Category Archives: Public health schools
Future of Public Health is an ongoing series focused on the emerging faces in the world of public health. We spoke with Erin Yastrow, a Bachelor of Science in Public Health candidate at the Tulane University School of Public Health and Tropical Medicine, about what helped lead her to the field, her work as a leader in Tulane’s undergraduate student government and where she hopes to go from here.
NewPublicHealth: What encouraged you to pursue a degree and career in public health?
Erin Yastrow: I’ve always been interested in the field of health. I was actually thinking about going into nutrition when I first started looking at undergraduate schools and I had a family friend at one school who had worked in nutrition, but then ended up working at the School of Public Health. When I met with her, she encouraged me to pursue public health with an emphasis on nutrition because it would give me more opportunities. From there, I started my exploration into what public health was and I realized how interesting and fascinating it was and how it was applicable to so many more areas besides just nutrition.
In the meantime, I had also applied to Tulane. I wasn’t really considering it that much because I didn’t know that much about it. My mom was looking through their brochure and told me that they have a great public health program. So, I started looking and I realized how established the Bachelor’s and graduate programs were. They also had an option where you could pursue a combined degree and it was really appealing to me.
NPH: Are you pursuing a Master’s as well?
Yastrow: Not currently, but I’m actually attending Johns Hopkins next year for a Master’s in Public Health. Tulane does have a really great program where you can do a combined degree with your Bachelor’s and Master’s. Part of my undergraduate core, which has now changed, included taking five graduate classes, so I took some classes at that School of Public Health here.
NPH: Within the field of public health, what are your primary interests and why?
Yastrow: That has also sort of shifted as I’ve learned more about public health. As I mentioned, I started out really interested in nutrition and obesity prevention. As I took more electives and did some internships, I became more interested in the similar patterns of risk factors that exist in obesity and other epidemics that aren’t always considered to be health problems, such as violence. That has developed into an interest about addressing inequalities in health and the social determinants, such as socioeconomic status, education and race and how those, to me, are unjust reasons that people are more likely to develop further health conditions.
Louis W. Sullivan, MD, former U.S. Secretary of Health and Human Services under President George H.W. Bush, recently wrote a memoir, Breaking Ground: My Life in Medicine, that offers a wide view of Sullivan’s experiences as a medical student in Boston, the founding dean of the Morehouse School of Medicine in Atlanta and as the country’s chief health officer. NewPublicHealth recently sat down with Sullivan to discuss the book and his thoughts on the history and future of improving the nation’s health.
NewPublicHealth: Looking back, what can you share about the highlights of your career in medicine and health promotion?
Louis Sullivan: Highlights would certainly include my time at the Boston University School of Medicine. That had many significant points. It was my first time living in an integrated environment because up until that time I spent all of my life in the South. Working in an environment without concerns about discrimination and bias, that was a great experience; my classmates and the faculty at Boston University were all welcoming.
Another highlight was later when I was a research fellow in hematology in the Harvard unit at Boston City Hospital. I had a paper accepted for presentation at a major research conference in Atlantic City. It was a paper showing that heavy drinking suppressed the production of red blood cells by the bone marrow.
And of course a tremendous highlight was going back to Morehouse College, my alma mater, to start the Morehouse School of Medicine. I was returning home in a sense. I had gained experience as a faculty member at Boston University, had been steeped in medicine and now I was in the process of establishing a new institution to train young people for the future.
NewPublicHealth: What changes have you created and supported to improve population health.
Sullivan: Well, certainly becoming Secretary of Health and Human Services was indeed an honor and a great opportunity for me, and it was also a very challenging experience.
In the late ‘80s, when I became Secretary, AIDS was a new disease. There were many demonstrations by various advocacy groups, groups that didn’t trust the government, and we had to work to develop a relationship with them. I convinced President Bush to put $1.6 billion in his budget to be used for research on this new disease, to develop mechanisms for treating the disease and to educate the public. And as a result of that initial investment and ones that followed, this disease has been transformed from a virtual death sentence to a chronic disease which is controlled by medication. And people, rather than living a few months, which was the case once the diagnosis was made in 1989, are now living for decades with the virus suppressed on medication, raising their families, working, earning wages, paying taxes. So that has been really a very satisfying outcome from that experience. And we hopefully are close to finding a cure for this disease as well.
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.
The celebrations earlier this month for the Harvard School of Public Health’s centennial included galas, world leaders and a $450 million fundraising campaign, about a third of which is already completed.
