Mentors & Lessons: Moving the School Health Agenda Forward

By Laura Kann, PhD | March 14, 2016
Chief, School-Based Surveillance Branch, CDC

Editor’s note: Last fall, Laura Kann was presented with the William A. Howe award at the American School Health Association (ASHA) annual meeting—their highest honor. In her acceptance speech, she shares some fascinating inside information on how our current school surveillance systems were developed. She also offers three lessons that can help us all be more successful in our work in school health.

Thank you. This is truly an honor and I am very grateful to ASHA for recognizing me in this way. I know that a lot of important people in our school health world have won this award in the past and I’m honored to stand where they have stood.

 

There are a couple of things I need to do while I have the podium. The first thing is to thank a whole bunch of people. You can’t win an award like this without a tremendous amount of support, and it is all the people who have supported me who are really the recipients of this award.

 

I'd also like to share a few of the lessons I’ve learned over the years at CDC.

Mentors and More Mentors

The first person on the list of people I need to thank is Morgan Pigg. Back in 1986 Morgan was editor of the Journal of School Health and I was a grad assistant to him at Indiana University. He made this crazy suggestion that I should try working at CDC when I finished my PhD. He went on to introduce me to Lloyd Kolbe at the ASHA convention in Denver in 1986. 

Lloyd didn’t have any reason to take a chance on a brand new PhD like me, but he knew and trusted Morgan. He encouraged me to apply for a position in what was then the Office of School Health and Special Projects at CDC. Six weeks later I got back a short, generic rejection letter from the government. I read it, tossed it and got back to studying for finals.

However, on December 21, as I was packing to go home for the holidays I got an invitation —apparently after a phone call between Morgan and Lloyd—to come down to Atlanta for a job interview. This turned out to be the one and only job interview I have ever had.

The second person on this list who I need to thank is Jack Jones. Jack was my first boss at CDC. He was a lover of funky music, really weird movies and anything not sports. For those of you who know me, you realize that means I had little in common with him.

Jack also happened to know more about how to do public health than just about anybody I have ever met. He taught me the ropes at CDC, how to get the bureaucracy to do what I wanted and the importance of building real relationships if you truly wanted to get something important done. His mantra was, “There is no truth in funding or hiring.” This still helps me navigate the bureaucracy when it doesn’t share my interest in getting someone hired or something funded the way I want.

Now I can’t go much further without thanking Lloyd Kolbe himself. In a book chapter that Lloyd wrote in the late 1970s he described a national surveillance system that would measure kids’ health behaviors. Imagine that! That was a good 15 years before I got hired. Nonetheless, there sat the vision for what would one day become the Youth Risk Behavior Surveillance System (YRBS).

Lloyd did this kind of vision thing better than anyone else I have ever known. Lloyd helped envision our field’s original model of what a school health program should be. The first AIDS funding for kids came to CDC the day before Thanksgiving in 1986. Jack and Lloyd spent their holiday putting in place the structure for funding school health programs at CDC—much of which is still intact today.

About midway through my first year at CDC, Lloyd wrote me a note on a piece of yellow CDC note paper that I still have. This was back when people actually wrote notes to each other. It said, “Are you going to become the leader of school surveys at CDC?”

Now keep in mind, I was a CDC project officer at the time, the YRBS did not exist (in fact, CDC had never even done a national school survey), and we had only just begun to talk about how we might measure sexual behaviors among kids in schools. This is what I mean when I say Lloyd did the vision thing better than anyone I have ever known. I will always be grateful to him.

I am also grateful to Jim Curran, the first director of CDC’s AIDS program, and Jeff Koplan, the first director of CDC’s chronic disease prevention center. It was Jim who understood that even though the AIDS epidemic was truly a public health emergency at the time, it was going to be impossible for CDC to launch a sex survey in schools. As a result, he allowed us to use AIDS dollars to build the far more broadly focused YRBS, even though it would have been easy for him to say, “These are categorical dollars and you can only do categorical work with them.”

Several years later, it was Jeff Koplan who asked the totally reasonable question about whether we knew anything about the programs and policies schools in our nation had put in place to address all the health risk behaviors we were by then measuring with the YRBS. Jeff’s question led to the development of both the School Health Profiles system (Profiles) and the School Health Policies and Practices Study (SHPPS).

YRBS Coordinators: Heroic!

And that leads me to some other very special people I need to thank—the YRBS coordinators in all the states and cities and our YRBS contractors. They have taught me far more than I ever taught them about how to collect data in schools. They were the true pioneers who were the first to approach superintendents, principals and parents about this thing called the YRBS. They were the YRBS eyes and ears on the ground. They made sure I knew what was working, what was not, and what they needed to make the YRBS what it is today.

