6 Questions: What's It Like to Work in Preventive Medicine and Biostatistics?
Dr. Jangho Yoon discusses what it's like to work in the specialization of Preventive Medicine and Biostatistics at the Uniformed Services University.
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Dr. Jangho Yoon of Preventive Medicine and Biostatistics uses data collected by the government for purposes like healthcare systems, medical claims data, medical payments data, and complex population health survey data to inform health policy. (USU photo) |
June 15, 2023 by Hadiyah Brendel
Professor: Jangho Yoon, PHD, MSPH
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Jangho Yoon, Ph.D., MSPH (Photo credit: Tom Balfour, USU) |
Years in field: 20 years
Special Interests: Aspects of health policy and how it shapes the mental health of the population. My particular interest is individuals with severe forms of mental disorders and behavioral health conditions. I'm evaluating health policy as an upstream social determinant of health and its effect on people’s health status and mental health status. Also, recovery from their mental health and behavioral health conditions and economic outcomes like labor and activities. And also, importantly, their involvement with the criminal justice system.
Favorite Accolade: In 2017 I was awarded “Policy Champion” from Oregon Public Health Association for my dedication and commitment to public health. The award is very important to me because it reminds me the ultimate goal of my work as a scholar and educator is to help others and reduce human suffering through public health policy research and education.
Q: Why did you decide to specialize in Preventive Medicine & Biostatistics?
A: Healthcare is an important determinant of health. I like investigating how to prevent disease in the population, and how to best allocate limited resources to prevent diseases. [And then using research to see] how we can approach it systematically to reduce unnecessary burden in the population.
And that also affects the national economy, which is very important given US GDP. Considering US GDP, 18% to 20% is spent on healthcare. Meaning we have significant lead distribution issues because 20% of national resources go to healthcare. So preventing diseases, saving lives, saving money and giving people time and the economy resources to improve the welfare of the entire population. That’s my major motivation when I'm doing my research.
Q: What does a researcher in Preventive Medicine & Biostatistics do?
A: You form a research team. So I lead the entire project, [then I] have research assistants, two or three usually. Here [at USU] you hire people from the Henry Jackson Foundation (HJF). I also have a processing manager and post-doc. We work together as population health scientists and social scientists.
For my research, I don't usually collect the primary data, but I use data already collected by the government for purposes like healthcare systems, medical claims data, medical payments data, and complex population health survey data. I utilize data already available to inform health policy.
The special population I’ve been studying more recently is women of reproductive age. I‘m studying Obamacare, the Affordable Care Acts, and its impact on that population and their infants and their health outcomes.
Q: What is one of the biggest challenges about working in this field?
A: The biggest challenge is to find clinical collaborators. By training, they’re clinicians. But clinicians in the US health system, including the military health system, see patients and approach healthcare from person-to-person, clinician-to-patient, kind of perspective. That's very important, to provide the patients care they need. But I think we need to kind of transform our perspective a little bit. So, there should be a complete paradigm shift to emphasize health of patients, health of population. So I think clinicians sometimes lack understanding on what it truly means to be a population-based health system. And, what their role is within the system.
So collaborating with clinicians [can be challenging] because of these different perspectives. I'm a public health scientist, so my ultimate interest is improvement in population health. Compared to clinicians' interest in, no matter what it takes, just take care of individual patients. I mean, that's how they’re trained. I mean, that’s noble, right? How much does it cost? It doesn't matter if clinicians can treat their patients. Person-to-person is right. But when we care about the entire healthcare system, probably we have to incorporate the idea that population health is also as important as individual clinical outcomes.
So having taught this for a long time, I emphasize to my students we don't want to lose either of those two lab rabbits. Both are important, but it is extremely hard to achieve both aims at the same time. But if we could kind of focus on high risk, kind of identify and focus on high risk patients, probably we can achieve two goals at the same time.
At the heart of [clinicians] effort is preventive care. Prevention in terms of primary prevention, secondary prevention, tertiary prevention. So preventive health, preventive care, should be a routine part of healthcare practice and public health practice to achieve those two ends.
Q: What aspects of your job do you find most fulfilling?
A: When my work is published and it's disseminated and studied by others, used by others, to inform policy. When I see that, I feel like I'm spending my time in a good way. Contributing to others lives. So even though I don't see patients directly, my research helps them. That's when I feel I'm helping people, improving the system and policy.
Also, an important part of my career is mentoring students. To train future generations of researchers and students. I'm trying to teach them a kind of new perspective. It can be very challenging when most of my students are military officers and some of them doctors in the military health system. Because in the military, you follow orders, right? So I help them to think creatively. To innovate the status quo so we can continue to improve the system. Oftentimes students when they start the program, start the training, they're like: Please, tell me what to do. My effort is to transform their perspective from a person who says, “please, let me know what to do”, to “okay, how about this?” So when I see that, I’m actually being rewarded.
Q: In your medical studies, what prepared you the most for this profession?
A: I came from a non-DoD environment, from civilian institutions. I spent almost my entire career studying state and better health policy. Now I'm trying to contribute, to include, the military system; so efficiency and functioning of the military system. The mental health parity for TRICARE is one of those efforts.
The United States healthcare system is kind of a place of metrics. In the civilian system, tremendous kinds of trials have already been made and there is a tremendous amount of information we could learn from the civilian system when we endeavor to improve the military system. When we focus on just the military system, we kind of lose that effort. Lose what is already known.
So I continue my research outside the military system to inform the military system. I have a more complete picture of the US healthcare system because I’ve known the TRICARE [system from the outside]. I read research done by others and so I've known TRICARE that way.
Right now, the military health system, I've been thinking, could be one of the role models for US healthcare reform. Given that TRICARE is really trying to improve itself to provide quality and access to healthcare for all its beneficiaries. I've been spending a lot of time doing research on value-based care. I think TRICARE has a potential to lead the national health reform with its current effort to modernize healthcare delivery toward value-based care.
In the private healthcare system, it is just too complicated. We know what kind of system is probably more efficient than others. But it is nearly impossible to enforce anything in terms of how healthcare is delivered. There have been several health proposals like Medicare For All, they received traction in US Congress but none of them were successful legislatively. So I think TRICARE can play a very important role informing national health reform in that aspect. I’m really glad that now I'm an insider of the TRICARE health system. I’m really studying and understanding the pros and cons of this system.
The TRICARE population is very different from the general US population in many ways but I’m using a kind of statistical modeling technique to make them alike. So that’s probably comparing apples to shido apples.
Q.: What advice can you offer medical students considering this specialty?
A: I think we can be better practitioners. By knowing how to use data to make evidence-based decision making. In health policy healthcare, data-driven decision making or evidence-based decision making, it received a lot of attention. But in practice, it is still not being well implemented by individual clinicians. Clinicians follow clinical guidelines, but it's not always being implemented as clinical guidelines. So sometimes a clinician, they kind of feel the experience. I see the tendency where they become more experience-dependent. So when they're making [decisions, thinking], “okay, this is what I know from my experience” and sometimes disregarding the evidence accumulated.
So, I'm recommending they continue to be someone who is teachable. Continue to learn advancements, not only in clinical practice, but overall how the healthcare system functions. How social determinants of health really shape people's lives, really affects people’s lives. Social determinants of health are really important. There's upstream and downstream social determinants of health. But it is becoming more and more important for clinicians to really understand not just clinical care but also other factors like the [patients] background, their financial situation, their residential location, residential type, race, ethnicity, cultural beliefs and so on. Those really have an important impact on their clinical outcomes as well. So keep up with all the accumulated evidence and when they make clinical decisions, use evidence to best deliver the care to patients.
