This fall, Duke Student Health will implement a system of prospective medicine, an educational and preventive approach that attempts to stem risk factors that could cause health problems in the future.
The shift comes as Student Health undergoes an internal reorganization that puts many of its programs under the jurisdiction of the Office of Student Affairs, rather than that of the Duke University Medical System. Administrators hope the new approach will help them recognize health problems prevalent on Duke's campus. With the rising cost of student insurance and the relative obscurity of Student Health's myriad educational programs, administrators are recommitting themselves to an age-old mantra: An apple a day keeps the doctor away.
"What we are doing is taking the opportunity to ride on the idea of prospective health care to do what we have always done," said Jean Hanson, administrative director for student health. "Now that the media is talking prospective health care, we can make people aware of our services and it actually means more to the average consumer."
Prospective health care is still a new idea and is relatively untested on any type of community. Dr. Ralph Snyderman, who stepped down as chancellor of health affairs July 1, was a champion of the approach, but practitioners have yet to figure out which aspects will yield effective results in a large population.
"One of the big challenges with prospective health care is getting a [trial] group together. The nice thing about students is that we have them for four years--graduate students even longer. We can work with them and track them and see if this is making any difference," Hanson said, stressing that this initiative is not scientific research, but only an opportunity to learn what does and does not work in creating a healthy community. "Hopefully we will be able to offer this as a model to other colleges and universities."
The theory behind prospective health care is that if students are educated to lead healthier lives, fewer expensive medical procedures will be required and insurance costs could potentially diminish.
In an effort to soothe stress and prevent sickness, Student Health will focus on educating undergraduates about better sleep habits, among other programs. In the fall, a planned sleep survey will provide information about how to attack this problem--even by potentially enforcing longer quiet hours.
"We know it will benefit students to get more sleep," said Franca Alphin, director of health promotions. "We don't want to intervene too much because we realize this is college. But if a majority wants this, we might make it happen."
Graduate students hope similar efforts will curb rapidly inflating insurance costs.
The cost of the insurance Duke offers has inflated by about 20 percent for each of the last three years. Rob Saunders, immediate past president of the Graduate and Professional Student Council, said graduate students are noticing the differences and want to prevent further increases.
"Graduate students have become a lot more aware [of inflating insurance costs] and we are looking at ways we can be more proactive, promote healthy behavior and how we use student health," Saunders said.
Insurance prices have been inflating due in part to the rising costs of hospital equipment, administrators said. These costs are particularly important to graduate students as Duke requires all students to carry health insurance.
Undergraduates are usually covered under a parent's plan, whereas graduate students are not.
But Saunders sees the current solution, prospective medicine, as incapable of fulfilling urgent goals.
"While health promotion and preventive medicine is a good idea, it is not a short-term answer," he said. "We won't be able to lower the costs within a year or two. This is more of a six-year thing."
Saunders also noted that the hope is to build up and promote some educational infrastructure at Duke to support such changes.
Dr. Bill Christmas, former director of Student Health who stepped down earlier this summer, poised the center to pioneer this approach by upgrading the medical program and improving access. The search for a new executive director for student health is currently underway.
"Dr. Christmas was terrific," said Larry Moneta, vice president for student affairs. "When he came in, the clinical practice really needed the attention. He has dramatically bolstered the clinical, so now we can think more about prevention issues."
Alphin, in her newly created position, has the task to increase awareness and focus on education and prevention. One of her first steps was to create a board of graduate students to help promote and find solutions for graduate students' current lack of participation in free programs.
"Visibility is key, and we need to remind the students that we are here" in order for education and preventive health care to work correctly, Alphin said.
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