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Stepping Out of the Exam Room and Into the Community

By Risa Wilkerson on June 5th, 2014

When Active Living By Design’s (ALBD) graduate assistant, Stephen Krumland, goes back to Omaha this month for his final year of medical school at the University of Nebraska Medical Center, he’ll return with a Masters in Public Health (MPH) degree in Health Care and Prevention from the University of North Carolina at Chapel Hill (UNC). Why did a future physician spend an extra year to gain this degree?

Initially, UNC’s Gillings School of Global Public Health piqued Stephen’s interest because of its emphasis on the clinical aspects of public health. Luckily for us, as he continued to research the intersection of the built environment and health outcomes, one of his professors told him about ALBD. We’ve had the pleasure of working and talking with Stephen about the role of physicians in healthy community work for the past six months.

Like many of us at ALBD, Stephen came to this work from lived experiences. He observed the norms in his community and noticed differences in the availability of healthy choices. “I’ve always been an active person, ever since I was a kid,” Stephen said, “and growing up in Lincoln we had a lot of trails, which made it easy.”

During college he started running marathons, and in medical school he used training as a way to discover Omaha. “I lived in a very walkable neighborhood, probably the most walkable in Omaha. [Training] gave me a lot of time to observe that some neighborhoods are easier to run in and be active than others.”

During his third year of medical school, Stephen counseled patients on exercise and healthy eating, but was frustrated knowing their options were limited due to street violence, poor access to fresh foods and lack of active infrastructure. These observations, along with continued research, reinforced his interest in working as a family practitioner and as a local advocate to influence policy.

Thinking about the physicians I know, I asked how he plans to find time to do this work. Stephen said his ideal goal is to work in a federally qualified health center (FQHC) where he can keep his hands in both the clinical medicine and community advocacy work.

Fortunately, through his internship at ALBD, he connected with some of influential physicians who are doing just that. Stephen’s master’s paper (in process) focuses on the role of physicians as community health advocates for built environment change. He is interviewing physicians across the country who are strong proponents for population-level changes and is researching what works.

The past year at UNC and ALBD helped Stephen reflect on new learnings he’ll take back to Omaha. He said he learned a lot about how population health can and should be connected to clinical work; how to better critically appraise research and policies, both in the community and in the clinical setting; and how much work goes into developing and implementing policy changes.

He’s looking forward to integrating population health, social determinants of health and upstream approaches into more conversations at medical school, in residency and beyond. As he put it, “I’d like to see more of a focus on health outside of the healthcare system, outside of the clinic.” He went on, “A lot of what physicians do is important, but some of the interventions we prescribe may be less effective than population-based strategies.”

Spoken like a true advocate already! We’re looking forward to keeping up with and learning from Stephen as he finishes school, goes out into the field and makes his community – wherever that may be – a healthier one through his clinical and community-based work.

Risa Wilkerson

Executive Director

Action-driven optimist, abundance thinker, and simplicity seeker.