Download - Health Without Boundaries 2008
-
7/30/2019 Health Without Boundaries 2008
1/44
Aga f AcVital Statistics
Deciphering the Mechanisms of Disease
Global Vision
Making an Impact
Only Connect
HealtH
BoundAries:Without
HARVARD
School of Public Health
-
7/30/2019 Health Without Boundaries 2008
2/44
THe HIgHeST aTTaINabLe STaNdard OF HeaLTH IS ONe
Constitution of the World Health Organization, July 22, 1946
OF THe FUNdaMeNTaL rIgHTS OF every HUMaN beINg...
-
7/30/2019 Health Without Boundaries 2008
3/44
Barry R. Bl, Dean
Jan L. and Julius H. Jacbsn II Prfessr f Public Health
Dear Friends and Colleagues:
On June 11, 1998, Harvard President Neil Rudenstine introduced me to the members o the
Harvard School o Public Health aculty as their new dean. It was my understanding that the
weighty responsibility I assumed was to continue the extraordinary stewardship o Harvey
Fineberg and Jim Ware, to expand the Schools global mission, and to assure that cutting-
edge science was brought to our public health enterprise.
Ten years later, I remain enormously grateul or the privilege aorded me and the
opportunity to work with our Harvard presidents. As in public health itsel, i deansdo their jobs well, the results o their eorts are oten invisible providing a smoothly
unctioning, scally sound platorm on which the work o aculty and students fourishes.
Much o what ollows describes some highlights o that fourishing research and its
application over the past decade.
The challenges were many: to develop a ar-sighted ramework or the Schools activities
grounded in the strong, discipline-based approaches o basic science, quantitative science,
and social and policy science; to tie the determinants o health to the most pressing public
health concerns; and to establish strategic directions that draw on both leading-edge science
and a wide array o expertise as problems change. This ramework provides the academic
underpinning or an anticipated new campus in Allston and or our connections across theUniversity.
One o the greatest joys o my deanship has been my interactions with extraordinary
students. We have worked to improve the excellence o our student body examining our
admissions processes and nancial aid policies to attract the best and the brightest. With
terric support rom our riends and all our presidents, the amount o nancial aid we can
provide rom School and University sources has grown six-old in the past decade.
In my rst speech to the Schools aculty and riends, I conessed that one o my
attractions to public health was a long-standing passion to ght or lost causes.
I quoted T.S. Eliot:
I we take the widest and wisest view o a Cause,
There is no such thing as a Lost Cause,
Because there is no such thing as a Gained Cause.
We ght or lost causes because we know our deeat and dismay may be the
preace to our successors victory, although that victory itsel will be temporary; we ght
rather to keep something alive than in the expectation that anything will triumph.
As I refect on events o the past decade, it is gratiying to be able to say that public health
is no longer perceived as a lost cause. It is not yet, however, a gained cause. We in
the School have not only ought to keep millions o people alive, but have made major
contributions through research, training and global engagement. Perhaps as important, I
am proud that we have contributed to keeping the liberal spirit and humane application o
knowledge alive. At the very least, these represent a small triumph.
PHOTO:RickFriedman
-
7/30/2019 Health Without Boundaries 2008
4/44
-
7/30/2019 Health Without Boundaries 2008
5/44
The last decade has witnessed proound and
novel threats to the publics health: the emergence
o deadly new inections such as SARS and the
H5N1 infuenza virus; 9/11 and the specter
o bioterrorism; the spread o drug-resistantpathogens; a steep rise in obesity, diabetes and
related chronic afictions; widening disparities
between rich and poor. All these trends represent
health and social problems compounded by the
orces o globalization. Against this backdrophave unolded revolutions in technology, genetics/
genomics and communications an explosion o
knowledge that, when properly harnessed, could
turn back many o the scourges o our time.
Health Withut Bundaries:Agendas fr Actin
-
7/30/2019 Health Without Boundaries 2008
6/44
Intrductin
The Harvard School o Public Health since 1922, the
worlds most dynamic and rigorous public health research
and teaching enterprise is strategically positioned to
meet the health challenges o the new century. Under
the leadership o Dean Barry R. Bloom, it has boldly
upgraded its mission and structure, building a rm
scientic, educational and nancial platorm or the
uture. Responding to rapid advances in technology
and deepening health crises, the School has envisionedand created entire new departments and programs in
order to address ever-evolving health threats. And HSPH
has vaulted intellectual and geographic boundaries,
embracing an interdisciplinary emphasis on genes
and the environment, quantitative health sciences and
bioinormatics, and global health. The prospect o moving
to a new Allston campus solidies the Schools vision and
central integrative role at Harvard.
Under Dean Bloom, who assumed leadership on January
1, 1999, the School has sustained its tradition o majorcontributions to the elds concepts and methodologies.
Its scientists have unraveled key mechanisms o obesity-
related metabolic syndrome and drug-resistant malaria.
They have modeled the course o emerging inections and
hospital outbreaks. HSPH helped catalyze the visionary
Public Health Foundation o India, and nurture the
ambitious Botswana HSPH AIDS Initiative Partnership to
enhance AIDS research, prevention and treatment. Just as
crucial, the School has continued to inorm public health
policy, rom government smoking bans and environmental
regulations to statutes eliminating trans ats rom
restaurants and requiring its labeling on ood products.
And HSPH is unique among its peers in having had our
o its current aculty awarded MacArthur genius grants.
This small sample o achievements speaks to the Schools
leadership in public health education and discovery.
In contrast to aculties traditionally structured around
disciplines, proessions, skills, or sectors (all o which are
emphasized at the School), HSPH is at heart organized
around solving problems and addressing threats to the
publics health and well-being. With its long-standing
mission o deterring global disease, ocused particularly on
poor and disadvantaged populations, it brings new ideas
to the rontlines o practice. By putting a premium on
prevention, it underscores an approach that has again and
again proven cost-eective, both in human and nancial
terms. By training public health leaders and strengthening
public health institutions nationally and internationally, it
lays the groundwork or lasting change.
To encompass the Schools broad scope o activity and
help it contend with uture threats, HSPH deans and
department chairs recently created a planning matrix,
which rames the Schools strategies or the next 20-50
years. One dimension o the matrix represents the
determinants o population health or the present and
oreseeable uture: environmental, biological, social,
and policy. The other dimension represents public
Harvard University President Drew G. Faust
There is an important public health moment
beore all o us right now. It is a time o great
opportunity or public health in the world
o intellect, in the world o understanding,
and also in the world o Harvard University.
-
7/30/2019 Health Without Boundaries 2008
7/44
Genes
and
Environ.
