In celebration of National Public Health Week

“The American Public Health Association was formed in 1872, when scientific advances were starting to reveal the causes of contagious diseases. For over 150 years, the APHA has championed “optimal, equitable health and well-being for all,” and in 1995, President Bill Clinton signed an executive order declaring that the first full week of April each year would be National Public Health Week – a celebration organized annually by the APHA. In 2026, National Public Health Week will be celebrated April 6 through 12. This year’s theme is “Ready. Set. Action!” The APHA is asking people to “look back at the progress we’ve made” and “look forward to the steps needed for an even healthier future.” We’ll request the same of Bernadette Boden-Albala in this episode of The UC Irvine Podcast. In a wide-ranging conversation, the founding dean of the Joe C. Wen School of Population & Public Health reflects on the transformations she’s witnessed since arriving at UC Irvine in 2019 and what it will take for health and well-being to thrive. She shares insights from her latest research on stroke and cardiovascular disease, the role of social networks in disease prevention, and how community partnerships – paired with stronger advocacy for science and investment in women’s health – can improve health outcomes for everyone. “Rising Sun,” the music for this episode, was provided by DivKid via the audio library in YouTube Studio. To get the latest episodes of The UC Irvine Podcast delivered automatically, subscribe at Apple Podcasts or Spotify . TRANSCRIPT Cara Capuano/The UC Irvine Podcast From the University of California, Irvine, I’m Cara Capuano. Thank you for listening to The UC Irvine Podcast. Our guest today is Bernadette Boden-Albala, Founding Dean of the Joe C. Wen School of Population and Public Health. She’s a professor in the Department of Health, Society and Behavior, and also in the Department of Neurology in the School of Medicine. And she’s an internationally recognized expert in the social epidemiology of stroke and cardiovascular disease. Dean Boden-Albala, thank you for joining us today. Bernadette Boden-Albala: It’s really a pleasure to be here. Thanks. Capuano: This certainly isn’t your first appearance on The UC Irvine Podcast, but your past visits were all related to topics focused on the COVID-19 pandemic. Now, while that feels both like yesterday and about a decade ago to many of us (Boden-Albala laughs), let’s focus on the here and now… Boden-Albala: Okay. Capuano: … and on you. Boden-Albala: Alright, great. Capuano: I’d like to start with your research. What questions are you and your team examining right now? Boden-Albala: Oh, that’s a great question. So, we are really looking at how to reduce cardiovascular disease and stroke in populations. And we’re really trying to come up with strategies that take the burden away from the healthcare system and really try to optimize settings in the community that can decrease things like hypertension or diabetes or obesity. And so, we’ve got a great program that’s really focused on the family. Because, in life, we’re either preventing something from happening for the first time – or we’re preventing something from happening for the second or third time. And you know, it’s interesting because nobody ever talks about combining primary and secondary prevention together. So, my focus is really thinking about strategies to do that. One of the things in, you know, doing the work that I’ve been doing for the last, probably two decades now – again, around cardiovascular disease prevention, around stroke prevention, secondary stroke prevention – is really trying to understand what are differences within the population: why people are successful and others are not successful in reducing their risk. And one of the things that we looked at early was this whole notion of family. What’s the role of family social networks? How do they play into cardiovascular disease and stroke? And there’s a reasonable amount of literature that says social networks like family – family and friends – can be both positive – really help you – or deleterious. So, in other words, not protecting you. So, if everybody in your network smoked, you would be more likely to smoke. But what we haven’t really done is taken that very interesting information and we haven’t applied it to interventions. And so, the kind of work that I’ve been doing – I would say in the last 10 years – is really trying to move forward and say, “How do we create interventions where we get social networks like family – and family and friends – together? How do we get them to work together to think about what their risk of cardiovascular disease and stroke is, and then work together to reduce that risk?” Capuano: In 2021, you helped to launch the program “Serve OC.” Now that stands for Skills-based Educational Strategies to Reduce Vascular Events in Orange County. How would you describe what Serve OC is doing? It sounds like you just did. Boden-Albala: (Laughs) A little bit. So, just one other thing: thinking about how we get our health, right? Or healthcare, I should say: how we go to the physician, how we get prescriptions and how do we take care of ourselves. So, we live with networks of people. We live as part of families. We live as part of faculty at UCI or staff at UCI. We live in groups in our networks. And yet when we go to see the doctor when we are sick – or the health provider – we usually go as individuals. And