health without boundaries 2008

7/30/2019 Health Without Boundaries 2008

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Aga f AcVital Statistics

Deciphering the Mechanisms of Disease

Global Vision

Making an Impact

Only Connect

HealtH

BoundAries:Without

HARVARD

School of Public Health


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THe HIgHeST aTTaINabLe STaNdard OF HeaLTH IS ONe

Constitution of the World Health Organization, July 22, 1946

OF THe FUNdaMeNTaL rIgHTS OF every HUMaN beINg...


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Barry R. Bl, Dean

Jan L. and Julius H. Jacbsn II Prfessr f Public Health

Dear Friends and Colleagues:

On June 11, 1998, Harvard President Neil Rudenstine introduced me to the members o the

Harvard School o Public Health aculty as their new dean. It was my understanding that the

weighty responsibility I assumed was to continue the extraordinary stewardship o Harvey

Fineberg and Jim Ware, to expand the Schools global mission, and to assure that cutting-

edge science was brought to our public health enterprise.

Ten years later, I remain enormously grateul or the privilege aorded me and the

opportunity to work with our Harvard presidents. As in public health itsel, i deansdo their jobs well, the results o their eorts are oten invisible providing a smoothly

unctioning, scally sound platorm on which the work o aculty and students fourishes.

Much o what ollows describes some highlights o that fourishing research and its

application over the past decade.

The challenges were many: to develop a ar-sighted ramework or the Schools activities

grounded in the strong, discipline-based approaches o basic science, quantitative science,

and social and policy science; to tie the determinants o health to the most pressing public

health concerns; and to establish strategic directions that draw on both leading-edge science

and a wide array o expertise as problems change. This ramework provides the academic

underpinning or an anticipated new campus in Allston and or our connections across theUniversity.

One o the greatest joys o my deanship has been my interactions with extraordinary

students. We have worked to improve the excellence o our student body examining our

admissions processes and nancial aid policies to attract the best and the brightest. With

terric support rom our riends and all our presidents, the amount o nancial aid we can

provide rom School and University sources has grown six-old in the past decade.

In my rst speech to the Schools aculty and riends, I conessed that one o my

attractions to public health was a long-standing passion to ght or lost causes.

I quoted T.S. Eliot:

I we take the widest and wisest view o a Cause,

There is no such thing as a Lost Cause,

Because there is no such thing as a Gained Cause.

We ght or lost causes because we know our deeat and dismay may be the

preace to our successors victory, although that victory itsel will be temporary; we ght

rather to keep something alive than in the expectation that anything will triumph.

As I refect on events o the past decade, it is gratiying to be able to say that public health

is no longer perceived as a lost cause. It is not yet, however, a gained cause. We in

the School have not only ought to keep millions o people alive, but have made major

contributions through research, training and global engagement. Perhaps as important, I

am proud that we have contributed to keeping the liberal spirit and humane application o

knowledge alive. At the very least, these represent a small triumph.

PHOTO:RickFriedman


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The last decade has witnessed proound and

novel threats to the publics health: the emergence

o deadly new inections such as SARS and the

H5N1 infuenza virus; 9/11 and the specter

o bioterrorism; the spread o drug-resistantpathogens; a steep rise in obesity, diabetes and

related chronic afictions; widening disparities

between rich and poor. All these trends represent

health and social problems compounded by the

orces o globalization. Against this backdrophave unolded revolutions in technology, genetics/

genomics and communications an explosion o

knowledge that, when properly harnessed, could

turn back many o the scourges o our time.

Health Withut Bundaries:Agendas fr Actin


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Intrductin

The Harvard School o Public Health since 1922, the

worlds most dynamic and rigorous public health research

and teaching enterprise is strategically positioned to

meet the health challenges o the new century. Under

the leadership o Dean Barry R. Bloom, it has boldly

upgraded its mission and structure, building a rm

scientic, educational and nancial platorm or the

uture. Responding to rapid advances in technology

and deepening health crises, the School has envisionedand created entire new departments and programs in

order to address ever-evolving health threats. And HSPH

has vaulted intellectual and geographic boundaries,

embracing an interdisciplinary emphasis on genes

and the environment, quantitative health sciences and

bioinormatics, and global health. The prospect o moving

to a new Allston campus solidies the Schools vision and

central integrative role at Harvard.

Under Dean Bloom, who assumed leadership on January

1, 1999, the School has sustained its tradition o majorcontributions to the elds concepts and methodologies.

Its scientists have unraveled key mechanisms o obesity-

related metabolic syndrome and drug-resistant malaria.

They have modeled the course o emerging inections and

hospital outbreaks. HSPH helped catalyze the visionary

Public Health Foundation o India, and nurture the

ambitious Botswana HSPH AIDS Initiative Partnership to

enhance AIDS research, prevention and treatment. Just as

crucial, the School has continued to inorm public health

policy, rom government smoking bans and environmental

regulations to statutes eliminating trans ats rom

restaurants and requiring its labeling on ood products.

And HSPH is unique among its peers in having had our

o its current aculty awarded MacArthur genius grants.

This small sample o achievements speaks to the Schools

leadership in public health education and discovery.

In contrast to aculties traditionally structured around

disciplines, proessions, skills, or sectors (all o which are

emphasized at the School), HSPH is at heart organized

around solving problems and addressing threats to the

publics health and well-being. With its long-standing

mission o deterring global disease, ocused particularly on

poor and disadvantaged populations, it brings new ideas

to the rontlines o practice. By putting a premium on

prevention, it underscores an approach that has again and

again proven cost-eective, both in human and nancial

terms. By training public health leaders and strengthening

public health institutions nationally and internationally, it

lays the groundwork or lasting change.

To encompass the Schools broad scope o activity and

help it contend with uture threats, HSPH deans and

department chairs recently created a planning matrix,

which rames the Schools strategies or the next 20-50

years. One dimension o the matrix represents the

determinants o population health or the present and

oreseeable uture: environmental, biological, social,

and policy. The other dimension represents public

Harvard University President Drew G. Faust

There is an important public health moment

beore all o us right now. It is a time o great

opportunity or public health in the world

o intellect, in the world o understanding,

and also in the world o Harvard University.


