Fall/Winter 2010 - What Makes Us Tick? Berkeley Health by UC Berkeley School of Public Health

University of California, Berkeley, School of Public Health

Berkeley Health The Magazine for Alumni and Friends

What Makes Us Tick? Exploring Mental Health

INSIDE: Life inside the Human Mind p. 4 Californiaâ&#x20AC;&#x2122;s Mental Health Services Act: Is It Working? p. 19

FALL / WINTER 2010

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With an estimated national shortage of 250,000 public health professionals, the need for superior public health education, research, and action has never been more urgent. Your support can help attract and retain the best Berkeley students regardless of their financial meansâ&#x20AC;&#x201D;students who are passionate about protecting your health and the health of those you care about. Make your tax deductible contribution online at sph.berkeley.edu/giving or mail your gift using the envelope in this magazine. For additional information about making a gift to the School of Public Health, call Pat Hosel, Assistant Dean, External Relations and Development, at (510) 642-9654.

Healthier Lives in a Safer World

The CAMPAIGN for the SCHOOL of PUBLIC HEALTH

UNIVERSIT Y OF CALIFORNIA, BERKELEY

University of California, Berkeley, School of Public Health

Berkeley Health

FALL / WINTER 2010

The Magazine for Alumni and Friends

FEATURES

Life inside the Human Mind 4

Throughout our lifetimes, mental health is essential to our overall health. What are the challenges of mental health and cognitive development at different stages of life? How can psychiatric services be made more cost-effective? Current research examines mental health from a variety of perspectives including neurobiology, psychology, and health policy.

From Pu blication to Pu blic Action

W ORKING WITH CO M M UNITIES TO IMPRO VE A D OLESCENT HEALTH

Calif ornia’s M en tal Health Services Act: Is It Workin g? 19

24 26 28

Five years after the Mental Health Services Act established the “ millionaire tax” aimed at improving services for Californians with severe mental illness, a panel of experts refl ects on the Act’s impact to date and shares predictions about its future.

Studen t Sp o tlig h t: LeCon té Dill EXPLORING RESILIENCE A M O NG URBA N A D OLESCENTS O F COLOR

A lumna Sp o tlig h t: Chia-Chia Chien SH ATTERING CULTURAL BARRIERS

Fresh Perspective A TYPICAL D AY AT A CO M M UNITY MENTAL HEALTH CLINIC

DEPARTMENTS 30 39 42

The Campaign f or the Scho ol o f Pu blic Health Arou nd the Sch ool A lumni No tes

Dean Stephen M. Shortell, Ph.D., M.P.H.

Design Archer Design, Inc.

Assistant Dean, External Relations and Development Patricia W. Hosel, M.P.A.

Contributors Linda Anderberg, Anne L. Bakar, Anthony Battista, Michael S. Broder, Timothy Brown, Abby Cohn, Julianna Deardorff, Stephen W. Mayberg, Neil Sachs, Richard Scheffl er, Stephen M. Shortell, Marvin J. Southard, Eduardo Vega

Director of Communications and Public Relations Michael S. Broder Associate Director, Communications Linda Anderberg Director, Annual Fund and External Relations Programs Eileen Pearl

Photography Shutterstock, cover, 4, 12, 40, back cover; Jim Block, 1, 7, 9, 11, 15, 39, 41, 44; Peg Skorpinski, 2, 19, 26, 31–33, 35, 37–38, 39, 43; Jupiter Images 12; Sarah Yang, 24; courtesy of the Prince Family, 25; José Rodriguez, 25; Abby Cohn, 27; Dion Shimatsu-Ong, 40; Ingrid Berg, 41

Communications Advisory Board Linda Anderberg, Michael S. Broder, Patricia A. Buffl er, Patricia W. Hosel, Joan Lam, Meredith Minkler, Linda Neuhauser, James Robinson, Steve Selvin, Stephen M. Shortell, John Swartzberg, Michael P. Wilson

Berkeley Health is published semiannually by the University of California, Berkeley, School of Public Health, for alumni and friends of the School.

UC Berkeley School of Public Health Offi ce of External Relations and Development 417 University Hall #7360 Berkeley, CA 94720-7360 (510) 643-2556 © 2010, Regents of the University of California. Reproduction in whole or part requires written permission.

Berkeley Health Fall / W inter 2010

From the Dean

Mind and Body One of the most exciting developments of the 21st century is the increased ability to probe and understand the human mind. Advances in neuroscience and related fields are bringing about, almost weekly, new discoveries of the functioning of the brain. This is good news, because a race is on. The race is between our ability to understand, prevent, and treat mental illness and its increasing incidence and prevalence throughout the world. Here are some facts: • The recent Global Burden of Disease Study conducted by the World Health Organization, the World Bank, and Harvard University found that mental illness, including suicide, accounts for over 15 percent of the burden of disease throughout established market development economies. This is more than the disease burden caused by all cancers combined. • About 25 percent of American adults suffer from a diagnosable mental illness in a given year, and 6 percent suffer from a serious mental illness.

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• Nearly half of those with any mental disorder have two or more disorders. • The economic burden of depression alone in the United States is estimated at $83 billion, including both direct treatment costs and indirect lost workplace productivity costs. • Depression is the leading comorbid condition for people suffering from other chronic illnesses such as diabetes, heart disease, and asthma.

I was first exposed to the human faces behind these numbers as a young college student working as an orderly in a 36-bed psychiatric unit of a community hospital. I worked the weekend graveyard shift from 11 p.m. to 7 a.m. I saw firsthand the pervasive economic and social impact of mental illness, not only on the patients, but on their families and friends. While the mental health professionals—psychiatrists and others—did their best with the medicines, shock therapy, and various counseling approaches, too often we saw “returnees.” I think this was the first time that I fully understood what was a “chronic” illness. As our knowledge of the relationship between mind and body advances, we are becoming increasingly aware of the important role played by the underlying physical and social determinants of both mental and physical illness throughout the life cycle. In the pages that follow, you will read about the fascinating research being conducted by Darlene Francis and Ray Catalano on the role of early nurturing and stress in the neo-natal, infancy,

and childhood period. Ron Dahl and Emily Ozer address their work covering the adolescent life stage. Joan Bloom and Lonnie Snowden turn their attention to the mental health systems in which most adults receive mental health services. These issues are also addressed by Richard Scheffl er and several California mental health leaders. In examining the later stages of life, Bill Jagust discusses his work to identify early markers of Alzheimer’s disease, and Bill Satariano identifi es the environmental factors that contribute to positive mental health and healthy aging. This issue also highlights the important work of several of our alumni and students to improve mental health in their communities. The need for progress is great. A recent assessment of the mental health objectives in the Healthy People 2010 report found that only one of 14 of the established objectives was met or exceeded. If greater progress could be made in mental health, it would likely have a positive multiplier effect on physical health status indicators as well, due to the high interdependence of our mental health with

our physical health. We also need better indicators to track our progress. What, for example, might be the mental health equivalent of clean water? A major area for future research (and subsequent policy interventions) will be to examine and disentangle the likely reciprocal relationship between a given community’s level of mental health and its development of the social capital needed to create healthier communities in which all residents can thrive—throughout their lives. I have every expectation that Berkeley faculty, alumni, and students will, along with others, be at the forefront of developing this knowledge.

Stephen M. Shortell, Ph.D., M.P.H., M.B.A. Dean, School of Public Health Blue Cross of California Distinguished Professor of Health Policy & Management Professor of Organization Behavior

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Life inside the

Human Mind By Linda Anderberg

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For an individual seeking good mental health throughout the lifespan, there are familiar adages that offer common-sense guidance and are grounded in science as well. To raise children with healthy stress responses, surround them with “friends and toys.” For teens struggling to control their emotions, “sleep is good.” Seniors looking to maintain mental acuity as they age will find that “what’s good for the heart is good for the head.” And, of course, at every age, the general rule is “use it or lose it.”

Talking to experts at the School, who have varied backgrounds—psychology, neurobiology, sociology, economics, and health policy—it becomes clear that, not only is mental health as broad a fi eld as physical health, the two worlds are also inextricably linked.

PRENATAL / INFANCY Not many people would take a three-month-old to see a psychologist, but there’s still plenty happening in the area of mental health for babies, even before birth. The human brain begins forming during week three of a pregnancy, and early life abounds with opportunity to steer the mind in a healthy direction. From a public health perspective, early interventions are the most effective and have the biggest payoff down the line. It’s all about evaluating the conditions during pregnancy and infancy that prevent negative outcomes such as mental illness and lead to a healthy, happy adult population.

Stress, gestation, and forces of nature When Professor Ray Catalano looks at population-level reactions to stress and anxiety, he thinks, “ How did we get here?” And he puzzles over not just the current population, but all the populations that might have been. “ Only 30 percent of human conceptions get born—probably fewer, ” he says. “So that any given time the human population will have in gestation a much larger number of possible humans than actually become live humans. And my job is to try to fi gure out what the fi lters are, what the criteria are by which you pass from being a potential human into a live human. ” If you’re reading this, Catalano believes you have passed some “ tests” in utero that were developed by evolutionary

mechanisms over hundreds of thousands of years. Clearly, the effi cacy of these tests has been proven—from an evolutionary standpoint—by the fact that humans as a species are still around. Unfortunately, passing these tests was likely to have had more benefi t many thousands of years ago, and does not necessarily guarantee success as a human living in modern society. In fact, the opposite may be true. “So what we fi nd today is that there probably are these atavistic mechanisms that made perfectly good sense in our evolutionary history, which may not be so obviously benefi cial any longer, but they are still at work, ” says Catalano. “The classic example of how this impacts mental health being that a stressed mother both epigenetically and behaviorally can infl uence characteristics of her offspring such that they become more reactive to stressful circumstances. And that that kind of heightened stress response will affect their later life health. ” The possible negative consequences of this mechanism include increases in physical health problems exacerbated by stress, such as increased cardiovascular disease, and also elevated mental health problems for some populations— specifi cally, clinical levels of anxiety. People who are clinically anxious respond biologically and behaviorally to events that most people don’t feel are provocative or require any particular response, to the point where it gets in the way of daily life. They may need psychological or psychiatric treatment in order to manage their reactions to small stressors. Catalano believes this high level of anxiety did not get bestowed on some members of a given population due to chance, but in fact because responsiveness to stress is a benefi cial quality to have in a challenging environment. “It’s possible that a population that includes pregnant women who are being subjected to high levels of challenge may produce a generation of people who respond at lower levels of challenge in the hopes that you will get more survivors given that environmental circumstance, ” says continued on page 6 Berkeley Health Fall / W inter 2010

Life inside the Human Mind, continued PRENATAL / INFANCY ADOLESCENCE ADULT ELDERLY

Catalano. “If the environment then becomes less challenging, what you’ve got are people who are hyper-responsive, which puts them at higher risk for behavioral and physiological problems. ” All this is not to say that everything is fixed prenatally, with no room for change later on. “Some people make claims that early life exposures change dramatically what people do later. It’s not so clear to me that that’s right, ” says Catalano, “ because there’s a lot of plasticity and malleability. After you’ve been selected and made epigenetically who you are, then after that there’s probably considerable leeway in what you’re going to do within the parameters that are available to you. ” Catalano also looks at other ways stressors affect gestation on a population level. Along with Tim Bruckner at UC Irvine and other researchers, he evaluated the phenomenon that catastrophic events and economic stressors—such as the 9/11 terrorist attacks, recessions, or mass layoffs—result in fewer male babies being born. They concluded this response is due to selection in utero, i.e., a higher number of male fetuses being spontaneously aborted in times of stress. The scientifi c evidence suggests that male fetuses, especially smaller males, are more susceptible than female fetuses to stress-induced hormones during pregnancy, because the mechanisms that test males and females for fi tness are different. The ratio shift is small, but statistically signifi cant, and shows that the gestation process can be affected by external stressors at a population level. Should these population-level fi ndings affect health and economic policy on a broad scale, or infl uence expectant mothers’ choices at an individual level? Catalano believes such decisions, made by public health professionals and the populations they serve, should be informed by rigorous research and exploration of basic science. “Public health as a science is trying to understand how we come to be as we are, ” he says. “It’s our job to study, at the frontier, what are the things that affect populations and population health. The fodder for the decision-making mill has to come from somewhere, and that has to come from science. That’s probably what Berkeley does better than most schools of public health, because we are embedded in a campus that has always been committed to basic science. ”

Neurobiology, environmental enrichment, and better stress management The stress reaction—or “ freaking out ”—is an unavoidable part of life, and not always a bad one. The ability to react Berkeley Health Fall / W inter 2010

to stress, to deal with imminent threat, is critical to survival. The bad part comes when the stress response is activated chronically and inappropriately—” freaking out over nothing. ” That can lead to increased vulnerability to stressrelated diseases and mental pathologies. The ability to distinguish between controllable and uncontrollable stressors can be the key to becoming a healthy, happy, functional adult. And, in part, this ability—or lack of ability—is formed very early on in life. “I’m interested in what contributes to an effi cient and healthy stress response, ” says Darlene Francis, assistant professor of public health, who is an expert in neurobiology and has a joint appointment with the UC Berkeley Department of Psychology. “ And we know from our work that the quality of parenting, or maternal care, absolutely trumps just about any other factor for determining the trajectories in which your stress response develops over time. ” Francis learns about the development of the stress response by working with rats and mice, but her ultimate goal is to improve the lives of humans. She can see from her extensive experience with rat families that their social interactions resemble those of humans in many ways. Moreover, animal models allow her to look closely at the biological mechanisms that underpin stress reactions and behaviors, to determine causal relationships, and test possible interventions at specifi c stages of life. Katherine Saxton, M.P.H. ‘06, a doctoral student in epidemiology who works in Francis’s lab, also sees the value of animal research to human public health. “ From my point of view, there’s a lot we can’t do with people, ” says Saxton. “But we can look at the rat brains; we can run experiments and control, or at least measure, maternal care and stress. So we can actually look at what matters, when it matters, and how it works. ” And, she adds, “To answer a simple question about development, you don’t want to wait 50 years. Maybe some people do, but I’m impatient. ” A good example of the power of animal research models is Francis’s research into the effi cacy of mental health interventions in early childhood. In human and rat brains alike, the hippocampus is a critical component in the coordination of the stress response, because glucocorticoid receptors located in the hippocampus bind stress hormones in order to turn off the stress response. Basically, having more glucocorticoid receptors gives a greater ability to “ fi ne tune ” reactions to stress. Francis has learned from her research and others’ that rats with highly maternal environments (more licking and grooming) will develop double or triple the amount of glucocorticoid receptors than rats with weak maternal environments.

Francis then looked at how a large-scale intervention might positively affect the rats that had grown up in low maternal care environments. She threw “ all the good stuff [she] could imagine ” into their environment, including larger cages to roam, other rats for social time, and toys for play time. “This massive intervention for the animals was able to successfully reverse the phenotype, ” she says. “So my prediction was that we must have reversed the levels of glucocorticoid receptors. ” However, she found that her prediction was “ absolutely false ” and that, although the intervention was a success in terms of the rats’ behaviors, their glucocorticoid receptor levels had remained fixed. She then theorized that the intervention was, in effect, creating a work-around in a part of the brain that develops later in life, probably the frontal cortex. “Rather than thinking about undoing, it’s more about looking for opportunities where you can effect change, ” concludes Francis. Results like these in animal models have many implications for the direction of public health interventions for humans.

Changes to the environment during pregnancy and the first few years of life, when critical brain structures such as the hippocampus are forming, will undoubtedly have the greatest impact on functioning as an adult. But it’s also true that the brain is malleable, and can create many different routes to the same desired destination. “ An appealing piece of this for public health people is the environmental enrichment, ” says Saxton. “ You might not be able to go back and change someone’s parenting experience, but you can change the environment they are in later and work around it that way. So when you’re thinking about racial disparities, poverty, trauma, or abuse, outside interventions later on in life can still make a difference. ” Francis believes many—perhaps all!—public health and mental health problems throughout the lifespan can be viewed in terms of stress management. “It’s really hard to escape, ” she says. “ When you’re thinking about any intervention for just about any mental or physical health outcome, managing stress will give you a huge bang for your buck. ” continued on page 8

Darlene Francis

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Life inside the Human Mind,

ADOLESCENCE

continued

Adolescence encompasses a broad age range that’s getting broader. Recent studies at the School (see page 18) show that puberty is beginning earlier in girls, as early as age 8 or 9. Additionally, some teens are delaying adulthood and postponing the time they strike out on their own in the world into their mid- to late-20s. But whatever the time frame, adolescence—the transition from childhood to adulthood—is a time of change in the brain. It is fi lled with potential but fraught with pitfalls. For public health experts, the goal is to understand how to steer adolescent minds in a healthy direction; avoid preventable disease; and prevent deaths from car accidents, homicide, suicide, and substance abuse.

Sleep, trajectories, and the adolescent mind The word “ teen ” brings to mind adjectives like “sullen, ” “lazy, ” and “rebellious. ” But for Professor Ronald Dahl, adolescence is more synonymous with phrases like “ window of opportunity” or “ endless possibility. ” He sees it as a time where the stakes are high and the risks are great, but—importantly—the potential rewards are enormous. “ Adolescence is a really a key window of time for the emergence of a lot of diffi culties with emotions and behavior, ” he says, pointing out that most problems with depression and anxiety as well as alcohol and drug

sculpt these systems during development—including some unique maturational changes. He joined the School’s faculty this semester, and is excited to leverage the latest advances in developmental neuroscience to inform the strategies, timing, and targets for behavioral interventions, as well as social policies to promote healthy outcomes. “By understanding windows in time in brain development when things are at a tipping point or rapidly changing, these advances can help us zoom in on a specifi c behavior intervention or social policies that take advantage of that knowledge and create positive changes with a more enduring impact, ” he explains. One key neural system undergoing a shift during adolescence is sleep regulation. There are two changes in the sleep system that happen at puberty: Kids want and need more sleep than they did pre-puberty, and there is also a subtle shift in the circadian system that causes a tendency to prefer staying up late and sleeping in late. This preference does not mean teens are incapable of getting out of bed before 10 a.m. or falling asleep before 11 p.m. but, when the natural tendency is combined with early school start times, access to artifi cial light, and the simulating distractions of modern life—television, cell phones, video games, Facebook, instant messaging—the end result is a surprising number of sleep-deprived teens. “Thirty to forty percent of kids are sleep deprived in American schools, ” says Dahl. “Japan is probably worse. These problems are increasing around the world in adolescents, this pressure to do more and more, staying up later, and using stimulants like caffeine. ”

“Adolescence is when we have the onset of a lot of psychological disorders, but there’s still a lot of chance for interventions.” problems and risk-taking behaviors often begin to emerge during adolescence. “But even more broadly, it’s a key time in the trajectory toward a healthy adult lifestyle. ” Like Francis, Dahl approaches social problems with an emphasis on neurobiological processes. He looks at the development of neural systems that underpin self-regulation, emotion regulation, and how experience and learning can

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Sleep deprivation may be great for the health of the coffee industry (“ the second-most-traded commodity in the world after oil, ” Dahl points out). But it’s bad for the health of adolescents, their parents’ sanity, and the safety of those sharing the road with “ chronically jet-lagged ” teens learning how to drive. Sleep deprivation also increases irritability and the tendency towards alcohol and drug use.

Emily Ozer

Dahl also believes there’s more to making sure kids get enough sleep than just avoiding the negative impact of sleep deprivation. “The neuroscience tells us that having an impact in positive ways on the trajectory of people doing well in their lives can be much larger than preventing people from going into some category of pathology, ” he says. “I think of adolescence as a tipping point, and if you can tip it more positively during this infl ection point, that can pay dividends for 30, 40, 50 years of life. ”

“ Adolescence is when we have the onset of a lot of psychological disorders, but there’s still a lot of chance for interventions, ” Ozer says. “ However, there’s not much out there for teenagers. Most of the work is being done at the grade school level. Teens are a harder group to work with. ” Part of the reason for this is that adolescents may already have begun experimenting with risky behaviors. Says Ozer, “If you’re trying to work with young people who are already using drugs, your approach has to be more subtle and differentiated than a broad curriculum that is implemented across the country. ”

ELDERLY ADULT

Some people may throw up their hands in despair when dealing with diffi cult teenagers, and it’s hard to blame them. But Emily Ozer doesn’t give up. As an associate professor of community health and human development, Ozer has observed a dearth of interventions and prevention programs available for adolescents. She’s looking to fi ll the gap by evaluating evidence-based programs and youth-led participatory research in high schools.

