harvard public health, fall 2012
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The dollars & sense of public healthTRANSCRIPT
Six Cities: A Decades-Long Fight for Clean Air
Making the Case for Public Health
Why Do We Age? Surprising Revelations from a Worm
HSPH.HARVARD.EDU
HEALTHHARVARD
PUBLIC
The Dollars & Sense of Public Health
Fall 2012
T of life expectancy on average in the United States.
According to the federal Centers for Disease Control and
Prevention, these advances included: the eradication of
smallpox and control of other infectious diseases through
vaccination; improved sanitation and access to clean
water; improvements in food safety and nutrition; safer
workplaces; family planning; and a drop in smoking rates.
Today, different public health problems threaten
economic gains, both in affluent and developing
countries. Of particular concern are rising levels of
noncommunicable diseases, such as obesity, diabetes,
high blood pressure, heart disease, cancer, and mental
disorders. In the U.S., three-quarters of health care dollars
go to treating these chronic—and often preventable—
diseases.
Health, of course, is an intrinsic value—an end in
itself. But it is no contradiction to add that healthy people
make for a healthier economy. In the U.S. and around the
world, a strong and sustained investment in public health
is the best policy bargain of all.
he cover story in this issue of Harvard Public Health
explores one of the most complicated intersections
in policymaking: the nexus of public health and the
economy. With the November U.S. elections just two
months away, voters can consider what we have learned
about these closely linked issues.
One thing we know for sure: A nation’s health
performance and economic performance can’t be
separated. On the most fundamental level, wealthier
nations tend to have better health conditions and
therefore healthier people. And as HSPH’s David Bloom
has shown, healthier people likewise promote economic
growth, in part because they are more productive and
Health & Wealth
A nation’s health performance and economic performance can’t be separated.
less likely to cost health care dollars. In developing
countries, a 10 percent increase in life expectancy at
birth is associated with a rise in economic growth of
0.3–0.4 percent a year, according to a 2001 report
by the World Health Organization’s Commission on
Macroeconomics and Health. Recent events in the news
confirm that as countries around the world advance,
they realize that creating universal health care systems
nourishes long-term economic growth.
Public health, which focuses on disease prevention
and health promotion, is central to an economy-
boosting healthy population. In the 20th century,
public health advances accounted for 25 more years
DEAN’S MESSAGE
Julio FrenkDean of the Faculty and T & G Angelopoulos Professor of Public Health and International Development, Harvard School of Public Health
2Harvard Public Health
HARVARD HEALTHPUBLIC
Fall 2012
Image Credits: main image, HSPH; all others clockwise from top, William Mair; Shaw Nielsen; courtesy of Jack Spengler; Jones Adam/Photo Researchers.
COVER STORY16 The Economy and Public Health
As the election season heats
up, seven HSPH experts draw
surprising connections between
public health and the U.S.
economy.
38 Why Do We Age? Surprising Revelations from a Worm
The School’s William Mair explores
why we get frail as we get older.
FEATURES
2 Dean’s Message: Health and Wealth
Healthy people make for a healthier
economy.
12 HSPH 2012 Commencement
14 Making the Case for Public Health
Q&A with HSPH professor Robert
Blendon.
25 Working the System
HSPH alumnus Anthony Chen tackles
the big issues in Washington State.
28 Infographic: The Dollars and Sense of Chronic Disease
DEPARTMENTS
42 Arku’s Journey
Student Raphael Arku traded a
lucrative job for a career cleaning up
air and water in Ghana.
30 Prevailing Winds
The Six Cities air pollution study
showed that when science triumphs,
the public wins.
4 Frontlines
9 Philanthropic Impact
45 Continuing Professional Education Calendar
46 Alumni News
48 Faculty News
Back Cover HSPH and the Affordable
Care Act
4Harvard Public Health
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top, ©Tony R
inaldo; Don Farrall/D
igital Vision
HSPH RAISES A HEALTHY CUP TO CHEF JAMIE OLIVERJamie Oliver—celebrity chef, TV personality, and “food revolution” activ-
ist—accepted HSPH’s Healthy Cup Award in May before an enthusiastic
audience of more than 500 at the Joseph B. Martin Conference Center in
Boston. “Jamie Oliver has changed the way millions of people think about
the importance of healthy eating and healthy cooking,” HSPH Dean Julio
Frenk said at the ceremony. “He … continues to be tremendously influential
in the battle against childhood obesity, which is of critical importance to the
world’s present and future health.”
“We need a food revolution,” Oliver told the audience. “Imagine a world
where children are fed real food and educated about it. Where I knew where
my meat came from and animals were treated with respect. Where children
and their parents eat and garden together. Where children get clean water.
Where the biggest cause of death was not self-inflicted by food.”
FRONT LINES
High Cost, Low Quality of U.S. Health Care Add to Woes of the SickA poll released jointly by the Robert Wood Johnson Foundation, National Public Radio, and HSPH revealed that a large majority of the U.S. general public (87 percent) consid-ers the cost of health care to be a serious problem for the country. The poll, entitled “Sick in America,” found that more than 40 percent of sick Americans (those requir-ing considerable medical care or overnight hospitalization within the past 12 months) experienced the cost of their care as a serious prob-lem for their family’s finances. And one in six sick Americans reported that there was a time in the past 12 months when they could not get the care they needed—most often because they couldn’t afford it or because their insurers would not pay for it. In the poll, which was released in May, many sick respondents also reported problems with the qual-ity of their care, with one in eight believing that they were given the wrong diagnosis, test, or treatment, and 26 percent feeling that their condition was not well managed.
New Study of Bee Colony Collapse Causes BuzzOne of the most widely used pesticides in agriculture and the residential environ-ment—imidacloprid—is the likely culprit behind the sharp decline in honeybee colonies worldwide since 2006, according to a new HSPH study, led by Chensheng (Alex) Lu, HSPH associate professor of environmental exposure biology. Lu has found “convincing evidence” of the link between the pervasive pesticide and colony collapse disorder, a mysterious phenomenon in which adult bees abandon their hives. Full study results are in the Bulletin of Insectology, June 2012.
LEARN MORE ONLINE Visit Harvard Public Health online at http://hsph.me/frontlines for links to press releases, news reports, videos, and the original research studies behind Frontlines stories.
5Fall 2012
Researchers have known that climate change and other atmospheric forces are causing dramatic increases in levels of mercury—a potent neurotox-in—in the Arctic. But now, a joint study by Harvard School of Engineering and Applied Sciences and Harvard School of Public Health (HSPH) has found that much of the mercury accumulation in the Arc-tic actually comes from three huge Siberian rivers—the Lena, the Ob, and the Yenisei—that flow into the Arctic Ocean. The study suggests that mercury levels in the rivers may be rising because of per-mafrost melting and other climate-driven changes in the landscape. Co-principal investigator Elsie Sunderland, Mark and Catherine Winkler Assistant Professor of Aquatic Science at HSPH, said, “Un-derstanding the sources of [the potent neurotoxin] mercury to the Arctic Ocean … is key to protecting the health of northern populations.” The bad news: Global warming may prolong the problem. Full study results are in Nature Geoscience, May 20, 2012.
HIV/AIDS Patients Living Longer, Presenting New Challenges as They Age Health and social systems must better plan for the aging of the
HIV epidemic, says Till Bäernighausen, HSPH associate professor
of global health. That’s because antiretroviral drugs have
changed the face of HIV/AIDS treatment and care: No longer an
automatic death sentence, HIV/AIDS can now be managed as
a chronic condition. The good news is that worldwide, “People
infected with HIV … live to old ages,” says Bäernighausen. He led
a team of researchers who ran national microsimulation models
for the 43 countries in sub-Saharan Africa. The team found that
with the scale-up of antiretroviral treatment, the number of HIV-
infected people older than 50 in the region will nearly triple over
the next three decades, from about 3 million in 2011 to 9 million
in 2040.
Bob Strong/REU
TERS; Leigh Vogel/W
ireImage
HSPH Alum William Foege Honored with Presidential Medal of FreedomLegendary public health epidemiologist William Foege, MPH ’65, has received the
nation’s highest civilian honor—the 2012 Presidential Medal of Freedom. Foege’s
distinguished public health career has been highlighted by groundbreaking work in the
1970s to eradicate smallpox; Foege developed the vaccination strategy that ultimately
broke the transmission cycle of deadly infection. Foege served as director of the
U.S. Centers for Disease Control and Prevention from 1977 to 1983. As director of the
Carter Center, he has worked for universal basic immunization for children and for the
elimination of river blindness and Guinea worm, two diseases that plague Africa. He is
a senior fellow at the Bill & Melinda Gates Foundation, a professor emeritus at the Rol-
lins School of Public Health at Emory University, and an affiliated professor of epidemi-
ology at the University of Washington School of Public Health.
Arctic Mercury Rising as the Mercury Rises
William Foege receives a Presidential Medal of Freedom from President Barack Obama in the East Room of the White House on May 29, 2012 in Washington, DC.
HPH Editor Receives National Journalism AwardMadeline Drexler, editor of Harvard Public Health, won a prestigious Sigma Delta Chi Award from the Society of Professional Journalists for an article she had published in the October 2011 issue of Good Housekeeping, entitled “Why Your Food Isn’t Safe.” The story detailed flaws in the federal food safety system. The same week the story was published, the United States Department of Agriculture announced tough new rules to prevent E. coli contamination in the meat supply—one of the measures strongly recommended in the article. Drexler received the award for Public Service in Magazine Journalism (National Circulation) at a ceremony in July at the National Press Club, in Washington, DC.
6Harvard Public Health
FRONT LINES
D-BASE/G
etty Images; Illustration, Shaw
Nielsen
OUR BODIES, OUR BUGS: Microbial Genes Outnumber Human Genes 100 to 1
URBAN ENVIRONMENTS DEPRESSING? JUST ADD TREES
It’s common wisdom that
block after block of un-
relieved streetscape can
be oppressive. With back-
grounds in architecture,
HSPH visiting scientist
Morteza Asgarzadeh and
research scientist Anne Lusk,
both from the Department
of Nutrition, teamed up with
architectural researchers from the University of Tokyo
to explore the psychological effects of high-rise urban
environments. Studying the influences of trees, build-
ings, and sky on emotions, they found that the distance
between a viewer and high-rise buildings, as well as
how large a solid object appears, influence stress and
depression in street observers. They also showed that
trees have a measurable mitigating effect on urban
“oppressiveness.” The scientists went on to develop
a mathematical tool for urban planners that gauges
environmental cheerlessness. Full study results appear
in “Measuring Oppressiveness of Streetscapes,” Land-
scape and Urban Planning, July 2012.
ew studies led by HSPH researchers in the Human Microbiome Project (HMP) have helped identify and analyze the vast human “microbi-ome”—the trillions of single-celled microbes and millions of microbial
genes that exist inside the human body. Researchers are studying the role that these microbes—bacteria, viruses, and fungi that live in the gut, mouth, skin, and elsewhere—play in normal bodily functions, such as development or immu-nity, as well as in disease. In a healthy individual, the microbial metagenome, or total complement of genes, can carry about 100 times as many genes as does our own human genome. The HMP, a consortium of 250 members from 80 research institutions, estimates that more than 10,000 microbial species live in humans,
including several opportunistic pathogens—microorganisms that typically coexist harmlessly with the rest of the microbiome and their human hosts, but can trigger disease under the wrong conditions. HMP research appears in Nature, Nature Methods, and several Public Library of Science (PLoS) publications.
HSPH Gathers World Health Ministers
Sixteen of the world’s ministers of health gath-
ered at the Harvard Kennedy School (HKS) in
June for the Harvard Ministerial Health Lead-
ers’ Forum, sponsored by the Ministerial Leadership
in Health Program, an initiative launched by HSPH
and HKS in collaboration with the Children’s Invest-
ment Fund Foundation. With the forum focused on
improving the health, growth, and development of the
world’s children, HSPH Dean Julio Frenk—Mexico’s
health minister from 2000 to 2006—told participants
that this is a time of opportunity to make gains in
child and maternal health. Frenk emphasized that
the 2015 deadline for achieving the United Nations’
Millennium Development Goals is fast approaching,
and that many nations not currently on track to reach
their goals could be encouraged to renew their efforts.
Frenk advocated focusing on health priorities—small-
pox eradication being the greatest historical example
of international coordination—to drive future im-
provements in the health care system.
N
A.Q.
7Fall 2012
WINSTON HIDE ASSOCIATE PROFESSOR OF BIOINFORMATICS AND COMPUTATIONAL BIOLOGY
Last May, you resigned from the editorial board of Genomics, protesting the exorbitant
subscription fees that scientific journals charge. Researchers and institutions in poor nations
often cannot afford to pay and are effectively shut out of new science. You called for a system
of open-access scientific publications. What’s been the fallout since your resignation?
For one thing, I was ranked in the top thousand tweets in Twitter for a couple of days, based upon this
announcement. Why did it go viral? Because my resignation got to the basic issue: Why must scientists, by
virtue of the fact that they were born in the wrong place, be excluded from doing science the way that
colleagues in the West do it? Why must they put out their hats and beg by email to get PDFs from authors?
They will never be able to compete intellectually if they are artificially excluded.
I didn’t resign with a marketing strategy or a political agenda in mind. I resigned because my heart told
me this practice was wrong. The only way we’re going to change the system is through the people who supply
the publishers: the researchers who submit papers, the reviewers, the journal editors. We also need to say
to governments in the West, which are funding access to these journals: You are perpetuating the scientific
divide between rich and not-rich nations.
OfftheCUFF
©Tony R
inaldo
LEARN MORE ONLINEVisit Harvard Public Health online at http://hsph.me/frontlines for links to press releases, news reports, videos, and the original research studies behind Frontlines stories.
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”
Starting a Revolution
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8Harvard Public Health
FRONT LINES
Aubrey LaMedica/H
SPH
LEARNING TO LEADaking a difference in public health requires more than knowledge and idealism. It also requires finesse in commu-nication, conflict resolution, negotiation, and mobilizing strangers. In short, it takes an expertise not widely recog-nized in public health education: leadership.
“If we want people to be agents of change, we have to invest in making them so,” says Jack Spengler, Akira Yamaguchi Professor of Environmental Health and Human Habitation at Harvard School of Public Health. “We don’t do this in public health—instead, we teach students to be statisticians, epidemiologists, lab analysts, exposure scien-tists. Look at how we failed in climate change, where the message is one of fear. Look at the message we constantly
deliver about food, carcinogens, lifestyle: it’s all negative. We can do better.”
This fall, new and expanded efforts at the School are filling that gap.
