Spring 2008 - Health Care Reform, From the Nation to the Neighborhood - Public Health

University of California, Berkeley School of Public Health

SPRING 2008

Public Health The Magazine for Alumni and Friends

HEALTH CARE REFORM FROM THE

NATION

TO THE NEIGHBORHOOD

INSIDE Electronic Medical Records: Will They Improve the Quality of Care?

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Spending Money and Saving Lives: The High Cost of Health 16

“Jeff, I’ve got an idea…”

Kathy Kwan

Kathy Kwan, M.B.A., M.P.H. ’93, had an idea: To send students into the community to make a difference. So she called fellow alumnus Jeffrey Oxendine, M.B.A., M.P.H. ’86, who directs the School of Public Health’s Center for Public Health Practice. Together, they agreed to pilot a program that partially funds interns in local community-based organizations.

“Our first year, we provided financial support for five interns,” says Kwan. “The experience was so positive for employers and students that the next year, we funded ten interns.” Interns have worked in Bay Area organizations that focus on issues such as health disparities, access to care, global health, HIV/AIDS, youth services, and nutrition.

Kwan has already provided a third year of funding. “Through my partnership with the School, I am able to leverage a relatively small number of dollars and take them a long way. Students receive broader and more diverse training in smaller organizations, and at the same time, they contribute to the communities those organizations serve.

“I can’t imagine a more positive result.”

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University of California, Berkeley

Jeffrey Oxendine

Support the School of Public Health Your tax-deductible contribution to the School of Public Health ensures the viability of valuable School of Public Health programs, such as scholarships, internships, and recruitment efforts. Support the future of public health.

Give online at sph.berkeley.edu/giving/how.htm or mail your gift (payable to the “School of Public Health Fund”) to:

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

SPRING 2008

University of California, Berkeley School of Public Health

Public Health The Magazine for Alumni and Friends FEATURES Health Care Reform from the Nation to the Neighborhood

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Members of the School community work to repair the U.S. health care system at the national, state, and community level.

In America’s Salad Bowl, Residents Find Barriers to Care

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Researchers at the Center for the Health Assessment of Mothers and Children of Salinas reach out to rural farm workers who have trouble accessing the health care system.

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Electronic Medical Records: Will They Improve the Quality of Care?

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Electronic medical records can facilitate doctor-patient communication, help physicians and patients monitor health progress, and help people manage their chronic diseases.

Spending Money and Saving Lives: The High Cost of Health Care

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Health care costs are spiraling upward. Are consumers getting their money’s worth?

The Nicholas C. Petris Center on Health Care Markets & Consumer Welfare keeps watch on the economy of health care.

A Conversation with Mark Horton

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The director of California’s new Department of Public Health discusses the states’ health challenges and his plans for the department.

Student Spotlight

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Inspired by activist experiences, medical student Monica Ulhee Hahn serves the Asian community.

Alumna Spotlight 16

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Clinic director Barbara Terrazas has dedicated her career to ensuring a health safety net for those in need.

DEPARTMENTS Past, Present, Future Around the School Partners in Public Health Alumni News In Memoriam Dean Stephen M. Shortell, Ph.D., M.P.H. Assistant Dean, External Relations and Development Patricia W. Hosel, M.P.A. Editor Michael S. Broder Associate Editor Linda Anderberg Design Archer Design, Inc.

Contributors Linda Anderberg, Ingrid Berg, Michael S. Broder, Johanna Van Hise Heart Photography Jim Block, inside front cover, pp. 41, 43; Peg Skorpinski, pp. 2, 26–29, 31, 34–37, 48, 51; Ben Ailes, pp. 5, 9, 17, 20–21, 44, 47, 52; iStockphoto, p. 8; Shutterstock pp. 14, 18, 32; Sirlin Photographers, p. 19; Julie Cook, p. 23; Ingrid Berg, pp. 24–25; Ruben Lizardo, p. 30; Patricia W. Hosel, p. 40; Claudette Bégin, back cover

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Communications Advisory Board Linda Anderberg, Michael S. Broder, Patricia A. Buffler, William Dow, Eva Harris, Patricia W. Hosel, Joan Lam, Meredith Minkler, Linda Neuhauser, Steve Selvin, Stephen M. Shortell, Robert C. Spear, John Swartzberg

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

UC Berkeley School of Public Health Office of External Relations and Development 417 University Hall #7360 Berkeley, CA 94720-7360 (510) 643-2556 © 2008, Regents of the University of California. Reproduction in whole or part requires written permission.

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LEADING THROUGH

From the Dean

SOLUTIONS As a professional school at the world’s leading public research university, we have a special obligation to apply our discoveries to solve societal problems.

Nowhere are those problems more manifest today than in the health policy arena. This issue of the magazine highlights the work of the UC Berkeley public health community— faculty, students, alumni, and our partners—in providing some potential solutions to the inadequate access, excessive costs, and varying quality of our health care system. As I

Dean Stephen M. Shortell

have said elsewhere, our health care system is the “poster child for underachievement.”

Approximately 47 million Americans are without health insurance coverage, representing about 15 percent of the population. We also have the costliest health system in the world, with total expenditures approaching $3 trillion, representing approximately 16 percent of our gross domestic product and involving expenditures of approximately $6,700 per person per year. At the same time, the quality of care we receive varies widely across providers, geographic regions, medical conditions, and sociodemographic groups. While some progress is being made, more than 100,000 Americans die each year from a preventable medical error; and, another 100,000 from preventable infections. On average, we receive evidence-based recommended care only about half the time. A recent Commonwealth Fund report on comparative health systems ranked the U.S. health system last among six countries studied. In brief, for the United States the “three-legged stool” of access, cost, and quality has totally collapsed and is lying on the ground.

As the work highlighted in this issue suggests, it is possible to have access to high quality, cost-effective health care if we understand how the issues of access, cost, and quality are interrelated. Access to care that remains affordable over the long run can occur only if we also reorganize and improve the delivery system.

Expanding health insurance coverage to all Americans must be accompanied by a higher performing delivery system that does not waste people’s time, employer or taxpayer dollars, and reduces the unnecessary variation in quality.

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A variety of solutions exist for expanding health insurance coverage and paying for it. These include mandating coverage for everyone; requiring employers to either provide coverage for their employees or pay into a pool; offering total subsidies for those who cannot afford coverage; tax credits and/or vouchers for others; and efforts to streamline administrative costs, such as establishing a single payer. Whatever approaches are used, two basic questions must be addressed: 1) How much will it cost? and 2) Who will pay? While these questions will be informed by analysis, the ultimate outcome will be determined in the political arena.

But expanding health insurance coverage alone will not solve the health care crisis. Rather, it only raises a further fundamental question of whether the delivery system is equipped to provide cost-effective care to the increased number of insured Americans. As noted earlier, current evidence suggests that it is not. There is need to create incentives for hospitals, physicians, health centers, and other providers to develop more integrated systems of care—particularly for the more than 100 million Americans suffering from chronic illnesses. If we want better care, we need to reward those providers who produce superior results rather than paying everyone the same. There is also a need for greater use of electronic medical records, health care teams, patient education for management of their illness, and closer linkage to public health and communitybased resources. In the process, there is need to draw on the tools and disciplines of operations research, human factors engineering, and quality improvement so that care can be made safer, more effective, and more efficient on a continuous basis. Only if these and related changes in the delivery system occur will the expanded financial access to care resulting from health insurance reform make care affordable and beneficial in the long run for all involved.

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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HEALTH CARE REFORM FROM THE

NATION

TO THE NEIGHBORHOOD

By Linda Anderberg

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University of California, Berkeley

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These days, everyone is talking about health care reform. Depending on whom you ask, you might hear any of the following: Our health care system is severely fragmented. It trails most other major industries in

policy for Northern California, which means she will continue to handle press and speak to the public about Obama’s health care reform initiatives, and she contributes regularly to the blog Daily Kos on behalf of the campaign.

Halpin envisions a slower transition to a single-payer plan, with the insurance industry still contributing to the reformed health care system by selling supplemental policies and performing administrative functions. She worked with the Lewin Group, a national health care and human services consulting firm, to model the CHOICE plan for California, and they discovered that within one year, 70 percent of the population would be in the single-payer plan.

“The majority of the population would have more choice, lower costs, and better access,” says Halpin.

“It’s a no-brainer, right?”

The CHOICE plan basically allows everybody to keep the insurance they have, but provides the option of a single-payer public plan, which operates alongside the existing system. The addition of a public plan is now a key component of the health care reform plans of the three leading Democratic presidential candidates—Hillary Clinton, John Edwards,* and Obama, although Clinton allows anyone to join the public plan, whereas under Edwards’s and Obama’s plans you may only join the public plan if you are

In addition to the public plan component, the leading Democrats’ plans each have a pay or play mandate for employers, a pool to connect individuals and small businesses to private insurance plans like members of Congress have, and each expands Medi-Cal and the State Children’s Health Insurance Program (SCHIP). “As far as the Democratic candidates,” says Halpin, “what’s most interesting is the extraordinary consensus on the framework.”

Some differences are that Edwards’s and Clinton’s

terms of technology and organization. Costs are spiraling out of control. The United States spends more money on health care than any other industrialized nation with arguably worse health outcomes.

Forty-seven million Americans remain uninsured.

In addition, our system is responding slowly to the challenges of an aging population living with a growing level of chronic disease. There is just not enough focus on prevention and public health. It’s increasingly clear that the health care system is not just due for a tune-up; it needs a major overhaul on every level. So it’s no surprise that as the 2008 election approaches, health care is one of the top domestic issues on the minds of the voters. And politicians, professors, and health care professionals are responding. The School of Public Health, with its mission of improving health, is well situated to contribute meaningfully to reform—thinking strategically about current and future problems, evaluating existing policies and procedures, generating new solutions, and translating research into results.

“As far as the Democratic candidates, what’s most interesting is the extraordinary consensus on the framework.” —Helen Halpin

What’s Happening in Washington?

When it comes to reforming health care, Professor of Health Policy Helen Halpin might be characterized as something of an overachiever. When the California Health and Human Services Agency called for proposals to reform health care and improve access in the state, Halpin submitted two. One, the CHOICE option, which Halpin developed (with the help of “an incredible group of outstanding women in health care in California,” she says) outlines a framework that Halpin brought to Democratic presidential hopeful Barack Obama when she joined his Health Care Policy Committee as an unpaid adviser last summer. Halpin worked on five of the different subgroups of the committee, including public health intervention, cost containment, defining a public insurance plan, and increasing quality. She was recently designated as the surrogate on health care

plan, the insurance companies would be out of business overnight. It’s a huge sector of the economy, and you just can’t do that.”

presently uninsured, employed in a small business, have private individual coverage, or have inadequate coverage through your employer.

“Almost everyone understands that a single-payer plan would be the most efficient, effective, equitable, and secure plan, hands down,” says Halpin.

“But politically, it would be impossible to adopt.

And it doesn’t make sense economically, because if we put everyone in the country in the single-payer

plans contain an individual mandate that would require every citizen to have insurance, whereas Obama’s does not. And Obama’s plan uses a direct subsidy model to help lower-income people pay for their premiums, while Clinton and Edwards use a tax credit model. In addition, Obama’s plan permits adult children to stay on their parents’ policy until they are 25 and offers a reinsurance program to stabilize premiums. continued on page 6

*As this issue headed to press, Edwards announced his withdrawal from the race.

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“I think the public is tired of being made afraid of change or different ideas.”

Health Care Reform,

continued

The driving goal behind every Democratic candidate’s plan is to provide quality affordable health care for all. But what’s different from previous reform attempts is the variety of options people will have to achieve this goal. “There has really been a paradigm shift,” says Halpin. “We used to talk about national health care reform in one-size-fits-all terms. And I think what politicians and policymakers have realized over time is that Americans don’t like one-size-fits-all; we want choices. So in the past we’ve offered people choices of health plans or plans with more choices of doctors, but this time we’re actually offering choices of systems.”

The Democratic candidates’ sweeping plans for health care reform lead to an important question: What if a Republican is elected? Associate Professor of Health Economics Will Dow, who served on President Bush’s Council of Economic Advisors (CEA) when the administration was planning major health care reform, has some insight.

“The Republican plans aren’t targeted at reducing the number of uninsured in the short term necessarily,” he says. “They’re targeted at trying to reduce cost growth. Average insurance premiums have almost doubled since 2000, which both exacerbates the uninsurance problem and increases the budgetary cost of proposals to expand insurance subsidies for low-income groups.”

When Dow served on the CEA, White House political advisers were focused on trying to reduce cost growth by making health consumers more aware of their spending. The idea was to make people more directly involved in paying for their health care, which would make them more price-sensitive, which in turn could lead to greater adoption of cost-cutting technologies and hence slow the growth of health care spending over the long term. “We know that a big chunk of technologies that people are developing aren’t really cost effective for many patients,” Dow says. “The theory is to change the priorities of technology developers so that they could profit not just from making better technologies that are more

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expensive, but also from making technologies that are more efficient. In practice we don’t yet know whether growth rates could be substantially slowed through significantly expanding cost-sharing, but Republicans argue that the approach merits trying.”

One mechanism to get people more involved in the cost of their health care is health savings accounts

(HSAs), which provide tax savings to individuals who enroll in high deductible health insurance policies, thereby incentivizing cost sharing. HSAs were rolled out by the Bush administration before Dow’s tenure with the CEA, and expanding high deductible insurance through mechanisms such as HSAs are major components of the Republicans’ plans.

“If you really want to tackle the uninsurance problem in the long run, you have to address the health care cost issue,” says Dow. “You could put a band-aid on the uninsurance issues today or you could pass something to expand SCHIP, but any significant insurance expansion that gets passed today is going to cause serious budget headaches 10 years from now unless we can lower cost growth.”

The chances of any of this reform being enacted varies widely based on who gets elected, which party controls Congress, and when and how aggres-

sively the new president pushes the legislation. For example, Edwards and Obama have promised to move on health care reform in the first year of their first term, while Clinton will wait until her second term. “If you introduce a bill for major change within the first three months of your presidency, your odds of success are 75 percent, which is huge,” says Halpin. “But if you wait until the end or your

first year to actually introduce anything, it drops to 15 or 20 percent. So there is urgency here.”

Despite the obstacles, Halpin is cautiously optimistic that some badly needed reform can occur on a national level. “The politics are going to line up against any plan and the insurance and pharmaceutical companies are going to get their guns out,” she says. “But with any luck, this time the Democratic Party will be better prepared to counter a lot of the fear mongering. I think the public is tired of being made afraid of change or different ideas.”

Learn a Lesson from California The health care reform struggle currently happening in California is a good illustration of the challenge of adopting comprehensive policy at any level.

Compromise legislation on comprehensive reform was agreed to by Gov. Arnold Schwarzenegger and

Learn the Language of Health Care Reform state Assembly Speaker Fabian Nuñez (D) in December, but has now stalled after being voted down in the state Senate Health Committee in late January.

Under the proposed reform, California would have an individual mandate requiring all state residents to have health insurance. It would be financed by a new tax on hospitals, an increase in the tobacco tax, and billions of new federal matching funds. Most employers who don’t currently offer employees health insurance would be taxed up to 6.5 percent of their payrolls to offset insurance costs. The plan has now stalled partly because of the state budget crisis, but also partly because of the challenge in creating a coalition of interest groups willing to support a compromise plan that differs from their preferred options. At this time, it is unclear whether any revised or scaled-back version of the plan could move forward in 2008.

Getting the details right in any such plan is crucial, and Dow had a hand in hammering out some of the details of the Schwarzenegger plan. The reform would require a substantial number of people to buy health insurance in the individual market, and Dow has been working on ideas to stabilize that market when it is faced with an influx of people, especially sick people. Dow is a champion of risk adjustment, a way to encourage insurance companies to insure risky individuals at the same rate as they do healthy people. He gives this example to illustrate: “What we’re going to do is give you some subsidy to enroll this potentially really expensive person, such that your expected profits for enrolling this person can be the same as enrolling a healthy 20-year-old kid. It’s a finely tuned way of providing appropriate incentives to insurance companies.”

Dow and others put forth an educational effort to convince the Schwarzenegger administration that risk adjustment can work, and the administration did include it in their legislation. This is one of the reform elements that would be feasible to approve in 2008 and start to be put in place while work continues on other more controversial elements of reform.

To help you frame the debate, here are the definitions of some terms that are used frequently in discussions of health care reform.

Community Rating: Under community rating, insurers have to charge the same price to every policyholder within a community, regardless of age, sex, or any other indicator of health risk. The premium is based on the average cost of providing medical services to all people in a specific geographic area. Under modified community rating, price differences could be based on age and/or sex.

Connector, Bridge, or Pool: These are state- or federal-sponsored programs that facilitate individuals and small businesses in purchasing products offered by private insurance companies. Small businesses and individuals lacking health insurance are eligible, and individuals at lower income levels may receive subsidies. Their goal is to provide continuous coverage for individuals regardless of employment status.

Consumer-Driven Health Care: Consumer-driven health care refers to health insurance plans that allow members to use personal health savings accounts, health reimbursement arrangements, or similar medical payment products to pay routine health care expenses directly, while a high-deductible health insurance policy protects them from catastrophic medical expenses. Funds not spent in a given year usually may be carried over to the following year.

Guaranteed Issue: Guaranteed issue requires that each insurer and health plan accepts everyone who applies for coverage and guarantees the renewal of that coverage as long as the applicant pays the premium.

Individual Mandate: Under an individual mandate, the state or country requires individuals to have health insurance. People who don’t receive such coverage through their employer or some other group are required to purchase their own individual coverage. Those who fail to do so are subject to fines or other penalties. Some individual mandates may exempt individuals who cannot afford to purchase insurance.

Pay-or-Play Laws: Pay-or-play refers to states mandating employers to pay a fee to the state to provide health insurance to their employees (to pay), unless the employer provides health insurance coverage directly to its workers (to play).

Single-Payer Plan: In a single-payer plan, the state or country becomes the single payer for all health care bills.

continued on page 8

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Health Care Reform,

continued

While the state politicians work on what Dow terms “the 30,000 foot framework of what needs to be done,” other organizations in California are already moving forward on some of the governor’s stated goals. Beyond insuring all Californians, Schwarzenegger’s administration is also focusing on prevention, wellness, and the treatment of chronic

They’ve also included a set of measures called IT-Enabled Systemness. Together these two groups should act as a guideline and incentive for physicians to improve chronic disease management. Take, for example, diabetes registries. Williams explains, “In the absence of a complete electronic medical record, you can implement an electronic registry so that

In addition to the continuing work with P4P, Williams and the IHA are working on a project on medical device use. Says Williams, “Once there’s FDA approval of a device or drug, then there’s not sufficient oversight, record keeping, or tracking of how things are going. So IHA is managing a demonstration project just to better understand medical device use and the relationship between the device companies and the surgeons and hospitals.”

A veteran of medical group and health plan management, Williams came to the School of Public Health to get his Dr.P.H. and refocus his career on his two main interests: quality improvement and managing health care costs. “If you’re working for a for-profit company, it becomes about making money,” he says, “which is fine. But I just felt like I needed to get into the nonprofit world and develop some skills so I could focus on what I wanted.”

Fortunately for patients, his focus is on helping improve the health care industry.

Local Reform on a Daily Basis

diseases, specifically diabetes. Tom Williams, executive director of the Integrated Healthcare Association (IHA) and a doctoral student at the School, has taken up this challenge.

Williams and the IHA are very committed to improving the quality of the health care system in California.

The Pay for Performance (P4P) Initiative, now in its fifth year, has already achieved improvements across clinical quality, patient experience, and use of information technology. The next step for Williams is to bring the P4P program to bear on chronic disease management. “Most Pay for Performance programs to date have focused on primary care,” he says.

“On the chronic disease side, there is tremendous opportunity to improve both the quality and cost of care, and that’s where we’re beginning to focus.”

Effective January 1, 2008, the IHA implemented a whole range of measures based on the coordinated care of diabetes patients, and doctors must score well on every measure in order to achieve payment.

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every single diabetic gets registered. Then you have 10 things that you take out of the medical record and put in this registry, including a foot check, eye check, blood pressure, blood glucose, etc. Now you can do population management, you can run reports, and you can have someone check periodically to ensure these tests get done. That’s just a simple example, but it’s very powerful.”

The P4P program provides bonuses to physicians who implement information technologies, including diabetes registries, population management reporting systems, and electronic drug prescribing, drug interaction checking, and retrieval of lab results.

“You can see intuitively, if you can do all these things, that’s really going to help your ability to manage your practice,” says Williams. “This has really captured the attention of the physicians’ groups. They like quality; they think it’s the right thing. So they’re very much engaged.”

It might seem counterintuitive, but School of Public Health alumnus Tony Iton, health officer and director of the Alameda County Public Health Department (ACPHD), believes health care system improvements have the best chance of happening on the local level. “Sometimes I wonder where the state and national fit in,” he says. “Because frankly, there is a difference between health care and health care insurance. Health care is delivered to individuals in communities through a delivery system, and that delivery system doesn’t change because a politician had a bright idea. It’s based on the local environment in which it is found.”

Iton, who earned his M.P.H. at the School and also has graduate degrees in law and medicine, puts his education to work every day for the residents of Alameda County. “I wake up each morning trying to figure out ways to make one and a half million people healthier today than they were yesterday,” he says. “It’s a huge intellectual challenge, and it’s a huge structural challenge.”

Local health organizations are also taking a cue from the governor’s agenda and focusing on better

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strategies for treating chronic disease. Alameda County is one of a handful of counties that applied for state money to participate in a pilot project called the Health Care Coverage Initiative, which is designed to test innovative ways to provide health services to the uninsured. Iton’s department is working with the patients in the county’s safety-net population who have diabetes, high blood pressure, or congestive heart failure—chronic diseases that drive a large proportion of health care dollars. They are looking at the cost of treating those patients, including hospitalization, clinic service, emergency room visits, and drugs, and finding ways to manage that care more effectively and cost efficiently. One major way is to make sure that every one of those people has a “medical home,” which is a concept in health care reform of linking people to a place where they can get care information 24 hours a day, seven days a week. Not just a doctor, but a medical assistant, a nurse, and disease management experts who will manage a group of patients—being

those critical resources that they need for health.”

These include lack of education, housing, jobs, and recreation, and also the risk factors that tend to congregate in the same areas: crime, fast food, alcohol, drugs, and policies around policing. “I think that the environment, physical and social, drives a lot of the behavioral choices that people can make,” Iton says.

“And I think changing the environments is critical.”

The department has set up some small “laboratories” in East Oakland, West Oakland, and Hayward, where public health workers go to every household, talk to people and invite them to participate in leadership and organized events. The program’s goal is to organize people and build social, political, and economic power among populations that don’t traditionally have that power. The program has been going on for about five years, and the results have been very promising. “We’ve found from the baseline to the first survey that we’ve substantially increased people’s sense of civic engagement, which

The Common Goal: Progress Local efforts are a good reminder that it’s important not to lose sight of the true goals of health care reform, and that any movement is progress. “Often we spend so much time arguing over the details of the reforms,” says Dow, “that we lose the big picture of what the overall benefits would be to choosing one and moving it forward.”

Dow continues, “When we think about the health of the public, insurance reforms by themselves aren’t sufficient to have major impacts at a population level. People talk about the United States having worse life expectancy than a lot of European countries. My perspective is that it has very little to do with insurance systems. It has to do with the broader fabric of our society.”

Iton agrees and paints a grim picture of the state of U.S. health care: “In this country, we’ve sold out health care to the private sector. And I don’t think

“I wake up each morning trying to figure out ways to make one and a half million people healthier today than they were yesterday.”— Tony Iton available by phone, checking in with patients and facilitating their participation in peer groups, and hooking people up with any technology that is cost effective and can help patients manage their health.

“These kinds of things really give the patient more control over his or her situation,” says Iton. “The literature demonstrates that it is linked with much better outcomes. Meaning in general less hospitalization, less emergency room utilization, less death, and therefore less cost and increased productivity amongst patients with chronic diseases.”

Iton’s department is implementing new place-based strategies to combat what Iton terms “the constellation of forces that conspire to deprive people of

we think is critical,” says Iton. “That is a huge change in people’s minds. And once they have that perspective, they’re going to be much more proactive about their environment.”

