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The five-year, $7 million award means that Gillings now serves as a hub for research, education and practice that creates healthy workplaces and accelerates the development of solutions for complex occupational safety and health problems.

“During the COVID-19 pandemic, we have witnessed the very nature of work — and the work environment — change drastically,” says Laura Linnan, ScD, principal investigator for the Carolina Center, professor of health behavior, and senior associate dean for academic and student affairs. “We believe the Carolina Center for Total Worker Health® and Well-Being is positioned to serve as a catalyst for conducting important research and translating results into practice and policy-based changes that support worker health in North Carolina, the southeast region of the United States and nationally in the years to come.”

"During the COVID-19 pandemic, we have witnessed the very nature of work — and the work environment — change drastically."

— Laura Linnan, ScD

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Key research projects underway at the Center are:

• Reducing falls and improving protection from falls for firefighters: Firefighters have one of the highest rates of slip, trip and fall (STF) injuries on the job, contributing to 20–25% of all firefighter injuries each year. Led by Eric Ryan, PhD, in UNC’s Department of Exercise Science and Sports, researchers will study 1,200 firefighters in the southeastern U.S. to identify STF events and risk factors, and determine the feasibility of a community-based participatory approach to develop STF mitigation strategies.
• Pandemic-related mental health and well-being of essential health care workers: Led by Marianne Baernholdt, PhD, MPH, RN, FAAN, at UNC’s School of Nursing and Samantha Meltzer-Brody MD, MPH, at the UNC School of Medicine, this study of nurses and physicians who work in varied inpatient clinical settings will identify interventions aiming to mitigate burnout, depression, moral distress and other mental health issues these workers typically face that have been exacerbated by the COVID-19 pandemic.

In addition to its primary research projects, the Carolina Center offers competitive pilot project funding to address emerging issues in the future of work and worker health, along with an outreach initiative that will provide a wide array of educational opportunities to support worker health and well-being.

The Center’s first round of pilot funding went to GracieLee Weaver, PhD, assistant professor of public health education at UNC-Greensboro, who plans to integrate a Total Worker Health® approach into an online opioid misuse prevention program she is developing for workers in industries with high risks for injury; and Becky Salmon, PhD, a postdoctoral fellow at the UNC School of Nursing, whose research on psychosocial safety as a component of Total Worker Health® will specifically focus on helping socioeconomically disadvantaged working mothers maintain employment and improve their well-being.

Complementing the Center’s research and outreach efforts is the School’s Total Worker Health® graduate certificate program, which trains students to collaborate across disciplines to protect and promote worker health and well-being. Students take a course on work as a social determinant of health; a course to learn about work-related measures/methods at the individual, organization, and population levels and how to engage with workers; and a course working directly with local businesses to plan, implement and evaluate comprehensive Total Worker Health® workplace interventions as part of an interdisciplinary team. As certified Total Worker Health® practitioners, graduates of the certificate program have the knowledge and skills to lead worker health, safety and well-being initiatives in a variety of settings.

“With an initial focus on essential workers, safety and mental health of workers, we are thrilled to be able to work with researchers and other potential partners at UNC, neighboring academic institutions, government officials, employers and workers as part of the research, outreach and education activities of this new Center,” Linnan says. “We hope to collaborate with others who are interested in helping shape the future of work and improving the well-being of workers.”

A $185 million five-year project funded by the National Institutes of Health, the Impact of Genomic Variation on Function (IGVF) Consortium includes 30 research sites across the country studying how DNA variants affect human health. Along with Hyejung Won, PhD, assistant professor of genetics, and Karen Mohlke, PhD, professor of genetics, Love is a principal co-investigator for UNC’s $9.25 million study, whose results may help identify new targets for drugs to treat common illnesses more effectively.

“The aim is to increase our knowledge and the predictive power of our models,” Love says of this intensely collaborative effort, which relies on the expertise of researchers across various disciplines. “It would not be possible to carry out this experiment without a large group of experts at UNC-Chapel Hill contributing their pieces. This experience in team science is incredibly valuable, with teams of geneticists, biologists, computer scientists, statisticians and others coming together to design experiments and interpret results.”

"The aim is to increase our knowledge and the predictive power of our models."

— Michael Love, PhD

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UNC’s team will select roughly 250,000 variants across the project’s five years, focusing on a different category of trait or disease each year and including variants from populations of diverse ancestries. Researchers will measure the variants’ functional effects and compare them across sex, tissue type (brain, heart, lungs, etc.) and other factors. These measurements will provide roughly 10 million data points that will be used to generate a comprehensive catalog to help researchers better understand how genomic variation impacts human health and disease, which in turn could accelerate biomedical research into more effective treatments.

