M A G A Z I N E O F T H E M A I L M A N S C H O O L O F P U B L I C H E A LT H
Columbia Public Health
Climate Change FAT FACTORS
Obesity Prevention BOOK SMART
MORE PEOPLE BIGGER CITIES
IN THE BALANCE
gr a nd r o u nds on
the future of public health ta k ing a c tion t o addr e s s t he u . s . h e a l th g a p
View the online version at mailman.columbia.edu/CPHmagazine DEAN
Linda P. Fried, MD , MPH E D ITO R IN CHIE F
Sharon Tregaskis D E SIGN D IR E CTO R
Jon Kalish A SSO CIATE E D ITO R
Maria Andriella O’Brien E D ITO R IA L A D VISO R
Bethany Jankunis STA FF WR ITE R S
Tim Paul Anne Foulke Toner CO P Y E D ITO R
Dana Cook Grossman
THE UNITED STATES SPENDS MORE ON HEALTH CARE THAN ANY OTHER COUNTRY. YET WE CONTINUE TO FALL FAR BEHIND IN MOST KEY MEASURES OF HEALTH. The Mailman School’s 2013–2014 Grand Rounds on the Future of Public Health draws visionary speakers from around the country to explore this decline and discuss how public health leaders can help change our nation’s course. At the conclusion of the series, a School-wide discussion will inform the creation of an action agenda through which the School can help close the U.S. health gap.
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se c t ion s
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12 Getting Warmer
32 Family Focus
Climate change isn’t just inconvenient; it kills people. Public health scientists tackle the consequences of greenhouse gases. BY ALISON FROMME & SHARON TREGASKIS
For the nation’s 32.4 million low-income children, the National Center for Children in Poverty makes an evidencebased case. BY KRISTINA STRAIN
18 Urban Vigor
36 Evolutionary Leap
Cities grow. Megacities emerge. Fresh data on urbanization—worldwide and close to home. BY ALLA KATSNELSON
In its first year of practice, a transformed curriculum prepares scholars for the emerging challenges of the 21st century.
Letter from the Dean
3 Innovations Supercomputing • Board expansion • New program: GRAPH • Ronald Bayer, PhD 7
Data Points Safe routes to school • HIV & breast-feeding • Opioid overdose • BPA & asthma
42 Faculty News 44 Class of ’13 Career News 46 Alumni News 48 Student Voices
BY PAUL ZAKRZEWSKI
26 The World That Makes Us Fat It’s harder to lose weight than to have never gained it in the first place. Scholars delve into the particulars of prevention. BY MELINDA WENNER MOYER
40 Lights, Action, Stopwatch This summer, students hit the road to put theory to the test. For their eightweek practicum, one team took on an emergency department.
Letter from the Dean
Mind the Gaps As the gap in health between the United States and peer nations grows, Mailman School scholars redouble their efforts.
A significant investment in public health by the federal government is just the game-changing move our country needs. The science and evidence to improve our nation’s health is critical to our future and will also strengthen our ongoing contributions to global health.
he United States spends an astonishing 18 percent of our gross domestic product on health care—significantly more than any other country. Despite such extravagant spending, Americans do not enjoy health advantages over peer nations. Far from it. Myriad studies over the last decade have detailed a gap in health status between the U.S. and other well-to-do countries. Most recently, the National Research Council and the Institute of Medicine made the case in a jointly issued report, released in January 2013. U.S. Heath in International Perspective: Shorter Lives, Poorer Health compared the U.S. to 16 peer nations and revealed that Americans have the worst life expectancy among our peers. We are also at or near the bottom of nine measures of health. Every single one. Given our chronic underinvestment in public health science and practice, that gap isn’t surprising. We direct a mere 3 percent of U.S. health spending to public health measures. Yet in 2008, the Trust for America’s Health found a fourfold return on investment from public health interventions. Furthermore, behavioral, social, and environmental factors account for roughly 60 percent of our health. Meanwhile, our elected leaders continue to reduce their financial commitment to the science that undergirds public heath and is a substantial driver of economic growth. The 2013 sequestration was the latest blow, compounding the problem for science in general and triggering the loss of significant federal research funding to the Mailman School and other schools of public health. At the Mailman School, we continue investing in new projects to address issues related to the U.S. health gap. Our new GRAPH program (p. 5) quantifies the return on investment of various public health interventions, providing a valuable tool for governments, corporations, and others. The addition of high-performance computing capability (p. 3) gives our researchers the technological power to perform complex analyses to identify the most effective interventions. Our interdisciplinary Obesity Prevention Initiative (p. 26) draws together the School’s experts as they seek more knowledge, develop more effective policies, and offer evidence-based solutions in this critical area. Simultaneously, we are promoting a national commitment to public health and engaging multisectoral partners to help close the U.S. health gap. As a springboard in this effort, we’ve dedicated this year’s monthly Grand Rounds on the Future of Public Health series to the issue. The series began in September with Dr. Steven H. Woolf, MD, MPH, co-editor of Shorter Lives, Poorer Health. The series concludes in April with a discussion among the Mailman community during which we’ll craft an action agenda. Our nation needs bold action to set a new course. A significant investment in public health by the federal government—together with corporations, foundations, and individual philanthropists—is just the game-changing move our country needs. The science and evidence to improve our nation’s health is critical to our future and will also strengthen our ongoing contributions to global health. The Mailman School will be on the forefront of making this happen.
N E W S FR OM T HE MAIL MAN S CHOOL
Get used to hearing these terms. The era of big data has arrived in public health and Mailman School faculty have a powerful new tool at their fingertips: Columbia’s C2B2 supercomputer, one of the fastest computer clusters in the world. Its 6,500 air-cooled silicon chips can process upwards of 200 trillion calculations a second and sequence a section of genetic code before lunchtime. High-performance computing (HPC, for short) is “an essential tool for almost any operationalization of big data,” says Dr. Roger D. Vaughan, DrPH ’97, the School’s vice dean for Academic Advancement and a professor of Biostatistics, who hammered out details of the new access plan with Andrea Califano, PhD, director of Columbia’s Center for Computational Biology and Bioinformatics (C2B2). Increasingly, grant funding is awarded based on researchers’ ability to analyze oversized datasets and do it fast. Says Vaughan: “This new technology brings our hardware in line with the incredible brainware of our faculty.” Among those already turbocharging their research is Jeff Goldsmith, PhD, assistant professor of Biostatistics. He and Andrew Rundle, DrPH ’00, associate professor of Epidemiology, are using the Mailman HPC to examine the relationship between body mass index (BMI) and physical activity in New York City youth. They arranged for the children to wear accelerometers—devices that record movement. The resulting data set was massive—approximately 100,000 observations. “When you start trying to do complex analyses, you need a computing cluster,” says Goldsmith. Tal Gross, PhD, assistant professor of Health Policy and Management, relies on a supercomputer to fuel his search through a hospital database to learn whether having insurance makes people more or less likely to visit an emergency room. Says Gross: “More and more hospitals not only have electronic medical records but are allowing research on those records.” Charles J. DiMaggio, MPH ’93, PhD ’02, an associate professor of Epidemiology, works with Medicaid Analytic eXtract, a database including records from some 1.2 billion patient encounters. In recent years, he’s used his desktop computer to crunch numbers on prescription fills and psychiatric diagnoses to find the effect of the 9/11 terrorist attacks on mental health. More complex analyses made his machine “seize up or grind to a halt.” Using C2B2 will transform his approach to such complex analyses. Says DiMaggio: “It’s like hearing the bugle call of the cavalry on the horizon.”
GIGAF L OP. TE R AF L OP. P E TAF L OP.
ACCESS TO SUPERCOMPUTER FUELS INQUIRY HONOR ROLL A SAMPLING OF FACULTY AWARDS
Salim S. Abdool Karim, MD, PhD, clinical professor of Epidemiology, elected to the Institute of Medicine. Sandro Galea, MD, DrPH ’03, Gelman Professor and Chair of Epidemiology, elected to the Institute of Medicine.
Quarraisha Abdool Karim, PhD, associate professor of Clinical Epidemiology, presented by South African President J.G. Zuma with the Order of Mapungubwe bronze award for outstanding achievement.
John N. Rowe, MD, Health Policy and Management professor and a former CEO of Aetna, listed in the health care sector on the Harvard Business Review’s list of 100 top-performing CEOs. He was also named an honorary fellow by the American Academy of Nursing.
Wafaa M. El-Sadr, MD, MPH ’91, professor of Epidemiology and Medicine, named a University Professor— Columbia’s highest academic honor. She was also named one of “50 Women Who Shaped America’s Health” by the Huffington Post.
BOARD EXPANDS MAILMAN SCHOOL NAMES NEW AMBASSADORS
the Mailman School Board of Overseers has added 9 members, bringing the total to 37. Board members provide strategic counsel and support to advance the goals of the Mailman School and of public health, more broadly, by sharing their expertise in business, government, and nonprofit administration. They also serve as ambassadors for the School, helping to increase awareness nationally and internationally. O VER THE LAST YEAR,
T RO YEN A . B R E N N AN  , MD, MPH, JD, is executive vice president and chief medical officer of CVS Caremark. He provides oversight for the development of CVS Caremark’s clinical and medical affairs and health care strategy, as well as the company’s MinuteClinic and Accordant Health Care businesses. South African businessman AD R IAN GOR E  is CEO and founder of Discovery Holdings, an international health and life insurance firm with a presence in South Africa, the U.K., the U.S., China, and Singapore. He is a director at the Vitality Group. RO BERT H AR V E Y  , MBA, MPH ’07, is senior vice president of alternative investments of the Ashforth Company. F R AN K JIM EN EZ [ 4] is general counsel, secretary, and managing director of government affairs at Bunge Limited, a global agri business and food company. He previously served as general counsel of the Navy, one of seven Senate-confirmed Pentagon civilians of four-star equivalent rank overseeing the U.S. Navy and Marine Corps. NAV EE N R AO  , MD, a native of India, leads Merck for Mothers, an initiative
of the pharmaceutical giant to reduce maternal mortality around the world, and serves as chair of the Maternal Health Pillar of the Millennium Development Goals Health Alliance. L IN D A TH A R B Y [ 6 ] is group president, preanalytical systems and biosciences, of BD, a global medical technology company whose clients include healthcare institutions, life science researchers, clinical laboratories, industry, and the general public. E R CUM E N T TOK AT  is a partner at Centerview Partners, an investment bank ing and advisory firm, and one of the founding members of the firm’s healthcare practice. He is vice chair of the Child Health Pillar of the Millennium Development Goals Health Alliance. L E O N A R D TOW  is CEO of New Century Holdings, a media company. He is chairman of the Tow Foundation. J E F F R E Y WAL K E R  is former vice chairman of JPMorgan Chase and managing partner of JPMorgan Partners. He is chairman of the Frontline Health Workers Pillar of the Millennium Development Goals Health Alliance.
HONOR ROLL Zena A. Stein, MA, MB, BCh, special lecturer and professor emerita of Epidemiology, awarded an honorary Doctor of Science by Columbia University. She has been a member of the faculty for more than 45 years. Roger D. Vaughan, DrPH ’97, professor of Biostatistics, winner of the 2013 Outstanding Teaching Award from the American Statistical Association.
Patrick Wilson, PhD, associate professor of Sociomedical Sciences, named an Emerging Scholar by Diverse: Issues In Higher Education, for outstanding achievements, research, and potential as a minority scholar under the age of 40. Linda P. Fried, MD, MPH, dean of the Mailman School, awarded the Ipsen Foundation’s 2012 Longevity Prize.
Carolyn L. Westhoff, MD, professor of Population and Family Health, awarded the Guttmacher Award by the Association of Reproductive Health Professionals. Robert E. Fullilove, EdD, associate dean for community and minority affairs, a recipient of the Allan Rosenfield Award for Public Health and Social Justice from the Public Health Association of New York City.
W. Ian Lipkin, MD, John Snow Professor of Epidemiology, awarded the Drexel Medicine Prize in Translational Research. John Santelli, MD, Professor and Chair of the Heilbrunn Department of Population and Family Health, recipient of the APHA David P. Rall Award for Advocacy in Public Health.
IN JULY, THE MAILMAN SCHOOL LAUNCHED GRAPH,
Global Research and Analytics for Public Health, a program to evaluate return on investment— both in strict cost-accounting terms and in enhanced quality of life—realized through preventive public health measures. “Public health officials have argued for years that if we engage in prevention, we can save money,” says Michael S. Sparer, JD, PhD, chair of Health Policy and Management and one of the group’s founding faculty members. “Sometimes that’s true—for example, with childhood vaccines or a daily aspirin to prevent heart attacks. But it’s not clear that other kinds of prevention are cost saving.” To analyze the payback on an array of population-based and prevention programs, Sparer and his collaborators—fellow professors Sandro Galea, MD, DrPH ’03, Peter A. Muennig, MD, MPH ’98, and Roger D. Vaughan, DrPH ’97—intend to leverage the acumen of their colleagues and the School’s burgeoning expertise at coaxing insight from huge data sets. Their goal: Formulate new ways of quantifying the effectiveness of particular programs and to identify emerging priorities. “This is part of a larger agenda,” says Sparer, “to make the case that the U.S. healthcare system and those around the world are far too focused on medical interventions and curative care, at the expense of population-based prevention.” Over the summer, the team met with Fortune 500 executives, heads of state agencies, and philanthropic organizations to discuss the questions for which those sectors most urgently seek answers. “Just about every Fortune 500 company has some kind of wellness program now,” says Sparer. ���Do we know their return on investment and aside from that, do we know the success rate of these programs, even if they cost a little more money?”