Genes
and
Environ.
Methods
Chronic
Disease
Chronic
Disease
Chronic
Disease
Injury
Systems
Disparities
Inf.
Dis.
Infectious
Disease
Infectious
Disease
SocialandPolicy
Bio
logic
alQua
ntitative
and
H
ealth
Society,
Hum
an
Dev
.
andManagementHealthPo
licy
andP
opulation
GlobalH
ealth
In
fec
tiousD
i sease
Immunolog
y
and
Comple
xDis
ease
s
Genetic
sand
NutritionEnv
ironmentalHealth
Biostatistics
Ep
idem
iology
5
PUBLIC HEALTH AGENDAS
HSPH PLANNING FRAmEWoRk
INTEGRATIoN oF ACADEmIC STRUCTURE
WITH PUBLIC HEALTH AGENDAS
DETERmINANTS oF PoPULATIoN HEALTH
health problems at the School is committed to addressing:
inectious diseases; chronic diseases; avoidable
environmental threats, injury and violence; health
disparities; and health systems. Far-reaching
and practical, this matrix will enable the School
to respond nimbly and eectively to both endemic
problems and unexpected public health emergencies.
To make progress on this ambitious set o agendas,
the School relies on the disciplinary strengths o its
departments and divisions. It has sought to integrate
these disciplinary approaches with its public health vision.
Investments o School resources stimulate interdisciplinary
research, and planning or a campus in Allston will allow
the use o physical conguration to urther support
academic interactions.
The School has also reinvigorated its educational mission.
A revised curriculum is in development that revolves
around active learning, case-based teaching, problem-solving, and greater attention to the needs o students.
Over the past decade, student nancial aid has increased
six-old, attracting the very top tier o applicants. This
growth in support has been made possible by the
generosity o numerous donors to the School and the
University as well as the increase in endowment payout.
The Schools many successes over the past ten years
under Dean Bloom a distinguished immunologist and
global health authority have built a rm oundation or
uture discovery and policy change. An institution that
has shaped the eld or nearly nine decades, the Harvard
School o Public Health continues to provide vision,
infuence and leadership in one o humankinds mosturgent pursuits.
Unnished Agenda o Inectious Diseases
Coming Epidemic o Chronic Diseases
Unnecessary Epidemic o EnvironmentalThreats/Violence/Injuries
Disparities in Health
Health Systems
Environmental Biological Social Health Policies
HSPH oers breadth
and depth o scholarship
unrivaled in any other
school o public health and
in ew medical centers.
Coupled with that is
great pride in teaching
and a storied tradition
o training the leaders in
the eld domestically
and internationally.
Steven A. Schroeder, MD,
Distinguished Proessor o
Health and Health Care,
University o Caliornia,
San Francisco Department
o Medicine; Chair, HSPH
Visiting Committee
-
7/30/2019 Health Without Boundaries 2008
8/44
-
7/30/2019 Health Without Boundaries 2008
9/44
Mapping and preventing disease over populations
is the signal achievement o public health. Today,
groundbreaking mathematical models are
changing how scientists plot out epidemics and
untangle the roots o complex diseases. At HSPH,quantitative research is paving the way or more
eective prevention and intervention.
Vital Statistics
-
7/30/2019 Health Without Boundaries 2008
10/44
Public Health by the Nubers
New genetic tools are yielding mountains o data about the
underpinnings o disease. But or complex conditions such
as heart disease, diabetes and cancer, how can scientists
determine which genes are relevant and which are not?
With its new Bioinormatics Core and its Program on
Quantitative Genomics, HSPH has wedded computational
biology and inormatics with research in basic science
and epidemiology helping to guide investigators
through todays thicket o inormation. In 2005, a team o
researchers led by HSPH biostatisticians gured out how
to analyze huge quantities o genetic data, surpassing the
capabilities o traditional techniques and speeding the
quest or the genetic basis o asthma, diabetes and other
disorders. This methodology is part o a reely-available
analysis sotware program called PBAT, developed
by Proessor o Biostatistics Nan Laird and Associate
Proessor o Biostatistics Christoph Lange.
Racing Against SARS
When a deadly inection emerges, public health ocials
need to know how the causative organism moves in time
and space. In 2003, Associate Proessor o Epidemiology
Megan Murray and Proessor o Epidemiology Marc
Lipsitch drew on detailed data rom Singapore and other
aected locales to predict how the rightening new SARS
epidemic could unold. Their intensive calculations,
carried out in two weeks to respond in real time to the
ast-moving outbreak, were abetted by Dean Barry R.Bloom, who encouraged the scientists and helped them
prepare their research to meet a grueling publication
deadline. Murrays and Lipsitchs conclusion: Without the
combination o isolation and quarantine the strategy
that, ater several disease control ailures, eventually
succeeded SARS would have inected millions within
six months.
Our young scientists took
on the global challenge o
SARS and with intellectual
brilliance, extraordinary
dedication and great spirit
made a contribution to the
world.
Dean Barry R. Bloom
Right: Transmission chain o
SARS in Singapore, 2003.Many biomedical scientists
are interested in the
complexities o human
biology why certain
people, or instance,
are more likely to have
unhealthy blood pressure,
cholesterol or body mass
index. Until now, no
statistical tools were
available that allowed
researchers to look at
once at several thousand
disease genes and nd
those ew genes that
infuence these complex
traits. Now we have those
tools. Christoph Lange
-
7/30/2019 Health Without Boundaries 2008
11/449
mdeling Drug Resistance
Numerical modeling doesnt only apply to large-scale
epidemics. Combining mathematical models with
epidemiological data, Marc Lipsitch has analyzed the
behavior o drug-resistant hospital pathogens. Lipsitch
examined the relationships between antimicrobial use
and antimicrobial resistance in a variety o bacterial and
viral pathogens. Putting these models to practical use, his
team developed improved treatment protocols to reduce
selection or resistant bacteria reversing what has longbeen seen as an intractable scourge in health care acilities.
Cnnecting the Dts f Chrnic Disease
In their epidemiological analyses, HSPH scientists have
also targeted chronic conditions such as heart disease
and diabetes. Working with colleagues at the Channing
Laboratory and Brigham and Womens Hospital in the
Health Proessionals Follow-up Study, the Nurses Health
Study and the Nurses Health Study II, they have been
ollowing more than 280,000 men and women, tracking
changes in risk actors, body mass index and disease
experience. Among their recent ndings:
Middle-aged and older men who ollow ve healthy
liestyle behaviors reduce their risk o coronary
artery disease. The heart-protective behaviors: not
smoking, exercising daily, drinking moderate amounts
o alcohol, maintaining a healthy body weight, and
eating a healthy diet.
