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Public Health
Living Long
LIVING
WELL
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Training Tomorrow’s Physicians to Care for an Aging Population
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Report From the Field: Fighting Disease and Heartbreak in Brazil
Building a Foundation for Healthy Aging From the Dean This issue of our magazine highlights a topic of growing importance to everyone: healthy aging. Aging, of course, begins at birth, and the correlates of healthy aging involve a complex interplay of biological, behavioral, and environmental factors operating over our lifetime. As such, the topic serves as a primary example of our School’s broadbased ecological approach to human health. Throughout this issue you will read examples of our faculty’s innovative research on the interaction of biological, behavioral, and environmental forces that influence the aging process. Importantly, you will also read about how we work to ensure that the results of this research are used in everyday practice to maintain and enhance the health and independence of older citizens. While the primary focus of this issue is on older citizens, we are also working on achieving a better understanding of the determinants of health at conception, birth, and the early stages of life that provide the foundation for healthy living at later stages. Some of these exciting discoveries will be highlighted in future issues of the magazine.
Dean Stephen M. Shortell
In this issue, we also celebrate a number of awards received by our faculty and alumni for their contributions to the public’s health. Three of our faculty and three of our alumni received major awards from the American Public Health Association (APHA). Among the faculty, Barbara Abrams, professor of epidemiology and associate dean for student affairs, received the March of Dimes Agnes Higgins Award; Mark van der Laan, professor of biostatistics, received the Mortimer Spiegelman Award; and Richard Scheffler, Distinguished Professor of Health Economics and director of the Petris Center on Health Care Markets & Consumer Welfare, received the Carl Taube award. (See sidebar, p. 20.) It is unprecedented for faculty from a single school to sweep all three of these awards in a given year. Among our alumni, Marion Nestle, professor at NYU and the School’s most recent Alumna of the Year and commencement speaker, received the David P. Rall Award; Larry Green, visiting professor at the School and former director, Office of Science & Extramural Research at the CDC, was honored with the Mayhew Derryberry Award; and Pat Crawford, codirector of the Center for Weight and Health at UC Berkeley, received the Catherine Cowell Award. (See sidebar, p. 29.) In addition, the School is singularly honored by the announcement that three of its recently retired professors emeriti received The Berkeley Citation award from the University. This highly selective and prestigious honor is given to Berkeley faculty who have made significant contributions over the course of their careers at the University. Professor Leonard Duhl was honored for his intellectual leadership in developing the concept of healthy cities and healthy communities, which has now spread worldwide. Professor Teh-wei Hu was honored for his lifetime work in health economics, particularly in regard to the examination of the effects of taxation on smoking. Professor Zak Sabry was honored for his contributions to the field of nutrition, and particularly for his longitudinal work on the examination of diet in adolescent minority populations. These awards are, indeed, an “embarrassment of riches” for the School and provide further evidence of the quality of our faculty and graduates and the growing impact of their work on the public’s health. I know that you join me in expressing our congratulations and pride in their accomplishments. Finally, I am pleased to end this fall message with a warm welcome to our new chancellor, Robert Birgeneau. An accomplished physicist and academic leader who served as dean of science at MIT for nearly two decades and as president of the University of Toronto for the past three years, Professor Birgeneau is extremely well qualified to build on the success of his predecessors in leading UC Berkeley to even greater heights in the years ahead. We look forward to working with him on this journey.
Cover: Students in the UC Berkeley-UCSF Joint Medical Program meet regularly with residents of continuing care retirement facilities to learn about geriatrics. At Oakland’s Piedmont Gardens, student Kevin Marsee (left) meets with resident Irene Hasenclever (center) and preceptor Dr. Claudia Landau, while Dr. Landau’s dog, Lucy, lends support.
Stephen M. Shortell, Ph.D., M.P.H. Dean, School of Public Health Blue Cross of California Distinguished Professor of Health Policy & Management Professor of Organization Behavior
University of California, Berkeley
Public Health Features Understanding Aging: Biology, Behavior, and Environment
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by Vivian Auslander
How do we maintain our health, vitality, and independence as we grow older? Faculty explore the needs of our nation’s rapidly aging population and suggest how we can marshal our resources appropriately.
Training Tomorrow’s Physicians to Care for an Aging Population
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by Michael S. Broder
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By incorporating an innovative geriatric curriculum, the UC Berkeley-UC San Francisco Joint Medical Program responds to an anticipated critical shortage of health professionals trained to care for the elderly.
Departments Past, Present, Future Sheldon Margen: An Amazing Passion for Learning and Teaching
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by Dale A. Ogar
A legendary professor emeritus with a brilliant, curious mind makes his mark at the School. Report from the Field: Fighting Disease and Heartbreak in Brazil
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by Krisztina Szabo
For one graduate student, a fieldwork fight against infection-causing bacteria leads to rebuilding a collapsed schoolhouse—and transforming her world view. Scholars in New Program Explore Health and Society
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by Michael S. Broder
Six visiting Robert Wood Johnson scholars seek to understand why some groups of people are healthier than others. Faculty News Research Highlight A new study suggests maternal diet is linked to lower childhood leukemia risk.
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Faculty News and Notes
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Meet the New Faculty The School welcomes two new members to its faculty: William Dow and Darlene Francis.
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Partners in Public Health Four new Policy Advisory Council members bring a wealth of experience to the School.
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Alumni News Alumnus Spotlight: Peter Szutu A commitment to teamwork, prevention, maintenance, and intervention help the president and CEO of the Center for Elders Independence to leave no senior behind.
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Alumni Notes
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In Memoriam
30 Associate Editor Johanna Van Hise Heart
Dean Stephen M. Shortell, Ph.D., M.P.H.
Design Archer Design, Inc.
Assistant Dean, External Relations and Development Patricia W. Hosel, M.P.A.
Contributors Vivian Auslander, Michael S. Broder, Johanna Van Hise Heart, Linda Neuhauser, Dale A. Ogar, and Sarah Yang.
Editor Michael S. Broder
Photography Peg Skorpinski, cover, inside front cover, pp. 9–11, 14–16, 18–22, 25–26, 28 (Brown), 29 (Nestle), and back cover; courtesy of Robbi Pengelly, The Sonoma Index-Tribune, p. 2; Getty Images, p. 5; istockphoto.com, pp. 6 & 8; courtesy of Krisztina Szabo, pp. 12–13; Robert Aichinger, p. 17; Patricia W. Hosel, p. 24; Vivian Auslander, p. 27; Michael S. Broder, p. 29 (Crawford, Green); courtesy of the Reeves family, pp.30–31;
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Karl Peace p. 32 (Hsu); George McKray, p. 32 (Reshetko).
School of Public Health, for alumni and friends of the school.
Communications Advisory Board W. Thomas Boyce, Patricia A. Buffler, Margaret Cary, Helen A. Halpin, Meredith Minkler, Linda Neuhauser, Lee Riley, Beth Roemer, Stephen M. Shortell, Robert Spear, and S. Leonard Syme.
UC Berkeley School of Public Health Office of External Relations and Development 140 Earl Warren Hall #7360 Berkeley, CA 94720-7360 (510) 642-9572
UC Berkeley Public Health is published © 2004, Regents of the University semiannually in the spring and fall by of California. Reproduction in whole the University of California, Berkeley, or part requires written permission. Public Health
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Understanding Aging: BioloË, Behavior, and Environment By Vivian Auslander
Dr. Armand P. Gelpi monitors the heart rate and breathing of Helen McKenna at different levels of exercise as part of the Study of Physical Performance and Age-Related Changes in Sonomans.
How do we maintain our health, vitality and independence as we grow older? What special needs do we have as a nation whose population is rapidly aging, and how can we marshal our resources appropriately? Our faculty is exploring these questions from a wide variety of perspectives. 2
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Staying Active For William Satariano, Ph.D., professor of epidemiology and community health, helping people to stay physically active is “the ideal public health intervention.” Satariano has focused his research at the intersection of health and behavior for more than 20 years, with a special interest in how we function as we age. His work ranges from studying the impact of cancer on physical activity among the elderly to the impact of the “built environment”—that is, how the characteristics of the neighborhoods in which older people live help or hinder their ability to maintain active lifestyles. With colleague Ira Tager, M.D., M.P.H., and others, Satariano has been studying 2,100 people aged 55 and older in the town of Sonoma, Calif., to learn about their physical performance as they age. The Study of Physical Performance and Age-Related Changes in Sonomans (SPPARCS), now in its twelfth year, is funded by the National Institute on Aging. Satariano’s area of focus in SPPARCS has been an assessment of the reasons older people give for limiting or avoiding physical activity. “Men were more likely to say they didn’t engage in physical activity because they didn’t want to,” says Satariano. “Women were much more likely to limit or avoid physical activity because they didn’t have anyone to do it with. Among women 55 to 64 years old, the absence of an exercise companion was the leading factor for not engaging in physical activity. This finding is important, because it indicates that a key determinant for engaging in physical activity is social.” With increasing age, the reasons men and women gave for limiting or avoiding
“The more physically active you are, the less likely you are to have chronic diseases or to be depressed, and the more likely you are to maintain flexibility and balance and to recuperate from illness or injury more quickly.” physical activity became more similar. “Health problems were a major factor, fatigue was a factor, and, interestingly, fear of falling was a major factor for both men and women,” Satariano says. His latest work on the Sonoma study focuses on how the health of one spouse influences the health of the other. “We know, for example, that depression clusters in families," he says. “I would like to understand this process.” The Sonoma study is typical of what it takes to investigate people’s health and well-being effectively today, Satariano says. “Researchers in a multitude of disciplines—biological, social, epidemiological—need to come together to take a comprehensive look. We have increasing evidence that all those factors are important, and we need to understand the relationship between them more clearly.”
engage in physical activity and what barriers there are to serving them. She was surprised to find that catering to seniors “was not on the radar screen” for many organizations, even though they could have targeted services to older adults. Based on her preliminary findings, Ivey, working with the City of Berkeley’s Chronic Disease Prevention Program, has produced a guide to places in the Berkeley area that offer programs of physical activities for older adults— everything from parks to pools to churches. (The guide is available through the City of Berkeley’s Department of Health Services.) Ivey is continuing this work by piloting a second survey to develop better ways to measure the supply and demand for such programs.
Healthy Aging Research Network Satariano and colleague Susan Ivey, M.D., M.H.S.A., direct UC Berkeley’s participation in the Healthy Aging Research Network, a national coalition established by the Centers for Disease Control and Prevention (CDC) to learn what keeps us healthy as we age and to help translate research results into action.
Environmental Factors Satariano and Ivey are also studying neighborhoods to determine whether or not they have characteristics that encourage older people, particularly those with functional impairments, to walk and remain physically active. They will conduct “environmental audits” to analyze, for example, the extent to which a neighborhood provides benches, rest rooms, and traffic lights that give slow walkers enough time to cross the street.
Ivey, who holds adjunct faculty appointments at UC Berkeley and UC San Francisco, recently completed the first phase of a survey designed to learn what resources exist in Alameda County for older adults who wish to
“The more physically active you are, the less likely you are to have chronic diseases or to be depressed, and the more likely you are to maintain flexibility and balance and to recuperate from illness or injury more quickly,” Ivey says.
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What happens to the brain as we age? If you’ve ever joked about having a “senior moment,” you should be aware that the implications of the joke are scary and profound. Is memory loss inevitable with aging? Can we tell the difference between “normal” change in the brain over time and change due to diseases that cause dementia? In a comparison of PET scans of the brain’s glucose metabolism in a normal older adult and a person with Alzheimer’s disease (AD), the Alzheimer’s patient shows reductions in glucose metabolism (darker areas) in posterior brain regions. These abnormalities may be diagnostically useful in detecting AD and in predicting who may later develop the disease.
With colleagues throughout the nation, William Jagust, M.D., professor of public health and neuroscience, is seeking answers to these questions. He has received a $1 million grant from the National Institute on Aging to participate in the Alzheimer’s Disease Neuroimaging Initiative, a five-year national study seeking better ways to predict who will develop Alzheimer’s disease and to assess people’s response to treatment. For Jagust, the timing couldn’t be more important. “We’re behind the curve with Alzheimer’s disease,” he says. “The Baby Boom generation is just starting to learn about it. If we don’t either come up with public health measures that have an effect or drugs that have an effect, we’re going to be in big trouble.” Jagust is particularly interested in what he calls “the border zone” between aging and Alzheimer’s disease: He wants to know how the brain changes with aging and what factors lead to Alzheimer’s disease. He has pioneered the use of positron emission tomography (PET)
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and other imaging techniques to analyze brain structure and function. PET scanning helps scientists explore how the brain works by taking high resolution pictures of chemicals in the brain. The Alzheimer’s disease initiative is examining the effectiveness of imaging technology and other techniques for analyzing changes in the brain. Jagust is coordinating the work of all the research centers conducting PET scanning tests for the study. “Many of us believe that, in the next five years, we will have drugs that are effective for slowing down the progress of Alzheimer’s disease,” Jagust says. “When that happens, we will need reliable measures for testing them. Right now the only measure we can make is a score on a memory test. What we’re hoping to do is to use some of these imaging methods.” Some 800 people are enrolled in the study throughout the United States. The largest group consists of people with mild cognitive impairment (MCI)— they don’t have Alzheimer’s disease but they do have memory loss. “We know these people are at high risk for developing Alzheimer’s disease,” Jagust explains. “We want to find out how effective our imaging tests are at predicting who is going to get
Diabetes and Dementia: The SALSA Study Much of Jagust’s research involves volunteers with specific problems that can affect the brain, like vascular disease. To learn more about the general implications of his findings, he participates in epidemiological studies in which volunteers are drawn from a broader population. For example, with epidemiologist Mary Haan of the University of Michigan, he recently completed a study of cognitive impairment and dementia among 1,800 older members of the Hispanic community surrounding Sacramento. The Sacramento Area Latino Study on Aging—SALSA for short—was the first to look at risk factors for cognitive decline in the Hispanic population, an important demographic group in California and the nation. “This community has some unique characteristics that we thought might give us clues about dementia,” Jagust says. “For example, we knew that diabetes might be related to dementia in the non-Hispanic community and that there is a high prevalence of diabetes in the Hispanic community, so we wondered if diabetes would be an important risk factor to look at in regard to dementia. We found that it was. Our study showed that the risks for dementia and Alzheimer’s dis-
“It’s becoming increasingly evident that all the things that are bad for your heart and vascular system are also bad for your brain.” Alzheimer’s disease in this group. We want to be as accurate as we can. When we do have these drugs, we will want to give them to the people who will benefit the most, and we will want to do this before they are really sick, because once a person has Alzheimer’s disease it may be too late to reverse the disease.”