RETURN ON INVESTMENT NEW PROGRAM PUTS PREVENTION TO THE TEST THE BIG QUESTIONS The GRAPH collaborators have put three topics at the top of their research agenda for the U.S. and the global community:
What contribution can public health make during the life course to reduce mortality?
What is the cost of public health efforts that can reduce illness over the life course?
What is the return on investment for prevention and where does it matter most?
6 GLOBAL LEADERS WORLD ECONOMIC FORUM FELLOWS STUDY PUBLIC HEALTH In late July, two dozen fellows in the World Economic Forum’s Global Leadership Programme spent a day at the Mailman School for a seminar on public health. This was the second year that the School hosted this cohort of budding business and policy leaders, pursuing a master’s program through the World Economic Forum. The seminar provided training in the basics of public health, emphasized the importance of multi-sector solutions, and helped the fellows identify their role in solving public health problems. A quick-paced series of lectures and discussions gave the participants an overview of a broad swath of scholarly thinking by Mailman School faculty. In the morning, they got a crash course in the foundations of public health, followed by presentations on the health impacts of climate change, including research by the Columbia Center for Children’s Environmental Health. Another session investigated aspects of urban health, from policies to combat obesity and promote healthy aging to the rights of slum-dwellers. A luncheon panel provided a window into issues of sustainable urban planning, such as neighborhood designs that promote foot traffic. Systems thinking was the order of the afternoon, as the Fellows took part in a group exercise to envision multi-sectorial solutions that accommodate the needs of both children and older adults.
PAPER TRAIL PROF PONDERS PRAXIS
the Mailman School honored Ronald Bayer, PhD, co-director of the Center for the History and Ethics of Public Health, with a symposium to celebrate his quarter century on the faculty. Panel discussions at the event, “Confronting the Moral and Political Foundations of Public Health.” This past year, Bayer has penned papers for the New England Journal of Medicine and Science, among other publications, including an analysis of shifts in HIV testing recommendations, musings on the rhetoric behind legal battles over FDA-designed cigarette labels meant to disgust, an investigation of the science behind public health recommendations on dietary salt, and a call for a presidential commission to investigate America’s declining health status. Says the professor of Sociomedical Sciences, “I was on a roll.” In the Socratic tradition, Bayer answered our questions with some of his own.
IN OCTOB E R ,
Is there a theme that infuses all of your work? In the face of imperfect information, how do you make decisions? When you say, We want to do evidence-based public health, what counts as evidence? How do ethical considerations enter into the equation for you? What is the obligation of public health officials to speak with candor about the state of the evidence? What are the practical implications of following your advice? To close off debate and claim that the evidence is a slam-dunk—when it’s not— is very troubling. We must make serious, straight, and transparent arguments and acknowledge the limits of the evidence. If you manipulate the evidence or don’t speak with complete candor, people become distrustful.
Ethicist Ronald Bayer champions sound science, “unsullied by dissimulation.” PHO TO : AL AN O R L I NG
Sticky notes enlivened analysis of the effect of climate change on children and the elderly.
Why call for a presidential commission on health status in the U.S.? We have a need in America to be number one at everything—the most powerful, the richest. In January 2013, the U.S. National Research Council and Institute of Medicine issued U.S. Health in International Perspective: Shorter Lives, Poorer Health, saying not only are we not 1 or 2, we’re number 17 in terms of life expectancy and health status during our lives. What was stunning to me is that Americans don’t know. They really don’t know how badly we’re failing. Why hearings? Our fear was that this report would end up in the dust-bin of history. Our commentary in Science was intended to keep that from happening. The evidence is very clear: This is not because of our inegalitarian, expensive, non-system system of health care. It’s something far deeper and broader. I think that’s something that has to be shoved in our face by a national commission that holds hearings and makes news.
PEE R-REV IEW ED RES E A R C H F R O M T H E MA I L MA N S C H OOL
Back to School, Safely Speed bumps and high-visibility crosswalks near high-risk schools in the Big Apple reduce injuries by 44 percent.
In 2005, Congress allocated $612 million for a federal Safe Routes to School program to protect children biking and walking to school by a range of meas ures, from widening sidewalks and installing speed bumps to teaching kids about safety. In January 2013, Pediatrics published an analysis by Mailman School faculty showing that as a result, the annual rate of injury to school-age pedestrians fell 44 percent during the peak times for walking to school in New York City neighborhoods where the safety program was implemented. Significantly, the injury rate did not drop in parts of the city where the program was not in place. “Our data show that interventions to make the built environment safer can greatly reduce injuries,” says lead author Charles J. DiMaggio, MPH ’93, PhD ’02, associate professor of Epidemiology and research director of the Center for Injury Epidemiology and Prevention at Columbia. The Safe Routes to School program was funded through 2012 and is now in place in all 50 states, at approximately 10 percent of elementary and secondary schools. Under the federal transportation bill, MAP-21, the Safe Routes program will no longer have dedicated funding. For now, state and municipal officials will have to decide whether the program is a good choice for their constituents. “Our study provides compelling empirical evidence that is essential to guiding policy makers,” says senior author Guohua Li, MD, PhD, Finster Professor of Epidemiology and Anesthesiology and director of the Center for Injury Epidemiology and Prevention. “The Safe Routes to School program has made a marked difference in improving the safety of school-age children in New York City.”
JONATHAN CO RUM
Injury Rates among NYC Schoolchildren 2010 Children on their way to and from school had lower rates of pedestrian injuries in 2010 than they did in 2001. Researchers looked at injury rates among children age 5 to 9 during school travel times. Most accidents in 2010 took place in highrisk areas (red), but at lower rates than in 2001.
Annual pediatric pedestrian injury rate per 10,000 children on their way to school
Schools with Safe Routes to School capital construction completed in 2008
BREAST-FEEDING PLASTICS Rx DRUGS
K A R L MU E L L E R
Study reveals that for moms with hiv, “breast is best” to protect baby from infection.
Because breast-feeding can transmit HIV, some health experts have suggested that weaning early could be advantageous. In a study designed to test that notion, Professor of Epidemiology Louise Kuhn, MPH ’93, PhD, found that HIVinfected women in sub-Saharan Africa who fed their babies exclusively with breast milk for more than the first four months of life had the lowest risk of transmitting the virus to their babies through breast milk. Women who stopped nursing earlier than four months had the highest con centrations of HIV in their breast milk. Those who continued to breast-feed, but not exclusively, had concentration levels in between the two practices. “Our results have profound implications for prevention of mother-to-child HIV transmission programs in settings where breast-feeding is necessary to protect infant and maternal health,” says Kuhn, whose report appeared in Science Translational Medicine. “Our data demonstrate that early and abrupt weaning carries significant risks for infants. It suggests that HIV-positive women who want to breast-feed should do so exclusively for the first six months of the baby’s life and in most cases longer, while also being adherent to antiretroviral therapy. Weaning should be done slowly.”
YA R E K WA S Z U L
BPA & Asthma
Opioid Epidemic prescription drug overdoses have risen dramatically in the U.S. By 2006, such fatalities exceeded the number of suicides and by 2009, they outnumbered motor vehicle deaths as well. In New York City, the rate of drug overdose from prescription opioids increased sevenfold from 1990 to 2006, according to an investigation by Magdalena Cerdá, DrPH, assistant professor of Epidemiology, and coauthors. Most investigations of recreational opioid use have focused on rural areas, which have been hit hardest by the epidemic, but this study suggests that urban areas contend with a growing health burden. The analysis, published in Drug and Alcohol Dependence, suggests that the profile of a recreational prescription opioid user is very different from that of a heroin consumer, with less involvement in street-based forms of drug trafficking and use of other drugs such as cocaine. “It’s a different type of drug with a different profile,” says Cerdá, “and we need a different type of response to it.”
OVER THE PAST 2 0 YEARS ,
P E R 1 0 0 , 0 0 0 P O P U L AT I O N
DRU G OVERDO S E DEAT H RAT E 12
In 2008, the death rate attributed to drug overdose was 11.9 per 100,000 population. Of the 27,153 deaths in which a drug was specified, one or more prescription drugs were involved in 20,044 of the deaths. S OU R C E : C D C
10 8 6 4 2
Since its synthesis in a Russian laboratory in 1891, the compound bisphenol-a (BPA) has become ubiquitous in plastics manufacturing, appearing in everything from the lining of metal food cans to the thermal paper used for cash register receipts. In a study, published by the Journal of Allergy and Clinical Immunology, faculty in the Mailman School’s Center for Children’s Environmental Health have documented a link between exposure to BPA among young children and elevated risk for asthma in that population. The study builds on evidence linking BPA exposure to respiratory symptoms, obesity, impaired glucose tolerance, and behavioral issues. In July, the Food and Drug Administration banned BPA in baby bottles and sippy cups. “It is very important to have solid epidemiologic research like ours to give the regulators the best possible information on which to base their decisions about the safety of BPA,” says senior author Robin Whyatt, DrPH, professor of Environmental Health Sciences and deputy director of the Center for Children’s Environmental Health.
LGBT Lifeline Suicide is the third leading killer of youth 15–24 years old; lesbian, gay, and bisexual teens are between two and seven times more likely than their heterosexual peers to attempt suicide. A study of anti-bullying polices and adolescent suicide rates, published in the Journal of Adolescent Health, reveals that in counties where school anti-bullying policies include protection for sexual minorities, rates of suicide attempts by gay and lesbian teens are halved. The analysis was performed by Mark L. Hatzenbuehler, PhD, assistant prof essor of Sociomedical Sciences, and Katherine Keyes, MPH ’06, PhD ’10, assistant professor of Epidemiology.
SCHIZOPHRENIA AGING VIROLOGY
Heavy Metal that mice engineered with a human gene for schizophrenia and exposed to lead during early life exhibit behaviors and structural changes in their brains consistent with schizophrenia. Tomás R. Guilarte, PhD, Hess Professor and Chair of Environmental Health Sciences, was senior author of the paper, published in Schizophrenia Bulletin. Guilarte’s findings suggests a synergistic effect between lead exposure and a genetic risk factor, and open an avenue to better understanding the geneenvironment interactions that put people at risk for schizophrenia and other mental disorders. While the role of genes in mental disorders is well established, insight into the effect of toxic chemicals in the environment is just beginning to emerge. The study’s results focus on schizophrenia, but implications could be broader. Says Guilarte: “We’re just scratching the surface.”
A M AIL M AN SCH OOL STUD Y R E V E AL S
New Clues in AIDS Vaccine Quest
3-D X-ray crystallographic image showing the broadly neutralizing antibody B12 (green ribbon) in contact with a critical target (yellow) for vaccine developers on HIV-1 gp120 (red).
T WO HIV-INFECT ED women from South Africa have revealed a vital clue in the search for an effective vaccine to halt AIDS. Antibodies isolated from one of the women were able to neutralize 88 percent of a large panel of HIV viruses. The other woman’s antibodies neutralized 46 percent of the viruses against which they were tested. “Broadly neutralizing antibodies are the key to making an AIDS vaccine,” says Salim S. Abdool Karim, MD, PhD, director the Centre for the AIDS Programme of Research in South Africa (CAPRISA) and professor of clinical Epidemiology. “This discovery provides new clues on how vaccines could be designed to elicit broadly neutralizing antibodies. The world needs an effective AIDS vaccine to overcome the global scourge of AIDS.” While the existence of broadly neutralizing antibodies against HIV has been known for years, such antibodies were only isolated about three years ago. How they are produced remained a mystery until Abdool Karim and his associates— including Quarraisha Abdool Karim, PhD, associate professor of Epidemiology—published their findings in the journal Nature Medicine.
E V E RY ON E OL D E R TH AN 70
be checked for frailty, a treatable— and potentially deadly—condition. Geriatricians representing six major international and U.S. medical organizations made the case with other leading experts on aging in “Frailty Consensus: A Call to Action,” published in the Journal of the American Medical Directors Association. Over the course of two decades of research and publication, Mailman School Dean Linda P. Fried, MD, MPH, and her team have led the science to characterize frailty as a medical condition. “With ever greater numbers of older persons, it is urgent that we confront the challenge of frailty by recognizing it as a medical condition that can be slowed and even reversed,” says Fried, an author of the article. “Establishing a new clinical standard for screening for frailty will help preserve health and extend the lives of millions.”
In 2001, Fried defined frailty as a clinical syndrome and proposed criteria to identify the potentially deadly condition.
A L E X N A BA U M
hiv & matrimony
Of Vermin and Viruses
High-throughput sequencing and other molecular methods for pathogen discovery that were pioneered at the Mailman School’s Center for Infection and Immunity have uncovered links between the viruses implicated in liver cancer and liver failure in humans and similar viruses common in bats and rodents. In two papers published in the journals mBio and Proceedings of the National Academy of Sciences, investigators report the discovery of hepaciviruses and pegiviruses—close relatives of Hepatitis C (HCV)—in rodents and bats. The newly discovered viruses provide insights into the origins of HCV, as well as the mechanisms behind animalto-human transmission. The findings may also enable development of new animal systems with which to model HCV pathogenesis, vaccine design, and treatment.
