Leadership Q&A: Elevating Student Health and Well-Being

Robert D. Ernst, MD, is the chief health officer and associate vice president of student life for health and wellness. As chief health officer, he serves as a key advisor to the president on matters related to the health and wellness of the university community, including the promotion of health and well-being, disease management, and public health preparedness on all three U-M campuses. His vision, one that aligns with the Okanagan charter, is to embed health and well-being into all aspects of campus culture and to inform the institution in its aspirational goal to become a health-promoting university.

As the Chief Health Officer of the state’s largest public institution, you are responsible for the promotion of health and well-being, disease management and critical public health preparedness for all three U-M campuses. What are the biggest issues or opportunities currently facing the community?

Our three campuses are now settling into a rhythm that more closely mirrors pre-COVID activity. When I walk onto the Ann Arbor campus, I see groups of people almost everywhere I go. Whether I’m stopping in the Michigan Union for a coffee or walking into the Big House on a football Saturday, campus is alive in a way that only happens with our students back.   

But while daily life may look and feel more comfortable and familiar compared to those early days of the pandemic, COVID-19 is still here. Fortunately, our very high level of vaccination provides the cornerstone of our mitigation strategy, along with established processes for clinical assessment, easy access to testing, and effective outpatient treatment options. We now know much more about how to protect ourselves and one another from COVID-19 than we did two years ago. There is already an updated booster shot and I believe that getting an updated booster will be one of the most important strategies to reduce the potential disruption associated with COVID-19 as we head into winter. And it’s important to remember that COVID-19 is not the only infectious disease with the potential to disrupt routines right as they’re being re-established.  We have an opportunity to take what we learned from these past several years to shift from a model of responsiveness to one of readiness.  

Many of the processes and partnerships that were built and strengthened over the course of the pandemic are now also working together to address other public health imperatives and are directly improving the student experience. In addition to our now-established structures to address infectious threats, we are also leveraging many of these same partnerships to improve our community’s mental health and well-being through a commitment to become a health-promoting campus. On the Ann Arbor campus, under the emerging structure of a “well-being collaborative,” eight work groups were assembled last fall to begin implementation of more than 40 recommendations to help U-M more holistically address the community’s mental health and well-being needs.  

In July, U-M transitioned to a new public health structure to align with a more stable, endemic phase of its COVID-19 response, including a new unit focused on infection prevention and an associated advisory committee. What does this mean and what can other organizations learn as they continue to adjust their public health strategies?

In many ways, the campus public health structure is new in name only—many of the same interprofessional stakeholder groups are represented and the team is under the direction of skilled and experienced project management. There have been new members added to provide additional insight and nuance from the regional campuses, university athletics and several other academic affairs areas, and focus of the advisory committee is no longer only on one specific disease. It became clear during the COVID-19 Campus Health Response Committee’s work that the knowledge, resources and community metrics our team assembled were extremely useful beyond COVID-19. Much of what we built to monitor and respond to COVID-19 activity on campus could be adapted for broader infectious disease surveillance. By tracking the right indicators, we can begin to predict earlier and more accurately if or when a disease outbreak may occur and ensure we have a plan in place. We’re moving beyond crisis response to a position of readiness to promptly address the next disease outbreak, whatever it may be.

The pandemic tested our institutional public health infrastructure in ways we simply had not previously seen or experienced, and it revealed gaps that needed to be addressed. Which we are. Establishing a permanent Public Health Infection Prevention and Response Advisory Committee that advises the chief health officer and university leaders on matters related to infectious-disease response, policy and protocols is one crucial piece. Another is establishing and maintaining strong partnerships across campus to address the university community’s health and well-being. We have representatives from Student Life and Academic Affairs areas, as well as colleagues from Michigan Medicine and our Dearborn and Flint campuses. This is, in every sense, an institutional-wide effort and commitment.

Finally, the executive leadership has also approved a proposal to create an ongoing Epidemiology and Infection Prevention (EIP) department, housed within the campus health center and reporting to the chief health officer. The key elements of the EIP include a lead epidemiologist, other public health professionals responsible for the established surveillance systems, data and analytics experts to help make sense of the trends observed, and dedicated communications professionals. It is expected that this team will oversee many of the response activities associated with the COVID-19 mitigation strategy and will work closely with other key campus partners including the U-M Environment, Health & Safety Department and Emergency Preparedness team from the Division of Public Safety and Security. The lead epidemiologist is also expected to be the primary liaison with the Washtenaw County Health Department and our own School of Public Health.