ease in the Hispanic community are different from those in the non-Hispanic community. In the non-Hispanic community, one of the important risk factors for Alzheimer’s disease is genetic. In our study population, the important risk factors were diabetes and stroke, as opposed to genetics.” Jagust is currently following
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Dementia or Alzheimer’s Disease? up with a smaller group of the SALSA study participants to learn how well brain imaging techniques will predict who is going to get dementia over time. Prevention Possibilities? So, if you are worried about “senior moments,” is there anything to do, while Jagust and other researchers push ahead to have a better understanding of the brain? “We have two kinds of approaches to improving health in later life—the public health approach and the molecular neuroscience approach—and I believe in both of them!” Jagust says. “The molecular neuroscience approach asks what has gone wrong in the brain and then develops a drug or a chemical to make it better. The public health side looks at the risk factors for having difficult times as you get older and asks how we can fix that. It’s becoming increasingly evident that all the things that are bad for your heart and vascular system are also bad for your brain. And there is increasing evidence that participating in mentally and physically stimulating activities may be helpful as one gets older. The studies aren’t perfect, but in the aggregate, they suggest that getting exercise, not becoming overweight, eating a balanced diet with antioxidants and lots of vegetables, staying physically and mentally active and not smoking will benefit your cognitive ability in later life. I certainly want to believe it—I ride my bike to work!” Aging at the Wheel Contrary to popular myth, older adults don’t all move to Florida—most remain in the same homes in which they have raised their children. “The real dilemma coming up in the next decade or two will be all these millions of people aging in places
where they are far from public transportation and highly dependent on the automobile. That’s going to be a real crisis, because many people will have to drive in order to function,” says David Ragland, Ph.D., M.P.H., adjunct professor of epidemiology and director of UC’s Traffic Safety Center. For most adults, driving is the key to mobility and independence, Ragland says. Indeed, his research with colleague William Satariano and others has shown that older people who stop driving are more likely to become depressed than those who remain active drivers. This finding is consistent with other research showing adverse consequences when people have to stop driving. Yet elderly drivers (roughly those aged 70 or older) are more likely to be injured or killed in a crash and are more likely to be involved in crashes than any other age group except the youngest drivers. Ragland has been studying the problems drivers face as they age with an eye toward helping older drivers maintain their mobility while improving their safety and performance on the road. “Our work indicates that the vast majority of older people limit their driving voluntarily—they are not being forced,” he explains. The key reason why older adults limit their driving is problems with vision. “The basic lesson of our studies is that, if we can identify medical or functional limitations, we can remedy some of them,” Ragland says. “Improving vision is obvious, but there might be other remedies that can compensate for declines in function.” Continued on page 6
Alzheimer’s disease and dementia are not the same. As Professor William Jagust explains: “Dementia, commonly called senility, is the loss of cognitive function—cognitive decline. Alzheimer’s disease is the most common cause of dementia, but it’s not the only cause. For example, you can get dementia from having multiple strokes. Alzheimer’s disease starts with loss of memory, but it progresses to loss of virtually everything—language ability, judgment, abstract thinking, spatial awareness. The major theory for the cause of Alzheimer’s disease right now is that there is an abnormal protein called amyloid that is deposited in the brain. This amyloid protein, many people believe, hurts or kills brain cells. Most of the research efforts now are directed towards drugs that will target amyloid.”
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Upcoming Conference Science & Society: Living Longer, Living Better?
Wednesday, April 20, 2005 Berkeley City Club Each year, the Center for Health Research hosts a conference focusing on one aspect of the nexus between science and its impact on society. For its third conference, “Science & Society: Living Longer, Living Better?,” an outstanding faculty of speakers, both national and from the Berkeley campus, will discuss the nation’s changing—and aging—population and the implications for medicine, technology, the economy, governmental programs and policies, and even personal attitudes toward growing old. What will be the issues that we face—individually and collectively—as our nation grows older? How can we assist, change, and enrich our own lives and the lives of those we love as we age? Is it only about living longer, or can we also live better? Join us for a lively exploration of these issues. If you would like to be notified when registration for the conference begins, please send a message by e-mail to aging_ucb@berkeley.edu.
Pedestiran safety measures, such as installing sidewalks, would encourage seniors to walk and remain active.
Ragland sees three approaches to providing this help: • Improved roadways. Larger, clearer road signs and less clutter at intersections will help drivers compensate for declining vision. • Improved vehicle design. Better mirrors, clearer dashboard dials, and devices that warn drivers if other vehicles are approaching will help older adults with functional difficulties such as difficulty turning their head and, thus, limited peripheral vision. • Training and rehabilitation. Better information about factors that limit driving and new training opportunities will help people understand and deal with the changes they are experiencing with age.
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Working with researchers in the College of Engineering and other campus groups, Ragland and the Traffic Safety Center team are investigating these approaches and designing solutions to extend the safe driving years. Beyond the Automobile Remedies for functional decline can only go so far, of course. “At some point,” Ragland says, “all of us will no longer be able to drive, no matter what environmental or engineering improvements we make or what training opportunities are available. Ultimately, we need alternative sources of mobility—everything from improved public transit systems to communities designed so that we have access to goods and services without having to use automobiles.”
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A major element of this vision is encouraging and enabling people to walk and to take transit, he says, and to do that, “we need to make walking safe and convenient.” To this end, the research he directs at the Traffic Safety Center has a second major thrust: conducting safety studies to identify and evaluate hazards and recommend changes that will improve pedestrian safety in high-risk traffic zones. Ragland hopes that this work will make it easier for older people to step out from behind the wheel and onto the curb. And he wouldn’t object if it would also help to address other critical public health concerns, such as reducing pollution from vehicles and helping the nation to slim down. Raising Families a Second Time Around More than 2.4 million older Americans are raising their grandchildren, a phenomenon that has increased dramatically since the 1970s and has only recently begun to level off, according to Meredith Minkler, Dr.P.H., professor of health and social behavior. California has the highest number of grandparents providing this care. “When my colleague Esme FullerThomsen of the University of Toronto and I did our first national study of grandparent caregiving in the mid 1990s, we were shocked to find that more than one in 10 grandparents had raised a grandchild for six months or more at some point in their lives,” says Minkler. In one-third of the homes where grandparents are raising their grandchildren, they are doing so alone, because their own children are addicted to drugs, mentally ill, or otherwise unable or unwilling to help, Minkler says. While many grandparents are relieved to be able to step in, their caregiving duties can take a heavy toll, including loss of income, a lowered standard of living, increased costs, physical problems, and depression.
Minkler first helped alert the nation to the struggles of grandmothers as caregivers more than a decade ago in a groundbreaking book, Grandmothers As Caregivers: Raising Children of the Crack Cocaine Epidemic, written with colleague and alumna Kathleen Roe, Dr.P.H. ’85, of San Jose State University. Minkler has continued to provide indepth analysis of the problems caregivers face in “skipped generation” households, and her research often provides the background for policy and legislation to address these problems. Last year, for example, Minkler and Fuller-Thomsen published research showing that, of the quarter of a million grandparent caregivers living below the poverty line in rental housing, 60 percent spend about one-third of their income on rent, and three out of 10 live in overcrowded conditions. These and other findings were used to help make the case for passing the federal American Dream Down Payment Act, which gives low income grandparent caregivers and others access to adequate housing. Generations United, a national coalition of 250 organizations representing children and older people, draws heavily on Minkler’s work to lobby for legislation to support grandparent caregivers. The coalition used her research four years ago to help argue successfully that some of the funding provided by the National Family Caregiver Support Act should be earmarked for grandparents caring for children. Currently, the coalition is seeking passage of the Kinship Care Support Act in the U.S. Senate, which would establish programs in large urban areas to help grandparents and other family caregivers make better use of social and health care services.
Ethyl Molo, a peer mentor and spokesperson for grandparent caregivers, cares for her granddaughter, Sheena.
The gap between the needs of grandparent caregivers and public policies to address those needs is still very wide, says Minkler. Grandparents receive less financial support for raising their own kin than foster parents get, for example. But there have been some positive changes. “Many state legislatures know there is a problem and are making an effort to increase equity for grandparents raising grandchildren,” she says. “When Congress instituted welfare reform in 1996, it mandated that the Census Bureau begin collecting data on this growing population to learn what impact the welfare reform might have. One of the nice things that happened is that I got a call from the Census Bureau asking me if I would like access to the Continued on page 8
“We were shocked to find that more than one in 10 grandparents had raised a grandchild for six months or more.” Public Health
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Aging Resources and Information at the School of Public Health Resource Center on Aging Under the leadership of Guy Micco, M.D., director, and Diane Driver, Ph.D., academic coordinator, the Resource Center on Aging is the coordinating mechanism for activities in aging on the UC Berkeley campus and serves as a clearinghouse for information on aging activities both on and off campus. It maintains affiliations with organizations in aging which provide resources for field research and current information on issues in aging in the community. The center disseminates information on education, research, grants, publications, fellowships, internships, job opportunities, and community resources in aging. It maintains a lending library open to students, faculty, staff, and the general public. The center is also home to the Academic Geriatric Resource Program. For more information about the Resource Center on Aging, visit http://socrates.berkeley.edu/~aging/.
Center for Community Wellness The Center for Community Wellness, headed by professors Linda Neuhauser, Dr.P.H., and S. Leonard Syme, Ph.D., translates research findings into practical programs to improve health for people of all ages. The center’s faculty and staff use an innovative approach in which consumers and health experts “co-design” and test information resources. Research shows that these “user-designed” programs are successful in helping seniors take more control over their health. The center’s programs now reach over 500,000 seniors in the United States and overseas: • The UC Berkeley HMO Guides (in English and Spanish) provide information to help seniors navigate health care systems, learn about patient rights, and connect to health resources. The guides, funded by the California Office of the Patient Advocate, are distributed to 300,000 members of California health maintenance organizations. • The UC Berkeley Chinese Wellness Guide is a bilingual resource distributed to 100,000 Chinese American families in California that includes information about eldercare and senior health resources. • In a joint effort with the state of Pennsylvania, the center is co-developing the first statewide initiative to help seniors prevent falls. • The center worked with the Australian government to design the Carers Guide, which provides information to caregivers of elders. For more information about the Center for Community Wellness, visit http://www.berkeleyhealth.com/.
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Understanding Aging...continued from page 7 Bureau’s full American Community Survey for my research—it’s an embargoed data set that includes 850,000 households. I was also invited to provide input on the shaping of a few of the questions they were planning to ask grandparents.” Minkler has been using this extensive, detailed data set ever since. She and colleagues recently completed the most detailed national study to date of African American grandparents raising grandchildren, to be published in the Journals of Gerontology in 2005. Minkler believes strongly in using her research to help the communities she is studying. In the course of her career, she has founded a national grandparent information center and local and regional coalitions on grandparent caregiving. The proceeds from her book with Roe were used to support one of the nation’s first respite centers for grandparents raising grandchildren. “In many of the nation’s largest cities, including San Francisco and Oakland, grandparents raising kids are saving the foster care system from collapse,” she says. “Many grandparents receive no financial support for raising their grandchildren, because they are not connected to the system. And our studies show that grandparents caring for their grandchildren delay care for themselves. They are turning their lives upside down to raise some of the most vulnerable kids in the nation—nearly six percent of all American children. As grandparents cope with this difficult role, they need and deserve our support.”
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Training Tomorrow’s Physicians By Michael S. Broder
to Care for an Aging Population
The number of older adults in the United States will increase dramatically as the members of the Baby Boom generation become senior citizens. According to the Alliance for Aging Research, older Americans will double in number from 35 million today to 70 million by the year 2030. The number of health professionals trained in caring for the elderly is inadequate even to meet today’s need—and with the anticipated growth in the elderly population nationwide, this shortage constitutes an impending crisis. The UC Berkeley-UC San Francisco Joint Medical Program (JMP) is addressing this gap through an innovative geriatric curriculum that matches medical students with elderly patients. Instituted last year, the curriculum brings students into continuing care retirement facilities to meet face-to-face with the residents and follow them over the course of three years. Unlike most medical degree programs, which usually introduce geriatrics late in a student’s medical education and often as an elective, this curriculum is required and begins in the student’s first year. The Joint Medical Program, which started in 1974, is a partnership between UC Berkeley and UCSF; the five-year program of study leads to a master of science degree and a medical degree, with students spending the first three basic science years on the Berkeley campus and the remaining two clinical years at UCSF. “Geriatrics is going to be the new paradigm for medicine in the future,” says Guy Micco, M.D., clinical professor in the JMP and director of UC Berkeley’s Resource Center on Aging. “The demographics are going to force us to look through the eyes of a geriatrician, because our patients are going to be geriatric patients.”
Response to an Urgent Need Recognizing the desperate need for health professionals trained to care for the state’s older patients, the state of California has mandated geriatric education for medical
Student Kevin Marsee (right) takes the medical history of Irene Hasenclever (left), while preceptor Dr. Claudia Landau observes.
students: In 1984, the California State Legislature passed AB 2614, which called for increased educational programs in geriatrics and gerontology. Sixteen years later, the Geriatric Medical Training Act of 2000 was also passed, requiring training in geriatric care for licensure as a physician and enhancement of geriatric training in California medical schools. Even with the early legislative mandate, “geriatrics was primarily elective before the new curriculum was instituted,” says Diane Driver, Ph.D., academic coordinator of the Resource Center on Aging at UC Berkeley, noting that this is still the case in most of the nation’s medical schools. The JMP is now taking an aggressive path with its new curriculum, starting with students who entered the program in academic year 2003–2004. By academic year 2005–2006, students in all three years of the program at Berkeley will be participating in the new training. “In addition to the geriatric patient encounters, our goal is to rigorously infuse our teaching—which is case-based—with the geriatrics curriculum that we’ve developed, evaluate it, and publish our experience in a way that can aid other medical schools in developing a similar curriculum,” says JMP director John Swartzberg, M.D.