But the most poignant moments may have been watching former graduates, many who are now in key health leadership positions across the globe, in quiet conversations with current students, answering questions about how to get the most out of their time in Boston to help improve population health when they hit the field. Kelechi Ohiri, MD, senior adviser to the Nigerian Ministry of Health, who got his Harvard Master of Public Health eleven years ago, sat out some of the formal Centennial lunch to speak to a current student from his country whose excitement at meeting Nigeria’s top health official bubbled over.
“Meeting him makes me believe I’ll be able to use what I’m learning to help make a difference at home,” she said.
Ohiri said that a critical focus should be “networking to improve skills and create contacts,” which he said is often underutilized by students of public health, and contrasted that with networking as an “explicit goal” of the Harvard MBA program.
Several graduates who are now world health leaders convened for a panel discussion moderated by Institute of Medicine President Harvey Fineberg (who received all his degrees, including his MD, from Harvard) about their experiences in the field of public health. In addition to Ohiri, participants included:
- Gro Harlem Brundtland, MPH ’65, the former Prime Minister of Norway and former Director-General of the World Health Organization
- Suraya Dalil, MD, MPH ’05, the Minister of Public Health of Afghanistan
- Howard Koh, MD, a former professor at the Harvard School of Public Health and currently the U.S. Assistant Secretary for Health
- Pradit Sintavanarong, MD, MPH ’89, the Minister of Public Health of Thailan
Public health institutions across the country are joining the 10.5 million users on the virtual pinboard website, Pinterest, to share important health information and images. Topics such as women’s health, healthy living, emergency preparedness and public health history are a few of the boards on the CDCgov page. Harvard School of Public Health focuses more on healthy eating, recommended readings and inspirational quotes. Users are able to categorize topics and pictures anyway they want, allowing every institute’s page to be unique.
Users of the online scrapbook view content, “re-pin” photos to their pages, add comments to images and “like” user’s content. Pages encourage users to leave comments on the images that they like most or would like to see more of. Pinterest is the third-fastest growing social network, with 80 percent of users being women and 50 percent mothers, according to TechCrunch. The site is another way for public health professionals to stay at the center of the public health conversation and interact with their key audience on the most recent public health issues. The dissemination of information continues to grow as more people participate in the sorting, collecting and sharing of public health information.
Take a look at some of the other public health institutions that are joining Pinterest: American Public Health Association (APHA), Ohio State's College of Public Health and Association of Public Health Laboratories (APHL).
A major theme at this year’s AcademyHealth Annual Research Meeting was the need to become more aggressive on translating and disseminating health research. Just last month, the Mailman School of Public Health at Columbia University announced that is was becoming the first school at the university and one of the first of U.S. schools of public health to adopt an open access resolution. The resolution calls for faculty and other researchers at the school to post their papers in openly available online repositories such as Columbia’s Academic Commons, where content is available free to the public, or in another open access repository, such as the National Institutes of Health’s PubMed Central.
“A wider dissemination of research and information has been a number one priority of our faculty, who are motivated by the belief that scientific knowledge belongs to everyone,” said Linda P. Fried, MD, MP, the dean at Mailman. “It is in the interest of all of us to take every measure possible to improve and simplify the process of gaining access to our research findings,” Fried said.
NewPublicHealth spoke with Bhaven N. Sampat, PhD, Assistant Professor of health policy and management at Mailman and a lead faculty member on the open access endeavor.
NewPublicHealth: Why haven’t many journals been open access before and what is making researchers, particularly in the field of public health, interested in more widely disseminating their research?
“Death is an inevitable part of life. But death from preventable causes like cervical cancer, early heart disease, or gun violence is a tragedy. Whether expressed in dry, cold numbers or by the images of first graders smiling at the camera for their school picture, these tragedies will continue to motivate us to use both left-brain science and right-brain passion to improve human health and prevent unnecessary death.”
That paragraph is from the foreword by Michael Klag, MD, MPH, dean of the Johns Hopkins Bloomberg School of Public Health (JHSPH) in the current issue of the school’s magazine. The issue is devoted to how public health researchers and practitioners probe, investigate, understand and fight death.
The full issue is well worth reading. A few notable pieces include:
- An interview with Vladimir Canuda Romo, PhD, a demographer and assistant professor at the school who says his research shows American life expectancy is on the rise.
- A critical article on making palliative care a public health issue.
- A summary of a recent forum at the school on dealing with gun violence.
- A piece on prescription drug abuse, which the author calls the “biggest public health issue you’ve never heard of."
Perhaps most poignant are a collection of essays by JHSPH alumni including a thoughtful look at the last minutes of a deer.