AN INNER JOURNEY
“There are three main approaches to teaching leadership,” says John McDonough, professor of the practice of public health and director of the Center for Public Health Leader-ship, part of the School’s Division of Policy Translation and Leadership Development. “One way is to teach theory. Another is to expose students to leaders. And the third way is to help students figure out their inner journey, to ask them, ‘What is it in you that strengthens you and gives you
the capacity to be a leader? And what holds you back?’” Students are immersed in theory through the center’s
new 10-credit interdisciplinary concentration in Public Health Leadership. They are also learning from experi-enced leaders in the division’s “Decision-Making: Voices from the Field” seminar series, now in its third year.
STANDING UP TO AUTHORITIES
Meanwhile, a series of noncredit seminars and workshops piloted by the center last year and officially launched this fall is aimed at the subjective and reflective side of leader-ship development—a critical component of training, says McDonough. “When you have to stand up and disagree
with someone, maybe someone who has more author-ity than you, how do you respond both intellectually and emotionally to that kind of challenge?” he asks. “We give students the opportunity to try out difficult situations and gain instantaneous and long-term self-reflection.”
“Students want to make a difference,” says Martin Reidy, SM ’13, co-chair of the division’s student commit-tee on leadership development. “But there are skills they might not have, like learning how to bring people with different beliefs than yours over to your side. Most people don’t understand what public health is. You have to figure out how to communicate in a way that helps people grasp how what we’re trying to do will benefit them.”
Amy Roeder is assistant editor of Harvard Public Health.
“If we want people to be agents of change, we have to invest in making them so.” Jack Spengler, Akira Yamaguchi Professor of Environmental Health and Human Habitation
T
9Fall 2012
LIVES TRANSFORMED
Kent D
ayton/HSPH
his month, as in every September for nearly the last century, a new group of students walks through the doors of Harvard
School of Public Health. Like the generations before them, they enter with hope, excitement, maybe a touch of fear—and
with plans to change the world.
There’s no better place for them to do so than at HSPH. From the classroom studies on Huntington Avenue to hands-on
lessons in developing countries, our students transform the health of millions. And when people’s health improves through
disease prevention and health promotion, so, too, do the economies of their countries. As Dean Julio Frenk says, “Investing
in health is not only the right thing to do on ethical grounds, but it is also the smart thing to do in order to achieve economic
prosperity.” As our cover story, “The Dollars and Sense of Public Health,” shows, public health is a critical economic engine.
Here at HSPH, philanthropy is the financial fuel that powers everything HSPH accomplishes. Without the generosity of all
of our donors—from the 1,400-plus alumni who supported us this year to the largest of foundations—our work simply could
not happen. One case in point: With their gift of $5 million, Jonathan and Jeannie Lavine have established the Lavine Family
Humanitarian Studies Initiative, as part of the new Humanitarian Academy within the Harvard Humanitarian Initiative (HHI).
Directed by HSPH professor of global health and population Michael VanRooyen, HHI advances the science and practice
of humanitarian response worldwide. The Lavines’ transformative gift has enabled the creation of a first-of-its-kind global
resource for educating and training leaders to respond to crises caused by war, genocide, and natural disasters.
I am delighted to report that this year, our contributors have been more generous than ever, supporting the School with
a landmark total of $63.7 million. To all of you who have given your time, talent, and treasure, know that you are making an
extraordinary difference in people’s lives—here on campus and throughout the world. I cannot thank you enough.
PHILANTHROPIC IMPACT
Ellie Starr, Vice Dean for External Relations
On May 1, 2012, Harvard School
of Public Health launched the
Harvard Humanitarian Academy.
From left to right: Professor
Michael VanRooyen, Jonathan
Lavine and Jeannie Lavine, and
Dean Julio Frenk.
P
10Harvard Public Health
PHILANTHROPIC IMPACT
New Scholarship Supports Doctoral Students in Nutrition, Honors Willett
rajna—a Sanskrit word that conveys ultimate wisdom—is
the name of a new scholarship for doctoral students in
the HSPH Department of Nutrition that was established
to recognize the leadership and distinction of the depart-
ment’s chair, Walter Willett. The first Prajna Scholar—
Neha Khandpur of India—envisions a career focused on
obesity prevention in disadvantaged population groups.
The new Prajna Chair’s Scholarship in Public Health
Nutrition, created through an anonymous gift of $1.75
million, will provide opportunities for highly accom-
plished and motivated but financially underprivileged
students to study at HSPH. The donors hope that, in par-
ticular, the scholarship benefits students from economi-
cally challenged countries.
“This scholarship will afford me the academic free-
dom to really think about my education and career in
public health nutrition and to really find my calling,” said
Khandpur, who has worked in India as a nutrition and
fitness consultant and for the Public Health Foundation
of India, which propelled her desire to influence nutri-
tion not just one-on-one but in populations. “It’s really
exciting.”
“Neha is a very good fit for this scholarship,” said
Willett. “She already has quite a bit of experience working
in India on nutrition programs and she’s planning to return
to India to work in this area. The scholarship underscores
what our department is all about—working at the very cut-
ting edge of science, but also applying this knowledge to
solve real problems of real people in the real world.”
The word Prajna (pronounced Pra´-gyia) refers to
wisdom that cannot be reached by developing intellect
alone, but includes insight from experience and under-
standing gained through engagement with the world. The
donors chose this word because it aptly describes Willett,
whose wisdom and insight has fueled his major contribu-
tions to public health nutrition. Likewise, the donors hope
that the scholarship will encourage its recipients to merge
intellect and practice together to compassionately advance
the welfare of humanity, and to become leaders in the field
of public health nutrition, like Willett. They also hope
their gift will inspire others to support both students and
faculty at HSPH.
Willett said that now, more than ever, support of stu-
dents and faculty is critical because of cutbacks in HSPH’s
major funding source, the National Institutes of Health.
“If someone wants to give to a worthy cause, supporting
a doctoral student is probably one of the very best things
they can do,” Willett said. “It’s investing in people who, for
decades in the future, will make a real difference in the
world. The multiplication effect is huge.”
Neha Khandpur, of India, HSPH’s first Prajna Scholar
Aubrey LaMedica/H
SPH
Transformative Education for Public Health Leaders
Killer infections. A dramatic rise in
chronic diseases. Environmental
emergencies. Unequal access to medi-
cal care. These problems—just a few of
the daunting public health issues facing
the world today—demand not only
wide-ranging expertise, but also in-
spired leadership. To help future public
health leaders meet this challenge,
a $5 million gift has been made to
Harvard School of Public Health to fund
a “Leadership Incubator for Strengthen-
ing Health Systems.” The gift is a key
component of the “Roadmap to 2013,”
a comprehensive review of HSPH’s
educational strategy, which is being
undertaken as the School approaches
its centennial in fall 2013.
The Leadership Incubator for
Strengthening Health Systems is ex-
pected to be supported by an anony-
mous gift of $5 million—the largest
gift ever made to HSPH in support of
education.
BREAKING THE MOLD
According to Dean Julio Frenk, the
incubator will foster changes in educa-
tion that will “break the mold,” push-
ing the traditional discipline-based
boundaries of academia, research,
and public health. It will encourage a
greater focus in coursework on the
importance of leadership and on the
complexities—political, economic, and
social—of achieving global improve-
ments in public health. “A new doctor
of public health (DrPH) degree that we
envision, for example, will be oriented
toward competencies in high-level
policy analysis and problem-solving
leadership,” he said. “This gift will
enable us to continue as the leading
school of public health—first in quality
as well as first in our capacity to shape
the future.”
“We have followed with admira-
tion the work of the School for more
than two decades, and this initiative
is one of the most exciting things that
we have seen during this period,” the
donors said. “It speaks to our deep
belief in the power of young people—
in particular, this generation of young
people—to change the world.”
IMMERSIVE EDUCATION
A key component of the gift supports
students at all levels of experience
and creates opportunities for them to
learn from each other. Another unique
and important part of the gift supports
faculty members’ efforts to work with
alumni and other public health leaders
to create state-of-the-art curricula, new
teaching methods, technology en-
hanced learning, and an immersive and
life-changing educational experience
for professional degree students.
Under a proposal to redesign the
DrPH degree, for example, 25 out-
standing students, beginning in 2014,
will be named each year as “Centenni-
al Fellows”; 10 will be supported by the
new gift. Students will complete two
years of coursework, bolstered by case
studies, crisis simulations, and field
experience, followed by an innovative
third-year internship experience that
serves as the capstone to the degree.
The Leadership Incubator is also
expected to sustain already estab-
lished leaders at various points in their
careers. For current leaders, HSPH has
already initiated a Ministerial Leadership
in Health Program, an intensive five-day
campus-based program for ministers of
health, which is followed by year-long
support from experienced public health
experts and HSPH faculty. Meanwhile,
leaders who have recently held high-
level public health positions can spend
time on campus as “Senior Leadership
Fellows,” sharing expertise with students
and project work with faculty members.
And a new joint initiative with Harvard
Business School will give advanced
leaders the chance to study major social
problems that shape health.
PRIMED TO MAKE AN IMPACT
“HSPH’s new Leadership Incubator will
provide the impetus for a paradigm
shift in educating entrepreneurial public
health students—both young and old,
less experienced and more—who will
be primed to make the greatest pos-
sible impact on the health challenges of
the 21st century,” said Ian Lapp, associ-
ate dean for strategic educational initia-
tives. “We are extremely grateful for this
historic gift, which will enable us to live
out the spirit of our centennial celebra-
tion by beginning our second century
with innovations in the education of
today’s and tomorrow’s leaders.”
11Fall 2012
Harvard School of Public Health Dean Julio Frenk encour-aged this year’s graduates to look beyond “tightly defined career paths” as “the only routes to personal and profes-sional achievement.” “It is vital,” he said, “that we have people educated in science and public health who see opportunities where others see barriers—who are comfortable moving eas-ily between the worlds of government, business, civil society, and academia, to improve people’s health.”
Frenk noted that the day’s Commencement speaker, HSPH alumnus Gerald Chan, SM ’75, SD ’79, went on to a “bold, nontraditional career path” as an entrepreneur and innovator, but has continued to work on improving people’s health. Chan founded Morningside Group, which has pro-vided support for companies and technologies that benefit the public’s health. Chan studied medical radiological physics and radiation biology while at HSPH.
Opposite are some of the remarks Chan offered at Commencement on May 24. Full coverage of the day, includ-ing photo slide shows and complete transcripts of remarks by Chan, student speaker Kevin Koo, AB’ 07, and HSPH Dean Julio Frenk, can be found at http://hsph.me/commencement2012.
12Harvard Public Health
Commencement
HSPH Commencement speaker alumnus Gerald Chan, SM ’75, SD ’79
FUTURE PUBLIC HEALTH LEADERS WILL “MOVE BETWEEN WORLDS,” GRADUATES TOLD
Highlights from the remarks of Gerald Chan at the School’s 2012 Commencement
A BEAUTIFUL MINDNew knowledge is now being produced at a breakneck speed and is readily accessible to anyone with connection to the Internet. A learned person can no longer be defined merely as one who is in possession of knowledge, or perhaps more accurately, and somewhat derogato-rily, one who is in possession of information. Today, whether a person can be considered a learned person hinges on what he does with the knowledge he has. A beautiful mind is not beautiful by virtue of its stor-age capacity, nor even what has been stored in it. A beautiful mind is a mind with beautiful ideas.
A SOUND BITE SOCIETYI see in the communications of today’s society … an impoverishment of ideas. Politicians are known by their sound bites. Messages with 140 characters or less encourage the communication of the trivial. Tweets are great for knowing where your friends are having dinner tonight, but they are not conducive to the generation nor to the communication of ideas … Being flooded with minutiae of everyday life subverts our intellectual life by luring us into, and holding us captive in, the present, in what is, such that we have no time and no energy left to consider what might be, or what can be, or what should be. The peril we face in today’s society is that we unwittingly become mere pragmatists, and soon, exhausted realists.
THE (NEW) THREE RsEnrich your lives with ideas, even big ideas. Read, reflect, and ruminate (the new Three Rs). Observe and deduce, postulate and verify, look for connections. Be curious, be open-minded, reframe problems rather than just looking for answers, have the courage to differ from conventional wisdom, do not dismiss your intuition. Discuss, debate, and discourse with others. Look into history, watch current affairs; study the sacred texts, observe humanity. These are the mental habits conducive to the spontaneous generation of ideas. A life is rich when it is rich with ideas.
To watch all of the commencement speeches, go to: www.hsph.harvard.edu/multimedia/video/2012/commencement.
13Fall 2012
Suzanne Camarata
HSPH 2012 COMMENCEMENT BY THE NUMBERS
Students from 57 countries, 34 U.S. states, and the District of Columbia received degrees at Harvard School of Public Health’s 2012 Com-mencement ceremonies on May 24. Six out of every 10 members of the Class of 2012 were women.
A TOTAL OF 515 DEGREES WERE AWARDED:25 Doctors of Philosophy1 Doctor of Public Health53 Doctors of Science11 Masters of Arts272 Masters of Public Health153 Masters of Science
AWARDSAt a reception the evening before Commencement, students, faculty members, and staff members were selected for special recognition.
STUDENT AWARDS
Albert Schweitzer Award Monica Bharel, MPH ’12
Dr. Fang-Ching Sun AwardJoshua Lee Glasser, SM ’12
Edgar Haber Award In Biological Sciences Jessica Lucas Yecies, PhD ’12
Gareth M. Green Award Jessica Terese Celentano, SM ’12; Alex Urban Cox, SM ’12; Joseph David Lippi, SM ’12
James H. Ware Award For Achievement In The Practice Of Public HealthAtena Asiaii, MPH ’12
Robert B. Reed Prize For Excellence In Biostatistical Science Matey Neykov Neykov, MA ’12, PhD ’16
HSPH Student Recognition Award Rosemary Wyber, MPH ’12
Teaching Assistant Award Caitlin Eicher Caspi, SM ’08, SD ’12; Ankur Pandya, PhD ’12; Pamela Marie Rist, SM ’09, SD ’12; Kristin Woody Scott, PhD ’16
Uwe Brinkman Memorial Travel Award Ca Eul Lim, PhD ’16
14Harvard Public Health
Making the Case for Public Health Robert Blendon rewrites the political script.
For nearly 30 years, Robert
Blendon, Senior Associate Dean for
Policy Translation and Leadership
Development, has been polling
Americans about their views of
public health, health care, and
other related hot-button issues.
Polls on the eve of the 2004 and
2008 presidential elections found
Americans deeply divided on these
issues. Today, with an uncertain
economy the most pressing concern
in voters’ minds, Blendon spoke
with Harvard Public Health
editor Madeline Drexler about the
current politics of public health in
America.