Longitudinal Exposure to a Continuum of Care Last year the students began seeing patients at Salem Lutheran Home, Mercy Retirement Center, and Piedmont Gardens, all continuing care retirement facilities located in Oakland. In addition, this year students will see independent living patients at the Center for Elders Independence, an East Bay communitybased clinic. The students are assigned, on average, two patients per semester, one of whom they will follow over their three years at Berkeley in order to get to know an elder and to see firsthand the complexities of geriatric care over time. Other residents will be seen in a variety of settings. An interdisciplinary committee composed of medical administrators, clinical faculty, geriatricians, students, and others chose the sites. The committee’s selections were based on two major considerations: First, the committee felt it important that students interact with and learn about both independent elders and frail elders. A continuing care retirement facility, as opposed to a nursing home, provides a continuum of care comprising independent living, assisted living, skilled nursing, and dementia care. Second, the committee felt students should be exposed to exemplary facilities, the concept of which they can carry with them into their practice of medicine.
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for a human being to being part of a team that cares for that person. This needs to be done not just in geriatrics, but in all of medicine, in my opinion,” says Swartzberg. With the overall dearth of geriatricians, finding preceptors for the curriculum is challenging. “They need to be pretty savvy in geriatrics,” says Driver.
“What’s exciting about it, besides the fact that students are getting the exposure to geriatric patients, is that they’re getting a longitudinal exposure,” says Swartzberg. “So they’ll be able to see how a person lives in that kind of setting and what issues arise. Some of these folks, unfortunately, because of their age are going to die in the interim, and the students will be dealing with death. But they’ll be getting to know people over time, which is the way doctors need to know people to really adequately care for them.” “My favorite experience has been with my longitudinal patient,” says Shirley Wu, a second-year student who plans to practice geriatrics. “I see this patient at her assistedliving apartment, and I feel very privileged to be there, surrounded by her favorite photos and gifts from her grandchildren. I think that sense of respect for the trust that patients will give you as their physician comes across so strongly when you are invited into your patients’ homes to learn from them.”
Teaching Teamwork Both Micco and Swartzberg stress that teamwork is essential to teaching and practicing geriatrics. “A major role of this curriculum is to not just teach medical students how to be better doctors for the patient, but that to adequately care for anybody, and especially the elderly, you have to be part of a team,” says Swartzberg. “Other people—social workers, physical therapists, speech therapists, and so on—are taking care of other parts of the patient’s life too. It’s trying to reorient the medical student away from being the sole repository of knowledge about how to care 10
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Micco elaborates, “They don’t necessarily have to be geriatricians, because there aren’t enough to go around to precept our students. But we need people who have a geriatric mindset.” One preceptor for the geriatric curriculum is Claudia Landau, M.D., Ph.D., medical director of Piedmont Gardens. “Geriatrics requires good synthetic thinking,” says Landau. “In geriatrics, there is a lot of knowledge that’s being accumulated, a lot of research, and people have diseases about which there is much historical knowledge. But the process of putting all of that together—integrating what is known and what is not known—is something that isn’t taught well in medical school. This program has a fabulous curriculum in that regard. “Learning how to take a history with elders is a challenge, because there’s a huge history,” says Landau. “Students come up against a lot of their own attitudes, belief systems, biases, things with which they might be uncomfortable, and learn how to deal with that effectively. And they learn it over time, because they’re taking care of someone longitudinally for three years. Learning and developing a relationship, not just for a moment, but over time, is extremely important.”
Helping Patients Live with Illness According to Micco, teamwork is one element of the “geriatric mindset;” another is an ability
to look beyond trying to cure certain problems and focus on how patients can live with their conditions. “Many of the problems that older people have are not going to be cured,” says Micco. “They have to live with them. And it becomes really important to think about how people are living with their chronic diseases. A lot of the activities of daily living are forgotten in a standard medical interview, and that’s a part of geriatrics that I think is really important for all of medicine to take on.” Wu has learned this lesson over the course of her training. “One of the most important aspects of the approach to geriatric care that we have learned in the new curriculum is the emphasis on function, assessing someone’s medical status in terms of what will help them live as independently as possible,” she says. “For example, the ability to walk independently depends on so many different aspects of health that physicians can try to help with, from obvious things like types and combinations of medications, to nutrition and the home environment—simple things like removing floor rugs and telephone cords and having enough bright light. I’ve learned that a geriatric approach to medicine really is about seeing people in their own context—what it's like for them at home, how all their different medical problems fit together and affect their daily lives.” The students may or may not go on to become geriatricians, but the knowledge gained through this curriculum will help them in whichever area of medicine they choose to pursue. “Geriatrics is emblematic of the way medicine should be practiced in some ways,” says Landau. “You really need to use a psychobio-social and spiritual model to take care of someone, and philosophically that’s important for all of medicine. It’s important to start teaching this to students early.”
“One of the most important aspects of the approach to geriatric care that we have learned in the new curriculum is the emphasis on function, assessing someone’s medical status in terms of what will help them live as independently as possible.”
Past, Present, Future
Sheldon Margen: An Amazing Passion for Learning and Teaching By Dale A. Ogar
At the age of 13 he had read the works of Euclid and was arguing with his high school geometry teacher over how to solve theorems. When he was 15 he enrolled at UCLA. By the time he was 20 he had a master’s degree in zoology and experimental embryology, and four years later he graduated at the top of his medical school class from UCSF. With a photographic memory and a passion for learning and teaching, he has become an acknowledged expert in fields ranging from medicine, to nutrition, to endocrinology, to biochemistry, to statistics, to public health, to ethics, and ultimately to what has become known as “wellness.” Between 1951 and 1972, Sheldon Margen, M.D., was a practicing physician in the Bay Area and the head of Solano Laboratories, which he turned into the first fully automated and computerized clinical laboratory in the western United States. In 1962 he joined the faculty of the Department of Nutritional Science at Berkeley and was the cofounder of the groundbreaking research facility known as The Penthouse. Along with Doris Calloway, Ph.D., he directed more than 20 human nutrition studies on a wide range of subjects, including protein, energy, and trace mineral requirements of healthy adults. The results of this work ultimately became the basis for many of the dietary recommendations still in use today. In 1979, when Ruth Huenemann, D.Sc., retired as chair of the Public Health Nutrition Program in the School of Public Health, Margen was appointed to fill her position. Up to that point, only one doctoral degree had ever been awarded in public health nutrition. One of Margen’s first acts was to revitalize the doctoral program, and in the first two years of his chairmanship, he had 12 doctoral students working under his supervision. Over the course of his career, he has directed the research of dozens of
On October 1, 2004, the public health library at 42 Warren Hall was named the Sheldon Margen Public Health Library. At the naming ceremony, Margen’s colleagues paid heartfelt tribute to the legendary professor emeritus, who then took the podium himself to offer thanks and expressions of admiration to his many friends and family members gathered there. Above: Dean Shortell (left) presents Margen with a commemorative plaque. Below: Margen (seated, right) is surrounded by his family at the naming ceremony.
students in both nutrition and public health. Many of them have now become established leaders in their fields. One of his former students, associate dean Barbara Abrams, Dr.P.H., refers to Margen as “an amazing mentor who asked the hard questions and inspired you to find the answers. His incessant curiosity was absolutely infectious.” Margen has worked extensively overseas as a consultant to major governmental and non-governmental agencies. He served as a member and chair of the U.S. Japan Malnutrition Panel of NIH, and as a consultant to the Agency for International Development, the World Health Organization, the Pan American Health Organization, and the government of India. On the domestic front he served as a member and cochair of the Food and Nutrition Board of the National Academy of Sciences and as a consultant to the McGovern Senate Select Committee on Diet and Disease and was instrumental in establishing the first set of Dietary Goals and Guidelines for the United States.
In 1982 Margen was approached by a publisher from New York with an idea for a newsletter on health promotion and disease prevention. Two years later the first issue of the University of California, Berkeley Wellness Letter was published. Margen became chair of the editorial Continued on page 12 Public Health
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Past, Present, Future
Report from the Field: Fighting Disease and Heartbreak in Brazil By Krisztina Szabo
Reprinted with permission of the UC Berkeley NewsCenter (http://newscenter.berkeley.edu) and edited from its original form. Over the past several months, I have been in Salvador, Brazil, collaborating on an infectious diseases research project and fulfilling my fieldwork requirement for my infectious disease master’s in public health program at the UC Berkeley School of Public Health. Tonight as I write, I am fortunate to be able to watch one of the amazing Brazilian sunsets overlooking the Baia de Todos os Santos from my apartment window in the city of Salvador da Bahia. The gigantic fluffy clouds reflect the sun’s rays in hundred ways in a huge mangoorange swirl. I feel very lucky every day to live and work in this close-to-paradise place for three months. Salvador, once a capital of Brazil and today the center of Afro-Brazilian culture, will mesmerize you with the rhythms of afroxé, the dance-martial art capoeira, and the spirituality of Candomblé, the Afro-Brazilian religion. The only thing bothering me now, though, is my fever and the muscle aches from a mild case of dengue—a mosquito-borne illness endemic in Brazil and in tropical environments. How did I get it? Well, certainly not from my well-situated apartment at Laderia da Barra overlooking the bay. Most likely I got it in Pau da Lima, a shantytown or favela with over 12,000 residents where I work several times a week. What is a favela? It’s an urban slum created by social
Sheldon Margen...continued from page 11 board, a position he held until September, 2001, when he turned over this responsibility to John Swartzberg, M.D., director of the UC BerkeleyUCSF Joint Medical Program. The Wellness Letter has not only become one of the most highly
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University of California, Berkeley
Krisztina Szabo holds a Brazilian infant.
inequality. Brazil went through a 350 percent increase in urban population in the last 30 years. One consequence of this urbanization is the favelas, which are found in all major cities of Brazil. More than 30 percent of the world's population live in shantytowns and subsist on less than $1 per day. One characteristic of a favela is that despite all its residents, it does not exist on any map. Pau da Lima does not exist because it’s located outside of one’s peripheral vision, down in a very steep valley with dense vegetation, narrow passages, mud, a huge number of stray dogs, open sewers, garbage, and rats. But most importantly, it is filled with the visible poor encountering visible diseases. It is also filled with spirited people, children playing on the fields with homemade toys, barefoot, but with huge smiles on their faces. It is also filled with volunteers, scientists, and doctors who work in this community with all their hearts. The faces of children and people are the faces of poverty that become part of you.
respected publications of its type in the world, but it has generated nearly $11 million dollars in royalties to the School—funds which Margen insists be used for student support. His close friend and colleague, former dean Joyce Lashof, M.D., comments, “His absolutely brilliant mind, coupled with
Open Sewers, Rats, and Leptospirosis My work is a combined effort between the Oswaldo Cruz Foundation in Brazil, UC Berkeley professor Lee Riley, and Cornell University professor Albert Ko. I came to work on a disease called leptospirosis, a life-threatening bacterial infection transmitted through contact with urine from infected animals, mainly rats. It is one of the most common zoonotic (communicable from animals to humans) diseases in the world, and in Brazil alone there are over 10,000 cases of leptospirosis per year. It is a disease of poverty that can be easily treated with inexpensive antibiotics, but mortality remains high, about 15 percent due to delayed treatment. Consequences of delayed treatment are severe kidney and liver failure with pulmonary bleeding. Delayed treatment can also result from its diagnostic confusion with dengue, the disease I contracted after working in Pau da Lima. Pau da Lima with its open sewers and high number of rats, makes it an ideal location for the transmission of Leptospira because people live and work very close to open sewers with a very high number of rats in the community. Due to problems with delayed treatment, we are studying if early diagnosis can improve disease outcome. The project team identified a new Leptospira protein called LigB that appears to serve as a sensitive target for antibody-based diagnosis. The team wishes to simplify the use of this antigen-detection method, apply it at community level, and see if early diagnosis will lead to early antibiotic intervention and prevent severe disease outcomes.
his attention to detail have never ceased to amaze me. Without Shelly there would have been no Wellness Letter.” — Dale A. Ogar is managing editor of the University of California, Berkeley Wellness Letter.
Past, Present, Future
from volunteers. There was a need to teach at least 200 children, but there was just not enough funding. This school is critical to the community, where there is high drug use and trafficking, and other criminal activities. The school had kept kids out of trouble and away from danger. About 40 kids per day, ages 1–7, stayed here with her every day. When I first stepped into the escolinha with only its walls remaining, the children’s happy drawings were still on the wall. I walked out with tears in my eyes and I knew then that I would have a very hard, emotional, but rewarding experience working in Pau da Lima.
Children in Pau da Lima, Brazil, were left without a school after heavy rains caused their escolinha to collapse.
My mind was racing with questions. Why don’t these children just go to another public school? Why is this school so important? The more I talked to Nivaldina, the simpler the answer became. Most children and their parents don’t have the legal documentation required to attend a real school. They are too poor to have identification and in the eyes of the Brazilian government they simply do not exist.
The Salvador team also identified risk factors for severe disease after infection, which can be due to differences in exposure levels to the organism, host factors, or the pathogenicity of the infecting Leptospira. When it rains in Salvador, it pours in Pau da Lima. When a person walks through rainwater or stands in a sewer contaminated by rat urine, Leptospira corkscrews through his skin, causing systemic disease. Preliminary studies have shown that living in close proximity to open sewers and sighting more than five rats in a previous week are significantly associated with severe disease because a person gets greater exposure. The first time I experienced rain in Pau da Lima while working, I was scared. Sewers flood and houses located at the bottom of the valley are flooded with sewage. The houses, which are located higher up often collapse from the mudslide.
We are currently searching for funding support to help reconstruct the escolinha. Any amount of support would be welcome. Those interested in doing so can contact me at kriszta@berkeley.edu.
