UCLA Fielding School of Public Health Magazine - Spring/Summer 2019

PUBLIC HEALTH SPRING/SUMMER 2019

The UCLA Fielding School of Public Health Magazine

O U R P L A N E T I S S I C K HOW WILL CLIMATE CHANGE AFFECT OUR HEALTH?

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ADDRESSING THE & IMMIGRATION POLICIES OPIOID EPIDEMIC AND ACCESS TO CARE

DEAN’S MESSAGE

THE LANDMARK REPORT BY THE U.N. INTERGOVERNMENTAL PANEL ON CLIMATE CHANGE released last October was unequivocal: We are already feeling the effects of a warming planet, and without rapid and far-reaching actions to reduce the carbon emissions that are altering our climate, the Earth’s future is fraught with peril.

Much of the early discussion on climate change centered on impacts such as melting glaciers that, while critically important, often felt disconnected from human health. We now have a much greater understanding that the threat we face to our natural environment directly affects our health and wellness. The U.S. Centers for Disease Control and Prevention has spelled out some of the likely consequences of climate change — increased respiratory and cardiovascular disease, more injuries and premature deaths related to extreme weather events, changes in the prevalence and geographic distribution of food- and water-borne illnesses and other infectious diseases, and threats to mental health. Some populations will see these effects more than others, but no country or community is immune.

It’s easy to feel powerless against planetary changes, but the reality is that public health can do a great deal to confront this crisis, both by contributing to the effort to slow global warming — commonly referred to as mitigation — and through strategies to limit the negative health effects of climate change (adaptation).

As this issue of our magazine illustrates, the Fielding School is home to some of the world’s most renowned researchers when it comes to addressing environmental concerns. Our faculty and alumni were instrumental in contributing to the knowledge and policies that dramatically improved air quality in the Los Angeles basin over the last several decades, and I am confident that our school will again play a key role as we address the public health challenges posed by climate change.

The challenges we face today as a local and global community can seem daunting, but we continue to confront them head on. In addition to climate change, the pages that follow feature our faculty’s ongoing work in addressing the health of immigrants (page 24) and the opioid crisis (page 26). At the Fielding School we remain deeply committed to finding and implementing solutions that will allow our present and future generations every opportunity to lead healthy lives.

Ron Brookmeyer, PhD Interim Dean

The UCLA Fielding School of Public Health Magazine

SPRING/SUMMER 2019

CONTENTS 08

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38

FEATURES

CLIMATE CHANGE AND HEALTH 04 Boiling Point Addressing public health issues raised by heat waves

14 Concerning Climate Researchers look to limit the health impact in Bangladesh

06 Feeling the Heat Rising temperatures hinder students and workers

16 Degrees of Influence Students’ studies promote health in a changing climate

08 Preparing for a Fiery Future Facing the prospect of more frequent, intense wildfires

18 Living Off the Changing Land FSPH alum explored climate impact on indigenous groups

12 Above and Beyond Moving to renewable energy would also clear the air

19 A Call to Action A mounting health threat demands new approaches

13 Rising Tides Ahead Higher sea levels pose a danger to community health

20 Q&A Michael Jerrett connects planetary, human wellness

IMMIGRATION POLICIES

24 Barriers to Health How lived experiences affect immigrants’ access to care

HIV AND SUBSTANCE USE

26 Addressing the Opioid Crisis Leading a national resource to fight the epidemic in groups affected by HIV/AIDS

TRAINING GLOBAL LEADERS

INTERIM DEAN PROFILE

28 Network of Admirers Roger Detels’ legacy includes preparing some of Asia’s key public health officials 30 Making Numbers Count Whether as a biostatistician or FSPH interim dean, Ron Brookmeyer is about impact

DEPARTMENTS 32 School Work 35 Faculty Honors & Service 36 Transformative Investments 38 Overcoming Our Greatest Public Health Challenge: Climate Change

by Dr. Jonathan Fielding

Visit us online: ph.ucla.edu

PHOTOGRAPHY & ILLUSTRATION Unsplash/Karl Fredrickson: cover. Jane Houle Photography: Dean’s Message; pp. 16-17, 20-21, 30; p. 32: LA marathon and LA Big 5K photos; p. 36. AP Photo/Steven Senne: TOC: photo for article on p. 4; pp. 4-5. Iuliia Savkina © 123RF: TOC: photo for article on p. 38; p. 38. Wally Skalij/Los Angeles Times. Used with permission: TOC: photo for article on p. 8; pp. 8-9.