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Genes

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Chronic

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Chronic

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5

PUBLIC HEALTH AGENDAS

HSPH PLANNING FRAmEWoRk

INTEGRATIoN oF ACADEmIC STRUCTURE

WITH PUBLIC HEALTH AGENDAS

DETERmINANTS oF PoPULATIoN HEALTH

health problems at the School is committed to addressing:

inectious diseases; chronic diseases; avoidable

environmental threats, injury and violence; health

disparities; and health systems. Far-reaching

and practical, this matrix will enable the School

to respond nimbly and eectively to both endemic

problems and unexpected public health emergencies.

To make progress on this ambitious set o agendas,

the School relies on the disciplinary strengths o its

departments and divisions. It has sought to integrate

these disciplinary approaches with its public health vision.

Investments o School resources stimulate interdisciplinary

research, and planning or a campus in Allston will allow

the use o physical conguration to urther support

academic interactions.

The School has also reinvigorated its educational mission.

A revised curriculum is in development that revolves

around active learning, case-based teaching, problem-solving, and greater attention to the needs o students.

Over the past decade, student nancial aid has increased

six-old, attracting the very top tier o applicants. This

growth in support has been made possible by the

generosity o numerous donors to the School and the

University as well as the increase in endowment payout.

The Schools many successes over the past ten years

under Dean Bloom a distinguished immunologist and

global health authority have built a rm oundation or

uture discovery and policy change. An institution that

has shaped the eld or nearly nine decades, the Harvard

School o Public Health continues to provide vision,

infuence and leadership in one o humankinds mosturgent pursuits.

Unnished Agenda o Inectious Diseases

Coming Epidemic o Chronic Diseases

Unnecessary Epidemic o EnvironmentalThreats/Violence/Injuries

Disparities in Health

Health Systems

Environmental Biological Social Health Policies

HSPH oers breadth

and depth o scholarship

unrivaled in any other

school o public health and

in ew medical centers.

Coupled with that is

great pride in teaching

and a storied tradition

o training the leaders in

the eld domestically

and internationally.

Steven A. Schroeder, MD,

Distinguished Proessor o

Health and Health Care,

University o Caliornia,

San Francisco Department

o Medicine; Chair, HSPH

Visiting Committee


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Mapping and preventing disease over populations

is the signal achievement o public health. Today,

groundbreaking mathematical models are

changing how scientists plot out epidemics and

untangle the roots o complex diseases. At HSPH,quantitative research is paving the way or more

eective prevention and intervention.

Vital Statistics


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Public Health by the Nubers

New genetic tools are yielding mountains o data about the

underpinnings o disease. But or complex conditions such

as heart disease, diabetes and cancer, how can scientists

determine which genes are relevant and which are not?

With its new Bioinormatics Core and its Program on

Quantitative Genomics, HSPH has wedded computational

biology and inormatics with research in basic science

and epidemiology helping to guide investigators

through todays thicket o inormation. In 2005, a team o

researchers led by HSPH biostatisticians gured out how

to analyze huge quantities o genetic data, surpassing the

capabilities o traditional techniques and speeding the

quest or the genetic basis o asthma, diabetes and other

disorders. This methodology is part o a reely-available

analysis sotware program called PBAT, developed

by Proessor o Biostatistics Nan Laird and Associate

Proessor o Biostatistics Christoph Lange.

Racing Against SARS

When a deadly inection emerges, public health ocials

need to know how the causative organism moves in time

and space. In 2003, Associate Proessor o Epidemiology

Megan Murray and Proessor o Epidemiology Marc

Lipsitch drew on detailed data rom Singapore and other

aected locales to predict how the rightening new SARS

epidemic could unold. Their intensive calculations,

carried out in two weeks to respond in real time to the

ast-moving outbreak, were abetted by Dean Barry R.Bloom, who encouraged the scientists and helped them

prepare their research to meet a grueling publication

deadline. Murrays and Lipsitchs conclusion: Without the

combination o isolation and quarantine the strategy

that, ater several disease control ailures, eventually

succeeded SARS would have inected millions within

six months.

Our young scientists took

on the global challenge o

SARS and with intellectual

brilliance, extraordinary

dedication and great spirit

made a contribution to the

world.

Dean Barry R. Bloom

Right: Transmission chain o

SARS in Singapore, 2003.Many biomedical scientists

are interested in the

complexities o human

biology why certain

people, or instance,

are more likely to have

unhealthy blood pressure,

cholesterol or body mass

index. Until now, no

statistical tools were

available that allowed

researchers to look at

once at several thousand

disease genes and nd

those ew genes that

infuence these complex

traits. Now we have those

tools. Christoph Lange


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mdeling Drug Resistance

Numerical modeling doesnt only apply to large-scale

epidemics. Combining mathematical models with

epidemiological data, Marc Lipsitch has analyzed the

behavior o drug-resistant hospital pathogens. Lipsitch

examined the relationships between antimicrobial use

and antimicrobial resistance in a variety o bacterial and

viral pathogens. Putting these models to practical use, his

team developed improved treatment protocols to reduce

selection or resistant bacteria reversing what has longbeen seen as an intractable scourge in health care acilities.

Cnnecting the Dts f Chrnic Disease

In their epidemiological analyses, HSPH scientists have

also targeted chronic conditions such as heart disease

and diabetes. Working with colleagues at the Channing

Laboratory and Brigham and Womens Hospital in the

Health Proessionals Follow-up Study, the Nurses Health

Study and the Nurses Health Study II, they have been

ollowing more than 280,000 men and women, tracking

changes in risk actors, body mass index and disease

experience. Among their recent ndings:

Middle-aged and older men who ollow ve healthy

liestyle behaviors reduce their risk o coronary

artery disease. The heart-protective behaviors: not

smoking, exercising daily, drinking moderate amounts

o alcohol, maintaining a healthy body weight, and

eating a healthy diet.

Women who carry excess at around the waist are at

greater risk o dying early rom cancer or heart disease

than are women with smaller waistlines.

Continued


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Women increase their risk or diabetes as their body

mass index rises or their physical activity declines.

Women can reduce their risk o breast cancer,

especially ater menopause, by avoiding weight gain

in adulthood or losing extra pounds.

Being overweight at age 18 is associated with

an increased risk o premature death in younger

and middle-aged women.