Let’s switch our focus to fall: what are you excited for this academic year in Ann Arbor?

I’m a graduate of the U-M Medical School, I completed my medical training within the Michigan Medicine health care system, and I’ve now worked at the university, both on campus and at the hospital, for more than 30 years. My wife is also a physician with an appointment to both student life and the medical school, and we have two children who are current U-M students. We would both agree that there is nothing quite like Ann Arbor in the fall, and that there is something very special about all that happens around us on campus. The positive impact of the university is certainly experienced by the students, their families, and the people who work here, but also by the surrounding neighborhoods and businesses that benefit from the culture and energy associated with being a vibrant college town.  

Again, with an extremely high level of vaccination as the cornerstone of our public health strategy, the campus has a renewed confidence to resume many of the academic offerings and co-curricular programs that facilitate student learning and the development of the whole student. This happens when students, faculty and staff come together to form a diverse and inclusive campus community. I’m proud of the fact that the university has so many programs, services, facilities, and partnerships that enrich educational experiences and provide opportunities for transformative experiences for students.  

Establishing and maintaining meaningful connections with others are often regarded as key contributing factors to personal well-being and contribute also to a rewarding Michigan experience. With the fall semester underway, campus is buzzing with activity and excitement, including activities beyond the classroom that include orientation events, social gatherings, participation in student organizations, and of course, athletics. The sense of isolation that was associated with the early stages of the pandemic clearly exacerbated the already prominent concern about student mental health. The opportunity for our students to more actively engage in their learning and to resume many of these other community experiences is what I find most exciting about this fall. 

The pandemic had a significant impact on how U-M prepares for in-person learning. What policies or best practices are being put in place for students, staff and faculty in 2022?

A high level of vaccination in our community provides the foundation of our campus mitigation strategy. Our ability to protect ourselves against COVID-19 and to minimize disruption to the community has also evolved as our knowledge of the disease has increased, access to evaluation and testing has become faster and easier, ventilation systems in campus spaces have been optimized, and effective and better treatments have become more widely available.

The best practices for minimizing the disruption of an otherwise exciting semester should now sound familiar to our campus community: stay home when you’re sick, get tested for COVID-19, isolate if you have COVID-19, wear a mask, and stay up to date on vaccinations.

Stay home when sick: Anyone who is experiencing symptoms suggestive of COVID-19—such as a new cough, sore throat, nasal congestion, fever, fatigue—even mild symptoms, should avoid gatherings and seek testing. If you are sick, even if it is not COVID-19, students, faculty and staff should stay home.

Get tested: I’d recommend everyone maintain a supply of home antigen tests, but testing is also available through a range of campus resources. Any U-M student, faculty or employee can obtain free testing if asymptomatic, after an exposure, or with mild symptoms at the U-M COVID-19 Community Sampling and Tracking Program (CSTP) locations on campus. Students can also self-schedule or call for an evaluation/test at UHS.

Isolate if you have COVID-19: Anyone who tests positive for COVID-19 is expected to isolate for at least 5 days, and should wear a mask when around others for a full 10 days after diagnosis, even as symptoms improve. All students should have individual plans for isolation in the event they have a positive COVID-19 test. Isolation spaces have been set aside for students living in university housing.

Wear a mask: Masking is no longer required in most indoor spaces on campus, but masking is recommended as an additional preventive measure when community transmission is high and maintaining social distancing from others is difficult. High filtration masks have been shown to provide a high level of personal protection and masking is recommended for anyone who may be at a higher risk of complications. Free masks are available at campus CSTP sites and at community centers within the residence halls.

Stay up to date on vaccinations: The Bivalent Omicron Booster, or BOB, is now widely available and is recommended for everyone in the university community. Through partnerships with local retail pharmacies, vaccines are being offered at multiple campus locations, including convenient, walk-in clinics that do not require registration. COVID-19 booster shots can be safely given at the same time as seasonal flu shots, which are also recommended.

Both the State of Michigan and the University of Michigan have made significant investments in public health, mental health and well-being resources in the past year. Why is this so important for our community and what has sparked this shift in strategy?