Women who carry excess at around the waist are at
greater risk o dying early rom cancer or heart disease
than are women with smaller waistlines.
Continued
-
7/30/2019 Health Without Boundaries 2008
12/44
Women increase their risk or diabetes as their body
mass index rises or their physical activity declines.
Women can reduce their risk o breast cancer,
especially ater menopause, by avoiding weight gain
in adulthood or losing extra pounds.
Being overweight at age 18 is associated with
an increased risk o premature death in younger
and middle-aged women.
In women, physical activity reduces the risk o
colon cancer.
In men, regular vigorous physical activity early in
adult lie reduces the later risk o Parkinsons disease.
Walking the most common orm o exercise in older
adults helps protect against memory loss.
Using Nurses Health Studies and Health Proessionals
Follow-up Study blood samples, the Schools
researchers ound that people with a genetic variant
known as T-87C, which sits on the region o a gene
that produces the aP2 protein, were ar less likely
than were people without the variant to suer
heart disease, type 2 diabetes, and other contributors
to metabolic syndrome.
To prevent diseases,
we have to distinguish what
we really know rom what
we think might be
as well as rom what we
hope is true.
Meir Stamper,
co-investigator, Nurses
Health Studies and Health
Proessionals Follow-up
Study
Right: Questionnaire, Nurses
Health Study.
-
7/30/2019 Health Without Boundaries 2008
13/4411
Our setting at HSPH
was critical at many
steps in the process.
At the time, ew other
American public health
schools had even one
inectious disease
modeler on their
aculties. We had twoactive research groups
and superb statistical
expertise down the hall
enough to get the
job done.
Marc Lipsitch, on
modeling the SARS
epidemic
-
7/30/2019 Health Without Boundaries 2008
14/44
-
7/30/2019 Health Without Boundaries 2008
15/44
The rontlines o public health extend
to the undamental processes within our cells.
HSPH research into the genetic basis o disease
yields big payos in both population health
and individual care.
Deciphering the mechanissf Disease
-
7/30/2019 Health Without Boundaries 2008
16/44
Let top and bottom:
Laboratory preparations o
brain tissue rom a child in
Arica who died o cerebral
malaria. Blue dots are malaria
parasites.
Right: Textile worker in China.
For decades, our
knowledge o the parasite
has been driven solely
by studies in cultured
cells, not humans. Our
work underscores the
importance o studying
the malaria parasite in its
natural environment, and
will hopeully spark novel
approaches to malaria drug
discovery.
Dyann Wirth
Unasing malaria
HSPH has conducted multi-pronged research into
the wily malaria parasite, which causes approximately 500
million new inections each year. In 2006, Dyann Wirth,
Chair o the Department o Immunology and Inectious
Diseases, and her colleagues unveiled a detailed map o the
one-celled organisms evolving genome a development
that will help scientists track the global spread o virulent,
drug-resistant strains, diagnose and treat malaria more
eectively, revise vaccine-making strategies, and guidethe creation o better drugs. Wirth, the Richard Pearson
Strong Proessor o Inectious Diseases, and HSPH
researcher Johanna Daily published a groundbreaking
study in 2007, identiying which o the parasites genes
are turned on or o during inection in humans. The
discovery sprang rom genomic analyses o parasites in
their natural state in patients blood and rom innovative
computational approaches to interpreting the results.
Genetics f Lung Disease
At the cutting edge o molecular epidemiology, David
Christiani, Proessor o Occupational Medicine and
Epidemiology, is exploring the links between airway
disease, airborne toxins and genetic actors. Using DNA in
long-rozen blood samples rom Shanghai textile workers,
Christiani and his colleagues ound the highest disease risk
in a small subset o non-smokers who have a variant orm
o a particular gene. One day, he predicts, doctors may be
able to screen people or this variant, then counsel thosewho test positive to avoid endotoxins, both in humid,
mold-prone homes and on the job.
Christiani who has conducted occupational-health
research in Asia, Arica and North America has also
developed new biologic markers or pollutant-induced
diseases such as lung cancer, bladder cancer, skin cancer
and upper respiratory-tract infammation. His work
exploring the molecular and genetic basis o lung cancer
serves as a model or examining gene-environment
interactions in cancer development.
-
7/30/2019 Health Without Boundaries 2008
17/4415
M. tuberculosis the
causative organism o TB in a
macrophage.
Tuberculosis is a major
threat to global public
health that demands new
approaches to disease
diagnosis and treatment.
By looking at the genomes
o dierent strains, we can
learn how the tuberculosis
When studying an illness
such as tuberculosis,
which has been around or
millennia, it is important
to consider not just
scientically interesting
microbe outwits current
drugs and how new drugs
might be designed.
Megan Murray
New Appraches t TB
HSPH genetic research has also revealed how the TB
bacterium continues to devastate human lives and evolve
new deenses. Associate Proessor o Epidemiology Megan
Murray co-led an international collaboration that in 2007
announced the rst genome sequence o an extensively
drug-resistant (XDR) strain o the tuberculosis bacterium.
Keenly aware o the swit spread o TB, the researchers
took the unusual step o immediately sharing the sequence
and their analysis ar in advance o submitting a scienticpaper, in order to speed scientic work on drug-resistant
strains.
To illuminate a central question in studying microbial
pathogens Which molecular determinants cause
virulence? Eric Rubin, Associate Proessor o
Immunology and Inectious Diseases, took a novel
approach. Deploying so-called jumping genes in the
tubercle bacillus, he perected a way to knock out 4,000
possible virulence genes, one by one. Rubin went on
to build a comprehensive library o gene mutations,
rom which he has selected mutants that are essential
or growth, inection and virulence, and that identiy
potential drug targets. To the gratitude o the TB research
community, he has generously shared this valuable
resource.
Sarah Fortune, Assistant Proessor o Immunology and
Inectious Diseases, in 2007 was among the rst recipients
o the NIHs New Innovator Awards, or her work delving
into the mechanisms by which the TB bacterium escapes
the host immune response research that may someday
yield targets or vaccines and therapeutics.
questions, but those that
are important to changing
the ace o TB.
Sarah Fortune
-
7/30/2019 Health Without Boundaries 2008
18/44
A T
T A
C G
G C
T A
A T
T A
C G
G C
A T
Let: On the let is a normal
mouse, on the right a mouse
bred to be obese. A rare
gene variant discovered by
Gkhan Hotamisligil protects
obese mice rom metabolic
syndrome a possible prelude
to treatments in humans.