We also hypothesize that naturally-acquired immunity develops after a previous infection, which reduces the risk of developing severe disease outcomes following reinfection. If a previous infection is found to be protective for subsequent disease, a possibility for the effectiveness of a vaccine can be demonstrated. I am analyzing epidemiological data collected over three years to look at the baseline prevalence and seroconversion of participants with Leptospira in a period in an open cohort study.
But the question that nags at me as my internship comes to an end in Brazil and Pau da Lima is, what will happen to the escolinha without a real financial and organizational structure? I came here with many questions and uncertainties in my mind about how much one can really help in this environment. I have learned that the escolinha and the work of Nivaldina are transforming the lives of many amid this cacophony of poverty. I know in my heart that I will come back to Pau da Lima and see the escolinha functioning once again.
Why did I choose to do this public health project in Brazil? My dream to help others began in a small village in Hungary, tagging along with my mother, a nurse during the hard times of a totalitarian government in the early 1980s. Working in the community there allowed me to see the health needs of people ranging from the very young to the very old, no matter where they live. Brazil was my first opportunity to work in South America. I was excited, hopeful, and scared of the unknown. I knew that this would be public health in action, something you learn about in your textbooks but seldom see in the United States.
A School That Transforms Lives My first visit on my first day of work at Pau da Lima, however, was not to collect data for the leptospirosis project. I went out for a site visit with volunteers to an escolinha (small school) that collapsed due to heavy rains. They were going to design a new school and rebuild it. While at the destroyed school, I experienced one of the most memorable moments of my life. There, I met Nivaldina, the teacher of the collapsed escolinha. She is not a conventional teacher by any means. She finished the third grade and taught the children the alphabet, the numbers and read them the Bible for three years. Money for supplies and food came from the community and
In fact, I must come back and work again with my friends. To me this has been a formative moment: I want to live my life to work with those who are voiceless. In Pau da Lima, I had an opportunity to scratch the surface of my dream, and to become part of the lives of others and to learn from them. I realize that to truly understand the forces of poverty and disease, and to improve the health and wellbeing of thousands, one must work with others and change things little by little. What I don't know yet and must still learn is whether this can be done through science as a form of advocacy for social change.
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Past, Present, Future
Scholars in New Program Explore Health and Society
By Michael S. Broder
The Robert Wood Johnson Health and Society Scholars Program at UC Berkeley and UCSF began last year with three scholars, now in their second year of the two-year program. Three new scholars have joined them this year. A national program of The Robert Wood Johnson Foundation, the Health and Society Scholars Program is designed to build the emerging field of population health, which takes a broad approach to understanding why some groups of people are healthy and others are not. The goal of this interdisciplinary program is to improve health by training scholars to investigate the connections among biological, behavioral, environmental, economic, and social determinants of health; and develop, evaluate, and disseminate knowledge and interventions based upon integration of these determinants. Program codirectors are Ray Catalano and Bill Satariano at the School of Public Health, and Nancy Adler and Hal Luft at UCSF. Second-Year Fellows A pediatrician by training, Douglas Jutte, M.D., M.P.H. ’03,
received his medical degree from Harvard Medical School and completed his residency at Stanford. Following his residency, Jutte joined Stanford’s Division of General Pediatrics. “Most of my work after finishing my residency was in low-income clinics, mostly serving Mexican American, Spanish-speaking immigrants,” he says. “After a few years of working there, it was increasingly clear to me that many of the problems of the families I was seeing were not due to health necessarily, but rather social, non-medical issues—their poverty or cultural barriers.” His interest in looking at the big picture in health led him to the UC Berkeley School of Public Health, where he earned an M.P.H. in epidemiology—and then to the Robert Wood Johnson program.
Jutte’s research interests include resilience in high-risk children and the biological links through which social contextual factors contribute to a child’s long-term medical, psychosocial, and cognitive outcomes. “When I heard about the Robert Wood Johnson program, it seemed like a perfect match of quantitative science with a real attention to the social side of health,” he says. During the first year of his fellowship, he began work on two projects. In one project, he is working with Professor Tom Boyce to start a pilot study of the effect of family and parenting styles on a child’s brain development. In the other, he is using a population health registry in Manitoba, Canada, to see how Apgar scores, which are given to newborns as a measure of autonomic nervous system function, interact with social environmental factors to determine long-term health. “Programs like this are important because they encourage physicians to participate in more of a public health or population health focus on health,” he says. “I also
“When I heard about the Robert Wood Johnson program, it seemed like a perfect match of quantitative science with a real attention to the social side of health.” 14
University of California, Berkeley
think this program is important because it is going to produce physicians who can speak across disciplines, the languages of public health, epidemiology, psychology, sociology, and economics.” “I truly believe that the environments in which we function, such as the neighborhoods we live in, the places in which we work, and our homes, can foster either healthy or unhealthy individuals and populations, and that health and social policies help facilitate such environments,” says Amani M. Nuru-Jeter, Ph.D., M.P.H. “I believe that in addition to the more traditional social and biomedical risk factors, it is the interaction of people in their places that can either promote or impede health and well-being.”
“The fact that this scholars program is a joint effort between UCSF and Berkeley adds a richer element to my training.” Nuru-Jeter earned her M.P.H. in maternal and child health from the George Washington University School of Public Health and her doctorate in health policy and management from the Bloomberg School of Public Health at Johns Hopkins University. Her dissertation examined the role of race and residential segregation in the relationship between income inequality and mortality in metropolitan areas in the United States. She has also explored doctor-patient race concordance and its effects on satisfaction with and utilization of health care services, the cumulative effects of multiple social risk factors on susceptibility for psychological distress, and the influence of racial discrimination on population health outcomes.
Past, Present, Future
“The fact that this scholars program is a joint effort between UCSF and Berkeley adds a richer element to my training, because while UCSF is a traditional health sciences campus and has all the benefits of biomedical sciences, the Berkeley campus adds another element, facilitating a truly interdisciplinary environment with public health, sociology, demography, psychology, and public policy all on the same campus,” she says. “That has made my experience here rich and diverse and will allow me to contribute more to the field of population health in the long run.” Though it was not her original goal, she now says that her future is in academia. “I intended to go back out into the field and do local health policy work and grassroots health advocacy, because that’s where my passion was,” she says, “and I still have a passion for that. But at the same time, I’ve learned through my doctoral program the importance of academic research and how that research helps to inform policies that affect populations and communities of people.” Ideally, she hopes to have the best of both worlds—to engage in academic research and use her skills working in communities. “I was interested in this program because it reflects a truly multidisciplinary effort at all levels—the program leadership at the national level, the directors at each program site, as well as the scholars,” says Constance Wang, Ph.D. Wang earned her Ph.D. in epidemiology with an interdisciplinary background in biometry, biological, and behavioral sciences at the University of Texas School of Public Health in Houston. She is interested in improving the ways in which health researchers study multilevel risk factors and relate them to distributions
“I hope to come up with a more causally consistent model, one that incorporates a cumulative life course approach, in how we study causation of disease in populations.” of diseases in the population, with the primary aim of prevention. “So accordingly, my efforts have been devoted to applying and extending novel statistical methods for modeling high dimensional data to characterize complex populationlevel factors, such as population-level health status,” she says. “I hope to come up with a more causally consistent model, one that incorporates a cumulative life course approach, in how we study causation of disease in populations.” Currently, under the guidance of Professors Len Syme and Bill Satariano and collaborating with faculty at the School, Wang is characterizing cohort aging profiles and studying the determinants of typical aging profiles, using data from the Study of Physical Performance and Age-Related Changes in Sonomans, a community-based longitudinal study of the epidemiology of aging, health, and functioning. First-Year Fellows Julian Jamison, Ph.D., has been an assis-
tant professor of managerial economics and decision sciences at Northwestern University’s Kellogg School of Management. He received an M.S. in mathematics from the California Institute of Technology and his Ph.D. in economics from the Massachusetts Institute of Technology. Jamison is interested in game theory and the formal modeling of interactions between agents; choices over time; experimental economics; and measurement of health outcomes.
“How do people with different health outcomes make decisions?” asks Jamison. To find answers, he wants to conduct experimental games. “To an economist, that means you get a bunch of subjects in a laboratory and set up an artificial game of some sort. You see what they do, you see how it accords with the theoretical prediction. If not, why does it differ?” Jamison would like to involve subjects with various clinical conditions, such as brain lesions, Alzheimer’s disease, and clinical depression, and compare their behaviors to learn about their decision-making processes.
“What really attracted me to this program was this sense of it being a new field.” Jamison has also worked in the area of measuring health outcomes in order to facilitate costeffectiveness analyses. “Measuring the burden of disease is a big issue,” he says. “Both death and disability need to be divided up to determine where we put our resources. For instance, which is worse: one death from tuberculosis or two cases of blindness from polio? It’s unpleasant to think about, but unfortunately resources are limited and policy makers must decide how to spend. The measuring is very difficult, in terms of how you calculate both death and disability.” As a Health and Society scholar, Jamison plans to continue delving into these issues. “What really attracted me to this program was this sense of it being a new field,” says Jamison. “There are still people working on trying to figure out the right questions,
Public Health
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Past, Present, Future
Scholars in New Program Explore Health and Society, continued
“Disease has its roots in society, not just in individual bioloË.” the right way to approach them and answer them. I feel like we can have a little bit of an impact on guiding where it goes and seeing what some of the answers are.” “I am a cultural psychologist by training,” says Janxin Leu, Ph.D. “The field is an outgrowth of people who are in psychology and anthropology—interested in issues of mind, behavior, and individuals— but who also feel that we can’t understand individuals until they are situated in a broader social context.” “From a top-down perspective, an individual who eats badly, smokes, or engages in risky behavior is a participant in social structures that create incentives for—or fail to provide alternatives to—unhealthy behavior. Disease has its roots in society, not just in individual biology. But the dominance of a biomedical perspective to studying disease in the United States makes it challenging to argue for the primacy of social causes of diseases.” Leu received her doctorate in social psychology along with a certificate of training in cultural anthropology from the University of Michigan and an M.A. in social psychology from Stanford University. She has examined the influence of cultural models of self and well-being on cognition and emotion. By applying her background to public health issues, she hopes to broaden the impact of her work. “Currently, psychological, social, and cultural theories of population health have a limited impact on U.S. health policy,” says Leu. “This may change by 16
University of California, Berkeley
demonstrating the pathways by which social experience comes to be embodied. For example, how does the wear and tear of life from being poor or chronically stressed get under the skin? I’m interested in examining social stressors on the immune system as another way of explaining illness and its uneven distribution across groups. “At Berkeley and UCSF, I am working to build a discourse about population health across the social and biomedical sciences,” she says. “I think the best way to further the discussion is through empirical demonstrations of a mind-body connection, making the point that social experience interacts with biology to pattern health and illness at the population level.” Michelle McMurry, M.D., Ph.D., is an
adjunct assistant professor of health policy at George Washington University, where her research focuses on the role of biomedical research in disparities in health and health care. She has also served as health and social policy legislative assistant to Senator Joseph Lieberman (D-Conn.) and senior health policy advisor for the Lieberman for President Campaign.
gene recombination during T-cell receptor gene rearrangement. She received her undergraduate training in biochemistry at Harvard University. “The research that I’m going to be working on is an offshoot of legislation that I’ve been working on in D.C., which is looking at how federal policy impacts biomedical research—federal funding, biomedical research—and how that emphasis on certain disease topics versus other disease topics impacts health disparities downstream,” she says. One of the issues that interests McMurry is how funding for different disease issues has been determined over time. “Basically, if you look at the top ten diseases that affect the country by mortality, and look at the top ten spending priorities for the National Institutes of Health, the lists don’t match. If we’re not basing our biomedical research spending on total disease burden, what is impacting the decision? Perhaps there are very valid and useful criteria for setting those top ten spending priorities, but it’s not been very clear. That’s where I want to start. “I see my role as bridging academic research in health policy and population health with policy makers so that we can impact health care spending, general federal spending, and state-level spending on health care and healthrelated issues,” she says. “But there’s a
“I see my role as bridging academic research in health policy and population health with policy makers so that we can impact health care spending, general federal spending, and state-level spending on health care and health-related issues.” McMurry received her M.D. and Ph.D. in molecular immunology from Duke University as part of the NIH Medical Scientist Training Program. While at Duke, her graduate work focused on the regulation of chromatin structure and
disconnect between what policy makers on the Hill, and throughout D.C., need, and what academics produce. I have a background to bring this together, because I have experience with both.”
Research Highlight
New Study Suggests Maternal Diet Linked to Lower Childhood Leukemia Risk A new study led by researchers at the University of California, Berkeley, suggests that women who eat more vegetables, fruit, and foods containing protein before pregnancy may have a lower risk of having a child who develops leukemia, the most common childhood cancer in the United States. The study, published in the August 2004 issue of Cancer, Causes and Control, is the first time researchers have conducted a systematic survey of a woman's diet and linked it to childhood leukemia risk. The researchers compared 138 women who each had a child diagnosed with acute lymphoblastic leukemia with a control group of 138 women whose children did not have cancer. The children of all the women in the study, which is part of the Northern California Childhood Leukemia Study, were matched by sex, age, race, and county of residence at birth. After comparing the women’s diets in the 12 months prior to pregnancy, the researchers found that the higher the intake of vegetables, fruit, and foods in the protein group, the lower the risk of having a child with leukemia. “Fetal exposure to nutritional factors has a lot to do with what Mom eats,” says Christopher Jensen, Ph.D., a nutritional epidemiologist at UC Berkeley and lead author of the paper. “These findings show how vital it is that women hoping to get pregnant, as well as expectant moms, understand that critical nutrients in vegetables, fruit, and foods containing protein, such as meat, fish, beans, and nuts, may protect the health of their unborn children.” The few studies that have been conducted on maternal diet and childhood cancer risk looked only at specific foods or supplements, and results have been mixed. This study is the first attempt to capture a woman’s overall dietary pattern—using a 76-food-item questionnaire—and its relationship to the development of leukemia in a child. Within the fruit and vegetable food groups, certain foods—including carrots, string beans, and cantaloupe—stood out as having stronger links to lower childhood leukemia risk. The researchers point to the benefits of nutrients, such as carotenoids, in those foods as potential protective factors. “This finding is consistent with research about the benefits of a diet high in fruits and vegetables in preventing adult cancers,” says study principal investigator and coauthor Gladys Block, Ph.D., UC Berkeley professor of epidemiology and public health nutrition. “The positive message here is that mothers may be able to transfer some of those benefits to their children.”