Rent Control Creative: TOC: image for article on p. 26; p. 15: physical health icon and ecosystems icon; p. 26. Unsplash/Alexander Klarmann: p. 2. Fatkhul Karim © CC BY 3.0: p. 3: thermometer icon. Rain by Icons Bazaar from the Noun Project: p. 3: rain icon. Biohazard by Hea Poh Lin from the Noun Project: p. 3: biohazard icon. Antonio Diaz © 123RF: p. 7. Unsplash/ Marcus Kauffman: p. 10. Arissara Saechin © 123RF: p. 12. Rick Nye/USFWS: p. 13. Abir Abdullah/Asian Development Bank © CC BY-NC-ND 2.0: pp. 14-15. Becris: p. 15: battery icon.

Nowdampproof.co.uk: p. 15: water resources icon. Smart/icons © CC BY 3.0: p. 15: agriculture and food security icon. Margaret Molloy: p. 19. Chanut is Industries © CC BY 3.0: p. 23: meals icon. Pondokmultimedia.com: p. 23: map icon. Alex Timashenka: p. 23: house icon. iStockPhoto/Benny Winslow: p. 24. Alexandra Foley Photography: p. 33. Dave Kessler Design, Courtesy of Rutgers University Press: p. 34: Emily K. Abel book cover. Naomi Louie: p. 34: group photo. © Jones & Bartlett Learning, An Ascend Learning Company, LLC: Balgrosky, J. A. (2020).

Understanding Health Information Systems for the Health Professions: p. 34: Jean A. Balgrosky book cover. Annual Reviews: p. 34: Jonathan E. Fielding book covers. DeVita, Lawrence, Rosenberg: (2018) DeVita, Hellman, and Rosenberg’s Cancer: Principles & Practice of Oncology: p. 34: Karin B. Michels book cover. Behance/Andrei Lacatusu: p. 39. Sasin Tipchai © 123RF: back cover. COURTESY OF: R. Jisung Park: p. 6. Nelida Duran: p. 18. Roger Detels: pp. 28-29. Kaiser Foundation Health Plan, Inc. and Hospitals: p. 32.

CLIMATE CHANGE AND HEALTH Ron Brookmeyer, PhD Interim Dean MAGAZINE STAFF

UCLA Fielding School of Public Health Website: ph.ucla.edu

Carla Denly Executive Editor & Asst. Dean for Communications

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Jurriaan Linsen Visuals Coordinator

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Dan Gordon Editor & Writer

Mikkel Allison Writer & Contributing Editor

UCLA Public Health magazine is published by the UCLA Fielding School of Public Health for the alumni, faculty, students, staff and friends of the school. Copyright 2019 by The Regents of the University of California.

Permission to reprint any portion must be obtained from the school.

Please send requests to communications@ph.ucla.edu.

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CLIMATE CHANGE is already jeopardizing health and well-being in the U.S. and abroad, and is projected to become a greater public health threat in the decades to come.

The World Health Organization has outlined some of the key ways in which climate change affects health. As the examples in this issue demonstrate, Fielding School faculty, students and alumni are leading efforts to protect populations against this developing crisis.

EXTREME HEAT

• Extreme temperatures contribute to deaths from cardiovascular and respiratory disease, particularly among the elderly.

• Heat raises the levels of ozone and other pollutants in the air that exacerbate cardiovascular and respiratory disease.

• Higher levels of pollen and other allergens in the air, which are also associated with heat, can trigger asthma.

NATURAL DISASTERS AND VARIABLE RAINFALL PATTERNS

• The number of weather-related natural disasters has more than tripled worldwide since the 1960s.

These disasters result in more than 60,000 deaths per year, mainly in low-income countries.

• Floods, which are increasing in frequency and intensity, contaminate freshwater supplies, heighten the risk of water-borne diseases and create breeding grounds for disease carrying insects such as mosquitoes.

• Rising temperatures and variable precipitation are likely to decrease the production of staple foods in many of the world’s poorest regions — increasing the prevalence of malnutrition and undernutrition, which currently cause 3.1 million deaths per year.

