Harvard Public Health, Spring/Summer 2012
The art of getting things done. Health care reforms fashioned by HSPH's Bill Hsiao prevail where others have failed.
HSPH.HARVARD.EDU The Promise of Big Data Your Healthy Plate HARVARD PUBLIC HEALTH The Art of Getting Things Done Health care reforms fashioned by HSPHâ€™s Bill Hsiao prevail where others have failed. Can Doing Good Be Done Better? DEAN’S MESSAGE Singular Vision P ublic health centers on improving the physical and mental well-being of people everywhere. But even The Spring/Summer 2012 issue also showcases alumna Kate Powis and master’s candidate Rob Buelow, who recast their lives to recast the public health enterprise. The Q&A with environmental epidemiologist Philippe Grandjean illuminates how a scientific hunch led to a major new direction in environmental health research. And the Off the Cuff quote from molecular entomologist Flaminia Catteruccia reveals how creativity and persistence in the mosquito-breeding lab may usher in new methods for controlling malaria. The essence of public health has always been a comprehensive curiosity, motivated by a desire to change the world. But as this issue of the magazine with this deep-rooted interest in the common good, it often takes visionary individuals to pave the way to scientific breakthroughs and policy reform. This issue of the magazine features Harvard School of Public Health faculty and students who are striking out in new directions in their mission to improve the health of many. The cover story on health policy eminence Bill Hsiao portrays a man who combines economic erudition with patience, tact, and a singularly humane touch—all in the service of promoting enlightened ©Corey Hendrickson It often takes far-seeing individuals to clear the way for scientific breakthroughs and policy reform. reminds us, the engine of scientific progress is fueled by individual passion. Speaking of creative visions, we are pleased to introduce a lively new look for the Harvard Public Health Review —and a sleek new title: Harvard Public Health. These changes reflect our desire to better showcase health care among governments throughout the world. The feature on “big data” showcases HSPH researchers Sarah Fortune, Winston Hide, Victor De Gruttola, Pardis Sabeti, and doctoral student David Reshef, who are drawing on fresh approaches to analyze giant datasets for hidden clues to disease. Three of the School’s leading practitioners in humanitarian relief—Jennifer Leaning, Mike Van Rooyen, and Parveen Parmar— discuss the frontline challenges of making their visions a reality. the School’s dedicated experts, who are educating new generations of public health leaders and producing powerful ideas to protect the health and improve the lives of all people. Julio Frenk Dean of the Faculty and T & G Angelopoulos Professor of Public Health and International Development, Harvard School of Public Health 2 Harvard Public Health HARVARD PUBLIC HEALTH Spring | Summer 2012 COVER STORY 20 The Art of Getting Things Done Vermont’s single-payer health care plan is just the latest of Bill Hsiao’s many public health reforms. FEATURES 2 Dean’s Message: Singular Vision How individual passion fuels scientific progress. 38 Finding Her True Path In the middle of a high-flying business career, Kate Powis reversed course and chose a life in public health. 51 Your Healthy Plate DEPARTMENTS 14 The Promise of Big Data Petabytes of raw information could provide clues for everything from preventing TB to shrinking health care costs—if we can figure out how to use them. 26 HSPH Delegation Visits India School’s friends and faculty see research sites. 28 Can Doing Good Be Done Better? Three accomplished humanitarian aid professionals at HSPH, each at a different career stage, describe what’s most challenging about the work, what’s most rewarding, and what advice they would give to students entering the field. 36 Accentuating the Positive HSPH student Rob Buelow wants to accentuate the benefits of healthy living to promote public health. 4 Frontlines 10 Philanthropic Impact 44 Alumni News 46 Faculty News Back Cover Continuing Professional Education Calendar Image Credits, clockwise from top: Tony Rinaldo; Aubrey LaMedica/HSPH; ©Frederic Courbet/PANOS; Anthony Freda FRONT LINES GENDER NONCONFORMITY MAY RAISE RISKS FOR KIDS Young children in the U.S. whose preferences for activities and pretend play fall outside those typically expressed by their biological sex—as many as one in ten kids—are vulnerable to abuse and posttraumatic stress disorder (PTSD), according to a study from Harvard School of Public Health researchers. An analysis of survey data from nearly 10,000 young adults found that men and women who were in the top 10th percentile of childhood gender nonconformity were more likely to have been physically, sexually, or psychologically abused by age 17 than those below the median of nonconformity. Rates of PTSD were almost twice as high among young adults who were gender nonconforming in childhood than among those who were not. The researchers recommend that pediatricians and school health providers consider abuse screening for this vulnerable population. Alumna Appointed Minister of Health and Social Protection in Colombia eatriz Londoño Soto, MPH ’90, was appointed Colombia’s minister of health and social protection on January 24, 2012. She previously served as deputy minister of health. A physician specializing in anesthesiology, Soto has been a consultant for several national and international institutions, including Mount Sinai Medical Center in New York and the World Heart Federation. She served on the World Health Organization’s Commission on Social Determinants of Health. B Find Us on Facebook Excess Weight May Lower Men’s Sperm Count Harvard Public Health is now on Facebook. Check out the new social reader for this magazine at http://on.fb.me/ harvardpublichealth to flip through pages of the latest issues, “like” the magazine, and share it with your friends. A new study coauthored by Jorge Chavarro, assistant professor of nutrition and epidemiology at Harvard School of Public Health, finds that overweight and obese men are more likely than their normal-weight peers to produce lower numbers of sperm, or even no sperm at all. While the results don’t prove that excess weight leads to fertility troubles, a lower sperm count can make it more difficult for men to conceive. The researchers combined data from 14 studies comparing sperm count in overweight, obese, and normal-weight men, along with data from an infertility center. 4 Harvard Public Health ©Rick Chapman/Corbis, Shaw Nielsen Who Gets Cancer? Some Answers, Many Questions t’s heartbreaking to realize that more than 2.4 million cancer deaths—especially from children’s cancers—could be avoided each year in developing countries, simply by using affordable prevention and treatment tools. A new report, “Closing the Cancer Divide: A Blueprint to Expanding Access in Low and Middle Income Countries,” organized by the Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries and hosted by a consortium of organizations that includes HSPH, inspired a recent symposium in Boston that explored solutions. Attending the symposium were representatives from developing countries’ governments, civil organizations, the private sector, and academia. Among the lead authors of the report were Felicia Knaul, director of the Harvard Global Equity Initiative and associate professor at Harvard Medical School, and HSPH Dean Julio Frenk. While some cancer deaths worldwide are clearly preventable, more puzzling is the increased risk among men for most cancers—even after adjusting for factors such as smoking, alcohol, and environmental hazards. In a new study led by Gustaf Edgren, research fellow in HSPH’s Department of Epidemiology, scientists concluded that for more than one-third of cancers that disproportionately strike men, the male excess risk is probably explained by intrinsic, sex-specific biological factors or a gender difference in susceptibility to risk factors. “For many of these cancers, the male excess risk is very strong,” says Edgren. “We simply have no idea why.” Harnessing Health and Education Policy to Counteract “Toxic Stress” in Childhood “Toxic stress” caused by adversity in early childhood can lead to a lifetime of mental and physical problems, including problems with metabolism and brain development. At a February 7 Forum event, Jack Shonkoff, director of the Center on the Developing Child at Harvard University and professor of child health and development at Harvard School of Public Health, spoke about the urgent need to revamp health and education policies to deal with the lifelong effects of early abuse, neglect, and economic hardship. Watch online at: http://www.hsph.me/toxic-stress I Ministerial Leadership in Health Program Launches in South Africa Dean Julio Frenk, together with South African Deputy President the Hon. Kgalema Motlanthe, launched the new Ministerial Leadership in Health Program at an event in Pretoria, South Africa, on November 4. The launch was attended by current and former ministers of health and cabinet-level officials from more than 20 countries. The Program—a joint initiative of Harvard School of Public Health and Harvard Kennedy School, in collaboration with the Children’s Investment Fund Foundation—will recognize and promote transformational leadership in health at the ministerial level, with the aim of strengthening health systems and improving service delivery and health outcomes in developing and emerging economies. The first cohort is expected to include 20 serving health leaders at the ministerial level from Africa, Asia, and Latin America, and will meet in June. The Progam Advisory Board is chaired by Dean Frenk and includes Harvard Kennedy School Dean David Ellwood. The joint vice chairs are Lord Nigel Crisp, former UK health secretary, and Joy Phumaphi, former minister of health of Botswana. Dean Julio Frenk and South African Deputy President the Hon. Kgalema Motlanthe ©Oscar Gutierrez 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. 5 Spring | Summer 2012 FRONT LINES Rotavirus Vaccine Proves Safe Surgery Pending? Don’t Eat that Steak The counterintuitive—but compelling—evidence is in: limiting protein or amino acids for several days before surgery may reduce the risk of surgical complications such as heart attack or stroke. The findings were published in Science Translational Medicine on January 25. The HSPH mouse study was led by James Mitchell, assistant professor of genetics and complex diseases, and Wei Peng, former HSPH postdoctoral fellow. Next steps: a clinical trial of hospital patients on protein-free diets before surgery, and the development of drugs that potentially target the biological pathway activated by amino acid deficiencies. More than 500,000 babies around the world die each year from severe diarrhea and dehydration caused by rotavirus. A widely used vaccine for the pathogen was pulled from the market in 1999 out of concerns that it raised a baby’s risk of developing intussusception, a potentially deadly intestinal blockage. Now, a study by Harvard School of Public Health research fellow Irene Shui finds that the orally administered RotaTeq® vaccine, one of several options, does not elevate intussusception risk. Shui conducted the research while at Harvard Pilgrim Health Care Institute. She and her colleagues examined nearly 800,000 doses of vaccination from infants in the U.S. who had been given RotaTeq® vaccine. clockwise from top left: ©Indeed/Getty Images; Photo Researchers, Inc.; ©Stockbyte/Getty Images Pay-for-Performance Programs Are Underperforming P aying hospitals to improve their quality of care, known as pay-forperformance (P4P), has gained wide acceptance in the U.S., and Medicare has spent tens of millions of dollars on bonuses and rewards for hospitals to improve. However, little is known about whether pay-for-performance actually helps patients. A new study from Harvard School of Public Health finds no evidence that the largest hospital-based P4P program in the U.S. reduced 30-day mortality rates, a gauge of whether patients survive their hospitalization. Given that the Affordable Care Act calls for the Centers for Medicare & Medicaid Services to expand pay-forperformance to nearly all hospitals in 2012, the findings suggest a need for heftier financial incentives and a sharper focus on patient outcomes. 6 Harvard Public Health Offthe Mosquitoes, Sex, & Malaria CUFF FLAMINIA CATTERUCCIA ASSOCIATE PROFESSOR OF IMMUNOLOGY AND INFECTIOUS DISEASES Q. “ Aubrey LaMedica/HSPH You study how genes affect mosquito fertility and mating, a potentially groundbreaking way to prevent malaria transmission. In perfecting this approach, you work with Anopheles gambiae, the chief vector of malaria—but also one of the most notoriously difficult insect species to adapt to the laboratory. What were the technical hurdles? To reproduce in a laboratory the way mosquitoes mate in the wild is not easy—we had to create our own protocols. To begin with, these mosquitoes mate just once a day. The males get together at sunset and swarm created a twilight lighting system that slowly dims the illumination. Second, for females to be inseminated, for 10 minutes or so, before it becomes dark. So first, since we study a process that happens briefly at dusk, we there has to be a correct ratio between males and females. When the males are swarming, we slowly add females to the cages so we can observe precisely when mating happens and later do time courses in the females to track which genes are induced or repressed. Finally, for females to lay eggs and bear progeny, they need to feed on blood. But it may not be the right time of the day for them to feed, or they may have fed on sugar two minutes before, so they’re not hungry. Sometimes males disturb the females, because the males want to mate while the females want to feed. With mosquitoes, you can draw human parallels. A. 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. ” 7 Spring | Summer 2012 FRONT LINES Vaccine Effectiveness Threatened by Everyday Chemical HSPH’s Philippe Grandjean answers questions about PFCs In January 2012, a study in the Journal of the American Medical Association (JAMA) showed that perfluorinated compounds (PFCs)—which are widely used in manufactured products such as nonstick cookware, waterproof clothing, and fast-food packaging—dramatically lowered children’s immune response to tetanus and diphtheria vaccinations. The report suggested that these chemicals may be undermining one of the keystones of public health: childhood immunization. Lead author Philippe Grandjean, adjunct professor of environmental health at HSPH, talked about the study’s wide-ranging implications with Harvard Public Health editor Madeline Drexler. Q: You found that 7-year-olds with twice the blood concentration of PFCs had about half the levels of antibodies in the blood to tetanus and diphtheria, compared with children with average PFC levels. Were you jolted by this finding? A: Very much. I’ve talked to pediatric immunologists about this, and they have never seen anything like it. HIV infection, rare inborn diseases, or treatment with chemotherapy can do the same thing. But apart from those situations, these colleagues had never seen these kinds of effects. Q: How exactly do PFCs dampen immunity? A: Apparently, these compounds hinder communication ©Blend Images Photography/Veer between white blood cells—the cells that tell the body, ‘There is a foreign microorganism or foreign protein that is causing a possible danger, and the body needs to deal with it.’ We were misled to believe that the PFCs wouldn’t be active biologically, as they are very stable. But it turns out that they fit into certain proteins or receptors in the body. 8 Harvard Public Health Q: Are the effects limited to tetanus or diphtheria vaccines? Or are these signs of broader problems in immunity? A: We looked at tetanus and diphtheria because both of those vaccines are proteins. But we don’t think that what we have seen is specific to tetanus or diphtheria. We think there is something going on there that reflects a more general immunotoxicity. I call it a sluggish immune system. Whatever is going on here, it’s the same system that kicks in when we are infected by disease-causing microorganisms. PFCs may not only be reducing the effectiveness of vaccines. They may also play a role in the exploding growth of allergies and other problems caused by a malfunctioning immune system. Q: Why are these damaging substances so prevalent in our lives? A: When the federal Toxic Substances Control Act was enacted in 1976, it only covered safety-testing requirements for new chemicals—all of the existing chemicals, such as PFCs, were grandfathered in. In the U.S., the production of PFOS [perfluorooctane sulfonate], one of the most common PFCs, ceased in 2002. But now PFOS is produced in increasing amounts in China, so we may be importing products that contain or have been treated with these chemicals from other countries. Though concentrations of PFOS in blood have come down over the last six or eight years in the U.S., we are being increasingly exposed to other PFCs which are, as a class, exempt from the strict rules that apply to new chemicals. Industry is introducing these chemicals as alternatives—but only now are we beginning to identify the toxic risks. Q: Would this fundamental damage to the immune system trigger such things as allergies or other conditions? A: Possibly. The immune system is responsible for allergy development—and we know that there’s an allergy epidemic. Could these immunotoxicants be kicking the immune system out of balance? A: You may even speculate further, because the immune system is also involved in conditions like autoimmunity and protection against cancer. We are not just talking about direct organ-related toxicity—to the brain or the reproductive system or the liver or the kidneys. We are talking about something that affects our whole body. It opens up a new perspective for studying how environmental chemicals affect public health. Q: What advice would you give consumers? A: Minimize exposure to those substances as much as possible. PFCs serve some extremely useful purposes. They make your raincoat water repellent. They act as stain repellents on rugs. Food-wrapping materials like paper plates, microwave popcorn bags, and pizza boxes often contain these compounds. A: The trick is to find alternatives that are just as useful but do not cause toxic effects. You can now get rain gear, wall-to-wall carpeting, and other products that are labeled “PFC-free” or “eco-friendly.” If consumers vote Philippe Grandjean, adjunct professor of environmental health at HSPH ©Tony Rinaldo with their wallets and scientists push, then industry will realize there is a new market niche. 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. 9 Spring | Summer 2012 PHILANTHROPIC IMPACT THE POWER OF ONE Above left, Vice Dean Ellie Starr with a young resident of the Kaula Bandar slum community in Mumbai. T Above right, Anita Patil-Deshmukh, MPH ’05, executive director of Partners for Urban Knowledge Action and Research (PUKAR), with Board of Dean’s Advisors member Roslyn Payne (center) and Leadership Council member Amy Spies (right). his March, Deans Julio Frenk and David Hunter and I traveled to India with several faculty members and friends of the School. For more than four decades, HSPH has been partnering with government agencies, nonprofits, and research colleagues on everything from raising nutrition standards and improving maternal and child health to battling infectious disease and advancing the cause of universal health care. In India, the experience was nothing less than transformative. Everywhere were illustrations of the ways in Take, for instance, Anita Patil-Deshmukh, MPH ’05. More than half of Mumbai’s 22 million people are estiwhich one person devoted to public health can change the lives of millions. mated to live in slums four times as crowded as Manhattan; Anita has made it her mission to improve their lives. We visited a slum where 12,000 people reside in tiny makeshift houses situated on alleys so narrow that, when walking down the street, you can touch the homes on both sides at once. There’s no public water or electricity. The children who live here have no birth certificates or medical records: they are the unknown generation of India. Anita and her nonprofit, PUKAR (Partners for Urban Knowledge Action and Research)—staffed by a dauntless cadre of “Barefoot Researchers”—are weighing, measuring, and vaccinating these children, and giving them medical identities. On my first trip to this land of 1.2 billion people, I saw countless examples of resilience and hope. Our faculty members, alumni, and partners are making a difference—whether it’s a child safe and happy in a temporary worksite day-care center, or a villager getting treatment for a long-neglected chronic disease, or a toddler newly vaccinated against deadly infections. To everyone who has contributed to our efforts in India, and around the world, THANK YOU! Each one of you is a shining example of how one person can change the lives of millions … and that gives me the most hope of all! Harvard School of Public Health Ellie Starr, Vice Dean for External Relations 10 Harvard Public Health New Gift to Expand, Improve Training for Humanitarian Aid Leaders W ars, natural disasters, genocide, and other tragedies in recent years have transformed global humanitarian aid into a $160 billion-a-year industry that employs 240,000 people in thousands of organizations across more than 100 countries. But too often, would-be humanitarians are ill-equipped to deal with the difficult and dangerous situations they find on the ground—armed militias, blocked roads, earthquake-damaged buildings, or masses of displaced people on the move. Now, a $5 million grant from Jonathan Lavine, MBA ’92, managing partner of Sankaty Advisors, Bain Capital’s credit and fixed income affiliate, and his wife Jeannie, AB ’88, MBA ’92, will enable the Harvard Humanitarian Initiative (HHI) to significantly expand its ongoing efforts to train the next generation of humanitarian leaders. Under the new Lavine Family Humanitarian Studies Initiative (HSI), 250 or more students a year—up from about 100—will be able to study at the School to learn how to provide aid effectively, efficiently, and safely. Both entry-level students and current fieldworkers will have access to courses, simulated trainings in rural and urban settings, and case studies. “The Lavine gift will help HSI extend the reach of humanitarian education to an international scale and boost the impact of humanitarian relief by focusing on professional skill building and evidence-based research on best practices,” says Michael VanRooyen, HHI director and a professor in the Department of Global Health and Population. It will also make HSI the world’s largest program in humanitarian studies. In addition, the expanded HSI will serve as the foundation for a new Humanitarian Academy—the first global center of its kind—that will coordinate Harvard-wide efforts in humanitarian issues and help define a new field of education. The Lavines decided to support HHI to “give back to Harvard broadly” to mark their upcoming 20th business school reunion. “Why is a business school alumnus doing this?” Jonathan Lavine asked. “Because cutting-edge management practices are critical in the effort to help systematically alleviate humanitarian problems all over the world. Too often people are asked to donate to the tragedy of the moment on television. But when we found Mike VanRooyen, we were blown away by what he’s doing every day all over the world. He and HHI are involved in groundbreaking and innovative work that will address some of the world’s biggest problems and help people for many years to come.” See article on page 28, “Can Doing Good Be Done Better?,” to learn more about efforts to improve humanitarian aid. A U.S. Navy helicopter takes off after delivering supplies to victims of the 2010 earthquake in Haiti. REUTERS/Staff Photographer 11 Spring | Summer 2012 PHILANTHROPIC IMPACT A Morningside Foundation Director Gerald Chan, SM ’75, SD ’79 Newly Created Morningside Professorship Honors Noted Radiation Scientist A $4 million gift from the Morningside Foundation will fund the creation of an endowed professorship in radiobiology at the John B. Little Center for Radiation Science in the Department of Genetics and Complex Diseases at Harvard School of Public Health. Morningside Foundation Director Gerald Chan, SM ’75, SD ’79, studied radiobiology at HSPH in the 1970s with John B. Little, now a professor emeritus. Chan, who came to HSPH after earning an undergraduate engineering degree at UCLA, went on to found Morningside, a venture capital group with investments in both America and China. While studying radiation physics at HSPH, he discovered exciting developments across the spectrum of life sciences. “To me, the mysteries of life provide endless fascination,” he says. The new Morningside Professorship in Radiobiology is meant to honor Little, who, in a career spanning nearly half a century, has made important contributions to a field that plays a major role in medical imaging, cancer treatment, and nuclear energy, as well as assessing the public’s exposure to radiation from metal detectors and cosmic rays, and preventing the threat of dirty bombs from terrorist groups. Chan hopes that Morningside’s support will help further HSPH’s objective of coupling laboratory science with the study of health at the population level. “This combination,” he says, “makes the Harvard School of Public Health a unique place that needs to be celebrated.” Kent Dayton/HSPH A A Boost for Gene-Based Malaria Research fessor of immunology and infectious diseases, working in collaboration with the Broad Institute, hopes to identify those genes most likely to respond to drug therapies. Malaria kills roughly 1 million people each year, mostly children under age 5 in sub-Saharan Africa. There is no licensed vaccine for the infection. “The award of this Phase II Grand Challenges Explorations grant from the Gates Foundation allows us to build on our Phase I grant, where we demonstrated the efficacy of our novel approach of targeting red blood cells,” says Duraisingh. “We will now expand and accelerate this research and produce a comprehensive catalog of candidates to help us identify and prioritize the most promising ones for drug development.” Because the malaria parasite frequently finds ways to resist antimalarial drugs, genetic approaches to study the parasite and validate new therapeutic targets are urgent, Duraisingh says. Instead of targeting the parasite, Duraisingh targets the red blood cell host, which cannot evolve resistance to new antimalarial drugs. Duraisingh and his colleagues plan to identify the molecules in red blood cells that play a crucial role in supporting the malaria parasite, thus creating a “blueprint” of all the genes that could be targets for antimalarial drugs. The Gates Grand Challenges Explorations grant supports creative, high-risk concepts with the potential to develop solutions to difficult global health problems. two-year grant from the Bill & Melinda Gates Foundation, totaling nearly $833,000, will help boost research at Harvard School of Public Health aimed at identifying the genes in red blood cells essential for the malaria parasite to survive. Manoj Duraisingh, associate pro- Eye of Science/Photo Researchers, Inc. 12 Harvard Public Health W PREVENTING YOUNG MOTHERS FROM DYING— AND THE RIPPLE EFFECTS WHEN THEY DO When a mother dies during pregnancy or childbirth in subSaharan Africa, the impact on the child or children left behind—and on the larger family—can be devastating. Studies suggest that children’s risk of dying before age 10 jumps by more than 60 percent after their mother dies. A new $2 million grant from the John & Katie Hansen Family Foundation will enable Harvard School of Public Health researchers to more accurately quantify the extent of the problem, tease out the primary reasons that maternal deaths wreak such havoc on those left behind, and develop practical solutions. The effort is unique because no one has ever measured the full impact that mothers’ deaths have in African societies. According to the latest estimates, roughly 273,500 women worldwide died from complications of pregnancy or childbirth in 2011, mostly in poor countries. “Our hope is that by quantifying the cost to the economy and to society of allowing these women to die, more resources will be applied to really make a difference in saving mothers’ lives,” will also conduct in-depth qualitative studies to delineate the particular hardships children experience when their mothers die in childbirth, as well as other dire effects on families left behind. “The idea is to create a wider sense of consciousness about the tragic ripple effects of a mother’s “ We hope this effort will create more energy behind national and international steps at eradicating maternal mortality.” —Jennifer Leaning, director of the FXB Center for Health and Human Rights says Katie Vogelheim, founder of the Hansen Foundation and a member of the HSPH Board of Dean’s Advisors. Under the new Hansen Program on Maternal and Child Health, HSPH’s Jennifer Leaning, François-Xavier Bagnoud Professor of the Practice of Health and Human Rights and director of Harvard’s FXB Center for Health and Human Rights, and Ana Langer, professor of the practice of public health and director of the School’s Women and Health Initiative founded by Dean Julio Frenk in 2010, are working on a two-pronged effort focused on Ethiopia and Tanzania—two countries where HSPH has existing connections and where the governments are concerned with reducing maternal mortality. Leaning and her FXB Center colleagues—whose work focuses on protecting and promoting the rights and well-being of children, adolescents, and youth worldwide—will analyze large databases to establish the impact of maternal deaths on children’s health and survival. They death,” Leaning says. “We hope this effort will create more energy behind national and international steps at eradicating maternal mortality.” Langer and her colleagues, building on Leaning’s analysis, will develop “concrete interventions that can be implemented and evaluated in Tanzania and Ethiopia