Fall 2005 - For the Health of California - Public Health by UC Berkeley School of Public Health

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University of California, Berkeley

Public Health

For the Health of California

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Informing Consumers and Policy Makers

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The School Responds to Hurricane Katrina

Save the Date 10th Annual Public Health Heroes Awards Ceremony

Friday, March 17, 2006

For more information:

The Exploratorium, San Francisco

(510) 643-6382

http://www.publichealthheroes.org

2006 Honorees The annual tradition of honoring public health heroes was initiated in 1995 by the School of Public Healthâ&#x20AC;&#x2122;s Policy Advisory Council. This honor acknowledges individuals and organizations for their significant contributions and exceptional commitment to promoting and protecting the health of the human population, and through

International Hero:

National Hero:

Jeffrey Sachs, Ph.D., director of the Earth Institute at Columbia University, for his work on the United Nations Millennium Project, a multinational plan to halve global poverty and hunger by the year 2015.

Norman McSwain, M.D., chief of trauma surgery at Charity Hospital in New Orleans and professor at Tulane Medical School, on behalf of all the unsung heroes of the Hurricane Katrina disaster.

this public recognition, broadens awareness and understanding of the public health field.

Regional Hero:

Organizational Hero:

Robert Scott, M.D., for his service and delivery of care to communities of color in the East Bay, especially his work in HIV/AIDS treatment and advocacy.

The San Francisco Free Clinic, for its work providing health care services to uninsured patients who do not qualify for federal or state aid.

University of California, Berkeley

Public Health Features Building the Public Health Workforce

by Michael S. Broder

With California facing a critical shortage of public health workers now and in the future, the School of Public Health is cultivating the next generation of health professionals.

Improving Life for Children

by Kelly Mills

Asthma, obesity, violence, and child-unfriendly physical environments are among the threats to children’s health that the School is working to overcome.

Meeting the Needs of Older Californians

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by Michael S. Broder

A statewide network of senior leaders works to enhance the quality of life for California’s elders, while medical students learn how to provide quality care for older patients.

Serving California’s Diverse Population

by Kelly Mills

Researchers and students at the School develop strategies to convey health messages to different cultural groups and look for the causes of vast disparities in health status among California’s many racial and ethnic populations.

Informing Consumers and Policy Makers

by Vivian Auslander

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Faculty at the School of Public Health offer practical advice for consumers and reasoned analysis for policy makers on a range of health issues that impact the future of Californians.

Preparing for Disaster

by Kelly Mills

The UC Berkeley Center for Disease Preparedness prepares students and public health practitioners to respond to natural disasters, major disease epidemics, and acts of bioterrorism.

Departments Dean’s Message

Past, Present, Future

Faculty News

Partners in Public Health

Alumni News In Memoriam

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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 Vivian Auslander, Michael S. Broder, Kelly Mills, and Sarah Yang.

Editor Michael S. Broder

Photography Istockphoto, cover & p. 24; Getty Images, cover & p. 4; Peg Skorpinski, pp. 2, 13, 22–23, 25–26, 27–33 (head shots), 35, & 37; Kelly Mills, p. 6; Jupiter Images, p.7; courtesy of Oakland Kicks Asthma, p. 8; Patricia W. Hosel, p. 10; Pam Riby,

Associate Editor Kelly Mills

p. 12; Ellen Davidson, p. 15; Corbis, p. 17; Dale A. Ogar, p. 18; Michael S. Broder, p. 34; and Anita Smiley, back cover. Communications Advisory Board W. Thomas Boyce, Patricia A. Buffler, Margaret Cary, Helen A. Halpin, Meredith Minkler, Linda Neuhauser, Lee Riley, Stephen M. Shortell, Robert Spear, and S. Leonard Syme.

UC Berkeley Public Health is published semiannually in the spring and fall by the University

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of California, Berkeley, School of Public Health, for alumni and friends of the School. UC Berkeley School of Public Health Office of External Relations and Development 140 Earl Warren Hall #7360 Berkeley, CA 94720-7360 (510) 642-9572 © 2005, Regents of the University of California. Reproduction in whole or part requires written permission.

Public Health

From the Dean

Fulfilling the California Dream All the leaves are brown And the sky is gray I’ve been for a walk On a winter’s day If I didn’t tell her I could leave today California dreamin’ On such a winter’s day* These lyrics from the popular 1960s folk song “California Dreamin’” by the Mamas and the Papas evoke the aspirations of many Americans who moved to California over the past century. From the gold rush days of the 1850s to the growth of the entertainment industry in the 1950s to the Silicon Valley biotech and infotech innovations of the 1990s, California has been the both the beacon and the icon for “dreamers.” These people have not just wanted a better life for themselves but have been driven to create something new, different, and better for others as well. They represent the spirit of California. Our ability to realize our dreams depends in large part on our health. Our health is determined not only our individual biology and behavior, but also by our collective interactions with each other and with our environment. Public health is the only field that embraces this broad understanding of the determinants of health. “Root cause” public health addresses and promotes the conditions “….in which people can be healthy” (Institute of Medicine, 1988).

Leadership in the Face of Challenge Dean Stephen M. Shortell

“Forty-five percent of the state’s public health workforce is eligible to retire within the next five years —among the highest percent in the nation.”

As described in the pages that follow, the UC Berkeley School of Public Health continues to provide innovative leadership in addressing issues facing all Californians, from our preparedness for natural disasters, infectious disease, and bioterrorism, to the growing epidemic of obesity among children and adults, to working to eliminate the disparities in health that exist by race, ethnicity, and socioeconomic status. But the challenges we face are quite daunting. While on many health indicators California does reasonably well, we lag far behind in others. For example, we are twenty-fifth among all states in heart disease deaths per 100,000 population and thirty-first in limited activity days reported within the last 30 days. A high percentage of our population is without health insurance coverage. For example, 36 percent of Californians under the age of 65 were uninsured for at least part of the past two years, representing 11 million people. Reflecting disparities, more than half of California’s Hispanic population and 39 percent of Californian African Americans were without health insurance coverage for at least part of the past two years. On a scale of 1 to 10 in which 1 represents the least degree of preparedness and 10 the highest degree of preparedness for infectious disease or natural disaster, California had a score of 5 out of 10; actually a drop from 7 out of 10 in 2003 (Trust for America’s Health, 2005). On the obesity front, 22 percent of California adults are obese and 59 percent are overweight or obese—similar to the national average. Further, nearly 18 out of 100 low-income children ages 2 to 5 are overweight—the second worst rate in the country. We are not even able to produce the data for high school students.

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We could meet these problems with confidence if we had adequate numbers of trained public health professionals, up-to-date facilities, and modern communication and disease surveillance systems. But this is largely not the case. A recent report on the health professions developed by the UC Office of the President documented a serious shortage of trained public health professionals in California with only about 20 percent of currently practicing public health professionals having received any formal training—similar to national estimates. Further, 45 percent of the state’s public health workforce is eligible to retire within the next five years—among the highest percent in the nation. We do not even have enough scientists to test for anthrax or plague (Trust for America’s Health, 2005). To address these issues, the Office of the President report called for a minimal 25 percent increase in the training of public health graduates between 2005 and 2010 and an additional 25 percent increase between 2010 and 2015 with associated increases in faculty and facilities. The report also notes the woefully outmoded and inadequate facilities at both Berkeley and UCLA.

A History of “Firsts”

Speaking about the University at large, UC President Robert C. Dynes recently made the statement that “if the University of California becomes just another university, then California becomes just another state.” As the data above indicate, in many respects, California has already become just another state. Without concerted remedial attention, the threats to our health will slowly undermine the long term economic growth, productivity, and quality of life of all Californians, effectively killing the “California dream.”

• Completed the first sequencing of the chlamydia trachomatis genome;

To remedy the situation we must invest in our state’s schools of public health and other health professions; we must invest in the public health infrastructure throughout the state; we must find creative ways of insuring that all Californians have financial access to at least a basic set of health services; we must find ways of working with our schools and communities to promote healthy eating and physical activity; and, perhaps, most importantly of all, we must work to eliminate the growing disparities that exist in access to health services, the quality of health services received, and health status by ethnicity, race, and socioeconomic status. There are many encouraging signs. State government has recently taken the lead by sponsoring the Governor’s Summit on Obesity and signing legislation to set nutrition standards for foods served and sold in schools.

Over the past 63 years our School of Public Health at Berkeley—the first school of public health west of the Mississippi—has worked to create the conditions under which all Californians can live healthy, productive lives. Among many other contributions, the School: • Developed the first vaccine for coccidioidomycosis;

• Established the first longitudinal cohort study of low-income Latino families to track the relationship between the environment in an agricultural community (the Salinas Valley) and children’s health; • Identified the genetic factors that predispose people to multiple sclerosis, as well as lupus and rheumatoid arthritis; and • Pioneered the field of social epidemiology, identifying social and environmental factors associated with heart disease.

We have also enjoyed tremendous success in lowering the rate of smokers. Building on these successes, our state government leaders can work with the private sector to address other serious health issues facing the state. Creative public-private partnerships stimulated by the state’s innovative health foundations are also beginning to demonstrate positive effects. As the School of Public Health at the world’s leading public university, we look forward to working with all partners so that everyone in California can continue to enjoy the good health needed to pursue their dreams.

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

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Building the Public Health Workforce By Michael S Broder

California depends on public health professionals working in a broad spectrum of occupations that protect and promote human health—from safeguarding our air, food, and water, to managing the delivery of our health care, to preparing for disasters. The public health workforce comprises clinicians, environmental health specialists, nutritionists, health economists, hospital administrators, epidemiologists, biostatisticians, health educators, policy experts, and many others, working in both the public and private sectors.

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The state’s public health workforce is already insufficient to meet current needs, and, based on demographic trends, the demands are certain to increase. California’s population is growing faster than that of any other state in the nation, and the proportion of older adults is also increasing. According to the California Department of Aging, California comprised 12 percent of the nation’s population in 1990 and is expected to have 14 percent of the nation’s population by 2020 (an increase of 15.7 million people). The state’s elderly population is expected to grow more than twice as fast as the total population.

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“We have an aging population that’s going to demand more public health services going forward, and we have an aging public health workforce,” says Jeffrey Oxendine, M.B.A., M.P.H., associate dean for public health practice. “If we’re going to have leaders and professionals in the future who are going to be able to take care of us, we’re going to need to really focus on building the next generation of health care professionals.” At the same time, the population is becoming more culturally diverse; projections indicate that by 2025, Hispanic Americans will constitute the largest ethnic group in the state. More than ever, the public health workforce will require the skills of professionals from diverse backgrounds who are culturally competent. In addition, new public health challenges, such as the emergence of new diseases and disasters, and the persistence of existing challenges, such as chronic illnesses, will tax the public health infrastructure even further. To meet these challenges head-on, the School is cultivating future public health leaders who come to the workforce with practical experience. Master’s Students Gain Hands-on Experience

The School’s Center for Public Health Practice prepares master of public health (M.P.H.) students for the workforce by matching them with practical opportunities that make a difference in the community. The center places more than 100 students in internships each year, in health departments, community-based organizations, health care systems, and other public health organizations. Says Oxendine, “Our School has produced many of the leaders in public health in California, and we’re working on making sure that in addition to their strong, world-class academic training, they’re getting the best possible practical experience.”

“We have a particular focus on finding internship opportunities that contribute to health inequity—for example, working with cultural or linguistic competency issues to help organizations deliver quality programs and services that are sensitive to the cultural dynamics of their population.” The center also facilitates students’ entry into the public health workforce through professional development activities such as the popular “What Can You Do with a Public Health Degree?” series, a 15-session program which brings in leaders to address key issues and discuss how public health graduates can become involved. Individual sessions have focused on obesity, HIV/AIDS, substance abuse, and, in the fall of 2005, Hurricane Katrina. Another professional workshop series, PH291, presents modules on management, communications and advocacy; planning and strategy; and personal and project management. A Diverse Workforce for a Multicultural Population

“Our population is becoming more multicultural in California, as we know,” says Oxendine, “so it’s natural that we want and need more people from populations of color to meet our workforce needs, just looking at sheer numbers. At the same time, they will be more knowledgeable about how to design and deliver services to the populations they represent.” Through a series of collaborative programs, the center is exposing young people from underrepresented backgrounds to the professional opportunities afforded by public health professions. The Health Professions Partnership Initiative, led by the School’s Health Research for Action Center (formerly Center for Community Wellness), enhances opportunities for middle and high school students, while the FACES for the Future program at Children’s Hospital and

Research Center of Oakland provides a comprehensive high school program. Another initiative, Health Career Connection, provides exposure, experience, and mentoring to college students, including Berkeley public health undergraduates. All three programs share the goal of inspiring and attracting a diverse group of students into the health professions. Oxendine also estimates that at least one quarter of the center’s internship placements are in organizations or communities where the students focus on addressing health inequities. “We have a particular focus on finding internship opportunities that contribute to health inequity reduction—for example, working with cultural or linguistic competency issues to help organizations deliver quality programs and services that are sensitive to the cultural dynamics of their population.” Doctoral Program Develops Leaders

The School’s Dr.P.H. (doctor of public health) Leadership Program aims to create public health leaders by providing academic research skills and practical leadership training and experiences in the public health community. Students working toward their Dr.P.H. focus on the development of knowledge and skills in the areas of research, professional leadership, administration, and the application of state-of-the-art approaches to public health problems. Graduates are prepared to occupy positions in which they will have major influence on the policies, programs, and institutions of public health. Public Health

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Building the Public Health Workforce, continued workers in California, and created a compilation of resources and a web site to support health promotion programs in California. This year’s class, inspired by the lessons of Hurricane Katrina, is working on community readiness and disaster preparedness in Alameda County.

Collaboration with Communities Is Key

“The Dr.P.H. program in the School is unique in being a true interdisciplinary program and one that puts a heavy accent on collaboration with communities,” says Meredith Minkler, Dr.P.H., professor of health and social behavior and director of the Dr.P.H. program. Grants from the WK Kellogg Foundation and The California Endowment were instrumental in transforming the program and facilitating its emphasis on community partnerships and diversity. Both the School and the participating organizations benefit from the Dr.P.H. program’s community-academic partnerships. For example, all Dr.P.H. students undertake a summer residency in which they make tangible contributions to the local organization or community, and at the same time learn about communitybased public health leadership. A network of Dr.P.H. alumni and professionals who serve as community mentors helps foster this exchange. In addition to working on individual research dissertations, the students in each class participate in a year-long “Dr.P.H. in Action” seminar—now in its third year—in which they choose a project of major concern to a local heath department or a community-based

Solid Academic Program

In fall 2003, the School’s “Dr.P.H. in Action” class undertook a collective semester-long project to assist the City of Berkeley Public Health Division. Students worked with community partners to develop recommendations to address an impending syphilis outbreak.

organization or other entity to tackle collectively with their research and professional problem-solving skills. The first year, the class chose as its project an impending syphilis epidemic in Berkeley. “They met with health department people, community members, and other stakeholders, and came up with a white paper, from which some recommendations have subsequently been put into practice by the health department,” says Minkler. The second year, students worked with Promotoras, a network of lay health

Practical experience is one part of a student’s training at the School of Public Health; the School also offers a strong academic program. In addition to its professional degree programs—the M.P.H. and Dr.P.H. programs—the School offers academic degree programs leading to the master of arts (M.A.), master of science (M.S.), or doctor of philosophy (Ph.D.) degrees in several different areas of study. The School also offers joint degree options with other Berkeley departments and other institutions. “The intellectual resources of Berkeley enable us to pursue a truly interdisciplinary approach to public health,” says Dean Stephen Shortell, Ph.D., M.P.H.

“The School’s broad curriculum provides students with an understanding of epidemiology, biostatistics, environmental health, health behavior, health policy and management, and the means with which this knowledge can address pressing health problems locally, nationally, and internationally.”

“UC Berkeley students have made profound contributions to the programs and services that the public health department offers to Alameda County residents. The students’ diverse skill sets, interests, and personal backgrounds serve as invaluable tools as they address a wide range of critical health issues affecting the entire Bay Area.” —Arnold Perkins Director, Alameda County Department of Public Health

University of California, Berkeley

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Improving Life for Children By Kelly Mills

“Some people say children are our most important resource. Children are not this nation’s resource; they are not iron ore or agricultural land,” says Richard Jackson, M.D., M.P.H. ’79, adjunct professor in the School of Public Health. “Children have value intrinsic to the gift that they are, and not because they are our resource.” Jackson is one of many researchers at the School using innovative and proactive approaches towards protecting children’s health. Children are especially vulnerable to health threats, and the alarming rise in asthma, obesity, and other health problems makes it clear that California must take strong steps towards improving the health of our children. Healthy Lifestyles In the modern urban neighborhood, most children do not walk or bicycle to school. Many areas are bereft of parks or safe places for children to engage in physical activities. This contributes to a sedentary lifestyle and a rise in obesity. “We have engineered activity out of children’s lives,” explains Jackson, who

has devoted much of his career to identifying and addressing environmental factors that endanger the health of children. (See new faculty profile, page 32.) Jackson’s research focuses on the built environment, and how urban planning can affect the health of children. He notes that many

children live in environments that lack adequate sidewalks, bike paths, and police protection, which contributes to a lack of physical activity. Modern schools are built on less expensive land far from the neighborhoods they serve, which discourages children from walking to school. As part of his research and advocacy, Jackson works with city planners Public Health

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Improving Life for Children, continued and transportation authorities to develop neighborhood designs that enable children to walk, bicycle, and play outdoors.