Right: Illustrations o
chromosome, DNA molecule
and typical gene variants
known as SNPs (single
nucleotide polymorphisms)
all involved in genetic
susceptibility to cancer and
other diseases.
Genes and Envirnent
The interace between genes and environment is
rich intellectual terrain or HSPH researchers. At the
Department o Genetics and Complex Diseases, created
by Dean Bloom, scientists explore how molecules, cells
and organisms adapt to nutrients and toxins, and how
genes control these responses. Such research builds on
the Schools tradition o excellence in environmental
health research, and its strengths in population sciences,
quantitative methods and bench science. The ultimategoal: deciphering the causes o complex conditions
such as obesity, diabetes, cardiovascular disease, cancer,
and aging.
Department Chair Gkhan Hotamisligil, the James
Stevens Simmons Proessor o Genetics and Metabolism,
has made major discoveries about the obesity-related
condition known as metabolic syndrome, which
combines risk actors that lead to type 2 diabetes and
heart disease and aficts a sixth o Americans. In 2007,
Hotamisligils team created a designer compound thatprotects mice rom those conditions and other problems
a promising stepping-stone to clinical trials in humans.
Earlier, the team ound a critical missing link in the
biochemical pathway between excess body at and diabetes,
as well as a rare gene variant in humans that helps protect
against type 2 diabetes and heart disease. Someday, proles
o genetic vulnerabilities and environmental exposures
may help quantiy individual risk and prevent and treat
disease beore its too late.
The Schools Program in Molecular and Genetic
Epidemiology, also created under Dean Bloom, applies
exponentially expanding knowledge o human genetic
variation to critical problems o public health importance.
Among the Programs activities: linking specic diseases
to specic genetic proles, and investigating how these
proles interact with the environment and liestyle to raise
the risk o disease. Researchers in the Program are working
with colleagues in the Nurses Health Studies, the Health
Proessionals Follow-Up Study, and the Physicians Health
Study to shed light on cancer, cardiovascular disease,
diabetes, and osteoporosis.
Weve known or a
couple o centuries
that amily history is an
important actor in disease
susceptibility. Now were
starting to draw back the
curtain and see not just
the principal actors rare
mutant genes with dramatic
eects but a whole cast
o characters, that is, minor
variations that infuence
our risk o cancer and other
diseases in big ways.
David Hunter
-
7/30/2019 Health Without Boundaries 2008
19/4417
Program Director David Hunter and collaborators at
the National Cancer Institute have ound inherited gene
variants that raise the risk o breast cancer in women and
o prostate cancer in men. Their discovery o variants
that increase breast cancer risk is viewed as the most
important nding about breast cancer genetics since
the BRCA1 and BRCA2 genes were identied in the
1990s. Work by Hunter, the Vincent L. Gregory Proessor
in Cancer Prevention, is part o the National CancerInstitutes Cancer Genetic Markers o Susceptibility
(CGEMS) project, a genome-wide association study
that capitalizes on the latest generation o DNA chip
technologies. Understanding the mechanisms by which
inherited genetic risks help trigger tumor ormation may
lead scientists to new angles o attack, both or prevention
and treatment.
I see a time bomb
waiting to explode in
the developing world.
Two-thirds o the
worlds population
will be experiencing
the diseases that we now
see in Western societies
within the next decadesChronic metabolic
diseases are the major
threat to the uture
o global health.
Gkhan Hotamisligil
Genome-wide scan or breast
cancer, rom the National
Cancer Institute Cancer Genetic
Markers o Susceptibility
(CGEMS) project, co-led by
David Hunter.
-
7/30/2019 Health Without Boundaries 2008
20/44
-
7/30/2019 Health Without Boundaries 2008
21/44
Research on global health problems pervades
every department at the School. Through
international partnerships and cutting-edge
research, HSPH is tackling the most urgent
health problems and strengthening publichealth institutions around the world. Through
educational exchanges, the School is training
the next generation o public health pioneers.
Students at the Cyprus International Institute or the Environment and Public Health
are joined by HSPH students during Winter Session.
Glbal Visin
-
7/30/2019 Health Without Boundaries 2008
22/44
Botswanas situation is
unique. Nowhere else in
the world has a signicant
raction o the population
been involved in both
ARV treatment or AIDS
Upper let: Max Essex, let,
speaks with Dr. Joseph
Makhema, Project Director
o the Botswana HSPH AIDS
Initiative Partnership.
Upper right, bottom let:
Scenes rom the Botswana-
Harvard HIV Reerence
Laboratory.
and chemoprophylaxis to
prevent transmission o
HIV/AIDS rom mothers to
inants.
Max Essex, Chairman o the
Harvard School o Public
Health AIDS Initiative
Bottom right: David Havelick,
right, Assistant to the Chair,
Epidemiology, asks questions
o a colleague at HSPHs
central site pharmacy in Dar es
Salaam, Tanzania. On the let
are boxes o vitamins.
Africa
The Schools presence in Arica in the early 1980s
expanded to meet the challenges posed by HIV/AIDS.
Over the past decade, HSPH has helped guide the global
outpouring o resources to address the pandemic.
In 1996, Mary Woodard Lasker Proessor o Health
Sciences Max Essex established the Botswana HSPH
AIDS Initiative Partnership, a research and treatment
training program which was the largest o its kind
in Arica at the time. The programs HIV Reerence
Laboratory opened in Gaborone in 2001 the rst
dedicated HIV research lab in southern Arica. In
2005, HSPH reported that the outcomes o Aricas
rst large-scale public program to distribute critical
AIDS drugs to a developing nation an eort led
by Richard Marlink, the Bruce Beal and Robert Beal
Proessor o the Practice o Public Health was
as successul as similar programs in industrialized
countries.
The Schools scientists conducted the rst vaccine
trials in southern Arica, learned how to prevent
mother-to-child HIV transmission, and made key
discoveries in protecting mothers against drug
resistance.
With unding rom the Bill & Melinda Gates
Foundation, HSPH embarked on its AIDS Prevention
Initiative in Nigeria (APIN) program, which couples
prevention with treatment by strengthening local
resources and inrastructure, and by training the
next generation o public health leaders in Aricas
largest nation.
-
7/30/2019 Health Without Boundaries 2008
23/4421
In 2004, based on its longstanding commitment to
conront HIV/AIDS on the continent, the School
was awarded one o our Presidents Emergency
Plan or AIDS Relie (PEPFAR) grants. Operating
in three nations o sub-Saharan Arica, this nearly
$200 million, ve-year project, led by Proessor
Phyllis Kanki, trains health proessionals, strengthens
in-country academic medical centers, and builds
sustainable capacity or treatment, preventive servicesand research.