so, the one sort of pivotal moment that we should have the people who care about us, who support us, together with us, we don’t have them. And so, what we started to think about – and what Serve OC is all about – is this concept: can we do primary and secondary prevention together? Can we shift the paradigm in healthcare so we’re not just thinking about the individual patient, but we’re thinking about the individual and their network. So let me just give you an example. I talked about smoking before. I go to my primary care. My primary care says to me, “Oh, your cholesterol’s high. You need to shift your diet. If you don’t shift your diet, I’m going to put you on medication.” But I’m not the one that cooks in my family. So, I can say to my primary care, “Okay, you’re absolutely right. I don’t want my cholesterol to be high. I don’t want to have a heart attack. I don’t want to have a stroke, and I don’t want to take medication, and I’m going to try very hard to shift my diet.” And then I come home. And there’s a big lasagna in front of me because the cook of the house has made that… plus the dessert, plus the bread. The point is that my whole healthcare is removed from the way I live my life. And so, Serve OC was kind of the culmination of evidence that we had built up that said, “People do better in families that support them do better.” Meaning they’re likely to reduce their hypertension, less likely to have a secondary stroke. So, Serve OC is: Why can’t we get out in the community, especially communities that don’t have a lot of access to healthcare or to good healthcare systems. So, we decided to work in Anaheim and Santa Ana and Garden Grove and Fountain Valley and to bring entire families together – kids from five years of age and up – and oftentimes these are multi-generational households – and risk assess everyone. And we use something called “Life’s Essential 8” – it’s an American Heart Association survey instrument and it gives us a good sense about ideal health; how ideal your health is. And it’s about blood pressure and cholesterol, but it’s also about diet. It’s about sleep, which is critically important. It’s about lifestyle, like exercise, to really get this sense and then have families identify some key things that they can do together. And then working with community health workers who are able to liaise between the healthcare system and the community – work as families to really increasing ideal heart health, which, of course, is increasing ideal health. And so, we have this randomized trial out there. We have all of these families that we’ve enrolled – close to 300 families. Everybody gets risk assessed. So, everybody knows from five years up and older, what their blood pressure is, what all of the variables that I just talked about are. And then half the group is going to work with a community health worker and really work together. That’s the goal: can we work together in our social networks to benefit the health for all of us in the family? And the other group – randomized not to that intervention but randomized to usual care – gets highly accessible pamphlets and information. And then everybody comes back at one year, two years and three years. And so that’s what Serve OC is. And we hypothesize – we believe – that if we can get families to work together and to really change habits together, that we are going to do primary and secondary prevention and increase ideal heart health. Capuano: Fantastic. Boden-Albala : Thank you. Capuano: What outcomes are you seeing so far or is it still too early? Boden-Albala: Oh, we’re seeing a lot of very interesting outcomes. So, we will be stopping the study in the next few weeks, probably in the next eight weeks. And we’re really excited to see if there are statistically significant differences. And again, our primary outcome is: “Did we increase heart health specifically in the families who were part of the intervention compared to the families who just received usual care?” But along the line – because we’ve been with these families for three years – what we are seeing is real excitement about cooking healthy. And so, things like we brought in local community chefs to work with families, multi-generations working together in kitchens in our community –like the Federally Qualified Health Center in Santa Ana has a cooking kitchen, it’s the Samueli kitchen. And the families for the first time are really cooking together, everybody. So, we’re seeing a lot of joy around working together around heart health. We’re seeing people really trying to understand high blood pressure and how important it is to reduce it. We’re seeing youth looking up information for their grandparents or their parents. And then we’re also seeing unexpected outcomes, like fathers playing with their sons, or grandpas playing with their grandchildren. And they’ve said to us, “Wow, had you not talked about how important it is to do things together, we wouldn’t have really gone out and done those things.” So, we will see very soon what the real outcomes are going to be. Capuano: Oh, we definitely look forward to those results. Like Serve OC, there are multiple programs initiated by teams in the Joe C. Wen School of Population and Public Health that involve work in the community surrounding UC Irvine. How does research integrating our local population translate into broader knowledge in the field? Boden-Albala: So, I think I want to say a couple of things here. One, I’ve been at a lot of schools of public health now, and I