to mitigate the impact of a mother’s death on the survival of her children,” Langer says. Her group will also train policymakers and program managers in the two countries to implement effective maternal and child health initiatives, and will work toward improving the quality of maternal health care at the community level. The Hansen gift is key to ensuring that this research moves forward, say Leaning and Langer. In the long term, they hope this new effort will help keep women’s health and maternal mortality at the forefront of the United Nations’ Millennium Development Goals, set in 2000 and due to be updated in 2015. ©REUTERS 13 Spring | Summer 2012 The Promise of Petabytes of raw information could provide clues for everything from preventing TB to shrinking health care costs—if we can figure out how to use them. to antibiotic drugs. HSPH microbiologist Sarah Fortune went to Camden, Maine in late 2010 to attend a small but widely revered conference on innovation called PopTech. Fortune had for more than a decade been trying to crack one of the tuberculosis bacterium’s most infuriating characteristics: its rising resistance Standing on the Camden Opera House stage, backlit by mammoth close-ups of fluorescent cells, Fortune shared with her fellow PopTech attendees TB’s grim annual statistics: 2 billion people—nearly onethird of the world’s population—are latent carriers. Every year, 15 million become sick and 1.4 million die. Unlike most bacteria, TB cells do not replicate as carbon copies but in random patterns, she told the audience. TB cells behave more like snowflakes than Xeroxes. Fortune believes it is this variety that gives TB its extraordinary ability to defy conventional antibiotics. Using silicon chips and a special camera, Fortune, the Melvin J. and Geraldine L. Glimcher Assistant Professor of Immunology and Infectious Diseases, and her fellow researchers had developed a way to capture 10,000 still images of this telltale growth every few days—exponentially more data than they had only a few years ago. 15 Spring | Summer 2012 ©Anthony Freda continued The images are combined like old-fashioned flip books into what Fortune calls “movies.” But only the human eye can assess the moving pictures, one by one—a method so laborious that it inhibits scientific progress. The question troubling Fortune, and what had brought her to the conference, was the following: How could her lab swiftly analyze this unprecedented treasure trove? The new data could be a gold mine—one that could yield fundamental insights about potential diagnostic tools, treatments, even a vaccine—but not without ways to speed up analysis. Fortune needed help. THE DILEMMA OF BIG DATA HSPH’s Sarah Fortune crowdsourced an image processing project. In two days, volunteers with no scientific expertise measured cell growth in a 5,300-image “movie” of dividing TB cells. Without the volunteers’ collective eyes, the task would have taken three months. Winston Hide, associate professor of bioinformatics at HSPH. “You can imagine what’s going to happen in the next five.” And this data isn’t simply linear; genetics and What was happening in Sarah Fortune’s lab is playing out in laboratories, businesses, and government agencies 1,000,000,000,00 everywhere. Our ability to generate data has moved lightyears ahead of where it was only a few years ago, and the amount of digital information now available to us is essentially unimaginable. “In the last five years, more scientific data has been generated than in the entire history of mankind,” says proteomics, to name just two fields of study, generate highdimensional data, which is fundamentally different in scale. “Imagine a city made out of stacks of paper, each stack printed with sets of data,” says Hide. He flings his arms in the air, drawing megaspace. “Imagine a whole planet that size. Imagine a million planets! Imagine a galaxy full Sarah Fortune, Melvin J. and Geraldine L. Glimcher Assistant Professor of Immunology and Infectious Diseases The crowdsourcing process Fortune used generated new, fundamental findings about Opposite and right, ©Tony Rinaldo TB cells that may yield clues to drug treatments. 16 Harvard Public Health In just two weeks, Winston Hide, associate professor of biostatistics, joined a cancer database with a stem cell dataset—and got a big payoff. “We discovered a single gene that we think is responsible for the initiation of a whole class of leukemias.” 00,000,000,000 of those, and we haven’t even got there yet! That’s highdimensional data.” REVOLUTIONARY APPLICATIONS a zettabyte equals 1021 bytes or one trillion gigabytes capturing huge quantities of air quality data from polluted areas and attempting to match it with equally bulky health care datasets for insights into respiratory disease. Epidemiologists are gathering information on social and sexual networks to better pinpoint the spread of disease and even create early warning systems. Comparative- In big data lies the potential for revolutionizing, well, everything. Police employing seismology-like data models can predict where crimes will occur and prevent them from happening. Astronomers using the Kepler telescope snag information on 200,000 stars every 30 seconds, which has led to the discovery of the first Earth-like planets outside our solar system. Businesses sifting social networking and supply-chain data dynamically tailor their products to fulfill desires we don’t even know we have. The same phenomena are at play in public health. For some time, DNA sequencing has held big data’s starring role—after all, a single human genome consists of some 3 billion base pairs of DNA. Researchers at HSPH and across the campus at Harvard are sequencing and analyzing human genomes to ferret out clues to infections, cancer, and noncommunicable diseases. But the potential public health uses of big data extend well beyond genomics. Environmental scientists are “In the last five years, more scientific data has been generated than in the entire history of mankind,” says Winston Hide, associate professor of bioinformatics. effectiveness researchers are combing government and clinical databases for proof of the best, most cost-effective treatments for hundreds of conditions—information that could transform health care policy. And disease researchers now have access to human genetic data and genomic databases of millions of bacteria—data they can combine to study treatment outcomes. continued 17 Spring | Summer 2012 010101001010010100101001101010101010000101110100000011110010101000011100000101010101010101000000001110100000111111101010101111111010 11000111000100010101011010100101010010110100010110010101001010101000001010101010101010000100111101001010100101001010010100110101010 1000000111100101010000111000001010101010101010000000010101010101010100001001111010010101001010010100101001101010101010000101110100 0100001110000010101010101010100000000101010101010101000010011110100101010010100101001010011010101010100001011101000000111100101010 1 PETABYTE =1 quadrillion bytes enough to store approximately: 2.8 million copies of the full text of the Encyclopedia Britannica; or 1,903 years of music recorded at standard quality for an Apple iPod; or as much data as a stack of DVDs, each containing a two-hour standard definition video, roughly 1.8 times as high as the Empire State Building Younger scientists— raised in an era of social networking— may embrace an idea that previous generations of researchers have not: sharing data freely. largely through reductions in expenditures. A CRITICAL BOTTLENECK According to McKinsey & Company, with the right tools, big data could be worth $9 billion to U.S. public health surveillance alone and $300 billion to American health care in general, the former by improving detection of and response to infectious disease outbreaks, and the latter 1 TERABYTE = 1 trillion bytes enough to store approximately: 2,767 copies of the full text of the Encyclopedia Britannica; It’s hardly a given, though, that we’ll get to this nirvana any time soon. Our ability to generate data far outstrips our ability to analyze it. “If we really start trying to exploit all these databases, we will need more trained staff and more resources to do it,” says Victor De Gruttola, who chairs HSPH’s biostatistics department. Most researchers agree that lives are lost every day that data sit in storage, untouched. The problems are vast and urgent. Consider just one example— recent news that a dozen Indian patients had contracted totally drug-resistant tuberculosis. “Even just a few people in Mumbai is a terrible danger sign,” says Fortune, because it could portend the rapid spread of a highly transmissible and untreatable infection. To counter these trends, some scientists are venturing into crowdsourcing. Others are developing sophisticated algorithms to parse data in a keystroke. And still more are inventing ways to share massive, disparate datasets to yield surprising insights. WISDOM OF THE CROWD or 16,667 hours of music recorded at standard quality for an Apple iPod; or 1,333 hours of standard definition video 1 GIGABYTE = 1 billion bytes enough to store approximately: 212 copies of War and Peace or almost three copies of the full text (all 32 volumes) of the Encyclopedia Britannica; or 250 songs recorded at Apple iTunes standard quality; or 80 minutes of standard definition video At PopTech, frustrated with the slow pace of her research, Sarah Fortune took a risk that most scientists wouldn’t. She asked the audience for advice on how to analyze her images. “We would like to engage lots of eyes in that process,” she said. When Fortune walked off the stage, Josh Nesbit, a young entrepreneur in the audience, resolved to meet her. Nesbit had launched a company, Medic Mobile, that had built an emergency response system after the Haiti earthquake, calling on 2,500 Creole speakers to translate text messages. When the system was overwhelmed by victims texting for help, Nesbit turned to a Silicon Valley crowdsourcing company called CrowdFlower, which has signed up more than 2 million people to perform micro-tasks, often for pennies a task. The volunteers used CrowdFlower’s website to translate, map, and organize nearly 100,000 messages, imploring rescuers for food, water, and help escaping from fallen buildings. 1 MEGABYTE = 1 million bytes enough to store a 500-page book in plain text a 1 KILOBYTE = 1 thousand bytes enough to store a short paragraph’s worth of plain text 1 BYTE enough to store one letter of the alphabet Sources: Apple Computer, Amazon.com, New York Times, Perma-bound.com, the Official Website of the Empire State Building 18 Harvard Public Health The evening after Fortune’s talk, at a glitzy reception, Nesbit shared his story. Fortune instantly saw the possibilities: She could crowdsource the image processing of her growing TB cultures. In May 2011, CrowdFlower put one of Fortune’s laboratory “movies” online. Some 1,000 interested people, with no scientific expertise, signed on to help. They measured and labeled the distance between cells as one cell split into two and two split into four, shooting off in patterns too random for computer programs to track. In two days, they’d measured cell growth in a 5,300-image movie. Without their collective eyes, it would have taken three months. More important, their analysis generated new, fundamental findings about TB cells, which are shaped like cough drops. “We discovered that mycobacterial cell growth is not even,” Fortune says. “One end of the cell is different from the other end, and in fact, it only grows from one end.” She calls the nongrowing ends “privileged”—that is, not terribly vulnerable to antibiotics. That crowd-enabled insight, she says, may yield clues to pathogenesis and drug treatment. THE SCALE On a computer, data is translated into 0s and 1s called bits. Eight bits make up one byte—enough information to represent one letter, number, or symbol. 2.5 PETABYTES Memory capacity of the human brain 13 PETABYTES Amount that could be downloaded from the Internet in two minutes if every American got on a computer at the same time 98 PETABYTES Websites indexed by Google 4.75 EXABYTES Total genome sequences of all people on Earth 422 EXABYTES Total digital data created in 2008 Pardis Sabeti, assistant professor in the Department of Immunology and Infectious Diseases at HSPH and computational biologist at the Broad Institute. 1 ZETTABYTE World’s current digital storage capacity FINDING ALL THE NEEDLES IN A HAYSTACK Around the time that Fortune was wondering how to quickly analyze thousands of images, David Reshef was pondering an even larger problem: He wanted to parse millions of relationships buried in big data. An MD/PhD candidate at ©Tony Rinaldo 1.8 ZETTABYTES Total digital data created in 2011 the Harvard-MIT Division of Health Sciences and Technology, Reshef and his brother, Yakir, spent their childhoods in Kenya with their physician parents, planting in David a lifelong fascination with global health. continued on page 42 Source: Popular Science and Katie Peek 19 Spring | Summer 2012 O Health care reforms fashioned by HSPHâ€™s Bill Hsiao prevail where others have failed. 