In women, physical activity reduces the risk o

colon cancer.

In men, regular vigorous physical activity early in

adult lie reduces the later risk o Parkinsons disease.

Walking the most common orm o exercise in older

adults helps protect against memory loss.

Using Nurses Health Studies and Health Proessionals

Follow-up Study blood samples, the Schools

researchers ound that people with a genetic variant

known as T-87C, which sits on the region o a gene

that produces the aP2 protein, were ar less likely

than were people without the variant to suer

heart disease, type 2 diabetes, and other contributors

to metabolic syndrome.

To prevent diseases,

we have to distinguish what

we really know rom what

we think might be

as well as rom what we

hope is true.

Meir Stamper,

co-investigator, Nurses

Health Studies and Health

Proessionals Follow-up

Study

Right: Questionnaire, Nurses

Health Study.


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Our setting at HSPH

was critical at many

steps in the process.

At the time, ew other

American public health

schools had even one

inectious disease

modeler on their

aculties. We had twoactive research groups

and superb statistical

expertise down the hall

enough to get the

job done.

Marc Lipsitch, on

modeling the SARS

epidemic


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The rontlines o public health extend

to the undamental processes within our cells.

HSPH research into the genetic basis o disease

yields big payos in both population health

and individual care.

Deciphering the mechanissf Disease


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Let top and bottom:

Laboratory preparations o

brain tissue rom a child in

Arica who died o cerebral

malaria. Blue dots are malaria

parasites.

Right: Textile worker in China.

For decades, our

knowledge o the parasite

has been driven solely

by studies in cultured

cells, not humans. Our

work underscores the

importance o studying

the malaria parasite in its

natural environment, and

will hopeully spark novel

approaches to malaria drug

discovery.

Dyann Wirth

Unasing malaria

HSPH has conducted multi-pronged research into

the wily malaria parasite, which causes approximately 500

million new inections each year. In 2006, Dyann Wirth,

Chair o the Department o Immunology and Inectious

Diseases, and her colleagues unveiled a detailed map o the

one-celled organisms evolving genome a development

that will help scientists track the global spread o virulent,

drug-resistant strains, diagnose and treat malaria more

eectively, revise vaccine-making strategies, and guidethe creation o better drugs. Wirth, the Richard Pearson

Strong Proessor o Inectious Diseases, and HSPH

researcher Johanna Daily published a groundbreaking

study in 2007, identiying which o the parasites genes

are turned on or o during inection in humans. The

discovery sprang rom genomic analyses o parasites in

their natural state in patients blood and rom innovative

computational approaches to interpreting the results.

Genetics f Lung Disease

At the cutting edge o molecular epidemiology, David

Christiani, Proessor o Occupational Medicine and

Epidemiology, is exploring the links between airway

disease, airborne toxins and genetic actors. Using DNA in

long-rozen blood samples rom Shanghai textile workers,

Christiani and his colleagues ound the highest disease risk

in a small subset o non-smokers who have a variant orm

o a particular gene. One day, he predicts, doctors may be

able to screen people or this variant, then counsel thosewho test positive to avoid endotoxins, both in humid,

mold-prone homes and on the job.

Christiani who has conducted occupational-health

research in Asia, Arica and North America has also

developed new biologic markers or pollutant-induced

diseases such as lung cancer, bladder cancer, skin cancer

and upper respiratory-tract infammation. His work

exploring the molecular and genetic basis o lung cancer

serves as a model or examining gene-environment

interactions in cancer development.


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M. tuberculosis the

causative organism o TB in a

macrophage.

Tuberculosis is a major

threat to global public

health that demands new

approaches to disease

diagnosis and treatment.

By looking at the genomes

o dierent strains, we can

learn how the tuberculosis

When studying an illness

such as tuberculosis,

which has been around or

millennia, it is important

to consider not just

scientically interesting

microbe outwits current

drugs and how new drugs

might be designed.

Megan Murray

New Appraches t TB

HSPH genetic research has also revealed how the TB

bacterium continues to devastate human lives and evolve

new deenses. Associate Proessor o Epidemiology Megan

Murray co-led an international collaboration that in 2007

announced the rst genome sequence o an extensively

drug-resistant (XDR) strain o the tuberculosis bacterium.

Keenly aware o the swit spread o TB, the researchers

took the unusual step o immediately sharing the sequence

and their analysis ar in advance o submitting a scienticpaper, in order to speed scientic work on drug-resistant

strains.

To illuminate a central question in studying microbial

pathogens Which molecular determinants cause

virulence? Eric Rubin, Associate Proessor o

Immunology and Inectious Diseases, took a novel

approach. Deploying so-called jumping genes in the

tubercle bacillus, he perected a way to knock out 4,000

possible virulence genes, one by one. Rubin went on

to build a comprehensive library o gene mutations,

rom which he has selected mutants that are essential

or growth, inection and virulence, and that identiy

potential drug targets. To the gratitude o the TB research

community, he has generously shared this valuable

resource.

Sarah Fortune, Assistant Proessor o Immunology and

Inectious Diseases, in 2007 was among the rst recipients

o the NIHs New Innovator Awards, or her work delving

into the mechanisms by which the TB bacterium escapes

the host immune response research that may someday

yield targets or vaccines and therapeutics.

questions, but those that

are important to changing

the ace o TB.

Sarah Fortune


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A T

T A

C G

G C

T A

A T

T A

C G

G C

A T

Let: On the let is a normal

mouse, on the right a mouse

bred to be obese. A rare

gene variant discovered by

Gkhan Hotamisligil protects

obese mice rom metabolic

syndrome a possible prelude

to treatments in humans.

Right: Illustrations o

chromosome, DNA molecule

and typical gene variants

known as SNPs (single

nucleotide polymorphisms)

all involved in genetic

susceptibility to cancer and

other diseases.

Genes and Envirnent

The interace between genes and environment is

rich intellectual terrain or HSPH researchers. At the

Department o Genetics and Complex Diseases, created

by Dean Bloom, scientists explore how molecules, cells

and organisms adapt to nutrients and toxins, and how

genes control these responses. Such research builds on

the Schools tradition o excellence in environmental

health research, and its strengths in population sciences,

quantitative methods and bench science. The ultimategoal: deciphering the causes o complex conditions

such as obesity, diabetes, cardiovascular disease, cancer,

and aging.

