In Debra Haire-Joshu’s early years as a registered nurse, she began noticing troubling patterns in many of the patients she cared for.

They would end up visiting the hospital or the doctor’s office for issues that could have been prevented with interventions focused on behavioral change. Instead, the health issues would continue to accumulate.

“I found myself wondering a lot of times why I was seeing people with the same health concerns over and over again, many of which were preventable,” said Haire-Joshu, PhD, the Joyce and Chauncy Buchheit Professor in Public Health at Washington University School of Public Health in St. Louis. “I worked with women who have young children, and they were always trying to do their best for their families. But many of the mothers I worked with had to prioritize meeting the basic physical and social needs of their children while dealing with challenges such as food insecurity and inadequate childcare. These difficulties often made it hard for them to implement health regimens.”

Following a call to dig in deeper on illness prevention and management, she took a position as director of education at the NIH-funded Diabetes Research Center at WashU School of Medicine. The experience further shaped her path.  

“I fell in love with research,” Haire-Joshu said. “I gained insights into conducting exceptional clinical research from outstanding researchers who were discovering solutions to prevent chronic diseases. Yet, the same question persisted: Why do so many people present with preventable conditions?

“Everything in your life informs what you do,” she continued. “Over time, I observed that many individuals could avoid developing conditions such as diabetes or heart disease if we changed our approach and met them where they are. This realization led me to partner with various community agencies, and eventually, informed my passion for policy-related work. I realized that despite our efforts, the lack of policy change informed by science was a significant factor contributing to persistent health challenges.”

Because WashU did not have a public health school or program at that time, Haire-Joshu’s deepening interest in population health took her to Saint Louis University School of Public Health, where she joined the faculty. But in 2008, she circled back to WashU, where she has been since.

As associate dean of faculty affairs at WashU Public Health, she leads the new school in faculty hiring and development, and related initiatives. Meanwhile, ever the researcher, she has remained in her longtime roles as director of the Washington University Center for Diabetes Translation Research, and the Center for Obesity Prevention and Policy Research.

Here, she answers some questions about her life and work in public health.

Q: What made you come back to WashU in 2008?

“From the time I first came here, what I saw was this outstanding university with wonderful science that didn’t leave the walls of the university and reach the population at large as rapidly as it should; it didn’t have the impact it should in the real world. When I arrived, the university excelled in basic sciences but had not yet developed a structured public health program. In around 2008, the university expressed interest in advancing public health initiatives, marking the beginning of a new chapter. I joined the Brown School faculty, which added a master of public health degree, and took on a role at the newly established Institute of Public Health.”

Q: You have a continuing relationship with the Parents as Teachers organization. How did that start?

“I was trying to test and sustain an intervention that was going to improve dietary intake, reduce weight and diabetes risk, and I was looking for a way to reach the populations that I otherwise couldn’t reach. I wanted an intervention that reached people where they lived and spent their time, a real-world setting and population. When I first partnered with Parents as Teachers, I learned that they had an infrastructure to consistently connect with mothers and children in their homes. This meant that the insights and strategies we developed here in Missouri, specifically in St. Louis, could be effectively disseminated through their system. Additionally, they had a national network of sites, which enables us to to reach families nationally. Through this outreach, thousands of parent educators, who visited them in their homes, would also receive regular training, expanding the impact of our science.”

Q: What has this relationship resulted in over time?

“Our academic-community research partnership began in 1995, and since that time, we have consistently been funded by the National Institutes of Health (NIH) to develop and test numerous interventions to prevent obesity and diabetes. We have worked together to develop the real-world evidence base to prevent chronic disease across generations. For example, we have co-created interventions in which parent educators were trained in the latest methods for lifestyle change, and embedded within a parent-child curriculum, leading to reduced maternal obesity and improved intake of children.

“I look at the thousands of families we’ve reached, and the thousands of parent educators who worked with us to develop and deliver these interventions, advancing practice-based research. And over time, PAT has expanded globally in its work with mothers and children, now conducting studies to prevent maternal morbidity and improve health. The foundation of what we do is science. If we trust our community experts, we can collaborate to co-create an environment where science can thrive and be adapted in ways that fit their real-world context. That, to me, is a significant achievement.”

Q: You also have a key role in the ENRICH clinical trial. Can you tell us about that work?

“ENRICH is a multicenter national trial funded by the NIH and the National Heart, Lung, and Blood Institute. It will test the effectiveness of a lifestyle intervention delivered through evidence-based home-visiting agencies throughout the prenatal and postpartum periods. It is designed to improve the cardiovascular health in over 3,000 mothers and their children, ages 0 to 5, who are of low socioeconomic status, live in low-resource rural or urban communities, or who are in diverse geographic regions of the U.S. with high burdens of cardiovascular disease risk. This trial was informed in part by our collaborative work with PAT, which showed the health impact of partnering with evidence-based home-visiting organizations.”

Q: With your extensive experience in public health here in St. Louis, what do you think about the new WashU School of Public Health taking shape?

“This is a huge accomplishment. When I first came here in 1983, I never thought I would ever see anything like this. And now we’re on the road to being an accredited school of public health. Sometimes I pinch myself when I see what has already been achieved and think about what is to come. This is great.”

Elizabethe Holland Durando is WashU Public Health’s director of communications and change management. She previously was executive director of medical news and media relations at WashU Medicine; a reporter for the St. Louis Post-Dispatch, the Las Vegas Sun and the Northwest Florida Daily News; and also taught journalism and writing courses at The Ohio State University, Lindenwood University and Webster University. She has a bachelor’s degree in journalism from the University of Illinois at Urbana-Champaign and a master’s degree in journalism from Ohio State.