20 Harvard Public Health O ‘Yes, if you are on it.’” ideological grounds. even presidents, had failed. LIKE A MASTER CHEF ©Tony Rinaldo The Art of Getting Things Done Looking professorial in a suit and dark tie, Hsiao warmed up the crowd by describing a On January 19, 2011, HSPH professor William Hsiao walked onto the podium in the well of the Vermont State House. Before him sat both chambers of the state legislature. Above him stood hundreds of onlookers in the observation gallery, crammed shoulder to shoulder. recent conversation he’d had with a nameless insurance executive—insurance executives being among the more vocal dissenters to his policy prescriptions. “I asked him if he would spend $50 billion to manufacture a shuttle to reach the moon,” said Hsiao. “The man said, He then delivered a second punch line of sorts: a radical plan to create the first state-level single-payer health care system in the United States. The plan promised to save Vermont $500 million in the first year, create 3,800 new jobs, ensure health care coverage for every citizen in the state, and reduce the amount many citizens and businesses pay for health care. It was a turning point in a fierce national debate, and many in the audience didn’t like what they heard. Health insurers worried they could be shut out of Vermont if it adopted Hsiao’s plan. Industry groups doubted the touted savings. Some politicians disagreed on But the biggest question was whether Hsiao would prevail on an issue where governors, If past performance could predict future events, then the smart money would be on Hsiao. Vermont is just the latest government to seek out the advice of the K. T. Li Professor of Economics at Harvard School of Public Health. The United States Congress, The World Bank, UNICEF, the World Health Organization, and the governments of China and at least half a dozen other countries have all folded Hsiao’s work into their policies. continued 21 Spring | Summer 2012 Bill Hsiao’s efforts have led to the creation of a single-payer health care system in Vermont—the first of its kind in the U.S. Hsiao’s true expertise lies in the ability to get things done where others cannot. “Politics tells you what political forces are at work, but it doesn’t give you good solutions to technical problems. Economics gives a good foundation to analyze the problem and develop technical solutions, but it doesn’t look at political viability,” he says. “If you don’t understand what is viable politically, you can design the most beautiful plan, but it won’t even get a hearing.” in political will, stirs in an understanding of an organization’s hierarchies, seasons it with on-the-ground details, and then mixes it all together with an honest and affable personality. In the end, Hsiao makes a dish that everyone, from patients to politicians, can swallow. H TAXIS, NOT LIMOUSINES Hsiao, responsible for the design of a good portion of the world’s health care financing, is often the first person If the single-payer plan in Vermont works, Hsiao estimates it will still be eight years of burgeoning health costs nationally before a similar model is seriously considered in the U.S. To achieve the perfect balance, Hsiao, like a master chef, follows a recipe but varies the amount of each ingredient every time he steps into the kitchen. He begins with a base of economic theory, carefully measures in the office at 8:30 a.m. and the last to leave at 8 or 9 p.m. He spends weeks or months annually traveling throughout the world; in China, he may be discussing health care policy with top Communist Party officials in Beijing (many of whom he taught) one day, the next asking rural farmers (whom his work will affect) about their motorcycles—a clue to the local economy. Even though chauffeured cars are provided for his use both in the U.S. and abroad, he almost invariably takes taxis, because he enjoys talking with the drivers to find out local socioeconomic conditions. Governments around the world offer him multimillion-dollar contracts to design their health care systems. He turns down most projects or passes them on to colleagues. He did accept $300,000 from the Vermont State Legislature to study the state’s health care financing system, but paid himself $0 for his own efforts, channeling the money to grad students who worked on the project. When funding for his new Rural Mutual Health Care research program in China fell through several years ago, he took out a $300,000 mortgage on his home in Cambridge, Massachusetts, to make sure the work could continue. Paula Stephens/Veer 22 Harvard Public Health Bill Hsiao documented the plight of uninsured peasants in China and developed a health care plan that covers hundreds of millions. W EARLY TRAGEDY William Hsiao was born in Beijing in 1936, just before World War II. Ahead of the Japanese advance, his family moved to Kunming and then to the U.S.; his father served in the Chinese delegation to a fledgling United Nations. Not long after moving to the U.S., Hsiao’s father suffered an asthma attack while preparing to go Christmas shopping with his children. An ambulance took him to a nearby private hospital, which refused to admit him because the family couldn’t pay. The ambulance raced to the nearest public hospital, but it was too late. Hsiao’s father had died en route. The following year, Hsiao’s mother was admitted to a sanitarium with tuberculosis. Hsiao and his five siblings, living at the time in Queens, New York, were advised to put themselves up for adoption. Rather than separate, they earned the money needed to remain a family. Hsiao delivered newspapers in the morning, worked in a grocery store after school, and delivered Chinese food in the evening. The children pooled their money to pay for, in descending order, rent, rice, vegetables, meat, fruit, and clothes. To this day, Hsiao’s lunch is sometimes just an apple. After college at Ohio Wesleyan University and a few years as an insurance actuary, Hsiao left corporate America and became a civil servant in the Social Security Administration. In 1968, he was promoted to deputy chief actuary and helped save Social Security from insolvency in the face of double indexed pension benefits— when benefits were hitched to both wages and a rising rate of inflation. Three years later, he left government service and enrolled at Harvard University, where he obtained a master’s in public administration and a PhD in economics. He became a full professor of economics at Harvard in 1986. His gilded academic credentials made him the perfect point man for shaking up the health care system. D THE ABCS OF RBRVS During the late 1980s, Hsiao created the Resource-Based Relative Value Scale (RBRVS). Essentially, it says that a physician should be paid based on the relative amount of work effort (resources) it takes to perform a procedure (value), compared with other procedures, and in the context of all medical procedures (scale). In other words, the more work, skill, knowledge, and effort it takes to deliver a service, the more a physician is compensated. HYSTERECTOMY VS. PSYCHOTHERAPY P Paying a person for his or her work effort is not revolutionary, but how Hsiao assessed a physician’s value was bruisingly controversial. The effort required thousands of interviews with doctors and took several years to finish. For instance, Hsiao and his colleagues compared a hysterectomy with a session of psychotherapy. They determined that a hysterectomy took twice as long, required 3.8 times as continued Courtesy of William Hsiao 23 Spring | Summer 2012 much mental effort, 4.47 times as much technical skill and physical effort, and entailed 4.24 times as much risk. When the RBRVS calculated all of these factors, a hysterectomy turned out to be almost five times more difficult than a session of psychotherapy. Congress eventually approved the plan, and in 1992 Medicare began to pay doctors based on the RBRVS. Private health insurers soon followed suit. Today, the RBRVS still determines a doctor’s pay. of my research should have focused on how to prevent self-interested groups from gaining power to control the updating of RBRVS.” REFORM IN CHINA A Americans are accustomed to sensationalized debate on health care reform. But not every country is so resistant to change. One reason so many of Hsiao’s projects have succeeded is that he focuses on those that have the best chance of success, William Hsiao’s true expertise lies in the ability to get things done where others cannot. “If you don’t understand what is viable politically,” he says, “you can design the most beautiful plan, but it won’t even get a hearing.” B SPECIALISTS HIJACK PAYMENT SCHEME But the RBRVS—which Hsiao had conceived as a rational means of saving medical dollars—took a paradoxical turn. Today, the system is blamed for the very problem it tried to halt: rising health care costs. In its original form, RBRVS would have led to a 20 percent drop in specialists’ incomes and a 20–30 percent rise in the incomes of primary care physicians. But according to Hsiao, powerful specialty groups— which now occupy the American Medical Association special board that updates the RBRVS—have captured the process and altered the original values to create a flood of well-paid specialists and a drought of low-paid primary care physicians. “For the first six to eight years, there was a positive impact, but now it’s been eroded,” Hsiao laments. “Some in such wide-ranging locales as Colombia, Sweden, and Uganda. But the foreign country Hsiao has worked with the longest is his homeland: China. And it is there that Hsiao can best apply his singular mix of skills. The first time that Yanfang Su saw Hsiao conducting an interview in China, she didn’t understand what was going on. Su is a student whom Hsiao had met in China and recruited to study in the U.S. “He asked the man making deliveries by motorcycle all these questions: how long it took him to get to the clinic, how many deliveries he makes each day,” she says. At the time, Hsiao and Su were traveling through the Chinese countryside to set up an advanced sputum testing system to do same-day diagnosis of TB. Su wondered: What does some guy’s motorcycle trips have to do with diagnosing tuberculosis? 24 Harvard Public Health As it turns out, quite a lot. For Hsiao, seemingly superficial questions may reveal how many deaths can be prevented. A traditional TB sputum test takes days to run. That means the man on the motorcycle must make two trips to the clinic: the first to supply the sample, the second to get results. In rural China, if the distance is too great or the road conditions too difficult, the man with the motorcycle won’t return to the clinic. The technology of same-day TB tests can save lives; the man makes one trip, supplies one sample, and is diagnosed on the spot. Using such commonsensical reasoning, Hsiao has made profound changes across China’s health care landscape. Over the past 20 years, he helped document the plight of uninsured peasants. In 2002, leveraging a newfound political will, Hsiao and his colleagues developed a plan that now covers most of the hundreds of millions of previously uninsured Chinese peasants. THE SPREAD OF SINGLE PAYER I In 1989, the Taiwanese government asked Hsiao to design a plan to guarantee the health care of every Taiwanese citizen. Studying the health care systems of six countries—the U.S., the UK, Canada, France, Germany, and Japan— Hsiao concluded that the Canadian single-payer system offered the best care and the most satisfied patients. A few years later, Taiwan passed health care finance reform. Six months after that, 92 percent of the population was insured for prevention, primary care, hospitalization, long-term, vision, dental, even for traditional Chinese medical techniques like acupuncture. Today, along with Great Britain and France, Taiwan is a leading example of a national single-payer health care model. With single payer, says Hsiao, “You can have universal coverage and goodquality health care while still managing to control costs.” And though he believes single payer is the best route, he concedes that what works for one country doesn’t necessarily work for another. If patients or politicians can’t swallow a single-payer system, he moves on to the next-best system that they can tolerate. If Hsiao feels that meaningful change of any kind isn’t possible, he walks away. In Hsiao’s view, political will and economic feasibility are the fundamental ingredients for change. As he puts it, “I would even work with a dictator, if I felt that he had the best interests of his people in mind.” he says. “I had to put aside my own research for a year.”) If Vermont’s version of singlepayer health care works, it could serve as a recipe for how everyone in the U.S. might receive affordable, high- ance coverage to more than 30 million Americans through an expansion of Medicaid and a provision that people buy health insurance starting in 2014 or face a penalty. If the Court strikes down the law, W A LASTING LEGACY When Vermont governor Peter Shumlin first asked Hsiao to design a reform of the state’s health care system in 2010, the Harvard professor initially refused. The RBRVS battle and the increasing rancor of the national health care debate had soured Hsiao’s attitude on the prospects of health care reform in the U.S. But Shumlin persisted. And five months after Hsiao stood alone before the legislature, Shumlin commanded the granite steps outside the Vermont State House. “We gather here today to launch the first single-payer health care system in America,” he declared. “To do in Vermont what has taken too long: have a health care system, the best in the world, that treats health care as a right and not a privilege.” Since then, California, Colorado, Minnesota, Oregon, and Pennsylvania have also asked Hsiao to help reform their health care systems, although he hasn’t agreed to work with any other states. (“Vermont was an anomaly,” Bill Hsiao, right, with Vermont Governor Peter Shumlin, left, and Speaker of the Vermont House of Representatives Shap Smith, on January 19, 2011. That day, Hsiao presented his single-payer health care plan to the state’s legislators. quality health care. But it will take another eight years, Hsiao estimates, before the U.S. will seriously consider such a plan. By then, America’s three biggest health care problems—tens of millions of uninsured, rising costs, and uneven quality of services—will be too great for patients, businesses, and politicians to bear, and the system will teeter on bankruptcy. “We already feel the pain,” says Hsiao. “In another eight years, costs will have risen so much that we will need radical surgery—and we will be willing to accept radical reform to correct it.” In the meantime, the U.S. Supreme Court is currently reviewing the constitutionality of the far-reaching health-reform initiative known as the Affordable Care Act. The first national legislative effort to rein in health care costs, the law aims to extend insur25 Spring | Summer 2012 it could hurt Vermont’s single-payer system in very practical ways, because Vermont’s system was crafted on the assumption that the federal Act would be implemented, providing an added subsidy for the state’s program. But for Hsiao, the stakes are even higher. “The Supreme Court case involves the philosophical divide between individual rights and collective well-being,” he says. “If the Court strikes down the law, it implies that the USA, one of the richest nations in the world, does not accept a right for every citizen to have equal social protection for basic health care. It raises the issue of what kind of nation we are: Do we care about our less fortunate neighbors—and are we willing to give up some of our rights so they can have better opportunities in life?” Eric Bland is a Boston-based freelance journalist. AP Photo/Toby Talbot Katie Vogelheim of the Board of Dean’s Advisors and Christopher Chin, HSPH India delegation member, with children from the Kaula Bandar slum community. HSPH Delegation Visits a delegation of Harvard School of Public Health friends and faculty members led by Dean Julio Frenk traveled to India from March 9–17, 2012. The group visited several of the School’s research sites, networked with alumni, and further strengthened relationships with Indian government agencies, academic institutions, and local organizations. More than two dozen HSPH professors and senior researchers are currently undertaking a diverse array of projects across India in areas such as maternal health, infectious disease, children’s safety, and environmental health. Dean Frenk was the guest of honor at the Public Health Foundation of India (PHFI), where he delivered a talk on transforming health professional education. HSPH is collaborating with PHFI to develop public health education and leadership curricula. This effort will both support and build upon PHFI’s work to establish five Indian Institutes of Public Health and create new centers of excellence addressing critical topics such as nutrition, health systems and policy, and maternal and child health. Theresa Betancourt, SD ’03, assistant professor of child health and human rights, led a site visit to Mobile Crèches, a day care center on a construction site outside of Delhi. The HSPH delegation also toured the Kaula Bandar slum community with David Bloom, Clarence James Gamble Professor of Economics and Demography, and HSPH alumna Anita Patil-Deshmukh, MPH ’05. Other highlights of the trip included an alumni reception hosted by Swati Piramal, MPH ’92, and a symposium on chronic disease cosponsored by HSPH and the Harvard South Asia Initiative and Harvard Business School India Research Center. Dean Julio Frenk and Swati Piramal, MPH ’92, at the Piramal Healthcare Life Sciences Facility, in Mumbai. The HSPH shield is made of sand—a traditional art form known as Rangoli. Photos from top, Harvard School of Public Health; Piramal Healthcare INDIA 26 Harvard Public Health Christy Turlington Burns, who recently joined the Board of Dean’s Advisors, walks through the Kaula Bandar slum community in Mumbai with David Hunter, Dean for Academic Affairs. Top, Board of Dean’s Advisors member Roslyn Payne and Vinod Paul, professor and head of the Department of Pediatrics at the All India Institute of Medical Sciences (AIIMS) in New Delhi. Above, Vinod Paul introduces Dean Frenk to a pediatrics resident at AIIMS pursuing a career in public health. K. “Vish” Viswanath, associate professor of society, human development, and health, and Padmini Somani, director of the Salaam Bombay Foundation. Photos, New Delhi: Kuku; Mumbai: Satyam Dean Frenk (center) with colleagues from AIIMS, HSPH faculty, and friends of the School. Participants from the corporate and foundation sector discuss the economic implications of chronic disease at a symposium held at the recently opened Harvard Business School academic facility in Mumbai. The symposium was co-organized by HSPH, Harvard University South Asia Initiative, and the HBS India Research Center. 