In Uganda, the strongest predictor of HIV infection among young people ages 15–24 years old is previous marriage. The association is even stronger than having had multiple sexual partners or having recently consumed alcohol, each of which is associated with a tripling of the risk of infection. Among young men, whether the marriage ended due to divorce or death, HIV infection rates were ten times higher. Contrary to some previous research, intact marriage was shown to be protective against infection. Also protective: being in school. The study will help inform HIV prevention programs to focus on school attendance, alcohol consumption, and multiple partners—and target previously married youth. These and other insights were published in July by JAIDS, the Journal of Acquired Immune Deficiency Syndromes. John S. Santelli, MD, MPH, Heilbrunn Professor and Chair of Population and Family Health, was the lead author of “Behavioral, biological, and demographic risk and protective factors for new HIV infections among youth in Rakai, Uganda.” Data was collected from the long-running Rakai Community Cohort Study, a survey of nearly 16,000 youth in a southwestern district of the landlocked African nation, conducted from 1999 to 2008.
Diet and Autism
A Journal of the American Medical Association study suggests that early in pregnancy, folic acid supplements reduce the risk of autism. Professor of Epidemiology Ezra S. Susser, MD, DrPH ’92, is a joint senior author of the paper. The latest analysis of the Autism Birth Cohort— a sub-study of the Norwegian Mother and Child Cohort Study—tracked women’s prenatal diets and later the emergence of autism spectrum disorders among their children. Women who took folic acid during the span from four weeks prior to eight weeks after the start of pregnancy had a 40 percent reduced risk of having children with the disorder compared with mothers who did not take the vitamin.
By Alison Fromme & Sharon Tregaskis
Scientists zero in on the health implications of a changing climate.
“ How’s the weather?” asks Kim Knowlton, DrPH ’05. but in this case it’s not just small talk. Knowlton, an assistant clinical professor of Environmental Health Sciences, has dedicated her career to unraveling the relationship between changing meteorological patterns and public health. “Climate change isn’t just inconvenient,” she says. “It kills people.” She should know. Knowlton’s doctoral dissertation at the Mailman School— completed just a few months before Hurricane Katrina put the collision of climate and health on the public radar—forecast the number of deaths likely to follow from increasingly frequent heat waves and high ozone levels in New York City. More recently, Health Affairs published her calculation, done with a team of economists and colleagues from the National Resource Defense Council, of the costs associated with mortality, illness, and health expenditures due to six discrete climate-change events in the United States between 2000 and 2009. Their tally: a staggering $14 billion, 95 percent of which came from valuations of lives lost. Estimated healthcare costs, for some 760,000 encounters with the healthcare system, amounted to $740 million. With a focus on index events—nothing too extreme—the team didn’t even tackle costs associated with Katrina. Or Irene. Or Sandy. Scholars have yet to embrace a set methodology for making such calculations, and Knowlton suspects the Health Affairs study was a gross underestimate. “Climate change-related events are costing Americans billions,” she says, rattling off a list of hazards to mind and body including depression, posttraumatic stress, asthma, respiratory damage from mold, heat stroke, and organ failure, as well as fatalities from drowning, waterborne illness, and disease. “We all want to avoid those costs—as well as the pain, suffering, and lessened quality of life they represent,” she says. “As public health professionals, we have to help policymakers understand that anticipating the influence of climate change on Americans’ well-being and preparing accordingly isn’t optional.” As climate change accelerates, expect extremes to become a way of life: more bad air days due to ozone pollution; longer heat waves; more intense hurricanes; dangerous new infectious disease outbreaks; extreme
YO U ’VE HEAR D TH E Q UE STI ON BEFORE,
Climate change isn’t just inconvenient. It kills people.
C OLU MBIA PU B L I C H E ALT H
flooding and drought; wildfires that start more frequently and burn longer. Knowlton and her colleagues in the Columbia Climate and Health Program—the first of its kind in the world, established in 2009 and housed in the Mailman School’s Department of Environmental Health Sciences—are elucidating the climate-health connection and advancing society’s capacity to understand, anticipate, and perhaps even prevent the health risks sure to follow. The complete list of consequences for human health is long, says Patrick L. Kinney, ScD, a professor of Environmental Health Sciences who founded and now directs the Program. The team’s nine faculty and four graduate students delve into the mechanisms, emerging trends, and future impacts of climate change on human health, as well as the immediate health benefits associated with mitigation policies directed at reducing greenhouse gas emissions. “The field is in its infancy,” says Kinney, who pioneered the study of climate, air quality, and health outcomes more than a decade ago. “Our research has only begun to scratch the surface.” Meanwhile, Knowlton, Kinney, and their colleagues at the Mailman School have already begun consulting with national and local politicians to begin preparing for what’s to come. Knowlton, the country’s first DrPH trained in the field, serves as a senior scientist with the Health and Environment Program of the Natural Resources Defense Council (NRDC), a nonprofit environmental advocacy group. She is also a member of NRDC’s Science Center and a member of the Climate-Health Adaptation Workgroup, part of Mayor Michael Bloomberg’s Office of Long-Term Planning and Sustainability. In January, Bloomberg appointed Kinney—Knowlton’s doctoral advisor and the sole public health representative—to his New York City Panel on Climate Change. Six months later, the mayor released the panel’s
1 Drought, low humidity, and high winds fuel a wildfire season that burns longer each year. Red scars in this 2011 satellite image highlight the one million acres burned in just two weeks by central Texas wildfires. IMAGE: N AS A / G S FC/ L ANDS AT 5
R E D INDIC ATE S B U R N SC A R S. V E GE TATION IS GR E E N, WATE R IS B L U E , A ND B A R E GR OU ND IS P INK A ND L IGHT R E D.
2 In October 2012, Hurricane Sandy killed 286 people and wrought more than $68 billion in damages in seven countries. Along the mid-Atlantic coastline, cleanup continues. PHOTO : ADR I A N K I NL O C H
$14 BILLION Costs associated with mortality, illnesses, and health expenditures due to six discrete climate-change events in the United States between 2000 and 2009
Portion of that figure due to the valuation of lives lost
Amount due to healthcare costs = $740,000,000
Heat-related deaths in Manhattan
Estimated increase over the next decade
report to the public. Among its findings: By 2050, temperatures will have climbed 4 to 6 degrees; precipitation will have increased by 4 to 11 percent; sea levels will have risen by 1 to 2 feet. “Hurricane Sandy made it all too clear that, no matter how far we’ve come, we still face real, immediate threats,” says the mayor, who expanded on the panel’s recommendations with a series of his own proposals for protecting Gotham residents. “This is urgent work and it must begin now.”
Hot Topic Much of Kinney’s work has focused on the effect of rising temperatures, especially on such vulnerable populations as the aging— at greater risk of heat stroke and organ failure because of their physiology—and those who are economically disadvantaged, and thus less likely to have easy access to air conditioning when the mercury soars. “We’re definitely going to experience more heat in the next few decades,” says Kinney, who notes that even if we were to begin slashing greenhouse gas emissions today, atmospheric self-correction could take centuries. “No matter what we do, it’s going to get warmer.” In a study published in May by Nature Climate Change, Kinney used historical records to reveal that during the 20th century, average temperatures in Manhattan’s Central Park increased 3.6 degrees Fahrenheit—substantially more than global and U.S. trends. Using a combination of methods to forecast weather patterns, they found that heat-related deaths in Manhattan could rise by 20 percent over the next decade. Although increasing temperatures are expected to save some lives during the winter heating season, those improvements will not completely offset the projected number of deaths during summer months. With any such project, says Kinney, uncertainty persists. “Whenever you make a big change in something as fundamental as temperature and rainfall patterns, it’s going to have all kinds of unforeseen consequ ences,” he says. Factor in public health projections, and additional layers of complexity emerge. “Health and climate are tough to study over long periods because there are so many other variables affecting health,” he says. “It’s not like studying a glacier that only responds to temperature and precipitation.”
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1 1 When heat waves strike, those who can turn to their air conditioning. For vulnerable New York City populations—including kids and the elderly—open hydrants and cooling centers offer relief.
2 A worst-case scenario projects that the health effects of sizzling summers may cost 1,000 New Yorkers their lives every year.
3 Infections caused by the influenza virus (orthomyxoviridae) ebb and flow with the weather. Elucidating the link led to real-time forecasts to inform management plans. I M A G E : S A N OFI PA STEU R
Infectious Disease The connection between health and infectious disease is a particularly knotty problem. When temperature and rainfall patterns shift, so do populations of the wild things that serve as vectors for disease. Already, tick populations—and the diseases they spread—have increased with higher average winter temperatures. Some climate change models predict heavy rainfall in New York state; mosquitoes might thus find more stagnant water for breeding in the future. But does that mean higher rates of West Nile virus? Or a resurgence of malaria? To find out, scientists must first answer a series of more basic questions. “We need to know how diseases are sensitive to climate, here and now,” says Jeffrey L. Shaman, PhD ’03, an assistant professor of Environmental Health Sciences. “And only then can we think about the relationship between disease and climate change more generally.” Influenza, for example, has long been known to vary seasonally, yet the mechanisms precipitating those patterns remained murky. In 2009, Shaman linked the occurrence of temperate-climate flu to low absolute humidity, which appears to help the virus survive. In a subsequent paper, he and his coauthors revealed how thresholds factor into the equation, explaining why infections actually increase during the rainy season in the tropics, contrary to the pattern in temperate zones. Borrowing methods from meteorological modeling, Shaman has since used those insights to create real-time influenza forecasts, an initial step in the development of a statistically rigorous flu prediction system. As he fine-tunes the model with further research—and possibly incorporates climate variables—he expects that the Centers for Disease Control and local municipalities could use his work to support decisions regarding the distribution of vaccines and antiviral drugs.
Heat or Eat MANY NYC RESIDENTS DO N’T HAVE THE L U X U RY
of turning on the air conditioning when it’s hot, or cranking up the heat on a freezing winter day. The cost is just too high, particularly for vulnerable populations.
Solutions New York City is already responding to the threat. Cooling centers welcome people without access to air conditioning. The city’s Department of Health and Mental Hygiene (DOHMH) has refined its heat warning system and identified vulnerable populations. “These aren’t theoretical problems,” Kinney says. “New York City is leading by example.” Case in point: Kinney’s PhD student Kate Weinberger, a lifelong asthma sufferer, has installed 45 pollen monitors, coupled with air quality monitors maintained by DOHMH, throughout New York City. In 2012, Kinney and Weinberger joined forces with DOHMH scientists to link pollen counts, which are expected to rise with climate change, and emergency room visits. Now, DOHMH uses pollen data to send allergy advisories directly to physicians, who can prepare themselves and their patients for specific spring outbreaks. “Climate change is real, it’s happening, and we need to prepare,” says Kinney. “Longrange planning and the research to guide it are essential if we are to avoid the worst consequences of climate change. It’s not insurmountable.”
Known as energy insecurity, the problem manifests itself in extreme indoor temperatures and the constant threat of utility shut offs. Thermal regulation at home is not just a matter of comfort—it’s necessary for survival, says Diana Hernández, PhD, an assistant professor of Sociomedical Sciences. Extreme temperatures affect sleep, and sleep deprivation lowers job performance and exacerbates existing health issues. Impoverished people are more likely to suffer from respiratory problems, which are linked to excess indoor moisture and air pollution resulting, in part, from inadequate or inefficient heat and insulation in their homes. They are also more likely to fall ill or die from extreme heat or cold stress. “These are serious problems,” Hernández says. “But solutions are available.” The U.S. Department of Energy’s Weatherization Assistance Program offers funds to low-income families for energy efficient upgrades; Hernández studies the resulting health and financial impacts. Structural improvements such as stopping drafts, for example, might enable a family to use their conventional heating system, instead of resorting to the oven as a source of quick warmth. In turn, an indoor environment less polluted by combustion products released by the oven might lead to fewer emergency room visits for asthma attacks. Hernández is also examining the effect of NYC’s Local Law 42, which mandates the conversion of boilers to burn cleaner fuels. Using indoor and outdoor filters, she is measuring exposure to particulate matter before and after the conversions and documenting the experiences of individuals living in affected homes. Beyond her interest in these issues as a researcher, Hernández has a personal stake. Four years ago, she returned to the South Bronx, where she grew up, and purchased two rental properties. She’s renovating them with a series of energy upgrades. “We can never go back in time to address climate change,” she says, “but we can interject at this point to reduce emissions.”
People who for generations have called rural communities home are migrating to urban centers in droves and for the first time in history, more than half of the worldâ€™s population lives in a city or metropolis. By 2050, researchers estimate that 70 percent of us will be urban dwellers.
THIS IS THE CENTURY OF THE CITY.
S CHOLA RS INV ES TIGA T E THE CIT Y’S V IT A LITY
BY ALLA KATS NELS ON
AS N E W AN D B IGGE R cities take hold worldwide, they are defining public health. Then again, cities always have. “Urban health is at the root of public health—and vice versa,” says Sandro Galea, MD, DrPH ’03, the Gelman Professor and Chair of Epidemiology. From 1854, when London physician John Snow made the connection between a public water pump and the spread of cholera, to 21st century restrictions on cigarette smoking in New York City, the urban environment has been a vital entry point for understanding health and a laboratory for improving it. The Mailman School’s mission flows from its urban roots. Since the 1930s, the School has partnered with New York City’s Department of Health and Mental Hygiene and committed itself to research and service to improve the well-being of surrounding communities. With the pace of urbanization quickening globally, Mailman School scholars have stepped up their own long-standing efforts, pounding the pavement from Dhaka, Bangladesh, to Orange, New Jersey, to reimagine cities for the coming decades. Here, we highlight a few of those projects.