Department Chair Gkhan Hotamisligil, the James

Stevens Simmons Proessor o Genetics and Metabolism,

has made major discoveries about the obesity-related

condition known as metabolic syndrome, which

combines risk actors that lead to type 2 diabetes and

heart disease and aficts a sixth o Americans. In 2007,

Hotamisligils team created a designer compound thatprotects mice rom those conditions and other problems

a promising stepping-stone to clinical trials in humans.

Earlier, the team ound a critical missing link in the

biochemical pathway between excess body at and diabetes,

as well as a rare gene variant in humans that helps protect

against type 2 diabetes and heart disease. Someday, proles

o genetic vulnerabilities and environmental exposures

may help quantiy individual risk and prevent and treat

disease beore its too late.

The Schools Program in Molecular and Genetic

Epidemiology, also created under Dean Bloom, applies

exponentially expanding knowledge o human genetic

variation to critical problems o public health importance.

Among the Programs activities: linking specic diseases

to specic genetic proles, and investigating how these

proles interact with the environment and liestyle to raise

the risk o disease. Researchers in the Program are working

with colleagues in the Nurses Health Studies, the Health

Proessionals Follow-Up Study, and the Physicians Health

Study to shed light on cancer, cardiovascular disease,

diabetes, and osteoporosis.

Weve known or a

couple o centuries

that amily history is an

important actor in disease

susceptibility. Now were

starting to draw back the

curtain and see not just

the principal actors rare

mutant genes with dramatic

eects but a whole cast

o characters, that is, minor

variations that infuence

our risk o cancer and other

diseases in big ways.

David Hunter


19/4417

Program Director David Hunter and collaborators at

the National Cancer Institute have ound inherited gene

variants that raise the risk o breast cancer in women and

o prostate cancer in men. Their discovery o variants

that increase breast cancer risk is viewed as the most

important nding about breast cancer genetics since

the BRCA1 and BRCA2 genes were identied in the

1990s. Work by Hunter, the Vincent L. Gregory Proessor

in Cancer Prevention, is part o the National CancerInstitutes Cancer Genetic Markers o Susceptibility

(CGEMS) project, a genome-wide association study

that capitalizes on the latest generation o DNA chip

technologies. Understanding the mechanisms by which

inherited genetic risks help trigger tumor ormation may

lead scientists to new angles o attack, both or prevention

and treatment.

I see a time bomb

waiting to explode in

the developing world.

Two-thirds o the

worlds population

will be experiencing

the diseases that we now

see in Western societies

within the next decadesChronic metabolic

diseases are the major

threat to the uture

o global health.

Gkhan Hotamisligil

Genome-wide scan or breast

cancer, rom the National

Cancer Institute Cancer Genetic

Markers o Susceptibility

(CGEMS) project, co-led by

David Hunter.


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Research on global health problems pervades

every department at the School. Through

international partnerships and cutting-edge

research, HSPH is tackling the most urgent

health problems and strengthening publichealth institutions around the world. Through

educational exchanges, the School is training

the next generation o public health pioneers.

Students at the Cyprus International Institute or the Environment and Public Health

are joined by HSPH students during Winter Session.

Glbal Visin


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Botswanas situation is

unique. Nowhere else in

the world has a signicant

raction o the population

been involved in both

ARV treatment or AIDS

Upper let: Max Essex, let,

speaks with Dr. Joseph

Makhema, Project Director

o the Botswana HSPH AIDS

Initiative Partnership.

Upper right, bottom let:

Scenes rom the Botswana-

Harvard HIV Reerence

Laboratory.

and chemoprophylaxis to

prevent transmission o

HIV/AIDS rom mothers to

inants.

Max Essex, Chairman o the

Harvard School o Public

Health AIDS Initiative

Bottom right: David Havelick,

right, Assistant to the Chair,

Epidemiology, asks questions

o a colleague at HSPHs

central site pharmacy in Dar es

Salaam, Tanzania. On the let

are boxes o vitamins.

Africa

The Schools presence in Arica in the early 1980s

expanded to meet the challenges posed by HIV/AIDS.

Over the past decade, HSPH has helped guide the global

outpouring o resources to address the pandemic.

In 1996, Mary Woodard Lasker Proessor o Health

Sciences Max Essex established the Botswana HSPH

AIDS Initiative Partnership, a research and treatment

training program which was the largest o its kind

in Arica at the time. The programs HIV Reerence

Laboratory opened in Gaborone in 2001 the rst

dedicated HIV research lab in southern Arica. In

2005, HSPH reported that the outcomes o Aricas

rst large-scale public program to distribute critical

AIDS drugs to a developing nation an eort led

by Richard Marlink, the Bruce Beal and Robert Beal

Proessor o the Practice o Public Health was

as successul as similar programs in industrialized

countries.

The Schools scientists conducted the rst vaccine

trials in southern Arica, learned how to prevent

mother-to-child HIV transmission, and made key

discoveries in protecting mothers against drug

resistance.

With unding rom the Bill & Melinda Gates

Foundation, HSPH embarked on its AIDS Prevention

Initiative in Nigeria (APIN) program, which couples

prevention with treatment by strengthening local

resources and inrastructure, and by training the

next generation o public health leaders in Aricas

largest nation.


23/4421

In 2004, based on its longstanding commitment to

conront HIV/AIDS on the continent, the School

was awarded one o our Presidents Emergency

Plan or AIDS Relie (PEPFAR) grants. Operating

in three nations o sub-Saharan Arica, this nearly

$200 million, ve-year project, led by Proessor

Phyllis Kanki, trains health proessionals, strengthens

in-country academic medical centers, and builds

sustainable capacity or treatment, preventive servicesand research.

The HSPH partnership in Tanzania which includes

HSPH, the Dar es Salaam City Council, Muhimbili

University o Health and Allied Sciences,

and Harvard Medical School has built a

state-o-the-art laboratory in Dar es Salaam,

In light o these

ndings, we recommend

that multivitamins be

considered or all pregnant

women in developing

countries, regardless o

their HIV status.