• More than half of the world’s population lives within 60 kilometers [37.28 miles] of the sea. Rising sea levels and increases in extreme weather events will destroy homes, medical facilities and other essential services.

People may be forced to move, increasing the risk of a range of health effects, including poor mental health and communicable diseases.

• Increasingly variable rainfall patterns are likely to affect the supply of fresh water. A lack of safe water can compromise hygiene and increase the risk of diarrheal disease, which kills more than 500,000 children under the age of 5 each year. In extreme cases, water scarcity leads to drought and famine. By the late 21st century, climate change is likely to increase the frequency and intensity of droughts.

PATTERNS OF INFECTION

• Climatic conditions strongly affect water-borne diseases and diseases transmitted through insects.

• Changes in climate are likely to lengthen the transmission seasons of important vector-borne diseases, as well as altering their geographic range.

• Malaria, which currently kills more than 400,000 people per year, is transmitted by Anopheles mosquitoes and is strongly influenced by climate.

The Aedes mosquito vector of dengue is also highly sensitive to climate conditions, and studies suggest that climate change is likely to continue to increase exposure to dengue, which is currently associated with approximately 25,000 deaths a year.

Source: World Health Organization

EDITORIAL BOARD Haroutune K. Armenian, MD, DrPH Professor in Residence, Epidemiology; Thomas R. Belin, PhD Professor, Biostatistics; Pamina Gorbach, DrPH Professor, Epidemiology; Moira Inkelas, PhD Associate Professor, Health Policy and Management; Marjorie Kagawa-Singer, PhD, MN Professor Emerita, Community Health Sciences; Cathy Lang, PhD Director for Research Administration; Adjunct Assistant Professor, Community Health Sciences; Michael Prelip, DPA Professor and Chair, Community Health Sciences; Beate Ritz, PhD Professor, Epidemiology and Environmental Health Sciences; May C. Wang, DrPH Professor, Community Health Sciences; Elizabeth Yzquierdo, EdD Assistant Dean for Student Affairs; Adjunct Assistant Professor, Community Health Sciences; Zuo-Feng Zhang, MD, PhD Associate Dean for Research; Professor, Epidemiology; Yifang Zhu, PhD Associate Dean for Academic Programs; Professor, Environmental Health Sciences; Frederick Zimmerman, PhD Professor, Health Policy and Management; Mark Alsay and Ivan Barragan Co-Presidents, Public Health Student Association; Rita Burke, MPH ’03, PhD ’08 President, Public Health Alumni Association ph.ucla.edu

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Heat waves cause more deaths and hospitalizations in the U.S. than any other weather-related disaster. As temperatures rise, FSPH’s Dr. David Eisenman is among the experts studying solutions.

BOILING POINT

AS AN EXPERT IN DISASTER PREPAREDNESS AND RESPONSE whose work has increasingly focused on the weather events that are occurring with growing intensity and frequency as the climate changes, Dr. David Eisenman has observed that one type of natural disaster is often overlooked.

“Heat waves don’t make the news in the same way as hurricanes, earthquakes and floods, but heat is already the leading weather-related cause of death in the United States, and with climate change it will only grow as a concern,” says Eisenman (MS ’02), professor in residence in the Fielding School’s Department of Community Health Sciences and director of the FSPH-based Center for Public Health and Disasters.

“It’s also an equity issue, because the most vulnerable members of our society tend to be the ones who are at the greatest risk.”

In addition to his work as a practicing physician, Eisenman conducts research to better understand who is most vulnerable to heat illness and death, in part by examining health outcomes data in conjunction with historical weather data. Populations that are most susceptible include the elderly, young children, people with chronic diseases and individuals who are homeless or otherwise impoverished. In Los Angeles, as in many other cities in the U.S., more than half of households lack central air conditioning, and low-income families are the most likely to be forced to endure high temperatures with a wall unit at best, Eisenman says.

He and his colleagues (including Linda Delp and Kevin Riley of the Fielding School-based UCLA Labor Occupational Safety and Health Program) have described another population vulnerable to extreme heat, outdoor laborers — finding, for example, that every 1-percent increase in residents

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who work in construction within a community results in an 8-percent rise in heat-related hospitalizations and emergency department visits. “It’s clear that we need to be thinking about this problem both in the workplace and in the community,” Eisenman says. “We also have to keep in mind that many of these workers come home to neighborhoods with little shade and no air conditioning, so they aren’t able to cool off.”