« NEW YORK, USA POPULATION 8.2 MILLIO N
aerial photo by
DO C S E A R L S
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CHONGQING, CHINA POPULATI ON 2 9 . 2 MILLION
1 Data Driven “ TR EES—A BREATH OF FRES H AIR,” declares a poster for MillionTreesNYC, an initiative to plant 1 million saplings throughout the Big Apple’s five boroughs. Los Angeles and Shanghai have embraced similar reforestation plans. Indisputably, bulking up the canopy enhances shade and promotes carbon sequestration. But is it doing anything for human health? The hypothesis that trees decrease air pollution and thus minimize asthma triggers sounds reasonable. But it might not be true, says Gina S. Lovasi, PhD, MPH, assistant professor of Epidemiology. A study she led this year—with New York’s Department of Parks and Recreation and the Department of Health and Mental Hygiene—revealed that increased tree cover didn’t protect children in poor New York communities from developing asthma, and might even have increased their risk of pollen allergies. That doesn’t mean city planners should halt the volunteer shovel brigades, she says, “but it does change the conversation about how we can plan these
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HE AV Y A U TOM OB IL E TR A FFIC L IM ITS WA L K ING, INC R E A SE S A C C IDE NT FATA L ITIE S, A ND SP E W S A IR P OL L U TION. TOGE THE R , THE SE FA C TOR S A C C OU NT FOR A L A R GE P E R C E NTA GE OF P R E M ATU R E DE ATHS.
massive plantings in a way that minimizes unintended consequences.” The first wave of research in the relatively young field of urban health generated a panoply of theories about how the environment could affect well-being, Lovasi says, but it’s time for researchers to take a critical look at the evidence. Indeed, says Peter A. Muennig, MD, MPH ’98, assistant professor of Health Policy and Management, “a lot of ideas we’ve come up with in public health and urban planning are just based on common sense and correlational studies.” In their disparate projects, both Muennig and Lovasi aim to buttress the field’s foundation with hard data. In addition to her tree work, Lovasi investigates the link between walkability and obesity. Once again, her data has
turned prevailing hypotheses on their head. Urban planners had assumed that people from disadvantaged communities would realize a greater boost in well-being from environmental improvements. In 2009, Lovasi’s team reported exactly the opposite. Conventional measures of walkability, they found, did not predict healthy weight among residents of disadvantaged communities, as they had among those of more affluent ones. In response to such discoveries, Lovasi has broadened her analyses to include environmental factors, including safety and comfort, and to delve deeper into the relationships among such considerations. “The more I look at this,” she says “the more complexity I see.” For Muennig, an ambitious urban renewal program in China promises the mailman.columbia.edu
NE W A PA RTM E NTS HAV E FE W E R P E STS, M OR E P L AY SPA C E , A ND HE AT SU P P L IE D B Y GA S, R ATHE R THA N INDOOR C OA L STOV E S.
T RA SH, BRO KEN GLA SS, A ND DEBRIS LIMIT PLAY SPA C E F O R C HILDREN. A MO NG T HO SE WHO DO PLAY O U T DO O RS, INJU RIES A RE F REQ U ENT.
possibility of untangling such complexity, prospectively. Inspiration struck on a trip to Hong Kong in 2011, when he read a newspaper article about plans for a massive housing lottery in Chongqing, a municipality of 29.2 million people in southwest China. The program will provide rent subsidies to 1 million randomly chosen lower-middle-income families who relocate from dilapidated apart ments in neglected neighborhoods into government-financed housing projects designed with the latest in health-promoting features: parks and playgrounds, access to public transport, exercise facilities, neighborhood shops, community centers, and health clinics. In those lucky lottery winners, Muennig envisions an unprecedented opportunity inset photo
PETER MUE NNI G
to test the effect of these urban design elements in real time. “It is so rare that we public health researchers have a chance to actually run an experiment like this,” he says. He pitched his idea to the president of Chongqing University, and a collaboration was born. If Muennig can secure funding, the team will assess family dynamics, psychological well-being, obesity rates, and biochemical and gene expression markers in 4,500 residents before they move and again five years later. In the process, they mean to tease out the effects on health of quality of housing, access to green spaces, pollution levels, and other features of city living. “We need the data,” says Muennig. “To get it, we’re basically going all the way from gene to society.”
IN “ DISOR GA NIZ E D HOU S I N G , ” I N W HIC H QU A RTE R S A R E C RAMP ED AN D R E SIDE NT INC OM E S A R E T O O L O W FOR R E NOVATION, THE H O US I N G B E C OM E S A HAV E N FOR RO D EN T S , A ND P E R SONA L B E L ONG I N G S CRO WD OU T P L AY SPA C E S.
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DHAKA, BANGLADESH POPULATI ON 1 5 MI LL ION
2 Transition Zones
FL OODS A ND OTHE R E X TR E M E W E ATHE R E V E NTS C OM M O N I N B A NGL A DE SH P OSE A PA RTIC U L A R HA Z A R D IN THE SL U M S , WH I CH A R E DISP R OP ORTIONATE LY SITE D IN L OW -LYING A R E A S.
slums in the developing world call up visions of society’s most downtrodden, desperate individuals, trapped in the fallout of globalization, constrained to a life of perpetual poverty. But as rapid urbanization propels a torrent of people from rural areas around the world into cities, that vision must shift, says Lynn P. Freedman, JD, MPH ’90, a professor of Population and Family Health. “We need to begin to understand slums as zones of transition,” says Freedman. “These are places where people with aspirations, incredible drive and energy, and hopes for their own future are trying to make a better life.” Their success hinges, she says, on whether local, regional, and national policies lock them into deadend situations or deploy their momentum for society’s greater good. Freedman was a lawyer in private practice when she enrolled at the Mailman School in the late 1980s, diving into the growing movement to promote women’s health and combat maternal mortality.
IN T HE POPUL AR I MA GINAT IO N,
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Back then, maternal health was a rural problem: The miles separating women in developing countries from medical assistance posed a significant threat to safe childbirth. With more and more women now residing in urban slums—many within walking distance of a hospital—those geographic statistics have shifted. Yet the problem of access remains. “Maybe it’s the human rights lawyer in me, but addressing problems in public health is a deeply political pursuit,” says Freedman, who directs Mailman’s Averting Maternal Death and Disability (AMDD) Program. “If you scratch the surface deep enough, it’s always about access to and distribut ion of power and resources.” Freedman’s team spent much of the
past year in Dhaka, the capital of Bangladesh, studying one of the few maternal and newborn health programs designed for slum residents. Of its 15 million residents, some 3.5 million make their homes in Dhaka’s slums; every day, another 1,000 people emigrate from rural parts of the country. Yet officials have refused to extend basic services like sewage and electricity into many of these crowded settlements, convinced that improvements will draw even more migrants. That leaves nongovernmental organizations to fill the gaps. Among them, the nonprofit BRAC (formerly the Bangladesh Rural Advancement Committee) has found success with a program called Manoshi, which trains community health workers to provide prenatal care in women’s mailman.columbia.edu
SO ME 40,000 R E SIDE NTS M A K E THE IR HO MES IN C OR R U GATE D IR ON, B A M B OO, A ND MU D SHA NTIE S V ISIB L E FR OM THE RO O F T O P OF THE NONP R OFIT B R A C .
THE U P SC AL E G UL S H AN NE IGHB ORH O O D , O N E OF THE WEALT H I ES T I N B A NGL A DE S H , RI S ES A B OV E TH E K O RAI L SE TTL E M E N T, D H AKA’ S L A R GE ST S L UM.
homes and invites the women to deliver at local birthing centers with ties to nearby hospitals. Women with more serious health concerns get help navigating the overwhelming and often abusive government medical system. Launched in 2007, Manoshi serves more than 6.3 million women in slums throughout Bangladesh; in its first five years of operation, maternal mortality plummeted from 294 per 100,000 births to 135. BRAC and the Bill and Melinda Gates Foundation, which funds Manoshi, invited Freedman to identify the elements that have contributed the most to the program’s success. “That gave us the chance to think big about slums and to look beyond the health sector to understand a wider set of issues,” she says. Freedman is currently photos courtesy
investigating the absence of formal legal protections—access to secure housing or civil services in the slums, for example— and the resulting emergence of an informal, shadow system of social services to meet the basic needs of slum residents. In addition to her directorship of AMDD, Freedman also serves as a senior adviser to the UN Millennium Project Task Force on Child Health and Maternal Health and was the lead author of the Task Force’s final report Who’s Got the Power: Transforming Health Systems for Women and Children. For her, the ongoing analysis has broad relevance. “Gaining access to public health— even for the world’s poorest and most disenfranchised—speaks to basic questions of one’s entitlement as a citizen.”
ONE OF THE FA STE ST GR O WI N G M E GA C ITIE S IN THE W ORL D , D H AK A IS HOM E TO SOM E 15 M I L L I O N P E OP L E ; 500,000 L IV E IN K O RAI L .
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ORANGE, NEW JERSEY POPULATI ON 3 2 , 8 6 8
3 Torn Cities, Mended
THE FOR M E R OR A NGE M E M OR IA L HOSP ITA L AWA ITS R E DE V E L OP M E NT. M U SE S FU L L IL OV E : “ HOW DO YOU INV ITE P E OP L E TO R E TA IN THE IR C ONNE C TION TO SU C H A STOR IE D P U B L IC B U IL DING? ”
have been tough on Orange, N.J.—all 2.2 square miles of it. In the years after the Civil War, thriving hat manufacturers and a brewery made the city a center of industry. Rich and poor, as well as a melting pot of ethnicities and cultures, mingled on Main Street. During the 20th century, however, the situation reversed. Wealthier residents fled; factories failed; the construction of a major highway cleaved the town center. Inequities such as redlining—the federally sanctioned practice of denying mortgage loans in communities deemed “risky” based on race and other factors—cemented divisions based on wealth, class, and race. The rise and fall of Orange mirrors that of hundreds of communities across the U.S., says Mindy Thompson Fullilove, MD, professor of Clinical Psychiatry and Clinical Sociomedical Sciences. Once set in motion, such divisions cascade. Reversing them is a herculean task. “The sorting of American cities by race and class,” she
THE L AST SEVERAL DECADES
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says, “that’s really the design issue that I think is fundamental to health.” Fullilove began her career as a community psychiatrist in the early 1980s, working with poor communities of color hit hard by the epidemics of AIDS and crack cocaine. It was clear that the neighborhoods most devastated had already been crushed by destructive urban policies of the 1970s such as planned shrinkage, a scheme that withdrew city services from blighted neighborhoods. With her then-husband, Robert E. Fullilove, EdD, now the Mailman School’s associate dean of community and minority affairs, she launched the School’s Community Research Group in 1992 to understand the cascade that flowed from the loss and displacement such communities experienced.
At a conference in Paris the following year, Fullilove heard a talk by French architect and urbanist Michel CantalDupart. If you want to pump life into an ailing neighborhood, he said, you can’t just address its local problems—you have to reconnect it to the urban ecosystem. That perspective gave Fullilove a new lens through which to see her own work. In 2000, Cantal-Dupart took her on a whirlwind tour of 43 French cities in 56 days. “His approach was to identify how places are deprived of the usual urban equipment”—be it parks, stores, or transportation—“that would otherwise connect them to the flow of the city,” she says. Fullilove has already extended the concept to urban development efforts in New York, Pittsburgh, and, more recently, mailman.columbia.edu
I N 2 0 0 7 , FULLILOVE WA S A C O F O U NDER O F T HE U NIVE R SITY OF OR ANGE, A F REE INST IT U T IO N T HAT M AKE S TH E CIT Y IT S C A MPU S, PRO MO T ING C O N N E CTION S WITHIN T HE C O MMU NIT Y A ND E M P OWE R IN G CITIZ ENS T O T EA C H O NE A NO T HER.
T H E H I G H WAY A N D T RAI N T RACK S T H AT B I S ECT O RAN G E E F F ECT I V ELY C REAT E AN I S L AN D .
Orange, her hometown. In Urban Alchemy, published this spring, she collects insights from her own fieldwork and that of several collaborators to formulate a set of principles to make a cleaved city whole again. The book, she hopes, will serve as a tool for community activists and students of urban health. Meanwhile, efforts to stem the damage in Orange are hitting their stride with the help of an active community development group that includes Fullilove’s daughter, a community activist. The two have forged a partnership with the honors track of Orange’s public high school to create a walking tour called “Everything you want to know about the American city you can learn in Orange, N.J.,” to showcase the history, promise, and problems of the city. photos by
Revitalizing a city demands celebra tion to counterbalance the hard work, says Fullilove, who included celebration as the ninth and final principle of urban restoration detailed in Urban Alchemy. Making merry to mark progress unites people. The networks among them grow, as does their capacity to affect change and their ability to imagine what’s possible. “Having a city fall apart around you is demoralizing,” Fullilove says. “When we celebrate, it creates a positive feedback loop that helps people work together.”
writes about issues in biological research, health, and science policy for Scientific American, Nature, and BBC Future.
THR OU GH U NIV E R SITY O F O RAN G E C OU R SE S, C OM M U NITY MEMB ERS SHA R E THE IR E X P E RTISE.
***** The World That Makes Us Fat *****
Overcoming obesity demands more than just nutrition education and access to good food. We must address deeper societal and environmental problems, too.