Reengineering communities to reduce the burden on the health care system is no easy task, but fortunately the ACPHD has community allies. “One of the benefits of being in Alameda County is that we don’t keep everything in government,” says Iton.

“We work very closely with the private nonprofit sector. Particularly those community entities like Clinica de la Raza and Asian Health Services that are culturally competent. They know their populations, they go back years, and they’re trusted assets to the community.”

you can walk your way back from that. We’re now trying to manage our way with that as a given— that profit-taking will be a core part of our health care system.”

Yet Iton remains optimistic about our ability to achieve quality health care in this country. He says, “People compare health care to a three-legged stool, with quality, access, and cost as the three legs.

And there are some cynics that say you can have any two of those, but you can’t have all three. And I think they’re wrong. Because I think all three of those things are synergistic.”

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IN AMERICA’S

SALAD BOWL, RESIDENTS FIND BARRIERS TO CARE

By Linda Anderberg

Even with excellent medical insurance, it can be difficult to access health care. Your doctor doesn’t have an available appointment for weeks, you have trouble taking time away from your work, or your pharmacy closes at 6 P.M. but you have to pick up your child from daycare right after your five o’clock meeting.

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But imagine if you don’t have decent health insurance, and you’re not even sure what coverage you do have or where to go to get help. And you’re in a rural area where services are sparse, and you don’t have a car—or even a driver’s license—and you don’t speak the same language as your doctor.

Maybe you’re not even a U.S. citizen. This combination of problems can turn even a simple doctor’s visit into a pipe dream.

Fixing the health care system in California is not just about giving everyone the right to care. Beyond the debate over the cost of health insurance and the levels of uninsured lies the basic need of individuals to have the knowledge and ability required to access their right to care. Take, for example, Salinas Valley residents—the majority of whom are rural farm workers, many of them undocumented immigrants.

Among them are women and children taking part in a research study by the Center for the Health Assessment of Mothers and Children of Salinas (CHAMACOS). The primary goal of the center’s main cohort study is to assess the health effects of low-level, chronic pesticide exposure and other exposures in children living in an agricultural community. And yet—from seven years ago when the mothers were pregnant to today when their children are school age—center researchers have been addressing access to care issues.

Brenda Eskenazi, professor of maternal and child health and epidemiology and director of CHAMACOS, says that the center has often negotiated additional care for the children and their mothers, such as school or medical attention. The reason is often less that the women wouldn’t normally get the services and more that they can’t access the system. “I would say that a good portion of the women, either because they weren’t that familiar with the United States or couldn’t speak English, could not readily figure out what to do,” says Eskenazi. “So there’s access at the level of ‘Would they have the right to have this if they knew how to get it?’, and there’s access at the level of ‘They just don’t know how to get it.’ And there were numerous times when we helped them to get what they had the right to get.”

A Scarcity of Specialists The right to medical and mental health services can be difficult to take advantage of in Salinas Valley for a variety of reasons, including transportation problems, language barriers, and distance issues, but one major obstacle is the dearth of trained professionals. Salinas Valley, considered “America’s salad bowl,” is rich in agricultural resources and home to an incredibly diverse yield of crops, including lettuce, strawberries, broccoli, artichokes, carrots, cauliflower, celery, and wine grapes. Medical resources are in short supply, however. Although there are a series of clinics dedicated to serving the farm worker population with staff members who do speak Spanish, specialized medicine and mental health services are much harder to come by. For example, at the beginning of the cohort study, CHAMACOS researchers needed to take blood samples from the children, a process that should be routine because it’s required

by MediCal at 12 and 24 months. But the local hospital was facing a very low success rate; a lack of pediatric phlebotomists in combination with parents’ uncertainties about services available to their children resulted in a great number of children missing standard blood screenings.

school age. Her tests now include assessments of mental health symptoms such as early onset of depression, as well as cognitive tests and behavioral inventories. If any red flags go up during these tests, then CHAMACOS researchers can make a referral to the school system to make sure the child is plugged in with the right community resources he or she needs.

“It’s pretty frequent that we are making a referral for a child in a case where a parent has had concerns about the child for a long time,” Kogut says.

“It’s rare that we find something that is completely new and surprising to the parent. But the parents have never found a way to communicate that to the school system or haven’t known that there was any source of help for them in the school system.”

When members of the school system are made aware of a problem, they may still struggle to find the resources to help. Kogut recalls a time when she

“In order for us to get the blood for our study, we had to hire somebody, train that person to become a pediatric phlebotomist, and send her down there,” says Eskenazi. “There’s nobody there.”

Even with their phlebotomist in place, researchers struggled with special blood tests. “There was a courier that would go from the different clinics back to Salinas where they could do some of the processing of the blood,” Eskenazi explains. “But that courier service only came once a day. And some of the blood couldn’t stand there unfrozen, so we had to get dry ice, but there was only one dry ice vendor in the entire valley.”

Katherine Kogut, a School of Public Health alumna and CHAMACOS study coordinator, oversees most of the neurodevelopmental testing of the children in the cohort study. She runs into access problems more often now that the children are

spoke to the woman who runs the special education program at a local elementary school about a girl who was expressing suicidal tendencies at age seven. The child was already on her radar, but because the school did not have a psychologist or child counselor who spoke Spanish, they could not intervene. “So that’s not going to be a help to this monolingual child. Or a comfort to this monolingual family,” says Kogut.

Eskenazi and her colleagues tried to find bilingual specialists able to work with uninsured families on a private family counseling basis, but again faced a resource scarcity. continued on page 12

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Enlisting the Help of Faith-based and Cultural Organizations Breast and cervical cancer screenings are considered “gold standard” by the U.S. Preventive Services Task Force, meaning that they have been shown to significantly reduce mortality; however, many women are not getting these vital services. Professor Joan Bloom is studying how culture and religion can serve as barriers to health services, and how community resources such as churches can be harnessed to improve access.

In California, breast and cervical cancer screenings are provided to women without health insurance at 200 percent of poverty line. Women can call 1-800-511-2300 to determine eligibility and enroll. Yet African American women are receiving these screenings at much lower rates than other state populations. Bloom—who is a member of the State of California Breast and Cervical Cancer Advisory Committee and serves on the Northern California Cancer Center’s board of directors—surveyed clinics participating in the program and interviewed women to find out why. Her research indicates that secondary access issues—travel times, lack of outreach, and cultural insensitivity—play a large role. “For example,” Bloom says, “when one African American woman called the 800 number, she was sent to a physician in Chinatown.

So she got to the Chinatown clinic and of course, as she said, ‘I stood out.’”

Bloom hopes to harness the resources of community churches to help women negotiate the system. She and colleagues are working with Glad Tidings, an evangelical church in Hayward, on a pilot project to provide outreach services, counseling, and even transportation to screenings from church. If successful, the program will be expanded throughout the Bay Area.

Bloom has also begun work on a breast health project with Afghan women in partnership with the Afghan Coalition—a nonprofit organization providing social services to Afghans in Northern California based in the Fremont area, where 60 percent of the U.S. Afghani population lives. Available data suggests that Afghan women may not use the medical care system even if they do have health insurance. While language and cultural issues play a role, Bloom believes religious barriers may be the greatest impediment. “Some of the religious taboos are actually in the Koran,” she says, “and some of them, according to my informants, are interpretations in the Afghan culture. So we’re trying to separate the cultural barriers from the religious barriers.”

Bloom’s team is training Afghan women as interviewers and will use the gathered information to develop and culturally adapt education programs to reduce barriers to health care. “There are a lot of issues in terms of moving to a new country with a different culture and losing roots with a religion that regulates family life,” says Bloom, “so we’re hoping to help.”

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Barriers to Care,

continued

The Trouble with Testing “It’s not just that there are very few psychologists, but there are also few assessment tools that can be used to properly assess these kids,” says Eskenazi.

The trouble with testing goes beyond finding a good standardized test in Spanish, although that in itself has proved difficult. The real challenge is figuring out how to assess a child who is learning two languages at the same time. There is a paucity of information on assessment of bilingual children: when to know when their problems are really cognitive and not a result of uneven language acquisition, and when to intervene.

“You know, there’s so little data on acquisition of cognitive ability and learning in two languages, it’s amazing,” Eskenazi says, “These kids might be getting lost because we can’t assess them.”

The language issue as it affects assessment and access to health care is only growing. According to the 2000 census, 39 percent of California residents speak non-English languages at home—a higher percentage than any other state in the nation. Twenty percent of California residents also reported that they don’t speak English “very well.”

To combat these challenges, Kogut came up with a method to assess their bilingual subjects using a fairly quick vocabulary test that is available in English and Spanish. It takes 10 minutes in each language, so researchers spend about 20 minutes at the beginning of each assessment figuring out the best language in which to proceed with each child. But they still have to take into account the language the child is using in school to learn reading and math. Kogut explains, “When we administer tests of achievement, even if they’re stronger in Spanish, it’s not going to work to ask them math equations in Spanish if they haven’t heard ‘plus’ and ‘minus’ in that language.”

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“It’s not just that there are very few psychologists, but there are also few assessment tools that can be used to properly assess these kids.”

The Binder of Black Doom Eskenazi and Kogut are hushed and somber when they talk about the “binder of black doom.” And with good reason. Says Eskenazi, “Each one of these pieces of paper represents a specific case where we either found neglect, abuse, or some situation where the child was in danger, and we intervened outside of the research setting.”

They have combated the “binder of black doom” with a more cheerful binder chock-full of resources they have compiled over time to help serve the Salinas Valley population. The binder includes a list of bilingual social services in the county, including mental health counseling, child abuse and suicide hotlines, and domestic violence shelters.

She can recall each case in vivid detail. In one instance, a woman came to them for help because she thought her husband was going to abuse her, and she didn’t have a safe place to go with her child. The staff realized that it was an emergency situation. “It was not something where we could refer her to a social service and maybe a week down the road something would happen,” says Eskenazi. “We did everything Farm workers tend a carrot field in the Salinas Valley. simultaneously. We figured out who to put her in touch with in the clinic, but at the same time we were on the Outreach Can Improve Access phone calling every shelter we could find to see if any of them spoke Spanish and were willing to The CHAMACOS study has led to improvements in accept a child. And I think there was one—one of health care access for study participants, in part them. Most would accept the woman but not the because of necessities for the research—as in the child. They just didn’t have the services or case of the phlebotomist and the bilingual assessment the capacity.” tests—and in part because center members engage in a lot of activities that are outside their role CHAMACOS is a research study and not a social service organization, and so its role in these situations because they “have hearts,” according to Eskenazi. In addition to collecting outside resources, CHAMACOS is necessarily limited. “But some of these women researchers are also beginning to provide some don’t feel comfortable or know how to access social resources of their own, based on the findings in services organizations,” says Eskenazi. “So our staff their research and their close experiences with members serve as an outreach to the community the access problems in the community. They have because they’re known as being people to talk to, produced an attractive and inviting suite of brochures and at the same time are acculturated enough to in Spanish, addressing health issues like exposure know how to access the system.” to sun, allergies, and protecting children from pesticides. They’ve also recently launched a kiosk

at their prenatal offices where women can access health information using a computer. The kiosk gives the women, most of whom are not computer savvy, a chance to train using a mouse and learn about computer navigation. “At first a lot of the women were reluctant to use it,” says Kogut. “They felt like they couldn’t learn to use the computer. But once they tried it, it empowered them.”

CHAMACOS is also helping to train bilingual individuals and encouraging undergraduates from Salinas Valley to give back to their community. An intern this past summer worked with CHAMACOS conducting research on the accessibility and cost of fruits and vegetables for the farm worker population in the county—finding that there were few stores in the region that offer fresh produce to the farm workers who grow it. Another student plans to develop an education program for seven- to eight-year-old school children on environmental health.

Kogut says, “When I see a kid in our study who pops up with high scores—130 and 140 IQ scores—I’m always thinking ‘we need to send that kid to college and we need to get that kid back in this community sharing those gifts.’”

In the long term, Eskenazi believes the solution to the Salinas Valley access problems lies with major policy change. “We have to do something about accepting that we have an immigrant population that’s providing the infrastructure to put food on our table and feeding us,” she says. “And we can’t let them continue to live on fringe and provide medical care for them as if they’re on the fringe, and then expect to have food on the table. We’re going to have to deal with the bigger picture.”

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ELECTRONIC MEDICAL RECORDS: WILL THEY IMPROVE THE

QUALITY OF CARE?

By Linda Anderberg Kaiser Permanente touts HealthConnect, its new electronic medical record (EMR) system, as the “missing link between current inconsistent care and best care.” The nation’s largest HMO promises an infrastructure that will “reengineer care” and help Kaiser “enter the decade of health information technology.” But can EMRs really deliver on such promises? And are they worth the initial start-up costs, which can range from thousands of dollars for smaller practices to billions of dollars for a large HMO? These are questions that Executive Associate Dean Thomas Rundall has set out to answer. Since 2005, Rundall, John Hsu of Kaiser Permanente, and colleagues have been studying the effects of the HMO’s implementation of HealthConnect in Northern California. Specifically, they are assessing the impact of the electronic medical records on

in expanding use of EMRs is that, as Rundall says, “a strong case can be made that a good EMR will improve physicians’ access to important clinical information about their patient, increase caregivers’ compliance with evidence-based care guidelines, reduce medication errors, and improve coordination of care across multiple providers.”

It’s clear that process improvements are needed in the health care industry. While other sectors like banking, retail, and auto repair have implemented continuous quality improvements and advanced information technology, the health care system has remained a cottage industry. As a result, workflow is inconsistent, and quality varies from one physician’s office to the next.

clinicians’ use of evidence-based care processes and patient outcomes for five different chronic illnesses: congestive heart failure, coronary artery disease, hypertension, diabetes, and asthma. This focus speaks to the negative impact of chronic disease, which affects more than 100 million Americans, and the potential of EMRs to improve chronic disease management.

The research is timely—currently about 28 percent of U.S. doctors employ some form of an EMR, and the federal government has set a goal of 50 percent by 2012. The reason for the government’s interest 14

University of California, Berkeley

EMRs are one tool that could help unify and standardize the industry, and therefore improve quality control. They offer the ability to better monitor health progress, laboratory and test results, and pharmaceutical prescriptions and potential drug interactions. They also allow doctors to communicate with each other and patients more regularly, and can provide patients with a way to educate themselves about their health and self-monitor their diseases.

Given the pending increase in chronic disease as the baby boomers age, Rundall believes that increased self management of chronic disease is essential to reducing the cost and improving the quality of health care. “The financial well-being of our nation’s

health systems dependent doing this,” heal he alth th care ccar aree sy yst stem emss is ddep eppen ende dent nt oonn do doin ingg th this is,” he says. sayys. “Havingg so manyy patients patients with chronic illnesses will overwhelm everything else that health systems syystems need to do,, unless we do a better jo jjobb of providing prov pr ovid idin ingg care care aand nd hhelping elpi el ping ng ppeople eopl eo plee to aacquire cqui cq uire re tthe he skills and motivation to do a better job of selfmanaging these diseases—that’s really what it’s all about.”

Rundall thinks information technology like EMRs offer a chance at “that rare double win” of improving quality while cutting costs. He says, “EMRs have the potential to improve patients’ quality of life and health and to reduce health system costs through the reduction of expenses in care for patients whose chronic disease is out of control. It’s a rare opportunity, which is why progressive, forward-thinking health systems are investing heavily, not only in information systems, but in care management improvement programs. They hope to achieve exactly these kinds of outcomes.”

While some studies over the last six or seven years have indicated that EMRs have beneficial clinical effects, others have found no clinically significant effect, and in a small number of cases harmful effects have been observed that may have been introduced by the EMR. But most of these studies have only looked at the effects of the EMR at one point in time, usually within a year of implementation. Rundall’s study has a longitudinal advantage.

“Kaiser is a very special context in which to examine this question because it is a highly integrated delivery system,” he explains. “It’s possible to follow a large number of patents over a long period of time and have fairly complete data on them because they are enrolled members of the HMO. This is not true in most health systems.”

Rundall and Hsu’s research will examine not only the immediate effect of implementing HealthConnect, but will look at improvements over a period of four years. It’s Rundall’s guess that—because of the

Measuring the Quality of Care Dean Stephen M. Shortell has a long-standing commitment to evaluating the quality of health care practices. Since the year 2000, he and his research team have been focused on care delivered to patients with chronic illness, specifically asthma, depression, diabetes, and congestive heart failure. Over the course of the National Study of Physician Organizations (NSPO), of which Shortell is the coordinating principal investigator, they have developed measures for evaluating physician performance and gathered robust data

tim required for people to adopt and implement time tim ggood go o care practices and also the time it takes to change physiological processes—the team is much cha more likely to see clinically significant effects three mo or ffour years out.

on what practices are associated with high-quality care.

Initial data analyses indicate that HealthConnect is having some of its intended effects. For example, one year after implementation, the percentage of physicians reporting that they have access to all relevant clinical information at the point of care has increased from 43 to 65 percent. And preliminary results with respect to hypertension patients indicate a clinically significant improvement in patient condition. But the team is just finishing Year Two of data collection and won’t publish any clinical results until after Year Four.

over time. They discovered that progress is slow.

Concurrently, Rundall is studying interventions with low-income individuals with diabetes, for whom EMRs may not provide much, if any, assistance. As a co-investigator with Dean Schillinger at UCSF, he is working with these patients to find ways to help them manage their diabetes. Their solution has turned out to be relatively low-tech and inexpensive: a package of services including automated weekly telephone calls, with nurse practitioner follow-up as needed and group medical visits to provide personal support for patients.

will have better patient outcomes,” says Shortell, “And those that aren’t doing them will

“Even with a low income population—many of whom may be uninsured, live in transient housing conditions, or have limited English literacy—there are innovative care management programs that are not particularly expensive,” says Rundall, “but rather rely on old-fashioned communication and relationships developed with patients.”

The group contains both high- and low-performing practices. Researchers will perform

It’s a good reminder that EMRs, while beneficial, are not the only possible savior of health care. “I wouldn’t want everyone to think the only answer to chronic disease is an expensive electronic medical record,” Rundall says. “There are ways in which EMRs are very helpful, but there are other approaches that can work and should be implemented by providers.”

for others to follow.”

Last year, the team—which also includes Kaiser Permanente Distinguished Professor of Health Economics James Robinson and researcher Robin Gillies from the UC Berkeley School of Public Health, Lawrence Casalino at the University of Chicago, and Diane Rittenhouse at UCSF—conducted an NSPO update to determine if care has improved

“The bottom line is there has been some improvement, but not a lot.” Shortell, who is the Blue Cross of California Distinguished Professor of Health Policy and Management, says, “On average, physician practices still implement less than half of recommended practices for patients with chronic illness.” This finding suggests several new paths of study that will delve further into the factors that contribute to high-quality care, with the NSPO variables serving as a base.

The team is pairing with investigators at Dartmouth College who have Medicare data files on patient outcomes, which they are linking with the NSPO data. “Our hypothesis is that those practices that do more of the things that evidence suggests they should be doing be worse. If the data show that, then there will be a stronger evidence base for making changes in physician practices.”

They are also beginning to look beyond large practices. The majority of physicians in the United States are in practices of less than 20—a lot are in solo practices or partnerships.

“Our prediction is the smaller practices will be doing even less because they won’t have the resources,” says Gillies. The team will begin examining these smaller practices in a project funded by the Robert Wood Johnson Foundation—which also funds the NSPO project, along with the California HealthCare Foundation and the Commonwealth Fund.

The Commonwealth Fund has also funded a project begun in early 2008 to generate in-depth comparative case studies of 12 of the practices included in the NSPO data set. site visits to gather detailed information about the governance and management of the physician organizations; their relationship with health plans; their culture and leadership; and barriers and facilitators to the implementation of care management, disease prevention, and quality improvement practices.

“We’re going to try to identify some of the key aspects that distinguish high performers from low,” says Shortell. “And then we’ll have some suggestions and recommendations

Finally, the team is working on a project to merge data with the Integrated Healthcare Association in order to evaluate California’s Pay for Performance program—the country’s largest Pay for Performance initiative—which offers financial incentives to physician organizations for achieving quality of care goals. “This work should be quite interesting as we examine the relationship between our measures and those used in this program,” says Shortell.

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SPENDING MONEY & SAVING LIVES:

THE HIGH COST

OF HEALTH

By Linda Anderberg

Everyone agrees that the costs of health care in the United States are rising, and rapidly. In fact, the U.S. Centers for Medicare & Medicaid Services (CMS) estimates that our national health care expenditures will reach 20 percent of the GDP by 2015.

Some economists project that this figure could reach 30 percent in 20 years’ time. Distinguished Professor of Health Economics and Public Policy Richard Scheffler states, “It’s unlikely that the trend in health care spending is going to change or be mitigated to any large degree. So the big issue

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University of California, Berkeley

is not how much we spend, but how to spend our money wisely.”

An expert in health care markets, health insurance, mental health economics, health work force, and pharmacoeconomics, Scheffler is well qualified to help Americans get their money’s worth out of the

health care system. As director of the Nicholas C. Petris Center on Health Care Markets & Consumer Welfare—a position he has held since the center’s inception in 1999—he has been able to raise more than 11 million dollars to support research and education in these areas. The Petris Center, based at Berkeley’s School of Public Health, has its own research staff and can also call on an impressive network of health experts and economists from coast to coast. The center’s mission is to conduct research that will objectively inform policymakers about the consumer health care issues of access, affordability, competition, and information quality, particularly as these issues affect low-income or vulnerable groups.

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Are Mental Health Measures Succeeding?

California’s mental health care system is, by design, a system of 58 county- and two city-based mental health care systems, each of which has significant control over the financing and delivery of its services.

The system is undergoing significant transformation following the 2004 passage of Proposition 63, the Mental Health Services Act (MHSA)—an initiative to support mental health systems by placing an ongoing 1 percent tax on individuals with incomes over $1 million, with the intent of raising $1.8 billion

for improving the system as a whole,” says Scheffler.

“This report and survey is the first in a series of surveys to measure progress toward the MHSA goal of a transformed mental health system in California.”

Putting a Price Tag on Technology Treatment of mental health disorders is one of many areas of medicine where technology, in the form of new pharmaceuticals, has led to better outcomes for patients. Says Scheffler, “It’s well understood now that people can function outside of facilities and have normal lives, and the right medication can be

Health Affairs documenting ADHD medication use among 5- to 19-year-olds in countries belonging to the Organization for Economic Cooperation and Development. The researchers found that use and spending grew in both developed and developing countries, but spending growth was concentrated in developed countries, which adopted more costly, long-acting formulations.

“Given the global diffusion of ADHD medications, as well as the prevalence of this condition, ADHD could become the leading childhood disorder treated with medications across the globe,” Scheffler says.

“The big issue is not how much we spend, but how to spend our money wisely.” over the first three years. This constitutes a 10 percent increase in mental health spending at the county level, and Californians should expect a return on their investment.

The Petris Center is already closely monitoring the flow of funds, program and service changes, outcomes, and the process of change. A study funded by the California HealthCare Foundation will examine the implementation and effects of Proposition 63 over three years. As part of that research, in November 2007 the center released a report, California on the Eve of Mental Health Reform, which presents findings from the researchers’ systematic compilation of key organizational information about county mental health departments prior to the passage of the MHSA. The report highlights commonalities between the state’s diverse county programs, including high participation in innovative demonstration programs, minimal spending on institutional care, low administrative overhead, and provision of care in languages beyond those that the state requires.

“While each county is different, the similarities between counties may be useful in providing lessons

an important factor to help them live in the community.” Positive advances have also been made in the treatment of heart disease, he adds, and there’s good evidence that some of the high tech services like coronary artery bypass, treatment of coronary artery disease, lipitors, and other approaches have had measurable and important impacts on saving people’s lives and improving longevity.

This technology comes at a price, however. The consensus estimate is that an average of 50 percent of the additional spending on health care each year is driven by technology, broadly defined as new drugs, tests, and procedures. “Some of these procedures are quite important and save lives,” says Scheffler, “and some are perhaps marginal improvements over things that are already done and may be quite expensive.”