For people without access to air conditioning at home or work, the U.S. Centers for Disease Control and Prevention recommends cooled public facilities such as shopping malls and libraries during heat waves. Eisenman’s group, including Stephanie Pincetl of the UCLA Institute of the Environment and Sustainability, has found that in extreme temperatures, heat-related deaths are lower in neighborhoods with more publicly accessible cooled spaces. Many cities have also established cooling centers as refuges, but Eisenman notes that these tend to be inaccessible to the peo-

ple who need them most. “They’re often not placed in the neighborhoods where we see the most harm from heat waves,” he says. Moreover, Eisenman has found that even when cooling centers are conveniently located, they are underutilized: “People prefer to go somewhere cool where there is an activity they want to be doing, such as going to the mall, rather than just going to a community center to cool off.”

Low-income communities often experience what’s known as the urban

“Heat is already the leading weatherrelated cause of death in the United States, and with climate change it will only grow as a concern.”

— Dr. David Eisenman

heat island effect, where the high concentrations of pavement and other surfaces that retain heat, along with minimal tree canopy to provide shade, lead to hotter temperatures during the day and less cooling off at night. “We have increasing evidence that if you put more green space into a community, and it’s well maintained, the temperatures go down both outside and in people’s homes, where they spend most of their time,” Eisenman says. He has begun collaborating with the Los Angeles-based nonprofit organization TreePeople to study the impact of increasing tree canopy and albedo (reflective surfaces that absorb less heat) as a strategy to reduce heat illness and mortality.

To help public health planners and policymakers know where to focus their efforts, Eisenman is mapping heathealth outcomes in Los Angeles County, using 10 years of data on heat-related emergency department visits, hospitalizations and deaths. The work has challenged traditional assumptions. “In Los

Angeles, the map of social vulnerability doesn’t neatly overlap with the map of actual heat-health outcomes,” Eisenman says. “At the county level we can predict who is at risk, but Los Angeles has so many different climates that we can’t just look at maps of social vulnerability to plan our programs.”

As a potential long-term solution, Eisenman is working with engineers from Arizona State University on a way to measure individual-level heat exposure over the course of a day. The project, funded by the National Science Foundation, involves developing sophisticated mathematical models in an effort to understand the threshold for heat absorption beyond which an individual is at risk for negative health outcomes.

“The idea is that valid individual-level estimates would be much more predictive of heat vulnerability than community-level measures,” Eisenman explains.

“And once we have that understanding, we might also be able to model how changes in the community and in daily activities could reduce an individual’s absorption of heat.”

In many ways, public health research on heat illness and deaths is in its infancy. “In the past we would rely on gross indicators for weather, even though in Los Angeles the temperatures are going to be very different depending on whether you’re by the ocean, in Downtown Los Angeles or in the high mountains,” Eisenman notes. “In addition, heat-related illness and deaths are undercounted — when people are hospitalized or die from heat-related causes, that’s not necessarily what’s written on their chart or on their death certificate.

And we need to develop better predictors of vulnerability. These are all important limitations that we must overcome as researchers — and as climate change brings more extreme heat, this work will continue to take on greater urgency.” ph.ucla.edu

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FEELING THE

FSPH’s Jisung Park has found that rising temperatures interfere with the ability of students to learn and the productivity of workers.

JISUNG PARK

BACK WHEN HE WAS A GRADUATE STUDENT, Jisung Park concluded that the insufficient urgency in addressing climate change was due in part to the way the issue was depicted. “ It seemed to me that the human element was missing,” says Park, now a Fielding School assistant professor of environmental health sciences. “For better or worse, we tend to understand the world in terms of stories, and most of the stories about climate change 6

have revolved around non-human aspects, which can make it harder to grasp. Of course, there are limitations to anecdote-based policymaking, so I wanted to get as rigorous a training as possible to determine whether the human stories were actually borne out in the data.”

A s he delved further into the data, Park, who earned a master’s degree in environmental change and management from Oxford and a PhD in economics from Harvard, became convinced that there might be a compelling story to tell in how the warming climate affects students and workers with no choice but to learn and labor, respectively, in the sweltering heat.