27 Spring | Summer 2012 b ©Frederic Courbet/PANOS Better-trained aid workers, closer coordination among relief agencies, and a bigger dose of humility while working in unfamiliar cultures would help ensure that the billions of dollars spent each year on humanitarian assistance are not wasted. Harvard Public Health editor Madeline Drexler spoke with Jennifer Leaning, François-Xavier Bagnoud Professor of the Practice of Health and Human Rights, a 30-year veteran in the field and a leading writer and scholar; Michael VanRooyen, director of the Harvard Humanitarian Initiative (HHI), who has launched relief efforts in more than 30 countries struck by war and disaster; and Parveen Parmar, associate director of the Brigham and Women’s Hospital International Emergency Medicine Fellowship and an associate faculty member at HHI, who set out on her first humanitarian mission in 2010. continued CAN DOING GOOD BE DONE 29 Spring | Summer 2012 BETTER? Q: W hy doesn’t humanitarian aid money trickle down to the people most in need? A: VanRooyen: When the NGO machine steps into a large-scale humanitarian emergency, it quickly provides water and sanitation services, food aid, health care, housing, and security. Most organizations don’t effectively prepare for long-term sustainability—they don’t build water delivery systems for the city, they don’t build housing that will last, they don’t build infrastructure for program delivery. In many ways, the NGO community creates an alternate economy, and much of the money is spent on the delivery of emergency services. So it’s a valid complaint from local residents: “Where did all the money go? We don’t have pipes, we don’t have ditches, we don’t have farmland, we don’t have tools.” On the other hand, it is difficult to deliver resources directly to affected individuals and families. And money delivered to a nonfunctional or nonexistent government rarely gets to the people in need. Those who argue that the humanitarian field needs to get more cash to recipients should instead “ We are now sufficiently globalized that even the most remote community that falls into calamity can discern the difference between being isolated or having the world pay attention.” —Jennifer Leaning HUMANITARIAN FACTS Death toll in 2010 Haiti earthquake: 222,000 + Source: Report of the United Nations in Haiti 2010 30 Harvard Public Health be saying, “We need to spend more money to plan and understand where the next humanitarian catastrophes are going to be, so that we can prevent them.” Q: W hat was the most difficult environment in which mortality. Hardly anyone had the capacity to rise above the melee and say, “We’ve got to do things differently.” It was hell. Q: W hat was one of the more satisfying humanitarian you delivered humanitarian assistance? A: Leaning: I was in Mogadishu, Somalia, in January ’92, operations you’ve been involved in? A: Parmar: In Pakistan during the 2010 floods, I worked during the height of the terrible internecine war that persists to this day. The fighting in Mogadishu was a combination of direct slaughter and indiscriminate firing of very heavy weapons on a city built of sandy concrete. Essentially, the city crumbled. People were trapped, killed, mutilated, and brought to hospitals that were completely unequipped to handle complex casualties. closely with relief partners in the region—Médecins Sans Frontières, Muslim Aid, and Islamic Relief, among others. We collaborated to avoid duplication of services in an often-chaotic environment, filled with misinformation. MSF, for example, referred us to local staff as they were scaling down in the region, and shared data they’d collected during their operations. This level of In Somalia, a woman waits outside a Red Cross feeding center during the 1992 famine caused by that nation’s civil war. Opposite, ©Corey Hendrickson; this page, Paul Lowe, Panos Q: The humanitarian teams were fraying under the coordination is unique in crisis and conflict settings. It reflects new initiatives to improve collaboration among humanitarian actors. The organization I represented also worked closely with the national government and local health departments, which strengthened the sustainability and impact of our efforts. Though our coordination was imperfect, it saved lives and sped aid to those who most needed it. continued stress. People were very strung out, just trying to put one foot in front of another, not get killed themselves. They were traumatized, overwhelmed, intimidated, and having great difficulty practicing according to the standards in which they had been trained. They were hungry, sleep-deprived, in a chronic state of anxiety. No matter what they did, they knew there would be high Death toll in 2004 Indian Ocean tsunami: 230,000 Source: American Red Cross Number of internally displaced people worldwide in 2010: 27.5 million Source: Internal Displacement Monitoring Centre 31 Spring | Summer 2012 A young boy in Port-au-Prince, Haiti escapes looting and gang-related gunfire after the 2010 earthquake. Q: W hen does humanitarian aid work well—and when The humanitarian community also does not do does it not? A: Leaning: This enterprise works well at dealing with well when it enters a deeply complicated society that has its own serious fault lines—great numbers of people already in serious need—and then tries to cope with new fault lines and new layers of need. The 2010 Haiti earthquake was slam-dunk the worst-case example of failures in humanitarian effectiveness. On the one hand, it was a massive disaster that created a massive humanitarian crisis. On the other, Haiti was already struggling with severe and entrenched social and economic chronic crises not amenable to an emergency response. Q: S hould humanitarianism be a profession? A: VanRooyen: Yes, it should. Think of it this way: How do refugees and internally displaced peoples who are not close to major cities. Cities can be messy—a lot of people, marketplaces, complex trade, networks of crime and corruption. Humanitarians do well when they have a clearer geographic and cognitive space in which to set up and provide hospitals, feeding stations, shelter, water, sanitation, education, and minimum livelihood options. In this operational context, humanitarian aid workers try to nurture new and existing leadership, bring together people who were stranded and separated, establish community conversations about what to do next, and bring everybody to a place where they have a breather from horrible, life-threatening concerns and can begin to make sense of their next steps in their lives. These actions are much more difficult to accomplish when the people in most acute emergency need are mixed in with the more chronic needs and established systems in large urban areas. you train a business student to lead Lockheed Martin? In the same way, how do you train people to work in humanitarian environments that are fluid and difficult? We need to recognize humanitarian assistance as a unique and specialized discipline. Students must know not only about humanitarian principles and the basic provision of services, but also about finance, personnel, diplomacy, culture, and very practical matters of secuChristian Als /Berlingske, Panos Number of refugees worldwide in 2010: 15.4 million Source: UN High Commission for Refugees 32 Harvard Public Health rity. They also need to be creative and to lead. The toughest challenge is teaching leadership. Today, the humanitarian assistance community doesn’t have a university that brings in entry-level people and apprentices them into the field. That’s what our Lavine Family Humanitarian Studies Initiative (HSI) and our new Humanitarian Academy at HSPH are all about. [See article on HSI, page 12.] Q: W hat advice would you give to students who want “ Students must know not only about humanitarian principles and the basic provision of services, but also about finance, personnel, diplomacy, culture, and very practical matters of security.” —Michael VanRooyen to become humanitarian professionals? A: VanRooyen: As a physician, my medical expertise is ©Corey Hendrickson tance are around organization and logistics: getting resources from one place to another. You need to know how to organize, move materials, build programs, manage logistics. continued not the thing that makes me useful in the field. Many of the challenges in providing humanitarian assis- Top five humanitarian donor nations in 2009: United States, EU Institutions, United Kingdom, Germany, Spain Source: Global Humanitarian Assistance Report 2011 33 Spring | Summer 2012 A: Parmar: You need humility, above all. You need to Q: H ow can a humanitarian worker stay sane in the recognize that you’re a foreigner in somebody else’s world—that they’re the experts and you’re a visitor. Diplomacy is essential. Change isn’t made by being bullheaded or adventurous. It’s made by collaborating with the people who will live with the consequences of the crisis long after you leave. Q: D o humanitarians often encounter a “headline midst of turmoil? A: Leaning: Do not be dismayed by external criticism of the humanitarian enterprise, much of which is moderately well founded, nor by the internal self-reflections and criticism, which are also valid and important. These arise because the work is rapidly evolving. This is a powerful and relevant undertaking that is now moving into a new generation of challenges and is going to require a new generation of people prepared to deal in complex systems. An important common denominator for all students going into the humanitarian field is that they understand the ethical and the human rights issues. That is very necessary, because you’re going to go into highly ambiguous settings. Students need to know how to determine what path they should take in complicated situations where questions of right and wrong are embedded in questions of safety and security and practicality. To do this work, aid workers must learn where they themselves stand in terms of their principles and lines of action. mentality” in regard to disasters? A: Parmar: When I was waiting for my plane to Pakistan, I watched hours of CNN in airport lounges. Millions of people had been affected by the massive floods in that country—people were literally living on roadsides and in flooded fields under tarps with the few belongings they had, little to no food, no security, no privacy, their kids out in the road. But in the hours of waiting for my plane, the floods weren’t mentioned once. Despite the scale of the disaster, the immediate mortality from the flood was relatively low, when compared to Haiti or other recent disasters. As a result, the Pakistan floods quickly fell out of the international spotlight—though aid was still sorely needed. In Pakistan’s Sindh Province, floodwater inundates the surrounding area after Manchar Lake burst its banks in 2010. Andrew McConnell, Panos Humanitarian assistance from governments in 2010: $12.4 billion Source: Global Humanitarian Assistance Report 2011 Humanitarian assistance from private voluntary contributions in 2010: $4.3 billion Source: Global Humanitarian Assistance Report 2011 34 Harvard Public Health “ You need humility, above all. You need to recognize that you’re a foreigner in somebody else’s world—that they’re the experts and you’re the visitor … Change isn’t made by being bullheaded or adventurous. It’s made by collaborating with the people who will live with the consequences of the crisis long after you leave.” —Parveen Parmar Q: W hat keeps you going? A: Leaning: What keeps me going is I know that having the world pay attention. We are reestablishing what it is to be part of the human community. It’s a universal handshake. A: Parmar: I was talking recently to a resident who people in need, who are trapped and suffering, actually care about whether the world cares. We ©Corey Hendrickson are now sufficiently globalized that even the most remote community that falls into a calamity can discern the difference between being isolated or said, “I can’t do global health work, because I can’t deal with the reality that if I took care of this person in Boston, they would live, but in a crisisaffected region, they’re going to die because there are no resources. That’s fundamentally wrong.” My response was, “You’re absolutely right. But we have to do something.” v Share of humanitarian assistance that went to conflict-affected and post-conflict states in 2009: 65 percent Source: Global Humanitarian Assistance Report 2011 35 Spring | Summer 2012 Accentuating Public health practitioners the Positive can do a better job selling the benefits of healthy living whether the topic is distracted driving or body image. I It’s an all too common scene: A girl looks at a photo in a fashion magazine and compares the model’s thin, airbrushed figure to her own rounder shape. She tells her friend, “I am so fat. I hate my body.” But what if, instead of playing along as usual, the friend flips the script and compliments her on something other than her looks? Could changing the conversation be a first step toward improved self-esteem and healthier behavior? Empowering students to speak up when they see their friends getting into unhealthy situations or behaving inappropriately is a common component of college antiviolence workshops. Now Rob Buelow, SM’12, a former violence prevention educator and antisexism activist studying health communications at Harvard School of Public Health, wants to know whether this type of positive peer pressure can be tapped to interrupt disparaging