When Martha Carvour, MD, PhD, thinks about improving health care systems, she does not begin by designing something new. She starts by asking the right questions. In her recent Grand Rounds presentation, Carvour referenced a Nature study that found that when people confront structural problems, they tend to add layers of complexity rather than remove barriers. Even when removing a single unstable element would remedy a barrier, most people instinctively build more around the flaw.

“We tend to add complexity instead of finding a foundational cause we can address,” Carvour said. “If we strengthen the foundation, the system can support all of those different health conditions and all the patients and communities we serve.”

Her focus on addressing foundational causes to strengthen health systems—what Carvour calls structural resilience—has defined her work and earned her the Ernest A. Lynton Award for the Scholarship of Engagement. This national award, given by Campus Compact in partnership with Brown University’s Swearer Center for Public Service, recognizes a faculty member who meaningfully integrates research, teaching, and service in collaboration with communities.

Over the past several years, Carvour’s research has examined how structural barriers shape health outcomes across Iowa, from diabetes and kidney disease to vaccine uptake during the COVID-19 pandemic. In one study of Midwestern frontline workers, her team enrolled nearly 900 participants to better understand the factors influencing their decisions to get vaccinated. These findings complicated a common one-dimensional narrative of medical mistrust.

“It’s not just hesitancy,” Carvour said. “When you look closely, decisions are based on thoughtful, often nuanced considerations that people are managing in their day-to-day lives—whether they can take time off work, whether they’ll lose wages, whether they have transportation. Those structural factors weigh heavily.”

For Aloha Wilks, the research coordinator and lab manager who has worked alongside Carvour for four years, those findings reflected what she was hearing in communities. In 2022, Wilks helped Carvour organize a two-day health fair in Storm Lake, a town in northwestern Iowa. Instead of asking the community members to travel to Iowa City for care, the team traveled the 240 miles to them—setting up events at Tyson Foods and at St. Mark’s Church, trusted spaces where people already gathered. At the Tyson plant, employees could step away during breaks to receive health information and screenings without sacrificing work hours or income.

“Maybe you need a van for the clinic, or maybe you need to go where community members are,” Wilks said. “And that might look different for each county—but you have to go in and build trust with the community to find out.”

The Storm Lake health fair required extensive coordination with local partners and careful attention to translation and interpretation services. More importantly, it embodied a core principle of Carvour’s work—that communities are not passive recipients of expertise.

“Dr. Carvour makes it so we aren’t coming in as experts and telling people what they need,” Wilks explained. “We’re asking, what are the community priorities around health? How can we pull together existing resources to help the communities fill the gaps they notice?”

The process of meeting people where they are, both literally and structurally, remains a common thread across Carvour’s research. However, the Lynton Award recognizes more than Carvour’s scholarly insights. It also recognizes how she has built an educational model that invites students into systems-level work in sustained and meaningful ways.

Through the educational framework that Carvour, Wilks, and University of Iowa student leaders developed, more than 50 undergraduate, graduate, and health professional students have taken part in community-centered initiatives across the state. Students help design and execute outreach efforts, author peer-reviewed publications, collaborate with community members and community health workers, and learn to translate evidence into practice.

Chris Ahlers, MD, now a resident physician in Internal Medicine at the University of Wisconsin School of Medicine and Public Health, worked with Carvour throughout medical school. In his letter supporting her nomination, he described his experience helping Carvour bring Storm Lake’s multi-day health fair to fruition.

As he reflected on his experience working with Carvour’s program, Ahlers observed that she strived to ensure the program’s research funding was used “to not only publish in reputable journals, but more importantly, directly engage with Iowa communities.”

That commitment extended beyond outreach events. In Iowa City, Ahlers collaborated with Carvour and other colleagues at UI Health Care on an initiative to improve access to kidney transplantation and address racial and rural disparities in chronic kidney disease.

“She always kept student leaders in the spotlight. No student ever contributed to a project without recognition,” Ahlers wrote. He added that while Carvour is “never the loudest person in the room,” her approach to mentorship, both professionally and personally, consistently achieves its intended impact.

Another former student leader, Precious-Junia De-Winton Cummings, PhD, MPH, wrote in support of Carvour’s Lynton Award nomination. She emphasized that Carvour’s educational model integrates academic learning with community-identified priorities, producing both scholarly output and tangible benefits for underserved populations across Iowa. Students work on real problems alongside the people affected by them; this prepares them to serve as health professionals and researchers who understand their patients and study cohorts as community members occupying systems that significantly influence their health outcomes.

Carvour’s projects span more than 1,400 client encounters supported by community health workers in rural northwestern Iowa, dozens of outreach events, and ongoing support groups focused on diabetes, infection care, and kidney disease. The process requires patience, collaboration, and the willingness to build new workflows within an academic health system. Carvour credits numerous staff in Internal Medicine who also helped to develop these workflows.

Carvour believes that integrating research, teaching, and academic-community partnerships can strengthen structural resilience. In this way, she sees collaboration itself as a structural intervention.

“When we bring more people to the table,” she said, reflecting on the program’s evolution, “we can solve a lot of problems together. Communities know what they need. Our job is to listen carefully, partner thoughtfully, and build systems that actually work for people who are affected by those systems.”

The Ernest A. Lynton Award recognizes Carvour’s enduring commitment to communities, students, and the development of structurally resilient health systems. And while working with community health partners and attending community advisory boards, she continues to pursue change by first asking the right questions.