One of the more surprising results of the study is the emergence of protein sources, such as beef and beans, as a beneficial food group in lowering childhood leukemia risk. “The health benefits of fruits and vegetables have been known for a long time,” says Block. “What we found in this study is that the protein foods group is also very important.” The researchers looked further and found that glutathione was the nutrient in the protein group with a strong link to lower cancer risk. Glutathione is an antioxidant found in both meat and legumes, and it plays a role in the synthesis and repair of DNA, as well as the detoxification of certain harmful compounds. National guidelines recommend that people eat at least five servings of fruits and vegetables every day, and two to three servings of foods from the protein group. A growing number of scientists believe that genetic changes linked to cancer later in life begin in the womb. Prior studies on children diagnosed with leukemia have found that blood samples taken at birth tested positive for the same genetic markers that were later found in the cancer. “It goes back to the old saying to expectant mothers, ‘You’re eating for two,’” says Patricia Buffler, Ph.D., study coauthor, dean emerita, professor of epidemiology, and head of the federally funded Northern California Childhood Leukemia Study. “We’re starting to see the importance of the prenatal environment, since the events that may lead to leukemia are possibly initiated in utero. Leukemia is a very complex disease with multiple risk factors. What these findings show is that the nutritional environment in utero could be one of those factors.” Other coauthors of the paper are Xiaomei Ma at the Yale University School of Medicine, Steve Selvin Ph.D., at UC Berkeley’s School of Public Health, and Stacy Month of Kaiser Permanente in Oakland, Calif. Funding from the National Institute of Environmental Health Sciences helped support this study. — Sarah Yang Public Health
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Faculty News
Faculty News and Notes Lisa F. Barcellos, Ph.D., assistant
professor of epidemiology, and colleagues at the UCSF Department of Neurology and Roche Molecular Systems in Alameda, Calif., have recently found strong evidence for the involvement of the NOS2A (nitric oxide synthase) gene on chromosome 17q11 in multiple sclerosis (MS), as reported in the June 2004 issue of the Annals of Neurology. Full genome scanning efforts in families with multiple MS patients and follow up studies have identified several genomic regions linked to disease susceptibility, supporting the view that the MS-prone genotype results from variation within multiple independent or interacting genes, each exerting small or moderate effects. Barcellos and colleagues performed a large candidate gene study of 34 genes from inflammatory pathways in well-characterized MS families and observed a strong association with a common variant in NOS2A. In order to further characterize the involvement of NOS2A in MS, Barcellos and colleagues have recently performed resequencing of the NOS2A gene to identify all potential variants in coding and promoter regions. Comprehensive studies of these variants are now underway in large collaborative studies with U.S. (UC Berkeley and UCSF), British, and Swedish MS researchers, involving more than 6,000 individuals. Barcellos presented results from additional analyses of NOS2A haplotypes in three MS datasets at the annual meeting of the American Society of Human Genetics in Toronto, Canada, in October 2004. Also, Barcellos was recently awarded funding from the National Institute of Allergy and Infectious Diseases for “Immuno-genetic Studies in Autoimmune Disease” to study the role of maternal-fetal HLA (human leukocyte 18
University of California, Berkeley
antigen) relationships in susceptibility to three common autoimmune conditions that disproportionately affect women: multiple sclerosis, systemic lupus eryrthematosus, and rheumatoid arthritis.
Michael Bates looked at health effects of amalgam fillings, visible in this x-ray as bright spots.
In the largest study of its kind to date, Michael Bates, Ph.D., M.P.H., adjunct
professor of epidemiology, and coresearchers in New Zealand analyzed 20 years of health outcome data for 20,000 members of the New Zealand Defense Force for whom detailed dental treatment records were available. They focused on the association between dental amalgam fillings containing mercury and diseases of the kidney and the nervous system, the main known targets of inorganic mercury exposure. The study should help to allay concerns that chronic exposure to the mercury in these fillings may lead to kidney disease or chronic fatigue syndrome (CFS), as the researchers found no association. However, the study suggests a possible risk for multiple sclerosis, a finding which will require further exploration. The National Institute of Environmental Health Sciences has awarded an additional $6.7 million to the Northern California Childhood Leukemia Study, directed by Patricia Buffler, Ph.D., M.P.H., dean emerita and Kenneth Howard Kaiser & Marjorie Witherspoon Kaiser Endowed Chair in Cancer Epidemiology. Buffler and colleagues are examining the genetic and environmental influences on childhood leukemia. The International Commission on Occupational Health honored Ralph
Catalano, Ph.D., M.R.P.,
professor of public health at UC Berkeley, and Harvey Brenner of the Johns Hopkins School of Public Health, for their contributions to research into the health effects of unemployment and economic dislocation. The researchers were cited at a September 2004 conference in Bremen, Germany, for their combined half century of intellectual leadership. The two, often characterized as the field’s principal antagonists, made a joint plenary presentation that highlighted not only their disagreements over the last quarter century, but also the convergence in their work. Paul J. Gertler, Ph.D., professor of health services finance at the School of Public Health and professor of economics at the Haas School of Business, has been appointed chief economist in the World Bank’s Human Development Network. Jodi Halpern, M.D., Ph.D., assistant
professor of bioethics in the UC BerkeleyUCSF Joint Medical Program, published “The Partners in Care Approach to Ethics Outcomes in Quality Improvement Programs for Depression” in the May 2004 issue of Psychiatric Services. The study describes an approach to addressing patient centeredness and equity in a randomized trial of quality improvement for depressed primary care patients. The article shows in measurable ways how managed care can serve ethics goals like social justice and patient autonomy. A genetically engineered listeria bacteria based on a strain created by Daniel Portnoy, Ph.D.,
professor of
Faculty News
public health and molecular and cell biology, has led to an experimental cancer vaccine that shows great promise in animal studies, successfully treating new cancers that have spread into the lungs of mice. The mouse study is reported in the September 21, 2004, issue of the journal Proceedings of the National Academy of Sciences by scientists at Cerus Corp. in Concord, Calif., and coauthor Portnoy. Buoyed by the success of the new cancer vaccine, Cerus scientists now are aiming for human trials. Malcolm Potts, M.B., B.Chir., Ph.D., F.R.C.O.G., Bixby Professor of Population and
Family Planning, coauthored “Partner reduction is crucial for balanced ‘ABC’ approach to HIV prevention,” published in the April 10, 2004, issue of the British Medical Journal. The article stresses the importance of partner reduction as a component in approaches to HIV prevention that have primarily focused on abstinence or use of condoms. Arthur Reingold, M.D., professor and
division head, epidemiology, was named to the World Health Organization (WHO)’s Scientific Advisory Group of Experts (SAGE), a committee that advises on all key vaccine-related matters. SAGE was established by the WHO to review, from a scientific and technical standpoint, the content, scope, policies, and operations of both the Children’s Vaccine Initiative and the Global Programme for Vaccines and Immunization. James C. Robinson, Ph.D., M.P.H., professor
of health economics, published “Reinvention of Health Insurance in the Consumer Era” in the April 21, 2004, issue of the Journal of the American Medical Association. The article looks at how the backlash against managed care has caused the private health insurance industry in the United States to change its products and policies. Stephen M. Shortell, Ph.D., M.P.H., Blue Cross of California Distinguished Professor of Health Policy & Management and dean of the School, delivered the Ozmun Lecture Continued on page 20
Three Public Health Faculty Receive Berkeley Citations Three faculty from the School of Public Health were recently recognized with the distinguished Berkeley Citation, which is awarded to individuals or organizations whose attainments significantly exceed the standards of excellence in their fields and whose contributions to UC Berkeley are manifestly above and beyond the call of duty. Leonard Duhl, M.D., professor of public health and urban planning, has radically changed thinking about the concept of health and the role of cities in maintaining or compromising the health of their residents. His early work on this idea, presented in his 1964 book, The Urban Condition, provided the beginnings of the conceptual and strategic frame for the global movement that is today known as “Healthy Cities.” He later prepared the crucial background papers that led to the establishment of the World Health Organization “Healthy Cities” project in Europe. Since that early work, nearly 7,500 “Healthy Cities” projects have been created in countries around the world. Teh-wei Hu, Ph.D., professor emeritus of health economics, has served as a consultant to the World Bank, the World Health Organization, the National Institutes of Health, the Institute of Medicine, the Agency for Health Care Policy and Research, the RAND Corporation, and the Ministry of Health of the People’s Republic of China. Hu had a leading role in reforming the health care system in the People’s Republic of China and helped China establish its first senior executive health systems training program. His specific work on tobacco control through demonstrating the impact of tax policies is likely to lead to thousands of lives saved throughout Asia. Zak Sabry, Ph.D., professor emeritus of public health nutrition, directed the Food Policy and Nutrition Division at the Food and Agriculture Organization, where his vision led to increased investment of resources in the problem of malnutrition in developing countries and to a new emphasis on the relevance of nutrition to national development. He helped set up training and development programs in the Philippines, Egypt, and Australia. Within the United States, he has been the lead investigator on a seminal ten-year multicenter longitudinal study involving the growth and development of African American and Caucasian girls. This study has led to greater understanding of the role of behavior, as well as social and economic factors, in the development of cardiovascular risk factors.
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Faculty News
American Public Health Association Honors Berkeley Faculty The following faculty were among those receiving honors at the American Public Health Association’s annual meeting, held in November 2004 in Washington, D.C.: Barbara Abrams, Dr.P.H., R.D.,
associate dean for student affairs and professor of epidemiology and public health nutrition, received the March of Dimes Agnes Higgins Award for maternal and fetal nutrition research, presented jointly by the March of Dimes and the American Public Health Association (APHA). The award honors individuals who have made substantial contributions in research, education, and clinical services in the field of maternal-fetal nutrition. The award is named for the late Agnes Higgins of the Montreal Diet Dispensary, who advanced the understanding of diet as a crucial factor in healthy pregnancy and prevention of low birthweight. Richard M. Scheffler, Ph.D.,
Distinguished Professor of Health Economics & Public Policy and director of the Nicholas C. Petris Center on Health Care Markets & Consumer Welfare, received the Carl Taube Award for distinguished contributions to the field of mental health services research. Presented by APHA’s Mental Health Section, the award memorializes Carl A. Taube, a longtime staff member of the National Institutes of Mental Health who played a major role in creating the field of mental health services and policy research. Mark van der Laan, Ph.D.,
professor of biostatistics, received APHA’s Mortimer Spiegelman Award. The Spiegelman Award
was established in 1969 and is presented annually to a young statistician for outstanding contributions in health statistics.
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University of California, Berkeley
Faculty News and Notes...continued from page 19 in Management at the Mayo Clinic in Jacksonville, Fla. The title of the lecture was “Crossing the Quality Chasm: Evidence-Based Medicine Meets EvidenceBased Management.” Kirk R. Smith, Ph.D., M.P.H., Brian and Jennifer Maxwell Endowed Chair in Public Health, contributed to a special report, Health Effects of Outdoor Air Pollution in Developing Countries of Asia: A Literature Review, produced by the Boston-based Health Effects Institute (HEI). The report summarizes the current and projected Asian situation with regard to urban population, economy, health, and air pollution. Smith is among those who influenced HEI to extend its research into Asia.
Smith has also worked on a study of babies born to mothers cooking with wood, dung, or straw, which confirmed early reports of an association between household use of biomass cooking fuels and reduced birth weight. Working with an international research team at the East-West Center in Honolulu, he analyzed demographic, socioeconomic, and health information for a random sample of mothers in Zimbabwe who had given birth in the years 1993–98, finding that babies born to mothers cooking with biomass fuel weighed about six ounces less than babies whose mothers were using propane, natural gas, or electricity. The study will be published in the Annals of Epidemiology. Eric Stover, Ph.D., director of the UC Berkeley Human Rights Center and adjunct professor of public health, received an honorary degree in humane letters from Colorado College on September 6, 2004, for his scholarship in the areas of health and human rights, war crimes investigations, and the medical and social consequences of landmines worldwide. Harvey Weinstein, M.D., M.P.H., clinical professor in the UC Berkeley-UCSF Joint Medical Program, coauthored of “Trauma and PTSD Symptoms in Rwanda,” published in the August 4, 2004, issue of the Journal of the American Medical Association. The study assesses the level of trauma exposure and prevalence of post-traumatic stress disorder symptoms and their predictors among Rwandans and demonstrates that traumatic exposure, PTSD symptoms, and other factors are associated with attitudes toward social justice and reconciliation. This is the first study to look beyond prevalence of trauma symptoms after mass violence to see how those symptoms may influence the processes of rebuilding societies.
Faculty News
Meet the New Faculty William H. Dow, Ph.D. Associate Professor of Health Economics “There are many different influences that drew me into health,” says health economist William Dow. “Health is one of the basic human rights that people mention universally as being important, in all different social strata. It’s something that resonates with people throughout the world and that has huge amounts of inequality throughout the world as well.” Dow, most recently an assistant professor at the School of Public Health at the University of North Carolina, Chapel Hill, started at Berkeley as an associate professor in fall 2004. His research areas are health economics, international health, and economic demography. Much of his research focuses on developing countries and underserved and indigent U.S. populations. He has extensive international experience, having studied in the Dominican Republic, England, France, Mexico, Japan, Cote d’Ivoire, and Costa Rica.