conversations about body image and weight. It’s one of several tactics the highenergy master’s student is exploring in his quest to spread the positive message of public health. “I have a passion for helping people and also for understanding what makes them tick,” Buelow says. “It’s exciting for me to try to understand who my audience is and how I can most effectively reach them.” Working with colleagues from the HSPH Strategic Training Initiative for Kent Dayton/HSPH HSPH student Rob Buelow uses unconventional methods to reach people everywhere in their daily routines— including the bathroom—with upbeat public health messages. the Prevention of Eating Disorders (STRIPED), Buelow is assisting in a pilot evaluation of the effectiveness of Fat Talk Free Week, a national social media campaign aimed at college women. After going through the intervention, were participants any more likely to stop a friend from engaging in fat talk? Analyzing survey data for his practicum, Buelow hopes to show that targeting the attitudes and behavior of bystanders can help change social norms. Although it has been tried before, most famously in the “Friends don’t let friends drive drunk” television commercials, bystander-focused interventions are still relatively new territory in public health, says Buelow’s adviser, Vish Viswanath, associate professor in the Department of Society, Human Development, and Health. “More empirical evidence is needed to show that this approach is effective across a range of problems. If Rob can show that this approach works, and why it works, then it may be appropriate to apply more widely,” Viswanath says. Teenage distracted driving is another problem ripe for a bystander-focused intervention. “There’s a big difference between saying to a teenager, ‘Don’t text while driving,’ versus a campaign that promotes a norm of friends who encourage other friends not to text while driving,” Buelow says. “When friends communicate this message to each other, it bypasses the teenage force field of invincibility that tunes out ‘This is your brain on drugs’–type scare tactics.” But according to Buelow, public health practitioners “The world looked different to me after taking that class,” Buelow says. “The fact that the instructor was a guy got me to question a lot of stereotypes I was unaware of. He taught me about privilege: who has it, who doesn’t, and why it matters. He ripped the rose-colored glasses off my face and inspired me to do something about it.” Buelow got involved in men’s antisexist activism and after graduation took a job conducting sexual assault prevention trainings at the University of California at Irvine. He quickly learned to tailor his message to his audience. “With fraternity men, I stressed that they were leaders on campus upholding a set of values,” Buelow says. “In women’s self-defense workshops, we would work on building confidence, self-esteem, and personal strength.” return on investment KIDS before they’ve had a chance to develop bad habits. Ideally, positive messages about healthy living should start in childhood, Buelow says. “Teenagers and adults have health needs that must be addressed. But you get the biggest return on investment by focusing on kids before they’ve had a chance to develop bad habits.” After recently taking an intensive course in informal learning for children, Buelow is excited to pilot another outside-the-box idea: a health newsletter that will be posted where all kids must go eventually—the restroom. Buelow, HSPH’s vice president of student life, launched the Stall Stories newsletter at HSPH earlier this year. Its mix of student-oriented news with fun features proved popular with its captive audience, and that got him thinking about realworld applications for both child and adult audiences. For Buelow, reaching people where they are is what public health is all about. “The pursuit of knowledge is really important, but what good is data and theory if they don’t have practical application? You’re not going to change the world if research stays in your lab and knowledge stays in your head.” but you get the biggest by focusing on Teenagers and adults have health needs that must be addressed— need to do a better job at selling the benefits of healthy living. “A lot of the things we are up against in public health—eating junk food, smoking cigarettes, unsafe sex—appeal to people as fun, sexy, cool, or rewarding. To offset that, our messages must generate positive appeal for healthy behaviors. We need to sell public health the same way alcohol or tobacco companies sell their products.” Buelow first learned the power of the right message at the right time as an undergraduate at Penn State University. Encouraged by a dating partner at the time, Buelow registered for a women’s studies class that turned out to be taught by a man. Amy Roeder is assistant editor of Harvard Public Health. 37 Spring | Summer 2012 Finding Her True Path In the middle of a high-flying business career, Kate Powis, MPH ’09, reversed course and chose a life in public health. Thirteen years ago, Kate Powis, then in her late thirties, earned a handsome salary as a vice president at electronics retailer Circuit City, overseeing an operation of hundreds of people and regularly flying from state to state on a corporate jet. Today, driving to work at Scottish Livingstone Hospital in Molepolole, Botswana, Powis gazes out at mud huts, donkey carts, and carrion birds wheeling in the sky. Here, she cares for adults or children in the outpatient HIV clinic or in the wards. Working on the Mpepu study—a randomized clinical trial led by Harvard AIDS Initiative’s researchers Roger Shapiro and Shahin Lockman—Powis analyzes why babies born to HIV-infected mothers don’t thrive like other babies. In 2012, she received a coveted five-year career development grant from the National Institutes of Health. continued 38 Harvard Public Health Kate Powis, MPH â€™09, works with HIV-infected women and their babies. 39 Spring 2012 “ Rather than forecasting staffing requirements or preparing for a ‘due diligence’ meeting with Standard and Poor’s … I use data from large clinical trials to improve the health of women and infants collectively.” In Botswana, Kate Powis is studying whether antiretroviral therapy for pregnant or breastfeeding HIV-infected women could help reduce disease transmission to their infants. Above, a three-year-old boy in Botswana; though both of his parents are HIV positive, he is HIV negative. A 180-degree turnaround? Yes and no. Powis, who earned her medical degree in 2003 at age 43 and her MPH at Harvard School of Public Health in 2009, sees a common thread linking her business and medical careers. Working in finance and earlier in store security, she focused on devising the most effective and efficient ways to get things done and on measuring performance. Today, she applies that same passion for results to public health— with outcomes that are far more personally satisfying. “Rather than forecasting staffing requirements or preparing for a ‘due diligence’ meeting with Standard and Poor’s, I have one-on-one interactions with patients and their families,” she explains. “And I use data from large clinical trials to improve the health of women and infants collectively.” A JOURNEY THAT BEGAN ON A LARK “I had this perception of Jamaica as a resort community,” Powis says. “We immediately drove from the airport to this impoverished village up in the hills. No running water— kids would carry up buckets every day from the bottom of the hill. One little girl was getting toted around because when she was two, she had broken her leg and it had never been properly set. The leg was grossly deformed and she couldn’t walk on her own—all because she didn’t have access to health care.” STR New / Reuters Powis’ life-altering journey began on a lark. Friends in a church group were traveling to Jamaica to rebuild the roof on a church that had been damaged in a hurricane. 40 Harvard Public Health Powis pauses. “That was astonishing to me. I thought, ‘This shouldn’t be.’” After the Jamaica trip, Powis changed course. She began taking the science prerequisites she needed to get into medical school, one course at a time, at Virginia Commonwealth University. “I realized I could be doing more important things with my life than earning a profit for Circuit City.” After medical school and a residency at MGH (she now works part of the year at Massachusetts General Hospital’s Chelsea Healthcare Clinic), Powis in 2007 received a Global Women’s Health Fellowship, a Brigham and Women’s Hospital-sponsored award that supports international research, clinical work, and a degree at HSPH. She immediately offered her skills to the Harvard School of Public Health AIDS Initiative. USING ALL HER SKILLS other talents—like when she helped the team switch from a paper-based to an electronic data collection system—and expanded her role. “Kate can do everything, which makes her unique,” says Shapiro. “She’s probably the hardest worker I’ve ever met. She approaches her job with an attention to detail that’s rarely seen. And she has a sense of the larger picture—how the research fits into the public health infrastructure in Botswana.” Powis’ NIH career award represents a significant recognition of her efforts. “She picked an important and timely topic for her research,” says Shapiro. “As we roll out anti- amounts of information that must be processed. “There are more than three-quarters of a million human blood samples in freezers,” Essex says, “and a new study enrolling more than 60,000 people.” It’s not easy to make a mid-career switch the way Powis did, Essex adds. But Powis was—and is—clearly committed to developing herself into a first-rate doctor and medical researcher. “She has the same excitement about her work as a 25-year-old doing the same thing,” says Essex. Though Powis says that she was happy in her former professional life, she doesn’t miss it. Looking back, she thinks she needed to try different careers before settling on the right one. “In many respects, I am doing the same thing now as I did before. I look at medicine and research with an eye toward improving systems, automating things, ensuring that errors can be eliminated—whether it be errors in the provision of care or errors in the collection of data for research,” she says. “But because of the women and children I’m working with, and the impact I am having both on individual lives and collectively in the public health arena, I know I’ve now found my true calling.” Karen Feldscher is a senior writer at HSPH. “ I know I’ve now found my true calling.” retrovirals in pregnancy and protect more infants from HIV infection, we need to make sure they also survive infancy.” CLEAR COMMITMENT At first, the HAI’s Shapiro, associate professor in the Department of Immunology and Infectious Diseases, assigned her clinical responsibilities, as well as work with mothers and infants on a study examining whether antiretroviral therapy for pregnant or breastfeeding HIV-infected women could help reduce disease transmission to their infants. But soon he recognized her According to Max Essex, Mary Woodard Lasker Professor of Health Sciences, and HAI chair, “Apart from her own research, which has been significant, Kate has helped us design ways to streamline the acquisition of information and data and determine how best to analyze it,” he says. It’s a crucial task because of the massive 41 Spring | Summer 2012 BIG DATA continued from page 19 In 2007, Reshef met Pardis Sabeti, an assistant professor in HSPH’s Department of Immunology and Infectious Diseases and a computational biologist at the Broad Institute. Reshef talked excitedly about his desire to apply computational methods to public health problems. Sabeti, a geneticist who has made discoveries about malaria and the lethal African Lassa virus by mining big data, found Reshef remarkably like-minded. “You should come work with me,” she told him. They began developing tools for visualizing relationships in huge databases (including a World Health Organization database containing more than 60,000 To discover hidden relationships in the data, he needed a treasure-seeking tool, the computational equivalent of a metal detector. Reshef and his brother, Yakir, who was just graduating from Harvard with a math degree, started to spend every spare minute together, scribbling equations on the glass walls of the Broad and consulting with Sabeti and Michael Mitzenmacher, professor of computer science at Harvard. One hot night, running the latest version of their algorithm on a PC, they realized their program finally worked—and fast. (The algorithm now produces results in minutes or hours, depending on the size of the dataset. Without it, the data could take months to analyze.) “We were so excited, we called Pardis,” Reshef says. It was 3 a.m. David Reshef, right, and his brother Yakir teamed with HSPH’s Pardis Sabeti to create tools for visualizing relationships in huge databases. relationships among data from 200 countries). But visualization tools work best when scientists have an idea of what to visualize in a pile of data. Reshef wasn’t seeking the proverbial needle in a haystack; he wanted to find all the needles. Scientists are excited by the potential of hypothesis-generating, rather than hypothesis-driven, science that big data mining offers. Over the next year, they tested the tool, called MINE, on several giant datasets, including the WHO data and a 6,700-variable database of the human gut microbiome that generated 22 million possible paired relationships. Last December, the Reshef brothers were the lead authors of a paper in Science that showed the tool’s range. The algorithm has helped pinpoint interesting associations between gut bacteria, demonstrating that both diet and gender influence gut bacteria. The tool also identified nonintuitive associations between female obesity and income. In just a few weeks, more than 50,000 visitors tapped the MINE website, including, says Sabeti, visitors from “every imaginable field: genomics to finance to pharma to education and beyond.” ChieYu Lin, courtesy of Pardis Sabeti 42 Harvard Public Health HARMONIZING INCOMPATIBLE DATA To analyze data, whether through crowdsourcing or algorithms, you have to start with a decent database—or several. Sharing massive datasets offers huge potential for improving public health. Biostatistics chair Victor De Gruttola is working on an Institute of Medicine project identifying indicators and methods for monitoring HIV care in the U.S. “There are many tremendous sources of information, but none are sufficient in themselves to gauge the prevalence of HIV care, as well as access to mental health and substance abuse treatment and support services,” he says. For example, the U.S. Centers for Disease Control and Prevention captures diagnostic, demographic, and medical information, but no data on the use of antiretroviral drugs. Medicaid and Medicare track service use through claims data, but not clinical measurements such as immune function at diagnosis. De Gruttola posits that if researchers could join these datasets, they’d learn which vulnerable groups of patients aren’t getting the treatments they need. Easier said than