As a result, I thought our readers would enjoy an abridged version of my Final Commencement address.
It is now more than a decade since the Jefferson University Board of Trustees unanimously approved the plan to create the nation’s first College of Population Health. I am truly grateful to serve as its founding Dean. As a primary care physician and health policy researcher, I have dedicated my nearly 3 decades of work at Jefferson College to making our healthcare system safer, more cost-effective, and more equitable. We now have a unique opportunity to train generations of future healthcare leaders. I believe that training the leaders of tomorrow is one of the most important jobs that current leaders in healthcare have. “Population health” was an unfamiliar term when we began our journey a decade ago. But health systems across the country are finally understanding the critical need to adopt a population health perspective. Regrettably, our great nation wastes $1 trillion annually on medical care that is unnecessary1; huge gaps in the coordination of care still exist, and the average white man in America will live more than 5 years longer than the average African-American man.2
In addition, sadly, after decades of gains, the average life expectancy in the United States has been declining for the past 4 years.3 Most of this decline is attributable to preventable conditions, such as drug overdoses, alcohol-related illness, suicide, homicide, and various forms of respiratory illness that result largely from smoking. How sad it is that the average life expectancy in the world’s richest country is going backward!
Another very sad fact is that since 1970, more Americans have died from gun violence than Americans who have died in all US wars, going back to the American Revolution.4 That’s right—the numbers are unarguable. Fewer than 1.4 million war-related deaths since 1775, with more than half of those deaths in the Civil War, compared with approximately 1.45 million gun-related deaths since 1970, including suicides, murders, and accidents.4
In addition to this reversal of life expectancy and a society characterized by terrible gun violence, we have another very complicated social problem in the United States. Today, 35% of all adult men and approximately 40% of all adult women are obese.5 I know that this is a difficult observation for us to think about.
So, if we are to address the pressing problems of rising healthcare costs, an aging population, and widening disparities in health outcome, we cannot operate in a silo. As a result, our college is devoted to bringing together academia, policymakers, and the private sector all under one roof. I know that change can happen, and, at our college, change is happening!
We currently have 6 unique online master’s degree programs, in addition to our fantastic public health program on campus, symbolized by the wonderful graduates sitting in the audience today. We have also launched 2 free-standing centers for population health research; one is focused on urban and suburban issues on the campus of the Lankenau Institute for Medical Research at Lankenau Medical Center right here in the suburbs, and the other is focused on the unique needs of rural health in Johnstown, PA.
Our faculty has trained more than 55 health economics and outcomes research fellows in direct collaboration with the pharmaceutical industry. These 55 research fellows now occupy positions of major responsibility in corporations over the globe.
Our unique doctoral program, which is based here on campus, and our 6 certificate programs, have helped to sculpt the field of population health. Indeed, we are tracking the emergence of more than a dozen new colleges of population health, and we are aiding those schools in an attempt to “raise all boats” and drive our field forward. In addition, our peer-reviewed journal, Population Health Management, and the third edition of our textbook Population Health: Creating a Culture of Wellness, which will be published in November 2019, are looked to across the country as the source of cutting-edge evidence in our field.
We are driving conversations around cost-effectiveness, patient communication, and what have come to be called “the social determinants of health.” Through our annual colloquium, forums, webinars, and our journal and textbook mentioned above, we embody what doctor Donald M. Berwick, MD, MPP, FRCP, called 10 years ago the “Triple Aim.”6 The triple aim strives to improve the health of the population, to reduce per-capita costs by reducing waste (principally by reducing medical error), and to improve the individual experience of care through better communication and patient engagement.6 We need to go upstream and shut off the faucet rather than repeatedly mop up the floor.
Like the ancient physician educator, Maimonides, we believe that our graduates will go forth and practice what the ancient Hebrews called “tikkun olam,” namely, to save (or repair) the world. In some respects, this entire commencement exercise is reflected in tikkun olam. We must rededicate ourselves to reducing pain and saving lives, as well as, more important, to lifting up the community, giving a young person hope, reducing disparities, making care safer, and renewing our commitment to a brighter tomorrow for our children and for their children.
In conclusion, speaking personally, as many persons on this stage know, this will be my last commencement address as Dean. After more than a decade at the helm, I have decided to voluntarily step aside. As noted earlier, good leaders train the leaders of tomorrow.
I intend to remain at Jefferson College as the Dr. Raymond C. and Doris N. Grandon Professor of Health Policy, and to continue the good fight by helping Jefferson Health to operationalize the triple aim we spoke of earlier, and to continue to mentor the next generation of leaders. To paraphrase the famous General of the Army Douglas McArthur in his farewell address before a joint session of Congress on April 19, 1951, old deans never die, they just rejoin the faculty and continue to make a difference.
It was certainly an emotional experience and thankfully I did not cry. That came later.
David B. Nash, MD, MBA, is Editor-in-Chief, American Health & Drug Benefits, and Founding Dean Emeritus, Jefferson College of Population Health, Philadelphia, PA.
- Kumar S, Nash DB. Demand Better! Revive Our Broken Healthcare System. Bozeman, MT: Second River Healthcare Press; 2011.
- Sidorov J, Romney M. The spectrum of care. In: Nash DB, Fabius RJ, Skoufalos A, et al. Population Health: Creating a Culture of Wellness. 2nd ed. Burlington, MA: Jones & Bartlett Learning; 2016:19-41.
- Narayan KMV, Patel SA, Cunningham SA, Curran J. Ominous reversal of health gains in the United States: time to rethink research priorities? Ann Intern Med. 2019;170:330-331.
- Kristof N. A new way to tackle gun deaths. New York Times. October 4, 2015:SR9.
- Zylke JW, Bauchner H. The unrelenting challenge of obesity. JAMA. 2016;315:2277-2278.
- Berwick DM, Nolan TW, Whittington J. The Triple Aim: care, health, and cost. Health Aff (Millwood). 2008;27:759-769.