The HSPH partnership in Tanzania which includes
HSPH, the Dar es Salaam City Council, Muhimbili
University o Health and Allied Sciences,
and Harvard Medical School has built a
state-o-the-art laboratory in Dar es Salaam,
In light o these
ndings, we recommend
that multivitamins be
considered or all pregnant
women in developing
countries, regardless o
their HIV status.
Waaie Fawzi, Proessor o
Nutrition and Epidemiology
and is studying how improved nutrition can curtail
the spread o HIV/AIDS, tuberculosis and other
illnesses. Led by Proessor Waaie Fawzi, a 2007 study
ound that giving daily multivitamin supplements to
HIV-negative women during pregnancy signicantly
reduces the risk o low birth weight a condition that
increases lielong risk o health complications.
Right: Mother and child at
Deborah Retie Memorial
Hospital, Mochudi, Botswana.
-
7/30/2019 Health Without Boundaries 2008
24/44
Top let: Yuanli Liu, ounding
director, HSPH China Initiative.
HSPH China Initiative
Launched in 2005, this ve-year collaboration between
HSPH, the Chinese Ministry o Health, the Central Party
School, and Tsinghua University will apply education
and research to promote health and social development
in China during a time o proound economic and social
transormation. The Initiative addresses occupational and
environmental health, public health surveillance, ood
saety and malnutrition, tobacco control, maternal and
child health, and health systems reorm. In 2007, HSPHwelcomed a delegation o senior health executives rom
China or a three-week intensive training program in
health systems leadership, part o the three-pronged China
Initiative that also includes a Harvard University-wide
orum and a series o applied health research projects.
As a global leader in
knowledge creation and
transer, the Harvard School
o Public Health has the
capacity to help China
eectively address major
issues in health sector
development through
research and education.
Yuanli Liu, Director o the
HSPH China Initiative
Public Health Fundatin f India
Expected to become the worlds most populous nation by
2040, India aces daunting challenges: huge burdens o
disease, a lack o needed medical care in many regions and
a dearth o public health proessionals. To grapple with
these problems, HSPH in 2006 helped to create the Public
Health Foundation o India, a public/private partnership
which is working in collaboration with the Government
o India, the Bill & Melinda Gates Foundation and other
private sector partners. PHFI will shape education, policyand practice, and build world-class Indian institutes o
public health and HSPH hopes to assist through aculty
and student training, and research ties.
-
7/30/2019 Health Without Boundaries 2008
25/4423
Cyprus Internatinal Institute fr the
Envirnent and Public Health
HSPH-Cyprus Prgra in Bstn
In 2005, HSPH and the government o Cyprus established
research, education and technology links to tackle
environmental health problems generating knowledge
and capacity that can be shared across the environmentally
ragile Mediterranean region. The collaboration ocuses
on a range o challenges, rom measuring environmental
and workplace contaminant exposures to investigating theeects o air pollution on respiratory and cardiovascular
health, and provides doctoral training.
Internatinal Field Classes
The Department o Global Health and Population recently
launched a lecture/seminar/case study course in Brazil, the
nation with the largest population in Latin America. Home
to one o the most inequitable income distributions in the
world, as well as some o the most entrenched inections,
Brazil exemplies the deep connections between health
and wealth, and the ecological dance between disease-
causing agent, host and environment. HSPH students and
Brazilian students work together in disease-endemic areas,mapping the economic, social, cultural and demographic
characteristics that raise the risk o schistosomiasis
and leishmaniasis. Teaching the course is Mary Wilson,
Associate Proessor in the Department o Global Health
and Population and Felipe Fregni, Assistant Proessor in
Neurology, Harvard Medical School. Other HSPH Winter
Session courses take students to India, Bangladesh, Chile,
China, and Tanzania.
Lower let: A So Paulo State
disease control program
worker prepares to spray
insecticide during the
Harvard-Brazil collaborative
course on inectious diseases.
-
7/30/2019 Health Without Boundaries 2008
26/44
concluded that health improvements boost developing
economies a concept they call health-led growth.
Canning, Bloom and their colleagues ascribe a signicant
portion o the success o post-World War II Asian Tiger
economies to the survival and education o a younger
productive generation the demographic dividend.
Improvements in health disproportionately beneted
inants and children who, while initially imposing a set
o burdens on their adult caretakers and society at large,eventually matured into a bulge generation that came to
represent a potent economic orce. In the v iew o Canning
and Bloom, health has contributed in multiplicative ways
to wealth in Asia not just the other way around.
The Degraphic Dividend
The demographic paradox o China and India emerging
superpowers as well as home, collectively, to hal the
worlds poorest individuals has inspired HSPH
researchers to ask what accounts or these two nations
spectacular rise, and what the uture holds. At HSPH, a
team o economists, demographers and experts in global
health have ound that improvements in health were major
actors propelling the countries economic success and
that investments in basic health care could sustain thesetwo nascent economies ar into the uture.
David Canning, Proessor o Economics and International
Health, and David Bloom, Chair o the Department o
Global Health and Population and the Clarence James
Gamble Proessor o Economics and Demography,
You need to invest in
health not just or its
contribution to well-being,
but also because health is
a source o productivity.
David Canning
-
7/30/2019 Health Without Boundaries 2008
27/4425
As a result o this
program, many
people who were
on their deathbeds
are back on their eet
and are productively
engaged and providing
or themselves and their
amilies.His Excellency Festus
Mogae, President o
Botswana, on the
Botswana HSPH AIDS
Initiative Partnership
Top: Chart rom Bloom, DE and
Williamson, JG: The World Bank
Economic Review, Vol. 12, pp
419-55 (1998).
The rising share o working-age
people in a population leads to
a rise in the rate o economic
growth the demographic
dividend.
-
7/30/2019 Health Without Boundaries 2008
28/44
-
7/30/2019 Health Without Boundaries 2008
29/44
At HSPH, the ultimate goal o knowledge
is improving lives and inorming policy. Today,
the School continues its long tradition o making
a dierence rom promoting international
tobacco control to ostering healthy eating habitsto reducing health disparities.
maing an Ipact
-
7/30/2019 Health Without Boundaries 2008
30/44
Breathing Easy
The air we breathe is cleaner because o HSPH researcher.
Proessor o Environmental Epidemiology Joel Schwartz,
who while at the U.S. Environmental Protection Agency
identied lead in gasoline as a crippling environmental
exposure. He has gone on to link elevated death rates to air
particulates rom coal-burning plants and motor-vehicle
exhaust and has worked to tighten government air quality
standards. At HSPH, he and colleagues have investigated
the link between atmospheric particulates and heartattacks, bronchitis and asthma. He played a pivotal role
in the EPAs decision to set stricter clean-air standards or
ne particulates and in the Supreme Courts 2001 decision
upholding that standard. In 2006, Schwartz coauthored the
eight-year ollow-up to the landmark Harvard Six Cities
Study, nding that people live longer in cities that most
reduce ne particulate pollution. His work continues to
engage collaborators and help rewrite regulations around
the world.
