The clinical setting directly influences about 20 percent of the outcomes and the patient’s genetic predisposition accounts for another 20 percent. That leaves about 60 percent of outcomes that are influenced by upstream factors related to housing, employment, education, social network. Those social determinants are actually driving health outcomes.

The Journey

When Tracie Collins MHCDS’18 was a teenager, her mother began suffering persistent abdominal pain, but each time she sought a diagnosis doctors assumed she was seeking drugs, and sent her away. Finally she decided fly to the Louisiana hospital where her sister worked as a head nurse, thinking doctors there would be more likely to take her seriously. She made it as far as Texas, where airline workers called an ambulance. She underwent emergency surgery for a bowel obstruction and spent three months in the hospital.

Her mother’s misdiagnosis drove home to Collins the power of preconception, as did a conversation with her aunt. “I told her maybe I’ll become a nurse like you, and she immediately said, ‘No. You're going to become a doctor.’”

The Calling

Collins did that and more, following her medical degree from the University of Oklahoma with an internal medicine fellowship and Masters of Public Health, both at Harvard. In her clinical practice as a vascular specialist, Collins recognized that her mother’s experience of inequity was far from unique.

“I noticed that folks of color seemed to get amputations more frequently as compared to non-Hispanic whites, and when I looked at the data, that’s what I found,” says Collins, whose research includes NIH-funded trials of new technologies to promote healthy physical activity among African American and Latino adults at risk for cardiovascular disease.

Looking Ahead

Collins credits Dartmouth’s MHCDS program with honing a holistic understanding of the health care industry that informed her work as Dean of the University of New Mexico’s College of Population Health and prepared her to lead New Mexico’s Department of Health through the worst public health crisis in more than a century.

She started the job in mid-December, as COVID-19 infections soared and her department was handed the time-sensitive task of distributing hundreds of thousands of vaccine doses. Just four days before Collins took the reins, the state of New Mexico activated crisis care standards, banning elective surgeries and setting the stage for rationing care should it become necessary. It’s a daunting task, she admits, “but I’m a lot more effective when I’m calm.”

Collins believes New Mexico’s pandemic response can be an example for other states, despite having fewer hospital beds per capita than all but a handful of states, and unusually large populations of elderly and low-income residents. “The experience at MHCDS around networking and organizational culture and change will help me in this new role,” she says. “It’s a major responsibility and an opportunity to make a difference for the people of New Mexico.”