“When you’re a biostatistician working with large amounts of data, practice doesn’t always mean getting out into a community,” says Lisa LaVange, PhD, biostatistics chair and professor. “But if you are analyzing data or running models to develop therapies that can improve diagnosis or treatment of disease and lead to better health outcomes, you can’t get more practical than that.”

Formally established at Gillings in 1999, NCIPH is a critical resource for public health practitioners in North Carolina. In addition to offering in-person and online courses, training sessions and conferences on a variety of topics to public health practitioners, NCIPH collaborates with local health departments through the N.C. Local Health Department Accreditation Program. N.C. was one of the first states to implement an accreditation program to assure and enhance the quality of local public health. NCIPH staff helps local health departments meet the required accreditation standards, assess the most urgent health needs in their communities and develop strategies to meet those needs.

“We work with community nonprofits and other partners, but state and local health departments are really our bread and butter,” says Amy Belflower Thomas, MHA, MSPH, director of community assessment and strategy at NCIPH and an adjunct professor in the Public Health Leadership Program. “We touch all 85 health departments regularly as part of the accreditation process, and, in the past few years, our emphasis has changed from quality improvement to strategic planning. We help local health partners strategize on how to meet their communities’ needs, and our mission is to help them increase their capacity to do that.”

"We help local health partners strategize on how to meet their communities’ needs, and our mission is to help them increase their capacity to do that."

— Amy Belflower Thomas, MHA, MSPH

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As the COVID-19 pandemic led to overwhelming demands on public health professionals, it also changed the way NCIPH did its work and interacted with its partners. For example, field surveys are a critical part of community health assessments, which are a requirement for accreditation. Typically, these surveys rely on field workers going door-to-door to reach the most households and collect the most robust and inclusive data. But due to concerns about the spread of the virus, data collection methods shifted to more remote, technology-based approaches that are not as readily available to all residents. Some counties tried a hybrid approach, sending a postcard to see if a resident was willing to engage and then following up with a call or porch visit. Others used socially distanced or virtual focus groups to ask for residents’ opinions.

“We focus on providing technical assistance and meeting our partners where they are, and the counties focus on engaging their community members,” Belflower Thomas says. “But we know we can’t truly improve equity without hearing everyone’s voices.”

That the pandemic brought more visibility to longstanding equity issues creates an opportunity to challenge the structural and systemic conditions that contributed to those disparities. “Public health has always known inequity, but COVID-19 was really able to bring that to light so everyone could see it,” Belflower Thomas says. “And because of that, our partners became more interested in rethinking how we do our work to better address those challenges.”

As part of the strategic planning effort on practice, Gillings leaders are discussing how to set the NCIPH on the right path forward to assure its continued relevance and effectiveness. The Institute’s interim director, Steve Cline, DDS, MPH, has served on the task force and conducted a more detailed assessment specific to NCIPH.

“Building this roadmap allows us to put our best foot forward to meet the needs that the new public health environment calls for,” says Cline, who talked to public health leaders in N.C. and nationwide, as well as current and former NCIPH staff and customers, as part of his assessment. “We all believe in the mission of providing service to the state by connecting practice to teaching and research and by connecting the School to communities across N.C. There is a lot of good practice being done at the Institute and at Gillings as a whole, and we need to find ways to elevate practice and make that work more visible.”

Helping School Staff Adapt to New Roles During Pandemic

As school leaders and staff across N.C. tried to adapt to rapidly changing roles and responsibilities and respond to a variety of needs that emerged during the pandemic, the state Department of Public Instruction turned to NCIPH for help.

“So many things were constantly changing during the pandemic, and it required our team to very nimble and responsive,” says Rachel Wilfert, MD, MPH, CPH, director of workforce training and education at NCIPH.

Critical areas where these training modules were most needed were understanding how to mitigate disease outbreaks, establishing best practices for virtual school nurse visits, development and leadership of school nursing teams, helping schools care for the emotional well-being of students and staff in the context of virtual learning, and working to raise awareness of critical inequities in oral health and supporting connections to care.

Lindsey Smith Taillie, PhD, Assistant Professor, Department of Nutrition

Chile’s law didn’t just address warning labels. Over a three-year period, it banned marketing directed at children, banned commercials for junk food and sugary drinks on television from 6 a.m. to 10 p.m., and banned sales of these products in schools.

“It went to a whole new level, changing the environment that kids are raised in with regard to food,” Taillie says. “Our evaluation showed that this policy works to reduce intake of products that have the labels.”

"It went to a whole new level, changing the environment that kids are raised in with regard to food."

— Lindsey Smith Taillie, PhD

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When a new president took office in Chile in 2018, Taillie supported Chilean colleagues in disseminating information about the law and its impact to officials in the new administration. “We were able to keep the law in place in Chile,” she says. Since then, “we have been working with people to use these results to inform policy in other countries.”

