Get to know Dr. Catherine K. Ettman, Assistant Professor in the Department of Health Policy and Management at the Johns Hopkins University Bloomberg School of Public Health. Her work explores the social and economic forces that shape population mental health and policies that can reduce mental health disparities. She is the co-editor of Urban Health (Oxford University Press, 2019) and Migration and Health (University of Chicago Press, 2022). Dr. Ettman received her PhD in Health Services Research at Brown University School of Public Health and studied public policy at Princeton University.
Where did you grow up? Tell us a little bit about your childhood and early career.
I was born and raised in Greater Miami, Florida. Growing up in Miami, I saw inequality firsthand, which is what inspired me to study public policy at Princeton as an undergraduate.
After completing my undergraduate degree, I began working in politics in Washington, D.C. and while I was living there, people told me, if you really want to see change, you should move to the states. So I took their advice, and I bought a one-way ticket to Texas, where I got a front-row seat to campaign politics and understanding what really matters to Americans. As I was in knocking on doors and talking to voters, I realized how important health policy was and how poorly understood it was. That experience inspired me to make the shift from politics to public health.
Following my work in politics, I served as Chief of Staff to the Dean at the Boston University School of Public Health. In that role that I saw the power of scholarship to influence policy, and that's when I decided to get my PhD. I headed to Providence, Rhode Island, to pursue my PhD in health services research at Brown University, where I focused on population mental health, assets, and policies across sectors that could reduce mental health disparities and improve mental health. After that, I did my postdoctoral fellowship with Dr. Elizabeth Stewart at Johns Hopkins Bloomberg School of Public Health, and then I became an Assistant Professor into the Department of Health Policy and Management.
How do you think about health assets at the population level?
In my writing, I've defined assets in three ways: financial assets, physical assets, and social assets. These assets together can facilitate access to health, promoting resources that then shape health. For financial assets, those include income and savings, but also debt, wealth, and credit. For physical assets, those include home ownership, auto ownership, and the devices that can facilitate other opportunities, including access to WiFi. Social assets include educational attainment, marital status, and religious affiliation. These are the social assets that may yield privilege in society or even access to material resources.
One reason I'm very keen on exploring these more deeply is that when we talk about economic inequity in the U.S., we often stop at income. But income alone does not tell us the whole story, whereas wealth tells us more holistically about the intergenerational ways that people have accrued assets. By looking at wealth and other financial assets, we may be uncovering additional ways that gaps are growing and become better at understanding historical investments or lack thereof in certain communities through the ability to generate intergenerational wealth, which could open up creative policy solutions. By evaluating these different assets, we can think of many different policies, within both the private sector and the public sector, that can improve people's assets over time and thereby improve their health.
How do you think about prioritizing policy change when this asset mapping presents so many potential levers to affect?
First, we begin where we have data. Even though income only tells us part of the story, it is better than nothing, and wealth is not well documented. Wealth data are hard to come by, so for people aspiring to build out research in this space, I think we want to use whatever asset data and variables we have. Now, if you could do data collection, that's even better, and that's what my team and I have done. I started a longitudinal study called the COVID-19 Life Impact on Mental Health and Well-Being (CLIMB) study with this very goal in mind: we collect detailed asset measures, mental health measures, stressors, and policy preferences. So first, let's use the data we have available to understand these relationships more.
The second answer is collaboration. One of the joys of working in academia is getting to work with students and colleagues, and as a mentor, I seek to understand what motivates my students, and I let them lead the research agenda where appropriate. The good news is that we have a lot to fix, and there is no shortage of questions to answer. With that in mind, I like to see what inspires passion in my students, and then we can pursue those avenues within the research agenda our team has set.
What kind of coursework are you currently teaching at Hopkins?
I teach the Introduction to U.S. Healthcare System with Dr Dan Polsky. This class covers everything from the financing of U.S. healthcare, including private and public payers, how we stack up against other countries, social determinants of health, to prospects for policy change. Our students walk away with the broad understanding of the many facets of the US healthcare system and the way we pay for it, and things that are working well and opportunities for improvement.
I think a misconception that students entering the class may have is that health care alone can fix our health. Hopefully, after taking our class, students also have a better understanding of the many factors that go into producing health and how health care is one part of that, and how having access to health care is very important, but many other sectors play a pivotal role in prevention and the creation of health.
Are there simple interventions that you have come across in your work that people can implement to maintain their own best mental health?
There was some work done over the pandemic by other teams around the factors associated with improved mental health, and many of them were non-medical interventions. For example, going outside, taking a walk, talking to friends, engaging in community–whatever that looked like at the time–eating healthy food that makes you feel energized, getting enough sleep. These are simple interventions that have been associated with better mental health symptoms.
Of course, having access to care is also important, particularly for people who need it or whose symptoms have exceeded clinical thresholds that would benefit from diagnosis and engaging with a healthcare provider, because there's a point after which we can't simply improve our lifestyle factors.
Mental health is sensitive to the world around us, in which there are factors inside our control and outside of our control. For example, we have research that found that job loss was associated with poor mental health symptoms more than two years after the job loss occurred. So stressors like job loss, relationship difficulties, challenges with finances, these are all associated with poor mental health but there are also individual behaviors that people can do to protect and preserve their mental health.
How did the pandemic impact mental health overall?
Symptoms of anxiety and depression were already rising in the 10 years leading up to the pandemic. Our work, along with that of many others, documented high levels of depression and anxiety during the pandemic. The pandemic exacerbated the stressors people were exposed to and it also removed people from some protective elements, for example, the community elements of going to school or going to work, the physical safety and the security that came from leaving the home and engaging with other people in our work.
What we found was that no group was spared the poor mental health that happened post-pandemic. However, there were inequalities that emerged. People with fewer assets going into the pandemic were more likely to experience stressors during the pandemic, and they were more likely to experience poor mental health over time.
One positive outcome has been that we learned how important the world around us is for our mental health. I have seen the national conversation on mental health shift in the years that I've been doing this work: the sophistication of the questions that I get from reporters, the way that people talk about mental health in the media, and the number of public figures who are coming out around their own mental health stories, their challenges but also their success. That has evolved, and my hope is that we can build on that momentum to improve people's awareness of the importance of mental health, build in prevention, and reduce stigma around getting treatment.
What changes you see happening in health care that make you feel optimistic about the future?
There are so many successes that we've made as a country and as a global community. Improvements in life expectancy, the role of women in the economy, in the workplace, in leadership, the role of minoritized groups–there has been tremendous progress in the human condition. There are so many technologies that make our lives so much easier that were invented in the last 100 years that have truly advanced how we exist, and I never want to lose sight of that.
If you could snap your fingers and change one thing about how we approach health overnight, what would it be?
I would invest in children, and I would advocate for policies that give them the strongest start to life, through any combination of policies that provide assets, such as baby bonds, safe and affordable childcare, adequate nutrition, access to medical care when needed, healthy places to grow and play, and high-quality schooling.
What do you enjoy doing outside of work? And what are your favorite things about living in Baltimore?
Outside of work, I like to run. Especially in the morning, I appreciate the quiet part of the day when there is so much potential for the rest of the day. And I love the people in Baltimore. The people are real, they are kind, they are genuine, and they are generous. And the food is excellent.