In research he started as a Harvard doctoral student and has continued as a faculty member at the Fielding School,

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Park has documented the implications of rising global temperatures on the learning and test performances of students — a problem that disproportionately affects lower-income and minority youths, whose classrooms are the least likely to be air-conditioned.

Park studied the effect of hot outdoor temperatures on the scores of 4.6 million New York City public students on a standardized test required to graduate from high school, and found that those who took the test on a hot day fared substantially worse — for example, students taking the exam on a 90-degree day had an 11 percent greater chance of failing than those taking it in more comfortable 72-degree weather. He followed that up with a study showing the cumulative effects of heat exposure during the

school year for 28,000 schools across the country. Park found that in school years with higher numbers of hot days, students performed significantly worse on standardized exams, suggesting that the heat impeded their learning.

Park and his colleagues have found that the negative effects of heat on learning and test taking appear to be offset in classrooms equipped with air conditioning. But, Park notes, low-income and minority students are the most likely to experience classrooms without adequate cooling. “We have found that a portion of the racial achievement gaps that have been reported in education are

found that in the United States, worker take-home pay is reduced by as much as 5-10 percent in some sectors in years that are especially hot — with 10 more above-90-degree days than average.

The effect is most pronounced among outdoor workers, including those in construction, agriculture, manufacturing, transportation and utilities. In separate research in which he examined GDP growth across countries over the last six decades, Park found that hotter-than-average years reduce GDP growth, with the strongest effects in the poorest and hottest nations.

More than 15 million U.S. workers

Park found that in school years with higher numbers of hot days, students performed significantly worse on standardized exams. driven by the combined influence of a hotter climate and worse school infrastructure,” Park says. This equity issue also has international dimensions: “In countries with both high temperatures and high levels of poverty, such as India and Bangladesh, the effects of heat on cognitive development are likely to be more profound.”

Beyond investments in air conditioning, other strategies will need to be considered to promote cooler learning environments amid increasing temperatures, Park says. This could include administering important standardized tests during cooler times of the year or moving them to climate controlled rooms, as well as architectural approaches designed to reduce the effects of the hot weather on the school environment. “Like it or not, no matter what we do today, we’ve baked a lot of warming into our climate over at least the next couple of decades,” Park notes.

“We certainly should redouble our efforts to reduce greenhouse gas emissions, but we also need to understand and direct our efforts toward the groups in our society that are least likely to have the means to adapt effectively.”

The warming climate is also exerting an economic toll. Park has

have jobs that require them to be outdoors, according to the Bureau of Labor Statistics. Park notes that just as there are economically driven disparities in the student populations affected by heat, workers in lower-income sectors are likely most vulnerable to the con-

sequences of rising outdoor temperatures. “We need to pay close attention to which types of workers are the most likely to be exposed and how we can help them adapt,” Park says. “You can’t air-condition outdoor worksites, but you could have people work different hours of the day, provide shade, and have heat-illness prevention protocols.”

California has been a leader in establishing outdoor-worker heat illness prevention standards, Park says. He and his colleagues are currently assessing the impact of those standards in reducing worker heat illness and injury risk, along with the lessons that can be drawn as other states begin to grapple with the reality of climate change related heat concerns.

Engaging in the work has only sharpened Park’s focus and determination.

“Every time I go through an airport now and look out to see people working on the tarmac, I think to myself, how do you stay safe on a 95-degree day lifting heavy luggage on a pitch-black asphalt surface?” he says. “That’s become a big motivator for me. We can probably do more to protect vulnerable populations from these effects, and I hope that my work can help shed light on their climate reality.”

ph.ucla.edu

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RESIDENTS OF THE SOUTHERN CALIFORNIA COMMUNITY OF LA CONCHITA WATCH THE APPROACHING THOMAS FIRE IN DECEMBER 2017.

THE FIRE BURNED MORE THAN 280,000 ACRES IN VENTURA AND SANTA BARBARA COUNTIES, MAKING IT THE LARGEST WILDFIRE IN THE STATE’S HISTORY UNTIL IT WAS SURPASSED BY THE MENDOCINO COMPLEX FIRE JUST SEVEN MONTHS LATER.