ADOLESCENCE

“It’s hard enough for motivated, well-supported kids, ” says Dahl, “ but think about those kids who don’t have parental support and who are already struggling with depression, anxiety, violence, or drug use; the sleep deprivation can really add to a downward spiral of health problems for them. ”

High school, peer pressure, and youth-led empowerment for at-risk teens

PRENATAL / INFANCY

It negatively impacts emotion regulation, concentration, and attention, and can cause teens to fall asleep during quiet activities like school or driving. There’s also evidence that it interferes with metabolic regulation in a way that predisposes to energy storage, thereby contributing to weight gain and obesity. And its effects are amplifi ed in populations that are already at risk in other ways.

continued on page 10

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Life inside the Human Mind, continued PRENATAL / INFANCY ADOLESCENCE ADULT ELDERLY

While it may be easier to develop and test programs for younger kids, it’s still very important not to neglect the health of adolescents and teenagers, especially at-risk individuals and populations. The top three causes of death in teens—automobile accidents, homicides, and suicides—are all preventable and related to mental health and behavioral issues. Beyond mortality, about one in five adolescents is suffering from mental health disorders nationwide, one in ten with a “serious emotional disturbance. ” The most common mental health problems during adolescence are anxiety and depressive disorders—which can lead to performance problems in school and increased risk for alcohol and substance abuse, violence, and suicide. Ozer has been struck by two movements in the fi eld of youth violence and substance abuse prevention: evidencebased programs, which have been proven effective based on rigorous examination, and participatory programs, which engage the community in a collaborative way. The goal of much of her research is to combine the two concepts. “I think both movements have a lot of validity, ” she says, “ but there’s no real exchange between the two. How do we use evidence-based practices and programs, but also try to make them locally relevant?” For the past fi ve years, Ozer has been working to evaluate the effi cacy of youth-led participatory programs in five San Francisco high schools. She collaborates with San Francisco Peer Resources, a program that staffs elective classes on peer mentoring and confl ict resolution in San Francisco high schools. In each school, Ozer randomly selects one class to get a specialized “youth research in action ” curriculum, during which young people are trained to identify a problem, research it, and develop ways to effect change in their communities. Ozer believes this type of intervention holds great promise for at-risk teens. “It’s an incredibly promising and powerful intervention that’s very developmentally appropriate for teenagers, ” she says. “If you look at an elementary school classroom, usually even kindergarteners will be asked to come up with rules to put on the wall. But when teenagers get to junior high and high school, they’re no longer able to have autonomy or participate in important decisions in their lives. This creates ‘developmental mismatch,’ that at the time kids are becoming more developmentally capable of having more control over their lives, they are put in a kind of lockdown environment, especially in public schools. ”

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An inspiring example of this method: One issue students identifi ed at John O’Connell High School was teaching practices—they felt teachers often taught in a way that wasn’t engaging to students and students were tuning out. So the class developed an observational tool, where students would go into a teacher’s classroom, observe what the teacher was doing that seemed to engage students, and then give the teachers individualized feedback sessions about what seemed to be working. “ You have a situation where these students, who I think have been seen as the problem in a lot of ways, are ending up doing professional development for their teachers and becoming experts through the research process, ” says Ozer. “They’re interacting in school in roles they never would have had before. I think it’s really powerful in that way. ” The teachers were responsive as well, perhaps in part because the students (with guidance from O’Connell teacher Gary Cruz) smartly decided to only give positive feedback through their “Best Practices Club, ” and also started with the teachers with whom they thought they would be most successful. “It was amazing, ” says Ozer. “The students did a really thoughtful job of engaging the teachers as allies. ” This type of intervention shows promise in improving the mental health of teens, not only in reducing youth violence and substance abuse, but also creating conditions within the schools that provide positive infl uences on mental health and well-being: connection to the school community, meaningful opportunities to effect change, and improved communication skills. Not neglecting the evidence-based side of the equation, Ozer and a graduate student, Marieka Schotland, spent a lot of time developing quantitative measures of tricky concepts like psychological empowerment. “Because it’s an area that hasn’t had a lot of systematic study, a lot of my time has been about defi ning a good implementation, process-wise, and developing measures to assess outcomes, ” says Ozer. Ozer will spend the next year doing in-depth quantitative analysis and use her results to determine next steps. “I’m in a great place to build a bigger study, ” she says. “The question is what will be the most fruitful next step?”

ADULTHOOD Mental illness is an all-too-common disabler of people who might otherwise be in their most productive years. Because they have trouble functioning in society, adults with the most severe mental disorders are oftentimes of low socioeconomic status. As a result, Medicaid is the biggest payer for mental health care in the United States. One strength of the School—which boasts a wealth of health policy and management experts—is its ability to evaluate public sector mental health systems in terms of access, utilization, cost-effectiveness, and outcomes. What works, what doesn’t work, and what could work even better? Also, what can we afford?

Emergency rooms, socioeconomic forces, and disparities in the system A “ fi fty-one-fi fty”(5150) is an involuntary psychiatric hold, i.e., being committed to an institution against your

will. Section 5150 of the California Welfare and Institutions Code allows a qualifi ed offi cer or clinician to involuntarily confi ne a person deemed to have a mental disorder that makes the person a danger to him or herself, a danger to others, and/or gravely disabled. Professor Lonnie Snowden describes the process in more detail: “ A person is in psychiatric crisis, having an acute episode of psychosis, they’re disruptive, maybe they’re seeing things. So someone intervenes, calls the police or takes them to the emergency room themselves. At the emergency room, they’re judged to determine whether they should be involuntarily committed. ” Clearly a 5150 is not ideal for anyone—not for the suffering person, the police offi cer, the hospital staff, or the taxpayers. Like most emergency room visits, it’s a traumatic and expensive event. And it happens to African Americans, both adults and children, at much higher rates than white Americans and also other minorities. As well, African Americans appear in emergency rooms, in general, for mental health problems in numbers much greater than their continued on page 12

Lonnie Snowden

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Life inside the Human Mind,

continued

representation in the U.S. population at large, and are more likely to receive inpatient treatment or institutionalization than outpatient care, such as psychiatric visits or talk therapy. This phenomenon has been robustly documented, but there has been little investigation to date of possible reasons or remedies. Snowden, a mental health policy expert who has a vision to improve California’s public mental health system, wants to understand the reasons behind this pattern of care in order to design systems and programs to eliminate it. He is pursuing, with the support of the National Institute of Mental Health and the California Program on Access to Care, several lines of research toward this end. “There are a lot of factors, a lot of possible explanations, ” says Snowden. “I want to try to point people in the direction of things they can study to try to sort out the explanations, fi nd out which are valid. ” Snowden, Professor Ray Catalano, and UCSF professor Martha Shumway published a paper in a recent issue of Psychiatric Services, which identifi ed variables that might explain how being African American translates into being exposed more often than white Americans to conditions that promote greater use of psychiatric emergency services. These variables include differences in the mental health system—for example, the fact that African Americans are

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less likely to have a trusting, ongoing relationship with a primary care provider who could give care directly or a timely referral to outpatient mental health care. There are also broader sociocultural and economic factors at work—and shifts in these conditions over time have particularly detrimental effects on African Americans. In previous work, Catalano has shown that in times of economic stress, people are less tolerant of mental illness and the rates of involuntary commitments rise. “ When the economy gets worse, people simply become less tolerant of the kinds of petty differences we have among each other, ” says Catalano. “There are some kinds of deviance we’re willing to put up with when everything is okay; when things aren’t okay we aren’t so willing to put up with that. The argument is, when things get bad, people get nasty. ” Says Snowden, “People who bring you to the emergency room themselves are under stress. And African Americans are more exposed to those things because of lower levels of income and more precariousness in the labor market. ” There is also greater scrutiny on mental health expenditures during economic downturns; budgets are likely to be cut and the safety net shrinks. This can lead to reduced access to primary care and outpatient care for people who depend

“One thing we see is that people with mental health problems, especially depression, show up in primary care.” up in primary care. And there has been a lot of effort in the last decade to have primary care to respond more productively, in terms of recognition, referral, and/or treatment. ”

Colorado’s example, capitation, and the challenge of costeffective care The State of Colorado presented health organization and management expert Joan Bloom with a challenge: Is it possible to spend less money and still provide quality mental health services? Bloom, who chairs the School’s Health Policy and Management Division, took up the challenge and then some—gathering Berkeley experts and others to explore the question in great detail over the course of two NIMH grants and a decade, and publishing

The state hoped that the fi nancial incentives introduced by capitation would lead to reduced reliance on inpatient care in favor of community-based outpatient care and an increased emphasis on preventative care. But there were also community concerns that people with severe and persistent mental illness—whose treatment is often the most complex, long-term, and expensive—would not be able to get the care they needed. “There was a lot of concern that you were dealing with the most vulnerable population and that capitation was a dangerous thing to use, and they would cut back services and save money, but people would do worse, ” says Bloom. “But we didn’t fi nd that. We didn’t fi nd any large difference in outcomes. ” It wasn’t for lack of searching—Bloom’s team had a stratifi ed random sample of 522 severely mentally ill

ELDERLY

“ From a public health perspective, the overlaps are hard to escape, ” he says. “ We now know to do more in response to the areas of overlap. One thing we see is that people with mental health problems, especially depression, show

Colorado provided a natural fi t for evaluation, because some counties remained in the traditional fee-for-service model, including the large mental health center in Denver. Additionally, some of the mental health centers were run by a for-profi t behavioral health organization, while others were run by not-for-profi t agencies. This unique set up provided many opportunities to compare and contrast the cost, utilization, and access offered by the different models of service.

ADULT

Integrating substance abuse and mental illness programs is a challenging proposition, but one Snowden believes could lead to much more successful treatment of both conditions. In general, Snowden sees more integration of mental health care and “regular” health care system as a positive direction, one that can lead to decreased recidivism to the emergency room.

In 1992, the Colorado State Legislature passed a bill to establish and evaluate a pilot program of a prepaid capitation system to provide comprehensive mental health services to Medicaid recipients. In a capitation model, each of the participating community health centers is provided with a fixed amount of money based on the number of people they serve, as opposed to the more traditional fee-for-service payment model. The system was implemented in 1995, with seven of Colorado’s 17 community health centers switching to the managed care model.

ADOLESCENCE

“Especially for people who use public sector services, the problems that are most prevalent are schizophrenia, major depressive disorders, and bipolar disorders, ” says Snowden. “ Also, a lot of times those problems co-occur with substance abuse problems—drugs and alcohol. This can complicate treatment and complicate fi nancing to some extent, because they may need dual programs. ”

more than 15 papers on their fi ndings. The short answer: Yes, it’s very possible. This is good news, not just for Colorado, but nationwide in terms of creating more effi cient mental health systems.

PRENATAL / INFANCY

on the public sector for treatment, which can result in more visits to the emergency room. Another complication is the high prevalence of co-morbidities in mental health, meaning cuts to service in one area could have negative consequences in others.

continued on page 14 Berkeley Health Fall / W inter 2010

Life inside the Human Mind,

subjects from across Colorado, and conducted a three-year analysis of how people fared, using measures including symptoms, functioning, quality of life, alcohol/drug use, public safety, and welfare. They also checked to see if anyone had fi led grievances complaining that they weren’t getting enough services. “There weren’t any grievances from the population; everybody pretty much liked the program, although they had lots of concerns to start with, ” Bloom says.

continued

Bloom’s team looked at costs pre- and post-capitation, developing a shadow billing system to evaluate costs post-capitation. They determined that a cost savings was achieved during the first year and maintained over the next two years. “ When we looked at both cost and use, the capitated areas were cost effective, ” says Bloom. “They provided a good service and had good outcomes. ” Professor Emeritus Teh-wei Hu, an expert on the costs and outcomes of mental health care methods, was very involved with the Colorado study and concurs with Bloom on the fi ndings. “ Managed care is an effective delivery approach to contain costs, ” Hu concludes. “ Capitation may be an effective fi nancing approach to contain cost, but it depends on the incentives and design of capitation. ” “There have been some other experiments in the country, and generally what they’ve found is you save money in

PRENATAL / INFANCY ADOLESCENCE ADULT ELDERLY

that in both the for-profi t and not-for-profi t areas the cost for inpatient, outpatient, and total services were reduced, although the strategies to achieve the savings were different between the two models. “The southern part of the state—the for-profi t area— hospitalized people and got them stable, but they put a discharge planner in the hospital to get them out early, ” says Bloom. “ One of the big things when you’re dealing with the mentally ill is housing, and they made sure that when they got out they had a place to go when they were released and were getting services to maintain their medications. ” The not-for-profi t center in Northern Colorado had a different strategy: They created a “red team ” that did an assessment to see if people needed to be hospitalized or if they could be treated within the community, with an emphasis on avoiding hospitalization. Also, the for-profi t centers focused on schizophrenia, while the not-for-profi ts took on major depression. “Both strategies worked, ” reports Bloom. “It was an interesting fi nding; it shows there’s more than one way to reach your goals. ” Also within this follow up, Catalano analyzed emergency room visits as an indicator of the system’s effectiveness, and found that emergency room use went down

“When we looked at both cost and use, the capitated areas were cost effective. They provided a good service and had good outcomes.” capitation programs because you keep people out of the hospitals; the hospitalization is the most expensive part of the services, ” says Bloom. “But nobody had really looked beyond one or two years or had the comparisons that we were able to do. So that’s where we brought in some new information. ” After the initial three-year study, Bloom began a five-year follow-up that looked at the differences between the for-profi t and not-for-profi t capitation models. She found

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after capitation was implemented. Snowden looked at differences between the African American, Latino, and white communities, and did not fi nd that health disparities increased under managed care. “It’s not always easy to get publicity on good news; most people want to hear about the terrible things that happened, ” Bloom speculates. “But most of our news was good news. ”

William Jagust

ELDERLY In the United States over the past 100 years, the percentage of the population aged 65 and older has grown from 4 percent to more than 13 percent. By the time the entire baby boom generation reaches age 65, about one in five Americans will be over the age of 65. This demographic shift has major public health implications. The need for effective and appropriate mental health care for older adults will continue to grow, as will the fi eld of healthy aging. As well, maintaining long-term cognitive functioning becomes more and more important, including the battle against dementia and Alzheimer’s disease.

Alzheimer’s, amyloids, and the Neuroimaging Initiative Much of Professor William Jagust’s research is devoted to the early detection of a disease for which there is currently no cure—Alzheimer’s disease. Jagust anticipates a question: “ You might say, why do we want to do that, because we can’t treat Alzheimer’s?” But he has good reasons: to be ready when an effective treatment is found, and also to help facilitate the search for a cure. “There is hope that an effective drug will be found to treat Alzheimer’s in the not-so-distant future, and it will

be important to treat people as early as possible, ” he says. “ Also, fi nding early indicators of Alzheimer’s will help identify subjects on whom new drugs should be tested, helping speed the development of such drugs. ” A leading theory in the cause of Alzheimer’s disease is that the build-up of a protein called beta-amyloid in the brain triggers the progression of the disease, loss of memory, and cognitive failure. This hypothesis has led to the development of drugs that block either the deposit of amyloid or the effects of amyloid. “ A handful of these drugs have been tested on patients with Alzheimer’s disease, ” says Jagust. “ And so far, they’ve all failed. They haven’t made people better. ” These disappointing results have led to two theories (“ and I actually believe both of these, ” Jagust says): That something besides amyloid needs to be targeted in the brain in order to treat Alzheimer’s, and that treatment needs to be started earlier before there has been too much degeneration in the brain for the removal of amyloid to have an effect. The Jagust Lab—which includes researchers from the UC Berkeley School of Public Health, the UC Berkeley Helen Wills Neuroscience Institute, and the Lawrence Berkeley National Laboratory—develops and uses brain imaging techniques to try to fi nd biomarkers that will help detect Alzheimer’s in people with very mild symptoms or no symptoms at all. The lab is also part of a nationwide effort, continued on page 16 Berkeley Health Fall / W inter 2010

Life inside the Human Mind,

the Alzheimer’s Disease Neuroimaging Initiative (ADNI), involving 60 centers, which has been at work for five years and will continue for another five years. The Jagust Lab uses a type of positron emission tomography (PET) scan that actually detects the levels of beta-amyloid in the brain. One of these types of PET scans is being utilized in ADNI as well as in the Jagust Lab research. “ We’re using these scans to detect this amyloid in people with very mild symptoms and people who are completely normal, ” says Jagust, “ and then we’re going to see what happens to them over time and if we can use these kinds of amyloid measures to fi nd who might be at risk. ”

continued

To date, Jagust is pretty confi dent that the build-up of amyloid is the first thing to “ go wrong ” in the progression of Alzheimer’s, the first change in the brain that can be seen. In fact, the PET scans can detect the presence of amyloid in people who are functioning completely normally. Other changes, like brain shrinkage, occur later and can be detected by MRIs. The project has revealed a lot about how biochemistry and brain structure and function change over time. In addition, the lab has developed a lot of standardized methods for

including MRI on them to determine whether or not amyloid is present in their brains. The researchers also interview them and test their cognition over time. One of the key scientifi c problems they are trying to understand is why some people remain cognitively healthy despite high levels of amyloid in the brain, while others get Alzheimer’s disease. “There’s this whole chain of evidence that says if you’re cognitively engaged in life, your risk of getting Alzheimer’s is lower, ” says Jagust. “It’s certainly not as simple as ‘use it or lose it,’ but we are fi nding out that it’s not simply a matter of being born with this and having a gene and you’re getting it—it’s also related to your lifestyle. ” Epidemiologic studies have shown a correlation between a good diet, exercise, cognitive stimulation and decreased incidence of Alzheimer’s disease. “Some of the studies we’re doing that are focused on causes and etiology over the lifespan will likely have a public health impact, ” says Jagust. “ What kinds of things people are exposed to really does affect what happens to their brain as they get older. There’s no doubt in my mind that that’s true. ” But Jagust cautions that there has not yet been a lifestyle intervention that’s been shown to have been effective in

“It’s certainly not as simple as ‘use it or lose it’ but we are finding out that it’s not simply a matter of being born with this and having a gene and you’re getting it—it’s also related to your lifestyle.” the biomarkers and collection of imaging data—methods which have been adopted in other countries and by drug companies. The Michael J. Fox Foundation for Parkinson’s disease has also picked up on it, with modifi cations.

reducing the incidence of Alzheimer’s disease. This may be because these kinds of interventions are diffi cult to implement and test, partly because a good intervention would need to start much earlier in life.

“ ADBNI been a very big success from the perspective of developing standards, ” says Jagust. But he worries that it may not lead to a cure. “The proof will be whether we can use these things to develop drugs and whether there are any drugs that work, ” he says. “It’s going to be fairly diffi cult to test these drugs in early stages, because people may have to be followed for a while before we can see a change. ”

“If you start doing crossword puzzles when you’re 60, and you think that’s going to prevent you from getting Alzheimer’s disease, I don’t think it’s too likely, ” says Jagust. “If you have a lifelong pattern of good health behaviors, then that will have an impact. That’s a tough intervention, and I think it’s hard to test. But it’s the right thing to do anyway. I think we can add cognition to the reasons to do it. We already have a million reasons to do it, so now there’s a million and one. ”

While waiting on progress in drug therapies, Jagust is working to learn more about how the presence of amyloid affects brain functioning and the impact of lifestyle factors on the incidence of Alzheimer’s disease. His lab has selected a smaller group of people, aged 65 and older, who have healthy cognitive functioning, and performed amyloid PET and a variety of types of other imaging techniques 16

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Depression, the built environment, and successful aging Thanks in no small part to the fi eld of public health, life expectancy keeps getting longer. But, as anyone with

Connectivity is a big factor in helping prevent depression in general. The ability to get around—whether it’s driving, taking public transportation, or walking—can have an impact on state of mind. At a policy level, Satariano looks at what we can change about the built environment in order to allow people to be healthier, especially when it comes to getting out and walking. “ One of the important things that someone might do if they’re feeling depressed is just start walking, ” he says.