By Melinda Wenner Moyer Illustrations by A. Richard Allen *****
***** Obesity rates have skyrocketed over the last 20 years and the condition now afflicts more than 500 million people worldwide. In the United States, an estimated 97 million people —- more than one-third of adults and 17 percent of youth -— suffer from the diagnosis, which was declared an official disease in June 2013 by the American Medical Association. We’ve all heard the litany: Obesity puts a person at increased risk for heart disease, type 2 diabetes, stroke, and certain types of cancer.
of course, obesity has a sim ple cause: Individuals gain weight when they store more calories than their bodies burn. But an underlying question lingers: What condition of the past two decades has created this rampant energy imbalance and what can be done to reverse the trend? In recent years, Mailman School scientists have delved into a range of environmental drivers of weight gain including new sources of foods, urbanization, and reduced physical activity—as well as such surprising factors as stress, family violence, and exposure to pollutants. Their research suggests that to solve the problem of obesity—and, ultimately, to prevent it from plaguing future generations—policymakers must do far more than simply educate the public about nutrition and make fresh produce available to all. A range of underlying environmental and social factors must also be addressed through policies informed by a clear understanding of how and why people make the food choices they do. To achieve these lofty goals, in May 2013 Y. Claire Wang, MD, ScD, an assistant professor of Health Policy and Management, and Andrew G. Rundle, MPH ’94, DrPH ’00, an associate professor of Epidemiology, kicked off a yearlong Obesity Prevention Initiative. With the sponsorship of Dean Linda P. Fried, MD, MPH, and the collaboration of three fellow faculty members— Jeffrey Goldsmith, PhD, Rachel C. Shelton, MPH, ScD, and Shakira F. Suglia, ScD—
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they will use the Initiative to make the case that obesity prevention, rather than treatment, will be the most effective public health intervention. Their investigations will also lay the foundation to promote success in the prevention of obesity. (It’s very hard for people to lose weight and keep it off and far better to have never gained it in the first place, a theme championed by the Institute of Medicine.) Together, the team of junior faculty will identify and address gaps in knowledge about obesity to ultimately furnish new insights into what causes the disease and what can be done to end it. “Prevention involves trying to make sure that the healthy choice is the easy choice, so it can be sustained and is effortless,” Wang says. “But it takes a lot of design wisdom to achieve that.”
DISTAL CAUSES Shakira Suglia, an assistant professor of Epidemiology, would probably have a very different career if she hadn’t grown up in Puerto Rico. She left when she was 18, for college at the University of Massachusetts at Amherst, but her early experiences raised lingering questions about the effect of stress on long-term health. Families who struggle to put enough food on the table or to stay safe from violence don’t always have the time or energy to exercise or eat well. “If you’re chronically exposed to stress, it has to leave its mark,” she says. “It makes total sense to me.”
In a study published in Pediatrics in April 2012 and funded by the National Heart, Lung, and Blood Institute, Suglia and colleagues showed that girls exposed to family stress during their preschool years have an increased risk of being obese at the age of 5. The data came from the Fragile Families and Child Wellbeing Study, an ongoing longitudinal investigation led by Columbia and Princeton universities; researchers had surveyed the mothers of 1,605 U.S. preschoolers to gauge how much stress their households were experiencing. Among other questions, the women were asked about their access to food and exposure to dom estic violence, and whether the children’s fathers had spent time in prison. Suglia and her colleagues found that girls whose households were experiencing at least two high-risk stressors when they were 1 or 3 years old had more than twice the odds of being obese at age 5 compared to girls whose households were experiencing no major stressors at those times. (Boys, she found, generally did not become obese after experiencing social stress.) Suglia says she isn’t yet certain how or why stress leads to weight gain for girls, but “these risk factors are social stressors that are affecting the parents’ ability to take care of the needs of their children,” she says. “This can directly impact what the children are eating and how much they’re exercising, or it can affect biological stress pathways, which can disrupt hormones related to appetite.”
The seeds of obesity can be sowed earlier, too—before babies are even born. In research published online in the American Journal of Epidemiology in April 2012, Andrew Rundle and colleagues asked 702 pregnant women from the Bronx and Northern Manhattan to wear special backpacks that monitored their air quality for 48 hours while they were in their third trimester. Then the researchers tracked the health of their children after birth. The kids of the mothers who had been exposed during pregnancy to the highest levels of polycyclic aromatic hydrocarbons (PAHs)— chemicals released during combustion which have been shown to affect hormone function—were 79 percent more likely to be obese at age 5 and 2.3 times more likely to be obese at age 7 compared to kids born of mothers who were exposed to the lowest levels. As co-author Frederica P. Perera, DrPH ’82, PhD ’12, a professor of Environmental Health Sciences, remarked, “This is the first time that the pollutants from fossil fuel burning have been linked to obesity in children directly.”
SMART CHOICES MADE SIMPLE If obesity is driven by many social and environmental factors—and so early in life— how can policymakers ever hope to eliminate it? “You can’t just tell someone, ‘You need to eat more healthily,’ because that person may not have the available financial or physical resources to eat better or exercise more,” Suglia says. “Obesity may fall down at the end of a long list of other issues that they need to resolve first.” Yet for society, delay poses its own hazard. With increasing rates of childhood obesity, the nation edges ever deeper into a classic public health conundrum: Obese children risk severe consequences for longterm ill health and drastically lowered productivity. Society as a whole suffers when long-term health and productivity decline. The risk is too great to defer to individual action—a collective response beckons. One option is to re-shape people’s environments so that healthy choices are effortless and economical. In 2012,Wang authored an analysis in Health Affairs on the potential health benefits of a penny-per-ounce excise
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tax on sugar-sweetened beverages like sodas and sports drinks—a 12-cent tax, say, on a 12-ounce Coke. “Sugar-sweetened beverages have no nutritional value whatsoever,” says Wang. “They’re sugar water.” Taxes on unhealthy products like these would preserve consumers’ free choice, yet give people an incentive to avoid buying them and, by extension, make it easier on the wallet to purchase healthier beverages like milk or water. In a 2010 report for New York City’s Department of Health and Mental Hygiene, Wang suggested that such a tax could reduce consumption of sugarsweetened beverages in New York state by up to 20 percent, ultimately preventing 145,000 adults from becoming obese and saving $2.1 billion in medical costs attributable to obesity over the course of a decade. (While the tax was ultimately rejected in the Empire State, similar taxes are currently being considered in nine other states.) Another option would be a cap on sugarsweetened beverage sales, such as the June 2012 proposal by New York City Mayor Michael Bloomberg to ban the sale by restaurants and other food establishments of such beverages in serving sizes larger than 16 ounces. (Research has shown that people consume more calories when they are served more calories.) In a study published online in the June 2013 American Journal of Clinical Nutrition, Wang and her colleagues found that such a ban would not, as some people feared, disproportionately affect low-income individuals. Instead, the scientists found that the ban—which was blocked by a judge in March 2013, a decision subsequently upheld by an appeals court—would target overweight individuals as hoped, reducing their consumption of sugar-sweetened beverages by about 60 calories a day, or 22,000 calories a year. Such calorie reductions could go a long way toward obesity prevention. Previous research by Wang and her colleagues— published by the American Journal of Preventive Medicine—found that a reduction of just 64 calories per day is all that’s needed to reach the country’s Healthy People 2020 goal for reducing obesity. The effort also gets a boost when families cultivate the habit of serving healthy foods
************* “You can’t just tell someone, ‘You need to eat more healthily,’ because that person may not have the available financial or physical resources to eat better or exercise more. Obesity may fall down at the end of a long list of other issues that they need to resolve first.” *************
================================================= to their young children. Sally E. Findley, PhD, a professor of Population and Family Health, has been studying the effects of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), a federal program that provides grants to states to distribute food and nutrition education to low-income pregnant women and mothers. In 2009, New York became the first state to improve its program by adding more fruits, vegetables, and whole grains and by substituting low-fat for whole milk. A lifestyle education program introduced at the same time emphasizes less time spent watching cartoons on the sofa and more time running, climbing, and jumping. In a study published online in Obesity in May 2012, Findley and her colleagues showed that children of women participating in the improved program not only ate more fruits and vegetables than children of mothers who were in the program before the improvements took effect, but that the kids in the improved program were also less likely to be above the 95th percentile in body mass index (BMI). These findings are important considering that, in 2008, more than half of children from low-income families in New York City were overweight by the time they turned 5. The road to obesity prevention will be painfully long, but the alternate route exacts a lethal toll. Obesity was responsible for 18 percent of all deaths among blacks and whites between 40 and 85 years old from 1986 to 2006—according to research conducted in 2013 by Ryan Masters, PhD, (then a Robert Wood Johnson Foundation Health and Society Scholar at the Mailman School) and colleagues—and it costs our country an estimated $147 billion a year. To effectively avert those costs—and address the myriad causes and paths that lead to obesity—policymakers will need to “think about the common themes across very diverse populations of individuals,” says Wang. “We need to create a world where it’s easy and cheap for everyone to eat well.”
Do the Math the domain of solitary dieters. Professor Y. Claire Wang has applied the practice to population health. Instead of add ing muffins and subtracting time sweating on an elliptical machine, Wang’s Caloric Calculator (CaloricCalculator.org) weighs the effect of policy on childhood obesity. Select a target population (middle-school-aged boys, for example) and the website displays their rate of obesity (18 percent) and the average daily calorie cuts required to turn back the clock to levels from the year 2000 or, more ambitiously, the early 1970s (109 and 237 calories, respectively). Next, choose from a menu of 15 interventions. Add 30 minutes of daily physical education classes, for example, and burn 49 calories. Not enough. Eliminate one can of soda for 136 calories. Year 2000, here we come. Reduce television time by an hour and whittle away another 106 calories. Hello, slim ’70s! To develop the tool, Wang and her colleagues reviewed the scientific literature on physical activity, dietary, and other preventive measures to estimate their influence on children’s “energy gap”—the difference between average daily calorie consumption and the number of calories required to support normal growth and physical activity. The team detailed their methods in the August issue of the American Journal of Preventive Medicine. “Our goal is to put policymakers—the foundations that fund programs, the professional societies that issue guidelines, and elected officials—in a mind set of comparative effectiveness,” says Wang. “We wanted a yardstick that would rank interventions that affect either energy intake or energy expenditure to promote systematic solutions.” —Tim Paul
COUN TIN G CAL OR IE S IS USUAL LY
Based in Cold Spring, N.Y., MELINDA also writes for Slate, Scientific American, Nature, and O: The Oprah Magazine. WENNER MOYER
YA R E K WA S Z U L
Advocate: RenĂŠe Wilson-Simmons stands up for impoverished youngsters as director of the National Center for Children in Poverty.
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AS DIRECTOR OF THE NATIONAL CENTER FOR CHILDREN IN POVERTY, RENÉE WILSON-SIMMONS PUTS KIDS IN CONTEXT
BY KRISTINA STRAIN
R O J R O DR I G U E Z
Gladys Wilson always went alone when government-surplus food—cheese, dried eggs in a can—was distributed to those in need at a public elementary school in the family’s East End Pittsburgh neighborhood. Renée Wilson-Simmons and her sister stayed home. “My mother dreaded having to get in line on those days,” says Wilson-Simmons, who, driven by intense distaste, often hid the canned eggs. “They were so terrible,” she says. “I was too young to understand that we needed the food.”
W IL SON- SI MMONS WAS LUCKY —her
mother served as a powerful buffer, insulating her girls from some of the worst insults of poverty. Many children don’t fare so well. The insults of poverty are simply too pervasive for one parent—or even two—to fend off. Today, as director of the Mailman School’s National Center for Children in Poverty (NCCP), Wilson-Simmons, DrPH, advocates for children in need. As head of the nonpartisan research center, she champions public policies to promote the economic security, health, and well-being of America’s low-income children and families, confront ing stereotypes and caricatures with hard facts. Her goal: to galvanize policy makers, journalists, advocacy organizations, researchers, the professionals who work with impoverished people, and the general public to confront the realities of kids growing up poor in America and to respond with evidence-based policies. The effort hinges on tackling—head on— the inextricable links between childhood
poverty and the policies that affect impoverished families. “Efforts to address this crisis are hampered in part by inaccurate and damaging beliefs,” she says. “Chiefly, that children are poor through no fault of their own and so deserve support, but poor adults—their parents—are responsible for the choices they have made and so must accept their fate.” The connection between childhood pov erty and public health can’t be underestimated. Kids boast extraordinary resilience; even so, the combination of stress, sleep deprivation, exposure to pollutants, limited access to health care, and poor nutrition imposed by poverty can have profound lifelong effects by disrupting the rapid brain, endocrine, and immune development under way during early childhood. “Many of those born into poverty have higher rates of morbidity and subsequent developmental delays,” says Wilson-Simmons. “They’re less likely to be prepared for school, more likely to experience cognitive and behavioral prob-
lems, and ultimately more likely to experience illness and unemployment as adults.” The data behind such trends—and their relationship to public policy—is freely available online, at nccp.org. The site’s Young Child Risk Calculator offers state-specific answers to such questions as How do my state’s policies compare to those in other states? Which children in my state are at high risk of poor school or health outcomes? How many infants and toddlers in my state are vulnerable? The Early Childhood State Policy Profiles help users evaluate trends across the states. “Evidence like this is essential,” says Wilson-Simmons. “With evidence, we can understand what’s out there, understand how current policy and practice work, and see what needs to improve.” About to embark on its 25th year, NCCP was founded in 1989 as welfare reform and broad expansions to Medicaid were signed into law. Today, its reach extends far beyond the staff’s 125th Street office, to foster policy change nationwide. In Illinois, the NCCP provided the governor with the facts and figures he needed to increase the Earned Income Tax Credit from 5 to 10 percent, boosting the family finances of 1 million children. Working with two partner nonprofits, NCCP staff are providing data and recommendations to help 20 states boost the quality of the early childhood programming they offer. Closer to home, the organization serves as an evaluator for NYC Project LAUNCH, a federal program that promotes the mental health and school readiness of at-risk children in two of New York City’s highest-needs communities.