love them all – mostly back on the East coast and now here – but I want to say, I wanna shout out to my faculty, because I can, that this is the best group of faculty researchers in terms of community engagement. And community engagement is really the only way we move health forward. So, whether it’s working on reducing lead exposure or working on climate or working like we’re doing out in the community with Serve OC, a couple of things: we’re working with community first on designing and planning our grants. We don’t just come in and say, “This is what we want to do.” It’s all about working with the community and hearing what the community feels the problems are and then meeting them in an equitable manner and planning and working on these interventions together. And that has huge ramifications. I mean, it’s going to – and it continues to demonstrate – that the only way that we really improve health – in California, in Orange County, across the nation and globally – is to work in partnership with communities. And so, everything we do and design without community input is really at risk of not having that uptake or utilization. And that’s wasted money. And so, we talk about family, we talk about community – the work we’re doing is really in full partnership. The science of doing good work in improving health is about working in partnership with communities. Capuano: You’ve seen a fair share of changes since your arrival in 2019. That includes heralding the transition from being a program in public health to the fourth school of public health in the UC system and the first in Orange County. What transformations stand out the most for you during your tenure as the founding dean? Boden-Albala: It’s been a wild ride in terms of transformations. Coming here in 2019, right before COVID. Starting a school at the same time that we were working really closely with Orange County Healthcare Agency and the communities of Orange County, as well as the community here at the University of California, to try and stop the transmission of COVID, and to build this school. So, transformations. We’ve grown from one department to four departments. We have tripled our faculty. We have 1500 undergraduates in public health – so public health policy and population science. When I started here, there were very few Masters of Public Health students, and that’s our professional degree. So, this transformation from 15 or so students to close to 200 at the MPH level, and then a fabulous doctoral student cohort – over a hundred. So, there’s been a huge transformation, obviously, as a school. We talked about partnerships with the community – working with grassroots organizations and larger organizations in the community – and really thinking about health. And I think communicating who we are – UC Irvine as a university – out through Joe C. Wen School of Population and Public Health, and really, you know, putting ourselves out there as being a place of knowledge and information around public health and public health problems. All of those I think are very transformational. We are doing this podcast in building that is new – thanks to Susan and Henry Samueli, thanks to the Irvine Health Foundation for some of their great support of our work. In every way, I think there’s been huge transformation for Joe C. Wen School of Population and Public health, and really for our Orange County community. Capuano: Let’s open up the lens now to include more of what’s going on nationally in public health. What are the top challenges in the field right now? Boden-Albala: Oh (sighs)… yeah. It’s a very interesting time and I think there are a lot of challenges for public health. I think the biggest challenge is not just for public health, but for science in general. There seems to be a lot of disinformation, misinformation about science. Science isn’t something we just think about in our head and where there’s nothing to test and there’s no evidence. And it’s just because, “Oh, because I feel like this, I think, you know, that the earth is flat, right?” I mean, science is built on principles and methodology that generate data that gives us evidence to take the next step. It’s unclear to me exactly how we failed – all of us as public health scientists and the scientific community at large – how we stopped communicating with the population at large, and how somehow, we created this terrible gap between what the evidence is and how people think about science. And so, I think one of the things that we learned – that we really are clinging to and that we really want to make sure we move forward – is that at the heart, not only is generation of evidence critically important, but it’s the translation of that information out to communities so communities understand, people understand, why this is important and how it will benefit people and change their lives. Under that kind of misinformation, we’ve got a lot of issues related to vaccines. We’ve got issues related to sort of the generation of science, which may be very upstream, and people might not understand how that’s related to their health. But clearly, we need to take people through that path so that they understand that. Climate change and its effects on individuals is another area. And again, I think a lot of that is around misinformation and around mistrust of science. You know, we’re challenged by people making – sort of picking and choosing – what they want to believe. And the thing about science is you need to believe the evidence. And the