Agricultural Toxins and Children Researchers for the Center for Health Assessment of Mothers and Children of Salinas (CHAMACOS) are also investigating the effects of environment on children’s health, specifically the impact of pesticides, toxins, and allergens on child development and respiratory disease, including asthma. The multifaceted project is the only longitudinal birth cohort study to focus on children in an agricultural area. The studies, which began in 1999 with 600 pregnant women in the Salinas area, have resulted in a number of advances for children’s health, including more efficient methods for measuring pesticide exposure and effects. The project has served as a model for the upcoming National Children’s Study, which aims to study 100,000 U.S. children from birth to age 20, to produce comprehensive data on the influence of the environment on children’s health. CHAMACOS has combined research on exposure and risk with pragmatic measures designed to reduce children’s contacts with harmful pesticides by working with their parents. For one study, investigators provided strawberry workers with coveralls and gloves, and gave them warm water to wash their hands. “We wanted to try and intervene at the field, to prevent farmworkers from taking pesticides into the home on their clothing and hands,” states Asa Bradman, Ph.D. ’97, associate director of CHAMACOS.

Combating Asthma Oakland Kicks Asthma takes a similarly aggressive approach towards combating asthma aggravation and complications in children. The program, led by principal investigator Ira Tager, M.D., M.P.H., professor of epidemiology, identifies children in Oakland middle and high schools with asthma, and then provides education and resources to school personnel, health care providers, families of the children 8

University of California, Berkeley

A participant in the Oakland Kicks Asthma program takes emergency asthma medication through a nebulizer, which converts the medication into a mist for more effective transmission to the lungs.

“Rather than waiting for children to come in for diagnosis and treatment, we go out to the schools and bring them services.” with asthma, and the children themselves. Oakland has the highest rate of hospitalizations due to asthma in the state, and one of the highest in the country. Screening children in schools enables researchers to identify students who have not received diagnosis or adequate treatment for the condition, or are otherwise not well-managed. Researchers also hired an asthma nurse for the Oakland schools, who passed one of the most comprehensive school asthma policies in the country, designed to institutionalize some aspects of the program and ensure continued treatment and resources for affected children. Many of the children in the program are from low-income and single-parent families, where the parent may not have the time to attend an asthma management education class at the local hospital. “This is a very proactive program,” says Adam Davis, M.P.H. ’99, M.A. ’01, of the American Lung Association of the East Bay, and director of the program. “Rather than waiting for children to come in for diagnosis and treatment, we go out to the schools and bring them services.”

Asthma educators make a series of visits to the homes of families of children with the condition, and offer services ranging from advocacy within the health care system and assistance obtaining health insurance to advice on how to make the home environment asthma-friendly.

High School Students Participate in Their Own Health Emily Ozer, Ph.D., assistant professor of community health and human development, works with adolescents in high schools to conduct research to identify the health problems that are the greatest concerns for the kids themselves, and then to develop action plans to address these issues. Last fall, teens who were enrolled in a peer resources class in a San Francisco school learned to design surveys and collect data on the health concerns of their peers. Students identified marijuana use as a major health concern, and program participants developed an action plan that included a Health Day Teach-In. “The event was quite inspiring for students and staff at the school because it was student-

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driven,” says Ozer. The principal of the school cited the teach-in as “the best day the school has ever had.” This academic year, Ozer is working with four additional high schools to further develop the model. The peer resources class offered the students experience in research methodology, data collection, and intervention design. “The students came and presented to one of my graduate classes, and many of the high school students said it was a very meaningful experience for them,” Ozer notes. Ozer is now working with the Center for the Study of Social Change in the establishment of the Center on Culture, Immigration, and Youth Violence Prevention, funded by a grant from the Centers for Disease Control. As lead investigator on a grant within the center, Ozer will expand the research to Oakland, where she will focus on using youth research and planning to strengthen violence prevention. “In early education, the process is more participatory,” says Ozer. “Even in preschool, children help determine the rules of conduct. But as children get older, the system becomes more rigid. We wanted to create a genuine process of participation—to have teenagers be contributors, rather than passive recipients.” As part of the interactive process, the local stakeholders—students, parents, teachers, and administrators—evaluate the effectiveness of health intervention and violence prevention programs.

Targeting Obesity The Center for Weight and Health has been targeting another issue in California’s schools: nutrition. The center recently concluded a study on the effects of removing sodas and other highly sweetened beverages from the vending machines at local high schools. One early finding of the Sodas Out of Schools project, or SOS, was that the students were fairly comfortable with the change in beverages. “People told us that if we took away the sodas, we’d have largescale student protests,” says Patricia Crawford, Dr. P.H. ’94, R.D., adjunct professor in the School of Public Health, codirector of the Center for Weight and Health, cooperative extension specialist, nutritional sciences and toxicology. “We found that was not the case at all.” In fact, students at the control schools not participating in the intervention expressed interest in healthier food and beverage choices. With obesity on the rise among California teens, the center is exploring the ways that changes in the environment—such as soda-free school grounds—impact the eating habits of children and adolescents. In another ongoing study, the center is examining the effects of schools offering lunches with a higher nutritional value. On September 15, 2005, the Center for Weight and Health participated in the “Governor’s

Summit on Health, Nutrition, and Obesity.“ Researchers from the center compiled materials on obesity for participants, including promising approaches towards improving nutrition, community priorities around weight and health, and an extensive list of resources and contacts. A wide range of leaders from various sectors of society participated in the summit. Among them were notable figures from the food industry, including Safeway, Kraft, Subway, El Pollo Loco, Dole, McDonald’s, Ruiz Foods, and 7-Eleven, all of whom pledged to offer and promote more nutritious food choices. Members of the California Association of Health Plans—specifically Kaiser Permanente, Blue Cross of California, Health Net, PacifiCare, and L.A. Care—made extenisve commitments to fight obesity. Governor Schwarzennegger signed groundbreaking legislation that extends the ban on the sale of sodas in vending machines at elementary and middle schools to include high schools, and sets nutrition standards for foods served and sold in schools, and provides funding for more fruits and vegetables for school meal offerings. “In order to make substantial changes we need community research, active community partners, and bold policy makers,” says Crawford. She is heartened by the positive response to the summit and the momentum of the new movement to combat obesity. “We are seeing the beginning of a cultural shift.”

“California is facing an obesity epidemic—over the last decade Californians have gained 360 million pounds and one in every three of our children is overweight. This dangerous trend is unacceptable. I challenge leaders in government, business, education, medicine and parenting to continue the work we have begun today to make California the nation's model for health, nutrition and fitness.” —Governor Arnold Schwarzenegger

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Meeting the Needs of Older Californians By Michael S Broder

The trend is clear: There are more older Californians than ever before, and the number is increasing. According to the state’s Department on Aging, there will be a 112 percent increase in the number of Californians age 60 and over during the period from 1990 to 2020. The 85-and-over age group will grow at even a faster rate, with an increase of 143 percent during the same period. With this in mind, the School of Public Health is taking action on a number of fronts to ensure that the needs of older Californians will be met—from training medical students in geriatrics, to translating research on aging into action, to building a network of seniors who are actively making a difference in their communities. Essie Reed (left) and Beverly Taylor are among 60 “Senior Leader” awardees who are enhancing the health and quality of life for elders in California.

Training Tomorrow’s Physicians to Care for Older Patients The UC Berkeley-UC San Francisco Joint Medical Program (JMP) is preparing tomorrow’s physicians to treat older patients through an innovative geriatric curriculum that matches medical students with elderly residents. The new curriculum, instituted by the JMP in 2003, brings students into continuing care retirement facilities to meet face-to-face with the residents and follow them over the course of three years. Led by John Swartzberg, M.D., the JMP is a partnership between UC Berkeley and UCSF; the five-year program of study leads to a master of science degree and a medical degree. Unlike most medical degree programs, which 10

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usually introduce geriatrics late in a student's medical education, and often as an elective, the JMP requires the geriatric curriculum and starts it in the student’s first year. Students learn how to work as a member of a patient’s care team; how to focus on living with chronic diseases; how to assess what will help an elderly patient live as independently as possible; and how to care for people over time. “It is clear that we need more doctors who have an understanding of what it’s like to be an elder in our society and who have some training in their care,” says Guy Micco, M.D., clinical professor in the JMP and director of UC Berkeley’s Resource Center on Aging. “The standard medical

interview often leaves out questions concerning various activities of daily living. An important contribution of geriatrics is to put front and center these matters of how well someone is able to function in their world. We can teach students to ask such things as, ‘Can you use the bathroom on your own?’ ‘Can you shop and prepare your own meals?’ ‘Are you able to manage your financial affairs?’ Thinking about how people live with the problems that come as they age— some of which are considered diseases, some of which are not—and how to prevent these problems or help make them better—this is the stuff of geriatrics.”

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Helping Seniors Stay Active In Sonoma, California, researchers in the Study of Physical Performance and AgeRelated Changes in Sonomans (SPPARCS) have been following 2,092 people ages 55 and older for approximately 10 years, looking at different aspects of age-related changes in physical activity and functioning. The study is supported with funding from the National Institute on Aging. Physical activity declines with age, despite the fact that it is associated with myriad health benefits, from lowering blood pressure to reducing risk of falls. “People who live with a spouse and maintain social networks are more likely than others to engage in healthy behaviors,” says William Satariano, Ph.D., M.P.H., professor of epidemiology and community health. As part of SPPARCS, he has been looking at the physical activity of older married couples, examining how the physical activity of one spouse affects the other. Over an eight-year period, he compared levels of physical activity among married couples with levels of activity among randomly assigned pairs. “There is a concordance in physical activity among older spouses, evident both at baseline and over time,” says Satariano. The findings from this study may be used to develop interventions to encourage seniors to stay active.

Building a Network of Senior Leaders In a mutually beneficial partnership, the School of Public Health is building a network of “Senior Leaders”—individuals age 60 and over who are making outstanding contributions in healthy aging or community building. “Typically, they are active on more than one level. They may be working on the neighborhood level and also on the policy level in Sacramento; or on the regional level and the national level,” says Meredith Minkler, Dr.P.H., professor of health and social

behavior. Minkler serves as principal investigator for the California Senior Leaders and Healthy Aging program, which is supported by The California Wellness Foundation. “Some of the seniors are working on issues affecting a particular group—such as African American elders in California—and are doing work to enhance and improve their health and quality of life.” The 60 leaders, who come from throughout California and range in age from 60 to 96, have been selected from a larger group nominated by health departments, foundations, academia, community-based organizations, and local and state government. The first class of senior leaders began in 2002, and the second in 2005. Awardees participate in a two-day recognition and training event, which includes interactive sessions on media advocacy, healthy aging, influencing policy, fundraising, and related topics. In addition, the seniors are linked with graduate students in the School of Public Health. Student project director Marty Martinson, M.P.H. ’05, and six other students—each focusing on a different issue area—check in with the seniors regularly over 12 months, learning about their progress and arranging technical assistance if needed. “We provide them with training in areas like how to more effectively utilize the mass media to bring attention to the issues that they’re working on, how to raise money for their organizations, and projects, offer tips on how to make an impact at the policy level, and we hook them up with classes of students that might be helpful to them,” Minkler explains. "Student participants learn at least as much as the seniors, and they learn from the masters,” says Martinson.

The School’s Health Research for Action Center (formerly Center for Community Wellness) has published a comprehensive 68-page resource to help seniors navigate HMOs, advocate for themselves, and take full advantage of their health care coverage. Minkler agrees. “We’re seeing a lot of benefits and the building of a web of connection between senior leaders up and down California, senior leaders and university students, and other intergenerational collaborations,” she says. For example, two senior leaders who recently returned from three weeks in Louisiana working on relief efforts for Hurricane Katrina will be serving as advisers to the School’s “Dr.P.H. in Action” seminar, in which students are working on a Katrina-inspired class project on disaster preparedness for Alameda County. The sharing of information among the seniors is a key element of the program. The participants hold reunions in different regions where they share ideas with one another and often apply what they’ve learned to their own communities. Some of the seniors from the first group also serve as mentors to the second group. Says Martinson. “We’re trying to build a network of California senior leaders who will be in touch, and we hope to ignite a more formal senior leadership alliance.”

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Serving California’s Diverse Population By Kelly Mills

California is one of the most ethnically diverse states in the nation, with a population that represents a wide range of cultures, languages, and backgrounds. However, there are vast disparities in health outcomes among residents, and rates of morbidity and chronic illness are significantly higher for African Americans, Latino Americans, and Asian Americans than for white populations, according to the Department of Health Services. Many researchers at the School of Public Health are examining why such inequities exist, and looking for ways to address these issues in communities and in the health care system. Examining Pregnancy Outcomes for African Americans and Latinas

One of the most glaring areas of health disparity for African Americans is in birth outcomes. The National Center for Health Statistics reports that nationally, African American women have the highest rates of preterm births and lowbirth-weight babies, two factors which are also linked to infant mortality. Amani Nuru-Jeter, Ph.D., M.P.H.,

assistant professor in the divisions of Community Health & Human Development and Epidemiology, is looking at the connections between racism as a chronic social stressor and birth outcomes among African 12

University of California, Berkeley

Oakland middle and high school students participating in the Health Professions Partnership Initiative created a mural titled, “What Is Health?” The program encourages minority youth to pursue careers in public health and health care.

American women. She is working with researchers at the UCSF Center on Social Disparities to develop a validated assessment tool of chronic exposure to racism for African American women of childbearing age in order to examine whether the experience of racism plays a part in pregnancy outcomes. NuruJeter and colleagues are in the process of analyzing data from a series of focus groups conducted with African American women, designed to measure perceptions of racism. “We are working to identify and measure the experience of racism across the life course,” she says. Nuru-Jeter is also examining data from a longitudinal survey project to further understand the effects of racism as a chronic stressor on birth outcomes and cardiovascular risk. (See “Meet the New Faculty,” page 33.) Sylvia Guendelman Ph.D., M.S.W.,

professor of health and human development, has researched an interesting paradox: Mexican-born women in the U.S. have better pregnancy outcomes in terms of birth weight and infant health than

Caucasian women, despite the fact that Mexican-born women have more health risk factors such as higher levels of poverty. Studies indicate that this may in part be attributable to better nutrition, and lower rates of smoking and illegal drug use among Mexican-born women than among Caucasian women. Guendelman examined hospital records and birth certificates and found that while Mexicanborn women in California had better birth outcomes, they also had higher rates of postpartum complications resulting from poor or suboptimal obstetric care, such as hemorrhaging and fever. She compared pregnancy outcomes for the U.S. born children of Mexican immigrants with women born in Mexico and discovered that pregnancy outcomes were worse for U.S. born Latinas. “We found that maternal health deteriorates with the process of acculturation,” says Guendelman. Understanding how acculturation disadvantages Latinas will help researchers design interventions to prevent the decline in positive birth outcomes.

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Developing Strategies to Bring Health Messages to Underserved Communities

At the Center for Family and Community Health, Joel Moskowitz, Ph.D., has collaborated with Asian Health Services and the Korean Community Advisory Board since 1993 to improve health in the Korean American community, a population that historically has been underserved and understudied in the state of California and in the nation. The center designed and implemented educational strategies to improve breast and cervical cancer screening rates among Korean American women. One offshoot of the effort was the creation of the Virtual Village Project with

the Korean Community Center of the East Bay. The project provides internet access and training at important community sites, such as churches and senior centers. Moskowitz believes that the internet can be an effective tool for delivering health information to members of the community. Currently, he is conducting a Korean-language internetbased smoking cessation study that contrasts two self-help strategies for quitting smoking. “Our data show very high rates of smoking among Korean American males, and good internet access,” states Moskowitz. “The internet offers a very promising technology for studying health promotion and disease prevention.”

Looking at Environmental Factors in Breast Cancer Breast cancer affects women and men of all backgrounds and ethnicities, but women of color are more likely to be diagnosed with breast cancer than any other cancer. African American women are less likely than white women to survive five years after diagnosis, according to the American Cancer Society. Patricia Buffler, Ph.D., Kenneth Howard Kaiser and Marjorie Witherspoon Kaiser Endowed Chair, professor of epidemiology, and dean emerita, has been a leading researcher and advocate for greater understanding of the causes of breast cancer— and how factors such as socioeconomic inequality contribute to the disease through environmental exposure risks. continued on page 14

New Position Helps Promote Diversity Rincón and the group organized an open forum, held on September 27, 2005. The event opened with moving speeches by a student who transferred to Berkeley from Tulane following the disaster and a physician who was one of the first responders to the rescue efforts. The forum was then opened up for students to share their thoughts and concerns. “The students found it very beneficial to discuss these issues,” says Rincón. “It was definitely a community-building event.” Abby Rincón, M.P.H. ’86, had only been working at the School of Public Health for a week when Hurricane Katrina devastated parts of the southern United States. Rincón, the newly hired director of diversity for the School, was approached by members of the Multicultural Students Organization about creating an event for students and faculty to discuss the questions and emotions that arose around public health issues for vulnerable populations.