“ With older people, it represents a signifi cant public policy issue, ” says Satariano. “Because on the one hand we know how important it is that older people have access to goods and services, that they have access to friends and relatives. But on the other hand, there’s the issue of public safety. I think with the aging of the population it’s going to become more and more signifi cant. ”

Satariano also recommends walking programs and mall walking as a viable option for older people— especially those who live in areas with bad weather—because of amenities offered there. “It’s a safe environment, it’s an opportunity to see what’s in the stores, but also to meet friends at a coffee spot in the mall, ” he says. While walking and spending time with friends will not prevent all mood disorders in older people, Satariano believes broad-based programs to increase these activities will go a long way towards improving the mental health of an aging population. He sees public health as working in concert with clinical medicine in this area. “I think we can improve the mood and the well-being of a lot of people with these types of programs, ” says Satariano. “This is a way in which public health can focus on large populations of people, and deal with factors that can serve to prevent or lessen the impact of certain conditions. ”

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ELDERLY

Satariano has done several studies on depression in older adults, including determining what factors in the environment contribute to increased incidence of depression, and what lifestyle steps people can take to help maintain good mental health. With Adjunct Professor David Ragland, who directs UC Berkeley’s Safe Transportation Research and Education Center, he looked at whether driving cessation leads to increased depressive symptoms in older people. They found that, two years after people stopped driving, their depressive symptoms increased, independent of other factors. Satariano believes there are three factors at work: the loss of connectivity to society, the cessation of the cognitive process of driving itself, and the symbolic nature of not being capable of driving.

“So you live here, and these are routes that you may want to take that are reasonably safe and the sidewalks don’t have many cracks or breaks, ” says Satariano. “This is not necessarily changing the environment, but trying to link older people to the best that their current environment has to offer. ”

ADULT

“ Depression is a key condition, a key co-morbid condition, ” says Satariano. “Regardless of what else you have, if you’re also depressed, it just makes everything worse. ”

The ideal walking path for an older person would be safe, away from traffi c and other hazards, with shade and places to rest, stop for a drink, or use the restroom. Reconfi guring the built environment with these considerations in mind, especially near senior centers, is a great goal, albeit expensive and time intensive. A more immediate intervention, perhaps to be done concurrently, is the creation and distribution of walking maps showing the best routes for walking.

ADOLESCENCE

Bill Satariano, professor of epidemiology and community health, is an expert on “successful aging, ” a goal that encompasses physical, psychological, and social health. His book, Epidemiology of Aging: An Ecological Approach, examines many practicalities about growing older, including survival, disease, social capital, sense of control, and living situation. Satariano says that a major threat to quality of life for older populations is depression, and notes that elderly people who are depressed are at increased risk for cognitive impairment, falls and injuries, and even death.

“There’s evidence to suggest that older people who live in environments that are perceived as unsafe or where it’s more diffi cult to walk or there’s a concern about crime are more likely to be depressed, ” says Satariano. “ Conversely the people who live in an environment that encourages physical activity and social interaction seem to be less likely to be depressed. ”

PRENATAL / INFANCY

chronic pain can attest, healthy aging is not just about longevity; quality of life is equally important. As we age, we want to remain high functioning, physically and cognitively, and we want to be happy and enjoy life.

FROM PUBLICATION TO PUBLIC ACTION

Working with Communities to Improve Adolescent Health By Julianna Deardorff Assistant Professor of Maternal and Child Health King Sweesy and Robert Womack Professor of Medical Science and Public Health

Theoretically, adolescents should be among the healthiest age group in the United States and globally. They’ve survived the diseases of infancy and childhood and have not yet begun to experience the trials associated with aging. However, even in developed countries, mortality and morbidity among adolescents remains shockingly high. The top causes of death, which include unintentional injury and suicide, illustrate that behavioral and emotional issues play a large role in why adolescents remain at risk despite their general good physical health. As an adolescent clinical psychologist, I occupy an interesting niche within the fi eld of public health. I was trained in a scientist-practitioner model; my research and clinical practice are inherently connected. I spend time each week engaging in clinical practice at UCSF’s New Generation Health Center, a sexual and reproductive health clinic that services predominantly low-income youth in San Francisco’s Mission District. In this setting, it is easy to see the challenges that youth face both on individual and contextual levels. I am consistently reminded why knowledge-based education about sexual health only takes us so far. Collaborating with researchers in OB-GYN at UCSF, we are currently devising new ways for practitioners to intervene with youth that take culture, context, and individual barriers and strengths into consideration. I also study developmental transitions, behavior, and contextual factors that influence adolescents’ health and well-being. There is a documented secular trend in the United States towards earlier pubertal onset among girls, which has established negative effects on physical and mental health. Through the Bay Area Breast Cancer and the

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Environment Research Center (BCERC), my colleagues at UCSF, Kaiser Permanente Northern California Division of Research, and the State Department of Public Health and I have been working on a transdisciplinary model to explain why puberty may be starting earlier among young girls. We work closely with community groups, including Zero Breast Cancer in San Rafael, to integrate public concerns into our research questions and have committed to reporting our research findings in a timely manner to the community. We have convened many community forums—with researchers and advocates sitting side by side—to address questions and concerns about pubertal timing, environmental exposures, and risk for breast and other reproductive cancers. We also hold “tea talks” with our researchers and participants, where we talk with parents of the girls in our study about how to manage their daughters’ transitions through puberty and help them navigate the emotional and social challenges they face. This intense level of community involvement and public engagement informs and enriches our research.

Recently, BCERC researchers worked closely with Zero Breast Cancer to educate Kaiser pediatricians about our findings related to early puberty in an effort to enhance their clinical practice. We have also collaborated to release fact sheets, monographs, and videos to the public that describe the work that we have done in both animal and human models examining the links between pubertal determinants, pubertal timing, and breast cancer risk. As a result of our efforts, the epidemiologic studies of the BCERC were recently awarded an additional five years of funding from NIEHS and NCI to follow our participants into adolescence. Ultimately, the work that my colleagues and I engage in has value, not just for local advocates and community members, but to inform public policy more broadly. Given the strong current investments at the federal level to improve adolescent health in the areas of sexual and reproductive issues and overweight and obesity, I believe that our research has far-reaching implications that are practical—and critical—at this point in time.

California’s Mental Health Services Act: Is It Working? The Mental Health Services Act (MHSA) became California law in 2005 after the voters passed Proposition 63. Funded through a 1 percent tax on personal incomes in excess of $1 million, the MHSA established a broad continuum of community-based prevention, early intervention, and other services for Californians with severe mental illnesses. The California Department of Mental Health administers the act, and counties and their contracted agencies provide the direct consumer services. Five years after the MHSA’s implementation, Berkeley Health asked a panel of experts and stakeholders to weigh in on its progress. Have mental health services in the state improved since 2005? Are Californians getting their money’s worth? Our panelists represent a range of perspectives: academia, state, county, private business, and client advocacy.

Nicholas C. Petris Center on Health Care Markets & Consumer Welfare UC Berkeley School of Public Health 1. Richard Scheffler, Ph.D. Director and Distinguished Professor of Health Economics

2. Timothy Brown, Ph.D. Associate Director and Adjunct Assistant Professor

Ho w have mental health services changed in California since the passage and implementation of the M ental Health Services Act?

What’s interesting about the Act is that its focus was to foster innovation. Some people have used the word “transformation,” but it is really about new ideas and new ways of delivering mental health services to the seriously mentally ill populations in California. The MHSA continues a tradition of change that started with AB 2034; it was basically built on the success of these previous programs, which were largely a variation of a key program in the MHSA, the Full Service Partnership (FSP). The FSP program was probably the most signifi cant change in the delivery of mental health services; it provides the most comprehensive level of services to individuals with serious mental illness in California’s public mental health system, including assistance in housing, employment, schooling, physical health care, co-occurring substance abuse disorder, and in learning effective social interactions. A key point is that in the FSP program, each individual consumer is at the center determining his or her own goals, working with clinicians, social workers, and/or family members. This goes beyond the clinical model that was used before, which was pretty much treatment by a mental health professional, psychotherapy, and perhaps drugs. It’s a big departure to treat the whole person with an integrated team. The focus of the FSP is to facilitate recovery, which is about people being able to achieve the highest level of functioning possible, as they define it.

In the past, clinicians focused more on standard goals using standard treatment modalities. In the FSP program, while some of these treatment modalities are still used, such as pharmaceutical interventions, treatment modalities and treatment goals and are much broader.

Looking back at the past fi ve years, w ould you say the Act has been a success? By w hat measures?

At the Petris Center, we have been studying the MHSA since its implementation, with funding from the California HealthCare Foundation and the Department of Mental Health. We have been the primary evaluator of the program. (For reports describing the Petris Center’s findings, visit www.petris.org.) We can say that the overall outcomes of services for consumers in the FSP program are signifi cantly better than those receiving usual care. The odds of mental-health related emergency room use have dropped dramatically for those in the FSP program compared to those receiving usual care. Homelessness has virtually disappeared among those in the FSP program, and employment has increased beyond our expectation. These are really big effects. We would be willing to say that the program is quite a success.

The current budget problems have an impact on everything in the state, including mental health service programs. Of course, there is an issue about continuing to fund the MHSA. The Act tries to protect these new funds by including language stating that the Legislature and the governor are not permitted to take these funds out of the program—a so-called firewall. There are also issues of whether the state will be able to put additional money into this program beyond the MHSA, and obviously this will be diffi cult without an additional funding source. There is some threat to the continued overall funding of MHSA in California, but we all have to live within our means and with the budget crisis. continued on page 20

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California’s MHSA: Is It Working?, continued Stephen W. Mayberg, Ph.D. Director, California Department of Mental Health

Ho w have mental health services changed in California since the passage and implementation of the M ental Health Services Act? The mental health system in California has changed in a variety of signifi cant ways since the passage and implementation of the MHSA. These changes have not just been limited to services and infrastructure, but also the areas of perception and politics. The voters sent a clear message that resonated throughout the United States that citizens firmly believe mental health is important, and not only is treatment essential, it works. The residents of California clearly understood that lack of access to care and the stigma of mental illness has profound social consequences including homelessness, school failure, incarceration, and unemployment. It was the vote of Californians that directed resources to treatment, not only initially, but on a second vote when voters rejected redirection of funds. The MHSA has changed values, redesigning a system around the needs of a community and specifi cally the needs of the client and family members, and that has proven to be more successful than anticipated. Shared ownership of the system and responsibility for outcomes with local and statewide accountability has contributed to the successes of implementation. Never has a change of this magnitude been attempted in a state, much less one the size of California. We have changed language and delivery systems. We have changed access and now have more than 200,000 new individuals engaged, and more than 450,000 persons in MHSA-funded services. Most of all, we have developed tremendous grassroots support through our stakeholder process. It is hard to envision that more than 125,000 people would participate in program planning and design and still continue to be actively involved in implementation, monitoring, and advocacy.

Looking back at the past fi ve years, w ould you say the Act has been a success? By w hat measures?

The MHSA has been a success by any measure, but that is not to say it was perfect or implementation was easy. In this type of major system reform, the number of “moving pieces” is exponential, and issues and programs are complicated, complex, and not always readily apparent. However, credit has to go to the stakeholders, providers, advocates, counties, and oversight bodies for persevering and working through these diffi cult issues, guided by a universally held vision of hope and recovery.

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In spite of these challenges, the program outcomes are better than expected. Studies by the Petris Center (UC Berkeley), UC San Diego, and state and county evaluations continually report outstanding outcomes. The reduction of homelessness, incarcerations, hospitalizations, and utilization of emergency rooms by Full Service Partnership (FSP) members reinforce the power and effectiveness of this model of service. Participation in employment and education has increased, outreach and engagement is dynamic, and access for many unserved individuals has dramatically increased. The evaluations uniformly report excellent results, and independent, objective research supports our perceptions that this is a dynamic, successful program. Not only has the service delivery system changed, the engagement of other state departments has been very productive. Currently, at the state level, approximately 19 departments use MHSA support and principles to leverage development of mental-health-related programs. Plans for suicide prevention, stigma reduction, mental health and the justice system, and veterans outreach programs—all have resulted from catalytic infusion of resources and a strong mental health focus.

As we embark on National Health Care Reform (HCR) and California explores an 1115b waiver, issues of mental health parity, benefi t design, and integration with primary care become essential for our state to address. Lessons learned from the MHSA process should help inform system reform issues in HCR. Outcomes and accountability are hallmarks of the Patient Protection and Accountable Care Act, and are requirements that MHSA has already addressed. The MHSA provides a model of processes and challenges that help inform health care reform efforts. If the MHSA continues to have good outcomes; reduce disparities; create better access, stress prevention, and early intervention; and reduce the consequences of untreated or undertreated mental illness, it will become the national model of care. In spite of diffi cult state and national budgets, the MHSA’s dedicated funding stream has guaranteed continuity, and the investment in treatment may be cost saving in many other areas of government spending. The model of change, identifi ed outcomes, raised expectations, and community accountability is powerful. The importance of collaboration and integration cannot be underestimated. Opportunities for system change are rare and must be capitalized on. California has embraced this challenge well with the MHSA, and this initiative will be the framework, vision, and guiding principles for the public mental health system for years to come.

Marvin J. Southard, D.S.W. Director, County of Los Angeles Department of Mental Health

Ho w have mental health services changed in California since the passage and implementation of the M ental Health Services Act? For counties that seized the opportunity, I believe the most profound and lasting change was in using the required stakeholder planning process for MHSA to make choices about the shape of the mental health system in a way that put the voices of clients and family members at the center of the decision-making process. This approach had the effect, at least in Los Angeles, of allowing the public mental health system, and all who rely on it, to adapt more successfully to the turbulent fiscal and political environments we have endured lately. The network of services available has also changed almost everywhere in three very important ways: First, a greater availability of Assertive Community Treatment (ACT) and Wraparound modeled programs has improved the life outcomes for the segments of the population most disabled by mental illness. Second, the creation of a network of “wellness”-oriented mental health programs has embedded services in the mainstream of communities, rather than constricting them within clinic walls. And third, a much wider use of peer advocates in the treatment system modeled the social inclusion of individuals with mental illness into the mainstream as one of the important goals of the public mental health system. The infrastructure for successful service delivery has also changed with the addition of many more permanent supportive housing resources. Finally, I would say that the confluence of the opportunities inherent in the funding and structure of MHSA and the fiscal challenges created by the recession ironically brought about a quicker transformation of mental health services in California from a medical model to a recovery model than would otherwise have been the case.

Looking back at the past fi ve years, w ould you say the Act has been a success? By w hat measures?

Looking back, I think the Act has been a rousing success in most places, especially compared to what would almost certainly have been the situation for public mental health systems without the safety net provided by the Act. In the face of the recession, the safety net provided additional financial resources, mandated the necessity for tracking outcomes, and—most of all—opened the chance to create a network of engaged stakeholders. Some of the most vehement criticism of the Act has been by people who object to a “two-tiered” mental health system with a few of the most ill receiving intensive service while the most basic services, especially for uninsured clients, continued to erode because of the recession. I think

the criticism is short-sighted for two reasons: First, the creation of programs and models “good enough” to show effectiveness (eventually even cost effectiveness) is essential for the long term survival of recovery-oriented mental health programs; and second, the switch to evidence-based early intervention programs, especially those focusing on trauma, though slow, will eventually provide a level of care superior to the services now being eroded. There have been some weaknesses in the implementation of the Act. The complexity of the planning and approval process meant that program implementation was much slower than most had expected that it would be. Additionally, the boundaries between sub-sections of the Act (Community Services and Supports, Prevention and Early Intervention, Capital Projects, etc.) sometimes led to confusion about what the priorities in a county should be and therefore to decisions that could seem quixotic.

Over the next five to ten years, everything will change. The implementation of health care reform in 2014 with the complicating demands from parity legislation in both mental health and substance abuse treatment means that both the mental policy arena and the context for the provision of all mental health service is likely to be very different from what we see today. I think the public mental health system will be faced with three categories of work. First, there are those services which, by their nature, will likely continue to be provided under the auspices of public entities. These include crisis and disaster response, 5150 and other involuntary services, law enforcement partnership programs, and the like. Next, there are those services for persons with high need for intensive community treatment, which could theoretically be provided by a private health care entity, but in actual practice have been provided much more successfully in the context of public programs. These would include the Full Service Partnership, ACT, and other recovery-oriented programs. I think this represents an area in which public programs, especially with the availability of both the insights and the resources provided by MHSA, would remain extremely competitive even after 2014. Finally there are the mental health services for milder sorts of mental illness, including some types of depression and anxiety that typically are now treated in private care networks or in primary care. I think public systems ought to consider entering into the competition to serve these customers if only to provide a complete spectrum of care for individuals who choose our care networks. At all three of these levels, the key challenge will be in creating a care coordinating mechanism that brings together primary care and mental health and substance abuse treatment in a manner that serves the needs of clients as they experience those needs. And of course the state budget will matter, not so much right now, but in planning for the time in which states start to assume some share of the costs of Medicaid expansion. continued on page 22

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California’s MHSA: Is It Working?, continued Anne L. Bakar President and CEO, Telecare

Ho w have mental health services changed in California since the passage and implementation of the M ental Health Services Act? From a provider perspective, there have been signifi cant changes in the system. One of the most positive of these has been the increase in Assertive Community Treatment (ACT)-type programs. Evidence suggests that ACT programs have been successful in reducing the negative consequences of untreated mental illness while enhancing individual well-being. Telecare has more than 5,500 clients in ACT programs in 12 counties across California. We are working to more systematically transition clients from ACT programs to less intensive services, not only celebrating the recovery process but opening slots for others to receive these intensive supports. Another positive development is that the infusion of substantial new funds from MHSA led to a temporary shift of power to the state, which set an important direction. The state set the tone for a larger role for consumers and family members, not only in MHSA planning, but in administrative and direct service. Telecare’s collaborative recovery model has historically engaged consumers, but the tone set by the MHSA added fuel and support to our direction. Also, since the implementation of the MHSA, wellness/recovery/resilience language has become almost universal within the state’s mental health system, and the Act has directed funding toward underserved populations, where the needs have long been unmet. Some of the changes brought about by the MHSA, however, have been more challenging. While MHSA programs were being created, existing programs for people already in the system were cut. As an example, the elimination of AB 2034 funds meant that many programs for homeless individuals with serious mental illness were eliminated. In addition, the state did not use this time as an opportunity to adopt a standardized information technology system. This missed opportunity has resulted in tremendous resource ineffi ciency that could have been redirected to services.

Looking back at the past fi ve years, w ould you say the Act has been a success? By w hat measures?

There have been signifi cant and meaningful gains as a result of the MHSA. First, it’s been a safety net for the system. Without MHSA dollars, the mental health system as a whole would have shrunk over the last five years as state and counties experienced massive budgetary problems. While the hope (and stated policy) of the Act was that it would expand the

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system, these earmarked dollars did succeed in offsetting some fiscal cutbacks. Second, it’s reached new populations. The Act has pushed the mental health system to serve populations, such as transitional-aged youth and older adults, as well as ethnic/cultural minorities. Without this specifi c requirement, this effort would not have occurred. Finally, it allows for policy direction. Public mental health systems are large bureaucracies with numerous constraints that make change diffi cult. The professional work force—trained and experienced in older treatment methods—is hard to influence. Holding out new funds only for programs that incorporate newer and more progressive treatment orientations and methods is one way in which change can be fostered.

