University Health Services Marks 100th Anniversary

It was a time when a quart of milk cost 3 cents, a gallon of gas set you back 7 cents, and college graduates started out earning about $750 a year.

 

February 1910 was a time when the University of Wisconsin-Madison stepped across the threshold of the young millennium and boldly developed a student health department, one of the first in the country.

 

Why have a student health department?

 

"Students have unique needs when they live and work together in a large closed community like the UW-Madison campus, so it is imperative that a safe and healthy environment is maintained," says Sarah Van Orman, MD, MMM, executive director of University Health Services (UHS) since 2008.

 

What's more, college is a pivotal time in the lives of young people developing into adults, when they are in the process of figuring out how to live on their own.

 

"It's a time when those of us working in student health can make a difference in students' lives now and influence their future lives," says Van Orman, a clinical assistant professor of internal medicine and of pediatrics at the UW School of Medicine and Public Health (SMPH).

 

Crafting a university clinical health department and curriculum adjunct to the medical school was a multifaceted endeavor that was not simply a dry exercise of necessity in the early 20th century; rather it was a radical fresh expression of the campus' values, traditions and innovations. That's why the history of UHS is one of not only significant growth and development, but also contributions to the university environment and its success.

 

Over the past 100 years, UHS has been lauded for being a college health model that emphasizes prevention, public health and environmental health. It is a teaching site for medical students, residents, nursing students and other health professions students. UHS medical staff participate in national research.

 

UW-Madison students today have many of the same health concerns as students a century ago, but what's very different now is that, thanks to a myriad of technological advances, they have access to a wide range of resources and services geared to a diverse, multicultural population.

 

Over the decades, UHS has evolved to become a major health education resource. Simply by "pointing and clicking" on their computers, students can get reliable information on:

• Drug and alcohol use
• Mental health issues such as depression, anxiety and suicide
• Violence
• Exercise
• Nutrition
• Women's health, including reproductive health care

In terms of comprehensive patient care, UHS offers:

• Primary care
• Counseling
• Psychiatric services
• Immunization
• Sexual health
• Women's health
• Physical therapy
• Athletic training
• Occupational medication
• Travel health

Vision Translates to Reality

 

The idea for student health care was originally explored by 19th-century UW-Madison visionaries who were interested in addressing fundamental health concerns facing the new campus. In 1899, UW president Charles Kendall Adams paved the way for limited health care for the women of Chadbourne Hall when a new facility was established for that purpose.

 

But it took a student health tragedy in 1908 to move the idea forward.

 

That fall, typhoid fever struck campus. Students were living in a vulnerable situation that invited communicable disease-congested dormitories in unhygienic situations with no access to centralized campus health care. Forty-nine students died and several others became seriously ill.

 

What happened next was inevitable, given the concern that students' parents had about their children. So Charles R. Bardeen, MD, then dean of the medical school, was charged with creating a department that would serve as an infirmary for sick students as well as a training site for medical students. At the time, Bardeen was exploring expanding the medical school from a two-year to a four-year program that would include clinical training in addition to a basic science curriculum.

 

It took two more years-until 1910, when Joseph Spragg Evans, MD, arrived on campus-to make the plan a reality. When Evans became the first UHS director, the campus population was 3,500. He and two assistants treated 837 patients during the first semester that UHS was an active clinic. When not treating sick students, Evans, following Bardeen's lead, espoused a medical philosophy of physical hygiene for the student community.

 

Still, UHS caused a stir. Some Madison physicians felt it represented unfair competition. Others accused it of being contract or socialized medicine. Eventually the hubbub died down and the community realized that the new on-campus health program might outlast the arguments.

 

Cornelius House on State Street served as the first student clinic, with additional infirmaries soon to follow. The department maintained its dual student health-clinical medicine purpose until 1925, when the school became a four-year institution and the Department of Medicine was created.

 

Looking back, it was a very different world when UHS charted a new medical era on campus. A lot has changed in a century -in health care, on campus and at UHS.

 

Integrated Approach

 

A patient visiting UHS today benefits from an integrative approach to health care. In addition to clinical services, the broad program includes prevention, public health, wellness services and mental health counseling.

 

The provider staff includes 13 physicians, 14 registered nurses, 11 psychologists, eight licensed counselors and social workers, eight nurse practitioners and three physician assistants. They serve a population of 42,000 students and 16,000 faculty members, with about 25,000 students making 85,000 visits per year.

 

Several units - epidemiology, community health, environmental health, communications and, most recently, occupational medicine - contribute importantly to UHS's mission of promoting, protecting and restoring health.

 

UHS is an independent entity on campus, but more than many other student health services in the country, it shares professional staffs and programs with the School of Medicine and Public Health.

 

"We have strong relations with the SMPH and UW Hospital, primarily through training programs," says Van Orman. "And we have several SMPH alumni working with us."

 

Van Orman was drawn to Wisconsin from the University of Chicago, where she served as the director of student health services, because she wanted to work for a public university with a large patient population. With national visibility as the vice president of the American College Health Association, she recently was quoted in a New York Times story on student health.

 

Addressing Growing Needs

 

In the past three years, UHS has experienced an upswing in demand for services. It may be due in part to its fairly new location. In 2009, the department moved to the just-built Student Services Tower at 333 East Campus Mall between Johnson Street and University Avenue, an easily accessible central campus area.

 

The demand for services is also related to a growing undergraduate population. Many of these young students do not have health insurance and if they do, they may have large deductibles that strain their budgets, making them inclined to seek UHS's mostly free health services.

 

Delivering top-quality health care to a "city within a city" is an ongoing challenge. UHS continues to fine-tune outreach methods to connect with this large population. Social media outlets including Facebook and Twitter are used, and three years ago, UHS started communicating with students through secure online messaging.

 

The health of the student population at UW-Madison is determined by many factors, not just the number and type of services provided on campus. It's imperative that students have access to high-quality health care along with public health measures ensuring a healthy environment.

 

"Not one of these factors is more important than another," Van Orman says. "In addition to providing direct care, we must promote prevention, offer population-level interventions and address the environment. The opportunity to take an integrated approach and work on all levels is what makes our work so exciting."

 

UHS's approach to high-risk alcohol use, a big health concern on campus, offers one example of how a multipronged, integrated strategy works. Medical providers offer brief interventions for students who say they engage in high-risk drinking, and mental health experts may offer more comprehensive treatment for students with serious problems.

 

The department's prevention team raises awareness of the problem through extensive social messaging, and UHS leaders engage in campuswide discussions about the problem, advocating when appropriate for policy change.

 

Looking Ahead

 

In recent years, behavioral health, mental health, environmental health, public health and women's health have emerged as practice areas of significant growth. Mental health, in particular, presents unique challenges.

 

"Historically, there has been a barrier to asking for help," Van Orman says, "but those barriers are coming down. And with that comes a demand for services."

 

UHS's services include a 24/7 crisis line and "Let's Talk" drop-in groups started last January. Still, reaching everyone who needs mental health intervention is a conundrum.

 

"There's also the issue that we can't provide long-term care," adds Van Orman.

 

health care in the future is bound to be even more complex than it is today. But the seeds of innovation that will evolve in college health over the next few decades may already be present on the campus today.

 

"We are most proud that we have been able to continue to develop that college health model of 100 years ago," says Van Orman. "We feel fortunate to have been able to adapt to a changing health care and university environment while maintaining our goal of protecting students' health and happiness so they will best be able to succeed as students and alumni."

By Sharyn Alden

This article appears in the summer 2011 issue of Quarterly.

Date Published: 08/31/2011