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S U C H WORK I S A L L THE M O RE RELEVANT AS
millions of families continue to pick their way out of the rubble left by the latest recession. Though the national poverty rate saw a dramatic drop in the ’90s, of the 72 million children in America today, 32.4 million live in poor or low-income families. “The nation’s share of poor children is one of the highest in nearly 50 years,” says Wilson-Simmons. “Many of these children start out early on a path that puts them far behind more advantaged children, and many never catch up.” Wilson-Simmons credits education with brightening her own future: She and her sister, whose parents divorced when Renée was in second grade, were the first black children to attend the Catholic grade school in their Italian-American neighborhood. Buoyed by SAT-boosting Latin and French courses— and toeing the line etched by some very strict nuns—each of the girls gained college admission. Wilson-Simmons majored in journalism, covering her hometown for the city’s flagship African-American newspaper, before earning a master’s in urban journalism from the University of Minnesota. Dedicated to helping—not just writing about—people stuck in the urban poverty cycle, she found a foothold at Education Development Center (EDC), a Bostonbased nonprofit that designs, implements, and evaluates programs in education, health, and economic opportunity. After 18 years, during which she ascended through the ranks at EDC, Wilson-Simmons enrolled at the University of North Carolina, Chapel Hill, where she earned a doctorate of public health. During a subsequent sixyear stint at the Annie E. Casey Foundation in Baltimore, her work involved equal parts administration and mentorship. To foster collegiality, Wilson-Simmons frequently opened her home, inviting colleagues to share a casual meal. “It created this great working relationship,” says Lindsey Mason, then a junior member of Wilson-Simmons’s team. “Those outings were really designed to make you feel special.” In her first year at NCCP, Wilson-Simmons has tested her dual capacity for warmth and leadership as she guides the 20-employee, $4-million organization through a strategic planning process. (NCCP has lacked a full-time, permanent director since 2009.)
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“ M A N Y OF T HESE C HIL D R EN STA RT OUT EA R LY ON A PAT H T HAT P UTS T HEM FA R BEHIN D M OR E A DVA N TAG E D C HIL D R EN A N D M A N Y N EV ER C ATC H UP.”
During her first month, Wilson- Simmons hosted one-on-one, hour-long interviews with each of the NCCP’s employees. “She really hit the ground running,” says J. Lee Kreader, PhD, NCCP’s deputy director. “She wanted to know everything: what turned people on, what frustrated them. She really made it a point to get to know everyone really well, really fast.” Over the coming year, Wilson-Simmons intends to hold to the fast track, mustering allies for a campaign to put childhood poverty front and center in the nation’s consciousness. “We have to change public sentiment before we can change public policy,” she says. “We have to help people understand who is poor and why, launch a national conversation about the effectiveness of poverty reduction policies, and engage the organizations to support new policies.” To bring that vision to fruition, she’s making the rounds of Mailman School departments, inviting faculty researchers to join in the NCCP’s efforts. “Their expertise is very exciting,” she says. “I look forward to identifying more ways we can collaborate.”
On the wooden table where WilsonSimmons holds meetings, an austere steel can contrasts sharply with the garnet- colored area rug and African wall hangings. “DRIED WHOLE EGG SOLIDS,” declares the label of the 13-ounce tin. “NOT TO BE SOLD OR EXCHANGED.” The can is one that Wilson-Simmons hid as a child and rediscovered four decades later as she emptied her childhood home. Today, that relic of her youth stands as a testament to a mother’s love, her capacity to shield her babies from the harshest truths of a family’s struggles. For Wilson-Simmons, it’s a reminder of the human truths at the heart of NCCP’s mission. “Children do better when families do better,” she says. “The NCCP’s vision is an America where all families are economically secure and nurturing, and all children thrive. I have no doubt that vision will be realized. It’s just about how we get there.”
Gilbertsville, N.Y.–based freelance reporter KRISTINA STRAIN covers medicine, science, and agriculture.
Put yourself, your students, or your employees in the shoes of key players facing critical public health challenges. Decide when to evacuate hospitals as Hurricane Sandy blasts the Eastern shore.
Orchestrate the w ho response to s a r s in Beijing.
Fix health care for Californiaâ€™s elderly and ill inmates.
These and other multimedia cases, prepared for the Mailman Schoolâ€™s MPH Core, are now available online.
Arsenic in Bangladesh During a clinical trial to mitigate arsenic exposure from naturally contaminated wells, local media accused researchers of poisoning participants. Explore the ethical, economic, and cultural challenges of doing public health research through this dramatic case about juggling local needs with international aid policy.
Public Health Series
BY PAUL ZAKRZEWSKI
P H OTO S BY R OJ R O D R I G U E Z
A new curriculum replaces silos with synergy
LEAP W 36
heard about a new curriculum for incoming students at the Mailman School of Public Health, she knew she was in for surprises. What she didn’t expect was that while learning the complexities of her chosen field, she’d also learn to interrogate her own biases and assumptions about the world and begin to reconcile her idealistic vision of public health with the pragmatic realities of working across sectors and specialties to make the world a better place. WHEN KATHRYN HEINEMANN, MPH ’14,
In one class, Heinemann reviewed a case from the late 1970s, involving pharmaceutical giant Merck and a drug that could cure river blindness, a condition afflicting millions in developing countries. Up for debate:What benefit was there in bringing to market a compound that a population in need couldn’t afford to purchase? And was the investment in research and development “worth it” if the company couldn’t provide the drug at a price people could pay? Heinemann was assigned to take the business’s point of view, grappling with its prospects for covering the costs of development and production, as well as its obligation to shareholders. “It was just such a totally different perspective for me to think about,” she says. “Learning to recognize what drives other sectors will inform my approach to working collectively for what’s ultimately a mutual goal— enhancing public health.”
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life-course, prevention-based perspective
fresh, integrated content
leadership, management, and innovation training
emphasis on diversity and inclusion
small group and cohort structure
In September 2012, the Mailman School unveiled a radical overhaul of its curriculum, perhaps the most revolutionary change to public health education anywhere in the past 70 years. Sandro Galea, MD, DrPH ’03, Gelman Professor and Chair of Epidemiology, led the faculty initiative to design the new curriculum and re-imagine the content. The new curriculum takes an interdisciplinary approach to its delivery that leaders in the field say is vital to address the complex public health concerns of the 21st century. Mailman isn’t alone in embracing the opportunity for change. Indeed, public health schools across the country are now considering significant modifications to content and methods of instruction in their own programs. The chance to share insights gleaned in that effort and to discuss the underlying challenges was the impetus for a daylong summit, “Innovations in Public Health Education,” conceived and hosted by the Mailman School this past June. Deans and associate deans from 43 of the 55 institutions in the Association of Schools and Programs of Public Health traveled to Manhattan for the event, gathering first for a reception and dinner hosted by Mayor Michael Bloomberg and Mailman School board member Diana Taylor, MBA, MPH ’06. The next morning, Howard K. Koh, MD, MPH, the assistant secretary of health in the U.S. Depart ment of Health and Human Services, gave the keynote address. In her opening remarks at the summit, Dean Linda P. Fried, MD, MPH, expanded on the findings of a 2010 report of the Lancet Commission, Education of Health Professionals for the 21st Century, which found that public health students must be prepared differently from those of former generations to face new challenges. These include the health effects of chronic disease and obesity, globalization, climate change, longer lives, migration, and urban living. At the same time, public health graduates must demonstrate new types of leadership and technical skills. “Innovation is critical,” says Fried. “The demands of the 21st century are very different from those of the 20th century. Academic public health leaders know—we all know—that public health education has to evolve with the times. The ability to create the conditions for disease prevention and health promotion at every age and stage of the life course is the core of public health for the 21st century, along with the ability to effectively analyze complex problems and find efficient solutions.” Among the many significant transformations in the Mailman School’s curriculum is the introduction of Integration of Science and Practice or ISP. At the heart of this yearlong course are case studies, such as the Merck example, in which groups of 20 students work together to consider historical and contemporary public health debates. Using an approach borrowed from business schools, students—who come from different academic departments—bring their individual perspectives to the conversation and consider those of each sector involved. Ronald Bayer, PhD, a professor of Sociomedical Sciences who oversaw the subcommittee that revised the core curriculum, says that the best cases put students in the shoes of officials struggling with the myriad limitations of data collection and solution implementation in the real world. “When students leave the classroom
California Policy for Ill and Elderly Inmates
THE BACK STORY In the wake of California’s 1 1994 “three strikes” law, prison populations have swelled, with the percentage of prisoners aged 55 and over spiking 500 percent since 1990. Fewer than 1 in 10 prisoners in California are 55-plus, yet they occupy nearly 4 in 10 “medical beds.” As demand for health care grew, the system’s failings became egregious, raising human rights and quality of care concerns.
Open Case In the case-based course Integration of Science and Practice (ISP), introduced as part of a holistic curri culum makeover in 2013, Mailman School students leap into debates at the fore of contemporary practice and make tough decisions based on competing visions. In the case “California Policy for Ill and Elderly Inmates,” students contend with the spiraling healthcare costs associated with an aging prison population. Each of the 19 faculty who teach the case highlight different themes and elements.
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THE REFORMERS In 2006, California put its bro ken prison healthcare system in receivership. Receiver Robert Sillen, a former healthcare executive, spent $6 million to recruit better, and board-trained, doctors. In 2008, his successor, lawyer J. Clark Kelso, implemented more extensive reforms, bringing a managed care model to the state’s 33 prisons. He also introduced “compassionate release,” a review process for inmates with a life expectancy of six months or less, and “medical parole,” for those needing 24-hour care. THE CRUX Students weigh the medical parole of Carl Wade, 65, whose congestive heart failure and treatment for a lifetime of occupational and smoking-related pulmonary damage cost the state $200,000 each year. “One could teach this case as a law professor, a criminologist, a sociologist, an ethicist, or an epidemiologist,” says Professor of Epidemiology Leslie L. Davidson, MD, MSc, who credits the best case studies with incorporating multiple perspectives. When she teaches this case, Davidson shifts students’ attention from Wade to systemic considerations, including California’s punitive “three strikes” law.
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EPIDEMIOLOGY Using epidemiological and statistical tools, students sketch out end-of-life scenarios across a prison population and refrain from forecasting individual outcomes. Then they weigh the efficacy of measures like medical parole and compassionate release for a single prisoner.
HEALTH MANAGEMENT This case features the overhaul of a vast health network. Students evaluate the efficacy of various management styles.
CASE INVOLVEMENT %
POLICY & ETHICS Analysis of the underlying causes of this case is a major focus in Davison’s class. Students consider arrest rates, long prison sentences, pervasive racism, and California’s “three strikes” law.
BIOSTATISTICS Davidson’s students consider a graph documenting the loss of daily functions with age in different populations. Such data drives home competing interests in cases like that of Carl Wade.
THIS NATION’S SCHOOLS
of public health, represented
In her speech to open the summit “Innovations in Public Health Education” conceived and hosted by the Mailman School in June, Dean Linda P. Fried reflected on the challenges and opportunities of training public health professionals for a fast-changing world.
by the deans who are here, have a commitment to identifying the changing factors that affect the health of populations, designing the solutions that protect and promote public health, preventing disease and disability, and translating knowledge into impact. Part
of that impact, of course, is our deep responsibility to educate the next generation of public health leaders, professionals who will lead not just in 2020, but and make decisions involving public health, they’re going to have to make decisions based on what they know, not what others ten years later are going to say about it,” he says. “The purpose here is to develop analytical thinking.” It should come as no surprise that in a school where an entire department applies its intellectual prowess to the pursuit of statistical rigor, implementation of the new curriculum is being meticulously monitored and evaluated. Melissa D. Begg, ScD, vice dean of education and a professor of Biostatistics, randomly sampled 40 students in the incoming class and followed up with them every two weeks throughout the fall. To further bolster her data set, she distributed a parallel set of biweekly surveys to different random samples of incoming students and collected additional feedback from all students through course surveys and from faculty and teaching assistants. Armed with this robust collection of data, Begg and her colleagues are fine-tuning the curriculum. And Begg says she’s not finished. We’re going to ask graduates what courses and requirements were particularly important and relevant to their careers,” she says, “as well as if they saw any gaps in what we taught them. Curriculum renewal is a dynamic process.” This fall, Fried, Begg, Galea and other colleagues will detail what they’ve learned so far in two papers slated for publication in the American Journal of Public Health. One expounds on the rationale and motivation for the new curriculum, while the other delves into the specifics of Mailman’s new MPH degree. “As the careers of our students unfold, they’ll need a robust tool kit that draws on multiple perspectives and approaches,” says Fried. “Our new curriculum helps students assemble that kit and refine their facility putting it to use. By learning to work across disciplines, using 21st century knowledge and skills, Mailman students are preparing for a future in which the field of public health and the challenges it confronts continue to evolve.”
in 2050. Whatever they are doing, it’s not going to be work that we can imagine. There are so many challenges we face. Health needs and scientific capabilities are changing. We are interdependent in ways never before imagined, and the issues we tackle must be addressed with increasingly interdependent solutions. Medical care systems are not up to the needs of our society, and we are not using the knowledge we have to optimally create health in populations or individuals. While these challenges are daunting, they may also result in a perfect storm of opportunity, drawing schools of public health together even more closely to answer questions like these: • What are the public health needs of the present and the future? • Where does public health not just play a role, but take the lead, for populations and/or individuals? • What will be the roles of future public health professionals in tackling these complex problems? • What does this tell us about how students must be educated?