Taillie and colleagues worked with researchers and advocates in Colombia, which eventually passed a law similar to Chile’s. Similar laws have since been passed in Argentina, Peru, Uruguay, Mexico and Brazil. Real-world changes are what she dreamed of when pursuing a career in public health, she said.

“Being able to work this closely to design laws that affect the entire food supply, and every person in that country, is super cool,” she says. “We can go and see it in action. We can go to the supermarkets in these countries and see these labels.”

Emily Gower, PhD, Associate Professor, Department of Epidemiology

Trichiasis is commonly managed through surgery that cuts the eyelid and rotates the lashes back to their anatomically correct position. Those who perform these surgeries often have the equivalent of a high school education, plus one year of nursing training and one week of trichiasis surgery training.

“When I started working on this, individuals who did one week in the classroom were chosen and then immediately started doing live surgery,” she says. “That is stressful, and the outcomes are poor.”

"Now the standard of care is to practice on Phil before going out and doing any surgery. It has significantly improved the training process for surgeons, and now the World Health Organization (WHO) requires it.”

— Emily Gower, PhD, Associate Professor, Department of Epidemiology

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To help train surgeons, Gower created a silicone model of a human head that has a removable orbital (eye) cavity and disposable eyelid cartridges. The device, Head Start, is affectionately known as “Phil” by Gower and colleagues. “Now the standard of care is to practice on Phil before going out and doing any surgery,” she says. “It has significantly improved the training process for surgeons, and now the World Health Organization (WHO) requires it.”

When Gower began working on trichiasis, more than 8 million people worldwide — most of them women — needed the surgery, and the condition was endemic in more than 50 countries. Today, nine of those countries have been certified as free of trichiasis by the WHO.

“I can see the difference that it’s made in people’s lives,” she says. “And I’ve enjoyed being part of the process of getting there.”

Gower’s current focus is on faster screening for trichiasis. She and collaborators have loaded 30,000 images of eyelids before and after surgery into a machine-learning app that is trained to identify candidates for surgery. “We’ve developed an app that will allow someone to walk up to someone and take a picture of their eye, and then the app can tell whether or not that person has trichiasis and needs to be brought for surgery,” she says. Her hope is that it will improve the screening process for future procedures.

Sean Sylvia, PhD, Assistant Professor, Department of Health Policy and Management

In China, Sylvia’s projects cover a range of issues, from maternal and child health to early childhood education to adult primary care. One project has retrained workers from China’s Family Planning Commission — the former keepers of China’s one-child policy — to deliver content about young children’s social-emotional and cognitive skills during home visits. Another project is aimed at early childhood development within child care centers.

"There are so many things that we can learn from each other. There’s a long history of cooperation between the U.S. and China in medicine and health, especially here at UNC."

— Sean Sylvia, PhD

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“In all of these, we’re looking at impacts,” he says. “We design randomized trials and look at how it affects kids’ cognitive outcomes, their social-emotional outcomes, how parents engage with their kids differently, how it changes what we as economists call ‘parental investment’.”

In rural China, he and colleagues have trained “standardized patients” (similar to “mystery shoppers”) to develop a direct-to-consumer telehealth system for primary care. Before COVID-19, they examined 44 different platforms to see which platform characteristics correlated to better care outcomes. He has also worked on training programs for better patient communication in sexual health clinics.

It’s exciting to work in China, Sylvia says, because there is a sense there of having a more direct impact on policy. “They’re at a point where they’re just rich enough to start investing in their health system and are going through all these massive health reforms,” he says. “We’ve been able to provide some good evidence to guide policy makers.”

Sylvia says he is concerned about the current research decoupling between the U.S. and China. “It’s a huge detriment to public health research in general. There are so many things that we can learn from each other. There’s a long history of cooperation between the U.S. and China in medicine and health, especially here at UNC.”

Sheila Leatherman, CBE, Gillings Global Advisor

The initiative has funded four interns in the 2020–21 academic year and six in 2021–22 through generous donor support. These internships pair current students with faculty and experts in the School’s Research, Innovation and Global Solutions unit, giving students firsthand experience applying their public health training where it can be of maximum impact.

“We aspire to have impact on improving the health and well-being of the lives of those suffering from humanitarian crises

— Sheila Leatherman, CBE, Gillings Global Advisor

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Through this initiative, students have supported humanitarian organizations, increased understanding of maternal health issues and sought to improve access to effective health care in fragile settings.

“We aspire to have impact on improving the health and well-being of the lives of those suffering from humanitarian crises,” Leatherman says. “Future efforts will be built on current activities and assets but further developed to increase impact.”

To make a gift in support of the Humanitarian Health Initiative, please visit https://go.unc.edu/HumanitarianHealthInitiative

So, when the Carolina Center for Public Service issued a call for grant proposals in fall 2019, Katherine Gora Combs, then a first-year Master of Public Health (MPH) student and a research assistant for senior administrative leaders, worked with staff and faculty to pull together an application to fund a new disaster response training program at the School.