Because of this concentrated spending in medical technologies, it’s important to monitor their implementation and outcomes. The Petris Center is keeping tabs on the global increase in usage of psychostimulant drugs to treat attention-deficit/ hyperactivity disorder (ADHD). The center published a study in the March/April 2007 issue of the journal

“We can expect that the already burgeoning global costs for medication treatment for ADHD will rise even more sharply over the next decade.”

Richard M. Scheffler, director of the Petris Center (center), with Tracey Fremd, president of the California Association of Nurse Practitioners (left), and Allegra Kim of the Epidemiology and Prevention for Injury Control Branch of the California Department of Health Services, at the 2007 Petris Symposium

The study recommends that countries compare data on spending to adjust overuse or underuse, and to weigh carefully the potential benefits versus potential liabilities such as side effects and addiction. continued on page 18

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The High Cost of Health,

continued

It also suggests that promoting optimal prescription and monitoring should be a priority.

Considering Costs in California Although it remains to be seen what health reform proposals in the state of California will be implemented, much work has been done to determine the economic feasibility of several plans. In addition,

that chronically ill individuals would have access to premiums at the same rate as anybody else. But one of the concerns is that insurance companies would very predictably lose a lot of money on these same individuals and will run away from these people.”

At a November conference cosponsored by the Petris Center and Boalt Hall’s Berkeley Center for Law, Business, and the Economy, Dow shared his

One of the Petris Center’s primary missions is to keep tabs on California’s health care market. “We’ve published many papers that look at the structure of the market and evaluate antitrust issues,” says Scheffler. “We also held a conference on antitrust issues in California; how to make the market more competitive and reduce costs.” Health care markets work best for consumers when prices are low and there are many providers to choose from. When the bargaining power of hospitals, health plans, and medical groups becomes too concentrated, higher prices for consumers can result.

Looking Ahead

many of the reforms proposed in California are included in the national plans being shaped by presidential candidates, such as the idea of an individual mandate and guaranteed access to health insurance. “California faces the same cost issues as the rest of the country,” says Scheffler, “and it also has a higher rate of uninsured.”

If, as has been proposed, California adopts a community rating system—eliminating the insurance companies’ ability to set premiums based on health status of individuals—healthy people could see their premiums raised. States with community rating like New Jersey, Massachusetts, and New York have some of the highest premiums in the country. And yet community rating is an important component of keeping costs at a more reasonable level for people with preexisting conditions.

Community rating is one of many potential landmines in health insurance reform. Associate Professor of Health Economics William Dow says, “Community rating solves one level of problems in

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expertise on the pitfalls of community rating, asserting that reinsurance and risk adjustment can help make it work by stabilizing the insurance market.

Market Forces at Work Our health care system is very fragmented, and part of the high cost of care comes from misallocation of resources and unnecessary administrative costs. “In the United States, some of the things we spend money on are unnecessary because they are duplicate services,” says Scheffler. “Things like tests that are done more often than needed or that don’t need to be done at all.”

The health care workforce, another area of focus for the center, is the subject of some planned activities for the coming year. In April 2008, the center will convene “The 2008 Berkeley Conference on the Global Health Workforce,” addressing topics such as policy recommendations for achieving adequate supplies of health workers, and the effect of the health workforce’s size, skills mix, and distribution on health care delivery. In addition, Scheffler has a book forthcoming in August 2008 from Stanford University Press, Is There a Doctor in the House?

Market Signals and the “Right” Supply of Physicians.

While the cost of health care can only be expected to increase, the Petris Center, working on many different fronts, is helping make certain that those valuable dollars will be put to the best use. And wise spending, in turn, will protect the public’s health and save lives.

“Community rating solves one level of problems in that chronically ill individuals would have access to premiums at the same rate as anybody else.”

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A CONVERSATION WITH

MARK HORTON

Dir e c t o r o f t h e C a l i for nia Depar tment Of P ublic Health In March 2007, Mark Horton was appointed by Governor Arnold Schwarzenegger as director of the California Department of Public Health (CDPH). The CDPH was created in 2006 to bring greater focus to the issues of public health in the state. UC Berkeley Public Health caught up with Horton to discuss the future of California’s public health initiatives.

What are your plans for the new California Department of Public Health?

There are three major areas that are extremely important to move forward with: strategic direction and focus, improving efficiency and effectiveness, and strengthening partnerships.

With regard to strategic direction, as a new department we have the opportunity to step back and take a broader look at the major challenges facing California today. When we find gaps or areas that need greater capacity, then we will reallocate resources to meet those challenges.

Efficiency and effectiveness means looking at our ability to attract and retain the kinds of professional scientists and technologists we need to remain an excellent resource for the state. We also need to ensure that we have an information technology infrastructure that enables us to archive, analyze, and disseminate data. I’m particularly concerned about our laboratories—we’ve had an outstanding national reputation for cutting-edge public health leadership and capacity in our laboratories—and I want to make sure that we are doing all we can to maintain that status.

And finally, it’s about partnerships. I’m convinced that there’s nothing that we do in the department that doesn’t involve a critical partnership with some outside entity, whether it’s the local health department, the health care industry, or academia. And it’s a matter of being much more strategic about those, and ensuring that we maximize our ability to work together.

What do you see as the biggest health challenges facing California today and in the future?

There are some obvious things on our plate right now that will continue to be major challenges as we move forward. Certainly preparedness has been a very hot top priority for the administration, the governor specifically, and for the department. The CDPH needs to be part of the overall state response to an all-hazards approach towards preparedness.

For example, responding to bioterrorism or anticipating a possible pandemic of influenza.

The governor’s health care reform agenda includes prevention and wellness components that—if they move forward, which we’re very much hoping and expecting that they will—will be a major priority for the department. The governor’s health care program also includes specific initiatives on diabetes, obesity, and tobacco use. So those will be big challenges for us as well.

There are some other emerging issues that I anticipate we will need greater capacity for in the future.

For example, dealing with the public health issues related to an aging population. Certainly the whole spectrum of issues related to the built environment, sustainable development, and climate change are all big challenges. And the implementation of electronic medical records may provide data that will allow us to do a much more sophisticated job in monitoring the health of the population.

Please describe the partnerships you’d like to build with schools of public health and other community resources.

Education and training is a two-way street. The CDPH and local government entities provide huge opportunities for training and education of public health students. On the other hand, we look to the schools and the universities to generate the kinds of professionals, technologists, and scientists that we need to staff our departments. So it’s a mutual dependency, and we want to be much more strategic about it to maximize its potential.

On the research side, we want to develop a common agenda. We completely rely upon academia and other research institutions to address some issues.

We want to make sure that we’re all on the same page about the key issues here in California and what should form the foundation of our research agenda. We need to have a much more vibrant relationship with the schools of public health and the university system.

What led you to the field of public health, and do you enjoy it?

I’m a board-certified pediatrician by training. As a Robert Wood Johnson Clinical Scholar at Duke, I was able to earn a public health degree at the University of North Carolina. That made an indelible mark on me. So I spent about 15 years in pediatric practice, but when the opportunity came up, I applied and was selected for the new director of public health position for the state of Nebraska, and that anchored me into a career in public health.

I loved being a pediatrician, and public health has been a wonderful complement to my personal commitment to improving the health of my patients—taking it to a broader perspective and understanding that you can take a more populationbased approach. But I must also say that I’ve been in administrative positions and governmental public health throughout my career, and I’ve very much enjoyed the challenges of management and leadership—providing the strategic direction, motivation, and resource allocation to a large organization to ensure that it can work effectively for the health of the population. That’s very satisfying work.

Clearly the schools of public health will be very high on the list as opportunities for moving ahead.

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STUDENT SPOTLIGHT

MONICA ULHEE HAHN

SERVING THE ASIAN COMMUNITY

By Linda Anderberg

A nervous 17-year-old stands in front of a projected photo of three brightly colored dildos, each covered in a wrinkled

baby she had been playing with in the orphanage, saying Hahn could save the girl’s life. This was not realistic for an 18-year-old college student working

condom. “You like this photo?” she asks the tittering crowd,

a job to pay for college, but Hahn realized there

composed mainly of teenagers, in a common room at the Asian

was a different way she could save lives. “Some-

Resource Gallery in the Asian Resource Center in Oakland.

traveling around the world, I made the connection

where in that craziness of too much activism and that I didn’t want to just be a doctor helping on

From behind the

but hadn’t quite figured out how to fit the two

the individual level only,” she says. “I wanted to do

projector, Monica

concepts together. As a UC Berkeley undergrad, she

something that affects health farther upstream. So

Ulhee Hahn,

majored in molecular cell biology, minored in ethnic

I started looking more into health disparities work.”

M.P.H. ’06, a

studies, and immersed herself in community activ-

This led Hahn to the School of Public Health, where

student in the

ism. “I admittedly just went overboard,” she says.

she studied maternal and child health. She spent

UC Berkeley-UCSF

“I was in maybe five different student activist groups.

her summer internship in the Dominican Republic

Joint Medical

I was definitely not a model pre-med student. I

conducting health needs assessment and develop-

Program (JMP), yells out, “I like that photo, Christina!

spent a lot of time organizing, demonstrating, and

ing a culturally appropriate and youth-friendly

I like it a lot!” The tension dissipates and the

attending sit-ins, and I’m embarrassed to admit that

curriculum on teen pregnancy and HIV prevention

17-year-old relaxes into her description of a sex

I missed an O-Chem class or two.”

for rural youth.

Things clicked into place for Hahn during a trip to

Hahn applied to medical schools while in the

South Africa with the National Youth Leadership

Dominican Republic, in spite of rolling blackouts that

Forum on Medicine to volunteer in HIV/AIDS clinics

caused the computer to crash while she was sending

and orphanages. A nurse urged her to adopt the

in her applications. The JMP was her first choice

education workshop that taught her a lot. “Before I joined this program, I didn’t even know what a condom was,” Christina concludes.

In all, eight teenagers spoke frankly about their experiences with gang violence, teen pregnancy, food choices, violence against women, and substance abuse. The event marked the culmination of the Asian Health Services (AHS) Youth Program Photovoice project, a project led by Hahn, in which Asian youth were given digital cameras to capture what they felt represented the most important health and social justice issues in Oakland. It is also a tribute to Hahn’s success in her goals: study medicine and public health, blend this training with focused social activism, give back to the Asian community, and break down Asian “model minority” stereotypes.

Growing up in what she describes as a very egalitarian and socially conscious household, Hahn always felt that health was a social justice issue,

20

University of California, Berkeley

Monica Ulhee Hahn with Oakland teenagers who participated in the Asian Health Services Youth Program Photovoice Project

1

3 1

Roger Saechao with his Photovoice display

coordinator and Monica Ulhee Hahn

3

2

Clifford Yee, AHS Youth Program

Christina Wong with her Photovoice display

2

because—in addition to adding a sociocultural

Women’s Suitcase Clinic, and cofounded Berkeley

coordinator. “Monica has truly set the bar for future

context to medicine—it allowed her to remain con-

Advocates for Sexual Health, among other activities.

interns due to her immeasurable commitment to

nected with her community, including the UC Berkeley

But her most focused devotion has been to the AHS

Asian Health Services.”

School of Public Health, Asian Health Services in

Youth Program in Oakland, where she has helped

Oakland, her nuclear family in the Bay Area, and

counsel at risk youth about health and sexuality

her apartment with her partner in San Francisco’s

issues since 2003. Hahn integrates AHS into her

Mission District. The description of the Program

training whenever possible: as her JMP thesis

for Medical Education in the Urban Underserved

project of Photovoice, her medical preceptorship for

(PRIME-US) also seemed like a perfect fit to the com-

PRIME-US training to be a clinician, and her research

When asked about the one thing she would most like to accomplish in her future, Hahn responds with many: “To learn how to be an effective advocate for health policy issues on many levels. Covering the whole spectrum of prevention—being able to

munity-conscious Hahn. “It’s basically a program for people who want to learn to be leaders in caring for the underserved communities and really look into health inequities,” says Hahn. “And that’s exactly how I want to practice medicine.” In addition, it allayed her concerns about losing her activist focus.

“I wanted to do something that affects health farther upstream.”

“Some of my friends would say, you’re going to go sell out and become a plastic surgeon and do nose

for the Schweitzer Fellowship Program working on

jobs for Hollywood!” But reading about PRIME-US

creating a male involvement program for Southeast

she thought, “That’s the support I’m going to get,

Asian youths. She also recently attended a legislative

and that’s a program that’s going to help me make

hearing with AHS to support legislation protecting

sure that doesn’t happen.”

the health of nail salon workers, who are dispropor-

Hahn can put these worries aside; one glance at her credentials assures one that she is in no danger of becoming a sell-out. Since her undergrad years, she

tionately Asian women. So Hahn is already giving back to the urban underserved as she trains to be a community health leader.

has served as a medical assistant with Amerispan

“As an intern, staff member, and volunteer, Monica

Guatemala, interned with Americorp Community

has played a vital role in educating youth on repro-

Health Corps, served as medical coordinator of the

ductive health and implementing leadership training

work at the policy level to affect legislation, but then also being able to do community organizing around really important advocacy issues, but then also being an effective one-on-one doctor and having a great relationship with patients.” And, she can’t resist adding, “to be a mentor to younger people all throughout my life wherever I am.”

It sounds like a tall order, but given all that Hahn has already accomplished, her passion for her ideal, and her seemingly tireless drive, it’s clear that she can achieve all this and more.

curriculums,” says Clifford Yee, AHS Youth Program

Public Health

21

feature

ALUMNA SPOTLIGHT

BARBARA TERRAZAS NURTURING THE SAFETY NET

By Linda Anderberg

Barbara Terrazas, M.P.H. ’76, is a big picture person with big ideas.

“I consider challenges as gifts—opportunities to bring light to situations that seem insurmountable,” she says. This is evident in her drive to bring quality, culturally competent health care to those in need, such as the uninsured. Her passion for her work is partly inspired by her own experience as a breast cancer survivor.

Terrazas makes a compelling case for the inestimable value of our health safety net, and she has dedicated her career to serving this cause at the international, national, statewide, and community levels. She currently serves as the director of planning, development, and policy at Tiburcio Vasquez Health Center, a community clinic offering primary medical care for residents of southern Alameda County.

“When I was working on the Health Recruitment Project, ultimately what I ended up doing was recruiting myself,” she says.

“There is an infrastructure already in existence for the implementation of aid for the health care of poor people, and that is the community clinics,” she says. “We’re doing more, with high quality, for less.”

the American Lung Association of California, she oversaw 21 local affiliate organizations and helped develop the association’s first strategic plan in 1982. She served as the CEO of Catholic Charities of Alameda/Contra Costa—the largest social service provider in the East Bay—for 10 years.

She has also worked as vice president of regional operations at “Just Say No” International and executive director for La Clinica de la Raza.

Before she became a nurturer of the health safety net, Terrazas relied on it—bringing her daughter to the local clinic while she earned her M.P.H. in health administration and planning at the School of Public Health. She also worked on a health manpower recruitment project with five Bay Area community clinics, exposing undergraduates to the realities of practicing medicine and encouraging them to give back by serving the people in their communities. Terrazas regularly encounters many of these former students serving as doctors and health professionals today.

This might have been her finest recruiting achievement, because Terrazas has spent more than 30 years developing her organizational development, strategic planning, and policy skills to the benefit of community health organizations. As director of affiliate relations and planning for

Now at Tiburcio Vasquez, Terrazas feels she has come full circle. “I’m doing a combination of planning, development, and policy,” she explains.

“We’re trying to be as responsive as much as we can to the needs of the community. And making sure we’re filling that void as a safety net.”

The recent influx in clinic clients—Terrazas believes their requests for service have tripled in the last year—speaks to both the clinic’s success in serving the community and the continuing need for those

services. “The good side to this is I think there is an increase in patients because people know that they can get quality care here and it will be culturally competent,” says Terrazas. “It’s friendly. And that’s critical.”

Terrazas also believes the increase is in part due to rising levels of people who have no other access to health care: the uninsured and working poor.

To meet the demands for service, Terrazas has once again turned to recruitment of community members. She has helped develop the Promotoras de Salud volunteer corps: about 20 women, primarily stay-at-home mothers, who meet with community families to share information, give advice, and promote a message of good health. “We’ve created a very innovative grassroots program,” she says, “We’re coming full circle, training clients to be the actual advocates of their health care.” Terrazas plans to take Promotoras volunteers with her on a trip to Washington, D.C., in March to serve as spokespersons.

Terrazas also lends her considerable health management expertise back to the School as a member of the Policy Advisory Council. “The School has been phenomenally instrumental in training people who work at the safety net level,” she says. One of her goals is to ensure that the School continues to support and improve community-based health.

—Linda Anderberg

22

University of California, Berkeley

Create A Legacy of Health

Making a bequest to the UC Berkeley, School of Public Health is a thoughtful and flexible way to achieve your charitable and financial goals.

If you would like to learn more

Your bequest to Cal may reduce your estate taxes as well as provide you with other benefits, including:

please contact Pat Hosel at

• Your assets remain in your control during your lifetime, yet you gain the satisfaction of knowing that your bequest will support the University in the way you intended.

Gift Planning at (510) 642-6300,

• You direct your bequest to a particular purpose.

• You can modify your bequest at anytime if your circumstances change.

about making a bequest to the School of Public Health,

(510) 642-9654 or the Office of

toll free at 800-200-0575, or via e-mail at ogp@berkeley.edu.

• You will be welcomed into The Benjamin Ide Wheeler Society.

Public Health and You:

Together, with your support, we’re creating a legacy of health.

Public Health

23

Past, Present, Future

Warren Hall’s Green Final Farewell The historic but seismically unsafe Warren Hall is going down—but at least it’s going down green.

Like a brick-and-mortar organ donor, the building’s many parts will be repurposed via reuse and recycling before and after demolition begins.

The takedown of the School of Public Health’s old home will be the keystone of a pilot project started by the campus sustainability and reuse communities, designed to increase the reuse of abandoned materials prior to the demolition of buildings.

“When departments leave a building that is scheduled to be demolished, they leave waste that contractors would otherwise take to the dump,” says Judy Chess, project manager with UC Berkeley Capital Projects. “The goal of this new project is to use those materials instead and minimize landfills.”

The project is a recent collaboration between the Chancellor’s Advisory Committee on Sustainability,

24

University of California, Berkeley

which promotes environmental management and sustainable development at UC Berkeley, and Re-USE (the campus materials exchange program), a project of Campus Recycling and Refuse Services that distributes unwanted but reusable materials back to the campus community. Two student interns funded by a grant from the Chancellor’s Intern Fund will be responsible for a waste triage to determine which items—including furniture and lab and office supplies—can be reused or recycled.

“We collaborated with local organizations and recycling centers such as Urban Ore, Cal Overstock and Surplus Den to find homes for as many of the

materials as possible,” says Renee Chaffin of Campus Re-USE. “Many of the items have since been moved and will be reused as the demolition project advances.

Campus Re-USE will also be involved in the takedown of Department of Health Services on Berkeley Way—the proposed site of the new home for the School of Public Health. “As the Warren Hall project proceeds, we will be conducting a process analysis to set up best practices for future demolition projects on campus,” says Chess.

Past, Present, Future

Demolition of Warren Hall itself began in January 2008, and the process continues to be as ecofriendly as possible. The contractors are required by the campus to recycle at least 50 percent of the building materials, including concrete and steel.

Although hazardous materials issues cause a degree of uncertainty as to what can safely be recycled from the hall, the campus still expects the amount to exceed 50 percent. Christine Shaff, communications manager with UC Berkeley Facilities Services, believes 70 percent of the building materials will end up being recycled.

The landscaping surrounding Warren Hall is also being preserved or recycled. “We are not taking down too many trees,” says Shaff, “even though it makes space for the demolition and construction very tight.” The trees along Oxford and on the West Circle will stay. Those few trees that will be removed will possibly be milled into lumber for use in future UC Berkeley building projects. An inventory of the building site will include moving or recycling various outside items including bike racks and lampposts.

Demolition will also proceed in a health-conscious fashion. Asbestos and other contaminants will

be cleaned out prior to the demolition. In nearby buildings such as Mulford Hall and the Genetics and Plant Biology Building, air flow will be re-routed and construction filters will be added to the intake system. Contractors are also required to control and minimize dust as they work.

Although Warren Hall itself will become a memory, parts of it will live on—a fitting tribute to a building that housed the School of Public Health for more than 50 years.

—Linda Anderberg

Public Health

25

Past, Present, Future

A Meeting of the Minds For the past five years, the UC Berkeley School of Public Health has offered the Advanced Health Leadership Forum, a highly successful international health leadership program cofounded with Universitat Pompeu Fabra in Barcelona.

from each other’s experiences and of best practice internationally.”

The first Bay Area session was held in San Francisco in January 2008. “It was highly successful, with a large number of gurus in their fields coming to interact with the participants,” said program

Now the Berkeley program has come together with

“This initiative enables both schools to build on

administrator Meg Kellogg. Experts included

the 12-year-old Cambridge International Health

current successes in training leaders to address the

Arnie Milstein, M.D., M.P.H. ’75, the leading

Leadership Programme, offered by Cambridge

global health challenges facing all countries,”

authority on how to creatively purchase health care;

Executive Education, which provides executive

commented School of Public Health Dean

Leonard Schaeffer, founding chairman and

education at Judge Business School, University

Stephen Shortell. “Participants will find this

CEO of Wellpoint; George Halvorson, CEO

of Cambridge.

to be a unique experience based on interaction

of Kaiser Foundation Health Plan; Sir Richard

with world class faculty working at the forefront

Feachem, founding executive director of the Global

of new approaches to improve health and health

Fund and professor at the UC Berkeley School of

care in both developed and developing countries.

Public Health and UCSF; and speakers from the

They will form a close professional network that

World Bank, WHO, and the journal Health Affairs.

New Global Health Leadership Forum Combines Best of Berkeley and Cambridge Programs The new combined program, the Global Health Leadership Forum, consists of two week-long summits held in the San Francisco Bay Area and Cambridge, UK, and offers highly interactive programs open to senior health care leaders from public and private organizations across the world.

Faculty from Berkeley, UCSF, and Cambridge are collaborating to support the delivery of the program, with additional input from industry executives. The Universitat Pompeu Fabra’s Center for Research in Economics and Health in Barcelona, Spain, continues to participate in sessions as well.

will benefit them throughout their careers.”

Larry Abeln, chief executive officer, Cambridge

2008, at Judge Business School, and will be

Executive Education, is delighted to be involved in

repeated in June 2009. The next Bay Area session

the creation of the groundbreaking forum. He says,

will be held in January 2009. The Global Health

“It will be a very dynamic program. Vigorous debate

Leadership Forum is sponsored by the British United

during the two sessions will address current issues

Provident Association Limited (BUPA), McKinsey, and

and common challenges being faced by senior

Johnson & Johnson. Launching sponsors include the

leaders from developed and developing countries,

Bill & Melinda Gates Foundation and the Thomas J.

such as health sector reform in the face of rapid

Long Foundation.

change and development. This unique exposure to a variety of methods will enable participants to learn

Participants and faculty at the January 2008 summit of the Global Health Leadership Forum.

26

University of California, Berkeley

The Cambridge session will be held June 8–12,

Past, Present, Future

Participants Share Information

in more than 6,000 subject areas developed for the

health workers were given one of two books—

Across Continents

Web-based information delivery systems of such

either Where There is No Doctor by David Werner

entities as managed care organizations, hospitals,

et al. or the Healthwise Handbook—with a 16-page

employers, and the popular website WebMD. In

insert featuring information about Ghana-specific

2007, Internet users accessed Knowledgebase

health issues, such as snake bites, worms, and malaria.

Donald W. Kemper, M.P.H. ’72, has taken part in every one of the leadership forums since the inception of the original

Donald Kemper

information more than 90 million times.

Anarwat’s staff gathered the volunteer health

Berkeley-Barcelona program,

When bringing the information therapy concept

workers, gave them materials, trained them to keep

bringing to the discussion his

to the Global Health Leadership Forum, Kemper

a log of when and how each book was used, and

own particular passion for

assumed the idea would

then checked back for results. The HHMG team

patient education and

hold the most appeal for col-

determined that the volunteer health workers were

empowerment. Kemper is chairman and CEO

leagues working in developed

overwhelmingly appreciative, that they used the

of Healthwise, a nonprofit he founded in 1975

regions of the world, where

books often and felt they made a positive impact

around the concept of “information therapy.”

