Transforming public health science into local and global practice

While we live in a world where scientific breakthroughs are reported nearly every day, it can be surprising to learn that only 14 percent of biomedical research is ever translated into practice, and when it is, up to 17 years can pass from the time research begins to when its findings are implemented.

A new academic track at the Yale School of Public Health seeks to improve the delivery and sustainment of proven health interventions by training a generation of scientists who are well-versed in rigorous implementation science methods to reduce inequalities and improve the health of communities everywhere.

Implementation science has recently emerged as a novel interdisciplinary field for developing and applying methods and strategies to improve the delivery of proven health interventions in routine clinical and public health practice. It offers a diverse set of tools to make public health programs more effective, efficient, and equitable.

The new Implementation Science Track is an example of how YSPH is leading the transformation of public health at Yale and beyond. While there are other academic implementation science programs around the country, these commonly focus on the application of preexisting methods and strategies, while YSPH is also advancing the field by creating new methods and strategies.

“If students are interested in implementation science, we want them to know that Yale has a program that will allow them to pursue it within a public health framework,” said Dr. Luke Davis, MD, MAS, associate professor of epidemiology and the director of YSPH’s Implementation Science MPH Track. Davis is also an associate professor of medicine at Yale School of Medicine (Pulmonary, Critical Care and Sleep Medicine).

The new track, which is offered by YSPH's Center for Methods in Implementation and Prevention Science (CMIPS), aligns with the school’s new strategic vision to link science and society, making public health foundational to communities everywhere. The track also addresses one of the strategic plan’s priorities to “create pathways for translating outstanding science into local and global health impact.”

Fueled by the growing recognition that too many evidence-based public health interventions are unused or not achieving their full potential, the emergence of implementation science as a distinct discipline has made it a vital practice in public health.

Implementation science shares many of the goals of population health, evidence-based medicine, and health equity, which seek to deliver high-quality, value-based care to all. However, instead of assuming that simply offering proven interventions will ensure their uptake, high-quality delivery, and sustainment, implementation science seeks to identify and apply strategies to achieve these goals.

There is “a huge toolbox of public health interventions already in place that could prevent cervical cancer, maternal mortality, most colorectal and lung cancers, and prevent, slow, or ameliorate most cardiovascular diseases and diabetes, improve mental health, and eliminate HIV,” said Dr. Donna Spiegelman, ScD, Susan Dwight Bliss Professor of Biostatistics, co-director of the Implementation Science Track, and director of CMIPS.

As an example, Spiegelman said that although cervical cancer is now uncommon in North America and Western Europe due to the widespread implementation of evidence-based interventions for screening and treating those with abnormalities before they develop cancer, it remains the first or second leading cause of cancer deaths among women in low- and middle-income countries, such as Mexico and India. Similar disparities exist with HIV/AIDS and maternal mortality.

“People think that many public health problems are concentrated in low- and middle-income countries,” Spiegelman said. “But actually, a substantial proportion of American adults with hypertension have uncontrolled hypertension, including right here in Connecticut. We frequently fail to screen patients for hypertension when they come in. And similarly with diabetes.”

Hypertension is the major cause of heart disease and stroke, but treatment with medications to lower blood pressure are highly effective at preventing these complications. “Many people do not understand that they have to keep taking the medicine or their blood pressure will go back up, and then they will have the same risks. Providers and health organizations often do not have systems in place to ensure long-term patient adherence to these medications.” Spiegelman explained.

In addition to medication adherence, other evidence-based practices to prevent and control hypertension include ensuring tests are properly and regularly performed and that the results are accurately interpreted and communicated to patients.

“There isn’t a single magic bullet that will all of a sudden have everyone in the world with hypertension on anti-hypertension medication, or that will prevent people from getting it in the first place,” Spiegelman said. “Complex, multi-component intervention packages simultaneously focused on the health system, providers, patients, and their social networks are needed. This is the complexity and the excitement of implementation science.”

The Implementation Science Track, which launched in the fall of 2024 with 13 MPH students, builds on the Master of Public Health (MPH) core curriculum. In addition, YSPH also offers an implementation science pathway within the Department of Biostatistics for Master of Science in Public Health and PhD students, which is different from the new MPH track, Davis explained. “One of our goals is to let students know that implementation science methods are not only relevant for biostatisticians,” he added.

“This new MPH implementation science track provides a great home for students who care about health equity and want to make the world a better place by reducing disparities, and who have the interest and inclinations to acquire rigorous technical skills to make this happen,” Spiegelman said.

After they graduate, students will be equipped to work at local, state, and national health agencies. “What we’re trying to do is impart these rigorous skills as well as experience and reinforcement to students, so when they graduate, they can be ambassadors for implementation science and make the difference they want to make,” she added.