Waaie Fawzi, Proessor o

Nutrition and Epidemiology

and is studying how improved nutrition can curtail

the spread o HIV/AIDS, tuberculosis and other

illnesses. Led by Proessor Waaie Fawzi, a 2007 study

ound that giving daily multivitamin supplements to

HIV-negative women during pregnancy signicantly

reduces the risk o low birth weight a condition that

increases lielong risk o health complications.

Right: Mother and child at

Deborah Retie Memorial

Hospital, Mochudi, Botswana.


24/44

Top let: Yuanli Liu, ounding

director, HSPH China Initiative.

HSPH China Initiative

Launched in 2005, this ve-year collaboration between

HSPH, the Chinese Ministry o Health, the Central Party

School, and Tsinghua University will apply education

and research to promote health and social development

in China during a time o proound economic and social

transormation. The Initiative addresses occupational and

environmental health, public health surveillance, ood

saety and malnutrition, tobacco control, maternal and

child health, and health systems reorm. In 2007, HSPHwelcomed a delegation o senior health executives rom

China or a three-week intensive training program in

health systems leadership, part o the three-pronged China

Initiative that also includes a Harvard University-wide

orum and a series o applied health research projects.

As a global leader in

knowledge creation and

transer, the Harvard School

o Public Health has the

capacity to help China

eectively address major

issues in health sector

development through

research and education.

Yuanli Liu, Director o the

HSPH China Initiative

Public Health Fundatin f India

Expected to become the worlds most populous nation by

2040, India aces daunting challenges: huge burdens o

disease, a lack o needed medical care in many regions and

a dearth o public health proessionals. To grapple with

these problems, HSPH in 2006 helped to create the Public

Health Foundation o India, a public/private partnership

which is working in collaboration with the Government

o India, the Bill & Melinda Gates Foundation and other

private sector partners. PHFI will shape education, policyand practice, and build world-class Indian institutes o

public health and HSPH hopes to assist through aculty

and student training, and research ties.


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Cyprus Internatinal Institute fr the

Envirnent and Public Health

HSPH-Cyprus Prgra in Bstn

In 2005, HSPH and the government o Cyprus established

research, education and technology links to tackle

environmental health problems generating knowledge

and capacity that can be shared across the environmentally

ragile Mediterranean region. The collaboration ocuses

on a range o challenges, rom measuring environmental

and workplace contaminant exposures to investigating theeects o air pollution on respiratory and cardiovascular

health, and provides doctoral training.

Internatinal Field Classes

The Department o Global Health and Population recently

launched a lecture/seminar/case study course in Brazil, the

nation with the largest population in Latin America. Home

to one o the most inequitable income distributions in the

world, as well as some o the most entrenched inections,

Brazil exemplies the deep connections between health

and wealth, and the ecological dance between disease-

causing agent, host and environment. HSPH students and

Brazilian students work together in disease-endemic areas,mapping the economic, social, cultural and demographic

characteristics that raise the risk o schistosomiasis

and leishmaniasis. Teaching the course is Mary Wilson,

Associate Proessor in the Department o Global Health

and Population and Felipe Fregni, Assistant Proessor in

Neurology, Harvard Medical School. Other HSPH Winter

Session courses take students to India, Bangladesh, Chile,

China, and Tanzania.

Lower let: A So Paulo State

disease control program

worker prepares to spray

insecticide during the

Harvard-Brazil collaborative

course on inectious diseases.


26/44

concluded that health improvements boost developing

economies a concept they call health-led growth.

Canning, Bloom and their colleagues ascribe a signicant

portion o the success o post-World War II Asian Tiger

economies to the survival and education o a younger

productive generation the demographic dividend.

Improvements in health disproportionately beneted

inants and children who, while initially imposing a set

o burdens on their adult caretakers and society at large,eventually matured into a bulge generation that came to

represent a potent economic orce. In the v iew o Canning

and Bloom, health has contributed in multiplicative ways

to wealth in Asia not just the other way around.

The Degraphic Dividend

The demographic paradox o China and India emerging

superpowers as well as home, collectively, to hal the

worlds poorest individuals has inspired HSPH

researchers to ask what accounts or these two nations

spectacular rise, and what the uture holds. At HSPH, a

team o economists, demographers and experts in global

health have ound that improvements in health were major

actors propelling the countries economic success and

that investments in basic health care could sustain thesetwo nascent economies ar into the uture.

David Canning, Proessor o Economics and International

Health, and David Bloom, Chair o the Department o

Global Health and Population and the Clarence James

Gamble Proessor o Economics and Demography,

You need to invest in

health not just or its

contribution to well-being,

but also because health is

a source o productivity.

David Canning


27/4425

As a result o this

program, many

people who were

on their deathbeds

are back on their eet

and are productively

engaged and providing

or themselves and their

amilies.His Excellency Festus

Mogae, President o

Botswana, on the

Botswana HSPH AIDS

Initiative Partnership

Top: Chart rom Bloom, DE and

Williamson, JG: The World Bank

Economic Review, Vol. 12, pp

419-55 (1998).

The rising share o working-age

people in a population leads to

a rise in the rate o economic

growth the demographic

dividend.


28/44


29/44

At HSPH, the ultimate goal o knowledge

is improving lives and inorming policy. Today,

the School continues its long tradition o making

a dierence rom promoting international

tobacco control to ostering healthy eating habitsto reducing health disparities.

maing an Ipact


30/44

Breathing Easy

The air we breathe is cleaner because o HSPH researcher.

Proessor o Environmental Epidemiology Joel Schwartz,

who while at the U.S. Environmental Protection Agency

identied lead in gasoline as a crippling environmental

exposure. He has gone on to link elevated death rates to air

particulates rom coal-burning plants and motor-vehicle

exhaust and has worked to tighten government air quality

standards. At HSPH, he and colleagues have investigated

the link between atmospheric particulates and heartattacks, bronchitis and asthma. He played a pivotal role

in the EPAs decision to set stricter clean-air standards or

ne particulates and in the Supreme Courts 2001 decision

upholding that standard. In 2006, Schwartz coauthored the

eight-year ollow-up to the landmark Harvard Six Cities

Study, nding that people live longer in cities that most

reduce ne particulate pollution. His work continues to

engage collaborators and help rewrite regulations around

the world.

