On March 15, 1918, the University of Minnesota Board of Regents approved “the immediate establishment of a University Public Health Department” funded by a student health fee of $3 per semester. Following the Regents’ action, U of M President Marion Burton commented on the importance of the Health Service to the university’s mission: “The Health Service is indispensable to the operation of a large institution. It exists to protect the health of students and prevent disease … it puts a heart into the university.”
Dr. John Sundwall, the first director of the health service, noted that “the best scientific treatment and care of illness and injuries must be one of the major concerns of the Health Service, but (it must also function) in a more progressive and advanced state, in the vanguard of the public health movement.”
With this aspiration, the Health Service developed a unique service model that not only contributed to the overall success of the University and its students but to the development of the field of college health throughout the country. That model continues in Boynton Health, renamed in 1975 in honor of Dr. Ruth Boynton, a public health legend and the first woman to head a major college health service.
Framework starts with community needs
The Boynton Health model was built upon a public health framework that starts with community rather than organizational needs. It recognizes the importance of housing; transportation; nutrition; and cultural, physical, and social environments in addition to clinical care. This framework stimulates collaborative partnerships with multiple nonmedical organizations that impact the social and environmental determinants of health.
The clinical care component of this model embraces a community-oriented primary care approach that comprises medical, dental, and mental health services using a multidisciplinary team including peer Health Advocates, the model for today’s Community Health Workers. With its community focus the primary care team is seamlessly integrated with public health and social services assuring that the medical, social, economic, and environmental factors affecting health are addressed.
The funding approach for Boynton Health is based on the student service fee – the tax students put on themselves to provide universal access to primary care and public health services. All students are assured access to these services with no co-pays or deductibles. It is a community-funded single payer for primary care and public health. An insurance model is used to fund hospital and specialty care. This approach encourages the use of prevention and primary care services, the most effective approach to improving health and controlling costs.
Core component: its governance
The core component of the Boynton Health model is its governance. Student Government, through its Student Fees and Student Health Advisory Committees, oversees the funding of the health service along with other on-campus organizations that impact the overall well-being of the university community. Because of their accountability to all fee-paying students, these committees help maintain fidelity to the public health framework; keeping community needs at the forefront of all funding and organizational decisions.
For 100 years Boynton Health has been at the vanguard of public health in implementing a model that has helped the University of Minnesota create and maintain a healthy environment in which to live, work, and go to school. As we celebrate that milestone, we can learn from the university’s experience and consider a similar model to address Minnesota’s multiple and seemingly intractable healthcare and public health challenges. A state-wide approach that is based on a public health framework, prioritizes community-oriented primary care, uses a publicly financed single-payer mechanism for public health and primary care, is accountable to the people it serves, and “puts a heart” in our state and health system might be a wise approach to re-establishing Minnesota in the vanguard of public health.
The University Health Service was established six months before the 1918 influenza pandemic and helped the university effectively address one of the greatest public health and medical care challenges of the 20th century. After 100 years of experience protecting and improving the health of the university community, the Boynton Health model appears to be even better suited for the significant public health and medical care challenges of the 21st century – not just the challenges facing the university but all of Minnesota.
Edward P. Ehlinger, MD, MSPH, is a former director of Boynton Health and former Minnesota health commissioner.
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