evidence is large – that’s a good thing. We are in such a better place than we were 50 years ago, a hundred years ago, 200 years ago. But in some ways, people want to take us back. And so, the challenge is to communicate well and often and clearly with everyone. And what we’re trying to do here at Joe C. Wen School of Population and Public Health is to teach our students how to do that better – whether it’s in written form, whether it is in oral form, whether it’s through policy. You know, when I started here and COVID was really the first big public health challenge around science, we would take our students and we’d say, “Okay, we need you to defend climate change at the dining room table for Thanksgiving.” Right? Because you’ve always got someone in the family who doesn’t believe this or doesn’t believe that. And I think that’s what we have to do, and we have to be prepared, and we have to be happy about doing it because we are going to have to do it really for the rest of our lives. So, I think those are big challenges. And I think then stemming from that, we have had a restructuring of the major funders around science – the NIH, which is the National Institutes of Health, the Department of Defense. All of us in science throughout the country have received a lot of money and really made huge positive movement around science and around data generation and that money has shrunk quite a bit. So that remains, I think, another real challenge. Not so much for California. And I have to say, I’ve never been so happy to live in the state of California as I am now – the last bastion of public health and public health training. And so, we need to keep people optimistic because public health is critical to health and well-being for all communities. Capuano: It’s a crucial mission. To get the messaging out there… Boden-Albala: Yes. Capuano: And to get it right. Boden-Albala: Yes. Capuano: March is Women’s History Month – feels like an apropos opportunity to shine a spotlight on women’s health, something I know that you’ve taken the efforts to do throughout your career. Women make up half of the United States population. Why does that not translate into more knowledge around women’s health? Boden-Albala: (Laughs) That’s a great question, and I have to tell you a story. So, right when I think I got here – or maybe six, seven years ago – I was asked to give a talk at a major stroke meeting around women and stroke. And so, I said, “Okay.” You know, I had been doing less around women than I’m doing now, but I said, “Okay, let me go. Let me prepare this lecture.” And I had published somewhat on differences between men and women in terms of stroke. And you know, there’s all these misnomers. People think men are more likely to get stroke than women, that stroke is more severe in men than women. And a lot of that is actually not true. Women are more likely to have stroke, for example, later in life – after they’ve taken care of their husbands. And then when no one’s there to take care of them, they end up pretty disabled and often go into nursing homes. And so, I knew that – that was a lot of the work that I had done – but really to do this deep dive into what we knew around women and stroke, and I have to say, I was shocked by how little we knew. And when I pieced it all together, I realized 1. that – to your question – why is it that we don’t have this information? And then second, from the information that we did have, stroke was a very different disease in women than men. And over the last five years, there’s been a lot of women, a lot of discussion around menopause, a lot of discussion around women’s health as not just around reproductive issues and reproductive rights, but around the life course of women in women’s health. And we know if you’re looking at work around longevity, around health span, that to live a long, healthy and joyous life, right? So, life span, health span, joy span – focused on women now, but same for men on this one – you need to land at 70 in good shape. And what we knew about landing at 70 in good health, we knew basically from a very famous study – the Framingham study, which really was pivotal cardiovascular study, which was originally in white men. And so, what we knew about women… we gained knowledge for women from a study from men. Guess what? We are not the same. Alright? We are not the same. Our biology is different. And why would we expect then to experience disease the same way? I think to your question: why was it that we only knew about women from white men? From men, at least, and the initial cohort was basically white. I think there was caution – that people did not want to enroll women in studies because there was a high likelihood that they could get pregnant. This was the discussion. And then I think there was even an acknowledgement: “Well, but maybe women could be different, and then how are we going to interpret those results?” It’s just cleaner to just have studies – and I’m talking about studies for medication – which just were men. And so there was not until really the late eighties, early nineties – there wasn’t even a policy at the National Institutes of Health and at the Food and Drug Administration that says, “If we’re going to do a trial, if we’re going to test a drug for whether it’s heart disease or sleep or whatever it is, that we need to make sure that women are part of that as well – that they are participants in that trial.” And thinking about enrolling women – there are different challenges than enrolling