Looking forw ard the next fi ve to ten years, w hat do you see for the future of the M HSA and of California’s mental health services policies? Will the state’s current budget problems have an impact? I think the transformative nature of MHSA will lessen. MHSA funds are replacing existing funds, counties are reasserting their primary control over the system, and the criterion for who qualifi es for MHSA-funded services is being broadened. Such a result is inevitable in this fiscal climate and is likely to continue unless/until the fiscal picture improves. I believe some MHSA changes, however, will be long-lasting. The shift to a recovery orientation for adults with serious mental illness has been broad and deep enough to have become “business as usual,” even if not fully embraced or implemented. Similarly, the empowerment of consumers and family members will continue, even though they may have to fight more to maintain their seat at the table. The budget will continue to have an impact. Counties are experimenting with strategies for managing ongoing funding shortages. One way is by establishing levels of care, which address the needs of clients with different severity of illness. This helps counties to maximize their limited resources and is seen as a more rational way to determine what services clients receive rather than the historical happenstance of whether a client was already in the system when the MHSA was enacted. The impact that health reform legislation will have on mental health in California is an open question that will evolve as state regulations get drafted. There is some possibility that accountable care organizations, including private sector providers, will take on greater responsibility for managing mental health populations. Mental health parity is also making integration with physical health a higher priority within both public and private sector. These trends should result in a wider network of services for individuals with mental illness, greater choice, and better medical care. It may also stimulate accountable care organizations to look more seriously at the question of how mental illness influences physical health.

Eduardo Vega, M.A. Executive Director, Mental Health Association of San Francisco Commissioner, California Mental Health Oversight and Accountability Commission

Ho w have mental health services changed in California since the passage and implementation of the M ental Health Services Act? Although MHSA funding represented a small portion of overall mental health dollars at the outset, the vision set forth by the MHSA—and the process of planning and implementing it—has had a dramatic effect on services everywhere. In particular, the contributions to program design by people who have lived with mental illness and recovery, and the widespread introduction of peer-support services, have brought focus to the important role played by recovery, hope, and natural supports in the process of reclaiming lives from the devastation of mental illnesses. The influence of these models has driven change across systems, and we now see innovative programs taking focus in services throughout the state. Mental health systems are initiating anti-stigma, suicide prevention, age-group and culturally-effective services, and prevention-focused programs that are completely new to them. In this way the MHSA has served as a massive agent of change, sparking creativity and engaging communities outside the “usual suspects” of mental health leadership and programming that is affecting services and supports globally.

Looking back at the past fi ve years, w ould you say the Act has been a success? By w hat measures?

The MHSA has absolutely been a success. It has been powerfully effective in driving community-developed interest and knowledge into new programming related to mental health services and supports. It has served as the central catalyst for bringing the most modern recovery-oriented programs supports such as Full Service Partnerships (FSPs), peer-run services, family advocacy and culturally focused services to the fore in a way that would never have happened otherwise. Objectively, MHSA resources have funded programs that have reduced the most serious impacts of mental illness for thousands across the state, most prominently through the widespread adoption of the FSP model. In addition, the connections built between public mental health, the private sector,

criminal justice, and community-based organizations—while diffi cult to quantify—are ultimately huge gains for anyone affected by mental illness, as these continue to evolve cross-systems collaboration and problem solving. In my opinion, this “secondary” gain is very powerful, because it has broken new ground in bridging the gaps between services and systems that are a result of infrastructure barriers and silos. Health care service reform will build on these starts to ensure that people in their most desperate times are not shunted from one closed door to another.

Looking forw ard the next fi ve to ten years, w hat do you see for the future of the M HSA and of California’s mental health services policies? Will the state’s current budget problems have an impact? The MHSA will continue to provide a growing focus on leading-edge services and supports for mental health. The structure through which these are provided will probably not shift away from county mental health authorities, but community-based programs, federally qualifi ed health centers, etc., will play an increasingly important role in the review, implementation, and development of new MHSA programs. As health care reform introduces systemwide opportunities, there will be challenges in integrating MHSA services with new financing structures and with a changing environment for county-provided programs, which up to now have been the primary or only provider of services to the uninsured. Due to the forethought placed into the legislation, there are signifi cant legal barriers to shifting MHSA resources into otherwise or previously funded programs—in particular, entitlement and federally-mandated services such as those under Early and Periodic Screening, Diagnosis, and Treatment. If today’s budget defi cits are not signifi cantly improved in coming years, the pressure may increase for the Legislature to take action to amend the statute. This was previously attempted through a ballot initiative in 2009, which California voters did not support. In addition, state-level services through public hospitals, etc., will continue to challenge the thinking about how much and what type of services should be provided by the state, as these cannot be funded by MHSA resources. Consumer advocates believe in the vision of the MHSA and its power to sustain a real transformation in California—transformation away from disempowering clinical practices and institutionalized stigma to community-integrated services grounded in hope and human dignity that give all people affected by mental illness the best resources and supports for recovery.

Berkeley Health Fall / W inter 2010

STUDENT SPOTLIGHT: LECONTÉ DILL

By Abby Cohn

Exploring Resilience Among Urban Adolescents of Color In the 1940s, LeConté Dill’s grandparents joined the droves of African Americans heading west for better opportunity. Leaving homes in Texas, Mississippi, and Louisiana, her relatives settled in South Los Angeles, putting down roots in vibrant but low-income neighborhoods anchored by strong social networks and black-owned businesses. Fast-forward to the present: Many inner-city communities like the one where Dill’s family lives are undergoing an exodus. Black families in Los Angeles, San Francisco, Berkeley, and elsewhere are picking up and leaving once more. In 2009, for instance, a San Francisco mayor’s task force found that the city’s African American population fell to 46,779 in 2005 from 78,989 in 1990, and pointed to the loss of many middle-income and upper middle-income households. Known as out-migration, this local and national phenomenon fascinates Dill, a Dr.P.H. student. Her doctoral research uses a public health and city/regional planning lens to understand what happens to the people left behind. Specifi cally, Dill is investigating how young people of color cope with their changing urban neighborhoods and looks at their strategies of resilience. “My question is, ‘Where do they go if their church closed and the local store doesn’t sell healthy food?’” she asks. “How can people be making it? And people are. I’m delving into ‘What are the safe places, and who are the supportive people?’” This semester, Dill hopes to answer some of those questions when she conducts in-depth interviews with youth in East Oakland. Her

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methodology will include a narrative analysis in which young people share their stories and ultimately create poems about their circumstances. She herself has written poetry and fi ction since elementary school. “I don’t know if they get to share their experience of neighborhood change,” she says. “I’m sure it has an impact on them.” Dill’s adviser, Associate Professor Emily Ozer, describes her student as “a fearless learner. She’s just expanding herself intellectually constantly.” Given the complex nature of studying communities in transition, Dill’s strategy of “getting to know stories and lives inside-out is a really promising approach,” Ozer adds. Out-migration and its consequences first caught Dill’s attention when, as a staffer at the City of Berkeley’s Public Health Division, she learned that some 2,000 black families in South Berkeley had left between 1990 and 2000 for various reasons. “I felt the story behind that story was huge,” says Dill, who stepped down from her city job to begin her doctoral studies at the School of Public Health in the fall of 2008. Dill has traced a 70-year span of migration into and out of the Bay Area from World War II to today. In studying that black exodus, she says, “I delved into national history and my history.”

Dill would like her research to shape future policy making and ultimately improve the quality of life for residents of urban landscapes undergoing upheaval. She believes the fi elds of urban planning, public health, and youth development should collaborate to tackle such common issues. After she graduates this spring, she intends to continue studying urban adolescents as a postdoc. “I’m really committed to doing community-engaged work,” she says.

“My question is, ‘Where do they go if their church closed and the local store doesn’t sell healthy food?’” Growing up in South Los Angeles, Dill got an early education about communities in transition. Her once-thriving neighborhood was plagued by gangs and drugs. “As an elementary student, I knew I couldn’t wear blue or red in certain neighborhoods,” she says. “But I was also

fortunate to be raised around my grandparents and other elders in the community and be exposed to South L.A.’s thriving arts and culture scene.” She earned a scholarship to attend private school when she was in the seventh grade, and selected Chadwick, a prep school in wealthy Palos Verdes Peninsula. “Every day, I had to leave my neighborhood and go to a neighborhood that was totally different,” she recalls. In high school, a winning essay, “How I Plan to Make an Impact on Black History,” led to a college scholarship. She headed to Spelman College, a historically black, all-women’s institution in Atlanta. “It was my dream school, steeped in history and dedicated to developing women in leadership,” Dill says. Spelman didn’t disappoint. Dill forged lifelong friendships and reveled in course offerings, extracurriculars, and opportunities for leadership training. Originally intending to become a doctor, she discovered public health through Spelman’s Health Careers Club. “I learned about this whole other way of looking at disease and health.” She studied sociology and took public health classes at neighboring Morehouse College. Her senior thesis examined the value of support groups in managing chronic diseases like childhood asthma and pediatric diabetes. Graduating in 2000, Dill headed back to Los Angeles for UCLA’s M.P.H. program, where she studied community health sciences and specialized in child and family health. Dismayed by the lack of ethnic diversity in her ranks, she cofounded a now-flourishing networking and support group, Students of Color for Public Health. Two years later, as a freshly minted M.P.H., she left for the Bay Area. She initially worked for local nonprofi ts involved in child health advocacy and community mobilization. In 2006, she joined Berkeley’s Public Health Division, where she was a health educator, public information offi cer, and program manager for chronic disease prevention programs. Though gratifi ed by the direct impact of her work, Dill felt the tug of more schooling. Once

she decided to get her doctorate, choosing where to go was easy. The Dr.P.H. program at Berkeley “just seemed like a perfect fi t,” Dill says. “They really value leadership development and community-based experience.” Besides her involvement as a self-described “urban health scholactivist,” Dill is active with Spelman’s local alumnae association and

Delta Sigma Theta Sorority, Inc., and serves on the board of the California Black Women’s Health Project. She continues to write poetry and fi ction. For Dill, public health is always on the front burner. “It just touches everything we do, from the food we eat to the air we breathe to the neighborhoods in which we live,” she says.

Remembering a Young Life Cut Short Though neither philanthropist J. Michael Mahoney nor Dr.P.H. student LeConté Dill ever met Phoebe Prince, they share a desire to keep her memory alive. Prince was a 15-year-old Massachusetts girl who took her own life in January after being subjected to a torrent of bullying by classmates. Moved by Prince’s story, Mahoney established a $50,000 endowed scholarship in her honor at the School of Public Health. The Phoebe Prince Memorial Scholarship supports graduate students at the School who seek to make a difference in the lives of children by Phoebe Prince helping them cope with troubled circumstances and by working to halt a culture of violence. Mahoney said his Irish heritage made him feel a special kinship toward Prince, who had moved to America from Ireland less than half a year before her death. “I had followed the story in the news, and it made me furious. It was a horrifying case,” he says. A framed photo of Prince sits on a living room table among dozens of pictures of family and friends in Mahoney’s home in Larkspur, California.

J. Michael Mahoney LeConté Dill, the first recipient of the Phoebe Prince scholarship, is entering her third year as a public health doctoral student, focusing on adolescent health, risk factors, and resilience. “I just really feel humbled,” says Dill. “Phoebe’s life had a tragic ending, but I hope that is raising awareness in her community and others about what young people are going through, and that we can’t be silent.” The Phoebe Prince Memorial Scholarship Endowment Fund marks the 24th scholarship Mahoney has established at UC Berkeley, including two others at the School of Public Health. Each of his scholarships, collectively valued at more than $9 million, commemorates a young life that ended tragically. “The main motivation of mine is to keep their lives going, in a way,” says the 81-year-old Mahoney. “Their names can go on and on in scholarships that help other people.” Individuals interested in donating to the Phoebe Prince Fund can do so at givetocal.berkeley.edu/publichealth.

Berkeley Health Fall / W inter 2010

ALUMNA SPOTLIGHT: CHIA-CHIA CHIEN By Abby Cohn

Shattering Cultural Barriers Schizophrenic, suicidal, bipolar, delusional, and depressed. In her 28-year career treating Berkeley’s mentally ill, Chia-Chia Chien, M.S.W., M.P.H. ’74, saw it all. But the most distressing cases for Chien, the city’s first Asian psychiatric social worker, involved patients who delayed getting help until they were in deep psychiatric tailspins. Many of them were Asian. “It was just a cultural stigma” to acknowledge mental illness, says Chien, a Chinese immigrant who came to the United States for graduate studies in 1970. “People don’t want people to know.” The patients who eventually landed in Chien’s offi ce were clearly in trouble. Among a hornet’s nest of problems, they might be hearing voices, experiencing paranoia, or at risk of harming themselves or others. Alarmed by the consequences of shrouding the reality of mental illness—Chien notes that Asian American women have the highest suicide rate among women over 65 in this country—she wasn’t willing to sit idly by. In 2001, she founded the Culture to Culture Foundation, an organization dedicated to shattering the barriers that prevent many Asians from getting psychiatric care—and committed to increasing the number of bilingual and bicultural mental health professionals in the Bay Area. “We wanted people to know that seeking help is nothing to be ashamed of,” says Chien, who earned a B.A. in sociology from Tunghai 26

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University in Taiwan and an M.S.W. from the University of Illinois at Urbana-Champaign before arriving at the School of Public Health in 1973.

as diabetes or heart disease. “You should open up and talk,” says the retired biochemist. “The important thing is to have family, relatives, and your community support you.”

Now retired from her city job, Chien runs her nonprofi t as a fulltime labor of love. Her base of operations is an airy offi ce in her suburban home in Alamo, California. Refl ecting on her clinical practice at Berkeley’s Mental Health Division, she says “so many cases illustrated the need for Culture to Culture.”

Concerned that people may not know where to go for help, Culture to Culture and its network of bilingual mental health professionals published a directory of mental health resources in the Bay Area and a set of bilingual questions and answers. For several years, the organization ran a mental health hotline serving the local Asian community.

In creating Culture to Culture, Chien launched a characteristically ambitious—and successful— plan of attack. She sponsored educational seminars—an estimated 50 in all—throughout the Bay Area, intended to shine a bright light on mental illness and the importance of early intervention. Panels of bilingual therapists gave advice, often fi elding questions written anonymously on slips of paper. With heavy fanfare from the Chinese language media, the events drew as many as

Today, dozens of Contra Costa seniors participate in free exercise classes, mahjong, and other activities organized by Chien and her corps of volunteers. From past trial-and-error, Chien knows that clients often shy away from activities that bear a psychiatric or counseling label. “If I said ‘mental health,’ no one wanted to see me,” says Chien. At the Danville Town Meeting Hall each Wednesday morning, the exercise classes draw

“I see Chia-Chia as a mental health heroine in the Chinese community.” 200 participants at a time. One of the most powerful gatherings was a talk by the family of acclaimed Bay Area author Iris Chang, who wrote the bestseller The Rape of Nanking. Chang had committed suicide the previous November at the age of 36. Though in mourning, Ying-Ying Chang, Iris’s mother, said her family “decided it was a good idea if we could go help the community.” Chang believes the stigma of mental illness cuts across many cultures and thinks mental problems should be treated like such conditions

an enthusiastic crowd. “Some seniors tell me they always wait for this day,” says Chien, who leads a lively session in the Chinese exercise discipline of Luk Tung Kuen. Participants include immigrants who might otherwise face language and cultural isolation. “We’re able to serve all seniors from all ethnicities,” says Chien, who greets attendees by name and invites them to count out exercise reps in Farsi, Japanese, Mandarin, and other native tongues.

“I wanted something to keep busy and not just vegetate,” says Champa Kripalani, a 74-year-old retired offi ce worker who moved to the United States from India in 1984. Kripalani, a regular at Culture to Culture-sponsored classes, says, “Everybody’s a happy camper here. Chia-Chia has created a wonderful atmosphere.” After back-to-back exercise classes, many head off to their afternoon mahjong game, also led by Chien. Barbara Smith, former chair of the John Muir/ Mt. Diablo Community Health Fund, says the loneliness endured by many elderly immigrants “wasn’t on our radar” until Chien approached the board for funding several years ago. “She was just determined she’d be a lifeline to those people so they’d feel connected to their country, and she’s done that,” Smith says. Today, Smith helps Culture to Culture with yearly prizes honoring outstanding senior volunteers in Contra Costa County. “She’s a pistol,” Smith says of Chien. “Nothing is going to stop her when she sees a need.” That’s a common sentiment among those who know Chien. “I see Chia-Chia as a mental health heroine in the Chinese community,” says Wing Tse, a 33-year-old San Francisco man who suffered a mental breakdown in 1998. Tse now does mental health work at San Francisco General Hospital and is earning a college degree. In 2008, he became the first recipient of a Culture to Culture “Mental Health Warrior Award” recognizing people who have triumphed over mental illness. Culture to Culture also bestows annual scholarships to students pursuing mental health careers aimed at serving Chinese communities. Chien credits a college entrance exam in her native Taiwan with steering her career path. “I took the exam and was assigned to go to the college for social work,” she explains. A seminal experience came when Chien did medical-social fi eld work at a rural Taiwanese hospital. Facing language and cultural differences of her own, Chien was challenged but nonetheless inspired. “Not many people were in social work, and people needed help,” she recalls.

After earning her bachelor’s degree, she headed to Illinois for her M.S.W. and spent a year doing psychiatric social work at a state hospital. Chien hoped to advance her training and concluded that the best place to do that was at the School of Public Health. “People love Berkeley, and I wanted to go west,” she says. At Berkeley, Chien met David Ying Chien, a young doctoral student in biophysics who had grown up in the same Taipei neighborhood. The two wed shortly after Chia-Chia’s graduation and lived in Albany Village’s married student housing while David worked toward his Ph.D., which he earned in 1978. Those were particularly happy times. “Everybody there was a poor student, but nobody felt poor,” she recalls.

David Chien, recently retired as a senior research director at Novartis Vaccines and Diagnostics, frequently rolls up his sleeves for Culture to Culture events. The couple has two grown daughters, Jo Chien-Meek, an oncologist at UCSF, and Shiao Chien Lee, a Berkeley Law graduate working for a New York-based nonprofi t. In recognition of her tireless efforts, Chien has garnered a string of accolades. They include the 2005 Peter E. Haas Public Service Award from UC Berkeley, a 2008 Purpose Prize Fellowship, and a 2009 Lifetime Achievement Award in Social Work from the National Association of Social Workers. “All my career, I didn’t do anything but mental health,” Chien says. And she has no plans to veer from that trajectory. “I still have a big energy and passion. Culture to Culture is my baby, and I want to see the baby grow.”

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FRESH PERSPECTIVE

A Typical Day At A Community Mental Health Clinic Narrative by Neil Sachs with commentary by Anthony Battista

It’s morning. I’m meeting with a young woman who has a lengthy drug history augmented by involvement in gangs. She has been afraid to leave her house for the past four weeks, and does so only to attend our therapy appointments. Since she has no friends and no ties to family, I appear to be her only connection to an external world. Her paranoia stems from a realistic fear of retribution from prior criminal associates and from exaggerated fears likely associated with extensive methamphetamine usage. She relates stories of being shot at, of being robbed, and of robbing others. It’s difficult for me to parse out whether the symptoms of paranoia, in addition to auditory and visual hallucinations (shadowy figures and voices that tell her what to do) that come and go, originated before her heavy drug use or as a direct result of it. We’ll probably never know. Community mental health is as much about the impact of drugs and alcohol on people’s lives as it is about addressing diseases of the brain. It’s uncommon to encounter a patient with a severe mental disorder who hasn’t dealt with substance abuse, regardless of socioeconomic status or ethnicity. It’s more pervasive, pernicious, and destructive than one could imagine, and it’s everywhere. While we try to help those who now struggle with demons of the past, a public health approach to mental health requires fighting these predecessors and aggravators of mental illness. Afternoon. I receive a call from a patient’s brother. He tells me that the patient has decompensated after a three-week trip with his girlfriend. He suspects that the patient is off medications for bipolar disorder and has been drinking alcohol heavily. He has been verbally aggressive with family members—quite out of character for this regularly buttoned-up, mild-mannered man, but predictive of spiral into agitated mania. A few hours later, the patient arrives for his appointment, 15 minutes early.