Santa Barbara-based PAUL ZAKRZEWSKI has written on contemporary culture for the New York Times, Boston Globe, and Washington Post.
LIGH TS , ACTIO N,
PHOTOS BY JOHN ABBOTT
Shrieking sirens. Clattering gurney wheels. Cries of “Stat!” Chicago native Erik Swanson, MPH ’13, grew up with the 15-year television series ER. So perhaps he could be forgiven for craving a bit of drama from his summer in the NewYork-Presbyterian Emergency Department (ED). 40
DIDN’T HAPPEN. Then again, when you confront preconceptions, you’re probably about to learn a lot. This summer, Mailman School students did precisely that, in practicums at more than 200 sites worldwide. // At the invitation of hospital administrators, including VP of operations Anthony Dawson, MSN, Swanson and four classmates spent two months as process improvement consultants. Their charge: Find ways to streamline the ED patient experience to provide the best care available, as quickly as possible. // But first there was a serious case of culture shock to overcome. “It was difficult to fathom how everyone worked together,” says Swanson. To sort it out, the team deployed process improvement tactics borrowed from the automotive industry. In the ED—armed with iPads and stopwatches—they mapped the flow of patients, noting every interaction with providers, around the clock. // Their guru was
practicum adviser Joan Leiman, PhD ’77, a special lecturer in Health Policy and Management and former chief of staff to the NewYorkPresbyterian CEO. “Early on, Joan set us on the right track by telling us to think about the ED through the eyes of a patient,” says Swanson. “This became our mantra.” // Fast-forward eight weeks. After dozens of interviews—with patients, nurses, docs, even execs and housekeeping staff—and days of data crunching, a new perspective emerged. “Not only does the ED have an organizational structure,” says Swanson, “but many of the best industry practices were already in place.” // In August, the students offered management 12 tips to further enhance efficiency. The work garnered high praise for its potential to improve care. At press time, Swanson was interviewing for healthcare consulting jobs, presumably with stopwatch in hand. —Tim Paul
Cultural Medium Through Masa Crítica, faculty forge new connections
Two years ago, at a graduation luncheon, professors Diana Hernández, PhD, and Manuela A. Orjuela-Grimm, MD, ScM, found themselves at the same table. Small talk revealed a string of commonalities, and the two made a date for coffee. Later, over cups of café con leche, they hatched a plan to bring together fellow Latina and Latino faculty from throughout the Mailman School to fuel the kind of serendipity that had sparked their first meeting. “Our intention was camaraderie and sharing experience,” says Orjuela-Grimm, academic director for the Global Health Certificate in Environmental Health Sciences. “Everybody could learn from what everybody else has done.” Today, the group they formed— known as Masa Crítica, “critical mass” —also includes participants on the faculties of Columbia’s College of Phy sicians & Surgeons, College of Dental Medicine, and School of Nursing.
Meeting of the Minds: Masa Crítica co-founder Manuela Orjuela-Grimm (left) teamed up with Helena Duch (right) to pen a research grant. Ana Abraido-Lanza (center) offered feedback on their proposal.
Monthly meetings, held in a seamless pastiche of English and Spanish, feature short research presentations by participants, as well as informal discussion of upcoming grant proposals, and coaching on career development challenges. Cele bration of accolades guarantees plenty of laughter and camaraderie. Unlike formal mentorship programs, which pair junior faculty with more senior colleagues who serve as coaches, Masa Crítica has evolved organically, exploiting the array of strengths and experiences each member brings. “We’re coming from different disciplines,” says Orjuela-Grimm, who notes that while she could coach Hernández on tactics that boost success on an NIH grant, Hernández reciprocated with insights into community-based research models and tips borne of her work as a social scientist. “Even if people are more junior in terms of the time they’ve been on the faculty,” says Orjuela-Grimm, “they’re coming with a different perspec-
In May, demographer James F. Phillips, PhD, professor of Population and Family Health, and Mary Beth Terry, PhD ’99, professor of Epidemiology, were honored as the first recipients of the Dean’s Excellence in Mentoring Award. The recognition is part of a growing effort to facilitate the relationships among junior and senior faculty that fuel early career professional development and promote retention. When junior faculty are hired, their department chairs assign each a mentor who shares their research interests. Vice
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tive that is very enlightening.” At Hernández’s invitation, Helena Duch, PsyD, assistant professor of Population and Family Health, attended one of the group’s first meetings, and met Orjuela-Grimm. At another meeting, Duch presented an overview of her work with Mexican immigrants in Washington Heights, a population with which OrjuelaGrimm had been particularly interested in working. Subsequently, the two joined forces with Carmen Rodriguez, PhD, assis tant professor of Population and Family Health and director of Columbia Head Start, and others to examine diet and cooking practices among the people with whom Duch had already been working. “To our delight, we discovered that nearly all of us are already working with Latino communities,” says OrjuelaGrimm. “The big surprise was that we didn’t know about each other’s work. Sometimes we were working with the same communities without even knowing it!”
Dean for Faculty Affairs and Research Regina M. Santella, PhD, whose office oversees the formal mentorship program, furnishes an array of online tools to help the pairs set realistic goals and make the most of their relationship. “We hire fantastic researchers and teachers, but it’s increasingly difficult to get NIH funding,” she says. “It’s not an easy environment, with the pressure to bring in your salary, teach, mentor students, do research, write grants, write papers. The role of the mentor is to show that it can all be successfully managed.”
b oo k sh e l f
Hot off the Presses. For Mailman School faculty, the drive to create and disseminate new knowledge runs deep. This past year’s publications exemplify their breadth of research interests and dedication to improving our collective future. * Democratic Governance and Health: Hospitals, Politics and Health Policy in New Zealand, by Miriam J. Laugesen, PhD, assistant professor of Health Policy and Management, with Robin Gauld, PhD. This analysis traces the development of elected health boards in New Zealand—unique worldwide—from the 1930s to their present structure as District Health Boards. It covers the history of democratic governance of health care, how boards have functioned, the politics surrounding their reform, and the role of local democracy in healthcare decision-making.
* Epidemiology of Women’s Health, edited by Ruby T. Senie, PhD, professor emerita of Clinical Epidemiology. This volume— which includes chapters by 11 Mailman School faculty members—reviews the body of literature on morbidity and mortality in the field of women’s health at the beginning of the 21st century. The book covers health promotion, sexual health, sexually transmitted diseases, endocrine and autoimmune conditions, malignancies, chronic conditions, and aging.
* Collective Trauma, Collective Healing: Promoting Community Resilience in the Aftermath of Disaster, by Jack M. Saul, PhD, assistant professor of Clinical Population and Family Health. This guide considers the role of mental health professionals who respond to large-scale political violence or natural dis asters. Saul offers a framework for practitioners to develop their own community-based, collective approach to treating trauma and providing culturally and contextually appropriate clinical services.
* Urban Alchemy: Restoring Joy in America’s Sorted-Out Cities, by Mindy Thompson Fullilove, MD, professor of Clinical Sociomedical Sciences and Clinical Psychiatry. Fullilove identifies nine tools to mend our broken cities and reconnect communities to make them whole. ( F OR M OR E O N FUL L I L O VE ’ S W O R K, S E E P. 2 4 )
* SAS for Epidemiologists: Applications and Methods, by Charles J. DiMaggio, PhD ’02, MPH ’93, associate professor of Clinical Epidemiology. This comprehensive text covers the use of statistical analysis system (SAS) software for epidemiology and public health research. Readers learn techniques for data entry and cleaning, categorical analysis, analysis of variance, linear regression, and more.
* Entrepreneurship and Sustainability: Business Solutions for Poverty Alleviation from Around the World, coedited by Paul W. Thurman, MBA, director of the Professional Development Program and lecturer in Health Policy and Management, with Daphne Halkias, PhD, editor of the International Journal of Social Entrepreneurship and Innovation. This volume of case studies details locally proven, for-profit solutions to alleviate poverty.
* The Family Guide to Mental Health Care, by Lloyd I. Sederer, MD, adjunct professor of Epidemiology. With a fore word by actress Glenn Close, this manual offers a comprehensive resource for the millions of people with a loved one suffering from mental illness.
* Structural Approaches in Public Health, edited by Marni Sommer, DrPH ’08, assistant professor of Sociomedical Sciences, and Richard G. Parker, PhD, professor of Sociomedical Sciences. Internationally recognized authors and case studies of innovative and influential interventions provide a holistic approach to improving population health and analyze the factors related to health and wellbeing that are both within and beyond an individual’s control.
* Lead Wars: The Politics of Science and the Fate of America’s Children, by David Rosner, PhD, MPH, Lauterstein Professor of Sociomedical Sciences, and Gerald E. Markowitz, PhD, adjunct professor of Sociomedical Sciences. In 1993, scientists in Baltimore launched a study of lead poisoning among predominantly poor African-American toddlers that launched accusations of unethical practice and a cascade of legal suits. Rosner and Markowitz delve into the debate and detail the history of lead poisoning over the last half-century as a prism through which to view larger questions about the practice and future of public health.
* Early Life Nutrition, Adult Health and Development: Lessons from Changing Dietary Patterns, Famines and Experimental Studies, coedited by Lambert H. Lumey, MD, PhD, MPH, associate professor of Clinical Epidemiology. This comprehensive overview of the mechanisms by which chronic disease in adulthood emerges from nutritional deprivation early in life integrates data from multiple fields and summarizes the long-term health and economic outcomes due to specific famines.
Class of ’13 Career News
I’m a postdoctoral researcher at the University of Michigan School of Public Health. Using a population-based survey, I’m looking at how the neighborhoods where black youth live affect how they form emotional bonds and develop high-risk behaviors. — — STEPHANIE COOK, MPH ’08, DrPH ’13,
I’m a program associate for monitoring evaluation and research at EngenderHealth. I analyze how programs are implemented in different countries and I assess the effectiveness of programs that provide reproductive health, including long-acting and permanent methods of contraception, and address issues of gender-based violence.
SOCIOMEDICAL SCIENCES — — LEAH JARVIS, MPH ’13, POPULATION AND FAMILY HEALTH
In Their Own Words The Class of ’13 gets to work
The Mailman School conferred 544 degrees in 2013, including 474 master’s of public health, 50 master’s of science, and 20 doctorates. New York City Department of Health Commissioner Thomas Farley, MD, MPH, a member of the Board of Overseers and recipient of the 2013 Dean’s Distinguished Service Award, gave the commencement address, welcoming his new colleagues in their shared enterprise to promote public health. “When we save lives,” he said, “we save them millions at a time.” A few grads told us how they’re embracing that opportunity.
I am the associate vice president for Environmental Health and Safety at Columbia University. Our vision statement is that EH&S provides expert guidance and timely service to the University community through our commitment to health and safety. Employing best practices and collaboration, and by build ing long-term relationships, we promote a productive and safety-conscious work environment. EH&S is committed to establishing and maintaining a healthful and safe work environment for our faculty, staff, students, neigh bors, and surrounding communities. Through the recognition, evaluation, and control of personal and environmental hazards, the University strives to eliminate individual risk and the environmental impact of its activities. — — KATHLEEN CROWLEY MPH ’91, DrPH ’13, ENVIRONMENTAL HEALTH SCIENCES
I direct the Albuquerque Area Southwest Tribal Epidemiology Center, which is one of 12 tribal epidemiology centers across the country. We provide public health surveillance, community health assessment, capacity building, and student development work to the American Indian population in our area, which includes all of New Mexico, southwestern Colorado, and portions of Utah and Texas.
C OLU MBIA P UB L I C H E ALT H
— — BECCA LOEB, MS ’13, BIOSTATISTICS
I’m a consultant for Grant Thornton, a company whose main clients are hospitals and healthcare providers. For the next two years, I’ll do revenue cycle management with a client in Upstate New York, finding ways to shorten the amount of time it takes for claims to be paid. I will be looking at the whole process, from start to finish. Do they need health IT? Do they need more people analyzing those claims?
While earning my master’s degree I offered to assist Happtique, a mobile health solutions company with a role in many aspects of the industry, in order to learn more about the medical technology field. I worked with them on a limited basis while I completed my education and accepted a full-time offer after I graduated in December. At Happtique we feel that we are at the forefront of health care or what’s going to be the new version of health care. It’s a really exciting time. Working at a start-up is fantastic. One of the great things about working at a small organization is the ability to work on multiple projects. You’re not trapped in a silo. You’re actually working with different departments on everything from strategy to product development to implementation.
