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Several weeks ago, the Harvard School of Public Health celebrated its Centennial with fanfare, fundraising and a panel discussion featuring world health leaders who are graduates of the school. Following the centennial, NewPublicHealth spoke with the School’s Dean, Julio Frenk, MD, MPH, PHD, who has a joint appointment at the Harvard Kennedy School of Government. He is also a former health minister of Mexico and a former senior fellow in the global health program of the Bill and Melinda Gates Foundation.
NewPublicHealth: What do you think have been the key changes in public health efforts since the Harvard School of Public Health was founded 100 years ago?
Julio Frenk: The 100 years that have passed since the School of Public Health was founded are not just any 100 years—they’re the 100 years with the most intense transformations in health in human history. We have seen a more than doubling of life expectancy since the school was founded. Around 1900, the global average for life expectancy was 30 years. At the end of the century, the global average was about 65 years. It more than doubled in the 20th century, and that increase has continued with some setbacks, most notably the AIDS epidemic in Saharan Africa. And we have had a qualitative shift not just in the level of mortality, but in the causes of death. So we went from a preponderance of acute infections to now a predominance of mostly chronic non-communicable diseases, and that’s an incredible transition.
A critical change is that the experience of illness became very different starting from the beginning of the 20th century. Before then, illness was mostly a succession of acute episodes, from which one either recovered or died. If you recovered, you went on to get your next acute illness. Now, illness is more a condition of living. People live with cancer. People live with AIDS. So that’s a big transformation of the patterns of health, disease and death.
Another big change is the emergence of complex health systems, and that’s—again—a process that started at the beginning of the 20th century. Before the 20th century, the social function of the sick was mostly trusted to undifferentiated institutions, such as the family or religious institutions, and it’s not until the 20th century when you see this incredible explosion of specialized institutions and specialized human resources, doctors, nurses and other health professionals. In the 20th century, healthcare is 10 percent of the global economy and employs millions of people, including eight million doctors. These are all profound transformations.
NPH: How has the training of students of public health changed in the last 100 years?
Frenk: There has been profound change. What happened at the beginning of the 20th century was the emergence of public health as a field of action. The practices of engineering emerged in Europe, especially with the rapid urbanization there starting around the 17th century, but then greatly expanded in the 18th century. Engineering allowed for access to clean water and taking care of waste, which resulted in some diseases coming under control. In the 19th century the discovery of microbiology gave rise to the abolishment of the germs as causes of illness. That is the junction that gives birth to public health, along with the idea of social policy, of social activism that actually changed social conditions. It’s in that mix that public health gets shaped.
The Association of Schools and Programs of Public Health (ASPPH), like the American Public Health Association, held its annual meeting in Boston last week. NewPublicHealth spoke with Harrison Spencer, MD, MPH, executive director of the ASPPH, from Boston about the meeting and what’s ahead for students of public health.
NewPublicHealth: How was the meeting and what were some of the key sessions?
Harrison Spencer: Our meeting this year was the first one held since we formed our new organization, the Association of Schools and Programs of Public Health, on August 1. The new organization is now comprised of all accredited public health academic institutions, both schools and programs. We’ve got 93 members now, an increase from 57 members before, so this was a wonderful and exciting and dynamic annual meeting with lots of energy and lots of promise.
Among the highlights were Harvey Fineberg, MD, PhD, president of the Institute of Medicine, who gave us an inspirational talk about public health leadership, and Laura Liswood, Secretary General of the Council of Women World Leaders, who led a discussion on diversity as a way to make organizations and institutes stronger.
Add flu surveillance to the list of casualties of the current government shutdown.
Every flu season, states collect data on flu cases — including case reports and viral specimens — and send those to the Centers for Disease Control and Prevention (CDC) in Atlanta for recording and tracking. That tracking is critical in order to:
- provide information on how well-matched the seasonal flu vaccine is to the flu viruses found in the community;
- identify severe outbreaks that require increased supplies of antiviral medicines for people who contract the flu; and
- identify emerging strains that might require a new vaccine to be developed this season, which is what happened several years ago when CDC identified the H1N1 influenza virus toward the end of the flu season, and quickly ramped up for a new vaccine.
Flu season generally runs October through April, with the peak from about January to March. If the shutdown continues then, “as the flu season goes on, our knowledge of what’s happening will be impaired,” says William Schaffner, MD, Professor of Preventive Medicine and Infectious Diseases, Vanderbilt University School of Medicine, and the immediate past president of the National Foundation for Infectious Diseases.
CDC director Thomas Frieden, MD, MPH, underscored his concern in a tweet on the first day of the government shutdown: “CDC had to furlough 8,754 people. They protected you yesterday, can't tomorrow. Microbes/other threats didn't shut down. We are less safe.”
A constant theme of this year’s Keeneland Conference is the emergence of the discipline of public health systems and services research (PHSSR) from strict research and evaluation to results that are beginning to be used by public health departments and agencies. So who better a dinner speaker than Joe Selby, MD, MPH, head of the Patient-Centered Outcomes Research Institute (PCORI), authorized by Congress under the Affordable Care Act. PCORI’s role is to conduct research and provide information about the best available evidence to help patients and health care providers make more informed decisions. The Institute's goals include:
- Substantially increase the quantity, quality, and timeliness of useful, trustworthy information available to support health decisions.
- Speed the implementation of patient-centered knowledge into practice.
- Influence clinical and health care research funded by others to be more patient-centered.
NewPublicHealth spoke with Dr. Selby about PCORI’s work so far and the critical goal of disseminating scientific research to improve health.
NewPublicHealth: Tell us about your talk at the Keeneland Conference.