The School of Public Health created the director of diversity position to help recruit and maintain a student body that reflects the community. The School also hopes to foster a culture that values and promotes diversity. “Much of what I do is putting a human face to the School,” says Rincón. “I’m building relationships with diversity coordinators across campus and on other campuses, and working on the best practices for recruitment.

I’m reaching students who may not have ever considered Berkeley, who didn’t believe they could come to Berkeley. I also follow up with current students, to make sure they are able to stay in school.” As a graduate of the School and a long-time public health professional, Rincón is excited about the opportunity to preserve and promote diversity. “I can’t think of a better way to devote my life’s work than to be part of making a difference in the next generation of public health leaders,” she says. Rincón, who earned her master’s degree from the School in 1986, has worked at the Genetic Disease Branch of the State Department of Health Services; as a lecturer for UC Berkeley and for City College of San Francisco; and most recently as director of health promotion for the Berkeley campus’s Tang Health Services Center.

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Serving California’s Diverse Population, continued with linguistically appropriate treatment and information. Language often presents a formidable barrier to people seeking care, both in interactions with physicians, and in reading printed materials ranging from prescription instructions to basic preventative care measures. Health Information in Many Languages

Korean American ministers and their spouses attend an orientation for a breast and cervical cancer screening project through the School’s Center for Family and Community Health.

Students Work with Communities to Combat Heath Inequities

The Center for Public Health Practice (CPHP) gives students at the School of Public Health frontline experience in the struggle to reduce health disparities. The center connects over a hundred students a year with internships in community organizations, professional health agencies, and government departments, many of whom serve populations with disadvantaged health status. “The students have the opportunity to work on real, pragmatic solutions to health inequities,” says Jeff Oxendine, M.B.A., M.P.H., associate dean for public health practice. The internships allow students to work towards health disparity reduction on a number of fronts: through the development of intervention methods and disparity assessments; by helping organizations deliver culturally and linguistically appropriate services; and by reseraching the causes of health disparities and understanding the barriers to health care access for particular communities.

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In 2002, the Center for Multicultural Health was formed within CPHP to help students and partner organizations design, implement, and evaluate practical strategies for reducing health inequity. One of the goals of the Center for Multicultural Health is to identify and support students from underrepresented backgrounds who are interested in a career in public health. The center conducts outreach with intermediate, high school, and undergraduate students. “We are creating a pipeline of support programs and exposure programs for students, so that someone can be inspired at an early age, supported at each step of the way, and actually make it into graduate school and into the field,” says Oxendine. Faculty and students from the Center for Multicultural Health often collaborate with local public health agencies in an effort to improve access to care. For one project, students and faculty from the center worked with the Alameda County Association for Language Access and Health Care Coalition to identify methods for providing non-English speaking patients

The Health Research for Action Center (formerly the Center for Community Wellness) has been providing important health information to California residents for over 18 years through the acclaimed Wellness Guide. The Guide has demonstrable results in improving access to health care knowledge and resources, notably for Spanish-speaking users. In 2004, the center built on the success of previous publications and released a Chinese/ English edition of the Wellness Guide. The Chinese/English Wellness Guide was developed in collaboration with an advisory board of community leaders and health care professionals, and aims to meet the needs of the diverse community of Chinese speakers, which includes people from mainland China, Hong Kong, Taiwan, Macao, and Vietnam, who speak English, Mandarin, Cantonese, and a variety of other dialects.

Infomacíon de salud en varios idiomas Por más de 18 años el Centro de Investigación de Salud en Acción (conocido anteriormente como Centro para el Bienestar de la Comunidad) ha proporcionado información de salud importante a los residentes de California a través de su aclamada Guía del Bienestar. La Guía ha demostrado resultados en cuanto al mejoramiento del acceso a información y recursos de cuidados de la salud, en especial para los usuarios de habla hispana.

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Informing Consumers and Policy Makers By Vivian Auslander

With research showing that health care in the U.S. falls far short of recommended standards, the School’s faculty has a major role to play in creating new knowledge, educating consumers and informing policy makers. On the following pages, we highlight some of the faculty’s recent contributions to health care research and evaluation, and discuss the newsletter that put the word “wellness” into everyday use.

Measuring Medical Group Performance As health care delivery has come under greater scrutiny for quality as well as cost, researchers and reformers alike have been focusing on how well medical groups are performing, particularly in caring for patients with chronic diseases. “Diabetes, congestive heart failure, asthma and depression are the high-cost conditions that affect all Americans,” says Dean Stephen M. Shortell, Ph.D., M.P.H., Blue Cross of California Distinguished Professor of Health Policy and Management. “It’s estimated that those four conditions account for 75 percent

of all health care costs in the United States. So the big question for this country is how we’re going to manage chronic illness.” Shortell and colleagues at UC Berkeley, UC San Francisco, and the University of Chicago are addressing this question by studying large medical groups throughout the nation that treat patients for those four chronic diseases. The work includes an in-depth look at some 200 groups of 20 or more physicians in California. Measuring quality of care, organizational capacity for learning, and financial performance, the researchers have found three key

characteristics that set high performance medical groups dramatically apart from other groups: the responsibility to report results externally, use of information technology (e.g., electronic health records), and a culture of commitment to quality improvement. The study has received widespread attention, especially from California legislators who are interested in encouraging the use of information technology in medical practice. It has also been the source of some of the measures being used in California’s demonstration Pay for Performance program, which is rewarding medical groups for providing better quality care.

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Informing Consumers and Policy Makers, continued In the five years during which Shortell and his research colleagues have been assessing medical group performance and identifying factors that contribute to high-quality care, many of those factors have come to occupy a larger place in the health care landscape: incentive programs like Pay for Performance have been launched; external reporting requirements have increased; more information technology has become available for tracking patients; and the government, through the Center for Medicare/Medicaid Services, has sponsored projects using financial incentives to improve treatment for the chronically ill. Have changes like these actually improved medical group performance? Shortell and colleagues are conducting a two-year update of their research to find out. “Because of all this attention, we would expect medical groups to be doing better at managing patients with chronic illness,” he says. “We’re going to see what areas have improved the most, what has improved the least, what the differences are across the country and why that might be.”

Rewarding High Quality Care California is a national leader in efforts to improve the quality of health care by offering financial incentives to medical groups and reporting on their performance-based on uniform measurable objectives. The Pay for Performance program (P4P) seeks to improve preventive services, like cancer screening, and treatment for chronic conditions, like asthma and diabetes. Developed by the Integrated Health Association (IHA), P4P is the largest undertaking of its kind in the nation, affecting the care of over 6.5 million Californians. IHA is a statewide organization in which leaders from across the health care spectrum— health plans, providers, academia, purchasers, policy makers, pharmaceutical firms, and 16

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“There is a huge need to connect the public health side of the world with the private sector health care side of the world.” consumer groups—come together, put aside their differences and “find areas for collaboration and innovation to improve health care and health care delivery to Californians,” as IHA executive director Tom Williams explains.

need to connect the public health side of the world with the private sector health care side of the world,” he says. “Dean Shortell and Jamie Robinson are folks who can connect those two worlds.”

Dean Shortell and James Robinson, Ph.D., professor of health economics and chair of the Division of Health Policy and Management, serve on the IHA board. Shortell oversaw development of the analytical underpinnings for P4P: uniform performance measures, standards for data collection and other technical components.

Informing Health Care Policy

“This program is new, and it’s evolving,” Williams says. “That’s why it took somebody like Steve Shortell to help us figure out what we should measure.” Based on measurements of clinical quality, patient experience, and information technology to support patient care, the health plans participating in P4P reward medical groups for their performance. The California Office of Patient Advocate posts the results of the quality assessment on a public web site (http://www.opa.ca.gove/report_card/). “Being able to compare the results is great for consumers,” Williams says, “but, more fundamentally, the medical groups now have an incentive to improve their care, which helps consumers get the care they need. For example, more women are now getting mammograms.” Williams, a former health plan executive who is working on his doctorate at the School of Public Health, is pleased that P4P has successfully engaged the private sector to work on public health initiatives. “There is a huge

When California legislators need to understand the potential impact of new bills that seek to mandate health insurance benefits, they turn to a trio of UC experts: Edward Yelin, Ph.D., M.C.P., adjunct professor of medicine and health policy at UC San Francisco, Gerald Kominski, Ph.D., professor of health services at UCLA and associate director, UCLA Center for Health Policy Research, and Helen Halpin, Ph.D., professor of health policy and director of the UC Berkeley Center for Health and Public Policy Studies. At the request of the legislature, in the 60 days following the introduction of a mandate bill, the trio revs into action: Yelin and his colleagues review the scientific literature for evidence that the proposed new benefit is medically effective, Kominski and his colleagues estimate its impact on state expenditures, and Halpin and her research team analyze its potential impact on public health. UC performs this service as part of the California Health Benefits Review Program (CHBRP), established by the Office of the President in 2002 in response to the legislature’s passage of AB 1996, which requires the University to provide comprehensive, objective, evidence-based information on which to base policy decisions. The bills cover the gamut of health care concerns— from drugs to length of hospital stays to professional services.

When California legislators need to understand the potential impact of new bills that seek to mandate health insurance benefits, they turn to a trio of UC experts.

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Mental Health Services Act, which taxes millionaires to fund mental health programs in California. Led by center director Richard Scheffler, Ph.D., Distinguished Professor of Health Economics and Public Policy, the researchers are tracking the fiscal impact of the law, examining how it is changing mental health services and studying its effect on mental health outcomes. Their findings will inform policy makers about how the funds affect the availability and design of mental health services.

“To date we have analyzed 22 bills,” Halpin says. “It’s an unbelievable effort. I have an amazing staff in my research center, and when the bills come in, we drop everything to work on them.” Halpin calls her team’s role “revolutionary,” explaining, “California is one of the few states in the country that actually considers the impact of health insurance policy on the health of the population.” The reports that UC provides play a significant role in decision-making. “In many cases, after our report comes out, we’ve seen bills pulled or gutted and something new introduced,” Halpin says. “Bills about mandates that we’ve found would be very effective and cost relatively little —for example, management of pediatric asthma—pass the legislature.” What happens after that point, she adds, is in the governor’s hands.

distinct advantages. It is independent and removed from the political process. And it can marshal expertise in many fields. Halpin, Yelin, and Kominski call upon colleagues at UC Davis and UC San Diego whenever they need their special experience. “I’ve been in many multi-university endeavors before, but this one has worked the best,” Halpin says. “Everyone has different expertise, and the reports are much better than any of us could do alone. We’re really proud of the products, and we feel like we’re introducing some rationality into the public policy process.”

Understanding the Impact of Change

In the course of their work, the researchers have developed new methodologies, which they will publish early next year in a special issue of Health Services Research, along with a paper detailing the process they used to analyze management of pediatric asthma.

The Nicholas C. Petris Center on Health Care Markets & Consumer Welfare, located at the School of Public Health, plays a critical role in examining how changes in health care and health care policy affect health care markets, consumer protection and access to care, especially for low- and moderate-income Californians. For example, the center is currently undertaking four studies that will have a major impact on health care decision-making and programs.

CHBRP—the only program of its kind in the nation based in a university system—has

In the first study, Petris Center researchers are evaluating the impact of Proposition 63, the

“The interest in this study goes well beyond California,” says Timothy Brown, Ph.D. ’99, Petris Center associate director. “Many people recognize that Prop. 63 is very innovative in what it is attempting to do. They are very interested in what programs are working and whether or not people are getting more access to mental health care.” In another study, Petris Center researchers are focusing on Attention Deficit Hyperactivity Disorder (ADHD)—the most common behavioral disorder in children—which is being diagnosed and treated at an accelerating rate throughout the world. The use of the many psychostimulant drugs that treat ADHD, including Ritalin, varies tremendously, and the Petris Center is partnering with the UC Berkeley Psychology Department and a major California health system to learn why. “The use of psychostimulants for ADHD is one of the most important public policy issues now for parents,” Scheffler says. “We are trying to document and understand the factors influencing the supply and demand for these drugs and the variations in their use. Our study will help policy makers and health professionals decide if the current treatment disparities are acceptable, and, if not, how they might be changed.” A third Petris Center study deals with prescription drugs. Although they are important for treating disease and improving health,

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Informing Consumers and Policy Makers, continued many people lack access to these drugs because of their cost. To inform decisions about proposed legislation addressing lack of access to prescription drugs for the uninsured—including Propositions 78 and 79, the competing measures on the November ballot—Petris Center researchers analyzed various methods for defining the number of uninsured Californians and examined the programs available to help those who cannot afford prescription drugs. Based on these analyses, they estimated that nearly 5 million to 6.5 million Californians are uninsured and that private programs to provide free or lowcost drugs to people in need reach only about five percent of the uninsured population. The state has yet to determine the number of uninsured Californians who require help to pay for prescription drugs. A fourth Petris Center study addresses the dearth of African American and Hispanic physicians in underserved minority communities, a problem that can contribute to disparities in the health of the people in those communities and the care that they receive relative to other populations. Center researchers have just completed a study examining the factors that influence African American and Hispanic doctors to move within California and leave the state. The

study will help UC and policy makers design programs to improve medical care for underserved minority communities.

Offering Practical Advice to Consumers Every month, the UC Berkeley Wellness Letter brings practical advice about healthy living, good nutrition and disease prevention to more than 350,000 subscribers here and abroad. Established in 1984, the popular newsletter has given meaning to the term “wellness,” and has built a reputation as one of the most credible resources in the world for plain-spoken analysis of health-related issues. “We see ourselves as a filter,” says Dale Ogar, managing editor. “We read and hear what the issues of the day are. Then we dig behind the reporting to look in-depth at the literature, review the data ourselves, and then stand back to offer sensible advice.” The 13-member editorial board, chaired by John Swartzberg, M.D., F.A.C.P., clinical professor of health and medical science at UC Berkeley and UC San Francisco, includes experts in preventive medicine, epidemiology, gerontology, cancer, risk assessment, occupational and environmental health, and nutrition. The board “goes over every word,” Ogar says,

and nothing gets published without their approval. Through the years the newsletter has had wide-ranging impact, influencing the kinds of questions that consumers ask their doctors, providing early warnings about the safety of dietary supplements, and inspiring efforts to promote the health and welfare of Californians. “Fairly early in our history, some people from Health Net came to us and said they wanted to start a foundation whose funding efforts would reflect the principles we were espousing in the newsletter,” Ogar recalls. “That became The California Wellness Foundation.” The newsletter’s contribution to the School of Public Health has been profound. Under the leadership of the late Sheldon Margen, M.D., world-renowned nutritionist and cofounder of the newsletter, the newsletter created an endowment and devoted all earnings above those needed for operations to student support. Generations of public health graduate students have been the beneficiaries of this support and have moved on to serve the public as health professionals.

Planning for a Healthy Future Looking to the future, the School of Public Health, in conjunction with the Public Health Institute and The California Endowment, is planning a health summit that will present a health report to the state and explore strategies for improving the health of all Californians. A steering committee drawn from the private and public sectors, consumer groups and academia has been established. Work groups will focus on infectious disease preparedness and chronic illness. Planners are seeking funding in the hope of offering the health summit next September as the first of an annual series that will raise visibility about health issues, develop action plans to improve health, and chart the state’s progress over time.

Dr. John Swartzberg, chair of the UC Berkeley Wellness Letter’s editorial board, reviews an issue.

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Preparing for Disaster By Kelly Mills

Recent calamities like Hurricane Katrina have left many people in California wondering if our public health system would be able to effectively respond to a similar emergency. The question seems to be not whether a large-scale disaster will strike the state, but when. A capable and efficient public health infrastructure is essential to the safety of the people of California, in order to meet the crises posed by natural disasters, major disease epidemics, or acts of terrorism. The Center for Infectious Disease Preparedness is working to address these challenges, providing training and resources in infectious disease control, bioterrorism response, and other health emergencies to public health practitioners and students across California.

Graduate student researchers Andy Anglemeyer and James Bullard compare notes at the Core Infectious Disease Emergency Readiness two-day intensive exercise.

