College: Where Healthy Habits are Born
A NextGen Focus on Your Health
College, as many adults recall, is the best time of one's life. In college, students can enjoy the same privileges as adults without worrying about the responsibilities of raising a family and paying the bills. But college students may think they are indestructible as they drink multiple shots of alcohol late Friday night, pull an "all-nighter" just before the chemistry final, or push themselves to the limit as the mountain of stress escalates in size. Dr. David S. Rosenthal, Director of the Harvard University Health Services (the university healthcare center that serves the entire university community), describes college students as reckless risk-takers who engage in risky behavior without giving enough consideration to how their actions can affect their health.
University health centers see a variety of "age group-specific" health concerns. The major health problems that university health centers treat are colds, flu-like symptoms, common allergies such as dust, mold and pollen, eating concerns, sports injuries, mental health issues such as depression, stress, and anxiety, sleep, and developmental issues such as relationship troubles and roommate concerns. Dr. Rosenthal identifies the above health concerns as the greatest impediments to students who want to feel well.
The average cold is the most common complaint among students, and treating it requires consideration of the cramped and close-knit dormitories in which college students typically live. "The dorms and dining halls are breeding grounds for disease," says Dr. Rosenthal. Offering an extreme scenario, Dr. Rosenthal describes a large epidemic that occurred in the early 1990s at Harvard University: "150 students were hospitalized within 24-48 hours all diagnosed with winter enterogastritis, the common viral stomach flu. Like on a cruise ship, disease is able to spread rapidly and everything happens quickly." University health centers must be prepared for the ease with which disease can spread.
Most universities provide basic health care in order to counter the risk-taking tendencies of their students. The university health centers range from basic infirmaries without in-patient facilities to hospitals that include primary care facilities, specialists, and a surgeon that steps in on a consultative basis. Student health centers are often closely associated with university medical school teaching hospitals. If teaching hospitals are not available, other universities, as Dr. Rosenthal explains "like Stanford and the University of Chicago, are closely [associated with] a hospital that serves the local community." All university health care centers follow the guidelines set by the American College Health Association that deal with the greatest health concerns of college students.
To accommodate the specific needs of college students, university clinics are also structurally different to other types of clinics. As Dr. Rosenthal elaborates, "Ease of entry is an important issue. We want to make it easy for students to come in and have their illness issues raised and responded to quickly. This may not be applicable in community health clinics." University health centers have the advantage of a larger staff of clinicians and a variety of services centralized within one location. They rarely have new patients that must be logistically entered into the system before they can be seen by a clinician. These advantages minimize the time students are forced to sit in a waiting room (an average of ten minutes at the Harvard UHS) and quickly connect students with the most appropriate clinician available. University health centers are open to all students and many do not require additional fees for the services being used. An overall annual health fee is often included in the tuition. Many university health centers are open longer hours than the average community health clinic. Harvard University Health Services, for example, is available to students twenty-four hours a day and seven days a week.
The university health center staff also caters to the college community. Dr. Rosenthal emphasizes diversity, interest in the university population, and most importantly the awareness "that this age groups is not always healthy." Members of the university health center staff often play dual roles. Many have positions at the university health center and at neighboring university teaching hospitals. Dr. Rosenthal says, "Harvard treats 35,000 people, and of those, 20,000 are young. Some universities specifically hire adolescent physicians (physicians who focus on adolescent health) to match the large number of young adults." Clinicians working in university health centers must also be aware of treating each student as an individual. Dr. Rosenthal explains, "It is unusual for college students to approach a university with a health problem. It is the job of the clinician to uncover the real reason of why they are visiting. Are there deeper problems? Clinicians need to be able to delve deeper without offending students." Dr. Rosenthal also advises students to build relationships with the university health centers: "Make contact even if you are well."
The greatest challenge the university health centers face is not a specific ailment, but "receptivity," says Dr. Rosenthal. "College health clinics should be receptive to all aspects of health and emotional development and rely heavily on educational programs to bring health information to the students. The college health focus is prevention and early detection rather than treating. We want to reduce the risk of illness and the development of chronic disease." These prevention and early detection measures address a wide variety of health issues, including "vaccinations, and alcohol and drug abuse. It is important to provide students with information on Sexually Transmitted Infections and how to lead a healthy and safe sex life. Immunizations like meningitis and hepatitis B are required of all university students. Even in mental health, we try to determine who is at risk for depression. We also offer cancer screenings to the graduate school population."
Many university health clinics offer programs and work closely with student peer
groups to increase student wellness. Duke University has created one of the few
integrative medicine (complementary and alternative medicine) health centers.
Also a supporter of integrative medicine, Dr. Rosenthal explains that "services
like massage, acupuncture, relaxation techniques, and chi gong" were added to
the Duke University Health System. Such services emphasize the mind-body
connection and have shown to prevent side effects associated with rigorous
medical treatments. "These services are not just about care, but wellness and
education," says Dr. Rosenthal. He fondly calls his goals of college health
care, "The Big Three": good nutrition, physical activity, and reduction of
stress and anxiety. And so it seems that college may not only be the best time
of life; it may also ensure a healthy life after college. 
Eva Luo is a writer for the Next Generation and a member of the Harvard College Class of 2008.
David S. Rosenthal, M.D. is the Director of the Harvard University Health Services, a Professor of Medicine at Harvard Medical School, and a former President of the American Cancer Society.