Health in the South

by Jay E. Maddock, PhD, FAAHB


The Dean’s Perspective focuses on issues pertinent to the relationship between academic public health and the practice community.

Jay E. Maddock, PhD, FAAHB

Jay E. Maddock, PhD, FAAHB

Two years ago, this month, I moved from Honolulu to College Station, Texas. People continue to ask me what it is like to move from Hawaii to Texas, and all I can answer is, “It’s different.” It is different in a lot of ways and not just changing Hawaiian shirts, surfing and eating poke for boots, rodeo and barbecue. The public’s health is different and not just in Texas but throughout the South. I had the good fortune to be part of the Healthy Hawaii Initiative from 2000-2015. This program, funded by the Tobacco Settlement Master Agreement, was visionary in addressing tobacco use, physical inactivity, poor nutrition, and obesity, using a social ecological approach. The Initiative combined the expertise of the Hawaii Departments of Health and Education along with the University of Hawaii to create a powerful engine for change. During this time, we watched Hawaii rise through United Health Foundation’s America’s Health Rankings to #1, a place that the state has now held for five years. It is a great example of a state understanding what public health is. In addition to the Healthy Hawaii Initiative, the state took bold actions that included the Prepaid Health Care Act, a school-based flu vaccines program, and raising the smoking age to 21.

With this 15-year experience in the back of my mind, I moved to Texas to become the dean of the School of Public Health at Texas A&M University.  In early October 2015, I was watching the Aggies crush Mississippi State in football at Kyle Field, our stadium that holds over 100,000 people. As I watched this powerhouse battle between two members of the famed Southeastern Conference (SEC), I started to wonder what if these great universities were also known for being engines for public health in their states.  Upon returning to my office, I examined the 14 institutions and 11 states from which they come. The results were not encouraging. The ten SEC states were clearly in the bottom of the health ranking. In 2016, here’s how they ranked: Mississippi (50), Louisiana (49), Arkansas (48), Alabama (47), Kentucky (45), Tennessee (44), South Carolina (42), Georgia (41), Missouri (37), Florida (36) and Texas (33). At 33, we, in Texas, were the healthiest state in the region! Over the past 18 months, I have worked closely with my colleague John Spengler to engage diverse parties around this issue, including university leadership, the Aspen Institute, the SEC Public Health dean and directors, the American Heart Association, and others. These conversations will culminate in the launch of our efforts in April with an action planning meeting.

The list of issues is long and includes obesity, diabetes, infant mortality, unplanned pregnancy, health disparities, and many others. Yet our universities hold much promise. Texas A&M alone has over 66,000 students enrolled. Our schools hold mass gatherings every weekend in the fall with an average of over 75,000 people at each game. The SEC institutions also coordinate the agricultural extension for 8 of the 10 states in the region, a potentially powerful public health workforce that can engage communities throughout the South. These 14 institutions, which includes two members of the prestigious Association of American Universities, represent the premier higher education institutions in many of their states. The potential of this collaborative is amazing, if realized. We know that we need Southern-based solutions that may differ from Hawaii, Massachusetts, and other states’ approaches. But working together, the South can be America’s healthiest region.


Jay E. Maddock, PhD is the Dean of the School of Public Health at Texas A&M University. He is internationally recognized for his research in social ecological approaches to increasing physical activity. He has served as principal investigator on over $18 million in extramural funding and authored over 100 scientific articles. [Full Bio]

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