done. That’s in part because scientists employ a mélange of incompatible structures to create their data. Winston Hide, the biostatistics associate professor, has taken a step toward fixing that problem. He and researchers at 30 organizations, including Oxford University, have invented a common language and tools for sharing data across disciplines, called Investigation-StudyAssay (ISA). (For information, visit isacommons.org.) The technology is intended to be simple for researchers to use—a sort of scientific lingua franca. In just two weeks, Hide joined a cancer database with a stem cell dataset—and got a big payoff. “We discovered a single gene that we think is responsible for the initiation of a whole class of leukemias,” he says. “Not until we could combine the information coherently could we discover things about the underlying molecular biology.” A NEW WAY OF DOING SCIENCE infection endemic in West Africa. She and Reshef believe that the hypothesis-generating power of big data will ultimately help researchers gain insights into the most pressing public health problems, such as the emergence and spread of resistant strains of malaria. Meanwhile, Winston Hide believes younger scientists— raised in an era of social networking—will embrace an idea that previous generations of researchers have not: sharing data freely. It’s an option that makes intuitive sense, he says, to generations raised with social networking. Crowdsourcing is also breaking down the walls between the academy and the rest of the world. For many scientists, though, it’s a tough transition: Academics have typically held their data close, because tenure, promotions, Most researchers agree that lives are lost every day that data sit in storage, untouched. and reputation rest on being the first to publish. Sharing research takes a leap of faith in a cutthroat academic world that has yet to embrace the notion of a public commons of data. The change also comes with ethical questions, including privacy dilemmas. And employing crowds to analyze one’s data begs the question of quality: How can you trust the results? Surprisingly, Fortune says she trusts the results more than those that would have come from her lab. “I think the power of crowdsourcing is that they’re going to give us better data than we can generate ourselves.” That’s because CrowdFlower uses redundancy to ensure quality (five people may analyze the same image). Indeed, she’s become a huge fan of speeding scientific progress through crowdsourcing. “I love the idea of citizen science,” she says. “We’re asking people to do some not very sophisticated tasks. You could stand in line at the bank and measure bacteria for me.” To a single citizen scientist labeling a batch of images, the work may feel tedious. In fact, it’s transformative—a small contribution to what may be public health’s datadriven revolution. “It’s just the beginning,” says Winston Hide. “You should watch this space.” Elaine Grant is assistant director of development communications and marketing at HSPH. These innovative methods for mining big data are transforming the way science is done. Sabeti and Reshef are excited by the potential of hypothesis-generating (rather than hypothesis-driven) science, providing researchers with important new questions to answer. Analyzing genetic data for natural selection, for example, Sabeti had stumbled on clues to the virulence of Lassa fever, a deadly 43 Spring | Summer 2012 ALUMNI NEWS 1945 Dr. Raquel Cohen, MPH, is retired but still actively sharing her public health expertise. She wrote a training manual for humanitarian workers on mental health during disasters that can be accessed on mobile devices or downloaded. It is available in both English and Spanish at http://helid. digicollection.org/en/d/Jh0681e/. 1982 Howard Hu, MPH, SM ’86, SD ’90, was named director of the University of Toronto’s Dalla Lana School of Public Health. Hu previously served as the National Science Foundation International Department Chair in the Department of Environmental Health Sciences and professor of environmental health, epidemiology, and internal medicine at the University of Michigan, and as a director of the Michigan NIEHS Center for Research on Lifestage Exposures, Epigenetics and Adult Disease. articles, abstracts, and book chapters in a long academic career in health and higher education policy. 1990 Dr. Philip Huang, MPH, was named the 2011 recipient of the Texas Academy of Family Physicians Public Health Award during the organization’s Annual Session and Scientific Assembly in Dallas on July 30, 2011. The award recognizes individuals who are making extraordinary contributions to the public health of Texans. Huang is the medical director and health authority for the Austin/ Travis County Health Department. He previously served as medical director for chronic disease prevention at the Texas Department of State Health Services, and for more than 15 years as chief of the Bureau of Chronic Disease and Tobacco Prevention at the former Texas Department of Health. His responsibilities at TDH included oversight of state activities related to cardiovascular disease, diabetes, cancer, Alzheimer’s disease, asthma, and tobacco use prevention. 1959 William Kannel, MPH, died August 20, 2011, at age 87. He was an epidemiologist whose work for six decades on the landmark Framingham Heart Study helped revolutionize the way heart disease is treated. 1964 William Jobin, SM, SD, ’67, delivered the Frederick S. Pardee Distinguished Lecture at Boston University on December 15, 2011, in memory of the late Andrew Spielman, professor of tropical public health at HSPH. Jobin’s work focuses on the prevention and control of malaria and other tropical diseases, especially in association with water and development projects that cause large-scale ecological changes. In 1984, Jobin founded Blue Nile Associates, which specializes in environmental assessment and improvement of existing and proposed development projects based on requirements for protecting human health, water quality, and agricultural land uses. 1983 Kent Woods, SM, was honored with a British knighthood for his services to health care. The accolade appeared in Queen Elizabeth’s Birthday Honors List 2011. Magda Peck, SM, SD ’86, became the founding dean of the Joseph J. Zilber School of Public Health at the University of Wisconsin-Milwaukee in March 2011. The school focuses on social and environmental justice and currently has three academic programs: Master of Public Health, Graduate Certificate in Public Health, and PhD in Environmental and Occupational Health. 1991 Dr. Mitchell Garber, MPH, is now a senior managing consultant with Engineering Systems Inc., an engineering and scientific investigation and analysis firm. For nearly 15 years, Garber had served as the medical officer for the U.S. National Transportation Safety Board (NTSB). During his tenure at the NTSB, he assisted the agency in identifying and addressing critical medical issues in transportation safety, including injury prevention, medication use by transportation operators, hypoxia in aviation operations, medical certification of commercial drivers, substance 1971 Dr. Norman B. Schell, MPH, died at age 86 on December 19, 2011. Schell was a pediatrician prior to studying at HSPH. After earning his degree, he served as deputy commissioner of health for Nassau County, New York, until retiring in 1990. Among other activities, he was involved in early promotion of the rubella vaccine. 1987 Dr. Eli Capilouto, MPH, SM, SD ’91, SPH ’97, became president of the University of Kentucky on July 1, 2011. He had previously served as provost of the University of Alabama at Birmingham (UAB) and as dean of the UAB School of Public Health. During his tenure at UAB, Capilouto helped lead the adoption of the University’s Strategic Plan, an integrated and more transparent budgeting system, and brought increased research funding. Capilouto has published numerous 44 Harvard Public Health Kent Dayton/HSPH ALUMNI NEWS dependence in pilots, and obstructive sleep apnea screening and evaluation. 50s, and 60s in his new book, Is This Normal? The Essential Guide to Middle Age and Beyond (Rodale Press Inc., 2011). Whyte, a member of the School’s Leadership Council, has since 2005 served as the Discovery Channel’s chief medical expert and vice president for health and medical education. inspiring people in health sciences. She was awarded the Leadership Medal of Honor by the Faculty of Health Sciences at the Universidad Anahuac. Llopiz was also elected secretary general of the Governing Board/House of Delegates of the International Federation of Associations of Pharmaceutical Physicians Europe, and president of the Association of Medical Specialists in the Pharmaceutical Industry in Mexico for the 2011–2013 term. Dr. Anna Banerji, MPH, was named to the 2012 Order of Ontario, the highest provincial honor bestowed on an individual in Ontario. She is a specialist in tropical and infectious diseases and a world-renowned expert in the field of respiratory diseases in Inuit children. She created the Immigrant Health and Infectious Disease Clinic and the Canadian Refugee Health Conference. 1992 Swati Piramal, MPH, director of Piramal Healthcare Ltd., received the Padma Shri award in April. One of India’s highest civilian honors, the award recognized Piramal’s innovative work in health care policy and the life sciences. Piramal is a member of the HSPH Board of Dean’s Advisors. 1998 David Bjorkman, SM, is the new dean of the Charles E. Schmidt College of Medicine at Florida Atlantic University. He previously served for seven years as dean of the University of Utah School of Medicine. Dr. John Fletcher, MPH, has been named editor-in-chief of the Canadian Medical Association Journal (CMAJ). He is an accredited specialist in public health in the UK and was a research fellow at Oxford University. He worked at the London office of what is now known as PricewaterhouseCoopers and managed his own Internet medical knowledge company before moving to the British Medical Journal, where he spent seven years. For the last three years, Fletcher has been the deputy editor for research at the CMAJ. 1993 Nathan Kupperman, MPH, received the Outstanding Contribution in Research award from the American College of Emergency Physicians and was elected to the Institute of Medicine last year. He is the Bo Tomas Brofeldt Endowed Chair of the Department of Emergency Medicine at the University of California Davis School of Medicine, and a professor in the departments of emergency medicine and pediatrics. He is both a pediatric emergency physician and a clinical epidemiologist. Navin Singh, SM, recently served as a visiting professor at Oxford University, England, where he lectured on and performed reconstructive surgery. Singh, who volunteers on reconstructive surgery projects in China, Ecuador, India, and Peru, published a children’s book called Special Smiles (CreateSpace, 2011), which is about children overcoming cleft lips. Proceeds from the book are given to charity. Learn more at www.SpecialSmilesBook.com. Deborah van Dyke, MPH, is the founder and director of the Global Health Media Project, which disseminates informational videos to health care workers around the world free of charge. The latest video, The Story of Cholera, is available at: http://globalhealthmedia. org/library/the-story-of-cholera. John Whyte, MPH, offers advice on issues facing adults in their 40s, 2004 Dr. Lauren Wise was the recipient of the 2011 Association of Schools of Public Health/Pfizer Young Investigator’s Research Award. She is an associate professor of epidemiology at Boston University School of Public Health. She was nominated for an article she co-wrote: “A Prospective Study of Dairy Intake and Risk of Uterine Leiomyomata,” which was published in the April 1, 2010 issue of the American Journal of Epidemiology. 1999 Randi Berkowitz, SPH, was named to the Centers for Medicare & Medicaid Services’ first class of “innovation advisors.” The program, created by the Affordable Care Act, is designed to give medical professionals the skills they need to assess and change the health care of large groups of patients. They also will become point people for testing and ramping up pilot programs for reforming the health care system. 2003 Marlene Llopiz, MPH, received several honors in 2011 for her contributions to public health and medicine in Mexico. She was chosen for two consecutive years by the readers of PharmaVoice magazine as one of the 100 most 45 Spring | Summer 2012 Harvard Public Health is interested in hearing from you. Please send comments or class notes to: Amy Roeder, Assistant Editor Harvard Public Health 90 Smith Street Boston, MA 02120 Phone: (617) 432-8440 Fax: (617) 432-8077 Email: email@example.com FACULTY NEWS AWARDS AND HONORS were awarded honorary degrees from Wheelock College in Boston during the school’s annual convocation ceremony on September 14, 2011. Byrd and Clayton, who are married, are both practicing obstetrician-gynecologists. Richard Cash, senior lecturer on global health, received the 2011 Fries Prize for Improving Health at the U.S. Centers for Disease Control and Prevention on November 8. The James F. and Sarah T. Fries Foundation honored Cash for his leadership in the development and dissemination of oral rehydration therapy, a practical treatment for cholera and other diarrheal diseases that has saved the lives of millions of children worldwide. Max Essex, Mary Woodard Lasker Professor of Health Sciences and chairman of the Harvard School of Public Health AIDS Initiative, was awarded the Institute of Human Virology Lifetime Achievement Award for Scientific Contributions for his work on animal and human retrovirus research and his public health leadership in Botswana. The award was presented during IHV’s 13th Annual International Gala Awards Banquet on November 1. Sarah Fortune became the inaugural recipient of the Melvin J. and Geraldine L. Glimcher Assistant Professorship in the Division of Biological Sciences in January. Fortune, who has been an assistant professor of immunology and infectious diseases at HSPH since 2006, seeks to understand the bacterium responsible for TB, and in particular how its ability to mutate contributes to drug resistance. The Glimcher Assistant Professorship was established by the transfer of teaching and research funds that had supported the work of Laurie Glimcher, the former Irene Heinz Given Professor of Immunology and Infectious Diseases. Richard Gelber, professor in the Department of Biostatistics, received the ECCO Clinical Research Award at the European Multidisciplinary Cancer Congress, held in Stockholm, Sweden, in September. The award honors an “outstanding international contribution to the integration of scientific research and clinical practice in the field of cancer.” Gelber was recognized along with colleague Aron Goldhirsch, of the European Institute for Oncology, for their research group’s work on breast cancer. Katherine Baicker, professor of health economics, Atul Gawande, associate professor in the Department of Health Policy and Management, and JoAnn Manson, professor in the Department of Epidemiology, are among the 65 new members of the