Dean Schillinger

Inspiration

Very early in my journey as generalist physician, I learned that health is generated by a complex interplay between our political and social contexts –at a local or global level –and the degree to which individuals have access to a range of enabling resources. When I was a medical student (yes, I am dating myself here), the existential life vs. death issue we faced as a society was the arms race, the impending nuclear war and the “mutually assured destruction” that would ensue. I became very active with, and was trained in policy/advocacy by the International Physicians for the Prevention of Nuclear War, an organization that ultimately won the Nobel Peace Prize for their work contributing to nuclear disarmament efforts. As I became a UCSF trainee and then a practicing primary care physician at SFGH, it became eminently clear that the health of my patients –especially the health of socially vulnerable populations –was especially sensitive to healthcare and social policies. To improve my patients’ health, I needed to not only be the best office-and hospital-based physician and researcher I could be, but that I had to play an active role in trying to influence or even shape policy for their benefit. In my first “real” job here, I served as Medical Director of our General Medicine Clinic (1995-2000) --not necessarily a job one would consider to be a “policy job.” I discovered, however, that my clinic work as a primary care physician, educator and administrator was as important as the research and policy efforts our team was making to demonstrate –through well-executed research --that a strong primary care foundation was the best way to evolve into an integrated and world-class safety net health system.

Impetus & Impacts

I have two main and related research and policy foci, each of which emanated from and are sustained by my ongoing clinical experience as a doctor at SFGH. The first has been demonstrating the importance of communication – at the physician- patient, system-, and public health levels -- to the health of patients and populations, especially those with communication barriers such as limited literacy skills. Health communications, when done well, represent an important enabling resource. I have been fortunate to receive federal funding for this research for two decades and to have been able to translate some of this work to healthcare policy initiatives that have elevated the importance of health literacy and health communications as means to improve healthcare quality, safety and value, as well as to reduce healthcare disparities.

The second has been my involvement in research and public health efforts to prevent and control type 2 diabetes. My research has contributed to scientific and lay understandings of type 2 diabetes as a disease whose incidence and control are heavily influenced by social and environmental conditions – not just genetics or individual behavioral “choices.” As I gained visibility for my work in this space, I was chosen to serve as Chief of Diabetes Prevention and Control for the California Department of Public Health (part-time gig). This both provided me with hands-on experience in running a large public health program, but also provided me with a timely platform to disseminate important scientific advances led by UCSF colleagues such as Dr. Kirsten Bibbins-Domingo (projected effects of a sugary beverage tax on diabetes incidence in CA), Dr. Alka Kanaya (vulnerability to type 2 diabetes and its complications among particular Asian sub-groups in CA), Dr. Urmimala Sarkar (relationship between limited health literacy and high incidence of hypoglycemia), and Dr. Hilary Seligman (contribution of food insecurity to the diabetes epidemic in CA). I also discovered what a central role communication needed to shift the discourse - among state legislature and the public - about the root causes of the epidemic. The public health diabetes prevention communication campaign I co-created with Youth Speaks was the product of that realization. Known as The Bigger Picture (www.thebiggerpicture.org), this spoken word arts campaign leverages social media to disseminate the unique voices and messages of young people of color who call out the drivers of the epidemic in their communities and advocate for social and environmental policy change to prevent type 2 diabetes in youth and young adults. The campaign has significantly improved “public health literacy” about diabetes in California and beyond, and likely contributed to the sugary drink tax laws in 4 Bay Area counties.

Strategies

Advisory/technical assistance role

I have been consulting with Mexico, Singapore and Israel on their diabetes prevention and control policy initiatives

Direct work with policymakers

Member of a new and important federal commission charged to make recommendations re how federal agencies can better work together to prevent and control diabetes. My main contribution to date has been to advocate that the commission agree that non-heath agencies (USDA, HUD, Dept of Transportation, Dept of Education) are included in our scope of work, not just health agencies (NIH, CDC, CMS, FDA). As a result, the commission accepted a diabetes social-ecological model to guide its work, and I have been appointed to be in charge of the sub-committee making recommendations regarding non-health agencies. Our recommendations will be delivered to Congress by the end of 2021.