Even before the pandemic, university leaders across the county were increasingly concerned about the pressing issue of student mental health. Validated studies have consistently shown that behavioral health issues such as depression, anxiety, ADHD, and sleep disorders are identified as some of most common barriers to academic achievement in college students. Social isolation and challenges accessing learning that have been associated with COVID-19 have only exacerbated that concern. Mental health problems can impact the academic performance and success of a college student. Poor mental health contributes to lack of motivation and problems focusing, which can lead to failing grades. Investment in campus-wide mental health resources and other innovative approaches to student support could be the key to both their academic success and improvement in overall well-being.

A possible silver lining to our COVID response effort has been the emergence of strengthened partnerships across campus that has allowed the university to more easily rally around a shared common agenda. As one important example, the student mental health task force, co-sponsored by the Provost and the Vice President of Student Life, convened at the height of the pandemic to develop innovative approaches designed to advance a culture of caring and holistic well-being. As a result of this work, the institution adopted the Okanagan Charter, a systems-based approach with an associated aspirational goal of becoming a health promoting university by embedding health and well-being into all aspects of university life. This institutional approach does hope to improve access to existing resources, and advance a more comprehensive continuum of care for students, but also acknowledges that we have an opportunity now—through strengthened partnerships with academic affairs colleagues—to better address some of the significant underlying drivers of student distress.

Community participation and broader societal collaboration were pillars of the global pandemic response. What have we learned about people’s ability to come together to ensure a safe and healthy campus or state?

Early on in the pandemic, identification of the ‘core work’ of the university – provision of student instruction, cutting edge research, and service to the community, including healthcare – established the context for what was critical in terms of continuity of operations. However, because it has been a pandemic resulting from a novel virus the roadmap has been far less certain along the way, and has, understandably, been associated concern about how to reasonably balance safety with advancement of the core mission. To help navigate that uncertainty, the university public health response team has relied heavily on expert opinion by university faculty, the U.S. Centers for Disease Control and Prevention (CDC), and the American College Health Association (ACHA), together with close communication and alignment of practice with colleagues at the state and county health departments Input from various key stakeholders groups from across campus also provided direction and opportunities for community engagement and communication. While the advancement of core work under an evolving mitigation plan has provided sufficient direction and reassurance for many, and the number of serious outcomes have been few, there have been some challenging disagreements from within the community, including some with a heightened sense of concern, and some who feel strongly that requirements have gone too far.

Still, on our campuses, we by and large have seen our community members advance a culture of caring for one another and with few exceptions have accepted an approach to containment and risk mitigation that has evolved with the emergence of better understanding of the virus, nearly universal vaccination, easier access to evaluation and testing, and effective treatment.

When one thinks of caring for or maintaining their well-being, what does that include?

Well-being really is this umbrella term that captures multiple dimensions, or areas, of your life. How you’re currently feeling about, or what you’re experiencing in, each of those areas collectively shape how you experience health and happiness.

People may first think of their physical health or fitness level as a prominent measure of their overall well-being. Increasingly, we’re also seeing that most people include assessment of their mental or emotional health as important measures of well-being. Both are true: it is important that we routinely assess and attend to our physical and emotional to maintain a balanced sense of well-being. Well-being is the experience of health, happiness, and prosperity. It includes having good mental health, high life satisfaction, a sense of meaning or purpose, and the ability to manage stress.

At U-M, with significant input from students, we have developed a model of holistic well-being that includes eight dimensions: Physical, emotional/mental, environmental, financial, occupational, social, intellectual, and spiritual health. Through this framework we help our students, faculty and staff appraise each dimension and provide them tools and resources to define and achieve their goals in each.

Well-being is a life-long journey. Each dimension shifts based on your individual experiences and circumstances. One trend we witnessed throughout the pandemic resulted from a broadly shared experience: the abrupt and prolonged disconnection from community and support networks. The pandemic exacerbated college students’ feelings of isolation, anxiety and depression, leading to a sharp decline in self-reported well-being.

Trying to find balance across eight dimensions of well-being may sound overwhelming, especially for those currently experiencing feelings of anxiety and depression. But it really is a journey. You don’t have to have everything figured out at once. Small actions, like walking through Nichols Arboretum or attending a U-M School of Music, Theater, and Dance performance, can boost well-being. Well-being is something sought by just about everyone because it includes so many positive things — feeling happy, healthy, socially connected, and purposeful.