Q: You published a fascinating paper in 2010, “Americans’
Conflicting Views of the Public Health System.” One
of your findings was that while most Americans favor
spending more on public health in general, and believe
public health saves money in the long run, they oppose
specific interventions and programs. What’s behind that
contradiction?
A: Our polling suggests that people have a great deal of re-
spect and support for what we think of as “traditional public
health”: communicable diseases, foodborne outbreaks, help-
ing people during disasters and emergencies, basic educa-
tion. The conflict is around chronic illnesses—heart disease,
diabetes, even conditions such as obesity. Americans aren’t
convinced that public health measures alter those.
Q: But chronic diseases are the top cause of death and dis-
ability in the United States. Three-quarters of the health
care budget goes toward treating those conditions.
Maybe people don’t understand the logic of prevention?
A: If you want to convince the public, you can’t just cite some
gross economic number: If I invest $8 now, I’ll get $12 later.
You have to be very specific before anybody sees it as
credible. You have to say: Studies show that if we do this in-
tervention, then type 2 diabetes will go down by this number
of cases within this time frame. Or: If we launch this program,
there will be this many fewer women diagnosed with breast
cancer in Kentucky.
The more specific you get, the more the public support
goes up. But people in public health are generalists. They
talk about abstract things like “prevention” and “education.”
Those are not budgetary winners.
Q&A
The Dollars & Sense of Public Health | SPECIAL REPORT
15Fall 2012
Q: In politics, the timeline is short. In public health, the timeline is usually long. Does that also work
against public health in our polarized, individualized, attention-deficit culture?
A: In public health, we talk about society. But actually, I’ve never interviewed a voter who has talked about
society. Voters talk about the federal government, state government, local government, their insurance
plan, their Medicare. But society? Never.
Q: So how should public health professionals make their case?
A: You get long-term confidence from the public if you do things for people in the short term. Every
time there’s an outbreak, you’re there. If people say, “Who are you?,” you say, “I’m the Commis-
sioner of Public Health.” With that one line, you show that you were there to save people’s lives
and that you give really solid advice. Plant that idea in people’s heads: “Public health. Working to
save your life. Gave sensible advice.”
Q: Isn’t that the message that’s conveyed today?
A: No. I’ve done many briefings for public health officials. They say, ‘Wow, you’re right. I get it.’ They
understand the concept—but their training is such they cannot stop talking in abstract terms. So
they testify before lawmakers: ‘We’re launching a new education initiative around noncommunica-
ble diseases.’ Later, they call me and complain, ‘The state legislature cut our budget by one-half.’”
Q: Are you saying that public health has a marketing problem?
A: Absolutely. We’re living in a world where people believe in smaller government and lower taxes.
So you have to convince people that there are interventions that can actually save their lives.
After the big hurricanes in 2005, a lot of government agencies were roaming around. Only
one group did not have rain slickers with the name of their agency on them: the Centers for
Disease Control and Prevention (CDC). Their jackets and hats were blank. Everybody else’s said
Coast Guard, State Police, this and that. A CDC employee told me, ‘We were there just to help the
state officials. No point seeking any attention for ourselves.’ I said, ‘Well, do you want the appro-
priation?’ In this world, you have to be targeted and directive.”
“ After the big hurricanes in 2005,
a lot of government agencies
were roaming around. Only one
group did not have rain slickers
with the name of their agency
on them: the Centers for Disease
Control and Prevention (CDC).
The CDC was not interested in
seeking attention for itself, but
the fact is you have to do that if
you want the appropriation.”—Robert Blendon
The Dollars & Sense of Public Health | SPECIAL REPORT
Public Health & the U.S. Economy
ith the November 2012 elections on the horizon, Americans surveyed in national polls consistently rank the
economy as their number one concern. Public health professionals can have a big impact on this ballot-box
issue. More than 17 percent of the U.S. Gross Domestic Product is spent on health care—in many cases, for
conditions that could be prevented or better managed with public health interventions. Yet only 3 percent of
the government’s health budget is spent on public health measures. A 2012 study in Health Affairs notes that
since 1960, U.S. health care spending has grown five times faster than GDP.
Why do these numbers matter?
First, a healthier workforce is a more productive workforce. According to an April 2012 report from the Insti-
tute of Medicine (IOM), the indirect costs associated with preventable chronic diseases—costs related to worker
productivity as well as the resulting fiscal drag on the nation’s economic output—may exceed $1 trillion per year.
A 2007 study from the Milken Institute found that when unhealthy workers show up on the job, as many must to
survive financially, the effects of their lower productivity on the nation’s economic health are immense: in dollar
value, several times greater than the business losses accrued when employees take actual sick days. Avoidable
illness also diverts the economic productivity of parents and other caregivers.
W
17Fall 2012
continued
Second, the costs of health care are built into the price of every American-built product and service. And the per cap-
ita cost of health care in the U.S. is higher than in any nation in the world. If the U.S. can reduce the costs of health care
over the long term—by preventing diseases that require costly medical procedures to treat and by making our existing
health systems more efficient—the costs of American products can become more competitive in a global marketplace.
Today, U.S. per capita health expenditures are more than twice the average of other countries in the Organization of
Economic Cooperation and Development. The IOM estimates that cutting the prevalence of adult obesity by 50 per-
cent—roughly the same reduction across the population as was achieved through public health’s multipronged attack
on smoking in the late 20th century—could cut annual U.S. medical care expenditures by $58 billion.
Put simply, effective public health measures, including those aimed at improving health systems, have the potential
to be economic engines. But these engines have been chronically underfunded and have received too little attention
from lawmakers and voters. Michael Blanding, a Boston-based journalist and author, asked seven Harvard School of
Public Health experts, from widely ranging fields, to assess public health’s vital but often overlooked role in the Ameri-
can economy. Here’s what they told him.
How the next U.S. president can stack the deck in favor of people’s health and wealthin 2013
The Dollars & Sense of Public Health | SPECIAL REPORT
18Harvard Public Health
STOP SPENDING Government Funds to Promote Obesity
All we have to do to fix this is apply the same criteria,
or similar criteria, to SNAP purchases that we already
have for the federal WIC program (Women, Infants and
Children program), which essentially allows purchases
only for healthy foods. That policy would cost virtu-
ally nothing, but it would transform the food supply and
dramatically improve the health and wellbeing of SNAP
recipients. Little stores and bodegas that only stock junk
now would start carrying healthy foods, the cost would
come down because of the greater volume of healthy alter-
natives, and these foods would also become available for
those not receiving SNAP benefits.
We are talking about doing something that is cost
neutral but would produce not just better health, but also
economic benefits in the medium and long term. How? If
you change what people eat—and perhaps return physical
education to our nation’s schools at the same time—within
months, children’s weight and incidence of diabetes will go
down. Their parents’ weight will decline as well. Within a
year or two, there will be important medical cost savings.
Long-term health costs will decline as fewer people
develop diabetes, and the cost of healthy food will drop for
all of us.
WALT WILLETTChair, Department of Nutrition
The obesity epidemic has huge economic consequences,
and we have not even begun to pay the full cost. There
is a generation of children today who have diabetes or
prediabetes, and they are just coming to the age when they
will start developing heart disease and kidney failure, and
need amputations as well as treatment for sight loss. These
conditions will cause enormous costs in the future, even if
we arrest obesity at the present levels.
The federal SNAP program (Supplemental Nutrition
Assistance Program, formerly called “food stamps”) allows
recipients to use SNAP dollars for any kind of food. As a
result, SNAP serves as a funnel for nearly $80 billion a year
of taxpayer money to the junk food industry. This industry
produces the foods most readily available in low-income
neighborhoods—a lot of soda and lower-cost foods loaded
with calories and refined starches. People on the SNAP
program are more obese, have more metabolic syndrome,
and have more cardiac risk factors than people not on
SNAP, adjusted for income. And their health care costs will
be higher, which ends up costing taxpayers even more.
19Fall 2012
“ Concepts like the patient-centered medical home have the potential to reduce waste from overuse and duplication of medical tests and services, and also increase the delivery of high-value preventive care.”
PREVENT Duplication, COORDINATE Care
Kent D
ayton/HSPH
MEREDITH ROSENTHALProfessor of Health Economics and Policy
What really matters to health economists is value.
Health care is a huge part of our national economy, and
our Medicare and Medicaid programs represent the most
important spending categories in the national budget. But
our health care system is subject to market failures, so
some of that spending does not generate improved health.
We are wasting money in health care that we could be
spending on education, roads, and other goods and services
that we value as private citizens.
So improvements in this area, particularly reforms to
health insurance and delivery systems, have an important
role to play in balancing the federal budget and in fixing
the economy as a whole.
One critical area for reform is primary care. Without
robust primary care, lots of people—especially patients
with complex needs—are getting poorly coordinated care.
The health care delivery system has been ineffective at
managing these patients, because as soon as they leave the
doctor’s office, the medical system disengages.
That’s why the concept of patient-centered medical
homes that we are studying is so important. In this model,
insurers pay primary care providers a fixed amount for
each patient every month, whether the patient sees the
doctor once a year or every week. The provider is account-
able for coordinating any care that may be needed across
specialists, hospitals, home health agencies, and nursing
homes, as well as care provided by community-based
services and the patient’s loved ones.
Concepts like the patient-centered medical home have
the potential to reduce waste from overuse and duplication
of medical tests and services, and also increase the delivery
of high-value preventive care. The result is a more efficient
and effective, and less costly, system designed to keep
patients healthy, rather than respond to illness.
continued
20Harvard Public Health
“ Private markets don’t produce public goods like clean water or clean air, which everybody draws on.”
in public health. When people are healthy, they rarely
attribute their health to a specific action taken by govern-
ment. They view it as their constitution or their lifestyle or
their luck.
But if they’re sick, it’s highly visible and they demand
to be treated. The visibility of that need creates enormous
pressure to heavily invest in medicine, rather than in
public health.
When legislators look for something to cut in the
budget, they cut something that has no visible effects.
If you stop investing in anti-tobacco campaigns, you don’t
necessarily see more illness right away—it might take a
long time to appear. But private markets don’t produce
public goods like clean water or clean air, which everybody
draws on. If you don’t believe that, just look at the rates
of diarrheal disease in countries that don’t have sanitary
conditions.
NORMAN DANIELSMary B. Saltonstall Professor of Population Ethics and
Professor of Ethics and Population Health
There is vast evidence suggesting that as important as
medical care may be, risk reduction—particularly public
health measures that reduce the chances people will
suffer adverse health conditions—has the greatest impact
on people’s health. The return on investment from these
measures is not always economic, but if we look carefully at
what improves the health of large numbers of people, we’re
going to place considerable value on public health initiatives.
A well-known Centers for Disease Control and Prevention
(CDC) report noted that people in the U.S. increased their
average life expectancy by 30 years in the 20th century.
When the CDC listed the major drivers of that increase,
most of them were public health initiatives: clean water,
motor vehicle safety, vaccine programs, occupational safety
programs, smoking cessation programs, and the like.
Because the benefits of risk reduction programs like
these are often invisible, there is an obstacle to investment
SPEND MORE to Reduce Risk
Kent D
ayton/HSPH
The Dollars & Sense of Public Health | SPECIAL REPORT
21Fall 2012
virus that causes cervical cancer, human papillomavirus,
then guidelines may well shift toward even less frequent
screening.
Intensive care unit treatment for patients with certain
fatal conditions, or extra diagnostic tests such as MRI, CT
scans, and PET scans, are expensive; for many patients
who don’t have clear indications of a disease, you often
get very small gains. In these scenarios, you’re talking
about cost-effectiveness ratios of hundreds of thousands of
dollars per quality-adjusted life-year gained.
continued
Kent D
ayton/HSPH
MILTON WEINSTEINHenry J. Kaiser Professor of Health Policy and Management
We’re spending more than one-sixth of our national income
on medical care. We’ve already reached the point of dimin-
ishing returns in some areas of medical care, but we can still
see very good returns for many medical and public health
interventions that are currently underutilized.
If you want to get more health for the money, then real-
locate resources from some of the things that are done in
medical care that are not cost effective and use that money
for underutilized, cost-effective programs, including both
medical and public health programs that aren’t being done
enough.
What does this mean on a practical level? We need to
convince doctors and patients that women don’t need a
Pap smear every year if they have had three normal Pap
smear tests. Doing a Pap smear once every three years is
extremely cost effective, but doing it every year adds about
$800,000 per life-year gained across the population. If
most girls and young women are vaccinated against the
“ We can get more value for the money we’re already spending—but that will mean doing more of some things and less of others.”
Identify What is COST EFFECTIVE
How do we persuade the American people that more
care isn’t necessarily better care? It’s hard. People view
medical care as an entitlement: If I’m sick, I should get the
best available medical technology. A first step is to show
that we can get more value for the money we’re already
spending—but that will mean doing more of some things
and less of others.
22Harvard Public Health
KATE BAICKERProfessor of Health Economics
The key is not spending less, but improving the value
delivered through our health care system. Lots of interven-
tions that are cost effective don’t actually save money. For
example: smoking cessation programs might be costly,
because smokers who die before the age of 65 then don’t
collect Social Security benefits and Medicare. If we just
want to save money, we could hand out cigarettes. But
that’s wildly inconsistent with public health goals.
Our focus should be on producing health at a reason-
able price, understanding that only a very small subset of
things actually improve health and are cheaper than free.
The relationship between health insurance and the
labor market is important because the vast majority
of private insurance in the U.S. is delivered through
employer-sponsored insurance plans. That is largely a relic
of post–World War II wage controls that limited increases
in wages but not in benefits, and the fact that employer
contributions to health insurance aren’t taxed. This tax
treatment of health insurance favors those who get health
insurance through an employer instead of buying it on
their own, and favors more generous health insurance rela-
tive to wages and other benefits.
There is thus a direct connection between health insur-
ance premiums and wages: When the cost of providing
health insurance to workers goes up, that leaves less money
for things like wages and other benefits that come with
employment. When health insurance premiums rise more
quickly, workers’ wages rise more slowly and some workers
are at higher risk of being laid off.
And what drives health insurance premiums? In large
part, it’s the cost of health care.
So it’s clearly good for the economy when we can
improve the productivity of the health care sector—or any
other sector. But it is also important to remember that
any effects improving health care delivery may have on
economic growth are second-order relative to the effect on
improving health itself.