Media engagement

Mother Jones 2020 “Certainly, the Messaging Was Botched”: How the Trump Administration Screwed Up on Masks

New York Times 2018. Using Art to Tackle Diabetes in Youth

New York Times 2016 Study Tied to Food Industry Tries to Discredit Sugar Guidelines

SF Chronicle 2016 Doctor fighting S.F. diabetes epidemic backs soda tax

LA Times 2016 Does the soda industry manipulate research on sugary drinks’ health effects?
LA Times 2015 Proposed tax on sugary drinks fails in Assembly panel

UCSF Dean Schillinger: Helping Kids Slam Diabetes – with Poetry

Participate in a policy-related academic center

In 2006, founded the UCSF Center for Vulnerable Populations (CVP) at San Francisco General Hospital. Serves as Director of the UCSF Health Communications Research Program at CVP and Site Director for an NIDDK Center for Type 2 Diabetes Translational Research. Previously served as Chief of the UCSF Division of General Internal Medicine (2009-20) at San Francisco General Hospital.

Participation in professional associations and advisory bodies

Provided public health leadership as Chief Medical Officer for the Diabetes Prevention and Control Program for The California Department of Public Health

Provided public testimony to legislators and regulator

2015 testified in favor of AB 1357, a 2-cent-per-ounce tax on sugar-sweetened beverages, which would have established the Children and Family Health Promotion Program.

Public advisory bodies

2018 Speaker: National Academies Workshop Integrating Oral and General Health through Health Literacy Practices

Public policy research

I serve as PI of an NIDDK R01 to evaluate the impacts of the sugary drink taxes, and related diabetes policy-relevant “natural experiments,” in the Bay Area

Published in professional literature

As a health communicator and academician, I have authored over 275 peer-reviewed articles, many with a policy focus.

Received training in a policy-related field

2000 Fellow, US Public Health Service Primary Care Policy Fellowship, Washington, DC

2005 Visiting Scholar, University of Chile School of Public Health

Served as an expert witness

Including scientific expert for City and County of San Francisco in defense against a federal lawsuit by The American Beverage Association re the city’s warning notice ordinances on sugar sweetened beverage ads/

Work with groups that advocate for policy change

The Bigger Picture (www.thebiggerpicture.org) is a spoken word arts campaign which leverages social media to disseminate the unique voices and messages of young people of color who call out the drivers of the epidemic in their communities and advocate for social and environmental policy change to prevent type 2 diabetes in youth and young adults. The campaign has significantly improved “public health literacy” about diabetes in California and beyond, likely contributing to the passage of the sugary drink tax laws in 4 Bay Area counties.

Write editorials/blogs promoting research-informed policy change

“The Disability Blues” was featured in A Piece of My Mind, a collection of the greatest physician essays from the last 25 years. “The Quixotic Pursuit of Quality” was featured in Intima, A Journal of Narrative Medicine

Timeline

I studied Russian Language & Literature at Brown, earned my MD in 1991 from U Penn, and served my residency at UCSF. Very early, I was inspired by UCSF faculty’s individual and communal contributions to major advances in health, especially the work that entwined research and policy. This included tobacco control, the response to the AIDS epidemic, the expansion of primary care access and the financing of healthcare among others. One of my many mentors, Dr. Andrew Bindman, demonstrated to me the relationship of policy and research in improving lives. The training I received at UCSF/SFGH encouraged me to understand and become involved in structural determinants of health that led our patients to be in treatment. In 1995 I coauthored a report indicating mandated domestic violence reporting may harm victims, and began advocating for policy re-crafting to address the issue.

1995-1999 Director, Adult Medical Clinics at San Francisco General Hospital and Trauma Center

1999- 2003 Director of Clinical Operations for the Department of Medicine at SFGH

2003 Institute for Healthcare Advancement Research Award

2004 contributed to IOM Report on Health Literacy

2006 founded the UCSF Center for Vulnerable Populations

2008 Research Award in Safety and Quality from the National Patient Safety Foundation

2008-13 Chief Medical Officer for the Diabetes Prevention and Control Program for California

2012 IOM authored publication defining the attributes of Health Literate Healthcare Organizations

I believe my contribution will be to steer our scientific translational efforts towards intentional training in communications. My hope is that UCSF will evolve into THE international leader in health communication science, discovering the best ways to harness communication to promote individual and population health and to advance health equity. Given the talent pool we have here and the research and policy legacy we enjoy, we already are off to a great head start.