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He is visibly upset, and demands to see me. Immediately, I sense that he is in a different psychic space than usual—on edge, with bloodshot eyes that stare at me with a too-strong gaze. I will see him in a few minutes. He paces. I consider alerting Security, but decide against it given the lack of any previous violence and the risk of diminishing what is now a tenuous alliance. We start the weekly psychotherapy session as we have for the past year, but this time he abruptly opens with a raised, pressured voice. He outlines various wrongs committed by his family members. I reveal his brother’s concerned phone call and explain that his privacy was maintained. This seems to increase the patient’s vitriol toward the family. On a dime, his irritation switches, latching onto my carpet: “Why is it blue?! Why don’t you answer me?!” he yells. I honestly reply that I’m not sure what to say. And at that, he marches out of my offi ce and down the street. I walk after him, hoping to help, but knowing that much is out of my control in what appears to be the early stages

of mania with an overlay of recreational drug use. I call out, but I am ignored. I have no legal grounds to place the patient on a psychiatric hold—he has made no threats to himself or to others and is able to provide for his basic needs, at least as far as I can assess. And so I place a rather meager phone call, which goes to his voicemail. I express my concern, and I offer to see him next week or sooner, should he so choose. I wonder when I’ll see him again. Controlling variables is a primary tool of academic research, and the lack thereof a foregone conclusion in the clinical world. Community mental health practice requires constantly letting go without giving up. Many with mental illness cannot see their own deterioration of health, while family and friends are privy to the ups, downs, and in-betweens. Who is to say ultimately what is in the best interest of each person? Mental health advance directives may allow individuals to direct treatment in anticipation of times when they are ill, such as in the case above. Simple, low-cost interventions from text message medication

Anthony Battista (left) and Neil Sachs

reminders to weekly phone check-ins may help stave off the otherwise inevitable consequences of untreated mental illness. While there is no cookie-cutter answer, it’s clear that all of life’s variables overlap and we need approaches that meet people where they are. Later that day. A patient arrives at the clinic unannounced, and says he was hospitalized last week with an acute asthma exacerbation. As is often the case, he has been prescribed prednisone, a steroid to decrease infl ammation in the lungs, by the internal medicine doctors. But the prednisone is causing severe mood lability and disorientation in this already tenuous man. He explains that he is confusing his prednisone with his mood stabilizing medications and thinks he may have taken too many of the latter. Without anyone to assist him or tend to him while he recuperates, he is at risk for an accidental overdose. I instruct him to wait out the rest of the afternoon in our clinic, in order to be observed and be around people. He remains alert and relatively calm throughout the day and eventually goes home. He calls a few days later.

He couldn’t bear to take the prednisone, for fear of what it would do to his mood, and is now back in the hospital, unable to breathe from his asthma. These are but a few anecdotes from a day in a community mental health clinic. In reality, each of us has a story to tell about mental illness and experiences that reveal the heavy burdens often unrecognized until too late. Even in the public health community, stigma drowns out the voices calling us to rise to the biggest health challenge of today. The future of community health will be determined by the way we respond to mental health needs, and will depend greatly on the inclusion of those who suffer as well as their loved ones. In the meantime, we’ll just have to see what tomorrow brings and respond the best way we can.

The future of community health will be determined by the way we respond to mental health needs, and will depend greatly on the inclusion of those who suffer as well as their loved ones.

Neil Sachs, M.D., M.P.H. ’07, graduated from the School’s Interdisciplinary M.P.H. Program and works as a resident psychiatrist at the San Mateo County Psychiatry Program. Anthony Battista, M.D., M.P.H. ’10, is also a graduate of the Interdisciplinary Program. He is a first-year resident psychiatrist at the San Mateo County Psychiatry Program.

Berkeley Health Fall / W inter 2010

DEAN’S CIRCLE The School of Public Health Dean’s Circle is a community of committed individual benefactors who share in and support the dean’s vision for the School’s future by making annual leadership gifts.

The following list refl ects gifts received from July 1, 2009, to June 30, 2010

$100,000 & Above Kathy Kwan & Robert Eustace Leonard & Pamela Schaeffer Kirk Smith & Joan Diamond

$25,000 to $99,999 Marilyn Barkin Patricia & Richard Buffl er Richard & Susan Levy J. Michael Mahoney Lisa & John Pritzker

$10,000 to $24,999 Gertrude & William Buehring Robert & Valerie Fish Barbara Hansen Catherine & James Koshland Naheed & Dayton Misfeldt Vera Poon Theodore & Gayle Saenger Allan & Meera Smith

$5,000 to $9,999 Howard & Joan Bloom Richard Blum & Dianne Feinstein Nancy Lusk & Michael Smith Janet Perlman & Carl Blumstein Sally & Steven Presser George & Linda Sensabaugh

$1,000 to $4,999 Anonymous Donald Arbitblit & Jill Suttie Stacey Baba & James Vokac Grace Bardine Lynn Barr Raymond Baxter & Aida Alvarez Jeffrey & Cathleen Brown Ralph & June Catalano George & Eleanor Cernada Alice Chetkovich 30

Healthier Lives in a Safer World

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Eunice Childs Nilda Chong Roberta & Leonard Cohn Margaret Deane Susan & Michael Eckhardt Deborah Edelman Robert Ettl Patricia Evans Lia Fernald & Guy Haskin Dava Freed Jonathan Frisch Wallace Gee Marshall Goldberg James & Patricia Harrison Paul & Lois Hofmann David Hopkins The Hosel Family Anthony Iton David & June Jeppson Jeffrey Kang & Brenda Lee-Kang Michael & Kimberly Kappel Nancy Karp Julia Klees Joan Lam Carol Langhauser Eleanor Langpaap Yvette Leung & Liwen Mah Suzanne Llewellyn Lolita Lowry Kok Lye & Joy Ohara Anthony Marfin & Amy Bode Arthur McIntyre Robert Meenan Daniel & N.E. Merians Arnold Milstein & Nancy Adler William Moeller Robert Montgomery Roberta O’Grady Kathryn Paul Karl Peace

Edward & Camille Penhoet Leland & Kristine Peterson Robert Porter Darwin & Donna Poulos Stephen Rappaport J. Leighton & Carol Read Kenneth & Frances Reid Carol Richards Lois Rifkin Shirley Roach Janet Schilling Steven & Sally Schroeder Michelle Schwartz Thomas Schwartz Betty Seabolt Sandra Shewry Stephen & Susan Shortell Nancy & Robert Shurtleff Shannon & John Siegfried Shoshanna Sofaer & Lawrence Bergner Maury Spanier Robert & Patricia Spear Harrison & Christine Spencer Charles & Patricia Steinmann Sheila Stewart & Charles Wilson Jim Strand John & Gail Swartzberg Paul & Andrea Swenson Stephen Taplin Patricia & Kenneth Taylor Kenneth Taymor & Beth Parker Nancy Thomson Joseph Toscano Eric Vittinghoff Joan Wheelwright Warren Winkelstein Robert Yarwood Arnold Zeiderman & Peggy Scott-Zeiderman

HONOR ROLL The School of Public Health gratefully acknowledges the following individuals and organizations for their generous contributions from July 1, 2009, to June 30, 2010. INDIVIDU ALS Partners ($500 to $999) Marcelle Abell-Rosen & Andrew Rosen Pamela & Rodrick Alston Paulette Arbuckle Anne Bakar Michael Bates Lan-Anh Bui Elizabeth Calfee Gretchen & Charles Carlson Albert & Yvonne Chang Po-Shen Chang & Julie Craig-Chang Linda & James Clever Norman & Wendy Constantine Bernard Cordes Douglas & Jacqueline Corley Martin & Diane Covitz Michael & Nan Criqui Alexandra Delano Patricia & Walter Denn Michael & Sandra Fischman Michael Gallivan Daniel Gentry Carol Giblin Robin Gillies Nelden & Victoria Hagbom Amanda Hawes Thomas Hazlet Genevieve Ho Laura & Richard Jacobs Don Johnstone Arlene Kasa Laurence Kolonel Carl Lester Michael Lipelt Steve Lipton Merle Lustig & Ronald Glass Elizabeth Martini David Matherly Caroline & Eric Martin Malcolm McGinnis Dokiso Nchama Mary Noke John Orman Diana Petitti Mary Pittman-Lindeman & David Lindeman Carleton & Maureen Rider Beth Roemer Lisa Safaeinili Gregg Schnepple Donna Seid Emily Stauffer Susan & William Stokes Constantine & Nancy Tempelis Barbara & Alfredo Terrazas Robert Tufel

Eileen & James Vohs Julia Walsh & Stephen Dell Margaret Wang & Michael Nguyen Patricia West Thomas Williams John & Roxana Yau Friends ($250 to $499) Elaine Adamson & Edward Gould Ramona Anderson Dean Baker Marina Baroff John Beare John & Ruth Bellows Chhaganbhai & Sarojben Bhakta Deborah Bohr Jane Borg Evelyn Caceres-Chu & Albert Chu Eva Catlos Charlotte Chang & Lastoskie James Jerome Chin Carol Clazie Dolores & Samuel Clement Charles Crane & Wendy Breuer Dale Danley Laurel & Stuart Davis Martin & Cindy Dean Louise Detwiler James & Dorothy Devitt Michael & Sharon Dillon Irene Doherty Kathryn Duke & Niels Kjellund John & Marlene Eastman Wetona Eidson-Ton & Hendry Ton Enid Emerson Jacqueline Erbe & Andrew Talbot Rosa Fernandez Carol & James Floyd Annette Goggio Jill & Larry Granger Amy Grossman Sylvia Guendelman Richard Gustilo Jean Hankin Glenn & Jan Hildebrand John Hillman Donna Howard Joseph Hummel Benjamin & Won Hur Priscilla Ilem Walter Keller Terrie & Arthur Kurrasch Mark Kutnink Andrew Lan Adam Levine Michael Lin Geoffrey Lomax

Leslie Louie & David Bowen Robert Lowe & Michelle Berlin Lowe Marion & James Lyon Natasha Mascarenhas Vincent Meehan Hellmut Meister Ralph & Jane Myhre Linda Neuhauser & Craig Buxton Jeffrey Newman Mary O’Connor & Emil Brown Young & Hyeon Pak Michelle Pearl Therese Pipe Philip Prendergast Christine Rammler Valerie Randolph & Donald Fenbert Judith & John Ratcliffe Justin Remais & Elena Conis David Rempel & Gail Bateson Anna Lisa Robbert Silvestre & Victor Silvestre Laura Roche Sidney & Sally Saltzstein Stephen Schultz & Mary Pacey Alison Seevak Peter Sherris Sharon & Scott Shumway Marilyn Silva & Warren Musker Robert Simon

Claudine Torfs Feng Tsai Judith & Clarence Ueda Marguerite Van Coops Craig & Patricia Van Roekens Rajesh Vedanthan & Sujatha Srinivasan Michael Weiss Kathleen Wesner & Daniel Sullivan Susan Yeazel & Richard Seegers Katherine Yu & David Su Jan Yuo Yi Zhou & Ququan Liu David Zimpfer Supporters ($150 to $249) Barbara Abrams Georgette Adjorlolo-Johnson Clayton & Pamela Akazawa Victor & Karen Alterescu Carolyn Anderberg Richard & Carlene Anderson Anonymous Tania & James Araujo John Balmes & Sherry Katz Cecilia Barbosa Kevin Barnett & Alison Neurin Lucinda & Ronald Bazile Heather Blume Nina & Steven Body Elizabeth & James Bowe Claire & Ralph Brindis Sally Bullock Alexandre Bureau Barbara Campbell Edward & Joann Cavenaugh Judy Chan Farmer & Kenneth Farmer Jeffrey Chang Alex Cheng

Left to right: Judy Moorad, Pat Hosel (assistant dean for external relations and development), and Naheed Misfeldt at a reception for members of the School of Public Health’s Dean’s Circle William & Jacqueline Smith Krikor & Caline Soghikian Robert & Martha Stebbins Bruce Steir & Yen Aeschliman Richard Stephens & Sherrill Cook Judith Stewart Sharmila Sudanagunta & Sreekanth Ravi Timothy Taylor Irene & Marsh Tekawa

Michael & Jan Clar Janet Coffman Simon Cohn Carol Copeland Laura Cordero Molly Coye Patricia & Roger Crawford David Crouch James & Evelyn Crouch David Dassey

Rena David & Walter Meyers Kathryn De Riemer Orville & Helen Deniston Alice & Robert Diefenbach Sarah Dixon Leonard Doberne & Cheryl Tau Jacquolyn Duerr & Alberto Balingit Gordon Dugan Leland & Marta Ehling Brenda Eskenazi & Eric Lipsitt Tamar & Joe Fendel Robin & Mark Fine Patricia Fobair Julie Frederick-Metos David Gan Connie Gee Liliane Geisseler Jack & Karen Geissert Robert & Patricia Gerdsen Sally Glaser & R.D. Bower Juan Gomez Janice Goode Laurel & Michael Gothelf Kathryn Graham Hubert & Jean Green Lawrence Green & Judith Ottoson Eric Grigsby & Mary Rocca Thaddeus Haight Corazon Halasan Carisa Harris Adamson & Nick Adamson Mary Henderson Enrique Henriquez Warren & Miriam Hill Rosemary Hoban Wilbur Hoff & Kris Muller Carolyn Hoke-Van Orden & Frank Van Orden Nina Holland David Hoskinson Max Jack Rachael Jones Weslie Kary Susan & Harvey Kayman Ralph & Carol Kuiper Susan Lambert Sandra Lane Lillian Lanka Robert Larsen Joyce Lashof Edmond & Linda Lee Kelvin & Brenda Lee Lynn Levin & Stanley Oshinsky Virginia Lew Rui Li Maurine Lightwood Hanmin Liu & Jennifer Mei James & Maureen Lubben Christiana & Charles MacFarlane Frank & Waneka MacKison Christina Malin & Stephen Texeira David & Anne Manchester Harry & Claire Manji Grayson & Sally Marshall Stephen McCurdy & Kathleen Ries Alan & Margaret McKay Virginia & Thomas McKone

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The CAMPAIGN for the SCHOOL OF PUBLIC HEALTH

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HONOR ROLL, continued Rosa Medina Meredith Minkler & Jerry Peters Nila & Chuck Mody Janet Mohle-Boetani & Mark Monasse Matthew Moore Florence Morrison Clark Maria Munoz & David Edelman Catherine Muther & Dennis Aftergut Cherie Ng Mark Nicas & Jennifer McNary Reiko Niimi Joel & Phyllis Nitzkin Barbara Norrish Jean Nudelman & Richard Bock Ann & Oldervoll Thomas Mary O’Leary Perkins & Arthur Perkins David & Mary O’Neill Susan Osaki Holm & Mark Holm Rena Pasick Richard & Martha Pastcan Sudhir Penugonda Douglas & Deloris Pike Tommie Pippins Donald & Ann Porcella Catherine Prato Denise & Michael Prince Diane Raleigh Stephen Rauch Kyndaron Reinier & David Henehan Barbara Reiss Patricia Brown & Pedro Reyes Richard Roach Gordon & Whit Robbins Maria Roberts Elizabeth Rockett James Rogge Anthony & Barbara Rooklin Nicholas Ross Thomas Rundall & Jane Tiemann Michael Samuel & Jane Martin Gopal & Andrea Sankaran William & Enid Satariano Catherine Schaefer Julie Schmittdiel Gretchen Schroeder & Toby Douglas Terry Shaw Tina & Jeff Sherwin Takeo & Maye Shirasawa Karen Shore Phoenix Sinclair James Slaggert Laura Smith Lorraine Smookler Karen Sokal-Gutierrez Usha & Bharat Srinivasan Mark & Nanelle Sullivan Franklin & Elizabeth Sunzeri Roger Swanson & Lena Zhang Hui Tang Ronald Thiele Richard Thomason Diane Tokugawa & Alan Gould

Robert Traxler John Troidl Laura Trupin Mary & Kenneth Tuckwell Jenifer & Stephen Turnbull Sandra Tye Janet & Curtis Vaughan Varsha Vimalananda Edward & Linda Wei Ardyce Wells Michael Williams

Howard Backer Katherine Baer Richard Bailey Robyn Bailey Harris & Patricia Baker Jennifer Balogh Keith & Gail Bandel Hoang Banh Jacqueline Barin John Barker & Fan Cheng Robert Barr Audrey Barrett Elaine Base Sheila Baxter

Policy Advisory Council member Arnold Zeiderman, M.D., M.P.H. ’73 (left), and his son, Matt Zeiderman, at a reception for members of the School of Public Health’s Dean’s Circle Marilyn Winkleby & Michael Fischetti Barbara Wismer Otis & Teresa Wong Evaon Wong-Kim & Jean Kim Walter Zaks Karen Zukor Contributors ($1 to $149) Heather Adair Simone Adams Paul Adamson Andrew Adelman Olako Agburu M. Bridget Ahrens Juan Alanis Margo & Marcus Alford Ellen & Paul Alkon Donald Allari Laura Allen Meghan Althoff Beth Altshuler Baharak Amanzadeh Richard & Sue Ames Adele Amodeo Henry Anderson John & Eleanor Anderson Joyce Appelbaum Karina Arambula Emmanuel Arinaitwe Laura Arroyo Carl Ashizawa & Rebecca Honma-Ashizawa Margaret Bradford Aumann Betty & Calvin Austin

Healthier Lives in a Safer World

Fall / W inter 2010

Gary Baysmore Nicole Bazell Satariano Robert & Meg Beck Stella Beckman Lucie Bedard Robin Bedell-Waite & Thomas Waite Charles Beesley & Deborah Raines Beesley James Behrmann James Bell Edward Bellfi eld Karen Ben-Moshe David Berke Hillary Berman Muriel Beroza Pamela Berven Aman Bhandari & Vicki Fung Balwant & Kulwinder Bhaurla Harvey & Bonnie Bichkoff Trinidad & Patricia Bidar Thomas Blair Kallista Bley Karen Bloch Daniel Bohl Lynda Bradford Joan Bradus & Dale Friedman Ellen & Nelson Branco Russell Braun Joseph Brazie Donald Brecker & Ann Darling Victoria Breckwich Rachel Broadwin Claude Brown Elize Brown

Julie Brown William Brown Maureen Browne Linda Bryant Hayley Buchbinder Merrill Buice Suzanne & Virat Bunthuwong Colombe Burnett Lauren Burwell Evan Busch Phillip Calhoun Peter Callas & Karen Nepveu Maximiliano & Patricia Camarillo Marilyn & Thomas Capener Julia Caplan Teresa & John Carlson Elizabeth Carlton James Carpenter Alice Cartwright Arthur Castillo Joanne Chan Raymond & Grace Chan Shawn Chandler Emiley Chang Jimmy Chang Michelle Chang Sophia Chang & Anson Lowe Bryan Chao Roger Chapman Patricia Charles Rokhsareh & Michael Charney Scott Chasalow Helen Chase Shiva Chaturvedi Connie Chen Susan Chen Iris Cheung Jim Chheng Constance Chiulli Alisun Chopel Eric Chow Catherine Christopher Karen Chu Kenny Chung Heather Clague Alfred Clancy Lisa Clarke Louis & Margaret Coccodrilli Pamela Cocks Laura Coelho Seymour Cohen Stephanie Cohen Karen Cohn Jacqueline Colby Nancy Collins & Francesco Adinolfi Emily & Christopher Contois Richard Conway Tuck & Nancy Coop June Cooperman James Cossolias Lawrence & Constance Cowper Marguerite Cowtun & Henry Terrell Katherine Crabtree Lavera Crawley Elizabeth Cretti Juliette Cubanski Edwin & Naomi Curtis Loring & Ann Dales