Internet access is readily

on the health of their communities.

“When we look at the health care system right now in the United States, or really anywhere, there are triple crises: the cost crisis, the quality crisis, and the workforce crisis,” Kemper says. “Every study that’s done on quality shows huge gaps, particularly in chronic illness—where we know what to do, but we just don’t do it, because nobody’s really paid to make it happen.”

As Baby Boomers become seniors, he cautions, the system will become overloaded. Information therapy, he feels, will be an essential part of the solution.

Kemper believes in a future wherein a patient will leave his or her health care provider’s office with not only diagnoses and treatment directives (including perhaps an Rx for medicine), but also an Ix, or a prescription for information, which would direct the

available. He was pleasantly S. George Anarwat

taken aback by the enthusias-

tic reaction of participant S. George Anarwat, a policy research officer from northern Ghana. “He just called my bluff,” says Kemper. “He asked, ‘But can this work in third world countries as it is working here in the U.S.?’” Anarwat challenged Kemper to test the viability of information therapy in a very rural, very poor region.

Anarwat and his NGO, House of Hope Mission Ghana (HHMG), had worked with a well-developed network of volunteers in villages to educate people

The ability to access web-based information in rural areas of Ghana is still a long way off and will require an influx of financial and technical resources.

Yet, even a reliable book, tailored to the needs of the community, can help. “You don’t need the Internet to benefit from information therapy,” Kemper says. “We always think of the scarcities we have, but in comparison to [northern Ghana], we have such a great abundance of resources.”

Perhaps, Kemper hopes, lessons learned from this small collaboration between professionals working

“You don’t need the Internet to benefit from information therapy.”

patient to a specific, reliable medical resource.

That’s one of the reasons why Kemper’s organization

about categorical illnesses, such as HIV/AIDS and

seeks to empower patients with self-care informa-

dengue fever. While most of the village workers

tion, tools to understand evidence-based guidelines,

were literate and proficient in English, they had no

and a stronger sense of autonomy. Since 1976,

resources to support what they do. “So we said,

Healthwise has distributed more than 33 million

let’s try to get some basic information to those

self-care guides. The Healthwise Handbook (now

volunteers and let them become the resource for

th

in its 17 edition), addresses approximately 200 common health issues. Even more far-reaching is Healthwise’s Knowledgebase, health information

worlds apart will serve as its own takeaway Ix, convincing others that raising the overall health competence of third-world populations is not only possible, but worthwhile.

—Johanna Van Hise Heart and Michael S. Broder

the village,” remembers Kemper.

Anarwat quickly developed a proposal for a small project that simply aimed to identify workable methods of delivering health information. Randomly,

More information about the Global Health Leadership Forum is available at ahlf.berkeley.edu and www.jbs.cam.ac.uk/execed/ghlf.

Public Health

27

Past, Present, Future

Teh-wei Hu: International Leader in Health Care Reform “No U.S. academic has had as profound an impact on the health system reform of Asian countries as Teh-wei Hu,” states Dean Stephen Shortell. The World Health Organization (WHO), the World Bank, and the Chinese Ministry of Health all look to the UC Berkeley professor emeritus for advice on issues of health care planning and tobacco control. More than a dozen countries, including China, Cambodia, Estonia, Indonesia, Latvia, Thailand, and Vietnam, have benefited from Hu’s advice on tobacco tax policy.

newly edited book, Tobacco Control Policy Analysis

Hu began working in health economics before

increase would raise revenue by $3.6 billion, while

the field had a name, and he has been involved

reducing cigarette consumption by 1.5 percent and

in China (World Scientific), which was published in

in tobacco control for more than 20 years. “I started

potentially saving 1 million lives. The extra tax

January 2008.

working on tobacco control in California, when

revenue could be used for health and social

the state had Prop. 99,” he says. Hu and colleagues

welfare programs.

analyzed policy and made recommendations to the state for the landmark legislation, which increased the tax on tobacco and earmarked the funds raised for tobacco-related education,

Hu joined the faculty at the School of Public Health in 1986 and served as a department chair in the

In a study funded by a five-year grant from the

early 1990s. In the early 2000s, while serving

Fogarty International Center of the National Insti-

as the School’s associate dean for research, he

research, and prevention.

“An analysis by Hu and colleagues shows

Hu has played a major role in reforming the health

that a 10 percent tax increase would

systems of China, Hong Kong, and Taiwan, and has devoted much of his time to trying to solve health

increase revenue by $3.6 billion,

problems there, including, but not limited to, smoking in China. The world’s number one consumer of

while reducing cigarette

tobacco products, China has 350 million smokers, making up a quarter of all smokers worldwide. An

consumption by 1.5 percent.”

additional 460 million people in China are exposed to secondhand smoke, most of them women and children. The country is also the world’s largest

tutes of Health, Hu and colleagues at the School of

producer of tobacco, so that industry is tremendously

Public Health and other UC campuses examined the

important to the national economy.

impact of an additional tobacco tax, the economic

organized a schoolwide Dr.P.H. program. In 2003,

costs of smoking, and the cost-effectiveness of

he received the Distinguished Teaching and Mentor-

tobacco-control interventions in China, in order to

ship Award at the School’s commencement ceremony.

inform policymaking by Chinese officials. The team

Upon his retirement in 2004, Hu received the

looked at factors such as the effects of secondhand

prestigious Berkeley Citation for his distinguished

smoke on women and the impact of China’s entry

and extraordinary service to the Berkeley campus. He

into the World Trade Organization. They established

remains involved with the School, advising doctoral

a framework for tobacco control research in China,

students on their theses. He also continues to

working closely with the World Bank; China’s

consult on tobacco control for the WHO, the World

Ministry of Health; the Chinese Academy of Preven-

Bank, the Rockefeller Foundation, and the Bloom-

tive Medicine; and health economists from China’s

berg Global Initiative to Reduce Tobacco Use.

This puts China’s economic interest at odds with the health of its people. “It is a well-known fact among Chinese officials that smoking causes lung and cardiovascular diseases and leads to high medical expenditures and premature deaths,” writes Hu. “Yet China has been reluctant to impose the most effective tobacco control policy—raising the tobacco tax—due to its concerns over the negative economic impacts of revenue loss, income loss among tobacco farmers, or employment loss in the cigarette manufacturing industry.” But an analysis

by Hu and colleagues shows that a 10 percent tax

28

University of California, Berkeley

Beijing University, Fudan University, and Sichuan University. The findings are summarized in Hu’s

—Michael S. Broder

Around the School

News and Notes New report outlines status of California’s county mental health programs California’s county mental health departments spent most of their budgets on outpatient services, with low overhead and low spending on hospitalization, according to a report released November 6, 2007, by the Nicholas C. Petris Center on Health Care Markets and Consumer Welfare. The survey covers the structure, organization, and financing of county mental health departments in the 2004 fiscal year, providing baseline data on each county before voters passed the Mental Health Services Act (MHSA) later that same year.

“The report provides a clear starting point for future measurements of how effectively the new funds and services resulting from the MHSA will improve the lives of mentally ill people in California,” said Petris Center director Richard Scheffler, Ph.D., Distinguished Professor of Health Economics & Public Policy and coauthor of the report.

The survey is part of a three-year study by the Petris Center, funded by the California HealthCare Foundation, to evaluate the impact of the MHSA. Timothy Brown, Ph.D. ’99, associate director of research at the Petris Center, is another report coauthor.

tive technologies to better understand the interplay of environmental exposure to contaminants and genetic variations on human disease.

Researchers find evidence linking stress caused by the 9/11 disaster with low birth weights A UC Berkeley-led study has found evidence of an increase in low birth weights among babies born in and around New York City in the weeks and months after the terrorist attacks on the World Trade Center. In the article published in the October 10, 2007, issue of the journal Human Reproduction, the authors suggest that stress may have contributed to the effect.

Brenda Eskenazi, Ph.D., professor of maternal and child health and epidemiology at the School of Public Health and director of the Center for Children’s Environmental Health, and colleagues studied data from birth certificates of 1,660,401 babies born in New York between January 1996 and December 2002. They divided the babies into those born in New York City (NYC)—whose mothers would, therefore, have been living closest to the disaster zone—and those born in upstate New York, which they defined as anyone living outside NYC, including Nassau, Suffolk, and Westchester Counties.

When they compared data from babies born in the week before the disaster with those born in the week after in NYC, they found a shift in the distribution of low birth weights (LBW), with a higher proportion of babies being born weighing less than 2,000g. “Normal” birth weight is considered to be above 2,500g.

Integrating and implementing research across hemispheres Linda Neuhauser, Dr.P.H. ’88, co-principal investigator for Health Research for Action at UC Berkeley, was a visiting professor at the Australian National University (ANU) this past fall. Her visit was hosted by the National Centre for Epidemiology and Population Health and supported by ANU’s vice chancellor’s travel grant program. Neuhauser’s research and lectures while at ANU focused on crossdisciplinary and translational research and action.

She led a class on integrating knowledge for action for 20 doctoral candidates from all areas of the university, including law, ecology, politics education, sociology, physics, humanities, and public health.

The vice chancellor’s travel grants program supports visits to ANU by academics with exceptional records and the capacity to add value to the university.

New center harnesses campus expertise to develop screening technologies School of Public Health professors are teaming up with researchers across the UC Berkeley campus to create the Center for Exposure Biology, a new research collaboration that will focus on developing biomarkers and biosensors to allow cost-effective testing for blood cancer risks.

Stephen Rappaport, Ph.D., adjunct professor of environmental health sciences, will direct the program and will lead one of its three interdisciplinary projects.

The center is being established with funds from a $4.7 million grant from the National Institute of Environmental Health Sciences (NIEHS) announced on September 4, 2007. The grant is part of the Exposure Biology Program of the Genes, Environment, and Health Initiative at the National Institutes of Health, a program which seeks to develop innova-

Sheldon Margen Public Health Library reopens in new location Due to the demolition of Warren Hall, the Sheldon Margen Public Health Library relocated in November 2007 to a newly designed space on the ground floor of University Hall.

Public Health

29

Around the School

News and Notes, (continued) State officials select School of Public Health experts to guide biomonitoring program With four environmental health experts appointed to a nine-person Scientific Guidance Panel, the UC Berkeley School of Public Health is poised to make a strong contribution to the California Environmental Contaminant Biomonitoring Program, which monitors the presence and concentration of designated chemicals in Californians. Professors Thomas McKone, Ph.D., and Richard Jackson, M.D., M.P.H. ’79, and scientists Asa Bradman, Ph.D. ’97, and Michael Wilson, Ph.D. ’03, M.P.H. ’98, were all appointed to the panel. The Scientific Guidance Panel assists the Department of Health Services and California Environmental Protections Agency by providing scientific peer reviews and making recommendations regarding the design and implementation of the biomonitoring program that will provide data to help scientists, researchers, public health personnel, and community members explore linkages between chemical exposures and health. The recently created California program is the first of its kind in the nation.

In Mexico, students learn about migration and health In July 2007, four students from the School of Public Health participated in a week-long program, the Summer Institute on Migration and Health, which took place in Puebla, Mexico. The Berkeley Diversity Research Initiative supported the attendance of Dr.P.H. students Juan Ibarra, Dr.P.H.(c), M.P.H., M.S.W., and Fatima M. Rodriguez, M.P.H., and M.P.H. students Julia Zeuli and Maria (Terry) Minjares. The students were able to gain analytical and practical tools that they can apply toward addressing migratory public health issues. Workshops and keynotes offered during the week focused on topics such as health promotion among migrant populations, qualitative research in migration and health, and migration and human rights. Students also took a day-long field trip to a nearby community that has prominent migration rates to the United States. They were able to talk to the local mayor, listen to stories by the family members left behind, and observe the impact of the U.S. dollar on the community. Director of Diversity

30

University of California, Berkeley

Abby M. Rincón, M.P.H. ’86, also attended the institute.

Students spread the public health message via news media Each year in the mass communications and public health course taught by Lori Dorfman, Dr.P.H. ’94, students learn to publicize their public health messages using the media. They write about public health issues of their choice and submit op-eds and letters to the editor to news outlets.

Left to right: Fatima Rodriguez, Abby Rincon, Terry Minjares, Oscar Lanza, Julia Zeuli, and Juan Ibarra

The Binational Summer Institute on Migration and Health is a program developed by the Health Initiative of the Americas (formerly the California-México Health Initiative), which recently joined the School of Public Health.

Ugandans want peace more than revenge against warlords, says survey War-fatigued Ugandans would rather live in peace than retaliate against leaders of the Lord’s Resistance Army, a rebel group that forcibly conscripted tens of thousands of women and children, according to a survey released in December 2007 by human rights and international development researchers.

The survey found, however, that many Ugandans still want the warlords to be held accountable for atrocities.

The population-based survey was conducted in northern Uganda by researchers from UC Berkeley’s Human Rights Center, Tulane University’s Payson Center for International Development, and the International Center for Transitional Justice, an organization that seeks accountability for human rights abuses and atrocities. The survey, “When the War Ends,” gauges attitudes about peace, justice, and social reconstruction in northern Uganda.

“As the peace process proceeds, the government of Uganda and the international community should heed the priorities expressed by those most affected by the conflict,” said Adjunct Professor Eric Stover, faculty director of UC Berkeley’s Human Rights Center and a coauthor of the report.

Typically one or two students get to see their words in print, but the Fall 2007 class was especially successful: The class of 14 students had 9 letters and 2 op-eds published. In The New York Times, Ann Oldervoll defended San Francisco’s health care plan in the name of social justice and good economics. Deborah Karasek’s letter on financing public education was published by The New York Times as well. Nickie Bazell and Katherine Schaff both had letters published on the same day in the San Francisco Chronicle, which also published letters from Rachel Larson, Karasek, Juliet Sims, Ann Oldervoll, and Julia Marcus. The Contra Costa Times published Bazell’s op-ed and the Los Angeles Daily News published one from Sims. Not to be outshone, Dorfman also had a letter published in The New York Times.

Latino traffic safety project enters implementation phase The UC Berkeley Traffic Safety Center (TSC) is currently conducting the third phase of the Latino Traffic Safety Project, a partnership with Sun Street Centers. The project was formed in 2003 in response to the finding that Latinos experience disproportionate risks of dying or being injured in traffic accidents compared to non-Latino whites. The fact that Latinos will be the majority population in California by 2040 makes it especially critical to address this statistic. During the third phase of the project, the center is working in the field to implement and evaluate the safety recommendations honed in the first two phases. In November 2007, TSC assistant director Jill Cooper presented a $106,500 grant to the Greenfield Prevention and Health Coalition (sponsored by Sun Street Centers) to provide traffic safety interventions to the Greenfield, California, community. Interventions there began in fall of 2007 and continue in 2008.

Around the School

Stronger cash incentives lead to better health outcomes for poor children In countries around the world, including the United States, governments are seeking ways to reduce poverty and its impact on children’s development.

Conditional cash transfer (CCT) programs, which aim to improve options for poor families through interventions in health, nutrition, and education, have been adopted as one possible solution.

Families enrolled in CCT programs receive cash to spend as they wish in exchange for complying with certain conditions—such as preventive health requirements, nutrition supplementation, education, and monitoring—designed to improve health outcomes and promote positive behavior change.

In 1997, the Mexican government established Oportunidades, one of the first CCT programs. Lia Fernald, Ph.D., M.B.A., assistant professor of public health nutrition, led a study to test whether receiving more money through the Oportunidades program was associated with improvements in child growth, health, and development utcomes.

The results show that the household cash transfer component is associated with improvements in height-for-age; several measures of cognitive development and language development; and reductions in BMI-for-age and obesity. The findings suggest that increasing the size of the cash transfer in CCT programs targeted at improving child health could potentially mitigate the effects of poverty on child growth and development and future welfare.

The paper has been accepted for publication in The Lancet.

Collaborating across universities This past fall, Assistant Adjunct Professor of Epidemiology Constance Wang, Ph.D., spent a month as a visiting scholar at the University of North Carolina (UNC) School of Public Health at the invitation of Jay Kaufman, an associate professor of epidemiology at UNC. Notably, Wang helped kick off the fall semester

for the UNC School of Public Health Social Epidemiology/Built Environment Research-in-Progress Group by delivering a talk titled “Bridging the Gap: Complex Descriptions to Advance Epidemiology.”

She also led several discussion groups. Wang is an alumna of the Robert Wood Johnson Health & Society Scholars Program at UC Berkeley and UCSF.

Study helps identify genetic causes of autoimmune inflammatory disease Systemic lupus erythematosus (SLE) is a chronic autoimmune inflammatory disease that can affect various parts of the body—especially the skin, joints, blood, and kidneys. A substantial genetic contribution to SLE risk is conferred by genes within the major histocompatibility complex (MHC) region on chromosome 6. This region of human genome contains a large number of genes that encode important proteins involved in the immune response.

While the human MHC has been shown consistently to be associated with several autoimmune and inflammatory conditions since the 1970s, it has been very difficult to identify disease-specific causal genetic variants due to the strong associations between particular variants located in this region. For many MHC-associated autoimmune conditions, it has only been possible to pinpoint larger association signals. Previous studies of MHC variation in SLE, specifically, have lacked statistical power and genetic resolution to fully characterize MHC influences.

Lisa Barcellos, Ph.D. ’96, assistant professor of epidemiology, is conducting a large, comprehensive MHC study in close collaboration with colleagues at UCSF’s Division of Rheumatology. The study comprises more than 700 SLE families and 1,600 SLE cases (totaling approximately 3,000 individuals) and uses genetic information from state-of-the-art genotyping of more than 2,200 closely spaced genetic variants (high-resolution) across this region. Initial results provide, for the first time in SLE research, strong evidence for three distinct and independent genetic contributions within the MHC. Barcellos presented findings from the study at the annual American Society of Human Genetics meeting in San Diego in October 2007. The study is funded by the NIH’s National Institute of Arthritis and Musculoskeletal and Skin Diseases.

Workshop opens discussion on improved prediction of chemical carcinogenicity Current methods for assessing hazards of chemicals are widely recognized to be outdated, resulting in an increased burden of disease. To begin to address this problem, Martyn T. Smith, Ph.D., professor of toxicology, organized a special workshop at the 38th Annual Meeting of the Environmental Mutagen Society, held in Atlanta in October 2007. The workshop, “Predicting Chemical Carcinogenicity, Moving Beyond Batteries,” reviewed key developments in the current understanding of cancer biology and their implications. Currently, agencies pick one mode of action for chemicals, but analyses by the workshop group show that chemicals act through multiple pathways, not just one. Looking at these multiple pathways could provide better predictions of cancer risk.

The workshop included presentations by a number of School alumni and faculty. Martha Sandy, Ph.D. ’88, M.P.H. ’83, of the California Environmental Protection Agency’s Office of Environmental Health Hazard Assessment, showed that assessment frameworks need to evolve to better reflect biology.

David Eastmond, Ph.D. ’87, professor of cell biology and research toxicologist at UC Riverside, discussed how this evolution may occur through a better understanding of the biology. Associate Adjunct Professor Luoping Zhang, Ph.D., presented her studies using toxicogenomics as biomarkers of cancer risk in humans exposed to toxic chemicals such as benzene, dioxin, and arsenic, and concluded that toxicogenomics could accelerate hazard identification. Amy D. Kyle, Ph.D. ’96, M.P.H. ’92, associate research scientist and lecturer at the School of Public Health, pointed out future directions and implications of these findings for chemical hazard assessment and public policy.

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Around the School

Recent Grants and Contracts

Exercise for Bone Health: Young Breast Cancer Survivors $1,017,156 from the NIH/National Cancer Institute Competitive Supplement PI: Joan Bloom, Ph.D. More young women diagnosed with breast cancer in their pre-menopausal years are becoming long-term survivors as incident rates remain steady and mortality rates decrease. The five-year relative breast cancer survival rate in U.S. women under age 50 is almost 81 percent for women diagnosed between 1995 and 2001. The increase in survival has occurred for all racial/ethnic groups as a result of greater utilization of screening mammography, and improved treatment. This raises new challenges in that successful breast cancer therapy may put this group of women at risk for long-term health consequences. This three-year study will determine whether exercise intervention is effective in improving biomarkers altered by chemotherapy weight gain that are related to increased risk of non-breast cancer morbidities as well as breast cancer recurrence and mortality. An interdisciplinary research team from UCSF, UC Berkeley, and the Northern California Cancer Center is conducting the project at the UCSF/Mt. Zion clinic.

Breast Health Behaviors of Immigrant Afghan Women $70,481 from the California Breast Cancer Research Program PI: Joan Bloom, Ph.D. Despite evidence that early detection leads to decreased breast cancer mortality, minority women—especially new immigrants—continue to underuse breast health services. Research shows that Muslim immigrant women are less likely than other women to use these services and are more likely to die from breast cancer. Due to the ongoing 32

University of California, Berkeley

war in Afghanistan, there has been an increase in the number of immigrants to the United States from this country. It is estimated that there are more than 60,000 Afghans in the United States, with approximately half living in the Bay Area. This project examines immigrant Afghan women’s beliefs, knowledge, and attitudes about breast health care and early detection as well as barriers to care.

Face-to-face interviews will be conducted with 50 first-generation immigrant Afghan women who are age 40 and older, have limited English proficiency, have no personal history of breast cancer, and live in Northern California.

Epidemiology Study of SwimmingRelated Illness at Non-Point Source Polluted Beaches $1,375,011 from Cal EPA Water Resources Control Board PI: John M Colford, Jr., Ph.D. ’96, M.P.H. ’92 This epidemiology study will quantify the risk of swimming-associated illnesses and will test indicators of that risk at beaches polluted by nonpoint sources of fecal contaminations. Fecal indicator bacteria (FIB) have long been used by public health managers to evaluate marine recreational water quality for warning swimmers or closing beaches. Humans are not the only source of FIB; they are shed by most warm-blooded organisms. Water quality regulators have been working diligently to find and eliminate human sources of fecal contamination in marine waters. The success in remediating point sources has led to a relative increase in the number of beaches that are impacted by nonpoint sources of fecal contamination, much of which is thought to be nonhuman. Yet, the fecal contamination inputs to Doheny Beach have resulted in this shoreline being frequently listed as the most polluted beach in California, while Malibu Surfrider State Beach has been listed as one of the 10 most polluted beaches

in California based on the magnitude and duration of high bacteria densities, length of beach contaminated, and number of swimmers. During the summers of 2008 and 2009, 17,600 beachgoers at Doheny State Beach, Avalon Beach, and Malibu Surfrider State Beach will participate in a beach study survey. A follow up computer assisted telephone interview will be conducted to gather health related information.

PBDEs, DDT, and Neurodevelopment in School-Aged MexicanAmerican Children $1,968,685 from NIH/National Institute of Environmental Health Sciences PI: Brenda Eskenazi, Ph.D. This four-year award will provide valuable information on modes of exposure to dicholorodiphenyltrichloroethane (DDT) and polybrominated diphenyl ethers (PBDEs), as well as the independent or interactive effects of these two compounds on neurodevelopment. The Center for the Health Assessment of the Mothers and Children of Salinas (CHAMACOS) is a birth cohort study of environmental exposures and health in children aged 0 to 7 years living in a predominantly Mexican immigrant, agricultural community in California’s Salinas Valley.

This new study will evaluate DDT, DDE, and PBDE exposure in the CHAMACOS mothers and children and determine whether these factors are associated with poorer neurodevelopment in school-age children to determine whether Mexican-American children in the United States have higher blood levels of PBDEs and lower blood levels of DDT/E than children in Mexico; factors predicting PBDE exposures in pregnant women and children; whether maternal PBDE exposure is related to pregnancy thyroid hormone levels; and whether in utero DDT and in utero and postnatal PBDE levels are associated with poorer neurodevelopment in school age children.

