Social Determinants, Health Policy, and the Public Health Classroom: A Discussion with Katie Pincura

Dean Stuart Shapiro and the EJB Talks podcast have returned for season 13 with associate teaching professor Katie Pincura. Katie’s path into public health began as a counselor in Vancouver, Canada, where she first witnessed how the social determinants of health such as housing, poverty, and access to care shape health outcomes. Her later work in Georgia, helping transition people with intellectual and developmental disabilities into community settings, gave her a clearer view of how public insurance and state policy impact vulnerable populations. Connecting her own experiences navigating health systems in Canada and the U.S. with her work fueled her interest in health policy and ultimately led her to pursue an MPH and DrPH. Since arriving at Rutgers’ Bloustein School last year, Katie has sought to integrate her students’ lived experiences into public health policy by encouraging them to critically examine the trade-offs between individual freedoms and collective well-being. She notes that the diversity and resources available at Rutgers, combined with student passion, helps her guide students to graduate with both a strong understanding of public health systems and practical skills needed for impactful careers.

Transcript

Stuart Shapiro

Welcome back to EJB Talks. I hope you have had a wonderful summer. I’m Stuart Shapiro, the Dean of the Bloustein School. And to remind you, for those of you that took the summer off from listening to episodes, the purpose of this podcast is to highlight the work that my colleagues and our alumni in the fields of policy, planning, and health are doing to make the world a better place.

To start season 13 of EJB Talks, we’re speaking with associate teaching professor and the person who runs our undergraduate public health program, Professor Katie Pincura. Welcome to the podcast, Katie!

Katie Pincura

Hi Stuart, thanks for having me.

Stuart Shapiro

Absolutely. So, I am wedded to tradition, and longtime listeners know that we almost always start with an origin question. What got you into public health?

Katie Pincura

So, it was kind of a winding road. I started off after undergraduate training to be a therapist. And I was working on a Master’s degree in Counseling in Vancouver, Canada. And so, yeah, that’s how I started. I wanted to be a counselor And during that training I worked. I did an internship. I did a community internship and a clinical internship. And my community internship was in the Downtown Eastside neighborhood of Vancouver, which is sort of a notorious area for a lot of, like, kind of…It’s like, basically, or it was at the time, like an open air drug market. And it’s where many of the homeless individuals in the city are concentrated. And there are many shelters there. And I worked in one that served that population.

So, at the same time or, subsequent to that during my training, I started taking clients at a clinic and learning to be a therapist. So I saw people from all walks of life as clients. And then I worked with people who were homeless and living with substance use disorder at the shelter. And during that, you saw a lot about how—what I would later come to know what are termed, the social determinants of health—impact health. And that was sort of where my eyes were opened to that. And I sort of grew outside of my own experience to learn more about how economic stability, access to education, access to healthcare, and so forth really do have an impact on the lifespan for all kinds of different people.

And, I returned after I graduated, to where I had moved from, which is Savannah, GA, and I ended up not counseling, not being a therapist. But working for an agency that specialized in transitioning people with intellectual and developmental disabilities from state hospitals into integrated community residential settings.

So they…this company was recruited after this very famous court case known as, like, the Olmsted Decision came down. That sort of gave the Americans with Disabilities Act its teeth. And Georgia was sort of Ground Zero. The state of Georgia ended up having to settle with the Department of Justice and agree to, as part of the settlement, reform its treatment of people living in state care. So the company I was hired by, you know, was recruited by the state to start helping them help them do that.

So historic case, and the state of Georgia, you know, 10-15 years on, still had a lot of folks living in state hospitals in substandard care. Not in integrated residential settings. And so I sort of learned quite a bit about that population while I was working to establish an agency presence in Georgia. And, especially with people with intellectual and developmental disabilities, that “social determinant of health,” that is, access to healthcare, I learned, is so salient because those folks are funded and served largely by Medicare and Medicaid.

Stuart Shapiro

Mm-hmm.

Katie Pincura

And you know. So that opened my eyes, and I learned quite a bit about public insurance in the United States and how deep of an impact that, among other things, involving state policy and state management of these folks, how that impacted people’s lives. Who are especially vulnerable and especially dependent on structural determinants beyond their control to have a good quality of life.

And so, you know, during this journey of mine this, you know, professional journey. I mean, I’d lived without health insurance at all during my early 20s as an undergraduate student, and mid-20s. And then when I moved to Canada, they have a public insurance system that I qualified for after six months of being a student there. And that was a completely different, you know, experience, of course.