Helena & James Daly Lois Damiani Richard Daniels & Arlene Kaplan Daniels Stephen Davis & Christine Laszcz-Davis Robert Day Brandon DeFrancisci Barbara & Alain de Janvry Sylvia de Trinidad Marlene Dehn Robin Dewey & Mark Ibele Debra DeZarn Lisa Diemoz Francisco Diez-Gonzalez Maureen Dion-Perry & Edward Perry Stephen Dippe Linda Dix-Cooper Andrew Doniger & Patricia Coury-Doniger Lori Dorfman Erin Dugan & Brian Purcell Kent & Irene Dunlap Ellen Dunn-Malhotra & Ripudaman Malhotra Kathleen Dunphy Danielle Duong Adrian Durbin Sarah Edson Molly Efrusy Jose Eguia Lucky Ehigiator Megan Ellingsen Reema Elziq Amanda Evans Stephanie Evans Peter & Connie Ewald Garold & Joyce Faber Denise Fair Jennifer Falbe Daniel & Sandra Feldman Denise Felix Bette Felton Kevin & Barbara Fennelly Flora Fernandez Carolyn Zecca Ferris Sammy Feuerlicht & Susanne Simpson Jared & Janet Fine Gerald & Linda Finer Laura Finkler & Lawrence Walter Brooke Finkmoore Emily Fireman Kari Fisher Shahla Fisher Robin Flagg Elizabeth Flick Laura Flores Mary Foran Constance Fraser Peter & Robin Frazier Larri Fredericks Robert & Carol Friis Katharine & Daniel Frohardt-Lane Michele Fromowitz Charles & Marilyn Froom Daniel Funderburk Marianne Gallo Jane Garcia

Decade Club Recognizing individuals who have given for the past 10 years consecutively Elaine Adamson & Edward Gould Pamela & Rodrick Alston Adele Amodeo Ramona Anderson Richard & Carlene Anderson Howard Backer Richard Bailey Dean Baker John Barker & Fan Cheng Marina Baroff John Beare James Behrmann Claude Brown Jeffrey & Cathleen Brown Patricia & Richard Buffl er Alexandre Bureau Elizabeth Calfee Barbara Campbell Gretchen & Charles Carlson Raymond & Grace Chan Alice Chetkovich Eunice Childs Carol Clazie Dolores & Samuel Clement Linda & James Clever Seymour Cohen Carol Copeland Bernard Cordes

Judith & Jose Garcia Terhilda Garrido Theresa & Michael Gasman Joan Gates Amanda Gatewood Jane Gehring Nicole & Jack Geiger Inna Gerlovina Neil Gesundheit & Eleanor Levin Nancy Gilien Hildegard Gillem Herbert & Charlotte Ginsberg Martha Goetsch & Linda Besant Betty & Larry Goldblatt Christopher Golden Alina Goldenberg Marilyn & Amos Goldhaber Brenda Goldstein Sandra Goldstein & Kenneth Wilkinson Maria Gonzalez Priscilla Gonzalez Anielka Gonzalez Webb & Matthew McCoffer Amy & George Gorman June Goshi & Samuel Sweitzer Gloria & Alfonso Grace Howard Graves & Julie Baller Marian & Roger Gray Susan & Lowell Greathouse Brent Green Linda Greenberg

Martin & Diane Covitz Lawrence & Constance Cowper Charles Crane & Wendy Breuer Dale Danley Margaret Deane John & Marlene Eastman Susan & Michael Eckhardt Leland & Marta Ehling Patricia Evans Robin & Mark Fine Gerald & Linda Finer Michael & Sandra Fischman Carol & James Floyd Constance Fraser Katharine & Daniel Frohardt-Lane Charles & Marilyn Froom Wallace Gee Liliane Geisseler Carol Giblin Marian & Roger Gray Richard Gustilo Jean Hankin Jovine Hankins Robert & Martha Harrell James & Patricia Harrison Thomas Hazlet Glenn & Jan Hildebrand Marisa Hildebrand

David Hopkins Patricia & Harold Hosel David Hoskinson Mark & Estie Hudes Marjorie Hughes Deborah & Martin Inouye Alma & Ian Kagimoto Arlene Kasa Leanne & Richard Kaslow Julia Klees Laurence Kolonel Catherine & James Koshland Ruby Kuritsubo Mark Kutnink Clement & Donna Kwong Joan Lam Joyce Lashof Frances Ledford Kelvin & Brenda Lee Carl Lester Lynn Levin & Stanley Oshinsky Leslie Louie & David Bowen Nancy Lusk & Michael Smith J. Michael Mahoney Shirley Main David & Anne Manchester David Mark Grayson & Sally Marshall Elizabeth Martini David Matherly Ruth McHenry-Coe Robert Meenan Raymond Meister & Mary Miller

Arlene Kasa, M.P.H. ’73, and Dean Stephen Shortell at a reception for members of the School of Public Health’s Dean’s Circle N. Anthony & Ella Greenhouse Jenalynn & William Greer Loyal & Joyce Griffin Jennifer Grinsdale Nina Grove & Kenneth Johnson Valerie Gruber Elisabeth Gundersen Karen & Richard Gunderson Sandeep Guntur & Sri Sakamuri Jose Gutierrez-Montes & Gabriela Vazquez Christina Gutowski

Anne Gwiazdowski & William Andersen Jennifer Hackett & Adam Blackburn Kamran Haikal Rita Hamad Mary & Paul Hamer Nicola Hanchock & James Moore Jovine Hankins Jeffrey Hanson Mary Hardy Robert & Martha Harrell

Mark Mendell Meredith Minkler & Jerry Peters Ralph & Jane Myhre Linda Neuhauser & Craig Buxton Jeffrey Newman Beata & Harlen Ng Joel & Phyllis Nitzkin Mary Noke Mary O’Connor & Emil Brown Alan Oppenheim & Alice Salvatore Edward & Camille Penhoet Janet Perlman & Carl Blumstein Donald & Ann Porcella Darwin & Donna Poulos Savitri Purshottam Barbara Razey-Simmons & Charles Simmons Lois Rifkin Shirley Roach Gordon & Whit Robbins Judith & Paul Rogers Thomas Rundall & Jane Tiemann Lisa Sadleir-Hart Sidney & Sally Saltzstein Leigh Sawyer & Gerald Quinnan Janet Schilling Takeo & Maye Shirasawa James & Jo Shoemake Stephen & Susan Shortell Elizabeth Shurtleff Nancy & Robert Shurtleff Allan & Meera Smith

David Harrington M. Antoinette Harris William Harrison Constance & Gregory Haslett Maureen Healy Alvia & Yvonne Hearne Karen Heckman John Heim Kathleen Hellum & W.R. Alexander Susan Helmrich & Richard Levine Geraldine Henchy Rona & Robert Henry Doris Henson Katherine Hetnal Constance Heye & Lance Smith Donald & Louise Heyneman Elizabeth Hibbard Marisa Hildebrand Lynette Hill Cynthia Hines Bruce & Valerie Hironaka Richard Hirsh Brian Hitt Frances Hoffman Guenter & Karen Hofstadler Karen Holbrook Joseph Hollowell & Emily Russell Hallie & Gilbert Holtzman Patrick Hou Mark & Estie Hudes Karen Hughes & David Mayer Marjorie Hughes

Esmond Smith Kirk Smith & Joan Diamond Lorraine Smookler Shoshanna Sofaer Karen Sokal-Gutierrez Robert & Patricia Spear Usha & Bharat Srinivasan Susan Standfast & Theodore Wright Bruce Steir & Yen Aeschliman Edith & Guy Sternberg Marilyn & William Stocker John & Gail Swartzberg Laurence & Ann Sykes Kenneth Taymor & Beth Parker Irene & Marsh Tekawa Ronald Thiele Pamela Thompson Claudine Torfs John Troidl Laura Trupin Sandra Tye Eileen & James Vohs Harvey & Rhona Weinstein Ardyce Wells John Williams Michael Williams Terry & Teri Winter Barbara Wismer Channing Wong Suzanne & John Young Katherine Yu & David Su

E.D. Huitron Romero & R. Medel Medel Ortiz Dorothy Hung Katherine Hung Phillip & Marcella Hurley Liem Huynh James Hynes & Lisa Feuchtbaum Kazuyoshi & Tokiko Ide Ernesto & I.D. Iglesias Somuadina Ikebudu Robina Ingram-Rich & Timothy Rich Deborah & Martin Inouye Kimberly Jackson Jeffrey Jacobs Mary & Kraig Jacobson Loisann Jacovitz Petra Jerman Sarah Jewel & Stephen Newman Nami Jhaveri Steven Joffe Kathryn Johnson Ryan Johnson Kanwar Jolly Andrew Joseph Jazmine & Jazmine Jung Alma & Ian Kagimoto Alison & Gerald Kajiwara Alice Kang Barbara & Snehendu Kar Lee Kaskutas Leanne & Richard Kaslow

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HONOR ROLL, continued Gerald Kataoka Irene & Kiyoshi Katsumoto Marjorie Keck Paula Keebler Alexander Kelsey Suzanne Kent Kenneth & Marchelle Kesler Angela Killilea Janice Kim & Jeffrey Stephens Young Shin Kim Nancy & Kenneth Klostermeyer Arthur & Laura Kodama Rachel Koontz Jill Korte Kathryn Kotula John & Ellen Kramer Richard & Kathy Kramer-Howe Ruby Kuritsubo Daniel Kwaro Clement & Donna Kwong Jennifer Lachance Carolyn Lake Duong Lam & Lan Phan Simone Lance Katherine Lao Abiose Lasaki Melinda Lassman Bernard Lau Serene Lau Fern Leaf Frances Ledford Ja-Tee Lee

Rena Lee Simon Lee Priscilla Lee Chu & Eugene Chu Henry & Helga Leighton Jonathan Leong Thomas Leong Danielle Lerer Sylvia Leung Eric & Jasmin Levander Barbara Levernier-Carlisle Jordan Levine Lillian Levy Arline Lewis Paul & Barbara Licht William Light & Robin Vernay-Light Jennifer Lin Samuel Lind Lois Lindberg Jean & Robert Lindblom David Lindquist Lois Lindsey Edwin Linsley Danielle Lloyd & Stuart Evans Lois & Donald Lollich Peggy Loper & Michael McShane Diane & Bill Louie Edward & Ida Low Walter Lucio & Lucio Marsha Anne & Charles Ludvik Robert Lund Peter Lurie Olivia Lustro

Claudia & Robert Lutz Theresa Ly Charles & Elissa Maas Daniel Madrigal Katherine Magwene Sheryl Magzamen Cara Mai Shirley Main Tanya Mamantov & Cornelius Jansen David Mark Rodrigo Marquez Alicia Marshall Marina Martin Sarah Martin-Anderson Caroline Martinez William Martinez Shaddai Martinez-Cuestas Claudia Martinez-Schwarz & Henry Schwarz Marty Martinson Karen Martz Maya Mascarenhas John Mateczun & Elizabeth Holmes Jill Mathews Marjorie & Robert McCarthy Robert & Darlene McCarthy Gary McCauley Brigid McCaw & William Finzer Marian McDonald Sean McFarland Mara McGrath & George Pugh Ruth McHenry-Coe Janet McNamara

Nancy & John Meade Raymond Meister & Mary Miller Mark Mendell Caitlin Merlo Ruth & Harry Metzger Rei Miike Andrew Miller Francine Miller & Daniel McLaughlin Ray Minjares Patrick Mitchell Idonah Molina Susan Montiel Patrick Moore Hilbert Morales Alan Morden Maureen Morgan Hallie Morrow Saam Morshed & Razani Nooshin C. Jean Morton John & Doris Moyer Marian Mulkey & John Powers Mark Munekata Edward Murphy & Miriam Eisenhardt Michael Musante Jean Naples Amalia & Carl Neidhardt Elana Neshkes Richard Neumaier Beata & Harlen Ng Vivienne Ng Margaret & Hugh Niall Russell Nickels Karen Nikolai

Katherine Nishimura Audrey Nolte Ramona Noriega Jean Norris & Bluford Hestir Charlotte Noyes Christina O’Halloran Afolabi & Mojirola Oguntoyinbo Cynthia & Brian O’Malley Melissa Ongpin Alan Oppenheim & Alice Salvatore Juliana Oronos Viviana Ostrzega Beverly Ovrebo Claudia Palacio Edward Panacek Valentine Paredes Tyan Parker-Dominguez & Manuel Dominguez Monique Parrish Afshin & Carolyn Parsa Padmini Parthasarathy Mary Patterson-Gilmer & Jonathon Gilmer Susan Paulukonis Eileen & Mark Pearl Christina Penfi eld Lesley Pereira Alissa Perrucci Lisa Peterson Jennifer Pham Tanya Pham-Neff & Ralph Neff Mary Philp Thomas Piazza & Mary Crosby Thomas Piepmeyer Samantha Pitts & John Scott

Advisory Council Welcomes Two New Members Paul Klingenstein has been a venture capital investor focused on health care innovation and young companies for most of his professional career. After a period as a fi eld scientist in Tanzania, he joined Warburg, Pincus in the early 1980s, and later Accel Partners in 1986, and through the next decade helped to build a leading venture capital firm. After a brief period as an adviser to the Rockefeller Foundation, he formed Aberdare Ventures in 1999. Klingenstein has been an active participant in more than 50 companies, the majority of which are now public, or have been merged into public companies. These investments comprise mostly early-stage domestic businesses, but also include later-stage, public, and non-U.S. companies. He has served on various boards and is currently chairman of the board of the International AIDS Vaccine Initiative, a global organization which supports science, clinical testing, advocacy, and policy in support of an HIV vaccine. He received an A.B. from Harvard and an M.B.A. from Stanford.

Healthier Lives in a Safer World

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Arnold M. Zeiderman, M.D., M.P.H. ’75, has been a practicing OB/GYN since 1972. Although he has primarily been in solo rural practice in Amador County and Arcata, California, he has also engaged in a spectrum of administrative, educational, academic, clinical training, and community activities. Zeiderman received his M.P.H. at the UC Berkeley School of Public Health as an NIH-granted fellow in maternal and child health, following two years of practicing and serving the Armed Forces and civilian dependents in Heidelberg, Germany, as a U.S. Army major, Medical Corps. He is a graduate of Columbia College (University), the University of Louisville School of Medicine, and the Stanford University Medical Center OB/GYN program. Currently, he continues his community-based women’s health practice in Jackson, Calif., including hospital and ambulatory gynecologic surgery, while consulting on standard-of-care determinations and medical liability issues. He has a special interest in the facilitating the initiation and development of models for distance education in rural communities.

Janet Place & Gerald Williams James Platts Jennifer & Matthew Plunkett Adam Polis Mary Potter Lee Prebil Tonya Premsrirath Savitri Purshottam Brian & Tacy Quinn Richard & Julia Quint Jane Radford-Barker & Brent Barker Patricia Ramsay & Shawn Oâ&#x20AC;&#x2122;Leary Barbara Razey-Simmons & Charles Simmons Irene Reed John Rendon Kenneth Renwick Columba Reyes Michael Richards Allyson Rickard Jean & Francis Riley Elizabeth Rintoul Stephan Ritter Marc & Karen Rivo Sara Roberts Martha Robles Diana Rodin Tracy Rodriguez Judith & Paul Rogers Michael & Sharon Rogers Eva Ros Guerrero Guido & Ruth Rosati Helen Ross & Paul Mico Shelley Ross-Larson Rebecca Roy Alice Royal Rachel Royce & Matthew Farrelly Linda Rudolph Maria Ruiz Ruelas Neil Sachs Lisa Sadleir-Hart Swathi Sampangi Ann & Lars Sandven Martha Sandy Baljeet Sangha Timothy & Kiyomi Sankary Clea Sarnquist Ingrid Sausjord Rosita Saw Leigh Sawyer & Gerald Quinnan Sunessa Schettler Robert Schlegel & Janet Fogel Judith Schnepp Jon Schwartz Megan Schwarzman Erika Schwilk Katherine Scott Kristine Serbonich Maria Serrano George Shaber Megha Shah Reema Shah Patricia Shane Glen & Joaquina Sheppard Zeheria Shifa Jeffrey & Edna Shipley James & Jo Shoemake Richard & Ronna Shpall

Students gather at the annual Scholarship Tea, where scholarship recipients have the opportunity to meet and thank their sponsors. Elizabeth Shurtleff Stephen Sidney & Carolyn Schuman Jessica Siegel Joan & David Skurnick Esmond Smith Joanna Smith Karen Smith Margot Smith Terrill Smith James & Muriel So Lucia & Peter Sommers Jonathan Soper Jeanette Spangle Gail Splaver Joan Sprinson Susan Standfast & Theodore Wright Kenneth Stanton James Stark Katherine Stearns Ashley Stegall Paul Stepak Norma Stephens Edith & Guy Sternberg Wayne Steward Marilyn & William Stocker Margaret Straub Corwin Strong Anne Sunderland Christine Swanson Megan Swanson Robert & Nancy Swanson Karen Sweeney & Byungyol Chun Louise Swig Laurence & Ann Sykes Cathy Tashiro Judith Taylor Maida Taylor & Edward Kelly Nicole Taylor

Yingmei Tcheou Patricia Terry Ryan Therrian Gregory & Bonita Thomas Geoffrey Thompson Mary Haven & Richard Thompson Pamela Thompson Colleen & Brian Thornton Beverly Tibbles Jennifer Tillett Hang Tran Minh-Hai & Tuan Tran Mary Traylor Suzanne Tsang Kazuko & Anthony Tu Janis & Daniel Tuerk Robert & Allene Tumelty Ashley Turek Michael & Barbara Turell Candace Vahlsing Fernando Valdes Barbara Vandenberg Nayabei Vanwoerkom Ludenia & Steven Varga Dorothy & Clasten Vaughn Wendy Verret Digna & Frank Vince Cruz Adam Visconti Rosalie & Paul Vlahutin Emily Vogler Lois von Husen & Richard Lehman Barry & Susan Wainscott Virginia Walega Huihui Wang Jenny Wang Linda Wardlaw Charles & Manuela Watson Christina Watson R. Berna Watson

Karen Weidert Harvey & Rhona Weinstein Morris & Audree Weiss Virginia & Wallace Wells Suzanne Welty Gordon Werner Colleen Wichser Sabrina Wickremasinghe John & Elizabeth Anne Wikle John Williams Terry & Teri Winter Sharon Witemeyer Lynne Wittenberg Marian Woessner Channing Wong Walter Wong George & Helen Woods Paula Worby Kara Wright & T. James Lawrence Nancy & Douglas Wright William Wright Evelyn Yee Leslie Yee-Murata Irene Yen Sallie Yoshida & Max Kelley Carol Youmans Donna Young Maria-Elena Young Suzanne & John Young Stella Yu & Hingloi Hung Susan Zahner Steven & Victoria Zatkin Courtney Zecher Marshall Zemon Danya Zhang Yun Zhang Lucas Zier Stephen Zoloth Lisa Zwerling & Ron Birnbaum

CLASS GIFT Heather Adair Carisa Harris Adamson & Nick Adamson Andrew Adelman Meghan Althoff Beth Altshuler Baharak Amanzadeh Emmanuel Arinaitwe Laura Arroyo Jacqueline Barin Lynn Barr Audrey Barrett Sheila Baxter Edward Bellfi eld Karen Ben-Moshe Hillary Berman Thomas Blair Kallista Bley Daniel Bohl William Brown Lauren Burwell Evan Busch Julia Caplan Elizabeth Carlton Joanne Chan Charlotte Chang & Lastoskie James Jimmy Chang Alex Cheng Iris Cheung Jerome Chin Alisun Chopel Kenny Chung Laura Coelho Stephanie Cohen Katherine Crabtree Elizabeth Cretti Linda Dix-Cooper Sarah Dixon

continued on pg. 36

The CAMPAIGN for the SCHOOL OF PUBLIC HEALTH

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HONOR ROLL, continued Reema Elziq Denise Felix Emily Fireman Shahla Fisher Michele Fromowitz Amanda Gatewood Inna Gerlovina Christopher Golden Juan Gomez Maria Gonzalez Priscilla Gonzalez Christina Gutowski Thaddeus Haight Kamran Haikal Mary Hardy Kevelynn Hare Maureen Healy Katherine Hetnal Brian Hitt Patrick Hou Katherine Hung Somuadina Ikebudu Kanwar Jolly Alice Kang Paula Keebler Alexander Kelsey Angela Killilea Rachel Koontz Daniel Kwaro Jennifer Lachance Serene Lau Rena Lee Thomas Leong Danielle Lerer Sylvia Leung Jordan Levine Theresa Ly Daniel Madrigal Sarah Martin-Anderson Caroline Martinez Shaddai Martinez-Cuestas Marty Martinson Saam Morshed & Razani Nooshin Elana Neshkes Katherine Nishimura Viviana Ostrzega Susan Paulukonis Christina Penfi eld Lisa Peterson Stephen Rauch John Rendon Elizabeth Rockett Maria Ruiz Ruelas Swathi Sampangi Baljeet Sangha Kristine Serbonich Laura Smith Katherine Stearns Ashley Stegall Megan Swanson Ryan Therrian Jennifer Tillett Nayabei Vanwoerkom Wendy Verret Adam Visconti Karen Weidert Sabrina Wickremasinghe Thomas Williams 36