— — IRENE FROHLICH, MPH ’13,
— — MARTIN MENDIOLA, MPH ’13,
— — KEVIN ENGLISH, MPH ’01, DrPH ’13, SOCIOMEDICAL SCIENCES
HEALTH POLICY AND MANAGEMENT
I work in the Department of Psychiatry at Memorial Sloan-Kettering Cancer Center as an assistant research biostatistician. I consult with investigators and help them with study design, grant writing, and statistical analysis. I also mentor research assistants in how to work with data and use basic statistics. For the Immigrant Health and Cancer Disparities Service, which provides outreach services to immigrants and low-income cancer patients I help to evaluate their programs. I’m also involved in behavioral sciences research, focusing on cancer prevention and the effects of cancer treatment on cognition. And I am working on a randomized controlled trial assessing a scheduled smoking cessation intervention, a study tracking sun protection behaviors over time in people with a family history of melanoma, and a study on the impact of chemotherapy on memory.
HEALTH POLICY AND MANAGEMENT
awa r d w i n n e rs
ABIGAIL LOWIN — MPH ’13
School Spirit Award honors work to transcend departmental boundaries
MAC LEVINE — MPH ’13
Greening the Concrete Jungle Gorman Prize winner promotes urban environmental health
“I’d noticed that it’s not cool to be interested in aging. I didn’t mean to force people’s interest, but I wanted to help people in other disciplines see that their interests overlap with the field.” — Ab igail Lowin, MPH ’13 Longtime professor Bernard Challenor, MD, MPH, taught in each of the Mailman School’s departments during the course of his 30-year career on the faculty. Challenor, who had also worked with the World Health Organization, was known for his concerted efforts to create a sense of community for students and faculty that transcended departmental boundaries. In May, Abigail Lowin, MPH ’13, was awarded the Bernard Challenor Spirit Prize for activities that extended Challenor’s legacy of integration among disciplines. As a student in the Department of Sociomedical Sciences, in the Aging and Public Health Track, Lowin served on the executive board of the Perspectives on Aging student group and established the Perspectives on Aging Speaker Series. Each effort brought together participants from throughout the Mailman School and the wider University community to explore the issues facing older populations. “I’d noticed that it’s not cool to be interested in aging,” says Lowin. “I didn’t mean to force people’s interest, but I wanted to help people
in other disciplines see that their interests overlap with the field.” As a teaching assistant for Lifecourse Epidemiology—part of the social, behavioral, and structural determinants module in the core curriculum—Lowin coached first-year students from throughout the School, spurring cross-disciplinary learning and collaboration. After completing her coursework, she spent the spring semester organizing a seminar on aging with Vice Dean Melissa D. Begg, ScD, and working in the Office of Student Affairs, as an activities coordinator and advisor to student groups. Now a student in Columbia’s School of Law, Lowin aspires to design a career that integrates her training in public health with legal credentials to serve aging patients and their physicians. “I’d like to facilitate communication among patients and providers, advocate for older people,” says Lowin. “And I’d like to help teach physicians how to talk with patients about advanced directives and end-of-life care—before it’s imperative because a patient is on their deathbed.”
In 2008, Mac Levine, MPH ’13, launched the nonprofit Concrete Safaris to promote leadership skills and civic involvement among schoolage kids from East Harlem and to cultivate homegrown leaders for the urban environmental health movement. Today, the organization serves more than 1,500 students through after-school, weekend, and summer programs. Participants vote on their healthy living goals, then pursue such group activities as gardening, biking, running, swimming, and fishing. This spring, Levine—who began her MPH studies just months after Concrete Safaris offered its first program and remains its executive director—was honored with the Mailman School’s John and Kathleen Gorman Public Health Humanitarian Award for her demonstrated excellence in and commitment to the humane care of individuals and communities, advancement of human rights, and promotion of health care and prevention. “I am proud to have been one of her professors and advisors during her time at Mailman,” says Associate Dean Robert E. Fullilove, EdD. “She is one of the most amazing students I have met in the course of 23 years at Mailman.” Levine penned her thesis on insights
gleaned from the California Children’s Outdoor Bill of Rights and applied to Concrete Safaris. She credits that study and her training at the Mailman School with furnishing the tools she’s needed to craft a long-range plan for her organization and bring it to fruition. “When I started, I had 16 kids in the program,” she says. “In the urbanism department, I learned how to implement a community-based participatory intervention, by getting the kids to make decisions and involve them in every step of the process.” This fall, Concrete Safaris hosted Jungle Gym, a two-day community service event in Harlem’s Thomas Jefferson Park featuring a street festival and a 16-obstacle adventure race designed and built by the children, who also did much of the event marketing. Proceeds will fund year-round Concrete Safaris after-school programs. For five years, Levine toggled between school and work—an often exhausting struggle to balance competing priorities. The effort ultimately enhanced both pursuits, Levine says. “I was able to go to class, learn theory, and go to work and practice it, then go back to the classroom.”
Helen Edelberg has worked as a geriatrician, an academician, and a biopharmaceutical executive. In 2013, she made the leap to drug safety, the latest step in her quest to optimize healthcare options for an aging population. Edelberg, MD, MPH ’02, credits every step of her trajectory to the accumulated wisdom and insight of a vast global healthcare and policy network that’s served as her personal sounding board and guide. In April, she became founding chair of the Alumni Board’s Mentoring Committee, which brings together alumni of all generations with current students and staff from the Mailman School’s offices of Career Services and Academic Affairs to organize a wealth of networking opportunities. What’s your goal for this program? I’m passionate about bringing people together to enrich one another’s lives and help them develop professionally. How can people participate? There’s a range: informal mixers, panel discussions featuring alumni in a particular field, speed net working events—which bring together a variety of people with different backgrounds—and opportunities for one-on-one connections. Who do you want to recruit? Anyone. Everyone. The beauty of this effort is our collaborative approach. We’re involving current students, new graduates, alumni who are mid-career, those at the pinnacle of their career, and retirees with a lifetime of knowledge. This is an opportunity for people to share what they have learned out in the world with people just beginning their careers and those transitioning to something new. To get involved: email@example.com
JOB OPPS FOR MAILMAN GRADS
Post your opening with the Office of Career Services. For details: tinyurl.com/MSPHJobs
C OLU MBIA P UB L I C H E ALT H
Data Driven Owen Ryan, MPH ’07 WORLDWIDE, HIV INFECTION IS ON THE DECLINE.
Yet among key populations—female sex workers, men who have sex with men, and transgender individuals— the epidemic rages. As deputy director of public policy for the nonprofit amfAR, the Foundation for AIDS Research, Owen Ryan, MPH ’07, crunches the numbers to promote evidence-based interventions to serve such vulnerable people. “A lot of our work is about how to get more services to key populations without putting people at risk,” says Ryan. “We’re drawing attention to populations some folks would rather we didn’t pay attention to.” Much of that work happens behind the scenes, with analyses of donor funding patterns and budget allocations that reveal how governments and nonprofits combat HIV. “We’re trying to build new data while also understanding what’s already out there,” he explains. In 2012, Ryan coauthored an analysis in Health Affairs that found US government aid for HIV was allocated less to countries with epidemics among key populations than to nations with infections among the general population— even when the former had more HIV-positive people. Another analysis showed that several governments redirected funding away from men who have sex with men, despite donor funding agreements stipulating otherwise. “We find time and again that the systems built to serve those most vulnerable to HIV are often most influenced by stigma and discrimination,” Ryan says. “Now we’ve got the data to prove it.” Previously a program officer for HIV policy and advocacy at the Bill and Melinda Gates Foundation, Ryan also serves as vice chair for the board of directors of Funders Concerned about AIDS and as an alternate board member to the Global Fund to Fight AIDS, Tuberculosis, and Malaria. He is also a global health advisor for the Global Health Corps and FSG–Social Impact Consultants. As supervisor of amfAR’s Allan Rosenfield Research Fellowship—named for the Mailman School’s former dean—Ryan emulates his own mentor, Vaughn I. Rickert, PsyD, a longtime professor of clinical Population and Family Health now at Indiana University. “As I went on the job market, there was a fire hose of options coming at me,” Ryan recalls. “Dr. Rickert helped me understand my skills and how they translate to the real world and showed me how to turn them into a career.”
R ACIAL DIS PAR ITIE S I M PE R ILE D N E W J E R SEY W O M E N AN D TH E IR I NFAN TS . ILIS E Z IMMERMA N, M P H ’7 9 , IN TE R VE N E D.
Great Grad Zimmerman honored In June, Dean Linda P. Fried, MD, MPH, presented the Allan Rosen field Alumni Award for Excellence to Ilise Zimmerman, MPH ’79. Zimmerman is co-executive director of the Partnership for Maternal and Child Health of Northern New Jersey. The partnership coordinates maternal and child health services in eight counties, a region including 24 acute-care hospitals and accounting for more than half of the births in New Jersey each year. Previously, as president and chief executive of one of the organizations now included in the partnership, Zimmerman established the Black Infant Mortality Reduction Resource Center to address racial disparities in perinatal outcomes. Her work led to the understanding that race is a critical factor in mortality rates and health outcomes, independent of economic factors and education levels. The finding ultimately persuaded former Governor Christine Whitman to authorize $2 million for a statewide campaign, Black Infants Better Survival. “Ilise’s work has significantly improved the health of some of the most vulnerable communities in the state,” says Fried. “Her focus on disparities in mortality among different racial groups is producing changes in outreach and care that will save many more lives across the country. Hers is a noble and important undertaking of which Dr. Rosenfield surely would have been proud.”
Per Annum Andrusco arrives In May 2013, Arianne Andrusco joined the Office of Institutional Advancement as director of alumni affairs and annual fund. As the manager of annual giving at NewYork-Presbyterian Hospital, she significantly increased the annual fund and enlarged membership in donor-giving societies. She was previously associate director of annual giving at Sarah Lawrence College and assistant director of annual giving at Union College. “I’m thrilled to be working with so many amazing public health professionals at the Mailman School,” says Andrusco. “Working at NewYork-Presbyterian, I saw the end results of poor health. It’s great to be working now to promote public health on a global scale, before people get into crises.”
photos courtesy the alumni
Outspoken Michael Rosanoff, MPH ’08 IN FEBRUARY 2007, THE CDC RELEASED A SPECIAL REPORT
on the incidence of autism spectrum disorders in the United States. For decades, experts had speculated that the disease affected just one in 1,000 children. In the meantime, its prevalence had soared to one in 150; the public, advocacy organizations, and scientists were galvanized. At the time, Michael Rosanoff, MPH ’08, was finishing his thesis on the genetic epidemiology of neurological conditions. But he’d already posted his résumé online. Soon after, the phone rang. Would you like to develop a global autism health initiative? asked the caller. The nonprofit Autism Speaks wanted prevalence data on autism worldwide. Rosanoff was a perfect fit. The incidence of autism has since doubled to one in 88 children in the U.S.; global awareness has soared. “As we started to support prevalence studies, we realized we were inadvertently creating a situation that placed demand on public health systems that weren’t prepared,” says Rosanoff, now an associate director for public health research and scientific review at Autism Speaks and staff lead for its International Autism Epidemiology Network. “These are countries worrying about drinkable water, not mental health.” In response, Rosanoff and his colleagues on the development team for the Global Autism Public Health Initiative partner with local stakeholders—parents, educators, government officials—to identify local challenges and develop strategies and services based on the latest science. “The idea was to make sure we weren’t going in and saying Here’s what you need to do,” says Rosanoff, who has traveled to more than a dozen countries so far. “The partnerships are key as we identify local leadership and local resources to support the development of sustainable programs.” In 2012, Rosanoff began a doctorate of public health at the Mailman School. In April, he helped to organize a Columbia University Epidemiology Scientific Symposium co-hosted by the Department of Epidemiology and Autism Speaks, where he remains a full-time employee. “Autism has been a part of my life for 25 years,” says Rosanoff, who has an adult cousin profoundly affected by the disease. “One of the most important things I’ve learned is that the research is only as good as the ability to share it with policymakers—and translate science into meaningful outcomes for families.”
Field Report Mailman School student bloggers run the gamut. They are entrepreneurs, patient advocates, and educators. They find patterns in data and design programs to promote healthy behavior. They clown around with kids and distribute food in low-income neighborhoods. After class, they run races and direct plays. The student blog offers glimpses into their personal and professional lives as they report from the field, the classroom, and beyond. Check them out at: columbiapublichealthstudentvoices.wordpress.com. 1
1 Carolyn combats HIV in Mozambique. 2 Tim tours in South Africa with U.S. Clowns Without Borders. 3 Grace shops for fresh food in the Heights. 4 Becky directs the Vagina Monologues at CUMC. 5 Mari chases work-life balance by running half-marathons. 6 Brian pursues a dual degree in social work and public health. 7 Laura promotes adolescent sexual health with Senegalese peer educators.
“My practicum was a great opportunity to apply my education. I engaged deeply with survey research and presented my findings at the nih equivalent in France. And I’m excited that my host site has encouraged me to write an article for publication.” Miki Duruz, MPH ’14 FPHL SCHOLARSHIP RECIPIENT
Over the summer, Miki Duruz, mph ’14, researched the perceptions of risk that motivate people to protect themselves against the threat of emerging tropical diseases in France. She looks to a career that enlists marketing savvy to combat public health crises both locally and globally. Thanks to the generosity of alumni who support the Fund for Public Health Leadership, she can afford to pursue her studies and make her dream a reality.
Each year, the Fund supports more than 20 bright, promising minds like Miki’s. Visit mailman.columbia.edu/fphl or call 212-305-4797 today to lend your support. When you contribute, 100% of your gift will go directly to scholarship aid.
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