Stuart Shapiro

Mm-hmm.

Katie Pincura

And then I moved back to the United States, got a job that offered private insurance, and suddenly I had my own private insurance. Okay? And so, I have this journey as I’m growing up essentially and becoming an adult, and a professional, where I see so many different sides of the healthcare system as a patient, as an insurance customer, and as a professional who serves people who are dependent on public insurance.

And that just really sort of, you know, those experiences collectively sort of, lit my fire. And I really started to become interested in health policy in particular. But from the public health angle. So, I went back and got my MPH after a while and went straight into my DrPH program at Georgia Southern University nearby, where I lived at the time. And they offered three concentrations. One was biostats, one was community health, and one was leadership. And leadership is the one I chose because it was the one that enabled me to zero in most closely on not just, institutional leadership like, management policy, stuff for institutions, but also looking at those structural determinants of health and studying a little bit more about how public health and healthcare are regulated in the United States.

And so that was really kind of how I ended up in public health. Started with the choice to be a counselor professionally, and that just ended up kind of broadening into a greater interest in the healthcare system.

Stuart Shapiro

I have to imagine that that variety of experiences really helps you relate to students and the diversity of experiences that they bring to the classroom. Is that right?

Katie Pincura

Yeah. And my students always, you know, contribute. My students surprise me. My students share their experiences when I share mine. A lot of times, they don’t know what—and this is unsurprising, especially for undergrad graduates — but they don’t know what they do know about our healthcare system and about how we regulate healthcare and public health in general, until you start talking. And, you know, they say, oh, you know, I know about the before times before my family qualified for Medicaid, AKA before Medicaid expansion.

Stuart Shapiro

Right.

Katie Pincura

Or, you know, I know what it’s like to live in a state where Medicaid is not available to undocumented families and a state where it is. Or, I know what it’s like to, you know, I’ve seen my parents struggle, even though they have health insurance, to afford health care. I know what it’s like to go to an FQHC clinic for care.

Stuart Shapiro

Mm-hmm.

Katie Pincura

I know what it’s like to be on a wait list to get my cavities filled at a dental school or a low-cost clinic. And I mean, you know, my students come from across sections, across the economic spectrum. We have, of course, a very diverse student body. So you get all kinds of… I have students who go, oh, yeah, my mom’s an OBGYN. And, you know, here are the struggles that she comes home and talks about with, you know, helping patients get access to care and things like this. And so on and so forth.

So yes, my students. It’s fun to watch them light up when you start, you know, talking about what they’ve experienced in life and sort of academic terms. You know, okay, this is Medicaid, this is Medicare. This is how vaccines are, you know, controlled at the state level. This is, you know, this is how you access…these are the policies behind access. And the cultural attitudes behind, you know, broader than healthcare, but public health more generally. I mean we talked about, you know, how…what… can the government force us to get vaccines, is one that I’ve zeroed in on a lot in my classes since COVID. Which I really started doing in 2020, when, you know, when COVID was ramping up.

But that’s a great case study right there to help them start to understand the policy routes of the questions that they encounter in the popular culture space on TikTok and on podcasts that they listen to and in the news. I go, okay, well, can we? Let’s go back to Jacobson versus Massachusetts in 1905. And you know, we start saying, we start connecting their lived experiences that they hear the buzz about to policy.

And we look at the real anchors of those questions. And so you just you take their lived experience and you know, you tap into their passion and then you say, OK. Now it’s time to…we’ve identified, you know, these issues. And now it’s time to get academic with it, you know? And really learn, okay? And clear up that sort of nebulous, ‘I wonder why things are the way they are,’ sort of feeling that students, you know, that students have and that’s really fun.

Stuart Shapiro

Yeah, that’s great. And you sort of answered this, but was wondering if you could at least put it in a few sentences. Given all that, what is your teaching philosophy when it comes to public health?

Katie Pincura

Yeah, it’s basically taking it, trying to clear up, I would say philosophically….to clear up, this is what I tell my students when we start to talk about how we get what we need to live and why our modern world looks the way it does in the context of how public health has changed life. I’m like, okay guys there is no ‘they.’ In the allocation of goods and services, there’s a private sector, basically, and there’s a public sector. And to better understand why you have, you know, why you can go to the tap and get a cup of water and it doesn’t give you cholera. You need to understand how they are making that the case. Because students will do that. They say, ‘I hope they clean up the oil spill,’ you know what I mean?