FOCUS ON VALUE not just price
“ The key is not spending less, but improving the value delivered through our health care system. If we want to save money, we could hand out cigarettes.” K
ent Dayton/H
SPHThe Dollars & Sense of Public Health | SPECIAL REPORT
23Fall 2012
DEBORAH ALLEN, SM ’80, SM ’86, SD ’98 Director, Child, Adolescent and Family Health
Boston Public Health Commission
In our economic system, payback comes when you sell
something expensive to a captive market. You have that
in health care, when you sell high-cost drugs, medical
services, and equipment.
But public health promotes the opposite: Let’s invest
now for a benefit that may not emerge for many years. Let’s
create the conditions for healthy birth, healthy infancy,
and healthy childhood. The payoff is extraordinary in
terms of lifetime health status and averting the need for
extraordinarily costly, often ineffective intervention at
the later stages of life. It also creates a population that has
a much higher quality of life. But it is more difficult to
persuade governments or individuals to pay for something
for which the payoff is not immediate.
Adverse health exposures for fetuses in utero or chil-
dren in the early years of life can cause lifelong problems.
It could be a mother inhaling toxic chemicals where she
works. It could be maternal stress associated with poverty
and racism, which causes her fetus to be exposed to toxic
levels of the stress hormone cortisol. Exposures like these
lead to disproportionate levels of preterm birth and low
birth weight. And even if there is no visible impairment,
the child is invisibly vulnerable and will have an elevated
lifetime risk of asthma, cardiovascular disease, diabetes,
and hypertension.
When you invest early in prevention, and a healthy
full-term baby grows into a healthy child, then you prevent
not only chronic medical problems, but also cognitive and
behavioral impacts.
We have to ensure that families have the internal
resources to raise kids, but also that families live in
communities where there’s access to exercise and good
food. These are not what people traditionally think of as
health interventions—but they are the things that shape
lifetime health.
Aubrey LaMedica/H
SPH
INVEST NOW … or pay later“ The payoff for public health investments is extraordinary in terms of lifetime health status and averting the need for costly interventions at the later stages of life. But it is difficult to persuade governments or individuals to pay for something when the payoff is not immmediate.”
continued
24Harvard Public Health
Treat HEALTH as the Nation’s number one ASSET
DAVID BLOOMClarence James Gamble Professor of Economics and
Demography
Another bridge between health and the economy is
education. Unhealthy children may enter school with phys-
ical and cognitive disadvantages, miss more days of school,
attend school for fewer years, and learn less when they’re
in school. By contrast, healthy children are more likely to
be able to take advantage of whatever education is available
to them—and a good education has profound economic
consequences throughout an individual’s life. These conse-
quences include a higher starting wage and larger salary
increases over the course of one’s working life—earnings
that ripple out into the larger economy.
Human health is fundamentally a national asset, which
means that spending on the promotion and protection of
health is more like a fruitful investment than a consump-
tion expenditure. A 2011 study on the global economic
burden of noncommunicable diseases estimated that
the five most serious conditions will cost $47 trillion in
lost output worldwide over the next two decades. In the
U.S., reducing heart disease and cancer alone could save
trillions of dollars over that time frame. Investments in
public health measures that can avert these diseases (and
frequently cost less than treatment) or measures that
can better manage these diseases if they do strike, are an
essential and highly justifiable way to enhance the value of
America’s most important asset: its people.
©R
obert ScobleThe Dollars & Sense of Public Health | SPECIAL REPORT
There are many links between health and the economy.
We’ve known for a long time that richer nations gener-
ally have better overall health conditions than do poorer
nations—and that, within a country, more affluent indi-
viduals have, on average, better health than do poorer indi-
viduals. This association has long been thought to reflect a
causal link running from income to health—which makes
sense for a variety of reasons, including simply that richer
countries can afford to spend more on health care.
But new thinking and evidence—much of it pioneered
at HSPH—shows that cause and effect also flow in the
other direction: A healthy population spurs economic
growth. First, healthier people are more economically
productive. Better health also leads to an increase in
savings rates—because healthier people expect to live
longer and are naturally more concerned with their future
financial needs.
T25
Fall 2012
Working the Systemhe elderly Taiwanese man had been Anthony Chen’s patient for years. When the patient
developed liver cancer, Chen worked closely with him, his wife, and his son to address
their concerns and calm their fears. Often, he made home visits as the man became
sicker. He’d do a physical exam. He’d ask if any help was needed in the household. And
he’d talk with the family about how they were coping with a husband and father’s decline.
It was heartbreaking for Chen to watch a longtime patient struggle with his disease. It
was even tougher to realize that his death from liver cancer could have been avoided—if
he’d simply been vaccinated for hepatitis B.
As director of the second-
largest health department in
Washington State,
Anthony Chen, MPH ’06,
tackles all the issues—from
infections to inequities—
that shape people’s health.
continued
©Brian Sm
ale
The Dollars & Sense of Public Health | SPECIAL REPORT
26Harvard Public Health
This was one of many frustrations
that propelled Chen, MPH ’06—after
16 years in family practice—into the
public health profession. Chen, 51, is
now Director of Health for Tacoma-
Pierce County Health Department,
the second-largest health department
in the state of Washington, with 270
B all the time, because the disease is
endemic in their countries of origin
and gets passed down from mothers
to children,” says Chen. “You look at
how much time and energy you’re
spending taking care of patients with
liver cancer—and it all could have been
avoided with a vaccine.”
Democratically controlled state legis-
lature passed a law requiring that all
Washingtonians have access to private
insurance, regardless of their health
status, and mandating that they
purchase coverage.
Two years later, Republicans took
control of the legislature, repealed
employees and an annual budget of
about $36 million. As director, he works
on the full gamut of public health issues:
obesity, air and water quality, sexually
transmitted diseases, pertussis, flu,
oral health—and hepatitis B.
A PREVENTABLE CANCER
After working in a number of under-
served communities—in Boston,
Chicago, and Seattle, as well as in
rural North Carolina—Chen came to
see that a broad systems approach and
population-based public health focus
visibly improved the lives of his indi-
vidual patients. This fact was brought
into stark relief through his work
since the early 1990s with the Asian
American and Pacific Islander (AAPI)
community in the Seattle area.
According to recent statistics,
AAPIs account for half of the estimated
1.4 million people infected with hepa-
titis B in the U.S., even though they
make up only 5 percent of the popula-
tion. “When you work with any sizable
Asian or Pacific Islander community,
you see patients with chronic hepatitis
CITY WITHIN A CITY
In 1996, Chen took a job as lead
family physician at a medical and
dental clinic in Holly Park, a heavily
Asian and African American section
of Seattle, where roughly 25 percent
of residents live below the poverty
line. His nine years at the clinic, he
says, sometimes felt like toiling in an
isolated Third World medical outpost.
“We were only six miles from the
nearest hospital, but many people
living there were poor or working and
didn’t want to travel to the hospital,”
Chen recalls. “We gave shots, drew
blood, orally rehydrated kids with
high fevers in the back room. In
Seattle, people don’t think there’s an
‘inner city’—but there is.”
Chen saw how political reali-
ties were hurting his patients. After
national welfare reform went into
effect in 1996, for instance, even
legal immigrants face new restric-
tions on benefits and could not
receive public assistance until they’d
lived in the U.S. for five years. It was
also sobering for him to witness the
fallout from Washington State’s failed
health reform effort. In 1993, the
most unimplemented provisions of
the law—including the individual
mandate—but left intact the guar-
anteed issue provision. The result?
Enrollment in health insurance
dropped, many bought insurance only
when faced with large expenditures,
insurers lost money, premiums rose,
and a number of insurers left the state.
MEDICINE AND MARKETING
Chen headed to HSPH so that he’d
have more tools to deal with such chal-
lenges. In 2006, he earned a master’s
of public health with a concentra-
tion in health care management and
completed the Commonwealth Fund
Harvard University Fellowship in
Minority Health Policy. In classes
with Robert Blendon, senior associate
dean for policy translation and leader-
ship development, and Howard Koh,
then Harvey V. Fineberg Professor of
the Practice of Public Health, Chen
learned about the importance of
shaping one’s message and providing
compelling arguments. “I knew that
medicine was important,” he says. “I
learned that communication was, too.”
“Seeing health care reform come to fruition was a powerful experience.”
—Anthony Chen, MPH ’06
The Dollars & Sense of Public Health | SPECIAL REPORT
27Fall 2012
After HSPH, as medical director
at several Boston-area health centers,
Chen witnessed the launch of health
care reform in Massachusetts. “I saw
patients come in after not seeing
doctors for years,” he says. “Seeing
health care reform come to fruition,
after seeing it falter in Washington
State, was a powerful experience.”
DOING MORE WITH LESS
In October 2008, as the U.S. economy
began to plummet, Chen became
Tacoma-Pierce County’s Director
of Health. Immediately, he put
together a new strategic plan. “Too
often, public health is reactive to the
economy,” he says. “When I got here,
the budget was $40 million with
300 employees. Now it’s $36 million
with 270 employees. Instead of just
shrinking our programs, we needed
objectives and strategies.”
Compared with the state overall,
Pierce County residents have worse
health, more heart disease, and
higher death rates, and breathe more
contaminated air. The poorest resi-
dents have high rates of obesity and
tobacco use. There are disturbing
health disparities between African
Americans and whites.
Under Chen’s leadership, the
Tacoma-Pierce Health Department has
tackled these problems head-on, encour-
aging landlords and property owners
to develop smoke-free rental housing,
for instance, and working to deliver
vaccines to children who need them.
THE BIG PICTURE
In public health, says Chen, it’s crucial
to look at the big picture. He thinks,
for example, about the impact of the
recession on children. “People lose
their jobs and their kids might not
get fed,” he says. “They lose the roof
over their heads, and then their kids
can’t concentrate at school. They lose
their health insurance, and then the
kids get sick.” He pauses. “It gets very
frustrating when you have to deal with
people who don’t see the connection
between all of these things.”
In 2011, Chen coauthored a study
examining how public health depart-
ments in the state of Washington
were dealing with budget cuts. The
researchers found that there was often
no systematic process for prioritizing
or cutting programs in response
to tight budgets. Because of a state
mandate to investigate dog bites and
rabies cases, for example, some coun-
ties were cutting crucial programs
like epidemiology or chronic disease
prevention. As Chen sees it, “People
end up doing things that may not be
evidence-based—instead, it’s just what
some lawmaker thinks.”
“Most people don’t understand
public health,” he concedes. “They
also don’t understand the difference
between health care and public health.
So funding for public health—which
has ‘health’ in its name—may be
neglected or may get cut because of
political opposition to health care
reform.”
“I know public health people are
stressed out right now, with their
budgets cut down to survival level.
They feel they don’t have the band-
width to think about policy on the
national level,” he says. “But we have to
get engaged in the debate. We need to
be on the phone and travel to our state
capitals and DC. We can’t do things the
same old way.”
Karen Feldscher is a senior writer at HSPH.
©Brian Sm
ale
Anthoy Chen, at the wheel of a “hand washing truck” that travels to schools, public events, and other venues to promote hand washing to children.
28Harvard Public Health
AUTCAN
FRA
GER
ESP
IRL
DENLU
X
NED NOR
USASW
ZCZE
POL
HUN SVKBEL
FIN
GBR
NZL
PORSLO
CHIKOR
ESTMEX
TUR
AUS
ISLSW
E
ISR ITA
JPN
GRE
THE DOLLARS AND SENSEOF CHRONIC DISEASE
The most common behaviors that lead to chronic diseases are:
According to the Centers for Disease Control and Prevention, nearly 1 out of every 2 Americans su�ers from a chronic disease, defined as a noncommunicable disease (NCD) prolonged in duration, including cancer, heart disease, stroke, and diabetes. Chronic diseases are the number one cause of death in the U.S.
The World Health Organization estimates that 80 percent of all heart disease, stroke, and type 2 diabetes, as well as more than 40 percent of cancer, would be prevented if Americans would stop using tobacco, eat healthy, and exercise.
Tobacco InsufficientPhysical Activity
Poor Eating Habits
Excessive Alcohol
The U.S. spends $2.5 trillion on health care every year.
Only $251 is spent per person on public health measures that prevent medical conditions before they occur.
In the U.S. alone, a 10% reduction in mortality from heart disease, cancer, and diabetes would have an annual socioeconomic value of
The projected global economic toll of noncommunicable diseases—chiefly cancer, mental health disorders, and cardiovascular and chronic respiratory diseases—over the next two decades is $47 trillion.
According to General Motors, employee health care costs add between $1,500 and $2,000 to the sticker price of every car the company makes.
Investing in health is not only the right thing to do on ethical grounds but it is also the smart thing to do in order to achieve economic prosperity...Good health is not only a consequence of, but a condition for, sustained and sustainable economic growth.
Noncommunicable Diseases
Injuries, Infections, and Other Conditions (includes communicable diseases, maternal and perinatal conditions, and nutritional deficiencies)
Unhealthy Habits
Noncommunicable Diseases: Comparing the Economic Toll
How Much Health Do We Get for Our Money?
Dollars and Diseases
Cost of the U.S. war in Iraq.
Economic losses from Hurricane Katrina.
$47 TRILLION
$800 BILLION
$250 BILLION
$10.9 TRILLIONNoncommunicable Diseases
Other
61%
39%
Life Expectancy, by Country
$8,000 $9,000$7,000$6,000$5,000$4,000$3,000$2,000$1,000
Total Health Expenditures per Capita Spending in U.S. Dollars and PPP Adjusted
85
80
75
70
U.S. Health Care CostsCauses of Death Worldwide
U.S. national debt (as of July 1, 2012).$15 TRILLION
is spent on medical care per person per year.
$8,086
—Julio Frenk, Dean, Harvard School of Public Health
Sources include: “The Global Economic Burden of Noncommunicable Diseases” World Economic Forum, 2011; “Health Care Costs & U.S. Competitiveness” Council on Foreign Relations, 2012; “An Unhealthy Truth: Rising Rates of Chronic Disease and the Future of Health in America” Partnership to Fight Chronic Disease, 2007; and “Chronic Diseases: The Power to Prevent, The Call to Control” Centers for Disease Control and Prevention website, 2009. For a complete list of sources, please visit: hsph.me/infosources
75%
25%
29Fall 2012
AUTCAN
FRA
GER
ESP
IRL
DENLU
X
NED NOR
USASW
ZCZE
POL
HUN SVKBEL
FIN
GBR
NZL
PORSLO
CHIKOR
ESTMEX
TUR
AUS
ISLSW
E
ISR ITA
JPN
GRE
THE DOLLARS AND SENSEOF CHRONIC DISEASE
The most common behaviors that lead to chronic diseases are:
According to the Centers for Disease Control and Prevention, nearly 1 out of every 2 Americans su�ers from a chronic disease, defined as a noncommunicable disease (NCD) prolonged in duration, including cancer, heart disease, stroke, and diabetes. Chronic diseases are the number one cause of death in the U.S.