Dr. Selby: I’ll start by talking about the historical trends that led to PCORI’s formation. I think that these trends are bringing what we do, which is called comparative clinical effectiveness research, together with quality improvement and with public health systems and services research. There is a convergence of interests between what the conference attendees do as public health practitioners and public health researchers and systems-based researchers and what the quality improvement world is doing and what we’re trying to do at PCORI. There are many common bonds and a new appreciation for that.
It has suddenly dawned on everyone that you’ve got to put your patients or, in the case of public health, your communities, at the center of the research activity. And I know that in the public health world, they are involving communities and patients within communities and clients and consumers in their planning and intervention activities. That is one of the bonds that ties us together and that leads to enhanced productivity whether we’re doing clinical research like PCORI does, whether we’re doing quality improvement, or whether we’re doing public health.
Inspired by the American Public Health Association Annual Meeting, all week we've been talking with national health leaders and highlighting promising strategies to improve our nation's health and health care.
>>View the full package of thought leader interviews, video conversations with leaders from across sectors, and more at RWJF.org/futureofhealth.
Now we want to hear from you on what’s needed—and what works—to achieve better health. Share your stories from the field, ideas or even the critical questions we need to be asking to achieve a healthier future.
To join the conversation, add your thoughts in the comments section below.
To get your ideas flowing around the future of health and health care, read more on:
Reversing the Trend of Childhood Obesity. Read a Q&A with Jessica Donze Black of the Kids’ Safe & Healthful Foods Project on a new report looking at snacks sold in secondary schools. Also find updates on a new Yale Rudd Center for Food Policy & Obesity study on parents’ attitudes about food marketing to children, and more.
Reducing Violence in Communities. Read a Q&A with Debbie Lee from Start Strong on preventing teen dating violence and a discussion with Sheila Regan of Cure Violence on partnering with hospitals for violence prevention.
Preparing and Responding to Disasters. Read discussions spurred by Hurricane Sandy, including about the role of public health as well as legal issues around orders to evacuate in an emergency.
Harnessing the Potential of Big Data. Read updates on how Big Data can change the landscape of public health, including a conversation with Farzad Mostashari, National Coordinator for Health IT, as well as Q&As and video interviews with other innovators and thought leaders.
Improving Health Equity. Read stories from the field and interviews with leaders on efforts to ensure everyone—regardless of race, ethnicity, income or zip code—has access to the resources they need to be healthy, including a diverse and representative health public health workforce.
Working Across Sectors to Improve Health. Read stories from the field and big ideas for bridging across sectors from thought leaders, including conversations with The California Endowment President Robert Ross and new APHA president Adewale Troutman.
Don't forget to share what YOU think will make for a healthier future in the comments below!
"Information is the oil of the 21st century, and analytics is the combustion engine.” - Peter Sondergaard
That was a quote from panel at APHA 2012 on how new data mapping tools can help support health departments and vulnerable population. Taking a look at everything from local health department budget cuts and their effect on vulnerable populations to how “big data” has implications for public health trends, the panel made an effective argument for the fact that mining data sets has increasingly important ramifications for the public health field and practitioners.
“We’re gonna get technical,” warned Matthew Dollacker of CSC, during his presentation. “But we can come away with a real appreciation for a fundamental shift that is taking place through what big data technology can do.”
>>Read related thought leader conversations on harnessing the power of Big Data:
- Read a conversation with Farzad Mostashari, National Coordinator for Health Information Technology at the U.S. Department of Health and Human Services.
- Read a Q&A with Thomas Goetz, Executive Editor of WIRED Magazine.
- Watch a video interview with Reed Tuckson, Executive Vice President of UnitedHealth Group.
Dollacker pointed out that today, we’re in a new era of data. Users posts about 2,200 tweets per second to Twitter, and conduct 1.6 billion searches today. Originally, decoding the human genomte took 10 years to process – today, it can be achieved in one week.
At the Health Data Initiative III: The Health Datapalooza this summer, which looked at the role health data plays in transforming health and health care, the Robert Wood Johnson Foundation (RWJF) announced the three winners of an app challenge calling for developers to create applications that would allow consumers to easily access and make use of comparative information about the quality of care provided in various regions of the country. The data behind the apps came from Aligning Forces for Quality, the Foundation’s initiative to improve the quality of health care in 16 targeted communities.
John Lumpkin, MD, MPH, senior vice president and director of the Health Care Group at RWJF, presented the awards to the top three winners of the challenge. Recently, NewPublicHealth spoke with Dr. Lumpkin about the explosion of health care data, and how to find the strongest data and use it well.
NewPublicHealth: Quantities of health data are increasing at a speedy clip. What kind of challenge does that pose in order to make sense of the numbers?
Dr. Lumpkin: In a single day there are over 300 million photos that are being posted on Facebook, and 3.2 billion likes and comments. We have 115,000 people participating in web sites such as Patients Like Me and about 9 million tweets each day. So we have all this data, but how do we access it in ways that make it meaningful? Kerr White, MD, the chairman for the U.S. National Committee on Vital and Health Statistics once said: “With the advent of new technology, data can be collected in any format, aggregated by the computer and arrayed in any desired output…untouched by human thought.” And so our challenge is to present it in a way that we actually have it touched by human thought.
Some good examples of this would include the County Health Rankings and the Aligning Forces for Quality Initiative where we have coalitions of consumers, purchasers and providers who, through public reporting of quality and price information and consumer engagement, we encourage to adopt quality improvement methods and use the data in ways that move that process forward.
NPH: Does everyone mean the same thing when they talk about “evidence-based” data?