Institute of Medicine (IOM). The news was announced by the IOM in October, in conjunction with its 41st annual meeting. Election to the IOM is considered one of the highest honors in the fields of health and medicine. Baicker also was appointed to the board of directors of Eli Lilly and Company and as chair of the Board of Directors of AcademyHealth in December. Manson received the American Heart Association’s Distinguished Scientist Award in November. Robert Blendon, senior associate dean for policy translation and leadership development, is the inaugural recipient of the Richard L. Menschel Professorship in Public Health. This honor recognizes Blendon’s leadership of the Division of Policy Translation and Leadership Development, as well as his commitment to innovation and creativity in public health practice, research, scholarship, and teaching. Blendon remains director of the division. W. Michael Byrd and Linda Clayton, instructors in HSPH’s Department of Health Policy and Management, David Hemenway received the Striving for Social Justice Award from Boston’s Community Works, an umbrella organization of 34 social justice groups, on November 15. Hemenway is the director of the Harvard Injury Control Research Center and the Youth Violence Prevention Center. He has spent much of his career studying youth violence and implementing violence prevention programs. Miguel Hernán was named an AAAS fellow by the American Association for the Advancement of Science. He Kent Dayton/HSPH, Aubrey LaMedica/HSPH 46 Harvard Public Health was recognized for “cutting-edge contributions to methodological and substantive research in epidemiology, outstanding professional service, and excellence in teaching.” New fellows were honored during the 2012 AAAS Annual Meeting in Vancouver, BC, Canada, on February 18. Nancy Kane was selected as 2011’s winner of the ASPH/Pfizer Award for Teaching Excellence. She was honored during the Association of Schools of Public Health Annual Meeting reception and award ceremony on October 31. Marc Lipsitch, professor of epidemiology, was honored last June by his colleagues at the North American Congress of Epidemiology 2011. Lipsitch was lead author of a paper titled “Negative Controls: A Tool for Detecting Confounding and Bias in Observational Studies,” which was awarded the Kenneth Rothman Prize for the best manuscript published in Epidemiology in 2010. According to a press release from the journal, the paper “addresses an underutilized but intuitively appealing approach in a clear and accessible way.” HSPH’s Eric Tchetgen Tchetgen, associate professor of epidemiology, and Ted Cohen, assistant professor in the Department of Epidemiology, were coauthors. David R. Williams, Florence Sprague Norman and Laura Smart Norman Professor of Public Health, received the prestigious Leo G. Reeder Award from the American Sociological Association’s Medical Sociology section in honor of his “outstanding and distinguished career in medical sociology.” It was presented in August at the ASA annual meeting. Marvin Zelen, Lemuel Shattuck Research Professor of Statistical Science, was appointed by Tel Aviv University’s Sackler Institute of Advanced Studies as a 2011–12 Sackler Lecturer. He delivered his lectures in December. Nan Laird was appointed the new Harvey V. Fineberg Professor of Public Health in December. This honor recognizes her more than 35 years developing statistical methodology, teaching, and conducting applied research. Laird also received this year’s Samuel S. Wilks Medal, the American Statistical Association’s most prestigious prize, for “her pioneering work on the EM algorithm, which set the foundation for many subsequent advances in computational statistics and biology.” Other areas of notable contribution include meta-analysis, longitudinal data, medical adverse events, and statistical genetics. Laird has authored or coauthored more than 250 publications and earned more than 75,000 citations to her work. PROMOTIONS Frank Sacks, professor of cardiovascular disease prevention, Department of Nutrition, received the 2011 Research Achievement Award of the American Heart Association. This award is conferred annually in recognition of distinguished scientific achievement in the field of cardiovascular research. He was honored on November 13 at the AHA Scientific Sessions. Vishal Vaidya, assistant professor in the Department of Environmental Health, received an outstanding new environmental scientist (ONES) grant from the National Institute of Environmental Health Sciences in September. The prestigious grants are awarded to “exceptionally talented early stage investigators,” according to NIEHS. 47 Spring | Summer 2012 Meredith Rosenthal professor of health economics and policy Eric Tchetgen Tchetgen associate professor of epidemiology Tianxi Cai professor of biostatistics NEW APPOINTMENTS Zulfiqar Bhutta visiting professor of global health and population Flaminia Catteruccia associate professor of immunology and infectious diseases William Mair assistant professor of genetics and complex diseases Jukka-Pekka Onnela assistant professor of biostatistics Mahlet Tadesse visiting associate professor of biostatistics IN MEMORIAM Harvard Medical School. She was elected to the National Academy of Science in 1994, and was the first pediatrician to serve as president of the American Association for the Advancement of Science. In her later career, Avery worked with UNICEF to promote oral rehydration therapy and polio vaccination. She was honored with a National Medal of Science in 1991. visiting professor in the Department of Population and International Health from 1995 to 2000. He also served as associate director of the Center for Health and the Global Environment at Harvard Medical School, which he founded with HMS assistant clinical professor of psychiatry Eric Chivian in 1996. Epstein was a pioneer in linking climate change and human health. He was one of the first medical experts to recognize the less obvious health effects of greenhouse gases, from the increase in ragweed pollen to extreme weather events. He contributed to the Intergovernmental Panel on Climate Change, which shared the 2007 Nobel Peace Prize with former vice president Al Gore. Epstein served as an adviser to Gore in conceiving the slide show about global warming that became the basis of the Academy Award-winning 2006 documentary An Inconvenient Truth. Mary Ellen Avery Mary Ellen Avery, whose work as a research fellow at HSPH in the 1950s led to one of the most important strategies to improve newborn care, passed away December 4, 2011, at age 84. Avery’s research showed that respiratory distress syndrome in premature newborns is caused by a lack of surfactant, a mixture of phospholipids and proteins that help lungs expand. Her ideas led to surfactant replacement therapy and to the modern neonatal intensive care unit. Avery was the first woman to serve as physician-in-chief at Children’s Hospital Boston and to chair a major clinical department at Franklin Neva Franklin Neva, 89, who helped isolate the rubella virus while a professor of tropical diseases at HSPH, died on October 16, 2011, at age 89. Neva joined the National Institutes of Health in 1969, where he established a clinical service to treat patients from developing countries as well as citizens of the United States. He directed the Laboratory of Parasitic Diseases at the National Institute of Allergy and Infectious Diseases for 26 years. In his scientific work, Neva focused on the biology of parasites and the human response to parasitic infections. Photographs provided courtesy of the Harvard Medical Library, Francis A. Countway Library of Medicine Paul Epstein Paul Epstein, MPH ’83, a physician known for making critical connections between the emergence and re-emergence of infectious diseases and climate change, died on November 13, 2011, at 67. Epstein was a 48 Harvard Public Health HARVARD PUBLIC HEALTH DEAN OF THE FACULTY Julio Frenk VISITING COMMITTEE Jeffrey P. Koplan, MPH ’78 Chair Ruth L. Berkelman Joshua Boger Walter Clair Nicholas N. Eberstadt Tore Godal Jo Handelsman Risa Lavizzo-Mourey Bancroft Littlefield Nancy T. Lukitsh Vickie M. Mays Michael H. Merson Anne Mills Kenneth Olden John W. Rowe Bernard Salick Burton Singer BOARD OF DEAN’S ADVISORS Jeanne B. Ackman Theodore Angelopoulos George D. Behrakis Katherine S. Burke Christy Turlington Burns Gerald L. Chan Lee M. Chin Jack Connors, Jr. Jamie A. Cooper-Hohn Mala Gaonkar Antonio O. Garza C. Boyden Gray Rajat K. Gupta Jeanne Lavine Jonathan Lavine Richard L. Menschel* Roslyn B. Payne Swati A. Piramal Alejandro Ramirez Carlos E. Represas Richard W. Smith Howard Stevenson Samuel O. Thier Katherine Vogelheim ALUMNI COUNCIL As of November 2011 Officers Elsbeth Kalenderian, MPH ’89 President Anthony Dias, MPH ’04 President Elect Ramon Sanchez, SM ’07, SD ’11 Secretary Royce Moser, MPH ’65 Immediate Past President Alumni Councilors 2009-2012 Marina Anderson, MPH ’03 Rey de Castro, SD ’00 Cecilia Gerard, SM ’09* 2010-2013 Teresa Chahine, SD ’10* Sameh El-Saharty, MPH ’91 Chandak Ghosh, MPH ’00 2011-2014 Haleh Armian, SM ’93 Michael Olugbile, MPH ’11* Alison Williams, PD ’10 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 Health Harvard School of Public Health Office for External Relations 90 Smith Street Fourth Floor Boston, Massachusetts 02120 (617) 432-8470 Please visit www.hsph.harvard.edu/review and email comments and suggestions to firstname.lastname@example.org. Dean of the Faculty Julio Frenk T & G Angelopoulos Professor of Public Health and International Development Vice Dean for External Relations Ellie Starr Associate Vice Dean for Communications Julie Fitzpatrick Rafferty Director, Strategic Communications and Marketing Samuel Harp Editor Madeline Drexler Assistant Editor Amy Roeder Senior Art Director Anne Hubbard Assistant Director for Development Communications and Marketing Elaine Appleton Grant *emeritus *Class Representative For information about making a gift to the Harvard School of Public Health, please contact: Ellie Starr Vice Dean for External Relations Office for External Relations Harvard School of Public Health 90 Smith Street Fourth Floor Boston, Massachusetts 02120 (617) 432-8448 or email@example.com For information regarding alumni relations and programs, please contact, at the above address: Jim Smith, Assistant Dean for Alumni Affairs (617) 432-8446 or firstname.lastname@example.org www.hsph.harvard.edu/give Principal Photographer Kent Dayton Contributing Photographers Corey Hendrickson, Aubrey LaMedica, Tony Rinaldo Contributing Illustrators Anthony Freda, Shaw Nielsen Marketing and Communications Coordinator Rachel Johnson Contributing Writers Eric Bland, Luisa Cahill, Karen Feldscher © 2012 President and Fellows of Harvard College 49 Spring | Summer 2012 Eleanor Murray SD’16 has been fascinated by infectious disease since she was 12, when her family moved to rural Thailand. With little health care available to the villagers, infections commonly left tragedy in their wake. “It really had a big impact on me,” says Murray. In 2003, the deadly SARS epidemic spread rapidly and some scientists warned that climate change could lead to more epidemics like it. Eleanor found that idea both frightening and intriguing. Murray was thrilled when she was accepted to HSPH. But without financial help in the form of the Horace W. Goldsmith Fellowship, she wouldn’t be able to attend. Today at HSPH, she is learning all she can about modeling the interplay between weather, climate change, and disease transmission, with the goal of developing an early warning system for infectious disease outbreaks. “ Just like you have a local weather forecast, you could have a local disease forecast. When there’s a particularly high risk of influenza, for example, people could take extra precautions.” 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. —Eleanor Murray, SD ’16, Epidemiology Horace W. Goldsmith Fellow The Healthy Eating Plate, created by experts at Harvard School of Public Health and Harvard Medical School, was designed to correct flaws in the United States Department of Agriculture’s (USDA’s) MyPlate. Though MyPlate is an improvement over the agency’s iconic but scientifically shaky Food Guide Pyramid and its cryptic MyPyramid, it still falls short on giving people the nutrition advice they need to choose the best diets to maintain their health. Unlike the USDA’s official dietary advice, the Healthy Eating Plate is based exclusively on the best available science and was not influenced by political and commercial pressures from food industry lobbyists. Why a Healthy Eating Plate? The central messages of the Healthy Eating Plate are: GET PLENTY OF PRODUCE—NOT POTATOES. CHOOSE WHOLE GRAINS—THE LESS PROCESSED, THE BETTER. CHOOSE HEALTHY SOURCES OF PROTEIN LIKE BEANS, CHICKEN, AND FISH. USE HEALTHY OILS. DRINK WATER OR OTHER BEVERAGES THAT DON’T CONTAIN SUGAR. Inside this foldout is a poster of a Healthy Eating Plate that you can tear out and use every day. Think of it as a guide to planning a balanced meal and serving it on a dinner plate— or packing it in a lunch box. Put a copy on the refrigerator at home or at work, for a visual guide to portioning out a nutritious and delicious plate of food. Harvard Medical For more information on the Healthy EatingSchool Plate, go to: http://www.hsph.harvard.edu/nutritionsource/healthy-eating-plate Harvard Health Publications www.health.harvard.edu Office for External Relations 90 Smith Street Boston, Massachusetts 02120 Nonprofit Org. U.S. Postage PD Burlington, VT Permit No. 586 Change Service Requested CONTINUING PROFESSIONAL EDUCATION PROGRAMS 2012 Where theory informs practice and practice informs theory JUNE 2012 June 4–6 Advanced Hands-On CAMEO Training June 4–8 Radiation Safety Officer Training for Laboratory Professionals June 11–15 Comprehensive Industrial Hygiene: The Application of Basic Principles JULY 2012 July 30–August 10 Building Design and Engineering Approaches to Airborne Infection Control AUGUST 2012 August 13–17 In-Place Filter Testing Workshop August 20–22 Measurement, Design, and Analysis Methods for Health Outcomes Research August 20–24 Radiological Emergency Planning: Terrorism, Security, and Communication SEPTEMBER 2012 September 10–14 Forces of Change: New Strategies for the Evolving Health Care Marketplace September 17–20 Work, Health, and Wellbeing: Strategic Solutions for Integrating Wellness and Occupational Safety and Health in the Workplace September 27–28 Sleep and Shift Work: Optimizing Productivity and Health Management in the 24/7 Global Economy OCTOBER 2012 October 1–5 Ergonomics and Human Factors: Strategic Solutions for Workplace Safety and Health October 14–26 Leadership Development for Physicians in Academic Health Centers October 28–November 2 Leadership Strategies for Evolving Health Care Executives DECEMBER 2012 December 3–5 Advanced Laboratory Design for Health, Safety, and the Environment 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 are facing 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.edu email: email@example.com call: 617-384-8692 Harvard School of Public Health Center for Continuing Education 677 Huntington Ave. CCPE-Dept. A Boston, MA 02115