“When dealing with a public health disaster, you need a well-trained workforce, and you may also need a rapid and massive response,” says Tomás Aragón, M.D., Dr.P.H., principal investigator and executive director, Center for Infectious Disease Preparedness (CIDP), and assistant adjunct professor, Division of Epidemiology. “A disaster is not the time to determine how you are going to respond. You need to know in advance how you are going to communicate, move water, and move antibiotics.” CIDP was founded in response to growing concerns about bioterrorism and the ability of the public health system to respond to microbial threats. “We started off looking at intentional threats like anthrax. If you don’t know how to identify cases or deliver antibiotics, you are going to end up with hundreds of thousands of people in hospital beds, and hundreds of thousands more dying,” Aragón states. Training Workers for the Front Line

CIDP offers a number of programs designed to address needs in the public health infrastructure. The Core Infectious Disease Emergency Readiness (CIDER) program is designed to train students and professionals in a number of areas, including emergency operations planning, field epidemiology, and infection control. The program focuses on effectiveness in core areas during an emergency. The Readiness continued on page 20

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Preparing for Disaster, continued Operations Planning and Exercise program helps health departments develop emergency operations plans and test them in exercises designed to simulate microbial threats and other disasters. CIDP also offers the Epidemiological Preparedness and Informatics program for in-depth training in infectious disease epidemiologic detection, investigation, and information management. Overall CIDP focuses on the core principles of detection, investigation, response, and recovery. While CIDP deals primarily with microbial threats, Aragón says that “many of the concepts are applicable to other disasters.” CIDP plans to offer courses in the spring 2006 semester that integrate the lessons learned from the Gulf Coast hurricanes. “You need the ability for collaboration and communication between states and the federal government, between the public and private sector,” says Aragón. Participants Learn from Simulated Outbreak

Students completing the CIDER summer intensive program face a special kind of test anxiety. The exam doesn’t involve number two pencils or essay questions. What it does require, however, is a combination of professional skill, adaptability, and teamwork. The culmination of the CIDER summer intensive program is a two-day simulat-

ed disease outbreak, during which the participants must work in teams to detect, investigate, and contain a potentially devastating epidemic. Of course, these aren’t ordinary students either— many have been working on the front lines of public health for years. Cindy Lambdin, R.N., M.S., one of the

organizers of the two-day intensive training, cites two major weaknesses in the current public health system. “Most professionals in public health do not see themselves as ‘first responders’ in an emergency, the way fire, police and EMTs do. And the Incident Command System is not fully integrated into the public health system.” The Incident Command System, or ICS, is an organizational tool that allows responders from different areas to communicate with each other effectively in an emergency. The system was created by fire personnel in response to problems that arose when firefighters from different areas needed to work cooperatively to combat multi-jurisdictional fires. It is already used by emergency personnel such as police and fire departments, and is slowly being implemented in public health. The ability to communicate across sectors and regions becomes critical in a large-scale emergency, when efforts must be coordinated in order to succeed. ICS

also helps establish responsibilities and chain of command, a factor that takes on fundamental importance when people are forced to take on unfamiliar roles to meet the demands of a situation. “For the second day of our exercise, we switched people’s roles. That created considerable stress,” says Lambdin. However, public health professionals should be prepared to fill any position in a disaster. “I always tell people, ‘During a crisis, you may be the most knowledgeable person in the room.’” The summer program offered by CIDER is aimed at familiarizing public health workers with ICS, and ensuring that participants have the necessary experience to meet the problems posed by a major disaster. The intensive exercise simulated pandemic influenza, and response roles were assigned to each of the students. The exercise created a realistic and highly stressful situation, and forced participants to quickly develop plans for containing the outbreak, communicating with the media and the public, and managing resources effectively. The summer intensive course is just one of the ways CIDP enables public health professionals to develop the skills necessary for meeting the next health crisis. “We occupy the space between public health practitioners and the academic community.” says Aragon. “There are really few opportunities for

“If we are to continue to protect our homeland from terrorism, then a well trained and sound public health infrastructure is a must. The University of California, Berkeley, School of Public Health plays a vital role building the nation’s capacity to detect, respond to, recover from, and mitigate consequences of terrorism and other health emergencies.” —Julie L. Gerberding, M.D., M.P.H. ’90 Director, Centers for Disease Control and Prevention

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professional development for people already working in the field of public health. We meet that need.”

Public Health Nurse Puts Emergency Training to Good Use

At CIDP, there is a strong focus on making courses accessible and practical for people working in the field. In addition to the two-week summer intensive program, CIDP offers free, half- to fullsemester classes all day on Tuesdays to allow long-distance commuters to make the most of their time. CIDP webcasts most of the courses for distance learning, and provides regional field training. Developing Leaders

CIDP plans to expand the CIDER summer intensive program to include courses on designing drills and exercises so that professionals can evaluate emergency plans and ensure that emergency measures will be effective in the event of a catastrophe. CIDER will also offer a one-week leadership training course, ending with another two-day emergency exercise in which participants will use ICS. “The leadership training is a unique course because people have to work in teams—they have to coordinate, delegate, recognize when their colleagues are stressed, and basically use real-world problem solving,” says Aragón. Aragón states that one of the strengths of the CIDER program is the value placed on the teaching skills of the faculty, many of whom are professionals working in the field of public health. Aragón himself served as a deputy health officer for San Francisco, which he believes gives him credibility with public health practitioners. “The field is changing so rapidly. It is difficult for academicians to keep up. New systems are being implemented constantly. My challenge is to bring in front-line responders as teachers, and to recognize that the courses will need to change all the time.”

Tamara Cohn didn’t have to wait long to use the training she received at the Core Infectious Disease Emergency Readiness (CIDER) summer intensive program offered by the School’s Center for Infectious Disease Prevention. A week after she returned to Inyo County, where she is the clinical services director for the Public Health Department, Cohn received reports of multiple cases of encephalitis in the area. “When we first heard of the cases, we immediately took out the tools from the summer intensive session.” Cohn said. “We work with epidemiologists from the state department of Health Services, and the tools from CIDER helped us anticipate what kinds of questions the epidemiologists would ask us. It not only made us feel more prepared, but it also enabled us to move much faster than we could before. The CIDER course gave me the leg up to be able to anticipate what we would need to know and do.” As a public health nurse in rural Inyo County for 25 years, Cohn has had plenty of practical experience dealing with infectious disease cases. She credits the CIDER training with giving her more confidence and consistency in identifying possible outbreaks and taking the necessary steps to contain them. “CIDER helped us develop a standardized approach to dealing with outbreaks, such as with the recent cases of pertussis in our area. The course gave us a language and a map.” Cohn passed on the information she learned at CIDER to the public health staff in her area. She developed a worksheet based on the principles of the CIDER course for an annual disaster drill. “The worksheet gave the staff parameters and a structure to use in the investigation. I think most of them had the same experience that I had at CIDER—it was really an ‘aha’ moment.” The course also helped Cohn develop a bioterrorism response plan that recruited emergency field investigators from outside public health. “Because we are a rural county, we only have six public health nurses.” Says Cohn. “We just don’t have the resources to respond. So we brought in environmental health investigators, child protective services workers, social workers...We have expanded our plan to embrace people with interview skills. I conducted a training using the foundation I got at CIDER, and we have been able to include these people from these other disciplines to use as field investigators if we were to have a biological event.”

Public Health

Past, Present, Future

Influential Epidemiologist and Esteemed Professor: Warren Winkelstein, Jr., M.D., M.P.H. UC Berkeley Public Health recently interviewed Professor Emeritus Warren Winkelstein, who joined the School’s faculty as professor of epidemiology in 1968, served as the School’s dean from 1972 to 1981, and has been a professor emeritus since 1991. Born in Syracuse, New York, in 1922, Winkelstein earned his bachelor’s degree from the University of North Carolina in 1943, his medical degree from Syracuse University in 1947, and his master’s degree in public health from Columbia University in 1950. He has received numerous honors, including membership in the Institute of Medicine; fellowship in the American Association for the Advancement of Science; and the prestigious Berkeley Citation.

Would you talk a bit about changes you’ve seen in your 37 years at the School? I suppose the most striking difference in the School during the years I’ve been here has been the change from a faculty that was very largely made up of former practitioners of public health to a more academic research oriented faculty. That’s not to say that there wasn’t a lot of research 30 years ago—there was—but I think it was perhaps more practice oriented than it is today. So today we have a faculty almost exclusively made up of Ph.D. research academicians, and I think they are making important and substantial contributions to knowledge, but I think there’s less emphasis now on application than there was in the past. Also the student body has changed, particularly with respect to gender. When I came here, two-thirds of the students were male. Today, at least two-thirds of the student population are female—which makes some difference in terms of orientation of interests and also on substantive issues. Of course one thing has remained quite constant, and that is the major problem created

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by an inadequate physical facility and the splitting up of activities into different venues. Public health is by its very nature multidisciplinary, and I think our School would benefit, both in terms of its research orientation and in its ability to provide students with meaningful instruction, by addressing this Balkanization, if you will, of the locations. So we could use a new building that would centralize the various activities. What would you say has been your most influential work? Well, probably the most influential work I did was my early work on air pollution in Erie County, New York, [which was the basis for setting up air quality standards for the United States] and the work that my colleagues and I did on HIV/AIDS in the 1980s and ‘90s. [Winkelstein directed the landmark San Francisco Men’s Health Study, a large cohort study of HIV infection and AIDS which helped determine the link between sexual activity— especially types of behavior—and HIV infection. Ed.] I also was involved in vaccine evaluation research. I worked on the polio vaccine field trial, but of course I was just a tiny part of a giant mobilization, if you will. And then I worked on other vaccine evaluation activities.

Past, Present, Future

I think, perhaps, from a scientific point of view, the most important thing I did was my early study on risk factors for coronary heart disease in women. I believe it may have been the first case control study of risk factors in women for myocardial infarction. One of your research interests is the life and work of Janet Elizabeth Lane-Claypon. Would you explain your interest in her? In our epidemiology program, all of the students in their first semester here read classics of epidemiology and discuss them and relate those classics to current research. And some years ago—eight years ago or so—I became concerned that we had no examples of classic work by women epidemiologists. When I was a student of epidemiology or of public health, the 1926 paper on breast cancer authored by Janet Elizabeth Lane-Claypon was always referenced when the issue of breast cancer epidemiology came up or when case control methodology was discussed. So I knew about

about Lane-Claypon, so I contacted friends I have at the library at the London School of Hygiene and Tropical Medicine and they wrote me that they knew nothing about her and could find out nothing. So I went to the London School to visit my friends and talk about my project. The London School of Hygiene and Tropical Medicine happens to be located right across the street from the administration building for University College London. Well, the British, as you may know, keep every little scrap of paper. They archive everything. After chatting with my friends in the library, I went across the street to see whether I could find out anything about Lane-Claypon, because on the face page of her classic paper, it gives her degrees, which were Sc.D.—doctor of science—and then there’s a parenthesis that says “London.” I assumed what that meant was that she got her doctor of science from University College London, and indeed when I

In your view, what are the key issues confronting epidemiologists in 2005? Well that’s a tricky question. You would think it would be easy to answer that. I think there are areas that are, let’s say, underserved, or underaddressed. Population explosion, the worldwide increase in population is, I think, a tremendous challenge to public health. I think you can relate many of our problems to population pressure. Problems like energy and violence… I think that civil unrest is a major unaddressed issue. It’s a field that I think epidemiology can well address. I think epidemologists have a role to play in better understanding natural disasters, what happens as a consequence of them. And then of course, as the industrial societies evolve, new problems in occupational health are going to continuously emerge. They’re going to have to be studied and understood and controlled—a function of epidemiology. I guess that’s at least a partial list. I’m sure there are many other things that could be identified as major challenges.

“Public health is by its very nature multidisciplinary, and I think our School would benefit, both in terms of its research orientation and in its ability to provide students with meaningful instruction, by addressing this Balkanization, if you will, of the locations.” this classic paper and this classic study—500 cases and 500 controls—and I introduced that into our seminar. At the same time, I introduced Florence Nightingale’s work— she’s remembered more as an expediter of the nursing profession, or an advocate or innovator of nursing, but she also did pioneering work in hospital epidemiology. So we introduced readings from Lane-Claypon and Nightingale into our program. Subsequently, my wife wanted to spend some time in England…and I felt that I needed to have something more to do than just go to art galleries, museums, and the theater and music, which I, of course, love to do as well. I decided I would like to know something more

went across the street, I found a filing cabinet with 3x5 cards in it, with all the people who had ever received a graduate degree from University College London. There was LaneClaypon’s card. But someone had written at the bottom of the card, “married Forber.” Well, that information was obviously an open door, and in fact I was so excited, I literally ran back to the library at the London School of Hygiene, and within a half hour we had her obituary. Janet Elizabeth Forber, née LaneClaypon. So with the obituary, I could easily construct her bibliography and then from that I went on to find out more about her. That led to several summers’ research work, and it revealed an amazing scientist.

Public Health

Past, Present, Future

The School Responds to Hurricane Katrina with Action, Training, and Caring

In the wake of the devastation and destruction caused by Hurricane Katrina, the UC Berkeley School of Public Health opened its doors to 14 public health students displaced from Tulane University’s School of Public Health. Dean Stephen Shortell, Ph.D., M.P.H., along with faculty, program managers, and student representatives, welcomed the Tulane students to the School at a lunch on September 16. Later that month, students organized an open community forum on Hurricane Katrina as a way of building community and expressing concern for the visiting students. A powerful part of the event was the Tulane students’ sharing of their experiences with the hurricane and its aftermath. Items discussed at the forum included racism and classism as they impact health and vulnerable populations; lessons learned from this

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disaster and how to better prepare for disasters as a School community; and the building of community capacity to make sure such devastation and human toll never takes place again.

project, conducted by first-year Dr.P.H. students, will be studying “Applying Lessons Learned from Hurricanes Katrina and Rita to Improving Local Disaster Preparedness for Vulnerable Populations.”

In addition, the School’s Center for Public Health Practice held a two-part panel session on Hurricane Katrina and disaster preparedness (part of its “What Can You Do with a Public Health Degree?” series), while the School’s Center for Infectious Disease Preparedness participated directly in response operations through activation and deployment of Cindy Lambdin, R.N., M.S., emergency operations specialist, to the impacted area.

In spring 2006, the Center for Infectious Disease Preparedness will offer several trainings related to Hurricane Katrina. A new course on disaster epidemiology will include preparation for deployment in the event of future disasters, and the center’s regular spring course, “Core Infectious Disease Emergency Readiness,” will address public health issues and challenges faced during the Gulf Coast hurricanes. The center will also conduct regional conferences throughout California on “Designing Exercises to Test Public Health Emergency Operations Plans.”

The School will continue to take on the issues raised by the Katrina disaster. This year, for example, the “Dr.P.H. in Action”

Students Mobilize for Day of Volunteerism

1 Students in action on Volunteer Mobilization Day: 1 Sprucing up People’s Park; 2 getting their hands dirty at the Malcolm X School garden; 3 fixing lunch at the Women’s Daytime Drop-In Center; and 4 preparing for a graduation celebration at the Bay Area Hispano Institute for Advancement. 5 Berkeley Mayor Tom Bates (left) addresses students at the kick-off ceremony.

In a major new joint effort to bring public health students into the Berkeley community, Berkeley Mayor Tom Bates and Dean Stephen Shortell launched the first annual Volunteer Mobilization Day for incoming public health graduate students on August 26. After a brief kick-off event, 70 participating students were deployed to childcare, homeless, and public health sites throughout Berkeley for a day of service. “This is an exciting opportunity for our students to be directly engaged with the Berkeley community. Public health embraces all aspects of the community, and we expect that this initial contact will lead to ongoing relationships that benefit everyone,” said Dean Shortell. “I am thrilled to welcome these public health students to Berkeley and put them right to

work in our community,” said Mayor Bates. “This is exactly the type of cooperation that we envisioned as part of the new UC-city partnership. I believe it will be a model for other departments to follow.” Following the kick-off event, organized teams of volunteers proceeded to preapproved sites to perform community service until 3:00 p.m. Volunteer sites included Berkeley Food and Housing Project, Options Recovery Services, Bahia School-Age Program, City of Berkeley Environmental Health, Center for the Education of the Infant Deaf, Lifelong Medical Care, Inc., Women’s Daytime Drop-in Center, Peoples Park, Fred Finch Youth Center's Homeless Youth Collaborative, and Berkeley Youth Alternatives.

5 Public Health

Past, Present, Future

Putting Theory into Practice How do you help students integrate their theoretical, often specialized academic knowledge with the realities and uncertainties of contemporary public health practice?

Outside Experts Discuss Real-Life Problems

This was the challenge that professor emeritus Warren Winkelstein, Jr., Ph.D., M.D., M.P.H., and lecturer Jeffrey Braff, Dr.P.H. ’01, M.B.A., of the Division of Epidemiology took on four years ago when they set about designing a course that would add a practical, real-world dimension to students’ experience.

“When we talk about what it’s like to run a public health department, we don’t rely on an academic discourse about what is important to know,” Braff says. “We get in one of the public health directors in the Bay Area to talk about dealing with a budget shortfall in one department when you have money for bioterrorism in another department that you can’t use—that’s a real-life problem.”

The course, PH 200D, “Applied Public Health: Putting Theory into Practice,” gives students a preview of what it will be like to work in the public health trenches and provides opportunities to meet with practitioners who are grappling with a broad spectrum of public health issues. All master’s degree students take PH 200D in their last semester. The core of the course is a group of 30 public health problems—everything from aging populations and public health to arresting the spread of West Nile Virus—that the students tackle in five- or six-person teams. As would occur in the real world, students cannot choose the topic they will address. Braff assigns the groups, but is careful that the members have a mix of skills, “so everybody has a different gift to bring to the team.” Thirty faculty members serve as consultants for the teams, each in his or her area of specialization. So, for example, a team looking into stem cell research can draw upon the expertise of Jodi Halpern, M.D., Ph.D., associate professor of bioethics and medical humanities. Another team investigating environmental lead can seek guidance from S. Katharine Hammond, Ph.D., C.I.H., professor of environmental health. The team studying health care in Los Angeles can discuss its work with Thomas Rundall, Ph. D., Henry J. Kaiser Professor of Organized Health Systems, who will also be coteaching the course in 2006. 26

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In addition to work on a public health issue, PH 200D exposes students to the reality of public health decision-making and practice through lectures, field trips and panel discussions in which they hear from outside experts.