Stuart Shapiro

Yep. ((laughing))

Katie Pincura

Or, ‘I hope they make it so I can afford insurance.’ You know, ‘I hope they, I hope they they they.’ So guys, there is no ‘they.’ You know, you get what you need in our, you know, our society, our economy, either from buying it or from having it provided to you. And you need to understand more about that.

So I really like to start there because I like to clarify that in public health, when we get ethical with it, we’re talking about utilitarianism. And we are talking about the tension between, you know, the liberties of the individual and private companies and the infringement on those liberties that republic health really does represent. And I want my students to think about that in a clear and cogent manner, instead of only having been exposed to the popular culture notions of freedom and infringement on freedom. Because I think that discussion gets muddled. You know what I mean?

We’re a passionate country when it comes to that topic, you know. And so, when I teach public health, I like to teach students in such a way that they can consider what life would be like without those investments. But to be honest with themselves about, hey, this is your tax money.

And it’s paying the government to essentially be stewards of your health in a way that does absolutely infringe on your liberties. And that’s a trade-off. And that’s, you know, at its essence, a utilitarian trade-off. And that’s public health. It’s not for me to say what you should think about that, but it is for me to teach you that that’s the way it is. There is no nebulous ‘they.’

There is no nebulous ‘they’ keeping you from getting the measles. You vaccinate your kids or not. You know what I mean? And that’s sort of like, philosophically speaking, that’s where I come from when I come in to, you know, teach public health policy.

Stuart Shapiro

That’s great. So, I suspect we’re going to be asking this question to our guests a lot, one way or another, this year. And you mentioned vaccines. So, I want to go right into it. Obviously, public health has been under enormous scrutiny since the pandemic started; in a way, it hasn’t been in my memory, certainly. And we’re in a week in which the head of the CDC testified that the Secretary of Health and Human Services does not really care about the science behind vaccines.

How does that come up in the classroom? If it does, how do you deal with it? What’s your approach in this really sort of fragile time?

Katie Pincura

Yeah, it is. It’s a tough time to teach some really foundational stuff. That is, I teach Principles of Public Health. For example, in the first few weeks, you know, we get into the foundations of, you know, I teach what is the CDC. I’m going to make sure they know what HHS is, what is FDA and what do they do. How much power does the state have to regulate public health, which is, of course, quite a lot. And why is that, and how does that relate to our Constitution? And you know, you have to teach them what the World Health Organization is, for example. And I’ve talked to colleagues about this a few times since January, is that we, you know, one of my slides is like, OK, here’s a graph of all the biggest contributors to the WHO. And the United States is number one historically by a lot.

Stuart Shapiro

Mm-hmm.

Katie Pincura

The United States and then right below that is the Gates Foundation. And so, America is just a massively influential player in global health, or has been historically.

And of course, you know, currently we are in the process of disengaging, as a country, with the World Health Organization.

Stuart Shapiro

Right.

Katie Pincura

You have to get up there, and you have to amend your slides. And you have to say, you know, this is how it was, and this is how it is now. And likewise, you have to talk about, you know, who is…I had the same lecture this week. I had to say, who is the leader of the CDC?

They say, well, they were just fired. And you know, they were just fired. And the reason they were fired is because there was a difference in opinion on, you know, vaccine recommendations between the leader of HHS and the newly appointed CDC chief.

So to answer your question about how students…how it’s happening with how students are reacting and how students are engaging with that. I would say that, I think I teach it like… that’s a 201 class, and I think students, this is the first time maybe, they’re being introduced to even what those agencies are. And so they a lot of times are kind of looking at me like, almost like they don’t want to speak about it.

Stuart Shapiro

Right.

Katie Pincura

They are absorbing the information. I mean, I’ve had a few who have raised their hands and specifically asked me about RFK. There seems to be some interest there. And yeah, you just have to prepare, I think, mentally more now than ever for your lectures. Because there’s always going to be astute students who, even if they’re just, you know, freshmen or sophomores, even if they’re, you know, early in their journey about learning about the world and how it works, they may have, they may have those burning questions. And, you know, as an educator, you have to know how to answer them in a way that is fair, because these days everything is subtext.

Stuart Shapiro

Right.

Katie Pincura

And everything is a signal for something else. At least, you know that’s just the pitch in our culture about, you know, the rhetorical sort of tension is that. Is that everything is a signal about what tribe you’re in. So what I try to do is I just try to address it head-on, and I say guys, this is a safe space in my class. You know, it’s my job to tell you how things are. It’s your job to decide what you think about them. And I just, I just tried it. But you know, you never know.

Stuart Shapiro

Sure.