Around the School

Worker Health and Safety in Chinatown Restaurants: A Community Based Participatory Research Study $367,777 from CDC/National Institute for Occupational Health & Safety PI: Meredith Minkler, Dr.P.H. ’75 The Bay Area is a gateway for Chinese immigrants, who are among the largest and fastest growing immigrant populations in the United States. In many urban areas, restaurants are the largest single employer of Chinese immigrants. Given the high rates of work-related injury and illness for restaurant workers and the likely compounding of these problems in a poorly educated, heavily immigrant population, Chinese restaurant workers may have particularly high rates of occupational illnesses and injuries. This community-based participatory research project will look at worker health and safety in Chinatown restaurants to develop an effective partnership between community, health department, and academic partners; create and train a restaurant worker leadership group; conduct a study of the association between physical and psychosocial restaurant conditions and occupational illness and injury in Chinese restaurant workers; provide culturally relevant worker education; use project findings to help inform subsequent research and action; and evaluate the project using both conventional and participatory approaches.

Training and Rider Experience Among Motorcyclists in California $280,299 from the California Office of Traffic Safety PI: David Ragland, Ph.D., M.P.H. ’80 This project will generate new information on motorcycle crashes and design injury prevention activities that are more effective and efficient. Between 1999 and 2004 in California, fatal motorcycle collisions increased 58 percent, and injury collisions increased 46 percent. Fatalities of motorcyclists (operators or passengers) aged 34 years or younger increased 41 percent, while fatalities of motorcyclists aged 35 years or older increased 74 percent. The changes in death rates appear to be too great to be explained simply by the aging of the motorcycling population.

In addition, the increase in deaths is accompanied

by a decrease in the proportion of motorcycle operators under the influence of alcohol. The trends may have resulted from middle-aged riders entering motorcycling in larger numbers than in previous years, a decrease in the number of motorcyclists who enroll in rider safety programs, or changes in the type and performance of motorcycles ridden by new motorcyclists.

Childhood Leukemia International Consortium $124,809 from NIH/National Cancer Institute PI: Patricia Buffler, Ph.D. ’73, M.P.H. ’65 The Childhood Leukemia International Consortium (CLIC) was recently established to overcome limitations of studies with limited sample size, especially for rarer childhood leukemia subtypes. The consortium seeks to combine anonymized data from the Northern California Childhood Leukemia Study (NCCLS) with data from five other comparable case-control studies in Canada, the United Kingdom, France, and Australia, resulting in a collection of more than 3,300 cases and 4,400 controls. The information will be used to evaluate the role of maternal folate intake, maternal alcohol consumption, and genes involved in folate metabolism, and to assess the interactions between these factors. The data will be pooled at the NCCLS offices at UC Berkeley, and the common datafile will be shared with collaborating researchers for joint analyses. Through this joint research, the project plans to elucidate the etiologic role of folate and specific genes, while establishing a proof of principle for the consortium approach in childhood leukemia research.

Medi-Cal Access Project $3,100,000 from the California Department of Health Services PIs: Susan Ivey, M.D., M.H.S.A., and Linda Neuhauser, Dr.P.H. ’88 Project Directors: Carrie Graham, Ph.D. and Beccah Rothschild, M.P.A The goal of the Medi-Cal Access Project is to develop and test communication interventions to help several million California seniors and people with disabilities on Medi-Cal make more informed decisions about their health care options. The project’s first phase will use participatory design methods to engage English, Spanish, and Chinese speaking

Medi-Cal members to work with Health Research for Action to create a consumer guide. In the second phase, the guide will be tested among these populations in a randomized controlled study in three counties. The study findings will inform the implementation design for a statewide rollout of the guide and development of additional communication interventions to benefit these populations. A 24-person project advisory group, with representatives from state agencies and advocacy organizations that serve Medi-Cal consumers, will offer guidance on all phases of the project. The project is also expected to provide recommendations to help other states improve communication with their Medicaid populations.

Immigration, Acculturation and Health Disparities Research Initiative $46,326 from the Berkeley Research Futures Grant Program, UC Berkeley Vice Chancellor for Research PI: Sylvia Guendelman, Ph.D., LCSW Studies have shown that immigrant health declines over time and across generations. This is surprising, given that the longer immigrants live in the United States, the greater the likelihood that they will experience better education, higher income, and improved access to health services—all of which are associated with better health outcomes in other populations. Assimilation to U.S. social norms and values, including negative health behaviors, have been suggested as one potential explanation for increases in risk factors and poor health outcomes among immigrants with increased time spent in the society. However, the process of acquiring values, norms and behaviors of a new society (i.e., acculturation) is complex and may not follow along a linear path for all immigrant groups. Acculturation is not well understood. There is controversy among researchers on what constitutes its key domains and how to measure it. Yet, there is widespread agreement that it is at the core of the immigrant—and specifically Latino—health paradox. The new Immigration, Acculturation and Health Disparities Research Initiative, which will be housed at the Institute for the Study of Social Change, will examine the role that acculturation plays in immigrant health.

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Around the School

Kudos!

Balmes appointed to Air Resources Board In December 2007, John Balmes, M.D., professor of environmental health science, was appointed to the California Air Resources Board (ARB) by Governor Arnold Schwarzenegger.

The board, consisting of 11 members appointed by the governor, is part of the California Environmental Protection Agency. Its mission is to promote and protect public health, welfare, and ecological resources through the effective and efficient reduction of air pollutants while recognizing and considering the effects on the economy of the state. The ARB also oversees the activities of 35 local and regional air pollution control districts. Balmes is a pulmonary physician by training, professor of medicine at UCSF, and chief of the Division of Occupational and Environmental Medicine at San Francisco General Hospital. He also directs the Center for Occupational and Environmental Health, a joint project of UC Berkeley, UCSF, and UC Davis.

Jewell named AAAS fellow Nicholas P. Jewell, Ph.D., professor of biostatistics and statistics at the UC Berkeley School of Public Health and the Department of Statistics, was named a fellow of the American Association for the Advancement of Science (AAAS). The organization announced his appointment on October 26, 2007, in its weekly publication, Science. Jewell was among 471 honored “for their scientifically or socially distinguished efforts to advance science or its applications,” according to the article. He was selected for his “seminal contributions to biostatistical methodology and their applications to current health problems and editorial leadership in the statistical sciences.”

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University of California, Berkeley

The new fellows for 2007 were presented with an official certificate and a gold and blue (representing science and engineering, respectively) rosette pin on February 16, 2008, at a special forum during the AAAS annual meeting in Boston.

Founded in 1848, the AAAS is the world’s largest general scientific society and includes some 262 affiliated societies and academies of science serving 10 million individuals. The tradition of AAAS fellows, who are chosen by their peers, began in 1874.

Barcellos honored by Prytanean Alumnae, Inc. Lisa Barcellos, Ph.D. ’96, assistant professor of epidemiology, received 2007 Honorable Mention at the Prytanean Faculty Award Reception held October 3, 2007, at University House. Prytanean Alumnae, Inc., the first women’s honor organization in the United States, awards financial grants to outstanding women junior faculty members on the Berkeley campus in recognition of scholarly achievement, distinguished teaching, and success as a role model for Berkeley students. The organization was founded in 1901, and the Prytanean Faculty Enrichment Fund was founded 20 years ago.

best to communicate to the public about the risks and benefits of FDA-regulated products so as to facilitate their optimal use. The establishment of the advisory committee was one of the recommendations of the Institute of Medicine’s 2006 report, “The Future of Drug Safety: Promoting and Protecting the Health of the Public.”

Scheffler honored by Charles University in Prague Richard Scheffler, Ph.D., Distinguished Professor of Health Economics and Public Policy, was honored on May, 23, 2007, in Prague, Czech Republic, with the Silver Medal of Charles University for his contributions to education in health economics and health policy in the Czech Republic. Scheffler delivered a public lecture, “Social Capital, Economics, and Health: New Evidence,” prior to receiving the medal.

Neuhauser appointed to FDA Risk Communication Advisory Committee Clinical Professor Linda Neuhauser, Dr.P.H. ’88, was selected by the U.S. Food and Drug Adminstration (FDA) in June 2007 to serve on its Risk Communication Advisory Committee, which will advise the FDA about how

Jan Skrha (right), Charles University’s prorector for international affairs and mobility, presents the Silver Medal to Professor Richard Scheffler.

Around the School

Publications win 2007 National Health Information Awards Health Research for Action (HRA), a center at the School of Public Health, received three National Health Information Awards from the Health Information Resource Center. The awards program recognizes the nation’s best consumer health information programs and materials and is meant to set an industry standard of quality.

Two of HRA’s guides—California’s HMO Guide and the Arizona Parents Guide—won Silver and Bronze awards, respectively, in the consumer decisionmaking information category. Pennsylvania’s Healthy Steps for Older Adults won a Bronze Award for Health Promotion/Disease and Injury Prevention Information. Healthy Steps for Older Adults, which HRA developed with the Pennsylvania Department of Aging, is the first statewide community-based fall-prevention program in the nation.

Paper by Berkeley alumni, faculty, on community-based participatory research lauded The journal Health Promotion Practice presented the Sarah Mazelis Paper of the Year award to the authors of “Addressing Food Security Through Public Policy Action in a Community-based Participatory Research Partnership,” which was originally published online by the journal on August 28, 2007.

The honor was bestowed at an awards banquet in conjunction with the 58th Annual Meeting of the Society for Public Health Education in November 2007. First author of the paper is Victoria Breckwich-Vasquez, Dr.P.H. ’05. Coauthors include Susana Hennessey-Lavery, M.P.H. ’89;

Shelley Facente, M.P.H. ’04; Helen Halpin, Ph.D., M.S.P.H., professor of health policy; and Meredith Minkler, Dr.P.H. ’75, professor of health and social behavior. The paper analyzes a community-based participatory research partnership in San Francisco’s Bayview Hunters Point neighborhood in which youth-involved research found poor access to quality food, and the steps that led to a successful policy solution.

Smith and other contributing authors share in IPCC’s Nobel honors On October 12, the Norwegian Nobel Committee awarded the 2007 Nobel Peace Prize jointly to the Intergovernmental Panel on Climate Change (IPCC) and Al Gore “for their efforts to build up and disseminate greater knowledge about manmade climate change, and to lay the foundations for

the measures that are needed to counteract such change.” The authors who contributed to the IPCC’s scientific reports share in the Nobel Peace Prize honors.

Kirk R. Smith, Ph.D. ’77, M.P.H. ’72, professor of global environmental health and Brian and Jennifer Maxwell Endowed Chair in Mothers’ and Children’s Health, was a contributing author for sections in two of the three main reports, Working Groups II and III (impacts and mitigation).

Rajendra Pachauri, chairman of the IPCC, said, “This is an honor that goes to all the scientists and authors who have contributed to the work of the IPCC, which alone has resulted in enormous prestige for this organization and the remarkable effectiveness of the message that it contains.”

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Public Health

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Around the School

Meet the New Faculty Jennifer Ahern, Ph.D., M.P.H. Assistant Professor of Epidemiology For Jennifer Ahern, science needs to mean something. Growing up in Baltimore during the 1970s and 1980s, she experienced a city that, she says, “was very segregated, had huge problems with poverty and drug use, and these lines between neighborhoods where you just cross the street and everything completely shifts.”

When she discovered she could apply science to the social problems that had been part of her world since childhood, she knew she had found her mission.

Ahern wants to understand how aspects of people’s communities shape their health and health behaviors. “As you might expect, places with lower income or higher poverty tend to have more health problems,” she says. “But what does that mean?” Through the New York Social Environment Study—using a general population sample with 4,000 adults from New York City—she is looking beyond community income at a wide variety of other community-level social factors, such as norms about particular health behaviors, and how they are related to health and health behavior. “For instance,” she says, “does the community think it’s acceptable to binge drink or smoke, or use certain drugs and not other drugs?” She is also looking at aspects of the built environment, such as the availability of parks and number of liquor stores.

The research is challenging, due in part to methodological problems. “It’s hard to determine if you’re seeing a causal association between the community environment and an individual’s health,” says Ahern.

For example, sometimes when people become ill, they are forced to move to a poorer area because of financial setbacks caused by their illness. “If you just look at them at a point in time, you see people in poor health living in worse places, but it may not be because the place did anything to them,” she says.

“So this is a big controversy: How do we tease out social selection from social causation?”

Ahern is interested in applying different novel methods to try to make it possible to identify causal

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University of California, Berkeley

associations. An example of such a method is agentbased modeling. “It uses a completely different approach from anything we do in epidemiology now,” she explains. “It’s based on modeling interrelations among components in a system. Rather than taking the data and trying to see what it explains, you use the information you have, try to define the relationships among the components in a system, simulate it, and see what happens. And then with the simulation, you can say, ‘Well, what if I perturbed this piece of it? How would the whole system change?’”

She also wants to present the results in a way that is useful for those who design interventions. “If we want to intervene on populations ultimately, and we want our work to inform that,” she says, “what can we change about what we’re doing?” Ahern believes the results should provide new tools and make it clearer how to intervene, what might happen, and how much of a difference to expect.

Ahern, who was recognized as an Outstanding Graduate Student Instructor at Berkeley in 2006, will be co-teaching a course on methods in social epidemiology with Assistant Professor of Biostatistics Alan Hubbard in Spring 2008. Having earned both her graduate degrees at the School of Public Health, she appreciates the fact that the School is part of the broader Berkeley campus, giving her unique access to experts across disciplines. “As a social epidemiologist, those are my resources,” she says.

—Michael S. Broder

Education Ph.D., Epidemiology, UC Berkeley School of Public Health, 2007 M.P.H., Epidemiology and Biostatistics, UC Berkeley School of Public Health, 2000 B.A., Human Biology, Brown University, 1997

Selected Experience Senior Research Analyst, Department of Epidemiology, University of Michigan School of Public Health, Sept. 2005–2007 Senior Research Analyst, Center for Urban Epidemiologic Studies, New York Academy of Medicine, 2001–2005

Selected Honors Dowdle Fellowship, 2006 Outstanding Graduate Student Instructor Award, UC Berkeley, 2006 Society for Epidemiologic Research Poster Session; First Prize, 2005 Society for Epidemiologic Research Poster Session; First Prize, 2002

Around the School

Rachel Morello-Frosch, Ph.D., M.P.H. Associate Professor, Community Health & Human Development At one point in her career, Rachel Morello-Frosch was considering becoming a civil rights attorney. As a research and policy associate at a civil rights organization, she

Education Ph.D., Environmental Health Sciences, UC Berkeley School of Public Health, 1998 M.P.H., Epidemiology/Biostatistics, UC Berkeley School of Public Health, 1993 B.A., Development Studies (Phi Beta Kappa), UC Berkeley, 1988

worked with undocumented and immigrant workers who were trying to assert their civil rights in the workplace.

Many of these workers, she noticed, were dealing with environmental issues in their homes and workplaces. This realization led her to pursue training in epidemiology, biostatistics, and environmental health science, and ultimately she chose a career in environmental health.

Morello-Frosch is passionate about environmental justice, and she credits environmental justice advocates, in large part, for advancements in the scientific thinking on environmental health and equality. “They’ve encouraged us to really think about issues of cumulative impact,” she says, “and they’ve compelled regulators and scientists to better understand the realities of people exposed to multiple chemicals and the diversity of microenvironments where they live, work, and play. They have also encouraged scientists to better think about the psychosocial stressors in terms of the neighborhood factors as well as the individual-level factors that might make people more susceptible to toxins.”

She has focused her research on environmental health disparities—examining race and class determinants of environmental health among diverse communities in the United States. Her current work concentrates on the relationship between segregation and environmental health inequalities; children’s environmental health; and the intersection between economic restructuring and community environmental health. Morello-Frosch conducted the first study to examine the relationship between racial residential segregation and the estimated cancer risks associated with ambient air toxics exposures in the United States.

She has also published articles on the theoretical and methodological issues for elucidating links

between community and individual level stressors and environmental health disparities.

Her scientific research is grounded in communitybased participatory research methods, in which the communities that are affected by research are equal participants. “I think there’s a real role for community partnership to help advance and improve scientific thinking in terms of how we understand these issues,” she says, “and ultimately, how we better address them in the regulatory policy arena.”

Before coming to Berkeley, Morello-Frosch was an associate professor at Brown University in the Department of Community Health and the Center for Environmental Studies. At Berkeley, she holds a joint appointment with the School of Public Health and the Department of Environmental Science, Policy, and Management. In Fall 2008, she will be teaching a course on environmental health and development, which will be a breadth course with an interdisciplinary orientation.

The opportunity for interdisciplinary work is one of the reasons that Morello-Frosch—who earned both her graduate degrees from the School of Public Health—enjoys being at Berkeley. “For those of us who are interested in environmental questions, this is probably one of the more exciting places to be, because there are so many people in diverse areas and in disciplines who are addressing the same issues,” she says. “When you’re able to establish good linkages with other departmental units, it encourages you to rethink how you approach your work, and think about how you approach your research questions in innovative ways.”

—Michael S. Broder

Selected Experience Associate Professor, UC Berkeley School of Public Health and Department of Environmental Science, Policy and Management, 2008–present Associate Professor, Brown University, Department of Community Health, School of Medicine & Center for Environmental Studies, 2007–2008 Robert and Nancy Carney Assistant Professor, Brown University Department of Community Health, School of Medicine & Center for Environmental Studies, 2004–2007; Assistant Professor, 2002–2004 Assistant Professor, San Francisco State University, College of Health and Human Services, Department of Health Education, 2000–2002 National Science Foundation Postdoctoral Research Fellow, University of California, Berkeley, Energy and Resources Group, 1999–2000

Selected Honors William G. McLoughlin Award for Teaching Excellence in the Social Sciences, Brown University, 2006 Professional Research and Development Award, San Francisco State University, 2001 US EPA’s Science and Technology Achievement (STAR) Award for the Cumulative Exposure Project, 2001 National Science Foundation Postdoctoral Fellowship, 1999–2000 California Public Health Association Award for Outstanding Student Contribution to Communitybased Research, 1999 University of California President’s Postdoctoral Fellowship, 1998–1999 Switzer Environmental Leadership Award, The San Francisco Foundation, 1997 Public Health

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Partners in Public Health

Policy Advisory Council Welcomes Three New Members

Richard Levy, Ph.D., is chairman of the board of directors of Varian Medical Systems, a company adapting high technology to the treatment of cancer. He was CEO of the company from 1999 to 2006. Levy served as senior vice president of Varian from 1989 to 1992, overseeing business areas including semiconductor equipment and vacuum products. He became executive vice president of the corporation in 1992 and oversaw the medical businesses and the Ginzton Technology Center, the company’s research and development center. Prior to assuming general management and CEO duties, he oversaw sales, marketing, service, R&D, and various corporate functions, as well as managing the corporate quality program. He began his business career at the Monsanto Company, where he served as a research specialist and project manager in both basic and applied research.

Levy is vice chairman of the board of trustees of the Palo Alto Medical Foundation. He is also a board member of Sutter Health, Pharmacyclics, and chairman-elect of the board of United Way of Silicon Valley. In addition, he is the cochair of the working group advising the Center for the Evaluative Clinical Sciences at Dartmouth, a 30-year program studying the variability and overuse of medical procedures across the United States.

“The U.S. health care system is in trouble with high costs, limited access, extreme variability, and patient dissatisfaction. Despite extensive attention by many very smart people, the trends are going in the wrong direction,” says Levy. “The UC Berkeley School of Public Health, with no vested financial interests in any of the constituencies involved in health care, has the challenge and the opportunity to develop creative solutions to these problems.”

Levy holds a bachelor’s degree from Dartmouth College and a doctorate in nuclear chemistry from the University of California at Berkeley.

Theodore J. “Ted” Saenger is the retired president and CEO of Pacific Bell. During his 36 years in corporate leadership, Saenger gained significant governance experience serving on and leading many corporate governing boards.

Since his retirement from Pacific Bell, Saenger has been active in civic activities.

He currently serves on the Sutter Health board of directors. His other board service includes the San Francisco Symphony, United Way of the Greater Bay Area, California Economic Development Corporation, Los Angeles Philharmonic, and the YMCA. He was a member of the board of the San Francisco Foundation from 1991 to 2001 and is the past chairman of the board of John Muir Medical Center in Walnut Creek, California. He was also a trustee for The California State University until 1997 and currently serves on the board of trustees for the University of California, Berkeley Foundation.

“The area that attracted me to the school, which is my highest interest, has to do with health care policy,” says Saenger. “Most particularly I value the ability of the Berkeley community to take a step back and examine complex issues from an objective standpoint. It’s very important in my opinion that the School be an objective analyst, to evaluate the pros and cons, and also present the alternatives.”

Saenger holds a bachelor of science degree from the University of California, Berkeley.

38

University of California, Berkeley

For the past 30 years, Dean Ornish, M.D., has directed clinical research demonstrating that comprehensive lifestyle changes may begin to reverse even severe coronary heart disease, without drugs or surgery. He founded the non-profit Preventive Medicine Research Institute in Sausalito, California, where he serves as president and holds the Safeway Chair. He is a clinical professor of medicine at UCSF. His current research is focusing on whether comprehensive lifestyle changes may affect gene expression.

He is the author of five best-selling books, including Dr. Dean Ornish’s Program for Reversing Heart Disease; Eat More, Weigh Less; and Love & Survival. He writes a monthly column for both Newsweek and Reader’s Digest magazines.

Ornish was appointed to the White House Commission on Complementary and Alternative Medicine Policy and elected to the California Academy of Medicine. He is chair of the Google Health Advisory Council, the PepsiCo Blue Ribbon Advisory Board, and the Safeway Advisory Council on Health and Nutrition. In 2007 he received the National Public Health Award Hero Award from the UC Berkeley School of Public Health.

Ornish received his medical training in internal medicine from the Baylor College of Medicine, Harvard Medical School, and the Massachusetts General Hospital. He received a bachelor’s degree in humanities summa cum laude from the University of Texas in Austin.

12th Annual

Public Health Heroes Awards Ceremony Reserve Your Seats Now!

Wednesday, April 2, 2008

Yerba Buena Center for the Arts, San Francisco www.publichealthheroes.org or (510) 643-6382

The UC Berkeley Public Health Hero Award recognizes individuals and organizations for their significant contributions and exceptional commitment to promoting and protecting the health of the human population.

International Hero

National Hero

Donald. P. Francis, M.D., D.Sc.

David A. Kessler, M.D.

For his many contributions to global health, including his leadership in the eradication of smallpox, the discovery of HIV, and the control of Ebola hemorrhagic fever

For his leadership as the nation’s top drug regulator and his courage in challenging the U.S. tobacco industry

Award to be presented by Dr. William Foege

Regional Hero

Award to be presented by former Vice President Al Gore (video)

Organizational Hero

Barbara Staggers, M.D., M.P.H.

International Medical Corps

For her leadership in promoting adolescent health, particularly among high-risk, urban, and minority youth

For advancing public health in the face of global shortages in the health care workforce, particularly in the world’s most poverty-stricken, remote, and dangerous environments

Award to be presented by former Assemblywoman Wilma Chan

Award to be presented by Dr. Mark Smolinski, Google.org

Public Health

39

Partners in Public Health

Honor Roll The School of Public Health gratefully acknowledges

Alan Wilson Liane & Mitchell Wong

the following individuals for their generous contributions from July 1, 2006 to June 30, 2007.