Staping out Cigarettes
That many nations in Europe and Asia passed smoking
bans or public places is a testament to the eorts o
Howard Koh, Harvey V. Fineberg Proessor o the
Practice o Public Health, and Greg Connolly, Proessor
o the Practice o Public Health in the Division o Public
Health Practice. Dean Bloom recruited Koh ormer
Massachusetts Commissioner o Public Health to the
School, specically to reorganize and strengthen the
Division o Public Health Practice. Koh, in turn, recruitedhis colleague Connolly previously director o the states
Tobacco Control Program to join him.
Both ocials have gone on to lead the charge or
worldwide tobacco control at both the grassroots and
government levels. Connolly, an advisor to the World
Health Organization and an international ambassador or
policies that saeguard the public against passive smoking,
shuttles rom one country to the next conducting local
research, coordinating anti-smoking media campaigns,
You have to build the
capacity to do research
locally, then add a heavy
dose o aggressive anti-
tobacco advertising to
oster social change and
build enough political will
to raise taxes, ban smokingLeading the charge against
smoking: Howard Koh (let)
and Greg Connolly.
in public places, and
oer people treatment or
tobacco addiction.
Greg Connolly
-
7/30/2019 Health Without Boundaries 2008
31/4429
and advising government ocials. Both he and Koh have
increasingly directed their attention to developing nations,
where smoking rates remain high and where multinational
tobacco companies see markets ripe or exploitation.
In 2007, an educational campaign o a dierent sort
led by Dean Bloom and Associate Dean Jay Winsten
paid o when the Motion Picture Association o America
responded to their presentations and announced that the
glamorized depiction o smoking in lms would, or the
rst time in 40 years, join sex, violence and adult language
as a actor in determining movie ratings. The new rating
criterion enables parents to protect their children rom
the harms o the largest preventable cause o disease
in the world.
Eating Healthy Fds
When the U.S. Food and Drug Administration in 2006
ordered that nutrition labels or packaged oods sold in
the U.S. must list all harmul trans atty acids, it signied
a long-sought victory or HSPH scientists. Walter Willett,
Chair o the Department o Nutrition and Fredrick John
Stare Proessor o Epidemiology and Nutrition, Proessor
Meir Stamper, and Associate Proessor Eric Rimm,
in the Departments o Epidemiology and Nutrition,
and collaborators had or more than a decade amassedevidence that these solid ats ound in commercially
prepared baked goods and processed oods raised the
risk o coronary artery disease, type 2 diabetes and other
ills. As a result o the new rule, many companies and
international restaurant chains were compelled to reduce
or altogether eliminate these insidious ingredients, which
annually account or tens o thousands o premature
deaths in the U.S. alone.
Now people have the
inormation they need
to make healthier ood
choices. Beore, it was
almost the luck o the draw
as to whether their product
was healthy or loaded with
trans ats.
Walter Willett
Let: Scarlett Johansson, in the
2006 flm The Black Dahlia.
On January 1, 2006, the U.S.
Food and Drug Administration
began requiring that ood labels
include trans at content.
-
7/30/2019 Health Without Boundaries 2008
32/44
Saving Wens Lives
In 2005, Sue Goldie, in HSPHs Department o Health
Policy and Management, received a MacArthur genius
award or creatively applying the tools o decision science
to combat major public health problems. Goldie, Roger
Irving Lee Proessor o Public Health, has devoted her
career to constructing decision models that have the
potential to save millions o lives. She is perhaps most
well known or her analysis o women in poor nations
who suer disproportionately rom preventable diseasessuch as cervical cancer, which is caused by the human
papillomavirus (HPV). Devising computer-based
models that link the basic biology o a disease and its
epidemiology to population-based outcomes and costs,
she ound that the number o women dying rom cervical
cancer could be reduced by 30-50 percent i two simple,
cost-eective methods were used to screen women in
poor nations once or twice between the ages o 35 and 45.
The methods include automated swab testing or cancer-
causing types o HPV, and direct visual inspection during
which vinegar is applied to the cervix the latter process
costing less than $1 per screening.
Iprving TB Vaccines
Alongside his academic leadership role, Dean Bloom has
kept up an active career in bench science, as the principal
investigator o a laboratory researching new vaccine
strategies or tuberculosis. The current TB vaccine is the
worlds most widely administered childhood vaccine
but requires needles, not only a health risk in developing
countries, but a method that has shown widely variable
eectiveness in dierent parts o the world.
In 2007, collaborating with a team assembled by Proessor
David Edwards, Gordon McKay Proessor o the
Practice o Biomedical Engineering in Harvards School
o Engineering and Applied Sciences, Blooms group
developed a novel spray-drying method or delivering the
most common tuberculosis vaccine. The process could
Young women dying rom
cervical cancer is a public
health tragedy in light o
eective and cost-eective
screening methods. Our
analysis adds strong
support to changing the
long-standing perception
that screening will be
Rising rates o
tuberculosis and drug-
resistant disease in
developing countries
have amply illustrated the
need or more eective
vaccine. While most new
TB vaccines continue to
call or needle injection, ourLet: Sue Goldie with children
at Clinique Bon Sauveur, Haiti.Right: X-ray o chest o patient
with miliary tuberculosis.
too dicult to implement
and sustain in the worlds
poorest countries.
Sue Goldie
vaccine could provide saer,
more consistent protection
by eliminating these
injections and the need
or rerigerated storage.
David Edwards
-
7/30/2019 Health Without Boundaries 2008
33/4431
one day provide a better approach not only or stemming
the TB epidemic, but also or delivering other vaccines
without needles in the developing world. In 2008, a version
o the vaccine administered directly to the lungs as an
inhaled mist showed signicantly better protection against
the disease in experimental animals than a comparable
dose o the injected vaccine.
Iprving Care fr minrity Ppulatins
Assessing hospital care or minority populations, HSPH
researchers have uncovered disturbing patterns o
inequities. Two recent studies examining where elderly
blacks and Hispanics receive hospital care ound not only
that their treatment is concentrated in a small number
o U.S. hospitals, but that these acilities provide a lower
quality o care or such common medical conditions as
heart attacks, congestive heart ailure and pneumonia.