Maria-Elena Young Courtney Zecher Yun Zhang Karen Zukor

IN H O N OR O F Pamela Alston by Paulette Arbuckle Erma Anderson by Ramona Anderson Sandeep Bhaurla by Balwant & Kulwinder Bhaurla Joan Bloom by Daniel Gentry Lester Breslow by Henry Anderson Robert & Meg Beck Eleanor Langpaap Ray Catalano by William & Enid Satariano Chin Long Chiang by Margaret Deane Diane Driver and the Senior Resource Newsletter by Amy & George Gorman Constance Frazer by Donald Brecker & Ann Darling Familia Gonzalez by Maria Gonzalez Maya Grace by Abiose Lasaki The Huynh Family by Liem Huynh Elaine Lam by Amy & George Gorman Joyce Lashof by Shirley Roach Anna Lee Lawler by Amanda Gatewood Lydia Librodo by Jacqueline Barin Neesha Mody by Nila & Chuck Mody Jean Morton by Shirley Roach Kyra & Jason Naumoff-Shields by Justin Remais & Elena Conis Eunice Pak by Young & Hyeon Pak Malcolm Potts by Bruce Steir & Yen Aeschliman Richard Scheffler by Daniel Gentry Stephen Shortell by Loyal & Joyce Griffin Elena Shpall by Richard & Ronna Shpall Esmond Smith by Kazuyoshi & Tokiko Ide James Smyth by Rona & Robert Henry Robert Spear by Michael & Sandra Fischman David Starkweather by Pamela Berven

Healthier Lives in a Safer World

Fall / W inter 2010

SCHOOL OF PUBLIC HEALTH POLICY ADVISORY COUNCIL 2010–2011 Kenneth S. Taymor, J.D., Chair Executive Director Berkeley Center for Law, Business, and the Economy UC Berkeley School of Law

Anthony B. Iton,M.D., J.D., M.P.H. ‘97 Senior Vice President, Healthy Communities The California Endowment

Raymond J. Baxter, Ph.D. National Senior Vice President, Community Benefi t Kaiser Foundation Health Plan and Hospitals

Kenneth Kizer, M.D., M.P.H. Chairman of the Board Medsphere Systems Corporation

Teresa S. Carlson, M.P.H. ‘84 Health Care Management Consultant (retired) Margaret Cary, M.D., M.B.A., M.P.H. Director, Physician Leadership Development Director, Clinical Field Program Development and Support Medical-Surgical Services Veteran’s Health Administration Linda Hawes Clever, M.D., M.A.C.P. Chief, Occupational Health California Pacifi c Medical Center Founder, RENEW Deborah Freund, Ph.D., M.P.H. Distinguished Professor of Public Administration Center for Policy Research Senior Research Associate Syracuse University

Ruth Stimson by Dava Freed Leland & Kristine Peterson S. Leonard Syme by Deborah Edelman Donald & Louise Heyneman Samuel Lind Linda Neuhauser & Craig Buxton Constantine & Nancy Tempelis Marilyn Winkleby & Michael Fischetti William Tschetter by Abiose Lasaki Helen Wallace by Claude Brown Hubert & Jean Green Dokiso Nchama

Paul Klingenstein Managing Partner Aberdare Ventures Lauren LeRoy, Ph.D. President and CEO Grantmakers in Health

J. Leighton Read, M.D. General Partner Alloy Ventures Beth Roemer, M.P.H. ‘76 Interim President, Public Health Alumni Association Senior Director Institute for Health Policy, Kaiser Permanente Steven A. Schroeder, M.D. Distinguished Professor of Health and Health Care UCSF Department of Medicine

Richard M. Levy, Ph.D. Chairman of the Board Varian Medical Systems, Inc.

Sandra Shewry, M.S.W., M.P.H. ‘81 President and CEO Center for Connected Health Policy

William E. Moeller, M.B.A. Operating Partner Linden LLC

L. James Strand, M.D., M.B.A. General Partner Institutional Venture Partners

Dean Ornish, M.D. Founder and President Preventive Medicine Research Institute

Barbara S. Terrazas, M.P.H. ‘76 Director, Planning, Development and Policy Tiburcio Vasquez Health Center, Inc.

Mary Pittman, Dr.P.H. ‘87 President & CEO Public Health Institute

Arnold Zeiderman, M.D., M.P.H. ‘75 Board-certifi ed OB-GYN

Lisa Stone Pritzker Advocate and Activist for Child, Adolescent, and Women’s Health

Warren Winkelstein by Deborah Edelman Sheryl Magzamen Thomas Piazza & Mary Crosby Rebecca Yau by John & Roxana Yau

IN MEM ORY O F Marjorie Abramovitz by Marshall Goldberg Janet Adelman by Karen Cohn Sally Bellows by John & Ruth Bellows Hellmut Meister

Henrik Blum by Richard Bailey Bernard Cordes David Crouch James & Maureen Lubben Jean Nudelman & Richard Bock Mary Pittman-Lindeman & David Lindeman Sandra Shewry Lavern Borg by Jane Borg Hilda Haus Boyd by Maurine Lightwood Don Cahalan by Lee Kaskutas

Marie Cassiday by Ruth McHenry-Coe Al Childs by Eunice Childs Lloyd Churgin by Shoshanna Sofaer Marguerite de la Vega Linsley by Edwin Linsley Susan Kersch DeYoung by Margaret Bradford Aumann Ramon Feliciano by Marian McDonald Georgianna Flaherty by Eileen & James Vohs Donald Gentner by Judith Stewart William Griffi ths by George & Eleanor Cernada Sidney & Sally Saltzstein Riad Hamad by Rita Hamad Dana Hansen by Barbara Hansen Marie Hatherel by Debra DeZarn Tom Haywood by Tommie Pippins David Holaday by Margaret Straub Ruth Huenemann by Jean Hankin Frances Hoffman Arlene Kasa Mary & Kenneth Tuckwell

Alex Irani by Denise Felix Doreen and Leonard Kotula by Kathryn Kotula Connie Long by Lynn Levin & Stanley Oshinsky Shirley Roach Linda Wardlaw Nahid Mahani by Alfred Clancy Jun Makashima by Irene & Marsh Tekawa Walter Mangold by Lawrence & Constance Cowper Orville & Helen Deniston Jonathan Mann by Patrick Moore Sheldon Margen by Linda Neuhauser & Craig Buxton Edward & Linda Wei Stephen McFall Barr by Lynn Barr Don Minkler by Sylvia Guendelman Nelden & Victoria Hagbom Donald & Louise Heyneman Marisa Hildebrand Meredith Minkler & Jerry Peters Dokiso Nchama Allyson Rickard Gopal & Andrea Sankaran

Ruth Musker by Marilyn Silva & Warren Musker Kim Nguyen by Marilyn Silva & Warren Musker G. Nicholas Parlette by Therese Pipe Robert Poon by Vera Poon Phoebe Prince by J. Michael Mahoney William Reeves by Constantine & Nancy Tempelis Shirley Roach by Patricia & Richard Buffl er Connie Gee Patricia & Harold Hosel Carol Langhauser Joyce Lashof Paul & Barbara Licht C. Jean Morton Richard Roach Betty Seabolt Richard Stephens & Sherrill Cook Beverly Tibbles Beryl Roberts by Elaine Base S. Roney by George & Linda Sensabaugh Ali Safaeinili by Lisa Safaeinili Duane Sewell by Jim Chheng

Roberta O’Grady (left) and Professor Joan Bloom at a reception for members of the School of Public Health’s Dean’s Circle Leona Shapiro by Marlene Dehn Margot Smith Jeanette Spangle Mary Traylor Charles E. Smith by Robert & Martha Harrell Shirley Roach Sandra Lurie Stein by Shoshanna Sofaer Gary Stewart by Sylvia Guendelman William Taylor by Judith Taylor

Jean Todd by Lynda Bradford Harold Van Coops by Marguerite Van Coops Virginia Lozano Vásquez by Kallista Bley Russell Watson by Christina Watson Christina Marie Williams by J. Michael Mahoney Sara Mae Zemon by Marshall Zemon

continued on pg. 38

Your bequest will help make the

world a healthier place You can help educate tomorrow’s public health leaders, recruit and retain world class faculty, advance scholarly inquiry through research and programs, build a new, state-of-the-art home for the School of Public Health, or provide funds for the Dean’s use in meeting changing needs. Whichever you choose, you will help to preserve and enhance the School of Public Health’s excellence— and allow it to keep making the world a healthier place. For more information on including the School of Public Health in your will or living trust, contact the Office of Gift Planning at (800) 200-0575 or ogp@berkeley.edu, or visit givetocal.berkeley.edu/giftplanning.

Healthier Lives in a Safer World The CAMPAIGN for the SCHOOL OF PUBLIC HEALTH UNIVERSITY OF CALIFORNIA, BERKELEY The CAMPAIGN for the SCHOOL OF PUBLIC HEALTH

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GIFTS IN KIND

HONOR ROLL, continued ORG A NIZATIO NS Executive Circle ($100,000 and above) California HealthCare Foundation The California Wellness Foundation Children with Leukaemia Consejo Nacional De Ciencia Techologia Consulado de Mexico Bill & Melinda Gates Foundation Genentech, Inc. George Washington University Gilead Sciences Johnson & Johnson Robert Wood Johnson Foundation Kaiser Permanente UBS Optimus Foundation Director’s Circle ($50,000 to $99,999) British United Provident Association GlaxoSmithKline The Safeway Foundation University of Texas - El Paso Leaders ($25,000 to $49,999) California Pacifi c Medical Center International Epidemiological Association Max Factor Family Foundation Kaiser Foundation Health Plan University of Minnesota World Health Organization

Benefactors ($10,000 to $24,999) Boehringer Ingelheim The California Endowment Council for Education & Research on Toxics Marshfi eld Clinic Patrons ($5,000 to $9,999) Burness Communications, Inc. The James Irvine Foundation Lymphoma Coalition Pharmasett, Inc. Sanofi-Aventis Western Union Foundation Advocates ($1,000 to $4,999) Gordon & Betty Moore Foundation National City Corporation Thornton & Naumes LLP UC Chinese Alumni Foundation Partners ($500 to $999) Global Health Access Program Friends ($250 to $499) Alegria Inn & Cottages Boston Law Offi ce DoubleTree Hotels Life Technologies Corporation

Benjamin Ide Wheeler Society Recognizing donors who have expressed their intention to include the School of Public Health in their estate plans Simone Adams Paul Boumbulian Doris Brusasco Patricia & Richard Buffl er Eunice Childs Nilda Chong Paul & Susan Conforti Viola Egli Robert Frangenberg & Ingrid Lamivault Marcia & Sergio Gerin Kenneth & Marjorie Kaiser A. Arlene Kasa Jogi & Tejbir Khanna

Joan Lam Carol Langhauser Eleanor Langpaap Roberta O’Grady Pamela Peeke Therese Pipe Robert Porter Harper & Leonisa Puziss Ronald & Genevieve Roberto Stephen Schultz & Mary Pacey Rosalind Singer Helen Thorall Barbara Whelan

Estates gifts received from July 1, 2009, to June 30, 2010 The Estate of Wallace Lowe The Estate of William Sherman

Berkeley Health Fall / W inter 2010

Carl Lester, M.P.H. ’65, and Sally Presser, M.P.H. ’74, at a reception for members of the School of Public Health’s Dean’s Circle Supporters ($150 to $249) Aztec Realty, Inc. Blue Shield of California Cancun Taqueria La Clínica de la Raza Novartis US Foundation PhoebesLaw.Com Rose Garden Inn Samuels & Associates Contributors ($1 to $149) Acme Bread Company Bobby G’s Pizzeria Casa Orinda César Dona Tomas Restaurant Garibaldi’s Restaurant Grand Lake Theater Hot Cups Gourmet Cafe Lala & Reyes LLC Lindsay Wildlife Museum Peet’s Coffee & Tea, Inc. Venezia

M ATCHING GIFTS Alta Bates Health System Anshen & Allen Architects, Inc. Applied Biosystems AstraZeneca Pharmaceuticals LLP Stacey Baba & James Vokac Foundation Barclays Bank Foundation BASF Corporation Beauregard Family Foundation Blue Shield of California Foundation Boeing Company Bristol-Myers Squibb Foundation California HealthCare Foundation Chevron Corporation CIGNA Foundation

East Bay Community Foundation East Bay Jewish Community Foundation Fidelity Charitable Gift Fund FMC Foundation Genentech, Inc. Google Foundation Law Offi ces of Gloria D. Haney IBM Corporation The James Irvine Foundation Jewish Community Federation of SF Robert Wood Johnson Foundation Juniper Networks, Inc. The Henry J. Kaiser Family Foundation Kaiser Foundation Health Plan W. K. Kellogg Foundation KPMG Foundation Lockheed Martin Dextra Baldwin McGonagle Foundation The McKesson Foundation The Medtronic Foundation Merck Company Foundation New York Life Foundation Nova Fisheries, Inc. The Oregon Community Foundation Pacifi c Gas & Electric Company The Pew Charitable Trusts Foundation Premier The San Francisco Foundation Schwab Charitable Fund Shortell Trust Silicon Valley Community Foundation Sutter Health Care Telecare The United Way of the Bay Area Wells Fargo Foundation The Westly Foundation Wyeth

Acme Bread Company Alegria Inn & Cottages Lucinda & Ronald Bazile P. Robert Beatty Harvey & Bonnie Bichkoff Bissap Baobab Restaurant Bobby G’s Pizzeria Julie Brown Patricia & Richard Buffl er Sally Bullock Café Rouge Cancun Taqueria Casa Orinda César Children’s Discovery Museum Constance Chiulli Dona Tomas Restaurant DoubleTree Hotels East Bay Nursery Rosa Fernandez Michael & Sandra Fischman Jonathan Frisch Fuji Restaurant Garibaldi’s Restaurant Grand Lake Theater David Harrington Hot Cups Gourmet Cafe Donna Howard La Note Melinda Lassman Lindsay Wildlife Museum Leslie Louie & David Bowen Andrea Menghetti Designs Mitama Restaurant Eileen & Mark Pearl Peet’s Coffee & Tea, Inc. Edward & Camille Penhoet Lisa & John Pritzker Beth Roemer Rose Garden Inn Janet Schilling See’s Candies Jeffrey & Edna Shipley Stephen & Susan Shortell Krikor & Caline Soghikian Bruce Steir & Yen Aeschliman Jim Strand Nancy Thomson John Troidl Venezia Jenny Wang R. Berna Watson Whole Foods Leslie Yee-Murata Zza’s Trattoria

Every effort has been made to provide a complete and accurate listing of individual donors and their gifts to the School of Public Health from July 1, 2009 to June 30, 2010. Should you discover a mistake or omission, please accept our apologies and contact us at (510) 642-2299 or trini@berkeley.edu so that we can correct our records.

Around the School

Kudos Buffler appointed to CDC health statistics board

Trailblazers honored at APHA event

Patricia A. Buffler, dean emerita and professor of epidemiology, was appointed in April to the Board of Scientifi c Counselors, National Center for Health Statistics (NCHS) of the CDC. The nation’s principal health statistics agency, NCHS compiles statistical information to guide actions and policies to improve the health of the American people.

Four individuals from the School received special recognition at the 138th Annual Meeting and Exposition of the American Public Health Association (APHA), held Nov. 6-10 in Denver.

Berkeley Citation awarded to health policy expert Rundall Professor Thomas Rundall, a dedicated member of the School of Public Health’s faculty for the past 30 years and the School’s executive associate dean from 2007 through June 2010, received the Berkeley Citation for his “distinguished achievement and notable service to the University.” In a nominating letter, Dean Stephen Shortell praised Rundall’s contributions to the fi eld of health services management and health policy, his dedication to teaching students and his extraordinary service in administrative roles at the School.

Hu takes mental health services research prize APHA’s Mental Health Section awarded Professor Emeritus Teh-wei Hu the Carl Taube Lectureship, which recognizes a person who has made significant contributions in the fi eld of mental health services research. Hu’s research in mental health services focuses on cost, cost-effectiveness, and financing. As part of the award, Hu presented a lecture, “Costs, Outcomes, and Financing of Community Mental Health Services: from California to Colorado.”

Ojeda acknowledged for contributions to Latino community health Gilbert Ojeda, director of the California Program on Access to Care at the UC Berkeley School of Public Health, received the 2010 Distinguished Nationally Known Health Professional Award from APHA’s Latino Caucus. Presented at the caucus’s annual awards dinner, the award recognizes “an individual whose outstanding accomplishments and tangible contributions have made an impact on access to health services and/or improved care practices of Latino communities nationwide.” Ojeda was selected based on his “superior commitment and contribution toward improving the health of the Latino community.”

Syme honored for pioneering the field of social determinants of health APHA’s Epidemiology Section awarded Professor Emeritus S. Leonard Syme the Wade Hampton Frost Lectureship, which recognizes a person who has made a significant contribution to addressing a public health issue of major importance by applying epidemiologic methods. Syme was selected for “opening a new field of research dealing with the social determinants of disease and for training a new generation of scholars who are now working on this issue.” He presented a lecture titled “Causal Models in Epidemiology: The Need for Some New Thinking.”

Morello-Frosch receives accolades for environmental work

Thomas Rundall and his wife, Jane Tiemann

Associate Professor Rachel Morello-Frosch received the Damu Smith Environmental Achievement Award from APHA’s Environment Section. The award recognizes crosscutting collaborative work that has enhanced or increased understanding of economic security, ecological conservation, culture, or health. Morello-Frosch was chosen for her scientifi c contributions to the fi eld of environmental health and her work in community-engaged research related to environmental justice.

Barcellos appointed to NIH study section

Rappaport receives exposure science award

Associate Professor of Epidemiology Lisa Barcellos was appointed to the Genetics of Health Disease Study Section at NIH. The study section reviews grant applications involving the discovery, application, and interpretation of genetic and genomic variation in human phenotype and disease.

Stephen M. Rappaport, professor-in-residence in the Division of Environmental Health Sciences, received the 2010 Jerome J. Wesolowski award at the Joint Conference of the International Society of Exposure Science (ISES) and the International Society for Environmental Epidemiology in Seoul, Korea, in August.

ISES presents the award annually to recognize sustained and outstanding contributions to the knowledge and practice of human exposure assessment. Rappaport is the third member of the Berkeley faculty in Environmental Health Sciences to receive this prestigious award, following Professor Kirk Smith (1999) and Adjunct Professor Thomas McKone (2008). continued on pg. 40 Berkeley Health Fall / W inter 2010

Around the School

Kudos,

continued

Castañeda honored for commitment to California’s Latino community Xóchitl Castañeda, program director of the School’s Health Initiative of the Americas, received a Spirit Award from the California Latino Legislative Caucus for “Achievement in Health and Academics.” The Spirit Awards recognize individuals who exemplify the spirit of the Latino community and who have furthered

the understanding and acceptance of Latino values, culture, and traditions through leadership and service.

Oxendine honored as Champion of Health Professions Diversity Jeff Oxendine, associate dean for public health practice, was named a 2010 Champion of Health Professions Diversity by The California Wellness Foundation for his

extraordinary leadership in higher education. As head of the School’s Center for Public Health Practice, Oxendine places more than 125 interns each year in health departments, community-based organizations, health care systems, and other public health organizations. He founded the School’s Center for Multicultural Health and Center for Health Leadership. He is also cofounder and president of Health Career Connection, a nonprofi t that has empowered more than 900 undergraduate students to discover and pursue health careers.