Education Ph.D., Economics, Yale University, 1995 B.A., Economics, Cornell University, 1991 Selected Experience Associate Professor of Health Economics, School of Public Health, UC Berkeley, 2004–present Assistant Professor, Department of Health Policy and Administration, School of Public Health, University of North Carolina at Chapel Hill (UNC-CH), 1998–2004; Adjunct Assistant Professor of Economics, Department of Economics, 2004 Faculty Research Fellow, National Bureau of Economic Research, 2002–present
Fellow, Carolina Population Center, UNC-CH, 1998–2004 Fulbright Senior Scholar, University of Costa Rica, 1998 Consultant, RAND, 1997–2000 National Institute on Aging Postdoctoral Fellow, RAND, 1995–1997 Selected Honors John D. Thompson Prize for Young Investigators, Association of University Programs in Health Administration, 2001 8th Annual Keith J. Arrow Award, International Health Economics Association, 1999
“We know that there are huge inequalities in distribution of income within and across countries,” he says. “We see this in health as well, but there are certain conundrums where some poor countries have excellent health. This is one of the things that has always intrigued me.” Dow is studying the case of Costa Rica, where the per capita income and per capita health expenditure are a fraction of that of the United States, “but the life expectancy is the same, or even slightly higher,” he says.
“The merging of different disciplinary groups is crucial to understanding the question of how you produce better health.” “First, what we really need to understand is, do people smoke less, do people have better nutritional habits, is there more physical activity, is there less stress, is the environment somehow better, is there better air quality in Costa Rica? We really don’t know. The next step will be to understand what forces have shaped these risk factors." To obtain the data necessary to test different hypotheses, Dow and colleagues in Costa Rica have begun a new survey, with funding from the Welcome Trust in the U.K. The Costa Rica Healthy Aging Survey is a longitudinal survey that will follow individuals for at least five years. “In addition to the usual socioeconomic data, we are collecting extensive biomarkers of health, and we will be the first developing country survey to collect allostatic load indicators of cumulative lifetime physiological stress,” says Dow. “It’s a multidisciplinary project involving economists, demographers, sociologists, epidemiologists, physicians, et cetera.” “The merging of different disciplinary groups is crucial to understanding the question of how you produce better health,” says Dow. “This is one of the reasons why I find the intellectual environment so attractive within the School of Public Health. Economists have for a long time used the term ‘health production.’ The discipline has much to contribute to thinking about the ecological framework that Berkeley public health has embraced, but at the same time I am excited by the chance to learn from the terrific non-economist colleagues here as well.” The international scope of UC Berkeley was one factor that drew Dow to Berkeley, along with the caliber of the faculty. He will be teaching a master’s level health economics course, a doctoral research methods course, and potentially a doctoral-level health economics course.
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Faculty News
Meet the New Faculty Darlene D. Francis, Ph.D. Assistant Professor of Psychology and Public Health Although she works primarily with rats and mice, Darlene Francis’s work is very much about people. Through her work with laboratory animals, she is examining how a person’s early life environment affects his or her neurobiological development. “What happens early in life really plays a role in wiring your brain, and ultimately, behavior,” she says. “I am looking at how early life regulates who you become, in essence, in adulthood.” As an undergraduate, she worked with mice in a stress lab looking at genetic differences and predisposition to stress. It was there that she fell in love with science and lab work. In graduate school, she continued working in a lab where animal models were used. “We did different things to the animals early in life, let them grow up, and then looked at how they differed in terms of their stress response,” says Francis. However, her real interest was in human beings, and when she began to feel that her work in the lab had little connection to the real world, she left the lab and spent two years as a youth counselor for the Department
Education Ph.D., Neurological Sciences, McGill University, 2000 B.S., Carleton University, 1992 Selected Experience Assistant Professor of Psychology and Public Health, UC Berkeley, starting January 2005 Research Associate, Neuroscience Division, Yerkes Research Center, Emory University, 2003–2004 Postdoctoral Fellow, Center for Behavioral Neuroscience, Emory University, 2000–2003 Student Research, Douglas Hospital Research Center, McGill University, 1992–1994 & 1996–2000
Selected Honors Center of Excellence for Early Childhood Development, award for one of the top ten articles on childhood development, 2003 Health and Emotions, University of Wisconsin, Madison, Scholar Travel Award, 2001 & 2003 International Neuroendocrine Federation Travel Award, 2002 International Society for Developmental Psychobiology, NIH Travel Award, 2001 Cure Autism Now, Young Investigator Award, 2001
of Social Services in Canada. That experience helped reinforce her interest in how early life affects development. “I was working with kids, looking at four- or five- or six-year-old kids whose lives were on completely different paths from the average kids that you see, and I’d wonder what happens so early in life that puts these kids on these paths.” To find answers, Francis returned to the lab, where she discovered she could focus on those kinds of questions, using animal models to undertake research that would not be possible in human subjects. “I got to do the experiments I really wanted to do, using rats and mice, and sometimes monkeys, and have it all be relevant to kids.”
“What happens early in life really plays a role in wiring your brain, and ultimately, behavior.” Much of her research focuses on the interaction between mothers and offspring and how changes to the maternal environment affect the offspring. “We know that maternal stress has an impact on a kid,” she says. “The stress axis of people is not so different from the stress axis of rats and mice. A lot of our work with the animal models shows that if you stress the mother, that pops up in negative effects in the offspring, and we can look at the biological basis for that.” She has also looked at how interventions can compensate for a poor early environment. In rats, an intervention might mean improving the environment through stimulation and social enrichment. “I’ve been able to take animals that would be on this trajectory over here and drag them over there by an environment intervention, and then look at their brains to see the direct effects of what those interventions have done to the biology.” Francis will join the Berkeley faculty in January 2005 with a joint appointment in the School of Public Health and the Department of Psychology. As an assistant professor in the School’s Division of Community Health and Human Development, she will be working closely with the division’s chair, Tom Boyce; together they plan to design a course on developmental programming of behavior. She notes that scientists are often forced to become increasingly focused on one specific area at the expense of the broader view. The School’s ecological perspective and interdisciplinary approach appeal to her because they allow her to look at the big picture. “My interests are much bigger than the research that I do. Funneling and becoming more reduced with respect to what I do is not what I’m looking for—so the School of Public Health is ideal for me,” says Francis. “It’s my dream job.”
— Michael S. Broder 22
University of California, Berkeley
Partners in Public Health
Policy Advisory Council Welcomes Four New Voices
Dean Stephen Shortell recently announced the addition of four new members to the School of Public Health’s Policy Advisory Council, a group established in 1993 for the purpose of advising the dean and supporting the School in its efforts to attain the highest level of quality in professional education, research, and service in all aspects of public health. “We are blessed to have four extremely talented individuals join the council to provide us with both visionary and practical advice as we continue to move the School forward,” says Shortell. Raymond J. Baxter, Ph.D., has earned a national reputation for his work in community health, health systems reform, policy development, and organizational change and strategy. He has worked as an executive, consultant, and researcher within government and in the private sector at state, local, and national levels. He has more than 20 years’ experience managing public health, hospital, long-term care, and mental health programs, including heading the San Francisco Department of Public Health and the New York City Health and Hospitals Corporation. In May of this year, Baxter was appointed interim president for the Kaiser Foundation Health Plan, Inc., and Kaiser Foundation Hospitals for the Southern California Region (KFHP/H). Baxter is also the senior vice president, Community Benefit, for KFHP/H at the national level. Before joining KFHP/H, Baxter led The Lewin Group, a health research, policy, and
management consulting firm headquartered in Washington, D.C. While with The Lewin Group, Baxter directed a national initiative involving stakeholders within the American automotive industry and headed numerous major foundation projects, including the 12-site community tracking initiative of the Center for Studying Health System Change and a multiyear evaluation of the W.K. Kellogg Foundation’s community health grant making. Baxter served on two Institute of Medicine Committees: the Committee on the Safety Net and the Committee on HIV Prevention. In 2001 the School honored Baxter with a Public Health Hero Award for his work while director of the San Francisco Health Department to fight the AIDS epidemic. Baxter serves on the American Public Health Association’s (APHA) California Campaign to Eliminate Racial and Ethnic Disparities Executive Committee, the Advisory Committee for RAND’s “Enhancing Public Health Preparedness” project, and the American Hospital Association’s Ad Hoc Committee on Payment for Health Services. He also is a board member for the Chabot Space & Science Center, the National Public Health and Hospital Institute, Boston College Center for Corporate Citizenship, Iris Alliance Fund, and the California Business Roundtable. As a medical officer with the World Health Organization in the 1970s, Larry Brilliant, M.D., M.P.H., helped manage the smallpox program in India and South Asia. Brilliant was a leader of a team of more than 100,000 workers, which over three years successfully searched out the last cases of variola major, eradicating the last vestiges of the disease. Inspired by this experience, Brilliant and his wife returned to the United States and founded the Seva
Foundation, a nongovernmental international health organization that restores sight to hundreds of thousands of people annually in Asia and Africa. By conducting national surveys of cataract-related blindness and establishing local self-sufficient eye-care hospitals, ophthalmology training programs, and manufacturing plants to produce low-cost interocular lenses, Seva’s projects have made possible more than 2 million operations and restored more sight than any entity in the world. Seva also helps Native American communities develop and implement their own prevention programs to combat the growing diabetes epidemic. In addition, Seva works with indigenous peoples of Chiapas and Guatemala to provide training and resources to help them deliver healthy babies, secure clean water, learn to read and write, and gain economic self-sufficiency. Currently Brilliant is chairman of the Seva Foundation; board member of several nonprofit organizations and technology companies; and a consulting physician epidemiologist with the CDC, for whom he has been a volunteer “first-responder” in the event of smallpox bioterrorism. The School honored Brilliant last spring with its Public Health Hero Award. During the last 30 years he has served the World Health Organization, the National Institute of Health, the CDC, and the White House in many capacities, contributing his expertise in the areas of smallpox, blindness, and AIDS vaccine policy. He has served on the faculties of the University of Michigan and the University of California, Berkeley, and published two books and dozens of articles on international health and the epidemiologies of smallpox and blindness. His broad interests have led to collaborations with eastern theologians, musicians, and political activists. His acumen for technological innovation as the founder of The Well, an early Internet online community, has won him nomination to the Internet Hall of Fame.
Continued on page 24 Public Health
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Partners in Public Health
School of Public Health Policy Advisory Council
Margaret Cary, M.D., M.B.A., M.P.H. (Chair) Deputy Chief Business Officer for VA+ Choice, Veterans Health Administration Raymond J. Baxter, Ph.D. Interim President, Southern California Region National Senior Vice President, Community Benefit Kaiser Foundation Health Plan and Hospitals
John W. Eastman, Ph.D., M.P.H. President, Public Health Alumni Association Lauren LeRoy, Ph.D. President and CEO, Grantmakers in Health Nancy K. Lusk Chairman of the Board, The Lusk Company Martin Paley, M.P.H. Management Consultant
Larry Brilliant, M.D., M.P.H. Founder and Chair, Seva Foundation
Arnold X. C. Perkins Director, Alameda County Public Health Department
Peter F. Carpenter, M.B.A. Founder, Mission and Values Institute
J. Leighton Read, M.D. General Partner, Alloy Ventures
Alfred W. Childs, M.D., M.P.H. Physician
L. James Strand, M.D., M.B.A. General Partner, Institutional Venture Partners
Linda Hawes Clever, M.D., M.A.C.P. Chief, Occupational Health, California Pacific Medical Center, Founder, RENEW Abla A. Creasey, M.P.H. Vice President, Biological Sciences, ALZA Corporation
Kenneth S. Taymor, Esq. Managing Member, Synexis CG, LLC Barbara S. Terrazas, M.P.H. Executive Director, Catholic Charities of the East Bay
Policy Advisory Council...continued from page 23 Martin A. Paley, M.P.H. ‘58, received his M.P.H. in health education from UC Berkeley. He subsequently was active in planning for health services and hospitals in San Francisco and throughout the Bay Area. He was president and CEO of an international consulting organization, which, at the time, was a wholly owned subsidiary of Arthur D. Little, and led the firm in a variety of programand facility-planning projects largely involving medical schools. In 1974, he became director of The San Francisco Foundation with a wide and diversified grant making program involving five Bay 24
University of California, Berkeley
Area counties. When Paley left the foundation, its assets were in excess of $600 million with interests in the arts, education, health, urban affairs, and the environment. Its annual awards approached $40 million. In the early 1990s, Paley went on to manage the capital campaign to furnish the new San Francisco Main Library, raising $30 million in three years. He has served as an adviser on organization and management issues to KQED, Kaiser Permanente, the Alameda County Board of Supervisors, and other nonprofit and governmental agencies. He has consulted with foundations and arts organizations nationally, including the National Humanities and Arts Endowments. Paley has served on the boards of the Independent Sector, the Council on Foundations,
the Graduate Theological Union, the Berkeley Symphony Orchestra, the University of California Press, and the Berkeley Community Fund. He is a longtime resident of Berkeley, where he resides with his wife Muriel, an exhibiting painter. L. James Strand, M.D., M.B.A., has been with Institutional Venture Partners (IVP) since 1986, where he has invested in the life sciences sector first as a venture partner and now as general partner. Prior to joining IVP full-time, Strand was president of Advanced Marketing Decisions, a biomedical marketing and product development consulting company serving pharmaceutical, emerging biotechnology, and device companies. Previously, he was vice president of medical affairs and director of marketing planning at Syntex Laboratories, medical director and chairman of the Product Assessment Committee at Alza, and CEO and director of both DDI Pharmaceuticals and Laserscope. Strand currently serves on the boards of directors of several private companies, including Iconix Pharmaceuticals, Innercool Therapies, and Point Biomedical. He also follows IVP investments in Alere Medical, Dominion Dental, and Idun Pharmaceuticals, and led or represented IVP’s investments in Arthrocare, Aviron, Biopsys, Biometric Imaging, Microcide, Presidium, Prograft, Amira Medical, Orquest, and Accordant Health Services. Strand is board-certified in internal medicine and gastroenterology and is a fellow of the American College of Physicians. He was assistant professor of medicine at the University of Texas Southwestern Medical School in Dallas and has been in private medical practice.