Arnold Epstein, Department Chair and John H. FosterProessor o Health Policy and Management, and Ashish
Jha, Assistant Proessor o Health Policy and Management,
examined the ve percent o U.S. hospitals with the highest
proportion o elderly black and Hispanic patients, among
the approximately 4,500 hospitals that provided medical
or surgical care to Medicare patients. These institutions
treated approximately hal o all elderly Arican American
and Hispanic patients. But the researchers conclusions
were not all dire: given the concentration o these ethnic
minorities in a small number o hospitals, interventions to
improve these acilities could disproportionately benet the
health o black and Hispanic Americans.
A very small number o
hospitals care or most
o the elderly Arican
Americans in this country,
and these hospitals refect
Americas overall problem
with health care quality: too
many hospitals provide poor
care.
Ashish Jha
-
7/30/2019 Health Without Boundaries 2008
34/44
Expsing Health Disparities
While overall lie expectancy in the U.S. increased between
1960 and 2000, a long-term study o mortality patterns
over those same our decades revealed troubling trends,
according to HSPH scientists. In a recent report, Majid
Ezzati, Associate Proessor o International Health,
and colleagues showed that lie expectancy declined or
stagnated among a signicant segment o the population,
beginning in the 1980s. Most o the counties that
experienced the worst declines were in the Deep South,along the Mississippi River and in Appalachia.
To graphically portray and monitor socioeconomic
inequalities in health, Nancy Krieger, Proessor o
Society, Human Development, and Health, and her team
developed a geocoding tool that matches health outcomes
data collected by public health systems with geography
in this case, census tracts or which the ederal
government collects economic data. Krieger and her
colleagues showed that people who live in neighborhoods
with the highest poverty levels suer more heart disease,
cancer, diabetes, sexually transmitted diseases, childhood
lead poisoning, low-birth weight inants, gunshot wounds,
tuberculosis, homicides, and other common indicators o
poor public health. The geocoding tool has been adopted
not only by health departments, but also by geographers,
urban planners and community-based health activists.
While death is inevitable,
premature mortality is
not, and neither are social
inequities in premature
mortality.
Nancy Krieger
Maps depicting change in
lie expectancy in the U.S.,
1983-1999. During that period,
lie expectancy declined
signifcantly in 11 counties or
men and in 180 counties or
women. Warmer colors signiy
decline in lie expectancy.
From Ezzati et al, PLoS
Medicine, April 2008.
1983 1999
-
7/30/2019 Health Without Boundaries 2008
35/4433
This isnt just pure
science its science
or public policy. I
youre not willing to rub
peoples noses in the act
that youve identied
a problem, and that
something needs to be
done about it, then haveyou improved public
health? You need to be
willing to take the next
step and to take a lot
o criticism o your
ndings rom people
who have a monetary
interest in their not
being true.Joel Schwartz
-
7/30/2019 Health Without Boundaries 2008
36/44
-
7/30/2019 Health Without Boundaries 2008
37/44
HSPH is one o the most academically diverse
o all the Harvard graduate schools, ranging rom
undamental science to global health practice.
This disciplinary richness, coupled with the
Schools ambitious mission to generate newknowledge and apply it to improve the health
o populations in this country and around
the world make it a natural connector
across the University.
only Cnnect...
-
7/30/2019 Health Without Boundaries 2008
38/44
A Comprehensive Cancer CenterDesignated by the National Cancer Institute
DANA-FARBER/HARVARD CANCER CENTER
Cnnecting acrss the Capus
The Schools connectivity is partly refected in its
combined degree programs. Medical students can pursue
an MD/Master o Public Health degree, and dental
students a DMD/DDS/MPH degree. HSPH and Harvard
Law School oer a Juris Doctor/MPH degree, which
supports careers in health law, public health policy and
related elds. Project Antares, an HSPH collaboration
with Harvard Business School, aims to address global
health problems through micronance and sustainableand scalable business enterprises. In addition, several
HSPH aculty members teach undergraduate courses
in Environmental Health and Global Health and lead
reshman seminars.
The Harvard Center or Population and Development
Studies, based at HSPH, is a University-wide center
which serves as a locus o interdisciplinary research
on population change, socioeconomic development
and human health. Among the Schools other thriving
University connections are its relationships with
the Harvard Initiative on Global Health; the University
Center or the Environment; the Institute or Quantitative
Social Science, the Center on the Developing Child, and
the Broad Institute at MIT and Harvard. The Schools
ongoing research ties to Bostons premier hospitals
include collaborations with the Channing Laboratory and
Brigham and Womens Hospital on the Nurses HealthStudies, and with the Dana-Farber/Harvard Cancer
Center, the largest comprehensive cancer center
in the world.
A new Gene-Environment Initiative, launched by
Dean Bloom, has gathered biologists, epidemiologists,
environmental scientists, and biostatisticians to integrate
knowledge about quantitative genomics, genetic
HSPH unctions as the
conscience o Harvard as it
helps to address the major
health concerns acing
the people on our planet.
Steven A. Schroeder, MD,
Distinguished Proessor o
Health and Health Care,
University o Caliornia,
San Francisco Department
o Medicine; Chair, HSPH
Visiting Committee
The Harvard School o
Public Health is among
the most interdisciplinary,
inviting and open academic
environments on campus.
Gary King, Director,
Institute or Quantitative
Social Science, Harvard
University
-
7/30/2019 Health Without Boundaries 2008
39/4437
epidemiology, exposure biology, and the mechanisms
o environmental injury, in order to spark new cross-
disciplinary research.The prospect o moving HSPH to
a new campus in Allston will acilitate yet more linkages
across the University rom biological sciences and
economics to government, regional studies and business.
Cnnecting with the Public
The Schools enhanced commitment to communications
is another orm o connection. Its robust Oce o
Communications, led by Robin Herman, Assistant Dean
or Communications, is the primary inormation resource
or the institution, keeping HSPH in the lead among all
schools o public health in media citations. The Schools
new Health Communication Concentration trains
students as well as public health leaders, practitioners
and researchers in eective communication techniques.The Nieman Fellowships in Global Health Reporting
a joint initiative between HSPH and Harvards Nieman
Foundation or Journalism deepen public understanding
o health issues in the developing world. This training
eort is led by Jay Winsten, Frank Stanton Center Director
o the Center or Health Communication.
2006 Mayors Award or
Excellence in Childrens
Health. From let to right, Matt
LiPuma, Executive Director o
the Family Nurturing Center
o Massachusetts; HSPH
Dean Barry R. Bloom; James
Mandell, President and CEO,
Childrens Hospital Boston;
Boston Mayor Thomas Menino.