Staping out Cigarettes

That many nations in Europe and Asia passed smoking

bans or public places is a testament to the eorts o

Howard Koh, Harvey V. Fineberg Proessor o the

Practice o Public Health, and Greg Connolly, Proessor

o the Practice o Public Health in the Division o Public

Health Practice. Dean Bloom recruited Koh ormer

Massachusetts Commissioner o Public Health to the

School, specically to reorganize and strengthen the

Division o Public Health Practice. Koh, in turn, recruitedhis colleague Connolly previously director o the states

Tobacco Control Program to join him.

Both ocials have gone on to lead the charge or

worldwide tobacco control at both the grassroots and

government levels. Connolly, an advisor to the World

Health Organization and an international ambassador or

policies that saeguard the public against passive smoking,

shuttles rom one country to the next conducting local

research, coordinating anti-smoking media campaigns,

You have to build the

capacity to do research

locally, then add a heavy

dose o aggressive anti-

tobacco advertising to

oster social change and

build enough political will

to raise taxes, ban smokingLeading the charge against

smoking: Howard Koh (let)

and Greg Connolly.

in public places, and

oer people treatment or

tobacco addiction.

Greg Connolly


31/4429

and advising government ocials. Both he and Koh have

increasingly directed their attention to developing nations,

where smoking rates remain high and where multinational

tobacco companies see markets ripe or exploitation.

In 2007, an educational campaign o a dierent sort

led by Dean Bloom and Associate Dean Jay Winsten

paid o when the Motion Picture Association o America

responded to their presentations and announced that the

glamorized depiction o smoking in lms would, or the

rst time in 40 years, join sex, violence and adult language

as a actor in determining movie ratings. The new rating

criterion enables parents to protect their children rom

the harms o the largest preventable cause o disease

in the world.

Eating Healthy Fds

When the U.S. Food and Drug Administration in 2006

ordered that nutrition labels or packaged oods sold in

the U.S. must list all harmul trans atty acids, it signied

a long-sought victory or HSPH scientists. Walter Willett,

Chair o the Department o Nutrition and Fredrick John

Stare Proessor o Epidemiology and Nutrition, Proessor

Meir Stamper, and Associate Proessor Eric Rimm,

in the Departments o Epidemiology and Nutrition,

and collaborators had or more than a decade amassedevidence that these solid ats ound in commercially

prepared baked goods and processed oods raised the

risk o coronary artery disease, type 2 diabetes and other

ills. As a result o the new rule, many companies and

international restaurant chains were compelled to reduce

or altogether eliminate these insidious ingredients, which

annually account or tens o thousands o premature

deaths in the U.S. alone.

Now people have the

inormation they need

to make healthier ood

choices. Beore, it was

almost the luck o the draw

as to whether their product

was healthy or loaded with

trans ats.

Walter Willett

Let: Scarlett Johansson, in the

2006 flm The Black Dahlia.

On January 1, 2006, the U.S.

Food and Drug Administration

began requiring that ood labels

include trans at content.


32/44

Saving Wens Lives

In 2005, Sue Goldie, in HSPHs Department o Health

Policy and Management, received a MacArthur genius

award or creatively applying the tools o decision science

to combat major public health problems. Goldie, Roger

Irving Lee Proessor o Public Health, has devoted her

career to constructing decision models that have the

potential to save millions o lives. She is perhaps most

well known or her analysis o women in poor nations

who suer disproportionately rom preventable diseasessuch as cervical cancer, which is caused by the human

papillomavirus (HPV). Devising computer-based

models that link the basic biology o a disease and its

epidemiology to population-based outcomes and costs,

she ound that the number o women dying rom cervical

cancer could be reduced by 30-50 percent i two simple,

cost-eective methods were used to screen women in

poor nations once or twice between the ages o 35 and 45.

The methods include automated swab testing or cancer-

causing types o HPV, and direct visual inspection during

which vinegar is applied to the cervix the latter process

costing less than $1 per screening.

Iprving TB Vaccines

Alongside his academic leadership role, Dean Bloom has

kept up an active career in bench science, as the principal

investigator o a laboratory researching new vaccine

strategies or tuberculosis. The current TB vaccine is the

worlds most widely administered childhood vaccine

but requires needles, not only a health risk in developing

countries, but a method that has shown widely variable

eectiveness in dierent parts o the world.

In 2007, collaborating with a team assembled by Proessor

David Edwards, Gordon McKay Proessor o the

Practice o Biomedical Engineering in Harvards School

o Engineering and Applied Sciences, Blooms group

developed a novel spray-drying method or delivering the

most common tuberculosis vaccine. The process could

Young women dying rom

cervical cancer is a public

health tragedy in light o

eective and cost-eective

screening methods. Our

analysis adds strong

support to changing the

long-standing perception

that screening will be

Rising rates o

tuberculosis and drug-

resistant disease in

developing countries

have amply illustrated the

need or more eective

vaccine. While most new

TB vaccines continue to

call or needle injection, ourLet: Sue Goldie with children

at Clinique Bon Sauveur, Haiti.Right: X-ray o chest o patient

with miliary tuberculosis.

too dicult to implement

and sustain in the worlds

poorest countries.

Sue Goldie

vaccine could provide saer,

more consistent protection

by eliminating these

injections and the need

or rerigerated storage.

David Edwards


33/4431

one day provide a better approach not only or stemming

the TB epidemic, but also or delivering other vaccines

without needles in the developing world. In 2008, a version

o the vaccine administered directly to the lungs as an

inhaled mist showed signicantly better protection against

the disease in experimental animals than a comparable

dose o the injected vaccine.

Iprving Care fr minrity Ppulatins

Assessing hospital care or minority populations, HSPH

researchers have uncovered disturbing patterns o

inequities. Two recent studies examining where elderly

blacks and Hispanics receive hospital care ound not only

that their treatment is concentrated in a small number

o U.S. hospitals, but that these acilities provide a lower

quality o care or such common medical conditions as

heart attacks, congestive heart ailure and pneumonia.

