Denise St. Jean is a PhD student in epidemiology at the University of North Carolina at Chapel Hill. She is part of the Health Policy Research Scholars Cohort 2018.
Before we begin, tell us a little bit about yourself and what your research interests are.
I was born and raised in Long Beach, California, with roots in the Caribbean. I completed my BS in ecology and evolutionary biology at Yale University, where I studied ecological factors contributing to the spread of tick-borne disease in the Northeastern United States. I worked for a bit in consulting in New York City prior to venturing down south to UNC Chapel Hill to pursue my PhD in epidemiology. Broadly, my research interests include global health (particularly in low- and middle- income countries); maternal and child health; and evaluating interventions, such as vaccines, for infectious disease.
What’s the story behind why you’re doing what you’re doing?
My parents immigrated to the United States from the Commonwealth of Dominica before I was born. As a first-generation American from a working-class family, I grew up keenly aware of the health inequities that existed at home in the United States, at home in Dominica, and between the two places. Witnessing these challenges in two distinct communities that I considered to be home ignited a curiosity surrounding global health disparities. This has motivated me to pursue research that is globally relevant and emphasizes the experiences of economically disadvantaged populations in particular.
Tell us about a project you are currently working on that you are excited about.
I am currently working on a project looking at factors influencing the completion of the recommended vaccine schedule for children under 5 in Zambia. This project will be a multilevel analysis of the individual, household, and provincial factors influencing vaccine completion. I’m excited about it because it’s a bit different than some of my other projects and allows me to apply analytical approaches that I am just now learning to a health issue that is important to me. There is no doubt that both personal and environmental factors influence health outcomes and health behaviors, such as vaccine completion; however, most analyses fail to take this into account. Thinking on multiple levels about what influences health enables more opportunities for collaboration and hopefully more innovative and effective interventions.
For people unfamiliar with your research area, what is one piece of information you think is important for them to know?
Many people consider infectious diseases to be a “developing country” problem, when that is simply not the case. As globalization spreads, boundaries of various kinds are being eroded and our world is more connected than ever. This is a phenomenon that influences the ecological and social conditions that promote the spread of many infectious diseases and makes them harder to control. An underpinning of the Gillings School of Global Public Health is that “Global is Local,” and I think that is an incredibly powerful thing to remember when thinking about why we should care about infectious disease research.
Who is a researcher you admire and why?
A researcher and faculty member at the Gillings School of Global Public Health who I admire is Dr. Daniel Westreich. Dr. Westreich is a professor in the methods sequence of the epidemiology PhD program and also advised me during my first graduate research assistantship at UNC. Despite being affiliated with the Infectious Diseases track, Dr. Westreich constantly pushes students to think critically about social determinants of health. He also insists that all epidemiologists, and not just social epidemiologists, should be thoughtful about social determinants in their research. I believe that sort of thinking has made me a better scientist, and I feel very fortunate to have had the opportunity to learn from him during the very early stages of my training.
How has being an HPRS Scholar helped you during your time as a doctoral candidate?
While doctoral programs are designed, first and foremost, to prepare students for academic research, I believe that the skills acquired during the PhD are widely applicable to a number of different settings. As someone who entered into my PhD program knowing that I would pursue a non-academic career upon graduation, the HPRS program has helped expose me to leaders outside of the traditional academic setting who are able to impact health in a significant way.
I also feel that being an HPRS Scholar has helped me to think “beyond the bench” to the bigger picture of academic research. For me, the end goal is not just to find problems, but to build solutions. Through a comprehensive curriculum ranging from economic theory to health impact assessments, the HPRS program has equipped me with the building blocks with which to frame and evaluate viable solutions to the health challenges that matter to me.
In the HPRS program, we have worked with you to help you think further about using your research to develop policy. If you could use your research to change any policy, what policy would it be?
If I could use my research to change any policy, it would be on the topic of vaccine coverage for adults. There is a federally funded Vaccine for Children (VFC) program that provides vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) to children who may otherwise skip required immunizations due to an inability to pay (i.e., the uninsured, underinsured, and Medicaid-eligible). VFC is a required component for each state’s Medicaid plan. By eliminating cost as a barrier, the VFC program encouraged improved vaccination coverage among eligible children and also significantly closed the vaccination gap between non-Hispanic white children and children of other racial groups.
However, vaccine coverage for adults enrolled in Medicaid varies significantly as individual states determine policy surrounding which vaccines to cover, co-payments, provider reimbursement, and settings where vaccines may be administered. In an ideal world, I would change the federal coverage for Medicaid such that all immunizations recommended by ACIP were considered mandatory under federal law. Vaccines for Americans (VFA) has a much nicer ring to it, don’t you think?
OK, here’s a fun question to wrap things up. If you could visit any place in the world, where would you choose to go and why?
Right now, I would say Peru. I have yet to travel to any country in South America and have heard incredible things from friends who have traveled to Peru about the culture, architecture, nightlife, and, of course, the food. I would also get a chance to flex my (incredibly unimpressive) Spanish language skills. If I could tackle Lima, the Inca Trail to Machu Picchu, and the Amazon rainforest all in one trip, that would be ideal!