DEAN’S CIRCLE ($100,000 & ABOVE) Individuals Anonymous Organizations Anonymous Blue Cross of California Fred H. Bixby Foundation California Wellness Foundation Children With Leukaemia William T. Grant Foundation Robert Wood Johnson Foundation Public Health Institute UBS Optimus Foundation DIRECTOR’S CIRCLE ($50,000 TO $99,999) Individuals Susan Desmond-Hellmann & Nicholas Hellmann Stephen Rappaport J. Leighton & Carol Read Lyle “Jim” Strand Organizations Chiron Corporation Marisla Foundation LEADERS ($25,000 TO $49,999) Individuals Ann Arndt Patricia & Richard Buffler Ruth L. Huenemann Trust Gordon & Elizabeth Moore Michelle Schwartz

Phyllis Friedman Bill & Melinda Gates William & Shand Green Helen Halpin & Scott Gehlke Robert Hosang & Joyce Yap A. Arlene Kasa Catherine & James Koshland Suzanne Llewellyn Edward & Camille Penhoet John & Lisa Pritzker Leonard & Pamela Schaeffer Stephen & Susan Shortell Allan & Meera Smith Robert & Patricia Spear Warren Winkelstein Organizations Bessemer Trust Company Daniele Agostino Derossi Foundation FMC Foundation Friedman Family Foundation Bill & Melinda Gates Foundation PATRONS ($5,000 TO $9,999) Individuals Peter Carpenter & Jane Shaw Domenica Chiuchiarelli Ranu Grewal-Bahl Hanmin Liu & Jennifer Mei J. Michael Mahoney Rosalind Singer Kirk Smith & Joan Diamond

Organizations Eustace-Kwan Family Foundation Jewish Community Foundation W. K. Kellogg Foundation Gordon & Betty Moore Foundation The San Francisco Foundation Shaklee Corporation

Organizations Alameda Radiation Oncology ETR Associates Give Something Back, Inc. Hewlett-Packard Company Foundation Johnson & Johnson Kaiser Permanente Pfizer, Inc. Philanthropic Ventures Foundation II

BENEFACTORS ($10,000 TO $24,999) Individuals Joan & Howard Bloom Teresa & John Carlson Ralph & June Catalano

ADVOCATES ($1,000 TO $4,999) Individuals Marcelle Abell-Rosen & Andrew Rosen Tayeb Alhafez Jeffrey & Elizabeth Austin

40

University of California, Berkeley

Stacey Baba & James Vokac Anne Bakar & Joseph Zadik Roland Brandel Lawrence & Girija Brilliant Isabel & Andrew Byrnes Margaret Cary George & Eleanor Cernada Farah Champsi Pansy Chan Alice Chetkovich Nilda Chong Linda & James Clever George & Marilyn Coombe Margaret Deane Marcia Delgadillo Susan & Michael Eckhardt Garold & Joyce Faber Jerry & Lorraine Factor Susan & James Foerster Charles Francis Elizabeth Fray Wallace Gee Richard Gosselin Frances Ann Hamblin David & Katharine Hopkins Jay & Kip Hudson Stuart Jordan Jeffrey Kang & Brenda Lee-Kang Joan Lam Raymond & Barbara Levine Virginia & Franklin Lew Nancy Lusk & Michael Smith Estate of David McNeill James & Kate Meyers Arnold Milstein & Nancy Adler Dean & Anne Ornish Janet Perlman & Carl Blumstein Robert & Mary Porter Darwin & Donna Poulos Sarah & Steven Presser Esther Quirolgico Estate of Lola Reshetko Shirley Roach Steven & Sally Schroeder Shoshanna Sofaer & Lawrence Bergner Jonathan Spanier Paul & Andrea Swenson Patricia & Kenneth Taylor Kenneth Taymor & Elizabeth Parker Eric Vittinghoff

Organizations Anshen + Allen Architects, Inc. California HealthCare Foundation Catholic Healthcare West Center for Health Improvement Chevron Oronite Company Chinese Hospital Cosmetic Toiletry & Fragrance Association Davis Wright Tremaine, LLP Dextra Baldwin McGonagle Foundation The Dow Chemical Foundation

Annette Goggio & Daniel Cohn John & Marea Grant Frederick Grose James & Patricia Harrison Paul & Lois Hofmann Roland & Barbara Hong Jeffrey Hunter Deborah & Martin Inouye Richard Jackson & Joan Guilford Nancy Karp James & Sarah Kimmey Julia Klees Sharon Knowlton Dan Laks Eleanor Langpaap Yvette Leung & Liwen Mah

Left to right: Doctoral student Marty Martinson, M.P.H. ‘05; School lecturer and field residency supervisor Ellie Schindelman, M.P.H. ‘80; and doctoral student Charlotte Chang, at the UC Berkeley Social Hour held in conjunction with the American Public Health Association’s annual meeting

National Academy of Sciences National Center For Healthy Housing Preventive Medicine Research Institute Marcelle & Andrew Rosen Foundation M.B. Seretean Foundation Telecare Corporation PARTNERS ($500 TO $999) Individuals Athena & Nick Arvanitidis Joanne & Daniel Azarnoff John Balmes & Sherry Katz Raymond Baxter & Aida Alvarez John & Ruth Bellows Warren Browner Washington & Paula Burns Elizabeth Calfee Po-Shen Chang & Julie Craig-Chang Bernard Cordes Ursula & Jeffrey Edman Michael & Sandra Fischman Michael Gallivan Ben & Ellen Gerwick

Sa & Qiuyuan Liu Anthony Marfin & Amy Bode Stuart & Judith Marylander Caroline McCall & Eric Martin Arthur McIntyre Hellmut Meister Anjali Morris Mary & Raymond Murakami Mary & Craig Noke Artist Parker Joseph & Nancy Restuccia Gordon & Rosemary Seck Nancy & Robert Shurtleff Mary & Marshall Small Erin Tanenbaum Resa & Matthew Warner Emily Warton & Steve Benting Ana Whitlock Lisa Zwerling & Ron Birnbaum Organizations Alameda Alliance for Health Berkeley Engineering & Research, Inc. Children’s Hospital & Research Center Oakland Chinese Community Health Plan

Partners in Public Health

Environmental Clearinghouse Hopelab International Medical Corporation Juniper Networks, Inc. The Lair of the Golden Bear Family Camp Noke Charitable Foundation Santa Clara Family Health Plan See’s Candies Spain Agency FRIENDS ($250 TO $499) Individuals T. Elaine Adamson & Edward Gould Victor & Karen Alterescu Ramona Anderson Anonymous Marilyn Barkin P. Robert Beatty Michelle Berlin & Robert Lowe Deborah Bohr & James Oakes Lawrence & Joan Budish Jennifer Burlison Evelyn Caceres-Chu & Albert Chu Korey Capozza Wanyen Chang Chin Long & Fu Chen Chiang Carol & Ronald Clazie Jonathan Cohn Robert & Susan Crane Susan Cummins Dale Danley Robert Day & C.J. Taylor Barbara De Riemer James & Dorothy Devitt Sandra & Jerry Dratler John & Marlene Eastman Leland & Marta Ehling Patricia Evans Florence & Arthur Feinfield Carol & James Floyd Jennifer & Robert Futernick Carol Giblin Thomas Goetz & Whitney Wright Auielka Gonzalez Webb & Matthew McCoffer Jack & Marjorie Guest S. Katharine Hammond Thomas Hazlet John & Leta Hillman The Hosel Family Joseph & Kimberley Hummel Bruce & Simone Ingram Katharine Iskrant Jerry & Darlene Jones Laurence Kolonel Andrew Lan

Audrey Lau & Buel Rodgers Che Keung & Chi Sim Lau Carl Lester Wallace Lowe Ying Lu & Weizhao Zhou Merle Lustig & Ronald Glass Betsy MacCracken & Virginia Hunter John & Susan Mamer Elizabeth Martini David Matherly George & Joanne McKray Juliet Melzer Nikki & Larry Meredith Ray Minjares Gita Murthy Ralph & Jane Myhre Jeffrey Newman Evelyn Nodal David Null Amy Nuttbrock David & Mary O’Neill Jeffrey & Lydia Oxendine Martin & Muriel Paley William Plautz & Kathleen Welsh Malcolm Potts & Martha Campbell Kathleen Regilio Arthur Reingold & Gail Bolan Anna Lisa Robbert Silvestre & Victor Silvestre Patricia Salber Sidney & Sally Saltzstein Sarah Samuels & Joel Simon Susan & William Stokes Richard Sun Linda Tartof Steven Tishman John Troidl Kim Vu Ann Weber Michael Weiss Patricia & Phillip West Katherine & Robert Westpheling Marilyn Winkleby & Michael Fischetti Brian Wong & Cindy Gok Lorraine Woo Jeremy Zhou & Ka Ho Organizations BJ & J Sports Awards & Gifts DoubleTree Hotels Funky Door Yoga Holland Kaufmann & Bartels, LLC It’s Yoga Lathrop Construction Company Native American Health Center

Nova Fisheries, Inc. On Lok Senior Health Services The Oregon Community Foundation Samuels & Associates Wells Fargo Foundation SUPPORTERS ($150 TO $249) Individuals Barbara Abrams & Gary Root Celia Allen Nancy Altemus John & Eleanor Anderson Richard & Carlene Anderson Paulette Arbuckle Richard Bailey Dean Baker Marina Baroff Lucinda & Ronald Bazile Lesley Bennett & Jayson Pereira Daniel Bertheau Lynda Bradford Lois Brady & Daniel Phillips Laura Brown & Mark Hanson Raul Caetano & Patrice Caetano Vaeth Jennesa Calvo-Friedman Rong Chen Dolores & Samuel Clement Davida Coady

Orcilia & Richard Forbes Shelby & Frederick Gans Jose & Judith Garcia Marion Gillen & Linda Edelstein Amy Goldberg-Day & Mark Day Christopher & Emma Graber Michael & Kazue Granich Thomas Hall & Elizabeth McLoughlin Jean Hankin Daniel & Gail Henderson Irva Hertz-Picciotto & Henri Picciotto Glenn & Jan Hildebrand Beverly Holt David Hoskinson Robert & Barbara Jackson Clay & Clarissa Johnston Virginia Jones Alma & Ian Kagimoto Matthew & Linda Kidd Arlene & David Klonoff Peter Kunstader Joyce & Richard Lashof Fern Leaf Geoffrey Lomax Donald & Elaine Ludwig Robert & Sharlene Lund Karen Martz Ben & Misato Mathews

Left to right: Rosana Weldon, recipient of the Edmond and Elizabeth Preston Scholarship; George McKray, M.P.H. ’57, who facilitated the creation of the Reshetko Family Scholarships; and Professor Emeritus Chin-Long Chiang, in whose honor one of the scholarships is named, at the School’s annual Scholarship Tea

Ashley & Kenneth Coates Jacqueline Colby Norman & Wendy Constantine Shawna & Neil Cooper Carol & S. Bruce Copeland Martin & Diane Covitz Edwin & Naomi Curtis Julian & Dorothy Davis Louise Detwiler Jacquolyn Duerr & Alberto Balingit Donald & Sheila Evans Ann & David Flinn

Kevin McGirr Alan & Margaret McKay Daniel & Elizabeth Merians Raphael & Tammy Metzger Rachel Morello-Frosch & David Eifler Kris Mungo Elizabeth & Robert Nobmann Robert & Janiece Nolan Barbara Norrish Mary O’Connor & Emil Brown Michael O’Donnell Luna Okada & Wynn Sheade

Alberto Ortega Valentine Paredes & Christopher Behrens Myrto-Xeni & Andrew Petreas Robert & Beverley Reeves Richard Ricketts & Mary Elizabeth Kelner-Ricketts Lois Rifkin Lee Riley & Jesse Furman Mary & Carl Rodrick Anthony & Barbara Rooklin Jo Ellen Ross Janet Schilling David & Lorraine Schnurr Judith Segall Donna Seid Terry Shaw Elizabeth Shurtleff Seth Silverman James Simpson Joan & David Skurnick James Slaggert Jim & Charlotte Smith Rachel & Arthur Smith Sharon & Harry Smith Robert Sparks Joseph Stretch Anne Sunderland Barbara & Alfredo Terrazas Phyllis & Max Thelen Ronald Thiele Barry & Susan Wainscott April & Timothy Watson Barbara Wismer Ellen Wolfe Diane & Glenn Yasuda Martha Young Katherine Yu & David Su Organizations Alta Bates Medical Group Applera Asian Health Services Julie Brown & Associates FJC Freddie Mac Foundation F. Korbel Bros La Clinica de la Raza Lumetra Metzger Law Group CONTRIBUTORS ($1 TO $149) Individuals Kathleen Abanilla June Abel Denise Abrams & David Harrington continued on page 42

Public Health

41

Partners in Public Health

Honor Roll, continued Anita Addison Mary Ader Adebiyi Adesina Georgette Adjorlolo-Johnson Dorothy Aeschliman Olako Agburu Jennifer Ahern & Yohance Edwards M. Bridget Ahrens & Jean Szilva Timothy Albertson Mary Alexander & Lyman Faulkner Ellen & Paul Alkon Ruth Allen Gian Allen-Piccolo Tanir Ami Adele Amodeo Prasanna Ananth Mariana Anaya Henry & Virginia Anderson Laura & Calvin Anderson Anonymous Anonymous Joyce Appelbaum Tomas & Irene Aragon Karina Arambula Lindsay Arnold Ann-Marie Askew Margaret & Donald Aumann Howard Backer Elizabeth Bacon Diana Badillo Katherine Baer Anna Bagniewska Jennifer Balogh Cecilia Barbosa John Barker & Fan Cheng Mark Barrett Elaine Base Claribel Baskin-Prince Suzanne Battaglia John Beare Gerald & Pamela Beck Robert & Meg Beck Robin Bedell-Waite & Thomas Waite James & Lisa Behrmann Martin Benedict Dorothy & Vernon Bengal David Berke Chhaganbhai & Sarojben Bhakta Harvey & Bonnie Bichkoff William & Shirley Biggerstaff Caroline & Charles Bliss Babette & Sydney Bloch Karen Bloch & David Morgan Gladys & Clifford Block Lavern & Jane Borg Jean & Robert Born 42

Christopher & Lisa Bottorff Anne Bracker & Jefferson Singer Joan Bradus & Dale Friedman Judith Bramson Priscilla Branch Donald Brecker & Ann Darling

Teresa & William Brusher Roy & Donna Bryggman Katherine Bryon Gertrude & William Buehring Merrill Buice Frederica Bunge

Barbara Campbell Edith Canfield Gerri Cannon-Smith Gretchen & Charles Carlson Ralph & Betty Carpenter Catherine Caserza

School of Public Health Policy Advisory Council 2007–2008 Kenneth S. Taymor, J.D., Executive Director Berkeley Center for Law, Business, and the Economy Boalt Hall School of Law Raymond J. Baxter, Ph.D. National Senior Vice President, Community Benefit Kaiser Foundation Health Plan and Hospitals Teresa S. Carlson, M.P.H. ’84 Retired Health Care Management Consultant

Abla A. Creasey, Ph.D. ’78 Director, Research & Development Center for Biomaterials & Advanced Technologies Medical Devices Group Johnson & Johnson Lauren LeRoy, Ph.D. President and CEO Grantmakers in Health Richard M. Levy, Ph.D. Chairman of the Board Varian Medical Systems, Inc.

Peter F. Carpenter, M.B.A. Founder Mission and Values Institute

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

Margaret Cary, M.D., M.B.A., M.P.H. Special Adviser Medical-Surgical Services Veterans Health Administration

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

Linda Hawes Clever, M.D., M.A.C.P. Chief, Occupational Health California Pacific Medical Center Founder, RENEW

Victoria Breckwich Letitia Brewster & David Walton Claire & Ralph Brindis Kenneth & Donna Briney Claude Brown Elizabeth Brown Julie Brown Marcia Brown-Machen & Terry Machen Wendel Brunner & Ruth Rosen

University of California, Berkeley

Martin Paley, M.P.H. ’58 Management Consultant

Lisa Stone Pritzker Advocate and Activist for Child, Adolescent, and Women’s Health J. Leighton Read, M.D. General Partner Alloy Ventures Theodore J. Saenger Member, Board of Directors Sutter Health Care Steven A. Schroeder, M.D. Distinguished Professor of Health and Health Care UCSF Department of Medicine L. James Strand, M.D., M.B.A. General Partner Institutional Venture Partners Barbara S. Terrazas, M.P.H. ’76 Director, Planning, Development, and Policy Tiburcio Vasquez Health Center, Inc.

Arnold X. C. Perkins Former Director Alameda County Public Health Department

Alexandre Bureau & Sylvie Marceau Frances & John Burgess Frances & Robert Burnette Robert & Gail Buschini Kimberly Buss Elizabeth Butrick Lyle & Margaret Byers Michael & Stair Calhoun Samuel Callaway

Arthur Castillo Jacqueline Cattani Raymond & Grace Chan Shawn Chandler Emiley Chang Hwa-Gan & Keh-Minn Chang Roger & Nancy Chapman Helen Chase Katherine Chen David & Stacie Cherner

David & Wendy Cheung Audrey Chiang Eunice Childs Mary Chisholm Constance Chiulli Catherine Christopher Heather Clague & Frederic Theunissen Heather Clancy Michael & Jan Clar William & Dorothy Clemens Geraldine Clifford Seymour Cohen Simon & Janet Cohn Nancy Collins & Francesco Adinolfi Elena Conis John & Dorothy Cooper Lawrence & Constance Cowper Marguerite Cowtun & Henry Terrell Myrna Cozen Richard Crane Patricia & Roger Crawford James & Evelyn Crouch John Culver & Kathryn Johnson Peter & Gwen Dailey Helena & James Daly Raymund Dantes David Dassey David Dauphine Gary & Martha Davidson Laurel & Stuart Davis Stephen Davis & Christine Laszcz-Davis Sylvia De Trinidad Joann & Craig Deasy Marlene Dehn Orville & Helen Deniston Rhea & Rajan Dev Debra & Michael DeZarn Melissa Diehl Judith Dobbins Florentina Dobrin David & Stephanie Dodson Martha Dominguez Glumaz Moira Donahue Barry Dorfman & Helen Leabah Winter William Dorn Chika Dow William Dow Fauna Doyle Harriet & Albert Draper William & Joan Drum Gordon Dugan Megan Dunbar Debra Durchslag & Craig Zarley Trina Dutta & Michael Clark

Partners in Public Health

Kathleen Dylan David & Elizabeth Eastmond Robert & Susan Emundson Sarah Edson Simone & Gene Edwards Lucky Ehigiator Kathleen & Gerald Eisman Alexandre Ekra Virginia Elahi Jean & James English Arline Erb Charles & Donna Everett Peter & Connie Ewald Denise Fair Renato Fajardo Barbara Famularo Tamar & Joe Fendel Kevin & Barbara Fennelly Lia Fernald & Guy Haskin Lisa Feuchtbaum & James Hynes Jared & Janet Fine Robin & Mark Fine Renata Fineberg Gerald & Linda Finer Kari Fisher Leslie FitzCallaghan Margaret & Marco Flores Janet & Thomas Foos Mary Foran Michael & Karen Ford Robert Frangenberg & Ingrid Lamivault Ellen Frank Constance Fraser Benjamin & Marianne Fraticelli Peter & Robin Frazier Larri Fredericks Jonathan Frisch Katharine & Daniel Frohardt-Lane Charles & Marilyn Froom Elena Fuentes-Afflick Daniel Funderburk Sara Gale Michael Gallagher Marianne Gallo Quan Gan Celeste Garamendi Carole & Carl Garner Jane Gehring Nicole & H. Jack Geiger Liliane Geisseler & Svein Rasmussen Steven Gelber Betty & G.L. Gendler James Daniel Gentry Kimberlee Gilhuly Nancy Gilien Gary Glaser & Christine Miller

Katharine Go Ang & David Ang Martha Goetsch & Linda Besant Betty & Larry Goldblatt Sidra Goldman Brenda Goldstein Janice Goode Petra & Stan Goodell Marion Goodin June Goshi & Samuel Sweitzer Deanne & Sidney Gottfried William Grant Doris Grasshoff Marian & Roger Gray Sharon & Barry Gray Susan & Lowell Greathouse Nina & Richard Green John Grima Jennifer Grinsdale Gail & Thomas Grogan William & Lynda Gross Amy Grossman Susan Gruber & Daniel Rose Erica & Casey Gunderson Robert Gunier & Andrea Saveri Pratima Gupta & Jonathan Soper Michelle & Christopher Haan Jill Hacker-Chavez & Raymond Chavez Jennifer Hackett & Adam Blackburn Gregory & Stacy Hahn Evan Haigler Corazon Halasan Thomas & Denise Hales Amy Halio Clay Hall William & H.E. Halliday Rita Hamad Frances Hanson Robert & Martha Harrell M. Antoinette Harris Roger Haskell Treva Hatchett-Marcus Mary Henderson Melvin & Carol Henry Rona & Robert Henry Denise Herd & Tyler Stovall Alfred & Stella Hexter Elizabeth & David Hibbard Marisa Hildebrand Beverly & Hugh Hilleary Richard Hirsh Donald & Marie Hochstrasser Ugur Hodoglugil Arlen & Helen Hoh Carolyn Hoke-Van Orden & Frank Van Orden Arthur Hollister

Elizabeth Holly Constance Holton Kristin Homme & Mark Elfield David Hornung Rita Hose Xiaohui Hou Kristina Hsieh Mae Hsu Colin & Jacquelyn Hubbard Mark & Estie Hudes Jonathan & G.F. Huenemann Marjorie Hughes Gail Husson & Susan Chen Phi & Le Huynh Kathleen Imhoff Laurel Imhoff Robina Ingram-Rich & Timothy Rich Ellen & Donald Irie

James Jurik Yasuhiro Kakiuchi Jane Kaplan & Andrew Condey Mark Kaplan Leanne & Richard Kaslow Gerald Kataoka Irene & Kiyoshi Katsumoto Harvey & Susan Kayman William Keene Steffi & Josh Kellam Jenness & James Keller Susan & Daniel Keller Margo Kerrigan Kenneth & Marchelle Kesler Eric Kessell Janise Kim Karl & Sarah Klontz Nancy & Kenneth Klostermeyer Freyja & Laurent Morton

Left to right: Lucinda Bazile, M.P.H. ’94, a member of the Public Health Alumni Association’s board of directors; Stacey Baba (who, with her mother, Seiko Baba Brodbeck, B.S. ’48, established an endowed fund for students); Joyce Lashof, professor emerita and former dean; and Pat Hosel, assistant dean for external relations and development, at the School’s annual Scholarship Tea

Howard Isenberg Sarah Ismail Robert & Beverly Isman Olive & D. Michael Jack James Jackson Jeffrey Jacobs & Ann Rojas Mary & Kraig Jacobson Nidhi Jain Patricia James Roland & Reona James Marion Jarrett Shaddy Javadinejad Kathony & Franklin Jerauld Petra Jerman Violet & Hong Jew Steven Joffe & Elizabeth Haas Lucy Johns Jon Johnsen Ruth Johnson Andrea Jones Andrew Joseph Dexter & JoAnn Jung

Samara Knight Arthur & Laura Kodama Jean Kohn Kathryn Kotula Willard & Grace Krabill Ruby Kuritsubo Robin & Brian Kurtz Nicole Kurzbard Marilyn Kwan Clement & Donna Kwong Darwin & Merrily Labarthe Carolyn Lake Rebecca Landau Bruce & Phyllis Lane Sandra Lane Sally Lawrence Clarence Braddock & Janet Leader Frances & Ronald Ledford Carrie Lee Diane Lee Kelvin & Brenda Lee

Roberta Lee Lois & Richard Lehman Michael Lemle Edward & Ly Hong Leong Jonathan Leong Cindy Leung Lynn Levin & Stanley Oshinsky Alexander Levy Beverly & John Levy Arline Lewis Kenny Lewis Tiffany Lewis Rui Li Liana Lianov Daniel Lieberman Adrienne & Van Horn Lieu William Light & Robin Vernay-Light Lois Lindberg Jean & Robert Lindblom David Lindquist Kris Lindstrom & Annette Chaplin Edwin Linsley Daisy Liu Lisa Loeb Shanon Loftus Lois & Donald Lollich Peggy Loper & Michael McShane Xiaoming Lou Leslie Louie & David Bowen Cheryl & Clyde Lovelady Edward & Ida Low Elizabeth Lown & Frederick Hecht Roger Luckmann & Erica Foldy Anne & Charles Ludvik Stephen & Linda Lustig Claudia & Robert Lutz Janet Macher Flora & Lincoln MacLise Heather Madison Sheryl Magzamen Naveen & Syed Mahmood Shirley Main George & Carlyne Majewski Tatiana Mamantov & Cornelius Jansen Mark Mammarella David & Anne Manchester Harry & Claire Manji David Mark Edward & Anita Marshall Ruben Marshall & Barbara Pierce Michael & Jeanee Martin Maya Mascarenhas Karla & David Massie Nancy Masters & Paul Cohen Jean & George Matthaei Beth McCaffrey continued on page 44 Public Health

43

Partners in Public Health

Honor Roll, continued

Scholars in the Bay Area Schweitzer Fellows Program and students in the Program in Medical Education for the Urban Underserved (part of the UC Berkeley-UCSF Joint Medical Program), came to a special reception to acknowledge the Blue Cross of California Foundation for its support.