The grant application was successful. Through almost a year of collaboration across School departments and with community organizations, Gora Combs and the planning partners created a training curriculum leveraging the expertise of a variety of speakers with on-the-ground experience in disaster preparedness and response. Called Gillings on the Ground, the new program was slated for a spring 2020 kickoff — and then, the COVID-19 pandemic hit.

“COVID had a huge impact on our plans — we had to put the program on pause and spent the summer modifying everything and pivoting to an online program,” Gora Combs says. “But it actually worked out better that it was virtual — we were able to expand our pool of speakers and participating organizations to include people who were not just from Orange County. Also, the online flexibility allowed us to expand our reach to more students.”

Gillings on the Ground trained its first cohort in fall 2020 in an all-virtual format. In fall 2021, the program offered a six-week online “mini course” focusing on multiple aspects of disaster response and community engagement, with speakers ranging from county health directors to geospatial mapping analysts to church pastors sharing their experiences. Once completing their training, participants had the opportunity to engage in disaster-related service opportunities with community partners. MPH student Arielle Moss took over the lead role for the spring 2022 program, developing a partnership with the American Red Cross and UNC Wilmington to offer a more hands-on aspect of disaster response that culminated in a one-day emergency shelter simulation in Wilmington led by the Red Cross and New Hanover County Emergency Management. After finishing the course, participants will be able to use a streamlined application process to become Red Cross volunteers.

“When most people think of disaster management, they don’t really think about all the complexities involved."

— Aaron Carpenter

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“When most people think of disaster management, they don’t really think about all the complexities involved,” says Aaron Carpenter, a first-year MPH student in the Department of Health Policy and Management who signed up for both the Fall 2021 and Spring 2022 sessions. “It has been really great to hear from people who have been working in the field for decades about their experiences and get their input. They really encourage you to ask questions, and I have gained a lot of knowledge about the ins and outs of disaster preparedness and response.”

Throughout her years of working with state and local governments on disaster recovery, Amy Belflower Thomas, MHA, MSPH, director of community assessment and strategy at the North Carolina Institute for Public Health and an adjunct professor in the Public Health Leadership Program, found that mobilizing volunteers after a hurricane or flood was not always a smooth process.

“Volunteers often are not properly or fully trained even though they really want to help — or a lot of volunteers show up immediately after a disaster hits, even though much more support is actually needed during longer-term recovery efforts,” says Belflower Thomas, who worked closely with Gora Combs to develop Gillings on the Ground. “Having a program like this that can train people proactively means they will be fully prepared to help whenever the time comes.”

For Gora Combs, who is now a doctoral student in the Department of Epidemiology, Gillings on the Ground builds on the School’s longtime focus on service and practice — and is a way to raise awareness about the breadth of public health when it comes to disaster response since the program is open not just to students, but also to interested faculty, staff, alumni and community members.

“There are a lot of different disaster response training programs across the country, but they don’t focus on response along the lines of public health like ours does,” she says. “While the COVID-19 pandemic has opened people’s eyes to public health throughout the pandemic, public health actually touches every part of health and well-being, including hurricanes, floods and other types of disasters. This program serves as a great addition to the applied training opportunities that Gillings already offers — and it shows those who are not at Gillings how public health is involved in disaster response more broadly, not just in the pandemic.”

Once a week for more than 50 years, SHAC’s medical and dental clinics have provided services to patients who couldn’t otherwise afford care. Student leaders have established newer initiatives such as Mental Health, Gender Affirming Care, Bridge to Care and SHAC XYZ (a free STI testing program) to address emerging community needs. Through SHAC’s outreach programs, volunteers go into the community to provide blood pressure and blood sugar monitoring, lifestyle modification counseling and other services, while social needs navigators work with patients from a more holistic approach, providing support to address food insecurity, safe housing, financial assistance, mental health, transportation or insurance.

“I think the fact that it’s run by students lets us be a little more nimble than larger institutions or organizations,” says MD-PhD student Caleb Easterly, who is in his second year as chief community relations officer (CCRO) at SHAC and is studying health policy and management at Gillings. As part of his work to maintain and strengthen SHAC’s relationships with patients and the surrounding community, he’s creating a patient feedback form and a patient advisory board. “Part of how I see my role as CCRO is to fight to make sure that the care we offer at SHAC is as good, if not better, than what people might get elsewhere, and this requires constantly reflecting on how we’re doing and how we can do better.”

SHAC partners:

• School of Medicine
• School of Nursing
• School of Pharmacy
• School of Dentistry
• School of Public Health
• School of Social Work
• School of Business
• Division of Physical Therapy (Department of Allied Health Sciences)
• Division of Occupational Therapy (Department of Allied Health Sciences)
• Division of Speech and Language Pathology (Department of Allied Health Sciences)