Dr.P.H. student Eddy Jara—who is collaborating with Professor Emily Ozer on a project to promote child nutrition through school garden programs—puts theory into practice by working in the garden at Berkeley’s Malcolm X Elementary School on Volunteer Mobilization Day.

In the course of the semester, each team explores its topic; researches precedents; defines the issues to be addressed and why they are important; looks at the options, costs, politics and other factors involved in solving the problem; decides upon a plan of action; and explains why the team has chosen that approach. This work culminates in a report and a poster presentation in the lobby of Warren Hall to which the entire School of Public Health is invited. Braff sends exceptional reports to appropriate government agencies, where they are invariably welcomed and appreciated.

Developing Work Skills “We are interested in the technical aspects of what folks produce, but we are very much more interested in assuring that students develop good working group habits, good interpersonal skills, and good planning, writing and presentation skills so that they can successfully continue to do projects like this,” Braff explains. To encourage meaningful group participation, a component of each student’s grade in the course is based on peer assessment.

The field trips take students to a multitude of local industries and services. Classes have visited a dairy processing plant to hear about pasteurization and product purity; San Quentin, to learn how prisoners are treated from a public health point of view; oil refineries, to learn about environmental protection and occupational health; the East Bay Municipal Utility District, to discuss water and sewage processing; and the blood bank of Northern California to learn about the public health implications of its work. The site visits provide for a lively exchange of views and information about public health practice in action. Braff recalls with a chuckle the first time he called the Hayward-based milk processor Berkeley Farms to arrange for a tour: “They normally deal with kindergarteners and first graders, so someone misunderstood and said, ‘You realize these students are all going to need permission slips from their parents.’ When I explained that these are all master’s and doctoral students at UC Berkeley, they successfully ratcheted up their presentation, assigning a microbiologist to meet the level of sophistication of the students. We see that response everywhere we go. People are proud of what they do and are thrilled to be able to discuss with peers the kind of work that goes on that has direct public health implications. They are pleased, and so are our students.” —Vivian Auslander

Faculty News

Faculty News and Notes Robin Baker, M.P.H., director of UC Berkeley’s Labor Occupational Health Program, received support from the State of California Department of Industrial Relations to provide outreach and educational information to California’s young workers regarding injury prevention as part of the statewide California Resource Network on Young Worker Health and Safety. Joan R. Bloom, Ph.D., professor of

health policy and management, is principal investigator for a study to determine whether weight-bearing exercises can help reduce bone loss among women who have gone through chemotherapy for breast cancer. With support from a new $2.1 million grant from the National Cancer Institute, researchers at UC Berkeley and UC San Francisco are teaming up with the YMCA of San Francisco and the Northern California Cancer Center. Women who participate in the intervention trial—all under age 50—will be randomly assigned to either an exercise intervention program at one of the 12 YMCA of San Francisco branches selected for the study, or a control group. Women in the intervention program will receive a one-year YMCA membership, be assigned a personal trainer and get a tailored exercise regimen based upon an assessment of their physical fitness. Bone density will be determined through X-ray tests and biochemical markers of bone turnover. The researchers will also monitor changes in lean body mass and reports of overall mental and physical health. In addition to studying bone health, the researchers will monitor each participant's fitness throughout the study. Ralph A. Catalano, Ph.D., professor of public health, is lead author of a study examining the impact of capitation on hospital emergency visits to address whether capitation has an impact on the effectiveness of the mental health system as a whole. The study was published in the June 2005 issue of Psychiatric Services. Joan R. Bloom, Ph.D., professor of health policy and management, is a coauthor.

Sylvia Guendelman, Ph.D., M.S.W., professor of community health and human development, and Brenda Eskenazi, Ph.D., professor of epidemiology and maternal and child health, received support from the Health Resources and Services Administration for a multidisciplinary program dedicated to developing and training maternal and child health leaders to conduct research and provide maternal and child health services at regional, state, and national levels. Jodi Halpern, M.D., Ph.D., associate professor of bioethics in the UC BerkeleyUCSF Joint Medical Program, has been selected as one of three Greenwall Faculty Scholars Program recipients in Bioethics. The Greenwall Faculty Scholars Program in Bioethics is a career development award that allows faculty members to conduct original research that will help resolve important policy and clinical dilemmas at the intersection of ethics and life sciences. The award includes three years of research support. S. Katharine Hammond, Ph.D., C.I.H., professor of environmental health sciences, is principal investigator of “Evaluation of the Effect of Changes Made in Response to the Respiratory Health Study in the New NUMMI Assembly Plant,” supported by New United Motor Manufacturing, Inc. (NUMMI). The project is a follow-up to an earlier study conducted in 2000–2001 by the University of California Northern Center for Occupational and Environmental Health, which found increased respiratory symptoms among NUMMI team members who worked in the body shop. As a result of the earlier study, the ventilation was increased in the body shop, and this new grant will evaluate the effectiveness of the changes through a survey of the ventilation system and administration of a follow-up respiratory symptom questionnaire.

Eva Harris, Ph.D., associate professor in the Division of Infectious Diseases, has received support from the International Vaccine Institute for “A Murine Model for Dengue Virus Infection and Disease.” The project’s major goals are to develop a model for secondary dengue virus infection, and evaluate changes in the in vivo cellular tropism, viral load, kinetics of viral infection, and immune response upon secondary infection. Susan Ivey, M.D., associate adjunct professor in the Division of Community Health & Human Development, is president-elect of the American Medical Women’s Association, an organization of 10,000 women physicians and medical students dedicated to serving as the unique voice for women’s health and the advancement of women in medicine. William J. Jagust, M.D., professor of public health and neuroscience, has been awarded the University Endowed Chair in Geriatrics for the Berkeley campus. The new chair is part of the UC Academic Geriatric Resource Program, authorized by the California Legislature in 1984 as a mechanism for developing new initiatives in geriatrics, gerontology and other disciplines related to aging. Thomas McKone, Ph.D., adjunct professor of environmental health sciences, received support from the State of California Air Resources Board for “Quantifying Pollutant Emissions from Office Equipment,” a study of the chamber concentrations of air pollutants emitted by major categories of distributed office equipment. Public Health

Faculty News

Faculty News and Notes, continued SPH researchers have found that a new blood-based tuberculosis (TB) test is as useful as the traditional tuberculin skin test in a head-to-head match-up between the two methods of detecting latent infection. The results of the study mean that switching to the more expensive blood test may not be necessary for people in India. Madhukar Pai, Ph.D. ’04, is the study’s lead author; other School of Public Health coauthors include John Colford, Jr., M.D., Ph.D., M.P.H., associate professor of epidemiology, Lee Riley, M.D., professor of infectious diseases, and Arthur Reingold, M.D., professor of epidemiology. The results of the study were published in a special June 8, 2005, theme issue on tuberculosis in the Journal of the American Medical Association. Mark Nicas, Ph.D., C.I.H., adjunct associate professor of environmental health sciences, and Michael P. Wilson, Ph.D. ’03, M.P.H. ’98, assistant research scientist, received support from the Bodycote Group for “Preventing Worker Fatalities in Confined Spaces: Evaluating the OSHA Confined Space Entry Standard.” The study examines the root causes of occupational confined space fatalities in California and the rest of the U.S. in the post-federal OSHA standard era (1993 to the present). Nicas is principal investigator and Wilson is project manager. The Nicholas C. Petris Center on Health Care Markets and Consumer Welfare recently released a report, Uninsured Californians and Access to Prescription Drugs. California is currently considering a number of bills and propositions, including competing propositions on the November special election ballot, Propositions 78 and 79, as well as Senate Bill 19 and Assembly Bill 75, which address the lack of access to prescription drugs for the uninsured. To help inform the discussion of the proposed legislation, this report examines various methods for defining the number of uninsured Californians and the programs, both 28

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public and private, that are available to provide assistance to those who are unable to afford prescription drugs. The report examines data from the California Health Interview Survey, the Current Population Survey, the Behavioral Risk Factor Surveillance Survey, and the National Survey of America's Families to estimate the number of uninsured in the state. It also looks at the uninsured population by age, federal poverty level, gender, county, and race. The National Women’s Health Network (NWHN) has honored Cheri Pies, Dr.P.H., M.S.W., lecturer in the Division of Community Health & Human Development, for her achievements in the field of women’s health. As part of the organization’s “30 for the 30th” project honoring its 30th anniversary, it recognized 30 activists who best represented the variety of people and issues addressed by the women’s health movement. “Cheri Pies has never shied away from addressing controversial topics. She has written about issues related to lesbian parenting, bioethics, and reproductive health.…Cheri makes it a priority to apply her vision of social justice to her work in women’s health,” states NWHN’s web site. Pies currently directs the Family, Maternal, and Child Health programs of Contra Costa County, California. Traffic Safety Center director David Ragland, Ph.D., M.P.H., and colleagues recently published two reports. The first, Pedestrian and Bicycle Safety Evaluation for the City of Emeryville at Four Intersections: Powell and Frontage, Powell and Route I-80, Powell and Christie, and Christie and Shellmound, was commissioned by the City of Emeryville. The project included field observations, intercept surveys and community forums. The second was the

final report of Phase I of the center’s Latino Traffic Safety Project, funded by the California Office of Traffic Safety. This project consisted of an extensive literature and best practices review, focus groups in urban and rural regions of the State, and convening of stakeholders on this issue of traffic safety in Latino communities in California. The Traffic Safety Center also received support from Caltrans to research and analyze twenty years of workplace injuries among Caltrans employees, with the goal of assisting Caltrans with promising approaches to reducing employee accidents and injuries. Thomas Rundall, Ph.D., Henry J. Kaiser Professor of Organized Health Systems, received the Filerman Prize for Innovation in Health Care Management Education from the Association of University Programs in Health Administration (AUPHA). The award was presented this past June at the AUPHA annual meeting in Boston. The prize recognizes individuals from AUPHA member programs who have made outstanding contributions to the field of health care management education, exhibited leadership in the field, and enriched their institutions, their students, and their field through their work. William Satariano, Ph.D., M.P.H., professor of epidemiology and community health, has authored Epidemiology of Aging: An Ecological Approach, a book published by Jones and Bartlett Publishers. It provides a comprehensive overview of the leading topics in

Faculty News

the epidemiology of aging, such as physical functioning, depression, and survival with the ecological model. Using this ecological model, Satariano highlights the causes and consequences of the aging population and illustrates that all of the topics are interrelated. The model is being used increasingly by national and international health bodies to characterize the multidisciplinary nature of research and practice in public health. Richard M. Scheffler, Ph.D., Distinguished Professor of Health Economics and Public Policy, and director of the Nicholas C. Petris Center on Health Care Markets & Consumer Welfare, has received funding from the National Institute of Mental Health for a new postdoctoral Mental Health Economics Training Program. He has also received funding from the University of California Tobacco-Related Disease Research Program for “Effects of Social Capital on Smoking: Elasticities and Pathways,” a two-year study on how community social capital (CSC) influences individual smoking behavior. CSC is a concept originally developed from sociology and political science, and represents the level of participation in civic, social, or religious organizations within a community. In this study, CSC is hypothesized to affect health through three possible pathways: political processes that bring health-promoting resources to the community; likelihood of access to social and psychological support; and diffusion of information and attitudes about smoking. In addition, Scheffler coauthored “Millionaires and Mental Health: Proposition 63 in California,” with Neal Adams, special projects director at the California Institute of Mental Health. Published in the May, 2005, isssue of Mental Health, the article analyzed the

election results for Proposition 63, a landmark California law funding mental health with a tax on those making more than $1 million a year. They found that counties that voted in support of the ballot measure were more likely to have a higher percentage of registered Democrats, a higher number of registered social workers per capita, and a higher rate of homelessness than those that did not vote in favor of the proposition, and that the measure had more support in urban and coastal areas. The Petris Center has received funding from The California HealthCare Foundation to undertake a three-year study to monitor and report on the implementation of Proposition 63. Kirk R. Smith, Ph.D., M.P.H., Brian and Jennifer Maxwell Endowed Chair in Maternal and Child Health and professor of environmental health sciences, received support from the Shell Foundation for “Promotion of Technology Innovation and Dissemination for High-Efficient, LowEmissions Biomass Household Stoves in China and Abroad,” a joint project with the China Association of Rural Energy Industry and the School of Public Health’s Center for Entrepreneurship in International Health and Development, with the primary objective of identifying the most promising high-efficiency, low-emissions biomass stove technologies and the best enterprises innovating in this field. The project will also identify subsequent export opportunities for these products in developing countries outside of China. S. Leonard Syme, Ph.D., professor emeritus, published an article in the April 19, 2005, issue of Epidemiologic Perspectives and Innovations discussing his experiences in the early days of research on social determinants of disease. The article is based on a lecture he delivered at Columbia University's Mailman School of Public

Spear Receives China’s Friendship Award

Robert C. Spear, Ph.D., professor and chair of the Environmental Health Sciences Division, was honored by the People’s Republic of China with the state-level Friendship Award, in recognition of his work to understand, monitor, and control the spread of the water-borne parasitic disease schistosomiasis in rural communities in China. Inaugurated in 1981, the Friendship Award is the highest recognition given by China to foreign experts for their contributions and dedication to the training of Chinese personnel, as well as China’s social development and economic, scientific, technological, educational, and cultural construction. The award letter commends Spear for his hard work and thanks him for promoting cooperation and friendship between the United States and China. Spear is one of 50 international recipients of the 2005 award, which was presented by Chinese Vice Premier Wu Yi at a ceremony in Beijing on September 29. After the event in Beijing, Spear traveled to Sichuan Province, where his nomination for the national award originated, for a provincial reception.

Public Health

Faculty News

Faculty News and Notes, continued publication. Two of his former students, Sir Michael Marmot, Ph.D. ’75, M.P.H. ‘72 and Irene Yen, Ph.D. ’97, M.P.H ’90, published comments in subsequent issues.

At the 2005 Joint Statistical Meeting in Minneapolis this past August, Mark van der Laan, Ph.D., who holds the Jiann-Ping Hsu and Karl E. Peace Endowed Chair in Biostatistics, received the 2005 Presidents’ Award, given annually by the Committee of Presidents of Statistical Societies to a young member

of the statistics community in recognition of extraordinary merit. The committee recognized van der Laan’s work in several areas of theoretical and applied statistics, including causal inference in longitudinal studies and computational biology. Van der Laan and Nicholas Jewell, Ph.D., professor of biostatistics and statistics, received the prestigious 2005 George W. Snedecor Award for an outstanding publication in biometry. The award recognizes an individual who has been instrumental in the development of statistical theory in biometry. Jewell and van der Laan were honored for their paper, “Case-control current status data,” which appeared in a 2004 issue of the journal Biometrika.

In addition, van der Laan was named 2005 Myrto Lefkopoulou Distinguished Lecturer by the Department of Biostatistics at the Harvard School of Public Health. Each year the lectureship is awarded to a promising statistician who has made contributions to either collaborative or methodologic research in the applications of statistical methods to biology or medicine and/or has shown excellence in the teaching of biostatistics. In September 2005, van der Laan presented a lecture at the Harvard School of Public Health, titled, “History Adjusted Marginal Structural Models: Applications in AIDS Research.”

Dow Starts Term as Senior Adviser on Presidential Council William H. Dow, Ph.D., associate professor of health economics, began a oneyear stint in Washington, D.C., serving as a senior health economist advising members of President Bush’s Council of Economic Advisors (CEA). Dow is one of nine senior staff economists advising the three-member council on specific sectors of the economy. The CEA was established by the Employment Act of 1946 to provide the president with objective economic analysis and advice on the development and implementation of a wide range of domestic and international economic policy issues.

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“Serving at the CEA is a tremendous opportunity to observe and participate in the policy-making process,” says Dow. “The CEA plays a unique role in the internal White House policy process given that it is staffed by academics and, as such, its role has historically been to provide objective economic analysis. That advice is not always welcomed, particularly when it conflicts with political interests. Working on health care will be particularly exciting in light of the magnitude of the challenges this nation faces, such as soaring health care costs and high rates of uninsured.” Dow’s background is in health policy, both domestic and international, particularly as it relates to health insurance. He received the 2001 John D. Thompson Prize for Young Investigators,

awarded by the Association of University Programs in Health Administration. He also won the 8th Annual Kenneth J. Arrow Award, given by the International Health Economics Association for the best health economics paper published worldwide in 1999. He earned his Ph.D. in economics from Yale University. Before coming to UC Berkeley, Dow was an assistant professor of health policy and administration at the University of North Carolina at Chapel Hill, and a National Institutes of Health postdoctoral fellow at RAND. He is also a faculty research fellow at the National Bureau of Economic Research.