Arnold Epstein, Department Chair and John H. FosterProessor o Health Policy and Management, and Ashish

Jha, Assistant Proessor o Health Policy and Management,

examined the ve percent o U.S. hospitals with the highest

proportion o elderly black and Hispanic patients, among

the approximately 4,500 hospitals that provided medical

or surgical care to Medicare patients. These institutions

treated approximately hal o all elderly Arican American

and Hispanic patients. But the researchers conclusions

were not all dire: given the concentration o these ethnic

minorities in a small number o hospitals, interventions to

improve these acilities could disproportionately benet the

health o black and Hispanic Americans.

A very small number o

hospitals care or most

o the elderly Arican

Americans in this country,

and these hospitals refect

Americas overall problem

with health care quality: too

many hospitals provide poor

care.

Ashish Jha


34/44

Expsing Health Disparities

While overall lie expectancy in the U.S. increased between

1960 and 2000, a long-term study o mortality patterns

over those same our decades revealed troubling trends,

according to HSPH scientists. In a recent report, Majid

Ezzati, Associate Proessor o International Health,

and colleagues showed that lie expectancy declined or

stagnated among a signicant segment o the population,

beginning in the 1980s. Most o the counties that

experienced the worst declines were in the Deep South,along the Mississippi River and in Appalachia.

To graphically portray and monitor socioeconomic

inequalities in health, Nancy Krieger, Proessor o

Society, Human Development, and Health, and her team

developed a geocoding tool that matches health outcomes

data collected by public health systems with geography

in this case, census tracts or which the ederal

government collects economic data. Krieger and her

colleagues showed that people who live in neighborhoods

with the highest poverty levels suer more heart disease,

cancer, diabetes, sexually transmitted diseases, childhood

lead poisoning, low-birth weight inants, gunshot wounds,

tuberculosis, homicides, and other common indicators o

poor public health. The geocoding tool has been adopted

not only by health departments, but also by geographers,

urban planners and community-based health activists.

While death is inevitable,

premature mortality is

not, and neither are social

inequities in premature

mortality.

Nancy Krieger

Maps depicting change in

lie expectancy in the U.S.,

1983-1999. During that period,

lie expectancy declined

signifcantly in 11 counties or

men and in 180 counties or

women. Warmer colors signiy

decline in lie expectancy.

From Ezzati et al, PLoS

Medicine, April 2008.

1983 1999


35/4433

This isnt just pure

science its science

or public policy. I

youre not willing to rub

peoples noses in the act

that youve identied

a problem, and that

something needs to be

done about it, then haveyou improved public

health? You need to be

willing to take the next

step and to take a lot

o criticism o your

ndings rom people

who have a monetary

interest in their not

being true.Joel Schwartz


36/44


37/44

HSPH is one o the most academically diverse

o all the Harvard graduate schools, ranging rom

undamental science to global health practice.

This disciplinary richness, coupled with the

Schools ambitious mission to generate newknowledge and apply it to improve the health

o populations in this country and around

the world make it a natural connector

across the University.

only Cnnect...


38/44

A Comprehensive Cancer CenterDesignated by the National Cancer Institute

DANA-FARBER/HARVARD CANCER CENTER

Cnnecting acrss the Capus

The Schools connectivity is partly refected in its

combined degree programs. Medical students can pursue

an MD/Master o Public Health degree, and dental

students a DMD/DDS/MPH degree. HSPH and Harvard

Law School oer a Juris Doctor/MPH degree, which

supports careers in health law, public health policy and

related elds. Project Antares, an HSPH collaboration

with Harvard Business School, aims to address global

health problems through micronance and sustainableand scalable business enterprises. In addition, several

HSPH aculty members teach undergraduate courses

in Environmental Health and Global Health and lead

reshman seminars.

The Harvard Center or Population and Development

Studies, based at HSPH, is a University-wide center

which serves as a locus o interdisciplinary research

on population change, socioeconomic development

and human health. Among the Schools other thriving

University connections are its relationships with

the Harvard Initiative on Global Health; the University

Center or the Environment; the Institute or Quantitative

Social Science, the Center on the Developing Child, and

the Broad Institute at MIT and Harvard. The Schools

ongoing research ties to Bostons premier hospitals

include collaborations with the Channing Laboratory and

Brigham and Womens Hospital on the Nurses HealthStudies, and with the Dana-Farber/Harvard Cancer

Center, the largest comprehensive cancer center

in the world.

A new Gene-Environment Initiative, launched by

Dean Bloom, has gathered biologists, epidemiologists,

environmental scientists, and biostatisticians to integrate

knowledge about quantitative genomics, genetic

HSPH unctions as the

conscience o Harvard as it

helps to address the major

health concerns acing

the people on our planet.

Steven A. Schroeder, MD,

Distinguished Proessor o

Health and Health Care,

University o Caliornia,

San Francisco Department

o Medicine; Chair, HSPH

Visiting Committee

The Harvard School o

Public Health is among

the most interdisciplinary,

inviting and open academic

environments on campus.

Gary King, Director,

Institute or Quantitative

Social Science, Harvard

University


39/4437

epidemiology, exposure biology, and the mechanisms

o environmental injury, in order to spark new cross-

disciplinary research.The prospect o moving HSPH to

a new campus in Allston will acilitate yet more linkages

across the University rom biological sciences and

economics to government, regional studies and business.

Cnnecting with the Public

The Schools enhanced commitment to communications

is another orm o connection. Its robust Oce o

Communications, led by Robin Herman, Assistant Dean

or Communications, is the primary inormation resource

or the institution, keeping HSPH in the lead among all

schools o public health in media citations. The Schools

new Health Communication Concentration trains

students as well as public health leaders, practitioners

and researchers in eective communication techniques.The Nieman Fellowships in Global Health Reporting

a joint initiative between HSPH and Harvards Nieman

Foundation or Journalism deepen public understanding

o health issues in the developing world. This training

eort is led by Jay Winsten, Frank Stanton Center Director

o the Center or Health Communication.

2006 Mayors Award or

Excellence in Childrens

Health. From let to right, Matt

LiPuma, Executive Director o

the Family Nurturing Center

o Massachusetts; HSPH

Dean Barry R. Bloom; James

Mandell, President and CEO,

Childrens Hospital Boston;

Boston Mayor Thomas Menino.


