In Conversation with Marilyn Winkleby, Ph.D., M.P.H.
Marilyn Winkleby, professor of medicine and faculty director of the Office of Community Health, is an epidemiologist committed to reducing health disparities in low-income and other medically underserved communities. She leads a research team that focuses on social determinants of health among low-income and ethnic minority populations, and conducts community-based interventions to address health disparities.
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At the Stanford School of Medicine, Dr. Marilyn Winkleby is known for two sustained endeavors that stand out in their creativity and contributions to innovative programs in science. The first is her scientific work on health disparities, which has made her an internationally known scientist (see Dr. Winkleby's profile). The second is the Stanford Medical Youth Science Program (SMYSP), a program for which she is the main visionary and faculty director. In her scientific work on health disparities, Dr. Winkleby has worked with low-income communities, often in response to health issues they identify as most important to their communities. Much of her work focuses on how one’s environment can influence health behaviors. She observes, “To improve health, we must understand how behavior is shaped by neighborhoods and how neighborhoods |
The following is an excerpt of a news report on one of her recent scientific articles about the health of Latinos in Salinas. (Access this article.)
In the middle of John Steinbeck country, the “salad bowl of America,” most of the Mexican farm workers who harvest the fruits and vegetables that feed the nation, aren’t eating enough of it themselves. Underpaid and overworked, Salinas farm workers are eating at fast food restaurants where the food is high-fat but low-cost. As a result, despite long hours working in the fields, the Latino farm workers, particularly single, young men living in the agricultural labor camps, are facing a very American problem: obesity.
“These young men often eat someplace that’s inexpensive and has fast food with a high fat content,” said Dr. Winkleby who has spent years visiting the Salinas Valley in an ongoing partnership with the Monterey County Health Department. “As their jobs become increasingly mechanized and less active, their take on the burden of obesity and diabetes.”
One of her recent surveys documented disturbing trends over time. In this study, Dr. Winkleby examined the changes in cancer-related health behaviors within the Salinas Latino population, most of whom are of Mexican origin, over the 10-year period between 1990 and 2000. The study surveyed almost 2,000 Latino women and men from both the community at large and within 29 agricultural labor camps. The goal was to examine changes in diet, physical activity, smoking, and alcohol use as well as cancer health screenings in order to help design future public health interventions. The study provides background data on Latinos as an initial step, showing that they are the country’s fastest growing minority group, and that they suffer disproportionately from poor health exacerbated by poverty, poor education, and a lack of health insurance and medical care. Furthermore, they suffer disproportionately from some types of cancer and are 20 percent more likely to die from a malignancy than non-Latino whites.
Among the positive behavior changes noted in the survey were continued low rates of smoking among both women and men and a substantial drop in alcohol consumption among men. But most striking among the results were the increasing obesity rates, particularly among men in the labor camps. Both men and women in the community sample had reached 60 percent rates of being overweight or obese by the year 2000; among men in the labor camps, there was a 90 percent increase in obesity. The majority of the Mexican-American population in Salinas has now been living in the U.S. for at least 10 years, long enough to have been exposed to the “high fat, low exercise American environment,” Dr. Winkleby observes.
There were some changes in diet that showed marked improvements: a shift away from the use of whole-fat to lower-fat milk among both labor camp men, and women from the community; and a decrease in the use of lard or meat fat for cooking among men and women within the community. However, fried food remained high on the menu.
The surveys showed significant increases in screenings for both breast and cervical cancer with a significant increase in the rates of pap screenings and mammograms. Mammography screening showed especially large gains, from 15 percent in 1990 to 53 percent in 2000. But researchers were concerned that annual blood stool testing for colon cancer remained infrequent and unchanged at 0 percent to 17 percent across the groups, about half as frequently as the non-Latino white population.
This research laid the foundation for a community-wide intervention in Salinas. For this intervention, Dr. Winkleby has partnered with the Monterey County Health Department to work with a diverse group of community health organizations to address the burden of obesity, diabetes, and asthma. She and the Health Department were awarded one of 12 five-year Centers for Disease Control “Steps to a Healthier U.S.” grants. The five-year program has resulted in extensive partnerships between the Health Department and the community. The Health Department has partnered with agricultural employers, fast food restaurants, faith-based organizations, schools senior centers, convenience stores, and even shopping malls, proposing changes that will encourage healthier behaviors such as asking taquerias and corner stores to offer low-fat milk and to increase their fruit and vegetable supplies. “For example, the Health Department negotiated with the main agricultural employers to provide healthy lunches and paid time off for workers to attend a Wellness Program,” Winkleby said. Senior centers have received healthier government foods from food banks that supply much of their menu.
Dr. Winkleby is also a mentor dedicated to increasing diversity in the science and health professions through her work with the Stanford Medical Youth Science Program (SMYSP). SMYSP is not a typical youth mentoring, pipeline-to-college program. It creates change in low-income students, excites them about science, links them with mentors, guides them to college, and then supports them for years to come. Each summer Dr. Winkleby and the SMYSP staff select 24 highly disadvantaged students from high schools in northern California from over 300 applicants. These 24 students live with 10 undergraduate students in a residential house at Stanford for the summer. All of their expenses are paid. The students attend lectures by faculty, learn anatomy from medical students, work side-by-side with physicians in the hospital, practice taking SAT tests, and become empowered about their own intellect and skills. These are high risk students—they have fled wars in foreign countries, been homeless, lived in labor camps, and have parents who are deceased, imprisoned, or suffer from substance abuse. Many have not excelled in school.
To date, 428 students have graduated from SMYSP. Dr. Winkleby has known them all, has continued to mentor many of them, and has written hundreds of letters of recommendation for them. Unlike most other biomedical pipeline programs, SMYSP has documented what happens to its participants. And what happens is amazing. All have graduated from high school and 99% have been admitted to college. Of age-eligible alumni, 81% earn a 4-year college degree. The majority major in biological or physical sciences (58%). Most impressively, 50% of four-year college graduates are attending or have completed medical or graduate school. Forty-four percent of all alumni are becoming or have become health professionals. An article chronicling these successes is published in Academic Medicine 2007;82(2)139-145.
Dr. Winkleby and the SMYSP staff continue to broaden the vision of SMYSP. There is now a school outreach program that partners with low-income high schools that serve Native American, African American, and Latino students. UC San Diego School of Medicine has replicated SMYSP, and other Schools of Medicine and Public Health are working with SMYSP staff to do the same. Hundreds of students use its web site that offers information about college admissions, and health and scientific careers. There is a powerful book Healing Journeys: Teaching Medicine, Nurturing Hope, written by Dr. Winkleby and Julia Steele, with a foreword by Dr. David Satcher. A 30-minute documentary film, Opportunity of a Lifetime, demonstrates the transformations that happen at SMYSP.