The World Health Organization estimates that 80 percent of all heart disease, stroke, and type 2 diabetes, as well as more than 40 percent of cancer, would be prevented if Americans would stop using tobacco, eat healthy, and exercise.
Tobacco InsufficientPhysical Activity
Poor Eating Habits
Excessive Alcohol
The U.S. spends $2.5 trillion on health care every year.
Only $251 is spent per person on public health measures that prevent medical conditions before they occur.
In the U.S. alone, a 10% reduction in mortality from heart disease, cancer, and diabetes would have an annual socioeconomic value of
The projected global economic toll of noncommunicable diseases—chiefly cancer, mental health disorders, and cardiovascular and chronic respiratory diseases—over the next two decades is $47 trillion.
According to General Motors, employee health care costs add between $1,500 and $2,000 to the sticker price of every car the company makes.
Investing in health is not only the right thing to do on ethical grounds but it is also the smart thing to do in order to achieve economic prosperity...Good health is not only a consequence of, but a condition for, sustained and sustainable economic growth.
Noncommunicable Diseases
Injuries, Infections, and Other Conditions (includes communicable diseases, maternal and perinatal conditions, and nutritional deficiencies)
Unhealthy Habits
Noncommunicable Diseases: Comparing the Economic Toll
How Much Health Do We Get for Our Money?
Dollars and Diseases
Cost of the U.S. war in Iraq.
Economic losses from Hurricane Katrina.
$47 TRILLION
$800 BILLION
$250 BILLION
$10.9 TRILLIONNoncommunicable Diseases
Other
61%
39%
Life Expectancy, by Country
$8,000 $9,000$7,000$6,000$5,000$4,000$3,000$2,000$1,000
Total Health Expenditures per Capita Spending in U.S. Dollars and PPP Adjusted
85
80
75
70
U.S. Health Care CostsCauses of Death Worldwide
U.S. national debt (as of July 1, 2012).$15 TRILLION
is spent on medical care per person per year.
$8,086
—Julio Frenk, Dean, Harvard School of Public Health
Sources include: “The Global Economic Burden of Noncommunicable Diseases” World Economic Forum, 2011; “Health Care Costs & U.S. Competitiveness” Council on Foreign Relations, 2012; “An Unhealthy Truth: Rising Rates of Chronic Disease and the Future of Health in America” Partnership to Fight Chronic Disease, 2007; and “Chronic Diseases: The Power to Prevent, The Call to Control” Centers for Disease Control and Prevention website, 2009. For a complete list of sources, please visit: hsph.me/infosources
75%
25%
O
PREVAILING WINDS
Jones Adam/Photo R
esearchers
30Harvard Public Health Review
n a raw January day in Washington, DC, Doug Dockery climbed Capitol Hill on his
way to testify to Congress about the Harvard School of Public Health study he’d
been running. He would have preferred to be anywhere else. It jarred Dockery—
today, chair of the Department of Environmental Health—to confront people
wearing white lab coats, holding signs that read, “Harvard, release the data!”
Employed by an industry-backed group called Citizens for a Sound Economy, the
protesters pressed on passersby fliers claiming that Harvard was hiding “secret”
data. Their message was aimed directly at Dockery.
A decades-long fight to bring clean air standards in line with environmental health science offers lessons for today.
continued
PREVAILING WINDS
31Fall 2012
T
32Harvard Public Health
he year was 1997, and Dockery had arrived in
Washington to tell Congress that because it had promised
study participants confidentiality, Harvard couldn’t share
the raw data from its federally funded Six Cities study.
The landmark research—one of the single most influen-
tial public health studies ever conducted—examined over
14 to 16 years the health effects of air pollution on more
than 8,000 adults and 14,000 children in six U.S. cities.
During that time, HSPH scientists published more than
100 peer-reviewed papers detailing their findings.
The blockbuster paper came in 1993, when Dockery’s
team described what he now calls amazing results.
Residents of Steubenville, Ohio—the city with the dirt-
iest air—were 26 percent more likely to die prematurely
than were citizens of Portage, Wisconsin, the city with
the cleanest air. The primary culprit: fine particulates, up
to hundreds of times narrower than a human hair, which
were associated with increased incidence of lung cancer
and cardiopulmonary disease. “The effects of air pollu-
tion were about two years’ reduction in life expectancy,”
Dockery says. “It was much, much higher than we had
expected.” To Dockery and his colleagues, the results
were conclusive evidence that soot produced by fossil fuel
combustion kills.
That evidence was also enough for the U.S.
Environmental Protection Agency (EPA), which in 1997
used the science, along with many other studies, as the
foundation for the first-ever Clean Air Act regulations on
particulate matter smaller than 2.5 microns in diameter.
The EPA claimed the new PM2.5 rules would prevent
15,000 premature deaths annually and produce other
huge benefits, among them preventing 250,000 inci-
dences of aggravated asthma, 60,000 cases of bronchitis,
and 9,000 hospital admissions every year.
But meeting the new standards would be far from
simple or cheap. Manufacturing, power, steel, auto and
other industries spent untold millions trying to disprove
the science, discredit the EPA, and defeat the new regula-
tions. The New York Times dubbed the clash “the environ-
mental fight of the decade.” It embroiled the Six Cities
study in a years-long controversy—one that holds lessons
for public health professionals working on issues critical
in this year’s election cycle, from new Clean Air Act rules
“ The effects of air pollution were about two years’ reduction in life expectancy. It was much, much higher than we had expected.”
—Douglas Dockery
33Fall 2012
and oil drilling to natural gas fracking and the ubiquitous
pesticides and chemicals in our food, homes, and bodies.
A DEADLY CLOUD
Ever since a toxic black cloud dubbed the “Great Smog”—
made up primarily of coal-burning emissions and diesel
exhaust—hovered over London in 1952 and killed more
than 4,000 people within days, environmental scientists
had worried about the mysterious ingredients composing
industrial haze. In the U.S., that concern intensified in
1973 following the Arab oil embargo, when power plants
were expected to substitute cheap, high-sulfur coal for
expensive oil. What could the nasty emissions from
dirtier fuel do to people?
HSPH’s Ben Ferris, a legendary public health
professor who died in 1996, and Frank Speizer, professor
of environmental science, proposed to find out: They
would sample the air quality in six Eastern cities with
varying degrees of pollution while simultaneously moni-
toring the health of thousands of those cities’ residents.
Among their team were the wiry, intense Jack Spengler,
now the Akira Yamaguchi Professor of Environmental
Health and Human Habitation, who built personal air
quality monitoring equipment that participants wore; and
the tall, reserved Dockery, who traveled from city to city,
setting up air pollution monitors in residents’ homes. Jim
Ware, professor of biostatistics, joined the team in 1979.
Later, Joel Schwartz, professor of environmental epide-
miology, would join the team and become one of its most
prolific authors.
Their goal was simple: to identify links between
illness and death rates and air pollution levels. They
sampled the air for toxic emissions, including sulfur
dioxide and particulate matter, a brew of acids, metals,
petroleum byproducts, diesel soot, and other potentially
harmful substances that readily deposit deep in the lungs.
In the mid–1970s, no one had yet conducted a
comprehensive study of particulates’ effects on human
health. Dockery and his colleagues expected to learn that
the true threat of industrial haze would stem from sulfur
dioxide. But it was the fine particles that were the biggest
dangers (although the study did not show how these
particles created illness, a missing link critics would
highlight). Another surprise: indoor air pollution was continued
Kent D
ayton/HSPH
WHY SIX CITIES MATTERS TODAYThe clash between industry, politics, and science over the Six Cities study remains relevant today. Consider just a small sampling of contemporary public health controversies:
Global Warming:
A U.S. federal appeals court in June agreed with the
EPA that auto and power plant emissions endanger
the public health. Opponents had filed more than 60
lawsuits to block the EPA from regulating greenhouse
gas emissions. As Matthew Wald of The New York
Times wrote, “The judges unanimously dismissed
arguments from industry that the science of global
warming was not well supported and that the agency
had based its judgment on unreliable studies.”
Natural Gas Fracking:
Public health studies show the hydrofracturing, or
fracking, process of drilling fouls the air and water and
may contribute to earthquakes. Industry advocates
question the certainty of that science and say the
country needs cheap, “clean” fuel.
Mining and Cancer:
The Mining Awareness Resource Group, a mining-
industry-funded organization, spent years going
to the courts and to Congress for assistance in
accessing data from, and delaying publication of, a
study showing that miners exposed to diesel exhaust
underground were at high risk of developing lung
cancer. Twenty years after the study was launched,
the Journal of the National Cancer Institute finally
published the results.
34Harvard Public Health
more harmful than outdoor toxins, setting the stage for
years of important research.
Today, because of Six Cities, it is conventional wisdom
that particulate matter contributes significantly to a
wide variety of illnesses across the spectrum of life, from
asthma and bronchitis to sudden infant death syndrome
and lung cancer.
INDUSTRY RESPONDS
Public health considerations aside, the new standards
forced dramatic changes on industry. The New York Times
reported that old Midwestern power plants would have
to install expensive pollution control equipment; states
would need to invest in mass transit and other initia-
tives designed to reduce auto pollution; and factories
that burned mountains of coal would have to switch to
cleaner-burning fuels. How much those changes would
cost depended upon who was doing the estimating:
industry spokesmen said the bill would reach into the
hundreds of billions of dollars. The EPA put the final tab
at $6 to $8 billion.
As the debate grew more contentious, many experts—
including Philip H. Abelson, former editor of Science
magazine—pushed the EPA to delay regulations until the
science was more certain. Abelson maintained that the
makeup of particulate matter differed greatly from place to
place. In an editorial, he queried, “How can the EPA mini-
mize the effects of particulates if it does not know what they
are or which, if any, have deleterious physiological effects?”
Others, like fellow HSPH faculty member John D.
Graham, professor of policy and decision sciences at
HSPH, were also critical of the EPA, arguing that the
Clean Air Act’s legal framework for rule making does not
allow the agency to consider costs, just health outcomes.
Graham had pioneered the study of risk analysis at
HSPH, having founded and, from 1990 to 2001, directed
the Harvard Center for Risk Analysis. From 2001 to
2006, he led the White House’s Office of Information
and Regulatory Affairs, making him what the Natural
Resources Defense Council called “the second most
powerful environmental official in the nation after
George W. Bush.” Today, he serves as Dean of Indiana
University’s School of Public and Environmental Affairs.
Over the years, Graham testified at many congres-
sional hearings that there should be an opportunity for
cost/benefit analysis during EPA rule making. “One of my
key arguments is that practical people are going to do it
anyway,” he says. “We shouldn’t make them do it behind
closed doors. That’s not good, because their arguments
are then not open to public scrutiny.”
“ To have a hostile group combing through your data looking for anything to attack you about was not something any of us relished.”
—James Ware
35Fall 2012
THE BATTLE LINES HARDEN
Citizens for a Sound Economy blanketed the country
with ads designed to influence public opinion. The group,
which the Washington Post called the “pro-industry alli-
ance at the center of an extraordinary, multimillion-
dollar campaign to turn back EPA regulations for smog
and soot,” attracted grassroots supporters by contending
the new rules would force bans on such American icons
as backyard barbecues, farm tractors, and wood stoves.
In addition, critics from industry, members of Congress,
and some governors demanded that Harvard release the
raw data. “We declined,” says Jim Ware, then HSPH acting
dean and now Frederick Mosteller Professor of Biostatistics.
The team had promised participants that their personal
data would never be released. When Harvard refused,
critics accused the researchers of conspiracy and pres-
sured Congress to hold hearings. “The issue is the quality
of the science,” said National Association of Manufacturers
spokesman Richard Siebert. “In order for people to ascertain
the science they need to understand the background data …
What are they hiding?”
“It was a painful time,” says Dockery. “You’d get up
in the morning and look in the paper and there you’d be
again.”
Still, the scientists held their ground. “We knew that
if we released the data, it would be endless aggravation
and defending against attacks,” says Ware. “To have a
hostile group combing through your data looking for
anything to attack you about was not something any of
us relished.” Furthermore, Frank Speizer told Dockery, to
release the raw data would be to allow “biased groups” to
manipulate it and to set a precedent that “will undermine
future research by academic institutions.”
EPA UNDER SIEGE
But the EPA, too, was under siege—from lobbyists and
from Congress, which demanded the agency produce
so-called “secret data” on which the new rules rested.
In February 1997, EPA bowed to the pressure and urged
Harvard to do so. As a compromise, the team came up
with the idea of asking an independent scientific panel
to audit the researchers’ findings. They gave a warehouse
full of data to the Cambridge, Massachusetts–based
Health Effects Institute (HEI), which was funded by both
the automotive industry and the EPA.
It took HEI three years to reanalyze the data—an
agonizing period of limbo for the scientists. But it was
continued
Aerial view of Steubenville, Ohio in 1958.
The Clean Air Act and the policies triggered by HSPH’s Six Cities study are classic examples of how public health should work: good science shapes public policy, and policy, in turn, saves people’s lives.
Opposite, K
ent Dayton/H
SPH; below
, Francis Miller/Tim
e Life Pictures/Getty Im
ages.
36Harvard Public Health
worth the wait. In 2000, HEI scientists confirmed the original Six Cities find-
ings. It was a huge win for the School.
In 1997, while HEI was auditing the data, President Bill Clinton approved
the new Clean Air Act’s PM2.5 regulations and tightened ozone standards.
In 1999, Alabama Republican Senator Richard Shelby, still simmering about
Harvard’s “hidden” data, inserted a single sentence into a 4,000-page budget
bill that would change everything for future researchers. The still-controver-
sial Shelby Amendment calls for those university scientists working on feder-
ally funded projects to share their data with anyone who requests it via the
Freedom of Information Act.
When the issue of sharing primary data first arose, critics like HSPH’s
Frank Speizer feared such a rule would dampen future research by dissuading
potential participants whose confidentiality could no longer be protected.
Today, the issue is so fraught that, even within HSPH, scientists find them-
selves on opposing sides. Doug Dockery calls the Shelby Amendment “a direct
assault on research conducted by universities,” because privately funded
studies aren’t subject to the same rules. In contrast, Jim Ware says, “As a
matter of principle, the Shelby Amendment is right: When the federal govern-
ment pays for research … that research ought to be made available for scru-
tiny by others and for debate and examination.”