Faculty News

Meet the New Faculty Lia Fernald, Ph.D. Assistant Professor, Public Health Nutrition, Community Health & Human Development

When she was an undergraduate at Swarthmore College, Lia Fernald spent a semester in Kenya studying wildlife behavior and ecology. “At that time, I thought I wanted to go into animal behavior,” says Fernald. “ But when I saw what extreme poverty people lived in, that was a turning point for me. I said, ‘I can’t let this happen. I can’t live in a world where people are living in such extreme poverty that they don’t have any food to give their children.’” After receiving her bachelor’s degree, Fernald won a Fulbright award to study public health in Jamaica, where she looked at malnutrition and its link with child development. “I worked with Sally McGregor, who is really a pioneer in this area of linking nutritional deficiencies with cognitive outcome,” she says. When McGregor went to the University of London, Fernald went with her, supported by a predoctoral fellowship from the National Institutes of Health (NIH), and earned her Ph.D. there. But research for its own sake didn’t satisfy her. “I felt it was all going into journals and it wasn’t turning into action,” she says. “I was alarmed by the fact that Coke can get anywhere in the world—you go to a rural village in Kenya and there’s Coke—so how come we can’t get micronutrients to those villages? I started thinking, how can we use the power of economics and business?” Fernald then began pursuing her M.B.A., which she earned at UC Berkeley’s Haas School of Business. There she worked with Paul Gertler, professor of economics at the Haas School and professor of health services finance at the School of Public Health, who was engaged in a project in Mexico that looked at child development. Fernald designed the child development outcome measures for the study; then, with funding from the NIH’s Fogarty International Center, she added components examining mental health and stress. She continues to work on this and other projects in Mexico. Fernald’s research focuses on inequalities in health and how variations in socioeconomic status contribute to adverse nutritional outcomes in children and adults. “I’ve been working for the past four years on a very innovative welfare program in Mexico that ties economic incentives with behavioral change, so families are given unconstrained cash transfers and then are required to go to the doctor and keep their kids in school,” she says. “We’re talking

about people who live on less than two dollars a day, so a thirty percent increase in their income is really quite substantial. Giving people health benefits may or may not result in behavioral change. Giving people cash with which they can do whatever they want—it’s a huge motivator.” She also has been consulting with the governments of Ecuador, Chile, and Colombia, all of whom have replicated parts of the program. Fernald joined the faculty in fall 2005 and will begin teaching in spring 2006. “The main draw for me was the integrated thinking at the School of Public Health,” she says. “I really resonate with the ecological model. My work has always been multidisciplinary…and I think that’s the only way to find solutions— through looking at the intersections.”

“I was alarmed by the fact that Coke can get anywhere in the world—you go to a rural village in Kenya and there’s Coke—so how come we can’t get micronutrients to those villages?” Education Postdoctoral Fellow in Health Economics, National Institute of Public Health, Mexico and UC Berkeley, 2001–2003 M.B.A., Haas School of Business, UC Berkeley, 2000 Ph.D., Clinical Medicine, with focus on International Nutrition, University of London, 1999 B.A., Swarthmore College, Biological Anthropology and Food Policy, 1994

Consultant to Governments of Mexico, Colombia, Ecuador and Chile, 2003–present Network Associate, MacArthur Research Network on Socioeconomic Status and Health, 2002–present Selected Honors NIH International Research Scientist Development Award, 2002–2006 Young Scholars Award, American Psychosomatic Society, 2004

Selected Experience Assistant Professor, School of Public Health, UC Berkeley, 2005–present

NIH Pediatric Research Loan Repayment Award 2002–2004

Assistant Adjunct Professor, Department of Medicine, UCSF, 2004–05

Fulbright Fellowship 1994–1995

NIH Pre-doctoral Fellowship, 1995–1998

Consultant to World Bank Obesity Task Force and Child Development Group, 2004–present

Public Health

Faculty News

Meet the New Faculty Richard Jackson, M.D., M.P.H. ’79 Adjunct Professor, Environmental Health Sciences and Health Policy & Management

“In public health, the patient is the population, and our patient has a systemic disease, one aggravated by the environment we live in,” says Dr. Richard Jackson, new adjunct faculty at the School of Public Health. “The illnesses we face are not random events. When a patient has a systemic disease, we need to find and treat the root causes, not just the blister or the fever.” Jackson attributes some of his passion for public health to his father’s death from polio when Jackson was young. After working as a pediatrician and an epidemiologist, he earned a master’s degree in public health from Berkeley in 1979. He served as the director of the National Center for Environmental Health, and then as senior adviser to the director at the Centers for Disease Control and Prevention. In 2004, he was appointed state public health officier and chief deputy director of the California Department of Health Services. Throughout his career, Jackson has worked on a broad range of environmental health issues, from pesticides in food to bioterrorism investigation. In the past several years, Jackson has received substantial acclaim for his work on the built environment and health. His research examines many aspects of urban planning, from the amount of parkland in a neighborhood, to whether children are able to walk or ride a bicycle to the local school. He plans to continue this research at Berkeley and further investigate how neighborhoods and transportation systems can be designed to encourage physical activity and other healthy practices. “Environmental changes can have major impact on behavior,” he says. He argues that designing communities that allow for physical activity benefits everyone, from children, to the elderly and people with disabilities. “What is so special about public health is that you are also expected to analyze the chain of causes leading to disease in order to put in place prevention efforts. Yes, the obesity epidemic is partly because we human beings don’t always have the self-discipline and willpower that we need, but largely the epidemic originates from an unhealthy environment—a dangerous nutritional, advertising, and built environment. A nutritional environment where school children are encouraged to consume abundant amounts of junk food in the very place where they need to learn and prepare for their future; a 32

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built environment that makes it hard to walk, run or play.” Jackson is enthusiastic about working with students at the School. “We need to develop the next generation of public health workers. The challenges we face in the twenty-first century are so profound and overwhelming… People who think of public health in a narrow, textbook way are not going to be prepared for these challenges. The most important thing we can do now is to prepare leaders that can step up.”

“Yes, the obesity epedemic is partly because we human beings don’t always have the selfdiscipline and willpower that we need, but largely the epidemic originates from an unhealthy environment.”

Education M.P.H., Epidemiology, School of Public Health, UC Berkeley, 1979

Selected Honors Alumnus of the Year, School of Public Health, UC Berkeley, 2005

M.D., School of Medicine, UCSF, 1973

Presidential Distinguished Rank Award, 2005

M.M.S., Rutgers Medical School, 1971

Presidential Citation, American Institute of Architects, 2004

B.A., Biology, St. Peter’s College, 1969

Commendation from the Governor, State of Hawaii, 2004

Selected Experience Adjunct Professor, School of Public Health, UC Berkeley, 2005–present State Public Health Officer and Chief Deputy Director, California Department of Health Services, 2004–2005 Senior Adviser to the Director, Centers for Disease Control and Prevention, 2003–2004 Director, National Center for Environmental Health, 1994–2003

Champion of Environmental Public Health, Centers for Disease Control and Prevention, 2003 Health and Human Services Secretary’s Award for Distinguished Service The World Trade Center Anthrax Investigation and Response Team, 2002 Calver Award, American Public Health Association, 2001 Presidential Citation, National Environmental Health Association, 2001

Faculty News

Amani Nuru-Jeter, Ph.D., M.P.H. Assistant Professor, Community Health & Human Development and Epidemiology

“For so long, we have focused on identifying the determinants of health,” says Amani Nuru-Jeter, assistant professor in the divisions of Community Health & Human Development and Epidemiology. “Now we need to know where to intervene. We know that race matters and that class matters. As we think about the complexities of how race and class interact, we need to better understand the pathways through which these determinants affect health differently for different social groups and how we can intervene at both the community and policy levels to affect change.”

Disparities in Health, the Centers for Disease Control, the Divisions of Public Health in Berkeley and Sacramento, and the San Francisco Department of Public Health, is to examine the possible link between racism as a chronic psycho-social stressor and pregnancy outcomes. In another project, Nuru-Jeter is working with researchers at UCSF and the Kaiser Division of Research to analyze the relationship between perceived discrimination, racial differences in allostatic load, and low birth weights. Allostatic load is the physiologic marker for stress, and is tied to health risk factors such as diabetes, atherosclerosis, a suppressed immune system, and decreased memory function. The study uses data from the Coronary Artery Risk Development Study in Young Adults, a longitudinal community-based sample with participants recruited from Oakland; Minneapolis; Chicago; and Birmingham, Alabama.

Nuru-Jeter’s research examines the links between social inequality and racial disparities in health. Previously, as a Robert Wood Johnson Health and Society Scholar at the UCSF Center for Health and Community and the UC Berkeley School of Public Health, her research examined social contexts and health, and how factors such as racial segregation of neighborhoods and concentrations of poverty influence the health of populations. Now she has combined this work with a more individual-centered approach, and is looking at the ways in which the social and structural aspects of environments interact with biological processes to effectively alter states of health and influence racial health inequalities.

An interdisciplinary approach is the foundation of much of Nuru-Jeter’s research. She works with epidemiologists, psychologists, sociologists, and cultural anthropologists for much of her research, and more broadly, believes in the importance of collaboration between academia, community, and public health agencies to develop pragmatic and sustainable interventions for improving public health.

Education

Selected Honors

“I’m interested in the process by which social factors such as racism ‘get under the skin,’ and in understanding the psychophysiologic mechanisms involved in the production of health both across and within social groups,” says Nuru-Jeter. “I’m looking at how repeated and prolonged exposure to social stressors such as racism can keep people cycling through the stress response process, and how that influences health.”

Ph.D., Health Policy and Management, Johns Hopkins University, 2003

University of Pittsburgh Center for Minority Health (Project EXPORT), Summer Research Career Development Institute, June 2005

“It is easy for us to go into a community and say, ‘You need to lower your blood pressure,’” says Nuru-Jeter, “but we also need to be mindful of the challenges people face, and how social factors, such as the availability of healthy food options and safe space for outdoor activity, influence health outcomes.” Nuru-Jeter is addressing these questions in a number of ways. For one project, she conducted focus groups with African American women, in order to develop a comprehensive diagnostic tool for measuring the perception and experience of racism. The long-term goal of the project, developed in collaboration with researchers at the UCSF Center on Social

M.P.H., Maternal and Child Health, George Washington University, 1998 B.S., Biology, University of Maryland, 1995 Selected Experience Assistant Professor, School of Public Health, UC Berkeley, 2005–present Robert Wood Johnson Postdoctoral Fellow, University of California, Berkeley and San Francisco, 2003–2005

Student Investigator Award, Black Young Professionals Public Health Network, November 2003 Minority Health Award, The Johns Hopkins University, Bloomberg School of Public Health, 2002 Victor P. Raymond Award in Health and Public Policy, Johns Hopkins Bloomberg School of Public Health, 2001 Washington Institute of Israel Health Policy Research Internship & Scholarship, Ministry of Health, Jerusalem, Israel, 1998

Public Health

Partners in Public Health

Policy Advisory Council Welcomes Terri Carlson School of Public Health Policy Advisory Council Margaret Cary, M.D., M.B.A., M.P.H. (Chair) Deputy Chief Business Officer for VA+ Choice, Veterans Health Administration Raymond J. Baxter, Ph.D. National Senior Vice President, Community Benefit, Kaiser Foundation Health Plan and Hospitals Larry Brilliant, M.D., M.P.H. Founder and Chair, Seva Foundation Terri Carlson, M.P.H. ’84 UC Berkeley Parents Fund Peter F. Carpenter, M.B.A. Founder, Mission and Values Institute Alfred W. Childs, M.D., M.P.H. ‘64 Physician Linda Hawes Clever, M.D., M.A.C.P. Chief, Occupational Health, California Pacific Medical Center Founder, RENEW Abla A. Creasey, Ph.D. ’78 Vice President, Biological Sciences, ALZA Corporation Lauren LeRoy, Ph.D. President and CEO, Grantmakers in Health Leslie Louie, Ph.D. ’90, M.P.H. ’85 President, Public Health Alumni Association Director, School-Based Health Clinics and Practice Administrator, Children’s Hospital and Research Center at Oakland Nancy K. Lusk Chairman of the Board, The Lusk Company Martin Paley, M.P.H. ’58 Management Consultant Arnold X. C. Perkins Director, Alameda County Public Health Department J. Leighton Read, M.D. General Partner, Alloy Ventures L. James Strand, M.D., M.B.A. General Partner, Institutional Venture Partners Kenneth S. Taymor, Esq. Attorney-at-Law, MBV Law LLP Barbara S. Terrazas, M.P.H. ’76 Director, Planning , Development, and Policy Tiburcio Vasquez Health Center, Inc. 34

University of California, Berkeley

“My passion is public health. That’s something my husband and I are dedicated to—so it’s an honor for me to serve.” Terri Carlson, M.P.H. ’84, is the newest member of the School of Public Health Policy

Advisory Council. An alumna of the School, Carlson earned her M.P.H. from Berkeley in 1984 and her bachelor’s degree in nursing from the University of Oregon Health Sciences Center in1978. She is married to John R. Carlson, M.D., a gastroenterologist and Berkeley alumnus. Their two sons both attend UC Berkeley. The Carlsons enjoy participating in the advisory board for the Cal Parents Fund, which provides the chancellor with flexible funding to invest in student programs and resources to support students. Terri’s work on behalf of Cal has included coordination of a “Discover Cal” event and a Cal Aquatics event, both in Southern California. She has also has also contributed her time and expertise as a volunteer for many other non-profit fundraising projects in northern and southern California, including educational institutions and health care institutions. Before raising her family, she worked in critical care nursing at UCLA and Cedars Sinai Medical Centers in Los Angeles and in London, England, among the National Heart Hospitals, particularly Brompton Hospital. She also worked as an independent management consultant on various West Coast hospital strategic planning projects, as well as serving as a functional and space programming consultant to Anshen + Allen Architects on a variety of hospital projects. Carlson is enthusiastic about the School’s collaborations with other departments and campuses, such as the combined master’s in public health and M.D. program with UCSF, and their potential for raising funds and capability and heightening public awareness. “My passion is public health,” she says. “That’s something my husband and I are dedicated to—so it's an honor for me to serve.”

Our Graduates are Trained to Tackle Complex Health Challenges “In my work with Cal/OSHA, enforcing occupational safety and health regulations, I am continually reminded that there is much yet to be done to improve the working conditions for men and women in California. Despite the many technological advancements of our age, workers are still exposed to a variety of hazards in the workplace that can leave them sickened, poisoned, crippled or dead. “The multidisciplinary training I received at the School of Public Health still forms the cornerstone of my ability to recognize and evaluate these hazards, whether they are chemical, physical or biological. Likewise, the broad education that today’s students receive at the School enables them to go out into the world and tackle some of the most difficult and complex public health challenges. “When I hear about the amazing work being done by students, alumni and faculty of the School, in Berkeley and around the globe, I feel proud to be a part of that work. I give to the Annual Fund out of my gratitude to the School, and to enable this work to continue.”

—Susan Eckhardt, M.P.H. ‘85 Industrial Hygienist Cal/OSHA Enforcement

Support the Annual Fund Your tax-deductible contribution to the School of Public Health ensures the viability of valuable School of Public Health programs, such as scholarships and recruitment efforts. Support the future of public health. Give online at http://sph.berkeley.edu/giving/how.htm or mail your gift (payable to the “School of Public Health Fund”) to: University of California, Berkeley School of Public Health External Relations & Development 140 Earl Warren Hall #7360 Berkeley, CA 94720-7360

For additional information about making a gift to the School, call Pat Hosel, Assistant Dean, External Relations and Development, at (510) 642-9654.

Public Health

A Time For Giving and Receiving Consider A Life Income Gift

Are you interested in supporting the School of Public Health while also supporting yourself?

Consider making a “life income gift” to Cal. These life income gifts, which begin at $10,000, provide the following benefits: • Income payments to you for your lifetime; • Avoidance of capital gains tax at the time of the gift if appreciated assets are donated; • A current income tax charitable deduction; and • The knowledge that your gift will ultimately benefit the School of Public Health. For more information, and a proposal prepared for your own situation, please contact the Office of Gift Planning at: (800) 200-0575 or (510) 642-6300.

UC Berkeley Sample Charitable Gift Annuity Rates:

University of California, Berkeley

Single-Life Charitable Gift Annuity Rates

Two-Life Charitable Gift Annuity Rates

Age

Payment Rate

Spouse 1

Spouse 2

Payment Rate

60 65 70 75 80 85 90 and over

5.7 6.0 6.5 7.1 8.0 9.5 11.3

60 65 70 75 80 85 90 95 and over

5.4 5.6 5.9 6.3 6.9 7.9 9.3 11.1

Alumni News

President’s Message Greetings Fellow Alumni, I’m honored to be serving you as president of the Public Health Alumni Association board of directors. Lots of changes are happening in the School of Public Health that make this an exciting place to be. The School is addressing health disparities by building more support for increasing diversity among students and faculty. The Center for Public Health Practice is developing a career center, which will benefit both students and alumni. Plans are underway to build a new home for the School—a huge project that presents many challenges. And so I’m excited to be working with an energetic board, which has already set high expectations for what we want to accomplish. During our summer planning retreat, we set an ambitious agenda for ourselves in which we outlined four major goals. One of these is to increase alumni engagement in School and board activities. I have personally found many opportunities for networking, professional development, socializing, and mentoring students—all of which have been rewarding—and I invite you to join me. With all of the changes and activities happening in the School, you can keep updated by signing up on the @cal web site (sphalum.berkeley.edu). We want to create and monitor the policies and procedures necessary for the board to conduct its business. In this time of change, our mission and bylaws need to be revisited. How should we focus our energies? Whom are we serving? How well are we doing it? Once we revisit these issues, we will need to have our membership (you!) give us feedback and vote on any changes. So we decided to bring back our Spring Brunch to hold our annual business meeting where you will get to voice your opinion—stay tuned for more details. Of course, you can give us feedback during the process if you want to join this committee. At the Spring Brunch you will also get to meet the student recipients of our PHAA scholarships, which this year includes several Reshetko Family Endowed Scholarships of $10,000 each, through the generous gift of Lola Reshetko, cousin of recent board member, George McKray. To further support both students and alumni, we want to collaborate with the Center for Public Health Practice to provide a link between teaching, research, and the practice of public health. This includes active participation in increasing diversity in the School as well as in other health professions, and supporting activities such as the career center, conferences for professional development, and the UC Berkeley Wellness Letter. Finally, we want to support the School and Dean Shortell by helping to develop a financial base that supports board business, student scholarships, and other priorities. While we have limited capacity for fundraising, we can increase efforts to enhance alumni membership and activity, increase awareness of the issues that the School faces, and give our feedback on School priorities. You can see that we have several areas that are key to the future of our alma mater and I invite you to join us in supporting these efforts. Board membership not required!