>>Bonus Link: In a new book, Happier Endings , Erica Brown, PhD, the scholar in residence at the Jewish Federation of Greater Washington, tells her readers: “we are all going to die, but some of us will die better.” The book, which Dr. Brown calls “a meditation on life and death,” looks at the deaths of several people and shares intimate details of last months, last weeks, last seconds—sometimes peaceful, sometimes not. It’s an important reminder that communities and populations, the building blocks of public health, are made up of individuals who are loved, and missed when they pass away, and that death is indeed a public health issue worth attention.
Just several weeks after Hurricane Sandy hit the New York City area, New York State Governor Andrew Cuomo appointed Irwin Redlener, MD, director of the National Center for Disaster Preparedness at Columbia University’s Mailman School of Public Health, to co-chair the New York State Ready Commission. The role of the Commission is to determine ways to ensure that critical systems and services are in place to respond to future natural disasters and other emergencies.
The specific areas for which the commission was asked to make recommendations include:
- Addressing vulnerabilities in the state’s health care, energy, transportation, communications and other systems
- Ensuring that new, modified and existing construction is resilient
- Ensuring the availability of adequate equipment, fuel, food, water and other emergency supplies
- Ensuring that first responders and other critical personnel are able to communicate efficiently and have access to adequate resources
- Ensuring the availability of reliable real-time information for decision-makers
- Ensuring that lines of authority are clear and officials have the authority to react rapidly to emergency situations
Both the Ready Commission and the 2100 Commission, which was tasked with finding ways to improve the resilience and strength of the state’s infrastructure in the face of natural disasters and other emergencies, submitted their reports to the governor earlier this week. Recommendations of the Ready Commission included:
- Create a statewide network of unified emergency training, coordination, protocols and communication
- Update the New York State Building Code
- Expand use of Vulnerable Populations Databases so first responders; outreach workers; and health care and human services personnel can find and serve those who may need assistance
- Require that gas stations in strategic locations have access to onsite back-up power capacity
NewPublicHealth spoke with Dr. Redlener about the Commission and the storm’s impact on New York residents.
>>Read about the 2012 edition of its Ready or Not? report from Trust for America’s Health, which looks at strengths and vulnerabilities in each state’s emergency preparedness status.
NewPublicHealth: You were appointed to co-chair the Ready Commission by Governor Cuomo in November. What is the specific focus of the Commission?
Redlener: What we are going to do is assess the current resilience of the city in terms of its preparedness efforts. Are we ready? Are we prepared? What are the missing elements right now in trying to make us more prepared for the next events than we were for this one? Some of this is not all that complicated and unfortunately these are problems that we have seen in prior disasters. Some of the things that we are seeing here were basically exactly what we saw in the Gulf and in New Orleans after Katrina. It isn’t like we haven’t been thinking about these things. I think that is why we were able to provide some reasonable recommendations, because these are not altogether new problems or challenges.
NPH: How strong is disaster preparedness training at schools of public health and within governmental public health?
Yes, today is Wednesday. But as a new year dawns and New Year's resolutions kick in (learning Zumba and building yoga into our weekly schedule are high on the list for NewPublicHealth staffers) let's call today an honorary Monday—a day to embrace a new plan for health. The Monday Campaigns are here to help.
With the slogan "The day all health breaks loose," Monday Campaigns are a public health initiative of the Columbia University Mailman School of Public Health, the Johns Hopkins Bloomberg School of Public Health and the Lerner Center for Public Health Promotion at Syracuse University. The goal is to help prevent chronic disease by offering a weekly prompt that can support people in starting and sustaining healthy behaviors.
Research at Johns Hopkins found that a week is a critical unit of time in planning lives and Monday has special significance as the beginning of the week. People view Monday as a day for a fresh start and a chance to set healthy intentions for the next 6 days. They’re more likely to start diets, exercise regimes, quit smoking and schedule doctor’s appointments on Monday than any other day. And, according to the Hopkins researchers, they’re looking for help in setting and carrying out their healthy intentions for the week.
The campaigns have grown to include government and non-profit organizations, businesses, media outlets and communities. The three schools provide research, case studies, health-related content, marketing concepts and programs ready for individuals, communities and public health departments. Specific campaigns include:
- Meatless Monday
- Quit & Stay Quit Monday
- Kids Cook Monday
- Move It Monday
- Man Up Monday
- Caregiver Monday
The 2013 campaigns began last Monday, with a weekly series that offers tips for 2013. First up: set some long and short term goals:
A long-term goal can be something to work towards, like getting 2 ½ hours of activity each week or eating 5 servings of produce each day. Short-term goals are the smaller actions you take to build up to your objective.
>>Weigh in: Which Monday campaigns will your community try this year?