THE LONG VIEW
Today, Dockery looks out his 13th-floor window across the Charles River at
the Cambridge skyline, a view that, decades earlier, had often been obscured
“UNCERTAIN SCIENCE” A COMMON CLAIM When public health and industry collide, foes of regulation often claim that epidemiology is an uncertain science, says
Sheila Jasanoff, Pforzheimer Professor of Science and Technology Studies at Harvard Kennedy School of Government.
“The most favored method is to ‘deconstruct’ agency scientific claims, on grounds of methodological inadequacy,” she
says. “The problem is that public health research often operates in zones of ignorance and uncertainty; it is relatively
easy to find, or at least claim to find, ‘problems in the science.’”
The inherent uncertainty of emerging science leads to fiery rhetoric on both sides—which is unfortunate, Jasanoff
adds. “The constant debates about ‘good science’ and repeated charges of overregulation undermine trust in
government and hinder a mature understanding of how to live prudently in complex industrial societies that will never
be risk-free and where full scientific certainty on many issues will likely take very long to achieve.”
Even today, the Six Cities debates linger. John Graham applauded HSPH’s decision to give its data to the
nonpartisan organization Health Effects Institute for analysis. But 15 years later, he remains frustrated that Harvard didn’t
share the original data earlier. “These findings are still utilized around the world,” Graham says. “They sit as a foundation
for multibillion-dollar decisions in China, Brazil, and elsewhere. I would still like to see the data be made publicly
available. It’s the basic principle of transparency in science.”
“ We teach people to be statisticians, epidemiologists, lab analysts, exposure scientists, but we must also equip them for the big fights.”
—Jack Spengler
Kent D
ayton/HSPH
37Fall 2012
by urban haze. “I can see a long way,” he says. “That’s
gratifying.”
Over the last 30 years, air quality nationwide has
improved dramatically, due to Clean Air Act rules
based in part on Six Cities research. In 2009, Dockery
and colleagues Arden Pope (now at Brigham Young
University) and Majid Ezzati (now at Imperial College
London) demonstrated that from 1980 to 2000, reduc-
tions in exposure to fine particulate matter had increased
average American life spans by 1.6 years. “That’s huge,”
Dockery says. “If you got rid of all cancers, the net effect
on average life expectancy would be two years.”
The Clean Air Act and the policies triggered by
HSPH’s Six Cities study are classic examples of how
public health should work: good science shapes public
policy, and policy, in turn, saves people’s lives.
“We provided the basis for quantifying how many hospital
visits, how many asthma attacks, how many COPD [chronic
obstructive pulmonary disease] cases, how many heart
attacks, and how many deaths were associated with these air
pollutants,” he says. “It completely changed the discussion.
When you actually used those numbers, suddenly the cost/
benefit analysis became very clear—and suddenly, the benefits
were found to far outweigh the cost of controls.”
Years later, Office of Management and Budget (OMB)
analysis confirmed Dockery’s claims: in a 2011 report, the
OMB stated, “Of [EPA’s] 20 air rules, the rule with the
highest estimated benefits is the Clean Air Fine Particle
THE DEBATE GOES ONThe controversy over standards for fine particulate matter
air pollution continues today. In June 2012, a federal court
order forced the EPA to propose new, tighter standards;
the agency settled on reducing the allowed annual level
from 15 micrograms per cubic meter to a range between 13
and 12.
But a 2011 report by the American Lung Association,
Clean Air Task Force, and Earthjustice claims that this
reduction doesn’t go far enough. Their analysis, which
cites Six Cities findings, argues that at those levels, a
maximum of 15,000 premature deaths would be averted
annually. The coalition argues that the EPA should adopt
a more stringent annual limit of 11 micrograms per cubic
meter, which its analysis shows would prevent nearly
36,000 premature deaths yearly.
The EPA is expected to issue final standards in
December 2012.
A STEEL BACKBONE
On a crowded shelf in his office, Dockery keeps two six-
inch-thick binders of correspondence and media clippings
from the Six Cities fight. Buried in them are memories—
many painful—but also lessons for today’s public health
professionals.
For Dockery, two stand out. First, “Solid, quality
science does stand up over time.” Second: “How you
present the information—how you translate the data—is
extremely important.”
He believes the PM2.5 standards survived because,
for the first time, the science made it possible to calculate
the costs and finger the sources of air-pollution-related
disease. continued page 45
“ Of [EPA’s] 20 air rules, the rule with the highest estimated benefits is the
Clean Air Fine Particle Implementation Rule, with benefits estimated at a
minimum of $19 billion per year. While the benefits of this rule far exceed
the costs, the cost estimate for the Clean Air Fine Particle Implementation
Rule is also the highest at $7.3 billion per year.” —Office of Management and Budget Analysis
38Harvard Public Health Review
HSPH’S WILL MAIR HOPES HIS WORK IN
WORMS WILL IDENTIFY MOLECULES THAT
HAVE AN EFFECT ON AGING-RELATED
DISEASES—AND WHICH COULD ULTIMATELY
BE TESTED AS TREATMENTS FOR HUMANS.
Why do we AGE?
Surprising revelations
Wormfrom a
39Fall 2012
“How old you are is immutable—you can’t change how old an animal is,” says William Mair, assistant professor of genetics and complex diseases at HSPH. “But you can change how it ages.”
That observation points to a new way of thinking about aging: not as a preordained
decline, but as a malleable function of the body. And viewed in this way, aging belongs at the
center of public health research. Rather than just treating endpoints—such as cardiovascular
disease, metabolic disorders, cancer, and neurodegeneration—could researchers improve
population health by targeting the aging process itself?
Mair’s young lab, launched last November, is trying to answer that question. “It’s not
enough to say it’s inevitable that we get more frail,” says Mair. “There’s something that hap-
pens that makes an old animal more susceptible to getting these disease states. For example,
if you look at cancer, one of the most common age-related diseases, it’s clearly not one pa-
thology. Similar tumors can result from very different mutations in different individuals. Trying
to find those specific mutations is one way to do research. But if you could make the environ-
ment more resistant to developing tumors in the first place, you can try to reduce the chances
of getting cancer with age.”
continued
William
Mair
Kent D
ayton/HSPH
M
40Harvard Public Health
air first became intrigued with aging
as an evolutionary question: If infirmity
isn’t just a product of wear and tear,
why do we age at all? His research
began with an observation known since
the 1930s: A diet severely restricted
in calories (about 30 percent below
normal, but above starvation levels)
restriction without the negative side
effects. “We want to try to uncouple
the good from the bad,” he says. “And
to do that, you need a system that you
can play around with genetically.”
A FAST-FORWARD VIEW OF AGING
His subject of choice: Caenorhabditis
elegans, the classic laboratory nema-
tode used across a wide field of re-
search. These tiny, transparent worms
have played a central role in aging
research. Though just a millimeter long
and composed of barely a thousand
cells, they show visible signs of aging:
they slow down, stop reproducing,
and even develop wrinkled skin. Easy
to manipulate genetically, and with a
life span of just two weeks, C. elegans
provides a quick time-lapse view of the
aging process. That speed suits Mair,
can increase lifespan, lower rates of
cancer, and slow declines in memory
and movement. This effect, first seen in
laboratory rats, has been replicated in
species as diverse as yeast, fruit flies,
worms, and even rhesus monkeys. Fur-
ther research has uncovered genetic
mutations in animals that can mimic the
effects of dietary restriction, and some
of these same mutations are found in
people who live into their 90s.
But laboratory-manipulated
longevity also comes with a price. Re-
stricted-diet animals grow more slowly,
reproduce less, and have dampened
immune systems. More than just cutting
calories, dietary restriction seems to
switch the body into a survival mode in
which growth and energy consumption
are suppressed.
Today, stalwart human volunteers
are testing whether dietary restriction
works in humans, both on their own
and as part of studies like the ongoing
federally funded clinical CALERIE trial
(for Comprehensive Assessment of the
Long-term Effects of Reducing Intake
of Energy). “It’s not something I would
advocate doing,” Mair says, not only
because food deprivation is unpleas-
ant, but also because it could produce
similar negative side effects in humans,
such as fertility problems or susceptibil-
ity to infections.
Mair wants to see if there’s a way
to tap into the health benefits of dietary
“ Everybody knows someone who’s had cancer or type 2 diabetes or Alzheimer’s disease. They see how it destroys people’s lives.”
— William Mair, assistant professor of genetics and complex diseases
41Fall 2012
whose rapid speech bears inflections
from his native Suffolk, England.
“What on earth can we learn about
humans from studying a worm? One
answer is that the worm is a way to
investigate causality. You can learn a
lot of stuff by doing an epidemiologi-
cal study to find out what’s changing
in population—but it’s very hard to find
causality in those changes. With this
simple worm, in a cheap and quick way,
we can tweak things and find causality.
And if we do that, coupled with what
at energy sensing and how that affects
stress resistance and healthy aging. But
it involves exactly the same molecules.”
For example, some of the patients tak-
ing the widely prescribed diabetes drug
metformin appear to be resistant to
certain cancers—an outcome unrelated
to the protective effect that the drug
has on diabetes. Mair’s lab has shown
that activating one of the key molecular
targets of metformin in worms makes
them age more slowly. Seeing the same
disease pathways turn up in research
FRESH PERSPECTIVES, ETHICAL
QUESTIONS
At the same time, tinkering with the
aging process could have huge public
health repercussions. “Everybody
knows someone who’s had cancer
or type 2 diabetes or Alzheimer’s
disease. They see how it destroys
people’s lives and they’re scared of
it,” says Mair. As for the argument that
research on prolonging a healthy life
is unethical, because the planet is
already too crowded: Mair doesn’t buy
it. “Everything that alleviates suffering
is unethical not to do,” he says. “All
public health strategies, if successful,
will help more people survive to older
ages—and hopefully, succumb less to
chronic diseases. How we cope as a
species with the effect that might have
on the age structure of our population
is a separate issue.”
Though he explores the funda-
mentals of aging, Mair, who is 33,
cultivates a decidedly fresh presence
on his HSPH website. One link features
a ticking digital clock showing the exact
age of the lab, down to the second.
Another tracks the music playing in the
lab (from Esperanza Spalding to Sigur
Rós to Radiohead). The lab also posts
Twitter messages.
“Being a young lab is a difficult
thing. You’re trying to get things off the
ground,” says Mair. “The ticking clock
is meant to reflect a certain level of
honesty about how long we’ve been
here. The more transparency you
have—showing what’s going on, that
we’re progressing and moving—the
better. We want people to feel excited
about our work. It’s also very important
to make a lab a community. If you can
give the lab a personality, it helps you
recruit. This lab website has a face—it’s
not just an entry on the faculty page.”
Courtney Humphries is a Boston-based science journalist and author.
we know from colleagues who are
working on how these genes are linked
to different pathologies, then it can be
a very powerful model.”
JOINING FORCES:
AGING AND DISEASE
After completing a postdoctoral fellow-
ship at the Salk Institute for Biological
Studies in La Jolla, California, Mair
moved to the School to collaborate
with scientists studying the chronic
diseases he believes his research can
help alleviate. There’s reason to join
forces: Many of the same genes and
cellular processes involved in aging also
play a role in diabetes, obesity, and can-
cer. Mair, for instance, recently received
an award for a pilot project through
HSPH’s Transdisciplinary Research
on Energetics and Cancer (TREC), a
program funded by the National Cancer
Institute to promote research on links
between obesity and cancer.
“I’m not looking at cancer or obe-
sity in the worm,” he says. “I’m looking
across widely separated disciplines
argues for a more integrated research
approach.
Mair hopes that his work in the
worm will identify molecules that have
an effect on aging-related disease,
which could then be tested in mice and
eventually in humans as possible thera-
pies. But for now, he’s focused on mak-
ing basic discoveries rather than hunting
for drugs. He sets himself apart from
scientists who explicitly want to boost
lifespan in humans, which he says has
given studies on aging a Frankenstein-
like reputation among the public.
“You have to walk a fine line in the
field,” he says. “There are certainly mem-
bers of it who don’t. Their motivation
is that they want a pill to make them-
selves live a long time,” he says. “Some
people—and it’s a very small minority
who are not well-credited in the aging
field—have said that the first human to
live to 500 is alive right now. There’s no
scientific basis for that. It’s so detached
from my reason for working on these
questions, it’s sci-fi rather than natural
science. We have a long way to go.”
WITH THIS SIMPLE WORM, IN A CHEAP
AND QUICK WAY, WE CAN TWEAK THINGS
AND FIND CAUSALITY.
R
ARKU’S JOURNEY
aphael Arku should have been on top of the
world. There he was, in his early 20s, a ge-
ologist for a gold mining company, a job with
prestige and money—neither of which he’d ever
had before.
The second of seven siblings, Arku had been
raised by his single mother in a rural village in
Ghana. At school, with his fellow students, he
would forage for firewood and carry water in
from a nearby stream. He always had a candle
in his pocket. “The lights can go off anytime,
and we don’t have generators,” Arku recalls.
“But you have to study because you’re compet-
ing with other students for the same national
exams to enter the university. So the best you
can do is have candles, and you light them up
to study. That was my high school.”
Justin Ide
43Fall 2012
ARKU’S JOURNEY
Arku won a slot at the University of Ghana and then se-
cured his lucrative job. To everyone who knew him, it made
sense that after those years of grinding work, Arku should
be happy.
But he wasn’t.
Exploring for gold in Ghana came with ugly surprises.
“We caused a lot of damage to villagers’ water resources, to
their farm fields,” Arku says. One day, working in a remote
village, the team dynamited a huge boulder. “It was right on
top of the water head,” Arku says. “Everything fell into the
water and it became muddy. We were washing the alluvial
gold right into the river.”
WATER FOULED
Villagers soon came to fetch drinking water. Before using
it, they simply let the toxic sediment settle to the bottom.
But the water was now fouled with contaminants from the
blasting, including arsenic and other toxic heavy metals,
and with gas and diesel from the miners’ leaky equipment.
“They didn’t even know they could boil it,” Arku says. After
only a year on the job, he quit. “I had a conflict between my
personal beliefs and what was happening in the field.”
Arku replaced his high-paying career with something far
more valuable: a commitment to improving the environment
for his fellow Ghanaians. Once again poor, the quiet, slender
student began a long, difficult journey toward a public health
career—one that had him earning two master’s degrees
before starting his doctorate at Harvard School of Public
Health in 2010.
Now 31, Arku has traded his interest in water for a pas-
sion to clean up Ghanaians’ foul air. The need, he implies, is
obvious. “Have you ever been to Accra?” he asks, eyebrows
raised. With some 4 million residents, Accra is the country’s
largest city and one of the fastest-growing urban areas in
the world. A stew of ingredients in the air—exhaust from the
city’s fleet of old imported cars, dust from unpaved roads,
and especially toxic emissions from the coal and firewood
most people use as cooking fuel—makes it one of the
globe’s most polluted. “If you go out in the morning,” says
Arku, “over the course of the day, you can actually see the
color of your shirt darken.”