men. And so, I think there was just this Catch-22, which led to this huge gap, even around treatment differences between women and men. And so, let give you an example: Ambien, which is a sleep aid. It was only after the drug was approved and in that post-approval surveillance that they found that women were much more likely to experience hallucinogenic effects with taking Ambien than men. But we didn’t look at women during the trial and, I believe, there wasn’t adequate representation of women to be even to be able to do that analysis. So, we didn’t have women in the studies, so we didn’t really have any knowledge about if there were differences or not by medication. And nobody really asked. There were a few people, but it wasn’t common to just do a study in women. And it was all about just getting the numbers of people in studies, not whether or not you had equal distribution by sex. Capuano: What needs to change? Boden-Albala: First of all – and I think that over the last five or six years, there’s been huge effort – as you said, more than half of the people in this country are women. And finally, we’re getting together and we’re saying, “Hey, we need fair treatment. We need to know what goes on in our bodies because we want health and well-being.” And so, we need funding at every level – from basic science funding all the way through to policy funding around women’s health. And to look at, again, health through the whole trajectory. If you’ve had diabetes or even blood pressure problems in your pregnancy, we now know there’s evidence that you’re much more likely then to have heart disease and/or stroke later on. But nobody talks about the time between pregnancy and the post-menopause time – maybe we could be doing preventive work. So, we need more money and more focus on women and women’s health. And we can’t be afraid as women to talk about our issues. To really say, “This environment is not good because I’m in menopause” – where we spend at least a quarter of our lives as women, peri- post- or during menopause. And so, we really need to push this effort out there that we need to have women’s health centers, we need to be doing work that is specifically around women’s health. And I just want to say that women’s health benefits everybody. Healthy women means healthy society. It means stronger families. It means good health for men. We only win when we invest in women’s health. Capuano: Are we moving in that direction? Boden-Albala: We are slowly, slowly. I’m anxious to see… you know the Women’s Health Initiative – a huge and important study around women’s health that’s been going on for decades – was stopped earlier this year. It has been, because of advocacy, restarted, although in the stop/restart, which people don’t understand, you lose women, you lose records. We can’t afford to lose one of the most important studies that really follows women throughout their life trajectory. I’m anxious to see what the new funding model at the NIH and other government funding agencies looks like for women in the next year or two. But I can guarantee you as good as it is, and hopefully it’s not bad, but either way, we will be advocating for more research and then the translation of that research out into communities to improve women’s health. Capuano: We look forward to seeing you continue that work. What haven’t we discussed today that you wanted to share in this conversation? Boden-Albala: Wow. Well, I think we touched on a little bit, but I think it’s a really important point that I’d just like to go back to – and that is that public health really is foundational to the health and well-being of everyone. Public health starts at birth, and it goes all the way through until death. Public health is about communities. It’s about the quality of well-being that people have, whether they are disease-free or whether they have disease – all the way through to sort of quality death and dying. Health is not just about when you enter a hospital or a physician’s office. Health practitioners and hospitals are critically important but they’re treating something that’s already happened. Public health is about preventing those very things from ever happening. If our mindset is longer life, if our mindset is longevity, joy span, health span, then our mindset has to start with prevention. And prevention is healthy behaviors, healthy communities, healthy temperature, healthy weather. It is also vaccinations. We worked really hard for a really long time to generate evidence so we could prevent people from dying prematurely, from devastating diseases – devastating bacteria and viruses like smallpox, like polio – and we never want to go back there again. So, prevention remains really important and it’s the only way to longer, healthier, and more joyous lives. Capuano: My Dad always says, “An ounce of prevention is worth a pound of cure.” Boden-Albala: That’s right. Congress needs to listen to your father! (Laughs) Capuano: Hopefully they will. Thank you so much for joining us today, Dean Boden-Albala. I’ve really enjoyed our conversation. Boden-Albala: I really enjoyed it. It’s been terrific. Thank you for having me. Capuano: I’m Cara Capuano. Thank you for listening to our conversation. For the latest UC Irvine News, please visit news.uci.edu. The UC Irvine Podcast is a production of Strategic Communications and Public Affairs at the University of California, Irvine. Please subscribe wherever you listen to podcasts.

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