Because of the YRBS coordinators and contractors, three pages of fairly vague guidance and a cryptic set of printouts for results that we produced in the early years turned into the YRBS machine we have today with the fancy trainings, handbooks, newsletters, blogs, websites and all the other bells and whistles.

Because of the YRBS coordinators and contractors (those brave enough in the early years), the YRBS has been in the business of collecting data on sexual minority status longer than almost any other federal surveillance system.

Because of the YRBS coordinators and contractors, for the first time—in the 2015 cycle—we finally have our sexual minority questions on both the core questionnaire and the national questionnaire. We can now generate the first ever national data on sexual minority high school students.

I may be prouder about that part of our surveillance system than any other, and all the YRBS coordinators and contractors who made it happen are my heroes.

I want to honor one particular YRBS coordinator, Wanda Jubb. Many of you knew her. She was a longstanding member of this organization. She led Michigan’s school health program for many years before coming to CDC. She was a mentor and leader to many of us.

Wanda died just about two weeks ago today, and I was truly saddened by her passing. It was Wanda who helped me understand, way back in 1988, why surveillance was a great public health word, but not necessarily a word that would be welcomed in education settings without proper introduction and explanation. She took the time to explain this to a very young and inexperienced version of me, and I will always be grateful for that.

My School Health Family

And so last, but definitely not least, I need to thank my school health family at CDC. Part of that school health family is my current Division Director, Dr. Stephanie Zaza. I value her support, wisdom, and sanity tremendously and am very glad she is here today.

Also, within my school health family at CDC is a very special group of people I cannot fail to thank specifically. This is all the folks in the School-Based Surveillance Branch. I have been truly blessed to work with some of the best, brightest, most talented, highly skilled and just plain nice people anyone could ever ask for. Some have been working with me for more than 20 years.

They are first-class colleagues and very important people in my life. They do the work day in and day out to make the YRBS, Profiles and SHPPS state-of-the-art surveillance systems. It is their expertise, creativity and dedication to being the best that has made my job so good and given this field our incredible surveillance systems.

Lesson 1: Love What You Do

I’d like to share a few of the lessons I’ve learned over the years at CDC. One of those is that you have to love what you do to be successful. Work takes up too much of your life to not love what you do. If you don’t love what you do and believe in what you do, there is little chance of success.

CDC is full of people who love what they do and I’m one of them. CDC is also one of those places where it is really possible to change at least a little bit of the world, which is something I’ve never taken for granted.

The other key to success is working really hard when opportunities come along. Thomas Edison once said, “Opportunity is missed by most people because it is dressed in overalls and looks like work." CDC has been one big opportunity after another for me. For those of you just starting your career, may I be presumptuous enough to encourage you to work really hard at the opportunities that come your way?

Lesson 2: It Never Hurts to Settle for the Best

Another lesson I’ve learned is that it never hurts to settle for the best. Every time we settle for less, it hurts school health and the kids it should be helping.

It really isn’t good enough to do programs that don’t have evidence of effectiveness, or to advocate for policies that don’t make a difference.

It really isn’t good enough for health education to be what schools do after they do reading, writing and arithmetic.

It really isn’t good enough to ever suggest that primary prevention isn’t the best investment we can make in all our kids.

It really isn’t good enough to have the federal leadership for school health fragmented across multiple agencies and units within agencies.

It really isn’t good enough to be so underfunded that we have to make decisions about which states, districts and schools get funded and which don’t.

It really isn’t good enough not to put health education and P.E. and health services and all the rest into the hands of highly trained professionals.

And it really isn’t good enough to make decisions about the future of school health without using our high-quality surveillance data to guide those decisions. We must set the bar higher and diligently measure our success against it. We must believe that just because something has always been the way it is, this doesn’t mean it can’t be made better.

Lesson 3: We Need to Treat School Health More Like Public Health

And finally, another thing I have learned is if we are ever going to be successful at school health, we need to treat it more like public health. It has to be driven by real science, hard numbers and facts. We need to spend a lot less time on the morals and values of issues—not because morals and values shouldn’t guide the personal decisions that each of us make, but because they can’t be the basis of the public health interventions that all of us need.

If science tells us that vaccines save lives, kids must get them.

If science tells us that our gay kids are more at risk and suffering from discrimination and harassment, then we have to help them and all kids reduce risks and feel safe.

And if science tells us that some kids are having sex, then we must be sure they can protect themselves when they do.

We have spent way too much time discussing, arguing and fretting over whose morals and values are right and wrong when public health science makes it abundantly clear what our path forward should be. It is time to be brave enough and wise enough to take that path—and I hope I can go down that path with you.

Thanks again for this incredible honor. I am very grateful.

 

Laura Kann, PhD, is senior scientist and distinguished fellow, serving as the chief of the School-Based Surveillance Branch in the Division of Adolescent and School Health at the Centers for Disease Control and Prevention. She can be reached at lkk1@cdc.gov.