Partners in Public Health
Help Preserve Access to Quality Education
Support the Annual Fund “When I went to the School of Public Health in 1963 and 1964, most of us had U.S. Public Health Service stipends. I received enough to live on and all my fees were paid. Those stipends are no longer available. Nowadays, students have to support themselves while going to school. When I got my degree, I vowed to pay back what I had received. “I think it would be a great tragedy if a student qualified for the School of Public Health, was committed to the public health profession, and couldn’t attend because he or she couldn’t afford it. “Working in the field of health education I have met the finest, most compassionate group of individuals I have ever known. I have made wonderful friends, and we have all supported each other. “Giving to the School is one way I offer this support.” —Rosalind R. “Bobbie” Singer, M.P.H. ’64, health education consultant and contributor to the School of Public Health for nearly four decades
Your tax-deductible contribution to the School of Public Health ensures the viability of valuable School of Public Health programs, such as scholarships and recruitment efforts. Support the future of public health. Give online at https://colt.berkeley.edu/urelgift/public_health.html or mail your gift (payable to the “School of Public Health Fund”) to: University of California, Berkeley School of Public Health External Relations & Development 140 Earl Warren Hall #7360 Berkeley, CA 94720-7360
For additional information about making a gift to the school, call Pat Hosel, assistant dean, external relations and development, at (510) 642-9654.
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Alumni News
President’s Message Dear Colleagues, Welcome, and congratulations to our new alumni from the class of 2004! The class has set a fine example. As their class gift, the graduates made three-year pledges of contributions to the School of Public Health Fund. Matching contributions were provided by the School’s Policy Advisory Council. The members of the alumni board, following the example set by the graduating class, voted at their last meeting that they too would each make a three-year pledge. Not everyone may be aware that the greater the number of alumni who give, the higher the School ranks in some evaluations, and the dollar amount is not always critical. We can hope that this 2004 class pledge will inspire more alumni to participate, even with a small donation. The alumni board addressed several important issues at its summer retreat. New and old board members had an opportunity to meet and exchange thoughts about the board’s future. New members “rolled up their sleeves,” proving they were ready to continue the fine work of their predecessors and tackle the new year’s agenda. We welcome the following new members to the alumni board: Philippa Barron, Lucinda Bazile, Julie Brown, David Harrington, Beth Roemer, Jan Schilling, and Sarah Stone-Francisco.
John W. Eastman
Public Health Alumni Association Board of Directors John W. Eastman, Ph.D., M.P.H. ’80 (President) Carol A. Clazie, B.S. ’62 (Vice President) James H. Devitt, M.P.H. ’77 (Secretary) April Allen Watson, R.D., M.P.H. ’98 (Immediate Past President) Philippa Barron, M.B.A., M.P.H. ’94 Lucinda Brannon Bazile, M.P.H. ’94 Julie Brown, M.B.A., M.P.H. ’85 Brandon DeFrancisci, M.P.H. ’96 David Harrington, M.P.H. ’88 Leslie Louie, Ph.D. ’90, M.P.H. ’85 George A. McKray, M.S., M.P.H. ’57 Lisa Tremont Ota, M.A., M.P.H. ’90 Beth Roemer, M.P.H. ’76 Jan Schilling, M.P.H. ’91 Sarah Stone-Francisco, M.P.H. ’03 John Troidl, Ph.D. ’01
The board of directors formed three small working groups that focused their discussions on different topics. One group discussed alumni participation in School affairs. It recommended that we continue our active participation in the Student Welcome and Career Café, as well as other School events. It also suggested that the board should continue to promulgate the benefits available to alumni, such as the @Cal and School of Public Health web sites. In return, all alumni should be approached for some financial support. We could take advantage of the workplace where alumni may have personal and professional contacts with other Berkeley graduates, not only for fundraising, but also to identify job and internship opportunities. A second group at the retreat addressed multicultural and diversity concerns. The School of Public Health aims high, as does the rest of the Berkeley campus, but achieving the goals is elusive. Goals include increasing the proportion of underrepresented students who apply, are admitted, and matriculate. Some of the objectives proposed to achieve the goals are: to fund a full-time diversity coordinator, to provide more financial assistance and support for applicants and students, and to strengthen community outreach. A third group focused on evaluating the annual performance of the Public Health Alumni Association. Performance indicators, such as the percentage of alumni making an annual gift and the average amount of yearly giving, were examined from year to year. The good news is that for the past three years, the number of participating alumni has been on the upswing. The bad news is that, even in 2003, the percentage of alumni contributing to the School of Public Health was only 12.07 percent. The visibility of the alumni association may be an issue. Some headline feature would help to make the alumni association more conspicuous, like a special scholarship that would have a substantial value. Any thoughts? We’d love to hear from you. You can reach any of the directors by contacting Eileen Pearl, associate director, external relations, (510) 643-6382, phaa@uclink.berkeley.edu. Sincerely,
John W. Eastman, Ph.D., M.P.H. ’80 President, Public Health Alumni Association 26
University of California, Berkeley
Alumni News
Alumnus Spotlight
Peter Szutu, M.P.H. ’81 Suturing up patients at the Ellington Air Force Base in Texas was a routine task for Peter Szutu. True, he wasn’t a doctor—hadn’t even finished college at that point— but, as a medic in the late 1960s, he was called upon to provide, shall we say, a wide range of care. And he didn’t hesitate. With a father who was a distinguished surgeon and a mother who had been a dean of nursing in his native China before his family escaped to the United States, Szutu had been exposed to medicine and medical procedures throughout his youth. After developing his clinical skills at the Air Force outpatient clinic for four years and finishing college in 1972, he looked around for a way to combine his interest in medicine and his desire to bring medical care to many people. He found his answer—and the start of a pioneering career in public health—at the Beach Area Community Clinic in San Dingo, serving the poor and the medically disenfranchised. Community clinic workers had to be versatile in those early, freewheeling days, and Szutu quickly discovered he could run “a fairly good size community-based organization” that had 20,000 visits a year. “I found a different part of myself there,” he says. “Instead of treating one person at a time, I could treat a population.” When Szutu arrived at the School of Public Health in 1979, elderly populations were not on his mind. He intended to get formal training and head right back to his surfers in San Diego. But his path changed when Grey Panther Lillian Rabinowitz, cofounder of Alameda County’s first day health care program for older adults—Community Adult Day Health Services (CADHS)—asked him to serve on the board. His commitment to CADHS took him from board membership to leadership of the organization into which it evolved. Today, Szutu is president and CEO of the Center for Elders Independence (CEI), the first program in the East Bay to incorporate a long-term health care service that enables frail seniors to live at home for as long as medically and socially feasible. Modeled after On Lok, a pioneering health care program in San Francisco’s Chinatown, CEI has grown since the early ’90s to include three centers with more than 360 participants and an annual budget of over $20 million.
“If you can maintain a person’s muscle tone and strength, that person will not fall as frequently. If you can get on that cold before it becomes pneumonia, then you avoid hospitalization. We practice those types of interventions in order to achieve the results we get.” Unlike other nonprofit health care services, which must limit what services can be provided or how long those services can be provided, CEI provides whatever services participants need—from home care to any medical specialist—for as long as they need it. This care is very expensive, but Szutu has built a successful program based on two notso-secret weapons. The first is dedicated interdisciplinary teamwork—involving a full spectrum of specialists, from physicians to nutritionists to transportation personnel.
Peter Szutu
“Our teams meet every morning to discuss the participants they are responsible for,” he says, “and they follow each individual in every facet of their lives, including their environment. If we need to dip the dog—to kill the fleas that cause the lesions that get infected that cause the hospitalization—we dip the dog.” The second weapon is an intense commitment to the principles he learned in the School of Public Health: prevention, maintenance, and early intervention. “If you are able to prevent, then you don’t have to pay the hospital bill,” Szutu says. “If you can maintain a person’s muscle tone and strength, that person will not fall as frequently. If you can get on that cold before it becomes pneumonia, then you avoid hospitalization. We practice those types of interventions in order to achieve the results we get. Our population is the 10 percent-most frail of the Medicare population, yet our inpatient hospital utilization is less than half of the Medicare average. Investing in prevention, maintenance, and early intervention works. It’s not academic. It works.” — Vivian Auslander Public Health
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Alumni News
Alumni Notes 1950s John E. Brockert, M.P.H. ’58 “Retired from Utah Dept. of Health in 1996.”
1960s D.J. Hansen, M.P.H. ’62 “Delightfully retired and an active volunteer with public TV, Red Cross, and Kaiser Permanente.” Bradley E. Appelbaum, M.D., M.P.H. ’64 ”My retirement as maternal and child health medical consultant, U.S. Dept. HHS, in 2002 has allowed me to be more involved in state/ local advocacy programs. I have retained contacts at state MCH programs and am consultant to my former employer, HRSA MCH Bureau.” Hazelle Junker Walker, M.P.H. ’66 “I am living in a retirement center in Scottsdale, Ariz.”
1970s John Avery Palmer, M.P.H. ’71 ”Ordained Episcopal minister; police chaplain, Santa Clara Police Department; 30+ year service awards: Santa Clara County, American Red Cross/ Cancer Society/Lung Association; member (knight) Order of St. John of Jerusalem; knight hospitaller chaplain, Order of St. Luke’s; hospital, AIDS & JAM chaplain.” David B. Crouch, M.P.H. ’73 “Thirty-one years of formulating and managing environmental policy and programs for four multinational resource companies, including five years on Federal Advisory Committee for EPA, chair of National Mining Association Solid Waste Committee, 12 years. Thanks to Bob Spear, Ph.D., for his support and inspiration.” Jack Geissert, M.P.H. ’75, is director of EHS & site services at Wyeth Biopharma in Andover, Mass. Arnold Milstein, M.D., M.P.H. ’75, received the 2004 Keystone Award from WorldatWork, a nonprofit professional association dedicated to knowledge leadership in compensation, benefits, and total rewards. Milstein, the medical director of the Pacific Business Group on Health, received the award in recognition of his efforts to improve health care programs for large purchasers, providers, and government. 28
University of California, Berkeley
Geoffrey F. Cole, M.P.H. ’79, has been named president of Norwalk Hospital, a 366-bed teaching affiliate of the Yale University School of Medicine. For the past 10 years he was president of Emerson Hospital in Concord, Mass., during which time he oversaw the completion of a new cancer center, two satellite facilities and a critical care unit.
1980s Terrie L. Kurrasch, M.P.H. ’80, has been promoted to associate at Ratcliff, an architecture, interior, and planning firm in Emeryville, Calif. She joined Ratcliff from Alta Bates Summit Medical Center in Oakland, where she served as director for implementation. At Ratcliff, her projects include the program and remodel of John Muir Medical Center in Walnut Creek. Ann Sandven, R.D., M.P.H. '81, is currently working as development officer and farmworker outreach manager at Terry Reilly Health Services, Nampa, Idaho. Recent projects include grantwriting to start new primary medical and dental clinics in southwest Idaho, as well as a pediatric overweight community collaborative proposal. Ann de Peyster, Ph.D. ’83, has been named interim director of the Graduate School of Public Health at San Diego State University. Pamela S. Turner, M.P.H. ’83, has written a book, Hachiko: The True Story of a Loyal Dog, based on a Japanese story about a dog who faithfully waited for his owner at a train station years after the owner’s death. Turner became aware of the story when she and her family lived in Tokyo. Julie M. Brown, M.B.A., M.P.H. ’85, recently coauthored Leaders Speak Out on Emotional Intelligence, a summary report from a study on
leadership, emotional intelligence, and personality type. Brown is the principal of Julie M. Brown and Associates, which provides management consulting services in the areas of operational performance improvement and leadership development. She uses her experience as a former hospital CEO to support clients navigating the whitewaters of organizational change. Rhys Jones, M.P.H. ’85, is a senior manager in the Healthcare Consulting Practice at PricewaterhouseCoopers in Tampa, Fla. His current work focuses on implementation issues relating to the Medicare Modernization Act (the prescription drug bill) and helping clients understand and assess its business impacts and opportunities. He also continues working with HIPAA privacy issues and Medicare Advantage health plans. Evelyne de Leeuw, M.P.H. ’86, has accepted a position as head of school at the School of Health and Social Development at Deakin University in Melbourne, Australia. Vivian Lin, Dr.P.H. ’86, is chair of public health and head of school at La Trobe University in Australia. Since arriving in Australia in 1982, she has worked for NSW Health, the Victorian Health Department, the National Occupational Health and Safety Commission, and the Commonwealth Department of Health and Family Services. Shawn E. Chandler, M.P.H. ’88 “I traveled to Addis Abba, Ethiopia, January 2004, to finalize the adoption of Tizibt, my five-yearold daughter. Tizibt’s adjustment to life in the U.S.A. has gone very well.” Irva Hertz-Picciotto, Ph.D. ’89, M.P.H. ’84 “Launched $5 million study of environmental epidemiology of autism as central project in new NIEHS-funded children’s center for environmental health. Also principal investigator of birth cohort studies of PCBs in Slovakia and childhood health in relation to air pollution in Czech Republic. Serve on
Alumni News
EPA’s Science Advisory Board, Board of Scientific Counselors for National Toxicology Program (NTP), and chaired the IOM Committee on Vietnam Veterans and Agent Orange.”
American Public Health Association Honors Berkeley Alumni
1990s
The following alumni were among those receiving honors at the American Public Health Association’s annual meeting, held in November 2004 in Washington, D.C.:
Priscilla Enriquez, M.P.H. ’92, was appointed senior program officer for the Community Technology Foundation of California, which supports community technology for access, equity, and social justice. She is responsible for managing general grants and key initiative programs. Susan Lehrman, Ph.D. ’93, M.P.H. ’79, has been named president of the newly formed Graduate College of Union University. The Graduate College was created this fall from the former Center for Graduate Education and Special Programs at Union College, of which she was dean of graduate education. Stephanie Bender-Kitz, Ph.D. ’97, M.P.H. ’91, her husband and two children have moved to in Boise, Idaho, after seven years abroad. She is cofounder of a new company providing an integrated, multidisciplinary team approach to assisting caregivers with consulting, resources, and advice.