He had begun his quest to understand how the tainted
environment affects the health of Accra’s residents, especial-
ly the poor, as an undergraduate at the University of Ghana
in 2003. There, he worked for Allan Hill, today HSPH’s An-
delot Professor of Demography. Hill was on leave, setting up
the Women’s Health Survey of Accra with the University of
Ghana. He needed skilled interviewers—and people capable
of persuading female participants to provide blood samples
and submit to medical exams. “Raphael quickly distinguished
himself as by far the most able of my new recruits,” Hill says.
MISTAKEN IDENTITY
One big problem: mistaken identities could easily foul up
the research sample. “In Ghana, people have family names,
‘days’ names, nicknames, and so on,” Hill says. “Raphael
would doggedly approach the women in turn and, by sys-
tematic inquiry and cajoling, ensure the right women were
recruited for the study.”
Arku’s day started at dawn, when he would hop a
minibus or ride a motorbike to the neighborhood they had
Raphael Arku
working in the Nima
neighborhood of
Accra, Ghana. He is
doing fieldwork at a
rooftop site set up to
measure ambient air
pollution.
continued
Raphael Arku was able to attend HSPH with the help of financial aid. He won a Thorley D. Briggs Scholarship, which is given to African students to attend the School.
He was also awarded a Mitchell L. Dong and Robin LaFoley Dong Scholarship, which is provided to students on the basis of need and academic excellence.
44Harvard Public Health Review
targeted. Often, he made several trips to catch the women
at home. “The work continued to late in the evening,” Hill
recalls. “But Raphael’s work rate was relentless.”
When he pursued his first master’s degree in 2006,
Arku helped another HSPH professor, Majid Ezzati (now an
adjunct professor at HSPH and chair in Global Environmental
Health at Imperial College London), who was equally im-
pressed. Their work, also with the University of Ghana, was
groundbreaking. With pockets of wealth, a sizable middle
class, and millions living in poverty, Accra is notable for its
striking economic inequality—inequality that, Ezzati theo-
rized, reaches all the way down into the air and water.
With the help of Arku and other students, Ezzati pin-
pointed the sources of air pollution in four neighborhoods,
from high-income areas to slums. “You’re trying to do really
good science in a place where everything from the elec-
tricity supply to the social conditions are unstable,” Ezzati
says. Trudging from place to place, the researchers learned
that in the densely populated slums, almost everyone uses
firewood; cheap, dirty coal; and dung for cooking, typically in
makeshift kitchens set up in bedrooms or on front porches.
In contrast, Arku says, about 80 percent of people living in
high-income neighborhoods use liquid propane gas (LPG),
with biomass fuels as a backup due to an unstable LPG
delivery system. Not surprisingly, “The lowest-income neigh-
borhoods had the highest air pollution,” Ezzati reports.
Poor residents cook with these low-quality fuels be-
cause it’s all they can afford. From previous studies else-
where—including HSPH’s Six Cities study (see page 30)—it’s
clear that high levels of particulate matter produced by fossil
fuels cause health problems ranging from low birth weights
to asthma, bronchitis, lung cancer, cardiovascular disease,
and premature death.
Intending to learn more about the link between Accra’s
dirty air and the health of its residents, Arku applied to
HSPH to do his doctorate. “My dream was to be at Harvard,”
he says. Although he hasn’t yet settled on a dissertation,
he is deeply interested in analyzing urban energy use and
infrastructure—and exploring technology and policy innova-
tions (further electrifying the city, for example, or introducing
clean-burning, affordable stoves) that could help reduce both
household and neighborhood air pollution exposures.
WRESTLING WITH BUREAUCRATS
Last summer, Arku returned to Ghana to collect more data—
this time trying to link illness to air pollution sources. In the
smoggy heat, he walked from one doctor’s office and clinic
to another, trying to find administrators willing to share
information. “It takes several hours or days to find the right
person,” Arku says. “Think of this as ‘wrestling with bureau-
crats’ to get the data you need.”
Arku wants to return home, Ph.D. in hand (expected
in 2015), to set up a world-class research program at the
University of Ghana. “If you ever lived in Accra and you have
a passion for the environment, I think you would be mad
enough so that you would like to do something,” he says.
But given his experience of growing up without a stable
source of energy, Arku has an extremely practical side.
“There is an urgent need for regular, community-level access
to cleaner fuel,” he says. The recent discovery of crude oil off
Ghana’s shores, along with the expectation of new produc-
tion of natural gas, could help alter the future for Accra’s
people, depending upon how new resources are expended.
According to Arku, “We need a relevant policy debate that
would focus on whether a portion of the proceeds and sup-
ply from these projects should be used to develop energy
infrastructure in low- and middle-income Accra neighbor-
hoods.”
Such fundamental changes could vastly improve resi-
dents’ health. Arku’s research will be central to building the
case for such changes, not just in Accra, but also in scores of
cities across Africa.
Elaine Appleton Grant is assistant director of development communications and marketing at HSPH and a former public radio reporter.
Arku discovered that a job exploring for gold had ugly—and toxic—surprises. He replaced his high-paying career with a commitment to improve the environment in Ghana.
45Fall 2012
Implementation Rule, with benefits
estimated at a minimum of $19 billion
per year. While the benefits of this
rule far exceed the costs, the cost esti-
mate for the Clean Air Fine Particle
Implementation Rule is also the
highest at $7.3 billion per year.”
Although not everyone agrees with
OMB’s assessment or even with the
legitimacy of assigning a price tag to
health outcomes (what is the monetary
value of a human life saved?), many
believe such data are more important
than ever. The industry lobby has
gained strength in the 15 years since the
Six Cities brouhaha. In 2011, a hearing
before the Republican-led House of
Representatives subcommittee on new
Clean Air Act rules was entitled, “Lights
Out: How EPA Regulations Threaten
Affordable Power and Job Creation.”
CHALLENGES IN TODAY’S POLITICS
Seen through a 2012 lens, it may be
surprising that the Six Cities imbro-
glio wasn’t a strictly partisan fight.
Unlike today, earlier environmental
battles didn’t erupt along party lines.
It was President Richard Nixon who
established the EPA in 1970, setting the
stage for a string of Republican envi-
ronmental accomplishments, including
the first major reauthorization of the
Clean Air Act in 1990 under George
H. W. Bush. “When you look at the
record,” says Dockery, “the Republican
administrations have been better
for environmental controls than the
Democratic administrations.”
Dockery believes today’s political
environment is actually far more diffi-
cult for science than it was in 1997.
“Before, there was the cry that we
wanted the best science for defining
the regulation,” he says. Now, he adds,
referring to debates like those over
global warming and certain childhood
vaccinations, “What we’re seeing is a
total rejection of science as the basis
for making regulatory decisions.”
HSPH’s Jack Spengler has become
convinced that scientists studying
today’s environmental problems need
both new communication skills and
a steel backbone. “You really have to
know you’ve got the personality to do
this,” he says. “If you choose a public
health career and you believe in it, and
if you have an urgent public health
message that needs to be delivered, this
is part of the territory.”
To Spengler, that means public
health educators have a new job to
do: teaching scientists how to lead
and how to deliver their messages to
policymakers. “We teach people to
be statisticians, epidemiologists, lab
analysts, exposure scientists,” he says.
“But we must also equip them for the
big fights.”
Elaine Appleton Grant is assistant director of development communications and marketing at HSPH and a former public radio reporter.
EXECUTIVE AND CONTINUING PROFESSIONAL EDUCATION PROGRAMS 2012–2013
Customized programs are also available. Foster the growth of your executives and your organization as a whole by developing a custom program that will address the specific challenges you face in today’s marketplace. CCPE brings custom programs to organizations around the globe.
All programs are held in Boston unless otherwise noted.For a complete list of topics and faculty, or to register,visit: https://ccpe.sph.harvard.eduemail: [email protected]: 617-384-8692
Harvard School of Public HealthCenter for Continuing Education677 Huntington Ave. CCPE-Dept. ABoston, MA 02115
SEPTEMBER 2012
September 17–20Work, Health, and Well-Being: Strategic Solutions for Integrating Wellness and Occupational Safety and Health in the Workplace
September 27–28Sleep and Shift Work: Optimizing Productivity and Health Management in the 24/7 Global Economy
OCTOBER 2012
October 1–5Ergonomics and Human Factors: Strategic Solutions for Workplace Safety and Health
October 14–26Leadership Development for Physicians in Academic Health Centers
October 28–November 2Leadership Strategies for Evolving Health Care Executives
JANUARY 2013
January 13–25Program for Chiefs of Clinical Services
FEBRUARY 2013
February 13 and May 17Leadership Strategies for Information Technology in Health Care
PREVAILING WINDS continued from page 37
45Fall 2012
46Harvard Public Health
1973Frank M. Torti, MPH, became vice presi-dent for health affairs at the University of Connecticut Health Center, and the eighth dean of the UConn School of Medicine in May. Torti holds a Board of Trustees professorship in the Department of Medicine. Torti previous-ly served as vice president for strategic programs, director of the Comprehensive Cancer Center, and chair of the Department of Cancer Biology at Wake Forest University School of Medicine in Winston-Salem, North Carolina.
1976 Alma Foggo York, MPH, passed away on February 9 after being struck by a car near her Huntsville, Alabama home. A native of Bermuda, she was a mentor and educator who served as dean of women and chair of the Department of Nursing at Oakwood University in Huntsville.
1977 Dr. Lonnie Norris, MPH, received the American Dental Education Association (ADEA) Distinguished Service Award during the 2012 ADEA Annual Session & Exhibition in March. He was honored for his significant contributions to education and research, and to the ADEA. Norris has been a faculty member at Tufts University School of Dental Medicine since 1980 and is a tenured professor of oral and maxillofacial surgery. He was appointed interim dean at Tufts University School of Dental Medicine in July 1995 and dean in February 1996. He retired as dean in 2011 and was named dean and professor emeritus.
1982Howard Frumkin, MPH, DPH ’93, co-edited the book Making Healthy Places: Designing and Building for Health, Well-being, and Sustainability (Island Press, August 2011). The book analyzes the
connections between the built environ-ment and public health. Frumkin is dean and professor of environmental and occupational health sciences at the University of Washington School of Public Health. Frumkin recently mar-ried Joanne Silberner, a former National Public Radio health reporter now teach-ing at the University of Washington.
1983 Jacques Carter, MPH, received a certifi-cate of appreciation from the Mashpee Wampanoag Tribe for his dedication to providing health care services to the tribal nation. The Mashpee Wampanoag Tribe is connected to Harvard University, both historically and currently, through the University Charter of 1650, which describes Harvard’s pledge to educate the tribe’s youth.
1990Dr. Robert Travnicek, MPH, re-ceived the Mississippi State Medical Association’s prestigious Community Service Award in June. He was cited for his more than two decades of service as district director of Coastal Plains Public Health District IX. During the aftermath of Hurricane Katrina in 2005, Travnicek “worked tirelessly for two consecutive months without a break,” according to the award citation.
1992Swati Piramal, MPH, director of Piramal Healthcare, was elected in May to serve a six-year term on Harvard’s Board of Overseers.
Endang Sedyaningsih, MPH, SD ’97, passed away on May 1 from lung cancer. In 2009, she was appointed minister of health in her native Indonesia. Minister Endang returned to HSPH in May 2011 to deliver a Dean’s Distinguished
Lecture on “Efforts in Materializing Health Care Equity in Indonesia.”
1994 Dr. Gina Solomon, MPH, was ap-pointed deputy secretary for science and health at the California Environmental Protection Agency in April by Governor Jerry Brown. Solomon previously served as a senior scientist for the Natural Resources Defense Council and as clini-cal professor of health sciences at the University of California, San Francisco.
1997 Brian Jung, MPH, performed with the San Francisco Gay Men’s Chorus in a music video posted online as part of the It Gets Better Project, which aims to inspire LGBT youth who are facing harassment and contemplating suicide. Jung appears in the video, viewable on YouTube at www.youtu.be/-XZRNL9ZnyM.
1998 Dr. Roderick King, MPH, was named deputy director of the Florida Public Health Institute in May. King previ-ously was president of Next Generation Consulting Group, a health care or-ganization. He is an instructor in the Department of Global Health and Social Medicine at Harvard Medical School, a senior faculty member at the Massachusetts General Hospital Disparities Solutions Center, and a for-mer director of the Program on Cultural Competence in Research in Harvard Clinical and Translational Science Center at Harvard Catalyst.
Dr. Martin Makary, MPH, published the book Unaccountable: What Hospitals Won’t Tell You and How Transparency Can Revolutionize Health Care (Bloomsbury Press) in September. The book received favorable notice from a Publishers Weekly
ALUMNI NEWS
Kent D
ayton/HSPH
47Fall 2012
ALUMNI NEWS
Meet Your Alumni Association Representatives Harvard Public Health runs an ongoing series of bios introducing elected representatives on the
HSPH Alumni Council. If you would like to get more involved as a representative, committee member,
volunteer, donor, or mentor, contact the alumni office at [email protected].
reviewer, who wrote, “This thought-provoking guide from a leader in the field is a must-read for MDs, and an eye-opener for the rest of us.” Makary is co-developer of the lifesaving checklist out-lined in HSPH Professor Atul Gawande’s best-selling book The Checklist Manifesto: How to Get Things Right. Learn more at UnaccountableBook.com.
1999Dr. Nawal Nour, MPH, is the 2012 re-cipient of the Lila A. Wallis Women’s Health Award, presented by the American Medical Women’s Association at their annual meeting in April. Nour was honored for her work establishing and directing the African Women’s Health Center at Boston’s Brigham and Women’s Hospital. The center is de-voted to the medical needs of African
Teresa Chahine, SD ’10
Teresa Chahine graduated in 2010
with an ScD in environmental health,
and stayed on as a research fellow at
HSPH, while exploring entrepreneurial
approaches to solving global health and
international development challenges
through MIT’s Legatum Center for
Development and Entrepreneurship. Prior to HSPH, Chahine
worked as a reproductive health coordinator with the Ministry
of Social Affairs and UNFPA (the United Nations Population
Fund) in Lebanon. Currently, she divides her time between
Boston and Beirut, where she joined the Systems Reform
Group, a consulting network dedicated to strengthening health
and education systems in Arab countries and other transi-
tional regions in Asia. Chahine conducts urban sustainability
research at HSPH in collaboration with the Harvard Graduate
School of Design and Qatar Foundation, and teaches sustain-
able development practice at Harvard Extension School.
