Natalia Nazarewicz was a high school senior in Oak Ridge, Tenn., when she won the 2006 Young Epidemiology Scholars (YES) competition. Now 24, she is firmly committed to a career in public health, more specifically global health.
It would be nice and tidy to report that the one led directly to the other. But as this adventurous young woman will tell you, her route was anything but a straight shot.
Indeed, she had guilt pangs taking the $50,000 YES scholarship that accompanied her first-place finish, she says. "I felt I shouldn't have won because I had no interest at all in pursuing any kind of epidemiology, any kind of public health. I felt like I was cheating them out of the money."
It was later, after trouncing though a thicket of uncertainty via Karatu, Tanzania, that Nazarewicz arrived at what she now sees as her life's calling. With a laugh, she describes her circuitous post-YES journey to the public health field:
"I felt like the Robert Wood Johnson Foundation had been guiding me from very, very far away, saying, 'All right, you were lost for a couple of years, but let's take you back to where you are supposed to be.'"
YES: "The best and the brightest." YES was a competitive scholarship program aimed at encouraging talented high school students to investigate public health issues and ultimately pursue a career in the public health field. Epidemiology—the study of the causes, distribution and control of disease among populations—is the basic science of public health.
Initiated in 2003 by the Robert Wood Johnson Foundation (RWJF) and managed by the College Board, YES ran for eight years, attracting the participation of nearly 5,000 high school juniors and seniors—"the best and the brightest from across the country," in the words of RWJF Senior Program Officer Pamela G. Russo, MD, MPH.
YES contestants identified a health problem, gathered data about the problem, and proposed a solution based on what the data showed. Survivors of the initial review process presented their projects in person to expert judges from the health field.
When the annual competitions ended in 2011—a casualty of the nation's economic recession and a change in RWJF's grantmaking strategy in the public health area—a total of 976 YES participants had collected some $3.7 million in college scholarships, ranging from $1,000 for semifinalists to up to $50,000 for each year's top two winners.
But while the YES program is now over, its impact is not. Natalia Nazarewicz's story offers evidence of what Russo describes as the program's lasting legacy:
"YES is definitely going to influence who's going to be in the lead in public health in the next 10 years."
The Road to YES. Nazarewicz was three when she emigrated with her family from Poland to the United States. Her father, Witold Nazarewicz, PhD, a nuclear physicist, is on the staff of the Oak Ridge National Laboratory and a professor at the University of Tennessee in nearby Knoxville (as well as at the University of Warsaw in Poland). Her mother also has a background in physics.
"I grew up in a very academic family," says Nazarewicz. She also grew up in a household where only Polish was spoken, though her English gives no hint of another tongue—or, for that matter, of an East Tennessee upbringing. "People tell me that all the time, and I just say that the Southern and the Polish kind of balance each other out."
Not surprisingly, Nazarewicz was good in science. But when her teacher at Oak Ridge High suggested she enter a contest in something called epidemiology, she had to look up the term. "I had no idea what it was."
The prospect of doing original research appealed to her, but she wanted a project that would be personally meaningful, not just an academic exercise. No stranger to internal stresses of her own, Nazarewicz settled on a topic that in a public high school environment is somewhere between sensitive and taboo: the phenomenon of self harm.
For her YES project, Nazarewicz, then a senior, surveyed more than 1,000 Oak Ridge students about whether they had ever deliberately hurt themselves—by cutting, burning, or any other method—and, if so, what the motivating factors were. "I had no idea if that would even qualify as epidemiology," she says. "It was just something I was interested in."
Her key finding was a surprise, if not a shock, to school staff: 26 percent of the students reported engaging in deliberate self-harm at some point, though two-thirds of those said they had since stopped the practice.
Looking back, Nazarewicz believes the data were not as alarming at they appeared. "A lot of this was people who tried it once just to see what it was like. Pretty typical of adolescents—the try-everything-once philosophy," she says, noting that the survey did not distinguish incidents of harm by severity or by method.
But whatever its flaws, her study—Deliberate Self-Harm Among Adolescents: Prevalence, Risk Factors and Treatment Options—obviously impressed the judges. Of 60 finalists invited to Washington in April 2006 to present and defend their research, Nazarewicz was one of two first-place winners.
The Road after YES. That fall Nazarewicz entered Brown University in Providence, R.I., an Ivy League institution that pretty much allows students to take whatever courses they want. "It can be incredibly liberating. It can be wonderful," she says. "It can also be very intimidating if you don't know what you want to do."
And she didn't know. "I had this idea that I should do something with my life to do the maximum good," she remembers. "It's a very naive and a very idealistic way of looking at the world, but that is how I was looking at it."
Though international relations seemed promising initially, Nazarewicz's interest in the subject didn't last and she spent her first three semesters hopping her way through the Brown syllabus, sampling a wide variety of courses—so wide, in fact, that she managed to never land twice in the same academic department—or in an epidemiology course.
No further along in her search after three semesters, she decided to leave Brown and go abroad—to some place that had a need and an organization willing to let her help address it on a volunteer basis. From the experience, hopefully, would come insight into what she should do with her life. That was the strategy.
The some place turned out to be the Karatu district of the east African nation of Tanzania. Why? Mainly because the one positive response to her inquiries came from the Tanzania director for Minnesota International Health Volunteers (now WellShare International), which was spearheading an effort in Karatu to improve maternal and newborn care and address other health issues.
"And that—completely by chance—is how I got back into public health," she says.
Arrival: Public Health. "I learned a lot more than I contributed," Nazarewicz says of her several months in Karatu, where she assisted with midwife training and the production of health education videos. She also picked up some Swahili. "It was definitely a crash course in the language. It's hard to edit a video in a language you don't understand."
But the main thing she got was a real-time look at public health work—and the positive impact it could have at relatively low cost. "That was the first time I had looked at health as a potential way to improve people's lives."
Her Karatu stint over, Nazarewicz moved to Dar es Salaam, Tanzania's major city, and studied Swahili at the university there. When student strikes shut down classes, she used the time to volunteer with international organizations working on a national contraception program.
The end result was that when Nazarewicz returned to Brown in 2009, she declared community health (the university's public health equivalent) as her area of academic concentration and began taking every course in epidemiology and global health she possibly could. "And I loved it. I just absolutely loved it. I felt like I had finally found my personal calling."
Nazarewicz graduated from Brown in 2011. When interviewed in early 2012, she was working in Washington for the Alliance of Community Health Plans—an opportunity, she says, to learn more about health issues in this country:
"I kept hearing—when I told people I was interested in global health—'Why would you work on global health issues when there are so many problems here in the United States?'"
Global health, however, remains her career focus, and she says she expects eventually to get a master's degree in public health. Just how her YES experience contributed to those intentions is not easy to discern. But maybe Nazarewicz' comment, made half-jokingly, is not so far off; maybe something was guiding her back to where she was supposed to be.