Katie Pincura

You never know how a student is responding to information that would appear to paint the, you know, administration in a negative light. And it’s, you know, frankly, it’s something I think that’s on all of our minds.

Stuart Shapiro

Yeah, very much so. I am very tempted to go down a rabbit hole on vaccines with you right now, but…

Katie Pincura

((laughing))

Stuart Shapiro

I’m going to focus on the teaching of the students.

You joined us about a year ago. Tell us a little bit about what’s different. And I’m not looking for praise here. But what’s been different here than in your previous institutions? Particularly with the students and the overall experience?

Katie Pincura

Yeah, um, well, you know, Rutgers is just so big! ((laughing))

Stuart Shapiro

Yeah.

Katie Pincura

It’s just such a fast and that’s such a, I mean, it’s such a great thing.

I cut my teeth at Western Carolina University, which is a small state school in the western part of the Appalachian Mountain region of North Carolina.

Stuart Shapiro

Right.

Katie Pincura

And it’s an amazing, an amazing place with its own unique culture that’s different from the Deep South culture, low country culture of Georgia, where I had been living and going to school before that. And it was a wonderful, wonderful experience. It is a beautiful place, too, as well.

Western Carolina University has, I think, about 12,000 students. So, coming from there to here, of course, when I say Rutgers seems so big to me, you know it really… But the resources that a school like this is able to provide for students and for employees and faculty, is just really tremendous. You know, there’s just… I’m just continually wowed by what this school is able to offer. What the university is able to offer to students.

And the opportunities there are to build things, you know. If you think, geez, I would like, I would like my students to have, you know this course or this experience, or perhaps we could build this internship. There’s always somebody if I bring that up around, who’s going, ‘Oh, yeah! You know, that’s a cool idea!’ You know, da da da da da. I mean it’s, you know, it’s just…it’s a well-resourced environment and it’s filled with very passionate, energetic people who are really interested in serving the student body.

And I, you know,it’s just, I’ve just been really struck by that. Maybe it’s northern culture. Not to not love Southern culture too. It’s got its own charms. But I think up here you’re close to… you know, you’re in an urban environment. You’re, of course, close to New York City. And I think the folks, the people that I work with are… I’m just struck by how enthusiastic and how much they lean in to what they do it. So yeah, so that’s that’s been really striking And the students, my students are…it was it was fairly diverse in my previous institution, but not like it is here. I mean, it’s a wonderfully diverse place. And the major I teach in attracts a great cross section of students.

Stuart Shapiro

Yeah.

Katie Pincura

And so that’s been really, really rewarding too.

Stuart Shapiro

So many first-generation students in the public health program.

Katie Pincura

Yeah, absolutely. Absolutely, yeah.

Stuart Shapiro

Yep. Well, let me wrap up by asking what’s your goal for your students? What do you want to see the graduates with a public health degree come out of here with?

Katie Pincura

Well, you know, there’s the things that you… I think it’s hard because these days, you know, there’s when you think okay, what do I want my students to gain from this program? There’s the things that you want them to know. And there’s the things that you want them to be able to do.

Stuart Shapiro

Yep.

Katie Pincura

And you know, I go in and I kind of talk about what I want them to know. I want them to have a deeply rooted understanding of what public health is. How it’s funded. How it differs from, you know, the world of buying and selling and yadda yadda yadda. And how it affects, how it affects their lives.

When they graduate, I want them to be able to get good jobs. Or go to great graduate programs. And you know, this is something that we talk about as a faculty quite a bit. Is balancing, you know? Keeping that educational quality there while going, okay, how can we introduce more practical skill building into our classes to make sure that our students emerge, you know, ready to enter or set upon, you know, really great career paths.

So yeah, it’s…But that’s an ongoing kind of dialogue that we have. And of course, now with artificial intelligence entering the scene, which of course dominates all faculty meeting discussions!

Stuart Shapiro

Yep!

Katie Pincura

It becomes an even more like okay, how do we master this new technology to the best of our ability, and then integrate it into our classrooms to give our students what they need? If this is what employers want, how do we make sure that our students are, you know, up to par and ready to go with it. So…

Stuart Shapiro

That’s great.

Katie, thank you so much. It’s been a great conversation. Thanks so much for coming on.

Katie Pincura

Thank you. Thank you! My pleasure!

Stuart Shapiro

Also a big thank you to Tamara Swedberg and Karyn Olsen, who are back to help yet again with the production of the podcast. We will be back in the next week or two with another episode with other experts from the Bloustein School. Until then, catch up on all the episodes and stay safe!