Sarah McCarthy Brigid McCaw Carol McClain Janet McDonald Marian McDonald Ruth McHenry-Coe Thomas & Patricia McLaren Jme McLean Michelle McMurry Bessanderson McNeil Mary McRae Rosa Medina Vincent Meehan Jancie Meerman Howard & Nancy Mel Christina & Randall Mellin Mark Mendell Angela Menegay Caitlin Merlo Ruth & Harry Metzger Juliet Mevi-Shiflett & Raymond Shiflett Joan Milburn Andrew Miller Kelly Miller & Denise Sanchez Marlene & Thomas Miller Donald & Elizabeth Minkler Shannon Mitchell & John Siegfried Irene & Neal Miura Telford Moore Hilbert Morales Frank & Mary Morris Pat & Ray Morris Florence Morrison Clark & William Clark Hallie Morrow John & Doris Moyer Mark & Nancy Munekata Lea & Benjamin Murray 44

Michael Musante Dorothea Myers Maryam Najafi Jean & Antionette Naples Amalia & Carl Neidhardt William Neilson Carolyn & John Nelson Shirley Nelson Linda Neuhauser & Craig Buxton Richard Neumaier Edison Newman Frances Newman Beata & Harlen Ng Keith Ng & Patricia Hui-Ng Viet Nguyen Mark Nicas & Jennifer McNary Khanh Ninh Jean Norris & Bluford Hestir Helen Nunberg Somao Ochi Carmen Ochoa & Eugenio Frongia Roberta O’Grady Afolabi & Mojirola Oguntoyinbo Naomi Okinishi Mary O’Leary Perkins & Arthur Perkins Kent Olson Cynthia & Brian O’Malley Douglas Oman Alan Oppenheim & Alice Salvatore Karen Oppenheimer Megan Orr Ruth Osuch Michael O’Sullivan & Edna White-O’Sullivan Lisa & Roger Ota Nitika Pai Lyn Paleo Richard & Martha Pastcan

University of California, Berkeley

Mildred Patterson Eileen & Mark Pearl Carolyn & T.E. Peterson Nicholas & Patricia Petrakis Audrey Pettifor & Mark Schoeman Christina Phares & Colin Garrett Alta Picchi Cheramy “Cheri” Pies Therese Pipe Sharon & Richard Pipkin Mary Pittman-Lindeman & David Lindeman Julie Plagenhoef Lawrence Plaskett Jennifer & Matthew Plunkett Adam Polis Katherine Pollard Howard Pollick & Linda Strean Donald & Ann Porcella Jacqueline & Richard Pryor Savitri Purshottam Kelvin Quan & Karen Lam Candice Quinlan Brian & Tacy Quinn Norman & Eilene Raiden Henry Ramirez Patricia Ramsay & Shawn O’Leary Lonette & Stanley Rappoport Carlisle Rast John & Judith Ratcliffe Reimert & Betty Ravenholt Blake Rawdin Barbara Razey-Simmons & Charles Simmons Irene Reed David Reese & Ellen Peach Lester Reichek Colleen Reid Barbara Reiss & James Snyder Justin Remais

Liza Reynolds & Jason Landis Anderson Rice & Rhonda Wilson-Rice Helen Rice Megan Rice Maxwell Richardson Rene Ricks Patricia & James Riddell Rochelle Ridgway Jean & Francis Riley Marilyn Robbie Jossens & Lawrence Jossens Gordon & Whit Robbins Annette & Wilfrid Roberge James Robinson & Juliann Sum Scott Robinson & Deborah Dobin Judith & Paul Rogers Michael & Sharon Rogers Patrick Romano & Allyson Sage Neda Roosta Evelyn Rorem Allan Rosenberg Martin Rosenblum Carolyn Rosin Nicholas Ross Elizabeth Rottger Rebecca Roy Thomas Rundall & Jane Tiemann Susan Runyan Elva Rust Jennifer Ruzek William Ryan Glen & Corinne Ryland Neil Sachs Jeffrey Sacks & Sue Binder Lisa Sadleir-Hart & Thomas Hart Linnea Sallack Victoria Sanchez & Chuck Holton Martha Sandy & Qi Dang Gopal & Andrea Sankaran Clea Sarnquist Leigh Sawyer & Gerald Quinnan Sunessa Schettler Jan Schilling Robert Schlegel & Janet Fogel Stephen Schultz & Mary Pacey Steven Schwartzberg Megan Schwarzman Victoria & Dell Schweitzer Harry & Monika Scott Katherine Scott Betty Seabolt Faith Seal James & Morgan Seward Gary & Nan Shaw Valerie Sheehan Tina & Jeff Sherwin Jeffrey & Edna Shipley Takeo & Maye Shirasawa

James & Jo Shoemake Frances & Norman Siebe Jessica Siegel & Stephen Tsoneff Kirstin & Geoffrey Siemering Elizabeth Sigman Susan & Thomas Silver Steve Simpson Phoenix Sinclair Mitchell & Bonita Singal Janey Skinner Margot Smith Linda Smith Schermer & Harry Schermer Lorraine Smookler Susan & David Snyder Krikor & Caline Soghikian Karen Sokal-Gutierrez Marcia & Robert Somers Jonathan Soper Anne Soule Linda Souza Kodman & Rod Kodman Jeanette Spangle & Alan Walfield Joan Sprinson Usha & Bharat Srinivasan Gail St. John Susan Standfast & Theodore Wright Kenneth Stanton & Rivka Greenberg James Stark Alberta Steele David Steffen & Nichole Robillard Alan Stein & Laura Peck Alan Steinbach Bruce Steir & Yen Aeschliman Wayne Steward Judith Stewart Howard & Virginia Stiver Marilyn & William Stocker Juli Stone Sarah & Benjamin Stone-Francisco Lucy Streett Antoinette & Long Stroup Eiko Sugano Dong Suh & Susan Park Christine Swanson John & Gail Swartzberg Louise Swig Samina Syed Laurence & Ann Sykes William & Carolyn Talley Patricia Tanquary Josephine & Eric Tao Elfi & Hugo Tarazona Cathy Tashiro Coralyn & Peter Taylor Gloria Taylor

Partners in Public Health

Timothy Taylor William & Judith Taylor Irene & Marsh Tekawa Constantine & Nancy Tempelis Corinna & William Tempelis Marilyn Teplow Gregory & Bonita Thomas Laura Thomas Pamela Thompson Richard & Mary Haven Thompson Lory Thomson Colleen & Brian Thornton Shirley & Richard Timm Frances Tittmann Gerd Tobias Diane Tokugawa & Alan Gould Boris Tong Claudine Torfs Laura Trupin Feng Tsai Clarisse Tsang Suzanne Tsang Janis & Daniel Tuerk Sandra Tye Judith & Clarence Ueda Verna & V.E. Unger Shrinivasa & Jaya Upadhyaya Timothy Uyeki Katrina Van Hoesen Presti & Blair Presti Bea Vandenberg Ludenia & Steven Varga Anne Vargas Janet & Curtis Vaughan Dorothy & Clasten Vaughn Juan Velasquez Jeannie & Peter Venturini Jack Vermillion Varsha Vimalananda Rosalie & Paul Vlahutin Eileen & James Vohs Donald Waite Hazelle Junker Walker Lawrence Wallack Virginie Walsh Adam Warren Martha Wasserman Mary Weagle Michael Weber Harvey & Rhona Weinstein Morris & Audree Weiss Ardyce Wells Suzanne Welty Sanford & Carolyn Werner Alana Wike Catherine Williams Constance Williams Diane Williams

Gregory & Patricia Williams John Williams Trevor Williams Jacquelyn Williams-Uqbolue Michael Wilson & Maria Kersey Terry & Teri Winter Ian & Margaret Wishart Sharon Witemeyer Katherine & Richard Wolfman Diane Woloshin Channing Wong Otis & Teresa Wong Patricia Wong Walter Wong Ron & Genevieve Wood Paula Worby Kara Wright & T. James Lawrence Joseph & Iris Wu Kevin Wu Frederick & Katinka Wyle Biao Xing & Yan Yuan Robert Yarwood Douglas & Janet Yee Grace Yeh Mary & Melvyn Yokan Genevieve Young Linda Young Suzanne & John Young Richard Younge & Yukiko Umemoto Stella Yu & Hingloi Hung Allison Zaum & Edward Roche Sara-Mae & Marshall Zemon Habteab Zerit Hanjing Zhuo Richard Zurow Organizations AARP Aspire Media Bank of America Foundation Barclays Bank Foundation Born Living Trust Byers Family Trust Freed & Associates Goodsearch Merck Partnership for Giving Rough House Editorial William M. Ryan Company, Inc. Summit Bank Tittmann Associates The United Way of the Bay Area WellPoint, Inc. Your Community Bank CLASS CAMPAIGN 2007 Kathleen Abanilla Olako Agburu

Jennifer Ahern Prasanna Ananth Mariana Anaya Karina Arambula Lindsay Arnold Diana Badillo Deborah Bain Brickley Daniel Bertheau Korey Capozza Emiley Chang Katherine Chen Catherine Christopher Jacqueline Colby Shawna Cooper Tapashi Dalvi Raymund Dantes David Dauphine Moira Donahue Fauna Doyle Megan Dunbar Alexandre Ekra Denise Fair Renato Fajardo Sara Gale Steven Gelber Kimberlee Gilhuly Thomas Goetz Sidra Goldman Christopher Graber Susan Gruber Pratima Gupta Michelle Haan Jennifer Hackett Evan Haigler Rita Hamad David Hornung Kristina Hsieh Mae Hsu Sarah Ismail Shaddy Javadinejad Andrew Joseph Yasuhiro Kakiuchi Eric Kessell Janise Kim Samara Knight Nicole Kurzbard Dan Laks Fern Leaf Jonathan Leong Cindy Leung Daisy Liu Lisa Loeb Heather Madison Sheryl Magzamen Maya Mascarenhas Jme McLean Caitlin Merlo Ray Minjares

Maryam Najafi Viet Nguyen Naomi Okinishi Megan Orr Alberto Ortega Colleen Reid Justin Remais Megan Rice Maxwell Richardson Neda Roosta Rebecca Roy Neil Sachs

Kevin Wu Grace Yeh GIFTS IN KIND The Albatross Berkeley Repertory Theatre Bette’s Oceanview Diner Harvey & Bonnie Bichkoff BJ & J Sports Awards & Gifts Brazil Café Julie M. Brown & Associates Patricia & Richard Buffler

Benjamin Ide Wheeler Society Recognizing donors who have expressed their intention to include the School of Public Health in their estate plans Simone Adams

Kenneth & Marjorie Kaiser

Dudley Aldous

A. Arlene Kasa

Ana Anderson

Jogi & T. S. Khanna

Grace Bardine

Joan Lam

Marilyn Barkin

Carol Langhauser

Paul Boumbulian

Eleanor Langpaap

Doris Brusasco

Wallace Lowe

Patricia & Richard Buffler

James Maas

Barbara Cohn

Edward & Carol McClendon

Paul & Susan Conforti

Pamela & Victor Peeke

Dorothy Crouch

Therese Pipe

Colleen Denny-Garamendi & John Garamendi

Robert & Mary Porter

Debra & Michael DeZarn

Lois Rifkin

Viola & Fredrick Egli

Ronald & Genevieve Roberto

Garold & Joyce Faber

Stephen Schultz & Mary Pacey

Robert Frangenberg & Ingrid Lamivault

Rosalind Singer

Ivan Frohne Marcia Gerin Joseph Homler

Harper & Leonisa Puziss

B. B. Teravainen Helen Thorall Paola Timiras Bryan Whelan

Jay & Kip Hudson

Clea Sarnquist Megan Schwarzman Terry Shaw Elizabeth Sigman Steve Simpson Gail St. John Samina Syed Clarisse Tsang Suzanne Tsang Adam Warren Emily Warton Ann Weber Suzanne Welty Alana Wike Paula Worby

Jennifer Burlison Doubletree Hotel Berkeley Marina ETR Associates Funky Door Yoga Gelateria Naia It’s Yoga Jimmy Bean’s Jodie’s Restaurant & Bar-B-Que Juan’s Place Kip’s Restaurant & Bar Korbel Champagne Cellars Jane Kunde La Mediterranée La Note

continued on page 46 Public Health

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Partners in Public Health

Honor Roll, continued Decade Club Recognizing alumni and other individuals who have given for the past 10 years consecutively T. Elaine Adamson & Edward Gould

Frances Ann Hamblin

Somao Ochi

S Katharine Hammond

Mildred Patterson

Nancy Altemus

Jean Hankin

Edward & Camille Penhoet

Adele Amodeo

Thomas Hazlet

Darwin & Donna Poulos

Ramona Anderson

Alfred & Stella Hexter

Arthur Reingold & Gail Bolan

Richard Bailey

Glenn & Jan Hildebrand

Joseph & Nancy Restuccia

Marina Baroff

Donald & Marie Hochstrasser

Lois Rifkin

James & Lisa Behrmann

David & Katharine Hopkins

Shirley Roach

Joan & Howard Bloom

Robert Hosang & Joyce Yap

Thomas Rundall & Jane Tiemann

Judith Bramson

Patricia & Harold Hosel

Sidney & Sally Saltzstein

Claude Brown

David Hoskinson

Leigh Sawyer & Gerald Quinnan

Jeffrey & Cathleen Brown

Mark & Estie Hudes

Janet Schilling

Patricia & Richard Buffler

Deborah & Martin Inouye

Betty Seabolt

Barbara Campbell

Robert & Beverly Isman

Nancy & Robert Shurtleff

Ralph & Betty Carpenter

Olive & D. Michael Jack

Mitchell & Bonita Singal

Alice Chetkovich

A. Arlene Kasa

Rosalind Singer

Eunice Childs

Jane Kenyon

Esmond Smith

Carol & Ronald Clazie

James & Sarah Kimmey

Kirk Smith & Joan Diamond

Linda & James Clever

Julia Klees

Robert & Patricia Spear

Carol & S Bruce Copeland

Laurence Kolonel

Martin & Diane Covitz

Catherine & James Koshland

Susan Standfast & Theodore Wright

Margaret Deane

Ruby Kuritsubo

Bruce Steir & Yen Aeschliman

John & Marlene Eastman

Clement & Donna Kwong

Howard & Virginia Stiver

Susan & Michael Eckhardt

Joyce & Richard Lashof

Marilyn & William Stocker

Kelvin & Brenda Lee

Laurence & Ann Sykes

Lynn Levin & Stanley Oshinsky

Marilyn Teplow

William Light & Robin Vernay-Light

Ronald Thiele

Carol & James Floyd FMC Foundation

Robert & Sharlene Lund

Sandra Tye

Susan & James Foerster

Nancy Lusk & Michael Smith

Verna & V.E. Unger

Constance Fraser

Ruth McHenry-Coe

Jack Vermillion

Katharine & Daniel Frohardt-Lane

Mark Mendell

Eileen & James Vohs

Joan Milburn

April & Timothy Watson

Donald & Elizabeth Minkler

Harvey & Rhona Weinstein

Linda Neuhauser & Craig Buxton

Katherine & Robert Westpheling

Jeffrey Newman

Michael Williams

Beata & Harlen Ng

Barbara Wismer

Joel & Phyllis Nitzkin

Channing Wong

Jerry & Lorraine Factor Robin & Mark Fine Michael & Sandra Fischman

Charles & Marilyn Froom Wallace Gee Liliane Geisseler & Svein Rasmussen Carol Giblin Marian & Roger Gray

Mary & Craig Noke

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University of California, Berkeley

John Troidl

The Lair of the Golden Bear Family Camp Joan Lam Carl Lester Mario’s La Fiesta Moe’s Books William Neilson Evelyn Nodal The Patio Pharmaca Integrative Pharmacy John & Lisa Pritzker Rick & Ann’s Catering Rosenblum Cellars The San Francisco Zoological Society See’s Candies Inc. Jeffrey & Edna Shipley Sierra Machado Kirk Smith & Joan Diamond T-Rex IN MEMORY OF Betty Grant Austin

by June Abel Jeffrey & Elizabeth Austin Elizabeth Bacon Claribel Baskin-Prince Martin Benedict William & Shirley Biggerstaff Christopher & Lisa Bottorff Roland Brandel Frederica Bunge Frances & Robert Burnette Robert & Gail Buschini Lyle & Margaret Byers Wanyen Chang Rong Chen William & Dorothy Clemens George & Marilyn Coombe John & Dorothy Cooper The Nancy & Hugh Ditzler Jr. Fund of the Farallon Foundation David & Stephanie Dodson Arline Erb Donald & Sheila Evans Shelby & Frederick Gans Ben & Ellen Gerwick Marion Goodin John & Marea Grant William & Shand Green Constance Holton Xiaohui Hou W. K. Kellogg Foundation Lathrop Construction Company Hanmin Liu & Jennifer Mei

Karla & David Massie Jean & George Matthaei Beth McCaffrey Thomas & Patricia McLaren Howard & Nancy Mel Donald & Elizabeth Minkler Frank & Mary Morris Shirley Nelson Frances Newman Edward & Camille Penhoet Carolyn & T.E. Peterson Nicholas & Patricia Petrakis The San Francisco Foundation Elizabeth Shurtleff Mary & Marshall Small Anne Soule Alberta Steele Summit Bank Phyllis & Max Thelen Frances Tittmann Tittmann Associates Jeannie & Peter Venturini Virginie Walsh Alan Wilson Ian & Margaret Wishart Katherine & Richard Wolfman Frederick & Katinka Wyle Your Community Bank Sally Bellows

by John & Ruth Bellows Hellmut Meister Jessie Bierman

by Lavern & Jane Borg Henrik Blum

by Anita Addison John & Eleanor Anderson Richard Bailey Myrna Cozen James & Evelyn Crouch Marlene Dehn Florence & Arthur Feinfield Nina & Richard Green Jack & Marjorie Guest Robert & Martha Harrell Merle A. Lustig Trust Mark Mendell Nicholas Ross Lawrence Wallack Seiko Brodbeck

by Stacey Baba & James Vokac April & Timothy Watson

Partners in Public Health

Sally Brother

by Clarence Braddock & Janet Leader Samuels & Associates Diane Woloshin Xavier Cervantes

by Isabel & Andrew Byrnes Alfred Childs

by T. Elaine Adamson & Edward Gould Ruth Allen John & Eleanor Anderson Teresa & William Brusher Patricia & Richard Buffler Washington & Paula Burns Carlisle L. Living Trust Linda & James Clever Simone & Gene Edwards William & H.E. Halliday Treva Hatchett-Marcus Robert & Barbara Jackson Nancy Lusk & Michael Smith George & Joanne McKray Irene & Neal Miura Roberta O’Grady Mary Pittman-Lindeman & David Lindeman Carlisle Rast Evelyn Rorem Elizabeth Shurtleff Gerd Tobias Marguerite de la Vega Linsley

by Edwin Linsley Kathryn De Riemer

by Barbara De Riemer

Susan de Young

by Margaret & Donald Aumann Katharine Go Ang & David Ang Frank Falkner

by Gopal & Andrea Sankaran Beryl Feinglass

by Lois A. Rifkin Living Trust Ramón Feliciano

by Marian McDonald Rodney Friedman

by Aspire Media Lawrence & Joan Budish Michael & Stair Calhoun Samuel Callaway Jennesa Calvo-Friedman FJC Clay Hall Holland Kaufmann & Bartels LLC Bruce & Simone Ingram Howard Isenberg Stuart Jordan Robin & Brian Kurtz Ruben Marshall & Barbara Pierce Candice Quinlan Norman & Eilene Raiden Robert & Beverley Reeves Seth Silverman Spain Agency Lory Thomson Steven Tishman Martha Wasserman Genevieve Young

Donald Gentner

by Judith Stewart Karen Grant

by Judith Dobbins William Griffiths

by George & Eleanor Cernada Martin & Diane Covitz Katharine & Daniel Frohardt-Lane Robert & Barbara Jackson Kathryn Kotula Rochelle Ridgway Sidney & Sally Saltzstein William & Sylvie Griffiths

by Glenn & Jan Hildebrand Ruth Johnson Roderick Hamblin

by Frances Ann Hamblin Ruth Huenemann

by Ann Arndt Elizabeth Fray Jean Hankin Ruth L. Huenemann Trust Alma & Ian Kagimoto Doreen Kotula

by Kathryn Kotula Connie Long

by Lynn Levin & Stanley Oshinsky Shirley Roach Betty Seabolt John Troidl Jean Low

by Harriet & Albert Draper Larry Macupa

by Linnea Sallack Walter Mangold

by Lawrence & Constance Cowper Orville & Helen Deniston

Donald Minkler

by William & Shand Green Robert Hosang & Joyce Yap Joan & David Skurnick Kirk Smith & Joan Diamond William Oswald

by Katharine Iskrant Janet Macher Myrto-Xeni & Andrew Petreas M.C. Pant

by Nitika Pai Jeanne Raisler

by Jonathan Cohn William Reeves

by Jacqueline Cattani Corinna & William Tempelis Beryl Roberts

by Elaine Base Octavio Romano

by Mark Kaplan Ellen Rosenberg

by Allan Rosenberg Charles Smith

by Henry & Virginia Anderson Robert & Martha Harrell Shirley Roach Keith Taylor

by Donald & Elaine Ludwig Jean Todd

by Lynda Bradford Van Unger

by Verna Unger

IN HONOR OF Asian American Students In Administration Program

by Linda Young Valerie Bengal

by Dorothy & Vernon Bengal Bhulabhai & Dhanima Bhakta

by Chhaganbhai & Sarojben Bhakta Chin Long Chiang

by Margaret Deane Dr.P.H. Program Students

by Victoria Breckwich D.A. Henderson

by Arthur Hollister Amar Kishan

by Shrinivasa & Jaya Upadhyaya Joyce Lashof

by Shirley Roach Jean Morton

by Rachel Morello-Frosch & David Eifler Shirley Roach Zak Sabry

by Patricia & Roger Crawford Martha Dominguez Glumaz Hopelab Martyn Smith

by David & Elizabeth Eastmond Helen Wallace

by Claude Brown

Every effort has been made to provide a complete and accurate listing of individual donors and their gifts to the School of Public Health from July 1, 2006 to June 30, 2007. Should you discover a mistake or omission, please accept our apologies and contact us at (510) 642-2299 or

Sheldon Margen

by Joan & Howard Bloom Public Health Institute

trini@berkeley.edu so that we can correct our records.

Left to right: Sam Nussbaum, executive vice president and chief medical officer of the Wellpoint Foundation; Dean Stephen Shortell; and John Swartzberg, director of the UC Berkeley-UCSF Joint Medical Program and chair of the Bay Area Schweitzer Fellows board of directors, at the Blue Cross of California Foundation Thank You reception

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Alumni News

President’s Message Hello Alumni, This is my last letter to you as president of the Public Health Alumni Association, as this is the last year of my three-year term. I have been pleased to serve you and the School. While we have many accomplishments, one of our greatest challenges in the future is building a new home for our School. Here are answers to some frequently asked questions that should interest all of us.

1. Why is Warren Hall being taken down?

Warren Hall was not seismically safe and needed laboratory and network upgrades that were beyond mere renovation work. The replacement building will be an interdisciplinary wet lab building focusing on cancer research, stem cell research, neuroscience, and infectious diseases.

Public Health Alumni Association Board of Directors 2007–2008 Leslie Louie, Ph.D ’90, M.P.H. ’85 (President) Mindi Lassman, M.A., M.S. ’77 (Vice President) Lucinda Bazile, M.P.H. ’94 (Secretary-Treasurer) Beth Roemer, M.P.H. ’76 (Secretary-Treasurer) John Troidl, Ph.D. ’01, M.B.A. (President-elect) P. Robert Beatty, Ph.D. ’94 Harvey Bichkoff, M.P.H. ’85 Julie M. Brown, M.B.A, M.P.H. ’85

2. What is the University doing to help us find and build a new home?

The University has acquired the property previously occupied by the State Department of Health Services, on Berkeley Way between Shattuck and Oxford. Plans for a new Community Health Campus on that site include the School of Public Health, the School of Optometry, the clinical portion of the Psychology Department, and part of the Helen Wills Neuroscience Institute. Our Campaign Steering Committee and the Dean’s Office have been working with the Chancellor and University at large to develop the fund raising strategy for the new building, which is preliminarily estimated to cost $180 million.