-
7/30/2019 Health Without Boundaries 2008
40/44
Active Learning
The Schools educational mission binds together its varied
and ar-fung activities. Oering a variety o doctoral and
masters degrees, HSPH strives to ensure that each o its
programs is not only rigorous academically but attracts
the best students in the world. Its increasing nancial
aid made possible by growing numbers o scholarship
gits received at the University and School levels, as well
as increases in the endowment payout draws todays top
young scholars. Adding to the Schools rich educationalenvironment is the diversity o the individuals who study
here; today, more than hal o HSPH students are women,
13 percent represent minorities, and 33 percent come
rom abroad.
As public health research broadens in scope and
complexity with increasing emphasis on inormatics,
genomics, communication, cultural competence,
community-based participatory research, global health,
policy and law, and public health ethics so will the
educational needs o HSPH students. Looking orward
to teaching and training or the 21st century, the newly-
established HSPH Oce or Educational Programs, led by
Associate Deans Nancy Kane and Nancy Turnbull, was set
up by Dean Bloom and Academic Dean James Ware, the
Frederick Mosteller Proessor o Biostatistics. Its purpose
is to rethink and strengthen the Schools educational
programs rom course work to mentoring to practicum.
Forging an aggressive agenda, the Oce is boosting case-based teaching and active learning across the curriculum.
It is systematically identiying high-quality practicum
experiences, inviting eedback to aculty on the quality
o teaching and providing support or improvement,
engaging key alumni, and adapting course oerings and
sequences to the needs o the student body. In all 2008,
it will oer a case-based alternate core curriculum or
proessional masters students.
Even people who were
students with me back
in the 1970s are still
my colleagues. I see
them around the country,
around the world, and
we have an instant basis
or collaboration and
conversation, as well
as riendship.
Walter Willett, Chair
Department o Nutrition
Each year when I ask the
graduating students what
was the most rewarding
aspect o their experience
at HSPH, the answer or ten
years has invariably been,
The other students.
Dean Barry R. Bloom
-
7/30/2019 Health Without Boundaries 2008
41/4439
HSPH attracts some o
the smartest and most
committed students
rom around the world.
My classmates have
been business leaders,
politicians, physicians,
lawyers, journalists, and
even poets. Each newconnection has given me
insight into how public
health aects all aspects
o the world around us.
Karen Grpin, HPM,
SM 2004
-
7/30/2019 Health Without Boundaries 2008
42/44
Endowment
Income12%
Other Investment
Income2%
Student Income8%
Gifts for
Current Use3%
Other Income
3%Federal
Research
58%
Non-federal
Research14%
The past decade has sustained the Schools 21-year record
o continued growth and strong scal management.
During this time, HSPH operating expenses have almost
doubled, rom $152 million to $297 million. The sources
o that unding have remained airly constant with
roughly 70 percent o revenues deriving rom sponsored
sources, mostly the National Institutes o Health (NIH).
This nancial model depends on both the continued
success o the aculty in obtaining research grants and
on steady Congressional unding o the NIH. During the
rst part o the past decade, the NIH saw a doubling o its
budget (1998 to 2003); more recently, however, it has been
level unded.
To address this scal reality, HSPH has taken two prudent
approaches under Dean Blooms leadership. First, the
School broadly analyzed its nances. Early on, it engaged
The Boston Consulting Group on how HSPH could
manage its resources more eciently. Based on the BCG
report, the School developed, with a aculty committee,
a budgeting method that has boosted transparency and
created reserves at both the School and department levels.
Second, the School quantied its nancial risk. It devised
a nancial sensitivity model to understand the impact
o possible reductions in sponsored unds. It also drew
up contingency plans that show how the School would
weather a downturn with the support o reserves and with
appropriate budget reductions.
Fortunately, the School has not had to implement those
measures, because o the continuing success our aculty
has enjoyed in garnering competitive grants rom
government and other sources and also because o the
expanding generosity o hundreds o individuals and
scores o corporate, organization and oundation donors
who support the Schools mission each year.
Finances
HSPH budget growth, 1999-2008 FY07 Operating Revenues
Through the Catherine
B. Reynolds Foundation
Fellowship, I have been
able to study at the best
school in the world
which I would never have
been able to do, given
my salary o less than
$4,000 USD a year. The
Fellowship ocuses on
social entrepreneurship and
leadership skills that are
important or bringing about
positive social change.
Julian Atim, 2007-2008
Catherine B. Reynolds
Foundation Fellow
-
7/30/2019 Health Without Boundaries 2008
43/44
2008, President and Fellows o Harvard College
Producer
Jonathan Barkan is the
Executive Producer/Director o
Communications or Learning, a ull-service
communications frm in Arlington, MA,
serving corporate, government and non-
proft clients since 1972.
Writer
Madeline Drexler is a Boston-basedjournalist and author, specializing in
science, medicine and public health.
She holds a visiting appointment at the
Harvard School o Public Health.
Designer
Yuly Mekler is Creative Director/Principal
at iMmedia Design, serving corporate and
institutional clients in branding and design.
Photography:
Fabrizo Bensch / REUTERS
Dan Bersak
Barry Bloom
Suzanne Camarata
CORBIS
Amit Dave / REUTERS
Kent Dayton
Eye o Science / Photo Researchers, Inc
Richard Feldman
Louise Gubb / CORBIS SABA
Harvard News Ofce
Michelle Holmes
Daniel Leclair / REUTERS
Nurses Health Study
Finbarr OReilly / REUTERS
Pan American Health Organization
Physicians or Human Rights
Paolo Santos / REUTERS
Stockbyte / Getty Images
Dadang Tri / REUTERS
Andrew Wong / REUTERS
Zephyr / Photo Researchers, Inc
Special thanks to HSPH contributors:
Robin Herman
Anne Hubbard
Julie Raer ty
Christina Roache
Alix Smullin
For information please contact:
HSPH Ofce o Communications
617-432-4388
www.hsph.harvard.edu
Over the past two years, increased allocations o
endowment income provided by the University or
strategic investment have enabled the School to support
recruitments and seed research supporting its strategic
initiatives. These investments are critical to maintaining
our competitiveness in obtaining sponsored unds.
Over the past decade, total budgetary support rom
endowment has grown rom 10 percent to 14 percent in F08.
Looking to F09, the School projects a budget o $304 million.
HSPH anticipates that it will continue to increase student
fnancial aid, support its strategic initiatives and build
its reserves.
-
7/30/2019 Health Without Boundaries 2008
44/44
Never doubt that a small
group o thoughtul,
committed peoplecan change the world.
Indeed, it is the only
thing that ever has.
Margaret Mead
HARVARD
School of Public Health