• reducing cardiovascular disease in Michigan
• providing information on Alzheimer's disease to anyone, anywhere in the state who needs it
• targeting preventive health programs to the places where they are needed

These are just a few of Michigan's health care goals. Delivering ambitious efforts like these, however, is beyond the capacity of any one group or organization.

"I really think that the name of the game today is partnership" says Jeff Taylor, who heads an organization that is trying to improve health in Michigan through research, conferences of experts, statewide information networks, and new education programs. Taylor is the executive director of the Michigan Public Health Institute (MPHI), a consortium of researchers from Michigan universities, government agencies, and other organizations that address health issues. Taylor explains that partnerships are attractive to potential funders of such programs because the combined groups can bring together more experts than any one partner can offer, making a "more complete" research team.

MPHI oversees about $6 million in grants annually, and carries out nearly 70 projects each year from offices in Detroit and Ann Arbor as well as its Okemos headquarters

At the University of Michigan, an MPHI partner, many health researchers have been involved in MPHI projects, says Taylor. This includes faculty members, graduate students, and research scientists from the School of Public Health, School of Social Work, Medical School, and Institute for Social Research.

Other research partners include Michigan State University (MSU), Wayne State University (WSU), and the Michigan Department of Community Health (formerly the Michigan Public Health Department). Many private and non-profit health organizations, such as the American Cancer Society and Vector Research, Inc. of Ann Arbor also collaborate on MPHI projects.

The "clout" of MPHI's assemblage of researchers is shown by its "Master Contract for Research Centers." This contract qualifies MPHI to bid on high-priority health care studies, a status awarded to only a few research consortiums nationwide.

To earn the Master Contract, MPHI recruited hundreds of researchers covering vast areas of expertise like health economics, health policy and financing, managed care, and biostatistics. William Weissert, UM professor of health management and policy and the Master Contract project director for MPHI, says he had unsuccessfully tried to secure this status for the UM several years ago. But through MPHI, Weissert organized researchers from Michigan universities and five private research organizations. With the Master Contract in hand, MPHI won its first federal contract, the Medicaid State Profile Project, and a second contract, Longterm Care, beating out nationally known competitors like the Rand Corporation and the Urban Institute.

Their work resulted in a computerized system that keeps track of how each state spends its Medicaid dollars. Currently, each state can choose what percent of the poor they cover with Medicaid, what services to cover, and how much to pay for these services. The ability to easily compare different Medicaid programs will help federal policy makers see how each state will be affected by policy changes.

Besides mustering the partners needed for these projects, MPHI overcomes some less obvious and much trickier obstacles to collaborative research. The Institute reduces the time and headaches involved in negotiating a complex relationship between collaborators. Collaboration procedures, from proposal writing to budgets to communication, have already been established by MPHI, so teams can prepare proposals quickly, and researchers can get on with their research.

In addition, MPHI creates a neutral zone for collaboration where all participants are equal partners. "This can enhance the chances for true mutual collaboration, and can minimize frustrations, jealousies, and unproductive competitiveness," says Toby Citrin, UM professor of public health and founding member of MPHI's initial Board.

MPHI collaboration allows many university researchers the satisfaction of putting their theories into practice. "It's difficult for faculty members to be part of this kind of applied research - the kind of work that may not result in publications for peer-review," says Susan Morrel-Samuels, of the department of Health Policy and Management in the UM School of Public Health. "Through MPHI collaborations, faculty can get involved without jeopardizing their own research agendas."

Fit Kids/ Fit Parents?

Perhaps the way to better adult cardiovascular health in Michigan is through children. Charles Kuntzleman, a researcher in the UM division of kinesiology, is heading MPHI's Cardiovascular Disease Pediatric Antecedents Project.

Kuntzleman had already been studying the health of Michigan children. Through MPHI Kuntzleman linked up with the Michigan Community Health Department to expand his research. The Pediatric Antecedents Project aims to reduce cardiovascular disease in families by identifying children at risk of developing cardiovascular disease or by helping families maintain low risk behavior.

For the study, cardiovascular health data, including height, weight, and physical activity levels, were collected from parents of children already involved in Kuntzleman's research. One goal is to determine if there is a relationship between child and parent risk. For example, does high blood pressure in a child indicate a parent with heart disease? If so, community health organizations will be able to identify families who are at risk for heart disease.

A second group of children will participate in an educational component. Students will take home "Skill-A-Week" activities that include health strategies to discuss and implement with their parents.

Kuntzleman wants to determine if the health behavior of a parent can be improved by first educating the child, who then takes the knowledge home. "Adults didn't have good physical education programs because of poor physical education and health requirements in school," says Kuntzleman.

After the 9-12 week period, the parents' cardiovascular fitness will be measured again. If take-home lessons successfully improve adult cardiovascular health, then the state health department could use this strategy throughout Michigan.

Community Health Profiles

How do you anticipate local or regional health problems? How do you direct health programs where they are needed? It requires a wealth of data on the health of individuals, on environmental factors, and on health systems already in place. Every county in Michigan now has that information thanks to the Community Health Profiles Project (CHPP), which tapped collaborators throughout the state to develop health status profiles for every county in the state.

Included in these published profiles are demographic, social, and economic indicators; and health status indicators, such as maternal and infant health, mortality and risk behaviors. Also provided is information about health systems - their capacity, supply, access and use. The profiles enable communities to conduct assessments of their local health conditions.

"The subject areas of these profiles are so broad, so all-encompassing, it requires a response from a wide variety of individuals and a wide variety of data," says Susan Morrel-Samuels, a UM School of Public Health researcher, and a collaborator on CHPP. "It definitely was a project of a scale that required collaboration."

UM professor of environmental and industrial health Bruce Chin is the primary author of the project's environmental health component. This section includes measures of the quality of a community's air, water, shelter, workplace, food, and waste. County-specific environmental data can used to determine how environmental factors affect a community's health.

Currently CHPP results are being used by community health departments, hospitals, and other health organizations for assessing their community's needs, setting priorities, and for developing and evaluating programs.

According to Toby Citrin, UM professor of public health and former MPHI board member, this information is in high demand as the country's health care system places an increasing emphasis on prevention. "This project has significantly strengthened the entire public health infrastructure of the state," says Citrin.

Dementia Information

As our population ages, more and more families confront the difficulties of caring for a parent or spouse with a dementing illness. Often the dementia results from Alzheimer's disease. Huntington's disease, Parkinson's disease, and multiple strokes also cause dementias. People with severe cognitive decline need medical assistance for diagnosis and treatment, respite care, and management of day-to-day living. Family members want to know what to expect and how to care for their loved ones and whether caregiving assistance is available. Also they wish to know whether they or their children will be afflicted with the disease.

The Michigan Dementia Program was established in 1986 to aid the state in responding to the needs of individuals and families affected by dementia. The program's partners are the University of Michigan, Michigan State University, Wayne State University, the Michigan chapters of the Alzheimer's Association, Michigan Parkinson's Foundation, the Michigan chapters of the Huntington's Disease Society, and the Michigan Department of Community Health.

The Program's referral information centers throughout the state provide resource libraries, contacts for appropriate professionals, and access to community and public health services.

The Michigan Dementia Program also works closely with pathology departments at the University of Michigan and Michigan State University, and has a statewide network of pathologists who have established uniform procedures for postmortem examination of brain tissue of people thought to have Alzheimer's disease.

UM neurology professor Sid Gilman, who directs an Alzheimer's disease program at the funded by the National Institutes of Health, was key in organizing the MPHI project and getting it funded. Gilman points out that statewide support is what makes the program successful.