Sameh El-Saharty, MD, MPH ’91
Sameh El-Saharty works as senior health policy spe-
cialist in the South Asia region at the World Bank in
Washington, DC. Before joining the bank, he held sev-
eral positions with international or-
ganizations, academic institutions,
and consulting firms, including the
United States Agency for International
Development, UNFPA, Harvard
University, the American University in
Cairo, and Pathfinder International. El-
Saharty has extensive experience for
more than 25 years as a researcher,
technical adviser, and international consultant on public
health, health policy and management, health insur-
ance, and health sector reform programs in more than
18 countries in the Middle East and North Africa region,
Africa, South Asia, and in the United States. El-Saharty, an
Egyptian national, is married with two children.
women who have undergone female genital cutting (FGC), also known as female circumcision. Nour, who also directs the hospital’s Division of Global Obstetrics and Gynecology, helped develop a surgical procedure that can alleviate some of the negative effects of FGC, such as urinary tract infections, painful menstrual periods, painful sexual intercourse, and difficulty con-ceiving and giving birth.
Dr. Kelly Moore, MPH, medical direc-tor of the Tennessee Immunization Program, was awarded the national Association of Immunization Managers 2012 Natalie J. Smith, MD, Memorial Award at the Centers for Disease Control and Prevention in February. The award recognizes her achieving national vac-cine preventable disease goals, visionary leadership, service as a role model, and
advancement of the mission of AIM. It is the highest form of recognition for an immunization program manager.
2000Jeffrey Blander, SM ’04, SD ’08, and his wife, Michelle, are celebrating the birth of daughter Rose Maisha Blander in May. The family relocated to Washington, DC, in the spring after Blander joined the U.S. Department of State as senior adviser for private sec-tor engagement, Office of the Global AIDS Coordinator, The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR).
2007Raul Ruiz, MPH, is running for Congress in California’s 36th District, where he works as a physician in the Coachella Valley. continued
Harvard Public Health is interested in hearing from you. Please send comments or class notes to: Amy Roeder, Assistant EditorHarvard Public Health90 Smith Street Boston, MA 02120
Phone: (617) 432-8440 Fax: (617) 432-8077Email: [email protected]
48Harvard Public Health
Associate professor Sarah Fortune re-ceived an award from the Burroughs Wellcome Fund’s Investigators in the Pathogenesis of Infectious Disease pro-gram in May. The awards are intended to give recipients the freedom to pursue high-risk projects and new avenues of inquiry. Fortune was recognized for her work on the diversity and virulence of the tuberculosis bacterium.
Atul Gawande, professor in the Department of Health Policy and Management, received a prestigious National Committee for Quality Assurance Health Quality Award in March for contributing to the public’s understanding through his writing and research. Gawande is a staff writer for The New Yorker and has written three best-selling books.
Assistant Professor Maria Glymour was promoted to associate site director of the Robert Wood Johnson Foundation Health & Society Scholars Program at Harvard in May. This interdisciplinary initiative has the goal of building the nation’s ca-pacity for research, leadership, and policy change to address the multiple determi-nants of health and supports postdoctoral researchers with activities integrated across HSPH, Harvard Kennedy School, Harvard Medical School, and the Faculty of Arts and Sciences.
Bernard Lown, HSPH professor emeri-tus, received a Lifetime Achievement Award at the British Medical Journal Group’s Improving Health Awards on
May 23 in London. Lown is renowned for his groundbreaking work on the causes and treatment of heart disease and cardiac arrhythmias and his dedica-tion to the prevention of nuclear war. During the Cold War, he co-founded International Physicians for the Prevention of Nuclear War. The organi-zation won a Nobel Peace Prize in 1985.
John McDonough, professor of the prac-tice of public health and director of the Center for Public Health Leadership, received the 2012 Schweitzer Leadership Award in May from the Boston Schweitzer Fellows Program. The award recognizes an individual in Greater Boston or Central Massachusetts “whose life example has significantly mitigated the social determinants of health, and whose commitment to service has influ-enced and inspired others.”
Franziska Michor, associate professor of computational biology, received HSPH’s second annual Alice Hamilton Award in April. She was honored for her path-breaking work applying evolutionary theory to cancer. The award is named in honor of Harvard’s first female faculty member, who was appointed assistant professor of industrial medicine in 1919 in what ultimately became the Department of Environmental Health at HSPH.
Eric Rimm, associate professor in the Departments of Epidemiology and Nutrition, received the 2012 General Mills Bell Institute of Health and Nutrition–Innovation Award from the
AWARDS AND HONORS
FACULTY NEWS
2011Oliver Mytton, MPH, who has con-ducted research on the health effects of taxing unhealthy foods, was cited in a May 16 article in The Guardian. Mytton and his colleagues found that the price of unhealthy food and drinks would need to increase by 20 percent to cut consumption by enough to reduce obesity and other diet-related diseases. They recommended that such taxes be accompanied by subsidies on healthy foods such as fruit and vegetables to help encourage a significant shift in dietary habits. Mytton is an aca-demic clinical fellow in public health at Oxford University.
2012 Jason Rafferty, MPH, recently complet-ed his doctorate in medicine at Harvard Medical School, along with his degree in maternal and child health from HSPH. He is continuing his training at Brown University in a residency program com-bining pediatrics, adult psychiatry, and child/adolescent psychiatry.
Xuehong Zhang, SD, received the American Society of Preventive Oncology’s inaugural Electra Paskett Annual Scholarship at the Society’s con-ference in March. Zhang, an instructor in medicine at Harvard Medical School, earned the scholarship for his abstract, “Prospective Cohort Studies of Vitamin B6 Intake and Colorectal Cancer Incidence: Modification by Time?” The award recognizes Zhang as an outstand-ing scientist in cancer research.
From top, ©
Tony Rinaldo, Aubrey LaM
edica/HSPH
49Fall 2012
American Society for Nutrition (ASN). This award is given to an investigator whose scientific contributions advance the understanding of the health benefits of whole grains. Rimm was honored dur-ing the ASN Awards Ceremony in April.
K. “Vish” Viswanath, associate profes-sor of society, human development, and health, became a member of the National Vaccine Advisory Committee of the U.S. Department of Health and Human Services in February. The com-mittee recommends ways to achieve optimal prevention of infectious dis-eases through vaccine development and provides guidance on preventing adverse reactions to vaccines.
IN MEMORIAM
Hilton Salhanick
Hilton Salhanick, profes-
sor emeritus and a former
chair of the Department of
Population Sciences, died
on June 20 at the age of 87.
Salhanick served as Frederick
Lee Hisaw Professor of
Reproductive Physiology
at HSPH from 1971 through
1996. He was also a profes-
sor of obstetrics, gynecology,
and reproductive biology at
Harvard Medical School for
many years.
Salhanick was instrumental
in the design and develop-
ment of many improvements in
contraceptive devices, partic-
ularly oral contraceptives. He
was the first to purify human
progesterone, in 1960, and
to show that it had biological
activity. He was also among
the first to identify some of the
side effects of first-generation
oral contraceptives, such as
liver toxicity and stroke.
Marianne Wessling-Resnick, profes-sor of nutritional biochemistry in the Department of Genetics and Complex Diseases, became the director of the Division of Biological Sciences at HSPH in May. She continues in her role as the director of the PhD Program in Biological Sciences in Public Health.
Marvin Zelen, Lemuel Shattuck Research Professor of Statistical Science and member of the Faculty of Arts and Sciences, was one of two awardees for the inaugural Karl E. Peace Award, established by the American Statistical Association to recognize “outstanding statistical contributions for the better-ment of society.” Zelen was honored at this year’s Joint Statistical Meetings, held in San Diego from July 28 to August 2.
APPOINTMENTS & PROMOTIONSXiaole Shirley Liu professor of biostatistics and computa-tional biology at HSPH and the Dana-Farber Cancer Institute
Sarah Fortune Melvin J. and Geraldine L. Glimcher Associate Professor of Immunology and Infectious Diseases
Josiemer Mattei assistant professor of nutrition
Joshua Salomon professor of global health
George Seage professor of epidemiology
Zhi-Min Yuan professor of radiobiology and director of the John B. Little Center for Radiation Sciences and Environmental Health
BOOKSHELFRenegotiating Health Care: Resolving Conflict to Build Collaboration Leonard J. Marcus, Barry C. Dorn, and Eric J. McNulty
Jossey-Bass 512 pages
Health care today is a complex field, rapidly evolving in ways that can spur divisive conflict or new opportunities for collaboration and innovation. The authors, all part of HSPH’s Program on Health Care Negotiation and Conflict Resolution, tackle the field’s critical is-sues with practical, proven techniques for navigating turbulent situations and achieving positive outcomes. This thor-oughly revised and updated edition fo-cuses on the complex interactions among those who deliver, receive, administer, and oversee health care. It outlines nego-tiation techniques and conflict resolution approaches that can improve efficiency, quality of care, and patient safety. The book also explores why unresolved con-flict can hamper an organization’s ability to make timely, cost-effective decisions and implement new strategies.
Kent D
ayton/HSPH
50Harvard Public Health
Harvard Public Health is published three times a year for supporters and alumni of the Harvard School of Public Health. Its readers share a commitment to protecting the health and improving the quality of life of all people.
Harvard Public HealthHarvard School of Public HealthOffice for External Relations90 Smith StreetFourth FloorBoston, Massachusetts 02120(617) 432-8470
Please visit http://www.hsph.harvard.edu/news/magazine/ and email comments and suggestions to [email protected].
Dean of the Faculty Julio Frenk T & G Angelopoulos Professor of Public Health and International Development
Vice Dean for External RelationsEllie Starr
Associate Vice Dean for CommunicationsJulie Fitzpatrick Rafferty
Director, Strategic Communications and MarketingSamuel Harp
EditorMadeline Drexler
Assistant EditorAmy Roeder
Senior Art DirectorAnne Hubbard
Assistant Director for Development Communications and MarketingElaine Appleton Grant
Principal Photographer Kent Dayton
Contributing Photographers Aubrey LaMedica, Brian Smale
Contributing IllustratorsShaw Nielsen
Marketing and Communications CoordinatorRachel Johnson
Contributing WritersMichael Blanding, Luisa Cahill, Karen Feldscher, Courtney Humphries
© 2012 President and Fellows of Harvard College
DEAN OF THE FACULTYJulio Frenk
ALUMNI COUNCIL As of November 2011
Officers Elsbeth Kalenderian, MPH ’89 President
Anthony Dias, MPH ’04President Elect
Ramon Sanchez, SM ’07, SD ’11Secretary
Royce Moser, MPH ’65Immediate Past President
Alumni Councilors
2009-2012Marina Anderson, MPH ’03Rey de Castro, SD ’00Cecilia Gerard, SM ’09*
2010-2013Teresa Chahine, SD ’10*Sameh El-Saharty, MPH ’91 Chandak Ghosh, MPH ’00
2011-2014Haleh Armian, SM ’93Michael Olugbile, MPH ’11*Alison Williams, PD ’10
*Class Representative
VISITING COMMITTEE Jeffrey P. Koplan, MPH ’78Chair
Nancy E. AdlerAnita BerlinJoshua BogerLincoln ChenWalter ClairLawrence O. GostinAnne MillsKenneth OldenBarbara RimerMark Lewis RosenbergJohn W. RoweBernard SalickEdward M. ScolnickBurton SingerKenneth E. Warner
BOARD OF DEAN’S ADVISORS Jeanne B. AckmanTheodore AngelopoulosGeorge D. BehrakisKatherine S. BurkeChristy Turlington BurnsGerald L. ChanLee M. ChinJack Connors, Jr.Jamie A. Cooper-HohnMala GaonkarAntonio O. GarzaC. Boyden GrayJeanne LavineJonathan LavineRichard L. Menschel* Roslyn B. PayneSwati A. PiramalAlejandro Ramirez Carlos E. RepresasRichard W. SmithHoward StevensonSamuel O. ThierKatherine Vogelheim
*emeritus
For information about making a gift to the Harvard School of Public Health, please contact:
Ellie StarrVice Dean for External RelationsOffice for External RelationsHarvard School of Public Health90 Smith StreetFourth FloorBoston, Massachusetts 02120(617) 432-8448 or [email protected]
For information regarding alumni relations and programs, please contact, at the above address:
Jim Smith, Assistant Dean for Alumni Affairs(617) 432-8446 or [email protected]
www.hsph.harvard.edu/give
HARVARD HEALTHPUBLIC
William Foege MPH ’65
Epidemiologist William Foege’s interest in global health began in his teen years, when he read about Albert Schweitzer’s work in Gabon. His fascination took him first to medical school and then to Harvard School of Public Health, where the shy six-foot-seven doctor earned his master’s degree in 1965.
His studies set the stage for a 50-year career that made him a public health hero. Foege is credited with helping implement the vaccination strategy that eradicated smallpox, one of the deadliest human scourges in history. He led the CDC from 1977 to 1983. In 1984, he created a task force on global childhood immunization, and in six years the proportion of children who had received at least one immunization rose from 20 to 80 percent. Foege led the Carter Center and is a senior fellow at the Bill & Melinda Gates Foundation. In May 2012, President Barack Obama awarded him the nation’s highest civilian honor—the Presidential Medal of Freedom.
“I’ve been so lucky in my life,” Foege told The Lancet. “I’ve worked on everything I’ve been interested in for half a century.”
“ There is something better than science … That is science with a moral compass, science that contributes to social equity, science in the service of humanity.”
With your help, HSPH can train a new generation of global health leaders who one day can have an impact as great as or greater than Foege.
Please give to support financial aid today. To find out how, visit http://hsph.harvard.edu/give or call Morgan Pendergast at 617-432-8436.
Nonprofit Org.U.S. Postage PDBurlington, VTPermit No. 586Harvard University
Office for External Relations90 Smith Street Boston, Massachusetts 02120
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As National Elections Near, HSPH Experts Weigh In On Affordable Care Act
The U.S. Supreme Court ruled on June 28, 2012
to uphold most of the Obama administration’s
health care law. But the fate of the Affordable
Care Act remains a hotly contested issue in
the upcoming presidential and congressional
elections.
Throughout the debate, Harvard School of
Public Health researchers have been part of the
national conversation, contributing innovative
research and expert commentary on the issues.
For the latest polling on health care, analysis
of the Supreme Court’s ruling, and coverage of
HSPH research on health policy topics ranging
from cost control to electronic medical records,
visit hsph.me/election2012healthcare.
TV networks report live on the sidewalk during the third and final day of legal arguments over the Patient Protection and Affordable Care Act at the Supreme Court in Washington Jonathan Ernst/REUTERS