40/44

Active Learning

The Schools educational mission binds together its varied

and ar-fung activities. Oering a variety o doctoral and

masters degrees, HSPH strives to ensure that each o its

programs is not only rigorous academically but attracts

the best students in the world. Its increasing nancial

aid made possible by growing numbers o scholarship

gits received at the University and School levels, as well

as increases in the endowment payout draws todays top

young scholars. Adding to the Schools rich educationalenvironment is the diversity o the individuals who study

here; today, more than hal o HSPH students are women,

13 percent represent minorities, and 33 percent come

rom abroad.

As public health research broadens in scope and

complexity with increasing emphasis on inormatics,

genomics, communication, cultural competence,

community-based participatory research, global health,

policy and law, and public health ethics so will the

educational needs o HSPH students. Looking orward

to teaching and training or the 21st century, the newly-

established HSPH Oce or Educational Programs, led by

Associate Deans Nancy Kane and Nancy Turnbull, was set

up by Dean Bloom and Academic Dean James Ware, the

Frederick Mosteller Proessor o Biostatistics. Its purpose

is to rethink and strengthen the Schools educational

programs rom course work to mentoring to practicum.

Forging an aggressive agenda, the Oce is boosting case-based teaching and active learning across the curriculum.

It is systematically identiying high-quality practicum

experiences, inviting eedback to aculty on the quality

o teaching and providing support or improvement,

engaging key alumni, and adapting course oerings and

sequences to the needs o the student body. In all 2008,

it will oer a case-based alternate core curriculum or

proessional masters students.

Even people who were

students with me back

in the 1970s are still

my colleagues. I see

them around the country,

around the world, and

we have an instant basis

or collaboration and

conversation, as well

as riendship.

Walter Willett, Chair

Department o Nutrition

Each year when I ask the

graduating students what

was the most rewarding

aspect o their experience

at HSPH, the answer or ten

years has invariably been,

The other students.

Dean Barry R. Bloom


41/4439

HSPH attracts some o

the smartest and most

committed students

rom around the world.

My classmates have

been business leaders,

politicians, physicians,

lawyers, journalists, and

even poets. Each newconnection has given me

insight into how public

health aects all aspects

o the world around us.

Karen Grpin, HPM,

SM 2004


42/44

Endowment

Income12%

Other Investment

Income2%

Student Income8%

Gifts for

Current Use3%

Other Income

3%Federal

Research

58%

Non-federal

Research14%

The past decade has sustained the Schools 21-year record

o continued growth and strong scal management.

During this time, HSPH operating expenses have almost

doubled, rom $152 million to $297 million. The sources

o that unding have remained airly constant with

roughly 70 percent o revenues deriving rom sponsored

sources, mostly the National Institutes o Health (NIH).

This nancial model depends on both the continued

success o the aculty in obtaining research grants and

on steady Congressional unding o the NIH. During the

rst part o the past decade, the NIH saw a doubling o its

budget (1998 to 2003); more recently, however, it has been

level unded.

To address this scal reality, HSPH has taken two prudent

approaches under Dean Blooms leadership. First, the

School broadly analyzed its nances. Early on, it engaged

The Boston Consulting Group on how HSPH could

manage its resources more eciently. Based on the BCG

report, the School developed, with a aculty committee,

a budgeting method that has boosted transparency and

created reserves at both the School and department levels.

Second, the School quantied its nancial risk. It devised

a nancial sensitivity model to understand the impact

o possible reductions in sponsored unds. It also drew

up contingency plans that show how the School would

weather a downturn with the support o reserves and with

appropriate budget reductions.

Fortunately, the School has not had to implement those

measures, because o the continuing success our aculty

has enjoyed in garnering competitive grants rom

government and other sources and also because o the

expanding generosity o hundreds o individuals and

scores o corporate, organization and oundation donors

who support the Schools mission each year.

Finances

HSPH budget growth, 1999-2008 FY07 Operating Revenues

Through the Catherine

B. Reynolds Foundation

Fellowship, I have been

able to study at the best

school in the world

which I would never have

been able to do, given

my salary o less than

$4,000 USD a year. The

Fellowship ocuses on

social entrepreneurship and

leadership skills that are

important or bringing about

positive social change.

Julian Atim, 2007-2008

Catherine B. Reynolds

Foundation Fellow


43/44

2008, President and Fellows o Harvard College

Producer

Jonathan Barkan is the

Executive Producer/Director o

Communications or Learning, a ull-service

communications frm in Arlington, MA,

serving corporate, government and non-

proft clients since 1972.

Writer

Madeline Drexler is a Boston-basedjournalist and author, specializing in

science, medicine and public health.

She holds a visiting appointment at the

Harvard School o Public Health.

Designer

Yuly Mekler is Creative Director/Principal

at iMmedia Design, serving corporate and

institutional clients in branding and design.

Photography:

Fabrizo Bensch / REUTERS

Dan Bersak

Barry Bloom

Suzanne Camarata

CORBIS

Amit Dave / REUTERS

Kent Dayton

Eye o Science / Photo Researchers, Inc

Richard Feldman

Louise Gubb / CORBIS SABA

Harvard News Ofce

Michelle Holmes

Daniel Leclair / REUTERS

Nurses Health Study

Finbarr OReilly / REUTERS

Pan American Health Organization

Physicians or Human Rights

Paolo Santos / REUTERS

Stockbyte / Getty Images

Dadang Tri / REUTERS

Andrew Wong / REUTERS

Zephyr / Photo Researchers, Inc

Special thanks to HSPH contributors:

Robin Herman

Anne Hubbard

Julie Raer ty

Christina Roache

Alix Smullin

For information please contact:

HSPH Ofce o Communications

617-432-4388

[email protected]

www.hsph.harvard.edu

Over the past two years, increased allocations o

endowment income provided by the University or

strategic investment have enabled the School to support

recruitments and seed research supporting its strategic

initiatives. These investments are critical to maintaining

our competitiveness in obtaining sponsored unds.

Over the past decade, total budgetary support rom

endowment has grown rom 10 percent to 14 percent in F08.

Looking to F09, the School projects a budget o $304 million.

HSPH anticipates that it will continue to increase student

fnancial aid, support its strategic initiatives and build

its reserves.


44/44

Never doubt that a small

group o thoughtul,

committed peoplecan change the world.

Indeed, it is the only

thing that ever has.

Margaret Mead

HARVARD

School of Public Health

health without boundaries 2008

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