Continued on page 30
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http://sphalum.berkeley.edu
Pat Crawford, Dr.P.H. ’94, R.D., received the Catherine Cowell Award, sponsored by the Food and Nutrition Section of the American Public Health Association (APHA). The award recognizes excellence and achievement in administration, planning, mentoring, and team building in public health nutrition, including meeting the special needs of urban populations and young children. Crawford is codirector of the Center for Weight and Health at the College of Natural Resources at UC Berkeley. Marion Nestle, Ph.D., M.P.H. ’86, received the David P. Rall Award, which is presented to an individual who has made outstanding contributions to public health through science-based advocacy. Nestle received the award for her work to shed light on the impact of food and nutrition policies on the nation’s health. She is Paulette Godard Professor of Nutrition, Food Studies, and Public Health at New York University, the author of Food Politics: How the Food Industry Influences Nutrition and Health, and the 2004 UC Berkeley Public Health Alumna of the Year. Lawrence W. Green, Dr.P.H. ‘68, received the Mayhew Derryberry Award for outstanding scientific contributions to public health education and health promotion. The award is named for former School faculty member Mayhew Derryberry, who established the Division of Health Education in the U.S. Public Health Service and created the Experimental and Evaluation Service before retiring from federal service and coming to Berkeley. Green is currently a visiting professor at the School.
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In Memoriam
“In one lifetime, Bill Reeves both identified a major cause of death and disease in California—western equine encephalitis— and developed mosquito control programs to eradicate it.” —S. Leonard Syme, UC Berkeley professor emeritus of epidemiology and a close friend of Reeves’s for more than 35 years
“The groundbreaking research that Bill and his colleagues did on the St. Louis encephalitis virus—a close cousin to West Nile virus—gave us a roadmap for understanding West Nile virus, helping us to predict how it would behave in North America. His death will resonate throughout the arboviral community.” —Dr. Roy Campbell, chief of the surveillance and epidemiology activity of the Arboviral Diseases Branch at the Centers for Disease Control and Prevention in Ft. Collins, Colo., and a former student of Reeves’s
“He was a giant in his field whose work has had a pervasive impact for over six decades.” —Stephen M. Shortell, dean,UC Berkeley School of Public Health
Alumni Notes...continued from page 29 Steffi Kellam, M.P.H. ’98 “Josh and I are now the proud parents of two beautiful girls—Lucy Caroline was born January 21, 2004. Katie is now almost three and adores her little sister. I would love to hear from EpiBiostat friends.” Karen Sweeney, M.P.H. ’99 “Primary care provider in family practice and women’s health at a community health center serving predominantly Latino-Caribbean immigrants and their families. Also involved in an NIHfunded Latino diabetes prevention project.” 30
University of California, Berkeley
2000s Richard Gosselin, M.D., M.Sc., F.R.S.C., M.P.H. ’01 “I am fortunate to have a finger in many different pies: war surgery with Emergency International and ICRC, orthopedic surgery (mostly for underprivileged children) with smaller NGOs such as Operation Rainbow or Orthopedics Overseas, technical consultancy on a trauma project with the WHO, needs assessment and programmatic evaluation with Handicap International, a research project with the Health and
William C. Reeves, B.S. ’38, Ph.D. ’43, M.P.H. ’49, died September 19, 2004, at age 87. Widely regarded as the world’s foremost authority on the spread and control of mosquito-borne diseases, Reeves was a professor of epidemiology at UC Berkeley’s School of Public Health for more than six decades, headed the School’s epidemiology program from 1971 to 1985, and served as the School’s fifth dean from 1967 to 1971. Reeves distinguished himself early in his career by leading the research team that in 1941 isolated both western equine and St. Louis encephalitis viruses from a species of mosquito called Culex tarsalis. This discovery confirmed for the first time that these viral diseases, which had been plaguing the western United States throughout the 1930s, were transmitted by insects. Public health officials
Conflict section of the London School of Hygiene and Tropical Medicine Health Policy Department, co-writing a chapter on the economics of surgical interventions in the developing world for a World Bank/WHOsponsored textbook, and even the occasional lecture at the School of Public Health.” Victor Chen, M.D., M.P.H. ’03 “I decided in mid-December to return to Modesto, Calif., where I took a position with the faculty group of the family practice residency program in which I had trained. I was looking
infected mosquitoes are in the vicinity. The system has since been copied throughout the world and is used today in some areas to monitor the spread of West Nile virus. Throughout his career Reeves discovered several new species of insects and is credited with coining the term arbovirus, short for “arthropod-borne virus,” a name eventually accepted by the World Health Organization. Reeves officially retired in 1987 but continued to actively advise from his campus office, participating in recent years in conference calls that the Centers for Disease Control held with state health departments. When West Nile virus emerged as a new public health threat, Reeves became an invaluable resource for public health officials, many of whom were his former students.
Reeves with his wife, Mary Jane.
were then able to effectively target a key source of disease transmission.
study the mosquitoes’ life cycles, including how far they travel, how long they live, and other critical information used to design and evaluate mosquito control programs.
One of only a few entomologists working in a field dominated by medical specialists, Reeves went on to isolate more arthropodborne viruses and developed numerous innovations. With his knowledge of what attracts mosquitoes to animals, Reeves designed the first method to trap live mosquitoes by using carbon dioxide and light. He also invented a way of tracking mosquitoes by marking them with a fluorescent dust, which has enabled researchers to
One of the more notable innovations established by Reeves was the now-famous “sentinel chicken” disease monitoring system. Reeves discovered that chickens develop antibodies after being bitten by infected mosquitoes, but they do not become ill nor carry enough of the virus to further transmit the disease. Because chickens are kept in one place, positive blood test results mean
for an opportunity where I could be involved with resident teaching, practice medicine in a community-based setting, the local public health department and the surrounding community. Currently, I’m based in West Modesto in one of seven county clinics….Our clinic gets strong community support, and we have the opportunity to not only develop a working model of community-oriented primary care, but to serve as a resource and active participant in the West Modesto community.”
Glenn Kan, M.D., M.B.A., M.P.H. ’03 “I am a preventive medicine resident with the California Department of Health Services (CDHS) and am in the home stretch of my practicum year….I was placed in a CDHS agency, the Office of Clinical Preventive Medicine, and in the Yolo County Health Department. In addition to getting exposure to a broader variety of projects with this state-county mix, seeing the dynamics that occur between the two levels of government with regard to particular
Reeves is survived by his wife and three sons, and an extended family that includes four grandchildren and one great-granddaughter. Donations in Reeves’s memory can be made to the William C. Reeves Memorial Fund for Students and mailed to the Office of External Relations, UC Berkeley School of Public Health, 140 Warren Hall, Berkeley, California, 94720-7360. Gifts can also be made online at https://colt.berkeley.edu/ urelgift/public_health.html.
topics was particularly interesting…My placements have been both complementary and skill broadening.” Deborah S. Edelman, Dr.P.H. ’04, started a postdoctoral research fellowship position at Johns Hopkins’ Bloomberg School of Public Health this past summer. She is continuing her research on the role of media in public health, focusing now on Youth Radio.
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In Memoriam Faiga Fram Duncan, B.A. ’34, M.P.H. ’59, died in April, 2004. One of the first students in UC Berkeley’s Department of Hygiene (the forerunner of today’s School of Public Health), Duncan’s career included work in Sydney, Australia, and at San Francisco General Hospital. A dedicated alumna, she shared a case-based curriculum module with the School based upon her experiences working with TB patients, pregnant undocumented immigrants, and counties that shirked care for the indigent. Recalling her own financial hardships at Berkeley during the Great Depression, Duncan proved a tireless volunteer for the School, participating in annual telephone fundraising campaigns, recruiting volunteer callers, and personally making more than 500 calls. She coordinated class reunions and sought employers to participate in the School’s annual career fair. In 1987 the California Alumni Association and the UC Berkeley Foundation presented Duncan with the Trustees Citation recognizing her as one of the campus’s 25 most active and supportive alumni. Jiann-Ping Hsu, Ph.D. ’77, an internationally known scholar and scientist in biostatistics, died February 9, 2004, at age 56, after a long battle with cancer. She is survived by her husband, her parents, and four sisters. Born in mainland China in 1947 and educated in Taiwan, Hsu was a scholar of mathematical sciences, earning a B.S. in mathematics at the National Taiwan University, an M.A. in mathematical statistics at Columbia, and a Ph.D. in biostatistics from UC Berkeley. She served with the Food and Drug Administration and sat on review panels for clinical trial grant applications for the National Institute on Drug Abuse. Hsu held research positions with leading pharmaceutical firms and became president of the Michigan-based Biopharmaceutical Research Consultants, Inc. Honored with many professional awards, she mentored and trained more than 60 biostatisticians. In January of 2004, the Jiann-Ping Hsu School of Public Health at Georgia Southern University was established and endowed in her name by
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University of California, Berkeley
her husband, Dr. Karl E. Peace, director of Georgia Southern’s Center for Biostatistics. It is the first school of public health in Georgia’s university system. Peace has also established the Jiann-Ping Hsu Biostatistics Award for Excellence at UC Berkeley’s School of Public Health. Lola E. Reshetko, B.A. ’54, M.A. ’55, died July 8, 2004, at the age of 71. Born in Harbin, Manchuria, she immigrated with her family to San Francisco in 1940. Reshetko spent much of her career teaching science at Mission High School in San Francisco, where she developed a program with local hospitals called “Mission Possible,” which offered students actual experience working in the medical field. She was also an active fundraiser for “Close Up,” a program that sponsored student visits to Washington, D.C. She is survived by her cousins, George McKray of Alameda, Calif., and Boris Fedushin of New York City; and the family of her partner, the late Col. Charles Kay. Reshetko’s belief in the potential of students inspired her to establish an endowment supporting scholarships in both the School of Public Health and the College of Letters and Science at UC Berkeley. Gifts in her honor may be made to the Reshetko Family Scholarship Fund, Office of External Relations & Development, UC Berkeley School of Public Health, 140 Warren Hall, Berkeley, CA 94720-7360. David Clement Riese, B.S. ’61, M.P.H. ’68, died July 19, 2004. Born and raised in Martinez, Calif., he earned his bachelor’s degree in business administration from UC Berkeley, then joined the U.S. Army Reserve at Fort Ord in
Monterey. After six months of active duty he went to work for the California Department of Health in 1961, taking a leave of absence in 1968 to earn his M.P.H. Riese and his wife, Mary Huntley Riese, both worked for the Department of Health, first in Berkeley and then in Sacramento, until their retirement in 1996. During his career with the Department of Health Services, Riese played an instrumental role in the creation and development of many of the state’s health programs, including the Tobacco Control Program, Breast Cancer Program, Preventative Health Care for the Aging Program, Cancer Surveillance Section and the California Cancer and Nutrition “5-A-Day” Campaign. His final position was as deputy chief of the Cancer Control Branch. Riese is survived by his wife, his sisters-in-law and brother-in-law, and many nieces and nephews. Hedwig G. Taylor, widow of Professor Emeritus Keith O. Taylor, died July 3, 2004. She was as an avid reader who enjoyed lawn bowling, painting, and playing Scrabble. The Taylors were generous planned giving supporters of the UC Berkeley School of Public Health. Veva Jeanne Winkelstein, wife of Professor Emeritus Warren Winkelstein, Jr., died September 15, 2004, at the couple’s home in Point Richmond, Calif. She loved travel, her garden, music, opera, theatre, and the arts. She was active locally in the University Section Club and The McInnis Park Women’s Golf Club and served on the board of the Pt. Richmond Masquers Playhouse. She had a successful career working for the University of California (San Diego, Berkeley, and San Francisco campuses). In addition to her husband of 30 years, Winkelstein is survived by her five children, three stepchildren, two sisters, and 13 great-grandchildren.
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Gift annunities Offer Stability In Uncertain Economic Times
Are you interested in finding an investment that will give you a fixed and healthy return?
A gift annuity offers the following benefits: • A current income tax deduction; • Avoidance of capital gains tax for gifts of appreciated property; • A fixed income for life—rates as high as 11.3 percent (deferred payment annuities offer even higher rates); and
Charitable gift annuities do just that. In exchange for a gift of cash or other property to the School of Public Health, you or the person of your choice will receive an annuity that pays a fixed amount of money for life.
• The knowledge that your gift ultimately will support the School of Public Health. For more information, contact the Office of Planned Giving at (800) 200-0575 or (510) 642-6300.
Cal Futures Annuity Rate Charts Two-Life Charitable Gift Annuity Rates
Single-Life Charitable Gift Annuity Rates
Single-Life Deferred Payment
Spouse 1
Spouse 2
Payment Rate
Age
Payment Rate
Current Age
1st payment age
Rate
60 65 70 75 80 85 90 95 and over
60 65 70 75 80 85 90 95 and over
5.4 5.6 5.9 6.3 6.9 7.9 9.3 11.1
60 65 70 75 80 85 90 and over
5.7 6.0 6.5 7.1 8.0 9.5 11.3
50 50 55 55 60 60 65 65
55 60 60 65 65 70 70 75
7.0 9.3 7.3 9.8 7.6 10.6 8.3 11.5
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University of California, Berkeley School of Public Health 140 Warren Hall #7360 Berkeley, CA 94720-7360
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The School Welcomes the Entering Class of Fall 2004
Alumni share lunch with entering students at the student welcome picnic, held August 24 outside Warren Hall.
This fall 203 new graduate students entered the School of Public Health, representing a wide range of backgrounds and academic interests. The new class comprises 154 women and 49 men, ranging in age from 21 to 60 years old. There are 156 students working on M.P.H. degrees (13 of whom are in concurrent or joint degree programs); 7 working towards an M.A. or M.S.; 10 students in the Dr.P.H. program; and 30 Ph.D. students.
203 graduate students
From 20 states and 17 countries
The students hail from 20 states (Arizona, California, Colorado, Connecticut, District of Columbia, Florida, Illinois, Indiana, Maryland, Massachusetts, Michigan, Minnesota, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Virginia, Washington, and Wisconsin) and 17 countries (China, Colombia, Germany, Great Britain, India, Israel, Ivory Coast, Japan, Korea, Kyrgystan, Mexico, Nepal, Nicaragua, Spain, Taiwan, Thailand, and the United States). Ages 21 to 60
49 Men
In addition, the School’s newly reinstituted undergraduate program is growing in popularity: 140 upper division undergraduate students have declared a major in public health. 154 Women
gloss coating