Leslie Louie

Public Health Alumni Association Board of Directors 2005–2006 Leslie Louie, Ph.D. ’90, M.P.H. ’85 (President) Carol A. Clazie, B.S. ’62 (Vice President) James H. Devitt, M.P.H. ’77 (Secretary-Treasurer) John W. Eastman, Ph.D., M.P.H. ’80 (Immediate Past President) Philippa Barron, M.B.A., M.P.H. ’94 Lucinda Brannon Bazile, M.P.H. ’94 Julie M. Brown, M.B.A, M.P.H. ’85 Brandon DeFrancisci, M.P.H. ’96 David Harrington, M.P.H. ’88 Paul R. Mico, M.P.H. ’58 Lisa Tremont Ota, M.A., M.P.H. ’90 Beth Roemer, M.P.H. ’76 Jan Schilling, M.P.H. ’91 Alan R. Stein, M.P.H. ’78, M.S., M.F.T. Sarah Stone-Francisco, M.P.H. ’03 John Troidl, Ph.D. ’01, M.B.A.

Yours truly,

Leslie Louie, Ph.D., ’90, M.P.H. ‘85 President, Public Health Alumni Association

Public Health

Alumni News

Alumna Spotlight: Sunne Wright McPeak, M.P.H. ‘71 As a master’s student in health education at the School of Public Health, Sunne Wright McPeak learned how to collect information by going directly into communities. She credits this education— the knowledge of how to survey her constituency—with helping her win election to the Contra Costa County board of supervisors, where she served for from 1978 to 1993, including several terms as chairman.

Appointed secretary of the Business, Transportation and Housing Agency by Governor Arnold Schwarzenegger in November 2003, McPeak directs California’s largest government agency.

“I was always interested in health,” says McPeak, who grew up on a dairy farm in rural Livingston in the San Joaquin Valley and received her bachelor’s degree in international medicine at UC Santa Barbara. “It seemed to me it would be tough to make the world well one patient at a time. I had studied public policy in college; I thought an M.P.H. degree would bring it all together.” As a Contra Costa County supervisor, she became known as a leader on state water policy and was one of the earliest advocates for promoting regional solutions to Bay Area policy challenges. “In 1979 I created the first HMO with licensure from the state,” she says. “That was a direct result of my training at UC Berkeley.” Under her leadership, the county was also ahead of its time in its efforts to curb tobacco use. “In 1985, the Tobacco Institute called Contra Costa County and me the ‘lunatic fringe’ for pushing tobacco-free efforts,” she recalls. Appointed secretary of the Business, Transportation and Housing Agency by Governor Arnold Schwarzenegger in November 2003, McPeak directs California’s largest government agency. Her 16 departments include such complex organizations as Caltrans, the California Highway Patrol, Department of Motor Vehicles, and the Department of Corporations. McPeak notes that her education at the School, which taught her to look at

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inputs and outcomes and to consider environmental quality and economic status, has shaped her approach to her work. Also, she says, she is able to use health data to enlighten policy discussions. “I am fully integrating and mobilizing to save lives,” says McPeak about her current post, citing such successes as seatbelt compliance. “Last holiday season, there was a 26 percent reduction in deaths on the highways. In 2005 to date, there has been a reduction of 14 percent—35 percent in incorporated areas of cities.” Prior to leading the Business, Transportation and Housing Agency, McPeak was president and CEO of the Bay Area Council, where she established and led major regional initiatives that addressed policy challenges involving transportation, housing, sustainable economic development, water policy, telecommunications infrastructure, and education and workforce preparation. Before joining the Bay Area Council in November of 1996, she served for three years as president and CEO of the Bay Area Economic Forum, a partnership formed in 1988 by the Bay Area Council and the Association of Bay Area Governments to facilitate public-private collaboration for promoting the regional economy. McPeak has been honored by more than 30 organizations and was named a "Women Who Could be President" honoree in 1997 by the League of Women Voters of San Francisco. The San Francisco Business Times has named her one of the 100 Most Influential Women in Business in 1998, 1999, 2000, 2001, 2002, and 2003. She is the recipient of the 2000 California Water Policy H2O Leadership Award. Recently, California State University, Hayward, and the board of trustees of California State University awarded her an honorary doctorate in humane letters. —Michael S. Broder

Alumni Alumni News News

Alumna Spotlight: Sandra Shewry, M.S.W., M.P.H. ’81 Sandra Shewry was a student at the School of Social Work at UC Berkeley when she took a class taught by Professor Emeritus Henrik Blum of the School of Public Health. “It was a class in health planning,” remembers Shewry. “It changed my life—Dr. Blum’s warmth and passion, and the sense of empowerment I gained through understanding the determinants of health (biology, behavior, and the environment) and the important but modest contribution of health care services to improved health outcomes.” Blum’s course helped Shewry see public health as a field for enacting social change. She went on to earn her M.P.H. at the School.

Shewry has worked on many aspects of policy in public health. She began her career with the state as a health planning analyst more than 20 years ago. She was the director of health at the National Governor’s Association’s Center for Best Practices. She also served as executive director of the California Managed Risk Medical Insurance Board, where she worked on developing and implementing California’s high risk pool, a subsidized pregnancy coverage program, a small employer purchasing cooperative, and the state’s Healthy Families. In 2004, Governor Schwarzenegger appointed Shewry director of California’s State Department of Health. In this position, she leads a staff of 6,000 and is responsible for the expenditure of over $37 billion in public funds. As a policy maker, Shewry looks for ways to advance the department’s mission of protecting and improving the health status of Californians. This year’s top priorities range from improving the state’s ability to detect and respond to public health emergencies—be they manmade or naturally occurring—to advancing policy that addresses the obesity epidemic, to expanding enrollment

of Medi-Cal members into organized delivery systems. “The way we have approached obesity is a good example of our approach to prevention,” says Shewry. “We support healthy eating, regular physical activity, and responsible personal choices. That being said, we know that people make choices within a context. We are looking at policy levers that create the kind of environment in which it is easy, natural and accepted for each of us to live a healthier life. We have moved away from looking at obesity and inactivity as simply a matter of personal choice, and look at environmental influences. People make personal choices within a context. The governor’s signature on the laws that will remove junk food and soda from school campuses and put more fruits and vegetables into school meals are examples of environmental changes that reinforce healthy living.” Shewry cites the importance of using multiple strategies for dealing with health issues, and assessing and evaluating those strategies. “The state has done a fabulous job on the challenge of teen pregnancy,” she says. “We have built many community partnerships and collaboratives. With a public health issue as complex as teen pregnancy, you need many ways of addressing the problem: strategies to influence community norms, community programming, and clinical services. The results are impressive: Teen pregnancy rates in this state have dropped significantly. We believe it is due to the comprehensive and sustained approach we have adopted.”

In 2004, Governor Schwarzenegger appointed Shewry director of California’s State Department of Health.

“I would advise more public health students to try public service,” she says. “The Department of Health Services is involved with the policy-related issues impacting the health of our state. We serve at the intersection of big picture policy decisions and daily implementation of programs and policies. I encourage students to consider a career in public service—it is a chance to make a contribution to improving the health status of Californians.” —Kelly Mills

Along with emergency preparedness, Shewry sees workforce recruitment as one of the primary challenges facing the public health system. “We have a generation of fabulously talented baby boomers who are now retiring. We need to find ways to bring people into the field.”

Public Health

Alumni News

Alumni Notes 1940s

1970s

Flora Everding Maclise, B.S. ’43 “I’ve digressed from public health a bit to teaching and helping run nature education projects for children and adults during the last 30-plus years. UC public health education has been invaluable in this field!”

Tommie J. Haywood Pippins, M.P.H. ’71 “After 31 years, retired as nurse practitioner from Alameda County Health Care Services.”

1950s Norman L. Roberts, Jr., M.P.H. ’55 “After 37 years at Baptist Health and three years visiting Southern Baptist Hospital and churches in India, Indonesia, and Germany, we nested back in North Little Rock for nine years. Recently we moved to Parkway Village, a Baptist Health Retirement Community. We are attempting to be the youngest people here and are having some success.” Laverne “Gerry” Borg, M.P.H., B.S. ’52, and Jane Wood Borg B.S. ’53, are retired and live in Watsonville, California. Both received bachelor’s degrees in public health from UC Berkeley. Gerry received his M.P.H. from the University of Michigan in 1957; his M.H.A. from Baylor University in 1966, and became an APHA Fellow (Community Health) in 1967.

1960s Anne Waybur, Dr.PH., M.P.H. ’60 “Retired, traveling to far and distant places, ‘agitating’ for a national health services system, so urgently needed!” Doris E. Hawks, B.S. ’63, has helped hundreds of California residents as an elder law attorney. Her contributions in the areas of unbefriended elders and non-beneficial treatment in institutions are being recognized by Santa Clara County’s Medical Association. Elaine B. Base, M.P.H. ’64 “Active member of Alaska State Defense Force—Medical Unit attached to aviation and costal command—in homeland security mission.” Mildred F. Patterson, M.P.H. ’65 “I still enjoy driving, quilting, keeping up with family and friends, selected activities in the retirement home.”

University of California, Berkeley

Margaret H. Jordan, M.P.H. ’72, executive vice president for corporate affairs at Texas Health Resources, was recently elected to serve on the American Hospital Association (AHA) board of trustees. The AHA, which includes nearly 5,000 hospitals, health care systems, networks, and other providers of care, is a nonprofit association of health care provider organizations that are committed to health improvement in their communities. Harrison Spencer, M.D., M.P.H. ’72, was elected to the Institute of Medicine in 2003. Spencer is president and CEO of the Association of Schools of Public Health. Before that, he was dean of the London School of Hygiene and Tropical Medicine. He has also served as dean of the Tulane School of Public Health and chief of the parasitic disease branch at the CDC. Ruth Grogan, M.S.W., M.P.H. ’73 “Retired as director of early childhood mental health programs, Richmond, California.” Michael E. Williams, C.I.H., M.S. ’75, M.P.H. ’74, recently became a reserve firefighter for the Healdsburg Fire Department in the Sonoma County wine country. Winnie Chu, M.P.H. ’76, is an independent consultant for nonprofit organizations and foundations. Brent Green, Ph.D., M.P.H. ’76, with E.F. Schmerl, M.D., invented Med Log™ (a medication adherence record tool for elderly outpatients and their caregivers). Green is a former FDA representative, a UN World Assembly on Aging delegate to Vienna, and former editor of the Journal of Social Issues. He is a consultant to Sutter Health. His recent publications focus on executive leadership development.

Daniel S. Janik, M.D., Ph.D., M.P.H. ’77, has authored a new book, Unlock the Genius Within: Neurobiological Trauma, Teaching and Transformational Learning, recently published by Rowman & Littlefield Education. In this second book in a series on neurobiological and transformational learning, Janik discusses his theory about the traumatic roots of traditional teaching—how it results in loss of interest and creativity—and describes the neurobiological foundations of a new form of nontraumatic learning.

1980s Pamela J. Armstrong, M.B.A., M.P.H. ’80, is author of the book Surviving Healthcare, which won two awards conferred at the annual Book Expo America Convention in New York City on June 3, 2005. Surviving Healthcare was named Health Book of the Year by ForeWord magazine and won the Publishers Marketing Association’s Benjamin Franklin Award as best health book. Jean Marie Naples, M.D., Ph.D., M.P.H. ’81 “Family medicine physician—certification, 1993; Ph.D., Johns Hopkins SPH, 1990; M.D., University of Maryland Medical Center, 1989; general surgery residency and certification, 2003; research fellow at JHSPH—association of schistosomiasis and bladder cancer—early disease detection and prevention of infection with the parasite (research project in Ghana, West Africa).” Linda Rudolph, M.D., M.P.H. ’81, was appointed health officer for the city of Berkeley in October 2005. She has more than 20 years’ professional experience in public health administration, program and policy development, and clinical practice. Sang-Ick Chang, M.D., M.P.H. ’85 “After attending the Interdiscplinary Program in 1985, I completed medical school at UCSF and a family practice residency at San Francisco General Hospital. Since then I have devoted my professional life to working with underserved populations in California, in both direct care and administrative capacities. After stints in rural health and the San Francisco Health Department, I am now vice president and medical director for San Mateo Medical Center, the county-run safety net health system for San Mateo County, just south of San Francisco. I still practice two half-days weekly at one of our community clinics.”

Alumni News

Jacob Eapen, M.D., M.P.H. ’85, was elected trustee-director on the board of directors of the Association of California Healthcare Districts, the industry association for health care districts providing hospital care, skilled nursing care, or diverse health and wellness services in their communities. Richard Hirsh, C.I.H., M.P.H. ’86 “Recently given Distinguished Scientist Award by Rohm and Haas Company. Recently elected as president-elect of the Northern California Section of the American Industrial Hygiene Association.” Michael G. Lyon, M.P.H. ’87, is a clinical assistant professor of medicine at Stanford University School of Medicine. His current research activities are in the use and effectiveness of group medical visits for arthritis patients. James E.T. Jackson, M.P.H. ’88, was named chief operating officer of San Francisco’s Saint Francis Memorial Hospital in June 2005. He has approximately 15 years’ experience in health care administration and most recently served as vice president of ancillary and support services at the Children’s Hospital and Research Center in Oakland.

Denise Koo, M.D., M.P.H. ’88, is now director of the Career Development Division at the CDC. This division houses public health residencies such as the Epidemic Intelligence Service, Preventive Medicine Residency, the Public Health Prevention Service, the Public Health Informatics Fellowship, and the Prevention Effectiveness Fellowship.

Paul B. Hofmann, Dr.P.H. ’94, M.P.H. ’65, recipient of last year’s Distinguished Leadership Award from the UC Graduate Program in Health Management Alumni Association, coedited Management Mistakes in Healthcare: Identification, Correction, and Prevention, published by 2005 by Cambridge University Press.

1990s

Bjørn-Inge Larsen, M.B.A., M.P.H. ’94 “Since 2001 I have been the director general of Norwegian Directorate for Health and Social Affairs.”

Terry Winter, R.N., M.P.H. ’90, continues to focus on developing interdisciplinary team of care for chronic disease. Luis Ramon Mireles, M.P.H. ’92 “As district manager of the Cal/OSHA Compliance Unit for San Diego and Imperial Counties, I am continually stimulated by the diversity of industries and sectors that we regulate. I get to use most of my public health graduate training. My next big life experience will be fatherhood, as my wife, Genoveva AvalosMireles, is expecting a baby boy due in 2006.” Renee (Cronk) Drellishak, M.P.H. ’94 “Currently a doctoral student in educational leadership and policy studies at the University of Washington.” Jacqueline Brooks Hanel, Dr.P.H. ’94, M.P.H. ’80, began a new job as site administrator for the Brentwood Medical Center of the John Muir/Mount Diablo Health System.

Robert S. Brown, Jr., M.D., M.P.H. ’96, was appointed to the scientific advisory board of Arbios Systems, Inc., a biomedical device company developing proprietary liver assist devices for the treatment of liver failure. Brown is associate professor of medicine and surgery and chief, Division of Hepatobiliary and Abdominal Transplant Surgery at the Columbia University College of Physicians and Surgeons. In addition, he is medical director, Center for Liver Disease and Transplantation at New York Presbyterian Hospital, a position he has held since 1998. Maureen Sinclair, M.P.H. ’98 “I moved to Almaty, Kazakhstan, last year to work as the deputy director of CDC’s Central Asia regional office. It is a beautiful part of the world and an exciting time to be here.” Stacy Sterling, M.S.W., M.P.H. ’98 “While in grad school I worked as an interviewer on NIDA and NIAAA-sponsored studies of drug and alcohol treatment services. The skills and the knowledge that I gained from the School of Public Health (biostatistics, epidemiology, program planning and evaluation, community organizing) enabled me to move from interviewing to a leadership role on the research team. I am currently a senior research project manager with the Drug and Alcohol Research Team at Kaiser Permanente’s Division of Research, overseeing many aspects of several large NIH-funded health services studies. Our research group addresses issues of access, treatment outcome, and cost and utilization of alcohol and drug treatment in public and private settings, including managed care.”

continued on page 42 Public Health

Alumni News

NEWSMAKER SPOTLIGHT

Bay Area’s Most Influential Businesswomen The San Francisco Business Times has named three women associated with the UC Berkeley School of Public Health as being among the Bay Area’s 100 most influential women in business. “These women were chosen because they are in high-ranking positions in their companies, and because they are outstanding leaders and role models with a wide range of influence,” reports the San Francisco Business Times. Anne Bakar, president and CEO of Telecare Corporation, served on the School of Public Health’s Policy Advisory Council from 2001 to 2004. She spent seven years in the investment banking field before taking over leadership of Telecare in 1987, following the unexpected death of her father, Telecare founder Morton Bakar. The company’s clinical and financial success has been attributed to her initiatives to forge active partnerships with her workforce as well as other constituencies involved in client care, consumers’ families, community providers, and county agencies. Bakar received her bachelor’s degree from UC Berkeley in 1980.

