanent than the other. And that's that students are transient.
So what happens when there's a great project that a student begins? And how do you, in your different programs, think about the longevity of that project so that the next student can still exert their own creativity, but the project that was started doesn't dissipate?
SPEAKER 3: So I can give you an example of something like that. I think it requires just a little bit of creativity. But we've had several projects that were started by students where it wasn't quite finished. The next student came on and had some ideas for where to take the next step and took the next step.
So we had one project where one of my students recognized that a lot of our patients were on brand-name medications when there were much cheaper generics available. So she came to me, and she said, why do you think this is? And I said, I have no idea. Why don't we find out?
So she conducted a series of focus groups to understand from those patients what was going on. Very interesting results-- lots of misperceptions about what are generics. That was one of the dumbest things we ever did, was to call non-brand-name drugs generic drugs because the word generic means something outside of the medical context. And it's not the same thing as what generic drugs are.
The second student came along and did a survey of primary care physicians. Are you aware that your patients have these sorts of beliefs? And a third student came along and surveyed a group of patients to find out how prevalent those beliefs were.
So it was one leading to another leading to another, and none of those projects would have happened if it wasn't for the students because they were sort of side projects to the larger research programs. So that's just one example.
SPEAKER 2: Terrific. Thank you very much. I want to applaud our panelists for their commitments to really, really challenging projects and the progress they've made. So let's give them all a--
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Public engagement has been a pillar of Cornell’s mission for more than 150 years. Today, through highly acclaimed initiatives such as Engaged Cornell, the university is bringing together students, faculty, staff, and community members to seek solutions to some of the world's greatest challenges. Provost Mike Kotlikoff and a panel of engaged Cornellians and community partners discuss how these partnerships are providing unique engaged learning opportunities for Cornell students, while simultaneously addressing complex societal issues, both in Ithaca and around the globe.