3. Why do we have to raise so much for a new home when this is a public institution that should be supported by the State of California?

The state only supports about 15 percent of the School’s operating budget. Increasingly, the School of Public Health, like the University at large, is required to reach out to the private sector to fulfill our mission—in our case, to protect and promote the health of individuals, families, and the population at large.

4. How are we going to achieve this fundraising goal?

The School’s Campaign Committee is developing strategies to carry our message to the community.

Here’s where you can help: As alumni, we are in the best position to be ambassadors for public health.

I encourage you to become familiar with the issues, spread the word, keep in touch with the School and your classmates, and participate in School events like the Public Health Heroes Awards Ceremony on April 2 and/or the Spring Brunch and Silent Auction on April 27. Help us reach our goal to increase the percent of alumni who donate to the School from 12 percent to 30 percent within the next two years.

This is one measure that philanthropists use to gauge their level of investment. You can donate or purchase an item at the Silent Auction or make an annual gift to the School. No amount is too small to count towards our level of participation!

It has been exciting, energizing, challenging, (and fun!) to work with you and the School. I thank all of you who have supported the work we have done and I look forward to remaining an active member of our association. I sincerely hope that you will join me in supporting the goals of our alma mater.

Laurel Davis, M.P.H. ’94, CIH David Harrington, M.P.H. ’88

Sincerely,

Joan Lam, B.S. ’62 Sally Lawrence, M.P.H. ’06 Kelvin Quan, J.D., M.P.H. ’81 Jan Schilling, M.P.H. ’91 Karen Shore, Ph.D. ’98 Alan R. Stein, M.P.H. ’78, M.S., MFT

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University of California, Berkeley

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

Alumni News

Alumni Notes

1940s Maurine B. Lightwood, B.S. ’47, Nursing Cert. ’49, is a retired school nurse. She worked for 31 years with Ceres Unified School District in California. Previously she was a civil service staff nurse with the U.S. Army during the Korean War and also worked with the San Francisco Public Health Department.

1950s Dan Funderburk, M.D., B.A. ’50 “Much appreciation to Dorothy Nyswander and Bill Griffiths.”

Henry P. Anderson, M.P.H. ’56 “Celebrated 80th birthday with all five children and nine grandchildren.”

John Brockert, M.P.H. ’56 “My wife died in August 2005. I’m living alone in an independent apartment at St. Joseph Villa (Salt Lake City). It is a

long-term care facility with independent apartments, assisted living, semi-assisted, and dependent care.”

local AARP, church circle, home economics club, and Arapahoe County Council on Aging.”

Jovine Hankins, B.S. ’56 “Just love traveling and enjoying visiting 2-year-old premie grandsons in Georgia. Volunteering when I’m home.”

Barry Karlin, Dr.P.H., M.P.H. ’59 “After serving in Thailand (1959–66), Pakistan (1966–69), Papua New Guinea (1988–92), and elsewhere, I am now ‘retired,’ meaning that I am tired all over again!

I teach global health at the University of Colorado at Boulder, which includes taking students on studytours abroad (Thailand in January ’07 and Venezuela in January ’08). Many of my students are engineers affliated with Engineers Without Borders who wish to serve in developing countries.”

Glenn Hildebrand, M.P.H. ’57, has been named vice chairman of the Access to Cancer Care Team for the California Dialogue on Cancer.

Chhaganbhai B. Bhakta, B.S. ’58 “I am still looking for 1958 yearbook (B.S. degree holders).

If any one has one, I want to buy and will pay up to $251. After my prostate radiation therapy, my wife Sarojben and I went to England and Paris May to June 2007.”

Beverly Collier Hilleary, M.P.H. ’58 “Being retired is busy!—with three children in Colorado and California. Being a grandmother to one fouryear-old is really fun. I’m health chairman in our

1960s Mildred F. Patterson, M.P.H. ’65 “Celebrated 95th birthday on October 15, 2007. Still active.”

Robert C. Harrell, M.P.H. ’67 “Now reside in O’Connor Woods [Stockton, Calif.] with my wife of 62 years, Martha.” continued on page 50

Twin Alumnae Write of Triumph Over Cystic Fibrosis For most people, a diagnosis of cystic fibrosis (CF) means the certainty of a life ended too soon. But for twin girls with the disease, what began as a family’s stubborn determination grew into a miracle.

The Power of Two (University of Missouri Press, 2007) is the first book to portray the symbiotic relationship of twins who share this life-threatening disease through adulthood. Isabel Stenzel Byrnes, M.S.W., M.P.H. ’98, and Anabel Stenzel, M.S. ’97, tell of their lifelong struggle to pursue normal lives with cystic fibrosis while grappling with the realization that they will die young. Their story reflects the physical and emotional challenges of a particularly aggressive form of CF and tells how the twins’ bicultural

heritage—Japanese and German—influenced the way they coped with these challenges.

Born in 1972, seventeen years before scientists discovered the genetic mutation that causes CF, Isabel and Anabel endured the daily regimen of chest percussion, frequent doctor visits, and lengthy hospitalizations. But they tell how, in the face of innumerable setbacks, their deep-seated dependence on each other allowed them to survive long enough to reap the benefits of the miraculous lung transplants that marked a crossroads in

their lives: “We have an old life—one of growing up with chronic illness—and a new life—one of opportunities and gifts we have never imagined before.” In this memoir, they pay tribute to the people who shaped their experience.

Isabel Stenzel Byrnes works as a community outreach coordinator, and Anabel Stenzel works as a genetic counselor in pediatric genetics, both at Lucile Packard Children’s Hospital at Stanford in Palo Alto, California.

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Alumni News

Alumni Notes, continued Public Health Institute Appoints Pittman President and CEO Mary Pittman, Dr.P.H. ’87, M.C.P., now serves as president and chief executive officer of the Public Health Institute (PHI), one of the nation’s largest nonprofit public health organizations. Previously Pittman was president of the Chicago-based Health Research & Educational Trust (HRET).

From 1993 through 2007, Pittman led HRET’s growth and development, synchronized the efforts of board members and research and educational professionals, and served on the executive staff of the American Hospital Association. Before assuming leadership of HRET, she was president and chief executive officer of the California Association of Public Hospitals.

“Mary Pittman has been a major contributor and leader of community health improvement efforts across the country, including founding the Coalition for Healthier Cities and Communities,” said the Public Health Institute’s board chair Robert Otto Valdez.

“We are thrilled to have Dr. Pittman leading PHI.” In addition, over the course of her 25-year public health career, Pittman has authored several books and numerous peer-reviewed scientific journal articles, and developed public policy and legislative proposals to reduce health disparities and expand access and quality of health care to underserved populations.

Public Health Institute is an independent, nonprofit organization dedicated to promoting health, wellbeing and quality of life for people throughout California, across the nation and around the world.

The institute now manages more than $80 million in annual revenues and oversees more than 200 programs that are funded by grants and contracts from national and state government agencies and private foundations.

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University of California, Berkeley

1970s David Werdegar, M.D., M.P.H. ’70, is currently serving as president and CEO of the Institute on Aging (formerly the Goldman Institute on Aging) in San Francisco.

Leonard Doberne, M.D., M.S. ’72 “After graduating from UCLA Medical School, I did internship and residency at Virginia Mason Hospital in Seattle, followed by fellowship in endocrinology at Stanford. I have been in the private practice of endocrinology in Mountain View, California, for 26 years. I am recently active in health care policy issues, trying to preserve choice while promoting affordable health care.”

David B. Dornan, M.P.H. ’72 “Retired four years ago as director of Michigan’s family planning program.”

Deborah Stebbins, M.P.H. ’73, was named chief executive officer of the Alameda Hospital in Alameda, California. She has served in a variety of leadership roles in health care management for more than 34 years, including president and chief executive officer of Alta Bates Ambulatory Health Services, president and chief executive officer of Seton Medical Center, and executive vice president of Masonic Homes of California.

Thomas M. Vogt, M.D., M.P.H. ’74, presented the fall lecture of the 2007–08 Buffalo Center for Social Research Distinguished Scholars Series sponsored by the University at Buffalo School of Social Work. Vogt, who is senior investigator for the Kaiser Permanente Center for Health Research in Hawaii, discussed “Quality, Costs, and Special Interests: Can We Change Our Behavior in Time to Save U.S. Health Care?” His research focuses on improving preventive care, particularly long-term weight management, health care quality, and reducing health care costs. He is the author of more than 125 peer-reviewed publications and three books.

Winnie Chu, M.P.H. ’76, is executive director of Survivors International, which provides services to survivors of torture and gender-based violence and advocacy against torture.

Daniel S. Janik, M.D., Ph.D., M.P.H. ’76, author of A Neurobiological Theory and Method of Language Acquisition (Lincom Europa, 2005), has published a second book on the neurobiology of learning titled Unlock the Genius Within: Neurobiological Trauma, Teaching and Transformative Learning (Rowman & Littlefield Education, 2006), which received both 2007 Eric Hoffer and Neurobiological Learning Society Choice Awards. Janik also produces environmental education documentary films. His latest, Clean Water, Common Ground, received two 2007 Telly Awards, for nature/wildlife documentary and for documentary.

Lisa Berkman, Dr.P.H. ’77, has been appointed director of the Harvard Center for Population and Development Studies. Berkman is the Thomas Cabot Professor of Public Policy and of Epidemiology at the Harvard School of Public Health and currently chairs the Department of Society, Human Development and Health. Recognized for her groundbreaking work in the field of social epidemiology, she is noted for identifying the effects of social networks on mortality risks that helped define the field in the late 1970s. Harvard Provost Steven E. Hyman said, “She brings both expertise in population-based research and a long history of collaborative activities that will serve to reinvigorate the center, expand the breadth of its work, and involve faculty and students from across the university.”

Gloria Grace, M.S.W., M.P.H. ’77 “I happily retired at the end of June 2007 as the coordinator of the Women’s Trauma Recovery Program at the National Center for PTSD at the VA in Menlo Park, California. I was not only a senior clinician but participated in teaching and research.”

Marc Fine, M.P.H. ’79, was named director of MissionWiseTM, a division of Comprehensive Health Education Foundation that mentors, trains, and consults with organizations on entrepreneurial strategies for the social sector. He is responsible for overseeing, planning, and implementation of all activities for the division and will initially lead a team of 10 professionals.

Alumni News

1980s Jean Marie Naples, M.P.H. ’80 “I am presently on disability as I recover from severe injuries sustained in a car accident when my car hydroplaned off a wet, rainy road and hit a tree.”

Google feedback on ideas for new products and services that will empower consumers in their health care decisions. She has led Kaiser Permanente’s efforts in the area of online health services for more than 10 years.

Victor Alterescu, M.P.H. ’87 “I’m still alive!”

M. Bridget Ahrens, M.P.H. ’81, was elected to the board of directors of the American Immunization Registry Association.

1990s

Annette Goggio, M.P.H. ’82, has launched a weekly radio program titled A Quantum Moment, which is currently broadcast from her website: www.aquantummoment.com.

Jonathan Frisch, Ph.D., ’90, M.P.H. ’87, is the principal risk manager for PG&E Corporation’s Enterprise Risk Management program. This past summer, Gov. Arnold Schwarzenegger appointed him to the Cal/OSHA Standards Board.

Mary Rodrick, Ph.D. ’82 “Retired after 23 years at Harvard Medical School doing research on regulation of immune response following thermal injury.”

Cathy J. Tashiro, Ph.D., M.P.H. ’83, received her Ph.D. in sociology from UCSF in 1998 and is currently on the faculty of the Nursing Program at the University of Washington Tacoma. She teaches classes in diversity, community, and population health. Her research and publications have focused on the meaning of race, mixed race identity, and issues of public housing residents.

Nina E. Grove, M.A., M.P.H. ’84, was named vice president for commercial planning and strategy at OneWorld Health, the first nonprofit pharmaceutical company in the United States. She was promoted from senior program director, malaria, a role in which she led the product development and commercialization planning for OneWorld Health’s malaria project and spearheaded a partnership selection process and due diligence review for OneWorld Health’s semisynthetic artemisinin grant.

During 20 years at Genentech, she held positions in product development, quality control, product operations, and most recently as director of commercial regulatory affairs.

Anna-Lisa Silvestre, M.P.H. ’85, vice president for online services at Kaiser Permanente, was named to Google’s newly formed Health Advisory Council in June 2007. Council members offer

Cate Teuten Bohn, M.P.H. ’91 “I am moving on from the New York Assessment Initiative program to a new position with the New York State Council on Children and Families as the project director for the Kids’ Well-being Indicators Clearinghouse (KWIC). KWIC is a council initiative aiming to advance the use of children’s health, education, and well-being indicators as a toll for policy development, planning, and accountability. The Council on Children and Families is authorized to coordinate the state health, education, and human services systems as a means to provide more effective systems of care for children and families. I will be involved in different areas of the council’s work, which has stayed true to its original intent—to be a neutral body within state government capable of negotiating solutions to interagency issues. This is an exciting career move for me and I am looking forward to it. Familywise, we’re thriving in upstate New York with the boys in second grade (Evan) and kindergarten (Connor).”

Grayson Marshall, D.D.S., Ph.D., M.P.H. ’92, is a professor at the UCSF School of Dentistry.

He recently received the 2007 Wilmer Souder Distinguished Scientist Award from the International Association for Dental Research and was also elected vice president of the American Association for Dental Research.

Monica L. Villalta, M.P.H. ’97, has joined Kaiser Permanente of the Mid-Atlantic States as director of diversity programs. She brings more than

15 years of experience in health care, cultural competency, and diversity. In 2003, she was selected by the Annie E. Casey Foundation as a Children and Family Fellow, and she also served as director of programs for Mary’s Center for Maternal and Child Care from 1999 to 2002. Most recently, she spent three years with the District of Columbia government in a number of critical roles.

2000s Arnab Mukherjea, M.P.H. ’02, is a thirdyear student in the Dr.P.H. program at the UC Berkeley School of Public Health. This past fall, he presented a lecture for the Asian Pacific American Medical Students Association national conference at Stanford and UCSF medical schools on the subject of South Asian health, which is also his dissertation topic. He received a Cornelius Hopper Diversity Fellowship Award from the Tobacco-Related Disease Research Program of the University of California for his research investigating the role of the tobacco industry in using South Asian products for tobacco promotion. He spoke on a panel alongside Alameda County health director Tony Iton, M.D., J.D., M.P.H. ’97, for the Association of Health Care Journalists about the role of media in covering multicultural health in the Bay Area. In addition, he recently completed his term as chair of the Asian Pacific Islander Caucus for Public Health, in official relations with the American Public Health Association (APHA), and was recognized at this past November’s APHA Annual Meeting and Exposition in Washington, D.C. Michael P. Wilson, Ph.D. ’03, M.P.H. ’98, was among two dozen of the nation’s top scientists and engineers tapped to join the California Green Chemistry Scientific Advisory Panel. The panel of experts will guide California’s Department of Toxic Substances Control on continued on page 52

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Alumni News

Alumni Notes, continued

scientific matters and provide the technical basis for the new California Green Chemistry Initiative, a new program to cut toxic chemicals in consumer products.

Krisztina Szabo, M.P.H. ’05 “The Salvador School Project, our school rebuilding effort in Pau da Lima, in the community of Baixa Fria, started in the summer of 2004. Nearly three years ago we wanted to rebuild an escolinha (small school), which housed approximately 50 children before it collapsed due to floods and rain. We made big progress over the last year due to the dedication, hard work, compassion, and belief of many in the United States, Brazil, and Hungary. As a Fulbright Fellow, I spent 15 months in Salvador and just returned recently after participating with a tuberculosis project at a local pulmonary hospital. These months also allowed me to participate with the building of the school and to engage

in grassroots organizing by utilizing elements of participatory action work through the empowerment of children and adults. This year, we established a legal Brazilian nonprofit organization called

Clube das Mães (The Mother’s Club) in Salvador with eight board members who live in the community. In 2007, we were fortunate to receive nearly $3,000 in donations. Also, Westlake Elementary School in Michigan initiated a school drive among elementary school students, which led to the collec-

tion of a large suitcase of school items. We also held a Children’s Beauty Day with a Salvadorian salon, Jacque & Janine. Currently the school functions daily with literacy and art classes, providing food and a safe environment for the children of Baixa Fria. Visit us at www.brazilreads.com.”

Sang-ick Chang, M.D., M.P.H. ’06, was appointed CEO of San Mateo Medical Center after serving as interim CEO since May 2007. San Mateo Medical Center is a department of San Mateo County, California, and a fully accredited public hospital and clinic system. The medical center operates 11 clinics throughout the county, an acute-care hospital, and long-term care facilities in San Mateo and Burlingame.

Spring 2008 Calendar Dean’s Colloquium Overcoming Poverty and Improving Global Health: Strategies That Work March 14 (Friday), 3–4:30 p.m.

150 University Hall, UC Berkeley campus Speaker: Helene Gayle, president and CEO of CARE; former director of the Bill and Melinda Gates Foundation’s HIV, TB and Reproductive Health program; and former director of the CDC’s National Center for HIV, STD and TB Prevention

Spring Alumni Brunch and Silent Auction April 27 (Sunday), silent auction 9 a.m.; program and brunch, 11:30 a.m.

Garden Room, Clark Kerr campus, 2601 Warring Street, Berkeley The Public Health Alumni Association board of directors cordially invites faculty and alumni to attend the 2008 Spring Brunch, Annual Meeting and Silent Auction. Gather with colleagues for food, camaraderie, and an opportunity to support the alumni association’s work. Watch sph.berkeley.edu for details.

12th Annual Public Health Heroes Awards Ceremony April 2 (Wednesday), 6:30 p.m.

Yerba Buena Center for the Arts, San Francisco The Public Health Heroes honor recognizes individuals and organizations for their significant contributions and exceptional commitment to promoting and protecting the health of the human population. 2008 awardees: International Hero, Donald P. Francis; National Hero, David A. Kessler; Regional Hero, Barbara Staggers; Organizational Hero, International Medical Corps www.publichealthheroes.org Cal Day April 12 (Saturday), 9 a.m.–4 p.m.

Take in all that Berkeley has to offer at the campus’s annual open house and see why Cal is the world’s premier public university. The schedule will feature numerous public health events. calday.berkeley.edu

Annual Edward E. Penhoet Lecture on Biology, Behavior, and Environment April 29 (Tuesday), 4–5:30 p.m.

Location TBA, UC Berkeley campus Speaker: R. Alta Charo, Warren P. Knowles Professor of Law & Bioethics at the University of Wisconsin

For a complete calendar of events at the School, visit sph.berkeley.edu/calendar.html

52

University of California, Berkeley

In Memoriam

In Memoriam Robert “Bob” Amber, B.S. ’54, died December 3, 2007, at age 83. Born in La Porte, Indiana, and orphaned at age three, he attended the University of Indiana for one year prior to enlisting in the Air Force. In 1945 he married Patricia Siegel in Alamogordo, New Mexico, with his flight crew serving as attendants. While stationed in Alamogordo they also witnessed the explosion of the first atomic bomb.

Following the end of the war, he and his wife moved to California where he entered UC Berkeley and was a member of Delta Chi Fraternity. In 1950 he graduated with a bachelor’s degree in public health and went to work for the Oakland Health Department. He later transferred to the newly formed Berkeley Redevelopment Agency and was involved in bringing BART to Berkeley’s downtown area. In 1959, the couple and their three children moved to Moraga, California. Bob immediately became involved in issues facing the new community, such as incorporation and the development of the Moraga School District.

He served on the board from 1961 to 1975 and was president of the board from 1968 to 1970. He is survived by his wife of 62 years, Pat, and three children. In lieu of flowers, the family requests donations to the UC Berkeley School of Public Health.

To make a gift in memory of Robert Amber, please make your check payable to the “School of Public Health Fund” and include a note that the gift is in memory of Robert Amber. Mail it to Pat Hosel, Office of External Relations, UC Berkeley School of Public Health, 417 University Hall #7360, Berkeley, CA, 94720-7360 or make your gift online at egiving.berkeley.edu/urelgift/ public_health.html.

Felice Kurtzman, R.D., M.P.H. ‘80, died November 3, 2007, at age 52 at her home in Sherman Oaks, California. Kurtzman spent a 25-year career at UCLA, beginning as the first dietitian with the Student Health Service. She went on to work with the Department of Biological Chemistry, where she was a lecturer for medical and dental school students. In 1995 she launched Nutrition Bytes, which published nutrition review papers that offered students an opportunity to survey and critically analyze nutrition research. She joined the sports medicine staff as the official nutritionist for the Athletic Department, a role that she particularly enjoyed. As chair for the Athletic Department committee, she helped guide health policy and research for UCLA athletes. She authored numerous publications about sports nutrition and disordered eating among collegiate athletes, and was a respected speaker at professional athletic and nutrition symposiums. She lived her passion for protecting the environment through travel and outdoor adventures.

She sought out new challenges and cultivated deep relationships with the people in her life.

Kurtzman was an inspiration to the thousands of UCLA students and athletes that she taught, counseled, and mentored.

She will be remembered for her enthusiasm, compassionate spirit, unflinching strength, and the ability to inspire others to explore their dreams and lay out a path to achieving their goals. She is survived by her husband, three sons, mother, a large extended family, and a multitude of friends.

Florence Stroud, M.N., M.P.H. ’66, died November 16, 2007, at her home in Oakland, California, at age 73. She was a leader in the Bay Area public health community who championed the needs of the poor and people of color.

Born in Oklahoma, Stroud graduated from Seattle Pacific University and earned her nursing degree at the University of Washington.

She later worked as a staff nurse for the Seattle-King County Department of Public Health. While working toward her nursing degree, she delivered obstetrical care in Nigerian villages through a World Health Organization program. She then enrolled at the UC Berkeley School of Public Health for her master’s degree in public health. While there, she met and married Welvin Stroud.

She taught nursing at UCSF from 1967 to 1976 and was appointed head nurse of pediatrics at the UCSF Medical Center.

After six years as health director for the city of Berkeley—the first African American to serve in that role—she was recruited in 1982 to the San Francisco Department of Public Health to become deputy director for Community Health Services, and she served twice as the department’s interim director. She authored critical guidelines for the prevention of prenatal transmission of HIV and the care of mothers, infants, and children infected with the AIDS virus.

Stroud was a cofounder of the Bay Area Nurses Association, the Bay Area Consortium for Quality Health Care, and the California Black Health Network. She was the first registered nurse appointed to the Medical Board of California and was former president of both the California Board Medical Quality Assurance and the Division of Licensing.

She is survived by her son and five granddaughters.

Public Health

53

Non-Profit Org US Postage PAID University of California

1-54837-14073-40-*CP5316-CPEXT

University of California, Berkeley School of Public Health 50 University Hall #7360 Berkeley, CA 94720-7360

The New Class at a Glance This fall, 195 graduate students entered the School of Public Health, representing a wide range of backgrounds and academic interests.

The new class comprises 134 women and 61 men, ranging in age from 20 to 57 years old. There are 146 students working on M.P.H. degrees (26 of whom are in concurrent or joint degree programs); 13 working towards an M.A. or M.S.; 8 students in the Dr.P.H. program; and 29 Ph.D. students.

The students hail from 19 states (Arizona, California, Colorado, Florida, Georgia, Hawaii, Illinois, Massachusetts, Maryland, Minnesota, New Jersey, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, Washington, and Wisconsin) plus the District of Columbia, and 17 countries (India, Iran, Ireland, Japan, Kenya, Korea, Mexico, Nigeria, Panama, Peru, Philippines, Taiwan, Thailand, Turkey, Uganda, United States, and Zimbabwe).

In addition, 50 undergraduates declared a major in public health, making a total of 175 undergraduate public health majors.

The School’s New Student Orientation finds a room full of fresh faces.