Susan DesmondHellmann, M.D., M.P.H. ’88, president, product development, Genentech, joined the company in 1995 as a clinical scientist, was named executive vice president, development and product operations in 1999, and later chief medical officer. Prior to joining Genentech, Desmond-Hellmann was associate director of clinical cancer research at BristolMyers Squibb’s Pharmaceutical Research Institute. While at Bristol-Meyers Squibb, she was the project team leader for Taxol.

Mary Ann Thode, M.P.H. ’78, was named president of Kaiser Foundation Health Plan and Hospital’s Northern California region in 2002. She previously served as the organization’s chief operating officer, Northern California, and prior to that, senior vice president and area manager for the Golden Gate Service Area (San Francisco, San Rafael, Santa Rosa, and South San Francisco). Thode started her health care career as a staff nurse at the Kaiser Permanente Oakland Medical Center. She also served as a senior vice president of operations of Catholic Healthcare West, and president and CEO of St. Mary’s Medical Center in San Francisco.

2000s

Sayan Tudupdorjiev, M.D., M.P.H. ’03 “I cordially extend my greetings to good old Berkeley, to the staff and faculty of my School. Upon returning back home I applied for a director position in my hospital [Zabailisk Regional Hospital, Chita region, Russia] and later was given it. Am now busy managing things, trying to make it better and sensible.”

Alumni Notes, continued

Blue Walcer, M.P.H. ’98 “I am the founder and director of San Francisco General Hospital’s CARE (Cancer Awareness, Resources, and Education) program—an innovative program that provides medically underserved cancer patients with education and psychosocial support.” Walcer was the 2004 National Grand Winner of the California Pacific Award for Excellence in Patient Education.

University of California, Berkeley

Geoffrey Lomax, Dr.P.H. ’02, M.P.H. ’97, was recently hired as senior officer for the Standards Working Group at the California Institute of Regenerative Medicine. He is the former research director for the California Environmental Health Investigations Branch, where he supported the professional and research needs of the legislatively mandated Expert Working Group that developed a strategic plan for the Environmental Health Surveillance System in California.

Jennie Walcek, M.P.H. ’05 “I will be getting married July 23, 2005, to Dr. Wil McClay, an electrical engineer at LLNL.”

In Memoriam

In Memoriam Glenn Elwin Austin, M.D., B.S. ’43, died April 11, 2005, at his home in Beaverton, Oregon, at age 83. Born July 5, 1921, in Berkeley, he served in the U.S. Army during World War II, then put himself through medical school at Stanford University. He practiced pediatrics in Los Altos, California, for 48 years. Austin was instrumental in establishing guidelines for testing and treating children with ADHD. He was active in medical politics, pushing the establishment to make changes in health care that were more sensible and affordable to the average person. His hard work and dedication to medicine led to a term as president of the American Academy of Pediatrics from 1981 to 1982. He is survived by his wife, Olive E. Austin, three daughters, one son, and seven grandchildren. Sir Richard Doll, M.D., D.Sc., D.M., one of the world’s foremost epidemiologists and a widely respected cancer researcher, died at the John Radcliffe Hospital in Oxford, England, at age 92. Doll and his colleague, Sir Austin Bradford-Hill, proved the link between cigarette smoking and lung cancer while working at the British Medical Research Council's Statistical Research Unit. Their report, published in 1950, was based on a survey of lung cancer patients in 20 London hospitals. The following year they questioned 40,000 British doctors about their smoking habits. As a result they were able to confirm the link between smoking and lung cancer, as well as other diseases such as coronary thrombosis. Doll’s 1994 report on 40 years of follow-up of a group of British doctors is considered the definitive paper on the health consequences of smoking. Follow-up studies proved that long-time smokers suffered three times the mortality rate of non-smokers. In addition to his studies into cancer and heart disease, he investigated the effects of alcohol on unborn babies, and the side effects of the birth control pill. For his

pioneering work, Doll was awarded $10,000 from the World Health Organization and received a knighthood in 1972. He received the UC Berkeley International Public Health Hero Award in 2000. Doll was born in Hampton, England, and attended St. Thomas’s Hospital Medical School. During World War II, he served in the Royal Army Medical Corps. His wife died in 2001; he is survived by his son and daughter. Reed E. Grier, Ph.D. '04, M.P.H. '82, M.C.P., died August 12, 2005, at age 51. Born in Seattle, Washington, he moved to the Bay Area in 1975 to attend UC Berkeley, where he earned his bachelor’s and graduate degrees. During his years in the Bay Area, he worked with a wide range of public and private sector research and service organizations addressing issues of health and welfare. Grier’s work included planning for services for the elderly including Alzheimer’s services and home support for frail elders. He was involved in community-based planning for the San Francisco Department of Public Health in the 1980s. Recently, he completed a research project for the Health Research and Educational Trust, which included several case studies from around the country documenting the hospitalpublic health linkages for disaster preparedness. Other recent projects were with the U.S. Public Health Services HIV/AIDS Bureau, the Mather Institute on Aging in Evanston, Illinois, the Public Health Institute in Berkeley, Nancy Frank & Associates in Oakland, and the National Assembly for Voluntary Health & Social Welfare Organizations in Washington, D.C. He is survived by his life partner, Glen Stroud, and his family in the Portland area. Donations to the “Reed Grier Memorial Loan Fund” may be sent to Patricia Hosel, Office of External Relations, School of Public Health, UC Berkeley, 140 Earl Warren Hall, Berkeley, CA 94720-7360. Emery A. Johnson, M.D., M.P.H. ’64, former U.S. assistant surgeon general and the longest serving director of the Indian Health Service, died June 26 at his home in Rockville, Maryland, at age 76. From 1969 to 1981 he ran the Indian Health Service, the principal health care provider and health advocate for

1.6 million American Indians and Alaska natives. He was a major contributor to the development of legislation such as the Indian Self-Determination and Education Assistance Act of 1975 and the Indian Health Care Improvement Act of 1976, both of which still govern federal policy. During his tenure, construction of major hospitals and clinics increased dramatically. Johnson was born in Sioux Falls, South Dakota. He graduated from Hamline University in St. Paul, Minnesota, and received his medical degree from the University of Minnesota in 1954. He received a master’s degree in public health from the University of California, Berkeley, in1964. He joined the Public Health Service after medical school, just as the Bureau of Indian Affairs was turning over the Indian Health Service to the Public Health Service. Johnson stayed with the agency throughout his career. He was a reservation staff physician in Winnebago, Nebraska, and White Earth, Minnesota, and an administrator in Billings, Montana, Phoenix, Arizona, and Silver Spring, Maryland. He helped develop the John F. Kennedy National Medical Center in Monvoria, Liberia, and was a consultant to the Peace Corps and World Health Organization in Africa. He is survived by his wife, Nancy Mourning Johnson, four children, and a grandson. Catherine T. Kennedy, B.S. ’37, died May 15, 2005, at age 91. She was a registered nurse for 45 years including 37 years as a nurse in the Long Beach Unified School District in Long Beach, California. She also served as a public health nurse during World War II. She was an active supporter of women’s rights and Alzheimer’s research and was involved with childcare and seniors’ issues. Born in Brooklyn, New York, she moved to Long Beach with her family as a child. She is survived by her son, Patrick Kennedy, three grandchildren, and four great-grandchildren. She was preceded in death by her husband and another son. Memorial donations may be made payable to the “School of Public Health Fund” and sent to the attention of Patricia Hosel, Office of External Relations, School of Public Health, UC Berkeley, 140 Earl Warren Hall, Berkeley, CA 94720-7360.

Public Health

In Memoriam

In Memoriam, continued Marc Alan Lappé, Ph.D., died May 14, 2005, at his home in Gualala, California, at age 62. Lappé was a leading figure in the movement to integrate ethics and public policy, especially as it related to toxics and genetics. He also served as an expert witness and consultant for plaintiff attorneys suing chemical companies, including lawsuits against silicone gel breast implant makers, the producers of the herbicide Agent

Orange, and the high-profile case against W.R. Grace & Co. The Newark, New Jersey, native earned his Ph.D. in experimental pathology from the University of Pennsylvania. He authored or edited fourteen books, many of which predicted public health and environmental problems long before their appearance. In 1978, he was named by California Governor Jerry Brown as chief of the state’s Office of Health, Law, and Values, and then as head of the state’s Hazard Evaluation System. He resigned in 1980 after opposing the state’s spraying of the insecticide Malathion to halt the Medfly outbreak plaguing California’s citrus crops. He held teaching posts at Sarah Lawrence College; University of

Illinois at Chicago School of Medicine; the College of Marin; and the University of California, Berkeley, where he was an associate adjunct professor at the School of Public Health from 1983 to 1985. He was the director of the Gualala, California-based nonprofit Center for Ethics and Toxics, an environmental public policy organization that works directly with California municipalities concerned about contaminants in their water supplies. Lappé was also an award-winning poet. He is survived by his wife, Jacqueline Durbin, as well as his father, his brother, two sons, three daughters, and two step-children.

Seiko Baba Brodbeck, Former Associate Executive Director of the American Public Health Association Seiko Baba Brodbeck, B.S. ’48, who served for 17 years as associate executive director of the American Public Health Association (APHA), died August 13, 2005, at the age of 77. Brodbeck received her bachelor of science degree in public health microbiology in 1948 from the University of California, Berkeley. Upon graduating, Brodbeck became a public health microbiologist for the Oakland City and Los Angeles County Health Departments. Shortly thereafter, she became the laboratory director for the Oakland City Health Department. When the Oakland City Health and Alameda County Health Departments merged, she was asked to direct their public health laboratory services, which she did for 12 years. In 1971 she assumed the directorship of the Western Regional Office of the American Public Health Association and became its executive director. In 1976 she began her 17-year tenure as APHA’s associate executive director at its national headquarters in Washington, D.C. In 1993 she returned to her California roots first as deputy director, audits and

University of California, Berkeley

Childcare Programs” and “Model Standards— Health Communities 2000.” In 1996 she received the Distinguished Member Award from the California Public Health Association–North; in 1970 she received the John J. Sippy Award from the Western Branch of APHA and in 1995 was named Outstanding Public Health Laboratorian by APHA. She was actively involved with the UC Berkeley School of Public Health as an alumna, serving on the Public Health Alumni Association board of directors from 1999 to 2002. In 1998, she received the School’s Alumna of the Year Award.

investigations, and subsequently as assistant deputy director of public health practice for the California Department of Health Services. Brodbeck was involved with a variety of public health projects over her long and distinguished career, including “National Health and Safety Performance Standards: Guideline for Out-of-Home

She is survived by her daugher and son-in-law, Stacey Baba and James Vokac. Gifts in memory of Seiko Baba Brodbeck may be made payable to the “School of Public Health Fund” and sent to the attention of Patricia Hosel, Office of External Relations, School of Public Health, UC Berkeley, 140 Earl Warren Hall, Berkeley, CA 94720-7360.

In Memoriam

Ruth Lois Huenemann, Professor Emerita and Public Health Nutrition Pioneer Ruth Lois Huenemann, D.Sc., professor emerita and founder of the public health nutrition program at the University of California, Berkeley, died August 19, 2005, at the Lake Park Retirement Residence in Oakland at the age of 95. Huenemann was one of the first researchers to recognize the importance of systematically studying the longitudinal development of obesity in children, conducting seminal studies that to this day inform the understanding of the current epidemic of childhood obesity.

Knoxville. During her years at Tennessee, she was offered a scholarship to study at Harvard University and proceeded to earn her doctor of science degree in public health nutrition in 1954. She joined UC Berkeley’s School of Public Health in 1953, where she founded the school's public health nutrition program, establishing its curriculum, research program, staff and funding.

“She was a legend in her time,” says Patricia Crawford, Dr.P.H. ’94, R.D., codirector of UC Berkeley’s Center for Weight and Health and one of Huenemann’s former students and colleagues. “Students sought out nutrition programs that she created.” Huenemann’s research and teaching combined rigorous scientific methods with a pragmatic approach to improving nutrition in a variety of cultural settings. She traveled widely in Latin America, Asia, and Europe as a consultant and lecturer for the World Health Organization, the U.S. State Department’s food aid program, and numerous international health and nutrition organizations. She was particularly noted for several longitudinal studies of nutrition and physical activity among adolescents and children. In the Berkeley Teenage Study, she studied nearly 1,000 students from the Berkeley Unified School District from 1961 to 1965 to determine the onset and prevalence of factors related to the development of adult obesity. She also led the initial four years, from 1969 to 1973, of what would become the Berkeley Longitudinal Nutrition Study, which worked with children from the age of six months through age 16 years. That study was subsequently led by a colleague in the School of Public Health, Leona R. Shapiro, M.S. “Research in which such a large group of children was studied for so long was unusual at that time,” says Shapiro. “Huenemann looked at the wide-ranging factors that could have influenced the development of obesity.” Her studies provided a wealth of detailed data on teenagers’ eating habits, physical activity and body composition. The research revealed a link

between low income and an increased risk for obesity, something researchers are still trying to fully understand today. “That was one of the first studies to show the complex relationship between socioeconomic status and obesity,” says Crawford. The researchers also found that teenagers were getting much less exercise than previously thought, signaling the influence of television and cars. Says Crawford, “The issue of childhood obesity seems so current now, but imagine what it was like in the 1960s when she sought funding for such studies. She had foresight into a growing problem.” Huenemann was born to a farming family in Waukon, Iowa, on February 5, 1910, the secondoldest of 14 children. In 1913, her father moved the family to Wisconsin. In 1928, Huenemann graduated from Menno High School in South Dakota, where her family had moved the prior year. She spent five years teaching in a one-room school, and saving money to attend college. She received a B.S. in nutrition from the University of Wisconsin in 1938, and earned an M.S. in nutrition from the University of Chicago in 1941 while working as a staff dietitian at the university's clinics. Over the next decade, she worked as an associate professor at the University of Tennessee, where she established the university's public health nutrition program as well as a community nutrition program in

“In her first class at UC Berkeley, there were only two students who majored in public health nutrition,” says Shapiro. “By the time she retired, the school had awarded more than 250 public health degrees in nutrition. The program she developed at the UC Berkeley School of Public Health had become the preeminent center for training of applied nutritionists in the country. By the time she retired in 1977, she had created an enviable record in teaching and research.” Her 24-year tenure at UC Berkeley included terms as chair of the Department of Nutritional Sciences at UC Berkeley’s College of Natural Resources, and chair of the Department of Social and Administrative Health Sciences in the School of Public Health. While at UC Berkeley, she created the first program to enable students earning a bachelor’s degree in public health nutrition to also become eligible as registered dietitians. This model has since been emulated in other public health nutrition programs around the country. Huenemann sat on many notable committees throughout her career, including the National Advisory Council on Child Nutrition and the National Research Council. She was also a member of the editorial board of the Journal of the American Dietetic Association, served as president of the Society for Nutrition Education and received the Dolores Nyhus Memorial Award in 1979, the highest honor given by the California Dietetic Association. Huenemann is survived by her brother and dozens of nieces and nephews. Donations in her memory may be made to the Ruth L. Huenemann Scholarship Fund, Office of External Relations, School of Public Health, UC Berkeley, 140 Earl Warren Hall, Berkeley, CA 94720-7360. —Sarah Yang

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W ELCOME , E NTERING C LASS

FALL 2005

This fall 206 new graduate students entered the School of Public Health, representing a wide range of backgrounds and academic interests. The new class comprises 162 women and 44 men, ranging in age from 21 to 58 years old. There are 151 students working on M.P.H. degrees (19 of whom are in concurrent or joint degree programs); 10 working towards an M.A. or M.S.; 10 students in the Dr. P.H. program; and 35 Ph.D. students. The students hail from 19 states (California, Colorado, Connecticut, Florida, Georgia, Indiana, Massachusetts, Michigan, Minnesota, New Jersey, New Mexico, New York, Oregon, Pennsylvania, Tennessee, Texas, Virginia, Washington, and Wisconsin) plus the District of Columbia, and 16 countries (Canada, China, Denmark, Ethiopia, Great Britain, India, Iran, Israel, Mexico, New Zealand, Nigeria, Singapore, Switzerland, Uganda, Vietnam, and Zimbabwe). In addition, the Schoolâ&#x20AC;&#x2122;s undergraduate program, which was reinstated in 2003â&#x20AC;&#x201C;2004 after a break of more than 30 years, continues to grow in popularity: 80 upper division undergraduate students declared a major in public health this year, for a total of 200 undergraduate public health majors.