Research Highlights Survey shows many child care centers have pests and use pesticides Ninety percent of California child care centers that responded to a survey on pest problems and pesticide use reported at least one indoor or outdoor pest problem, according to a report released by the Department of Pesticide Regulation (DPR). Ants were cited as the number-one problem both inside and outside the facilities. A total of 637 licensed child care centers responded to the survey conducted for DPR by the School of Public Health’s Center for Children’s Environmental Health Research. The center’s associate director, Asa Bradman, Ph.D. ’97, was lead author.

Cash rewards and counseling could help prevent STIs in rural Africa Giving out cash can be an effective tool in combating sexually transmitted infections in rural Africa, according to a study conducted jointly by researchers at UC Berkeley, the Development Research Group at the World Bank, and the Ifakara Health Institute in Tanzania.

Berkeley Health Fall / W inter 2010

The study found that people who were offered up to $60 each over 12 months to stay free of STIs had a 25 percent lower prevalence of those infections after a year compared to those who were not eligible for the money. William H. Dow, Henry J. Kaiser Professor of Health Economics, coauthored the study, which was presented July 18 at the International AIDS Conference in Vienna, Austria.

Father absence linked to earlier puberty among certain girls Girls in homes without a biological father are more likely to hit puberty at an earlier age, according to a new study led by Julianna Deardorff, assistant professor of maternal and child health. The findings, published Sept. 17

in the Journal of Adolescent Health, found that the absence of a biologically related father in the home predicted earlier breast and pubic hair development, but only for girls in higher income households. The findings held even after the girls’ weight was taken into account.

Prenatal pesticide exposure linked to attention problems in preschool-aged children Children who were exposed to organophosphate pesticides while still in their mother’s womb were more likely to develop attention disorders years later, according to a new study. The findings, published Aug. 19 in the journal Environmental Health Perspectives, are the first to examine the influence of prenatal organophosphate exposure on the later development of attention problems. The researchers found that prenatal levels of organophosphate metabolites were significantly linked to attention problems at age 5, with the effects apparently stronger among boys. Amy Marks, M.P.H. ‘02, was the study’s lead author; Brenda Eskenazi, professor of epidemiology and of maternal and child health, was the principal investigator.

Around the School

News and Notes For more news, visit the School’s web site at sph.berkeley.edu and click on “News.”

Annual day of volunteerism kicks off academic year More than 85 incoming public health graduate students spent the afternoon of August 24—a day of record-breaking heat in the Bay Area—performing public service at nonprofi t organizations throughout Berkeley as part of the 6th annual UC Berkeley School of Public Health Volunteer Mobilization Day. The event was sponsored by the School and the Berkeley Mayor’s Office.

Pictured: Incoming students Irene Headen (left) and Jennifer Wang prepare a meal for residents and volunteers at the Berkeley Food and Housing Project Russell Street Residence, an adult residential facility for mental health clients.

International scholars visit Berkeley for summer HIV/AIDS training This past summer, the School’s Division of Epidemiology hosted 18 public health professionals from Cote d’Ivoire and Vietnam for a scholar exchange program sponsored by the U.S. President’s Emergency Plan for AIDS Relief (also known as PEPFAR). The training focuses on building capacity in epidemiology and biostatistics to cultivate public health specialists engaged in the implementation and evaluation of public health programs related to HIV care, treatment and prevention. Activities included six weeks of coursework in epidemiology and biostatistics, plus several site visits and a special presentation by State Department of Public Health staff on monitoring and evaluation.

New affiliation to advance HIV research and policy agenda The Forum for Collaborative HIV Research—a public/private partnership representing government, industry, patient advocates, health care providers, foundations, and academia—has affiliated with the UC Berkeley School of Public Health and has set up new facilities at the UC campus in Washington, D.C. Founded in 1997, the Forum organizes roundtables and reports on a range of global HIV/AIDS issues, including treatment-related toxicities, immune-based therapies, health services research, co-infections, prevention, and the transference of research results into care. While it will not change its mission, this new affiliation allows the Forum to take advantage of existing partnerships with faculty and researchers at the UC Berkeley School of Public Health to frame the issues and help set the research strategy in HIV/AIDS, co-infection, and advancing universal HIV testing.

Demolition clears the way for a future home for the School

The School of Public Health is raising funds to build a new home, envisioned as the centerpiece of a proposed Community Health Campus on western side of the block bounded by Shattuck Avenue, Oxford Street, Hearst Avenue, and Berkeley Way. The building that formerly stood on the site—once home to the State Department of Health Services—was recently demolished. Another project, the Helios Energy Research facility, is currently under construction on the eastern side of that block. Berkeley Health Fall / W inter 2010

Alumni Notes

Alumni Notes Public Health Alumni Association Board of Directors 2010–2011 Beth Roemer, M.P.H. ’76 (Interim President) Melinda Lassman, M.A. ’75, M.S. ’77 (Vice President) Lucinda Brannon Bazile, M.P.H. ’94 (Secretary-Treasurer) John J. Troidl, Ph.D., ’01, M.B.A. (Past President) Shahram Ahari, M.P.H. ’05 Myrna Cozen, M.P.H. ’89 Rosa Vivian Fernandez, M.P.H. ’91 Michael Fischman, M.D., M.P.H. ’82 Jonathan Frisch, Ph.D. ’90, M.P.H. ’87 Mariah Lafl eur, M.P.H. ’09 Timothy Sankary, M.D., M.P.H. ’80 Jan Schilling, M.P.H. ’91 Erika Schwilk, M.D., M.P.H. ’09 Maxine Tatmon-Gilkerson, M.P.H. ’91 Rob Tufel, M.S.W., M.P.H. ’90 R. Berna Atik Watson, M.D., M.P.H. ’99

1950s Melvin H. Kirschner, M.D., M.P.H. ’55 “I’m now a retired family physician, but I’m still in demand as a biomedical ethicist and active at two hospitals and several groups, such as the Southern California Consortium on Biomedical Ethics. I’ve recently published a book, All Medicines Are Poison! It overviews my 60 years in public health and medical practice arenas and the many problems of health care in the United States. I suggest some solutions. It’s not Obama care.”

Berkeley Health Fall / W inter 2010

1970s Marsha Epstein, M.D., M.P.H. ’71, retired from Los Angeles County Department of Public Health this year. She will continue to give CME to health professionals on “Helping our Patients Successfully Stop Smoking” and will be starting some research projects with the Department of Public Health. L. Martin (Marty) Griffi n, M.D., M.P.H. ’72, was honored on the occasion of his 90th birthday at Audubon Canyon Ranch in Bolinas, Calif. Griffin, who received the UC Berkeley Public Health Heroes award in 1999, has been a key figure in preserving open space in West Marin County. While practicing medicine in Marin County after World War II, he began to recognize that the destruction of the tidelands, bays, and coastal rivers posed a serious threat to the physical and emotional health of his patients. Motivated by this knowledge, he led the effort to create the Audubon Canyon Ranch preserve and wildlife sanctuaries on Bolinas Lagoon, Tomales Bay, and Highway 1, which helped guarantee the creation of the Point Reyes National Seashore. The 1,000-acre Bolinas Lagoon Preserve, run by Audubon Canyon Ranch, was renamed the Martin Griffin Preserve in his honor. Darwin R. Labarthe, M.D., Ph.D. ’74, M.P.H. ’67, has authored a new book, Epidemiology and Prevention of Cardiovascular Diseases: A Global Challenge (2nd edition), published by Jones & Bartlett Learning. The book describes the nature of atherosclerotic and hypertensive diseases, including determinants, prevention, and control, as well as policies for intervention. Labarthe is director of the Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion. He is a former faculty member of the University of Texas School of Public Health.

Goldman named dean of The George Washington University School of Public Health and Health Services In May, the George Washington University announced the selection of

Lynn R. Goldman, M.D., M.P.H., M.S. ’79, as dean of its School of Public Health and Health Services. A pediatrician and epidemiologist, Goldman is a graduate of the UC Berkeley-UCSF Joint Medical Program. She most recently served as a professor of environmental health sciences at the Johns Hopkins University Bloomberg School of Public Health, principal investigator for the Johns Hopkins National Children’s Study Center, and dual principal investigator for the National Center of Excellence for the Study of Preparedness and Catastrophic Event Response. In addition, Goldman recently received the prestigious Heinz award for her powerful role in advancing policies and public understanding of toxic chemicals. She has made a remarkable impact in strengthening the Food Quality Protection Act (FQPA) and expanding citizens’ “right to know ” about pollution in their community. The Heinz Awards annually honor the late U.S. Senator John Heinz’s long-standing commitment to the environment.

Alumni Notes

1980s Margaret McLane de Jovel, M.P.H. ’82 “Recently received a ‘tent call’ (a.k.a. house call), from a doctor in Florence, Italy, while traveling there. We stayed in ‘Camping Florence’ for two days while seeing the arts. My daughter had Salmonella or Shigella . I was impressed by the doctor. He has been doing this ‘specialty’— tourist medicine—for about 20 years. Skilled in the art of medicine—of listening, watching, observing. Very nice to experience, as I work in the high tech, procedure burdened, overutilization world of California hospitals.” Elaine Moquette Magee, M.P.H. ’85, R.D. “My latest book—Tell Me What to Eat if I Suffer from Heart Disease—is now available! It’s part of my medical nutrition series, which includes Tell Me What to Eat if I Have Diabetes, Tell Me What to Eat if I Have Acid Reflux, and Tell Me What to Eat if I Have Irritable Bowel Syndrome. ” Vivian Lin, Dr.P.H. ’86, M.P.H. ’79, is professor of public health at La Trobe University, Melbourne (and was head of school from 2000 to 2005), after 17 years in senior positions in various Australian governments. She is currently vice president for scientific affairs for the International Union for Health Promotion and Education and advisory editor for health policy for Social Science and Medicine . Lin has been inaugural president of the Chinese Medicine Registration Board in Victoria for nine years, convener of the Australian Network of Academic Public Health Institutions, board member of the Cooperative Research Centre on Aboriginal Health, member of the public health committee of the Australia Medical Association, and a member of the AustraliaChina Council. She is a long-standing consultant for the World Bank in China and for the Western Pacifi c Region of the WHO. She has published books on health planning, public health practice, and evidence-based health policy in Australia.

1990s Claudia Colindres Johnson, M.P.P., M.P.H. ’92 “My project, Lawhelp Interactive, just received a coveted award from the College of Law Practice Management. It is in recognition of the work of the past three years, for using technology to improve access to justice for thousands of people.” Paul Hofmann, Dr.P.H. ‘94, M.P.H. ’65, B.S. ’63, received the Award of Honor from the American Hospital Association (AHA) at a ceremony in April. Hofmann is president of Hofmann Healthcare Group in Moraga, Calif. The award recognizes his exemplary contributions to people’s health and well-being through leadership on major health policies and social initiatives. With more than 40 years in health care, Hofmann has played a central role in shaping the fi eld’s understanding of ethics. He has been an active participant in AHA’s biomedical policy development and governance, with a strategic leadership role in creating AHA’s biomedical and institutional ethics policies. He is a fellow of the American

College of HealthCare Executives. Hofmann is also co-editor of Managing Healthcare Ethically: An Executive’s Guide, second edition (Health Administration Press, 2010). Bruce Kieler, Dr.P.H. ’94, M.P.H. ’88, presented a poster session at the 12th Biennial Conference of the International Society for the Study of Work and Organizational Values, held June 27–30, 2010, in Lisbon, Portugal. He reported on his research (funded by the Fulbright Senior Research Scholar Program) on community-based participation in health and safety planning in rural areas adjacent to Chennai, Tamil Nadu, India.

2000s Denise Brahan, M.D., M.P.H. ’00 “After finishing the M.P.H. Program in 2000, I went to the Boston Combined Residency Program in pediatrics and stayed on to do a two-year general pediatrics health services research fellowship at Boston Medical Center. There I expanded my interest and skill set around continued on page 44

Petitti honored as the School’s Alumna of the Year Diana Petitti, M.D., M.P.H. ’81, was recognized at the School of Public Health’s Commencement ceremony as the School’s 2010 Alumna of the Year. The award was presented to her by John J. Troidl, Ph.D. ‘01, president of the Public Health Alumni Association. A professor in the Department of Biomedical Informatics at Arizona State University since 2008, Petitti has worked with the Centers for Disease Control as a fi eld epidemiologist, 10 years as a member of the full-time faculty in the Department of Family and Community Medicine at UCSF, and 19 years as a researcher and then senior executive of the Kaiser Permanente Medical Program. She is widely regarded as one of the leading epidemiologic experts on hormones and disease and has infl uenced health policy in this area. Recently, she provided national leadership with the review of mammographic screening for the U.S. Preventive Services Task Force, an independent panel of experts in primary care and prevention that systematically reviews the evidence of effectiveness and develops recommendations for clinical preventive services.

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Alumni Notes

Alumni Notes,

continued

research and program planning in health care disparities, particularly for Asian and Pacifi c Islanders and subgroups. In 2005 I took a position at Kaiser Milpitas (Bay Area) in primary care that I have shaped and enjoy greatly. In my current role, I am the diversity lead for Santa Clara and its satellites, comprising over 600 providers. My other passion is using technology to improve both personal effi ciency, quality of care, and service. Finally, I run a Stanford fourth-year outpatient pediatrics rotation at Kaiser and precept students from the core pediatric rotation. But my most

important role has been at home. We have grown our family from two to six since the M.P.H. program, and Kathleen (9), Timothy (7), Ryan (5), and Natalie (2½) are our greatest joy.” Juliet Melzer, M.D., M.P.H. ’00, was a transplant surgeon at UCSF when she entered the Interdisciplinary M.P.H. Program. “I had long wanted to work abroad,” she writes, “but found myself so involved I my practice that I ‘couldn’t possibly leave.’“ After graduating from Berkeley, she earned a diploma in tropical medicine at the London School of Hygiene and

Tropical Medicine, and then went to work with Médecins Sans Frontières (MSF)—Doctors Without Borders. Her projects with MSF have included work on drug-resistant TB in Abkhasia, Thailand, Kenya, and Georgia, and general medicine in Liberia and Darfur. Following those missions she worked as a health adviser in MSF’s Toronto headquarters before returning to the United States and working for MSF remotely. “I feel privileged to have been in the Interdisciplinary M.P.H. Program, which has helped give me the skills I’ve needed to keep moving toward new challenges.”

Alumni and friends gathered for “Swing into Spring, ” a silent auction and raffl e held by the Public Health Alumni Association (PHA A) in May. Proceeds from the event supported the annual PHA A scholarship.

Erin Dugan, M.P.H. ’02, is a consultant for Policy Studies Inc., in Cambridge, Mass. She works from her home in Providence, R.I., and primarily does health communications consulting for programs at the Rhode Island Department of Health.

Top Left: Former PHAA board president Leslie Louie, Ph.D. ‘90, M.P.H. ‘85 (center), bids on an item while her daughter Carlee Bowen (right) and event committee chair Karen Shore, Ph.D. ‘98, look on. Top Right: Guest speaker Barbara Staggers, M.D., M.P.H. ‘80 (left), director of adolescent medicine at Children’s Hospital & Research Center Oakland, joins PHAA board Lucinda Brannon Bazile, M.P.H. ‘94. Below: The Skyline Jazz Band provided the evening’s entertainment.

Sandra Tsai, M.D., M.P.H. ’03, just completed a three-year research fellowship at the Stanford Prevention Research Center in which she examined how socioeconomic status and living environments affected nutrition and physical activity, and to what degree improving access to health care changed disease outcomes. In addition, she works in Stanford’s Preventive Cardiology Clinic once a week. Now that she is completing her fellowship, she writes, “I am planning to continue working with the Stanford non-communicable disease work group on global projects to improve the growing number of non-communicable diseases in the developing world. I’ll also continue my clinical work in the Preventive Cardiology Clinic and look for opportunities to work in disadvantaged communities.”

Alumni “Swing into Spring” at Silent Auction

Julie Stein, M.D., M.S. ’06, has been selected as UCSF Moffi tt Hospital chief resident for pediatrics for 2011–2012. Thomas Goetz, M.P.H. ’07, has published a book, The Decision Tree: Taking Control of Your Health in the New Era of Personalized Medicine (Rodale 2010). Combining his education at the UC School of Public Health with his 44

Berkeley Health Fall / W inter 2010

Alumni Notes

technology experience as executive editor of Wired magazine, he provides a framework in which consumers can make better choices for their health. His central organizing principle is a decision tree to map options and informational factors. The book is divided into three sections: prediction and prevention; diagnosis and detection; and care and treatment. He also maintains The Decision Tree Blog. Emily Hawkins Contois, M.P.H. ’09, is part of the Healthy Workforce team at Kaiser Permanente, which launched the first national employee wellness program for all Kaiser Permanente employees in April.

Have you seen the latest news? You can stay up to date on the latest School ne ws—including training opportunities, research fi ndings, and articles from the UC Berkeley Wellness Letter—by subscribing to SPH e-Ne ws, the monthly electronic bulletin for alumni and friends of the School of Public Health.

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In Memoriam

Lillian and Dudley Aldous

Dudley A ldous died May 30, 2010, at age 94. Originally from New Zealand, he left to serve with the RAF Bomber Command as a pilot during World War II. After the war he studied and worked in Canada, where he met and married his wife, Lillian Aldous, M.S., M.P.H. ‘68. In the early 1950s, they moved to San Jose, Calif., where Dudley worked at Kaiser Aluminum as a research chemist/engineer until his retirement. In 1981 they retired to Santa Cruz, Calif. Lillian, a public health nurse, died

in 2004. To honor her memory, Dudley funded the Lillian and Dudley Aldous Endowed Chair in Public Health at the UC Berkeley School of Public Health and an endowed chair in nursing at UCSF.

military career he received numerous citations; of special note was his role in the effort to combat Bolivian hemorrhagic fever. He is survived by his wife, Jane Wood Borg, four sons, seven grandchildren, and a great-grandson.

Col. Lavern Gerald “ Gerry ” Borg, B.S. ’52, died March 14, 2010, at his home in Sunset Beach, Calif., at age 84. Born in Dickson, N.D., he served in the U.S. Marine Corps, including the 5th Marine Division’s invasion of Iwo Jima. Following WWII he graduated from the UC Berkeley School of Public Health with a bachelor of science degree. After graduation he was commissioned in the U.S. Army Medical Service Corps, from which he eventually retired as a Lt. Colonel. Borg earned his M.P.H. at the University of Michigan and his M.H.A. at Baylor University. A fellow in the American Public Health Association, he published early research work on the use of gamma globulin in controlling infectious disease. Over the course of his

Karen Kirby, B.S. ’64, of Lafayette, Calif., died April 5, 2010 at age 67. Joseph W. Schurhammer died Sept. 13, 2010 in his home in Rochester, Minn., at age 94. He attended the UC Berkeley School of Public Health as an undergraduate and worked for the Civilian Conservation Corps at Isabella, Minn. Schurhammer then enlisted in the U.S. Navy, where he served 21 years, retiring as a lieutenant in 1956. Subsequently he sold insurance and worked for the Rochester Health Care Center in their maintenance department. He was preceded in death by his brother; he is survived by his wife, Cher Hager, as well as his sister-in-law, nephew, and cousins.

If you would like to make a donation in someone’s memory, please make your check payable to the “School of Public Health Fund” and include a note indicating the name of the person you are memorializing. You can make your gift online at givetocal.berkeley.edu/publichealth or mail it to the attention of Pat Hosel, Offi ce of External Relations and Development, UC Berkeley School of Public Health, 417 University Hall #7360, Berkeley, CA 94720-7360.

Berkeley Health Fall / W inter 2010

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SAVE THE DATE Wednesday, March 30, 2011 Yerba Buena Center for the Arts, San Francisco www.publichealthheroes.org

INTERNATIONAL HERO

Kenneth E. Behring For improving the lives of hundreds of thousands throughout the world by distributing wheelchairs and delivering clean drinking water

NATIONAL HERO

REGIONAL HERO

Marion Nestle

Dr. Washington Burns

For her national leadership in nutrition policy and her guidance in stemming serious nutritionally-based diseases, including obesity

For his tireless efforts to strengthen and revitalize the West Oakland community and enhance the lives of its residents

ORG ANIZATIONAL HERO

Building Opportunities for Self-Suffi ciency For its longstanding record of serving homeless individuals in Alameda County