Preparing for a Fiery Future

With wildfires expected to increase in frequency and intensity in California and elsewhere in the U.S., FSPH faculty address emerging public health concerns.

THE CAMP FIRE that started on November 8, 2018 in Northern California’s Butte County burned through more than 150,000 acres and destroyed more than 18,000 structures over 17 days. Eighty-five lives were lost, making it the deadliest and most destructive fire in California history. The Woolsey Fire, which started the same day, blazed through nearly 100,000 acres in Los Angeles and Ventura counties, destroying more than 1,600 structures and forcing the evacuation of nearly 300,000 people.

The twin wildfire disasters were preceded in July 2018 by the Mendocino Complex Fire, the largest in the state’s history, which covered nearly 460,000 acres across four counties in Northern California. Before that, the largest was the Thomas Fire, which

burned more than 280,000 acres in Ventura and Santa Barbara counties, in December 2017.

California’s wildfire season is starting earlier and ending later, and as the run of recent record setters suggests, the fires have increased in severity in recent years. There are reasons to suspect that climate change is an important factor. Most of the state’s hottest and driest years have occurred since 2000, and the longer spells without precipitation give vegetation more time to dry out and become more combustible. “Some areas of California are projecting a 200-300 percent increased risk by 2030 in wildfire events,” notes Michael Jerrett, professor and chair of the Fielding School’s Department of Environmental Health Sciences.

The public health threat from these

CLIMATE CHANGE AND HEALTH

fires is exacerbated by the considerable amount of real estate development that has occurred in recent years in traditionally fire-prone areas. A 2018 study found a 41 percent increase between 1990 and 2010 in the number of new homes built at the wildland-urban interface — described as where houses and wildland vegetation intermingle, and where wildfire problems are most pronounced.

Beyond the threat to lives and property, these increasingly occurring disasters raise a number of public health concerns that Fielding School faculty are working to address.

Studying the health impacts of exposure to wildfire smoke is challenging given that the smoke levels are constantly shifting, which makes it difficult to determine where and at what levels residents are being exposed. In an effort to tackle the issue, Jerrett is part of a research group that has developed a machine-learning model incorporating satellite imagery, atmospheric chemistry models, ground-based information on pollution levels, and other factors known to influence pollution, such as traffic and land use, to predict with high levels of confidence the location of the smoke plume on a given day. In linking that information to data on hospital visits and admissions, Jerrett and his colleagues have found significant effects on respiratory disease during the wildfire period in the areas that experience steep elevations of fine particular matter — the small particles that can penetrate deep into the lungs.

Beyond the immediate health effects, Jerrett points to the need to better measure the ongoing chronic health impacts of wildfires that are occurring on a regular basis in or near major population areas. “During these fires in California, we see pollution levels that are more like Beijing, China, or New Delhi, India,” he says. “And as the fires are becoming both larger and more frequent, we’re interested in what it means to go through two or three of these events, where people are getting doused with Beijing levels of pollution for a month or so at a time.”

Much of the ash and particulate matter deposited in homes as a result of wildfires has the potential to transform into toxic gases that can affect health, Jerrett adds. “Our concern is that if people return to their homes without having them professionally cleaned by an industrial hygienist, they could unknowingly expose themselves to unhealthy indoor air for months at a time.”

Jerrett is also working with Sudipto Banerjee, professor and chair of the Fielding School’s Department of Biostatistics, along with doctoral students Jonah Lipsitt and Gregory Watson (MS ’11), to develop so-called counterfactual models that would help to guide policies and strategic decisions during the fires. The FSPH researchers hope to shed light on issues such as the health impact of investing additional resources in reducing pollution levels during the wildfire, the optimal time to call for evacuations, and the public health consequences of residents ignoring those calls.

Dr. David Eisenman (MS ’02), professor in residence in the Fielding School’s Department of Community Health Sciences and director of the FSPH-based Center for Public 10

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Health and Disasters, is a practicing physician who has studied the public health impacts of wildfires and other disasters in an effort to inform strategies that enhance the preparedness for and response to these events. The distress that occurs in the wake of a wildfire — being displaced from one’s community and losing social supports, along with the associated psychological trauma — often endures long after the flames have been extinguished, Eisenman notes. He points out that although media coverage often shows fires affecting wealthy areas, the reality is that many communities in areas susceptible to wildfires consist of significant numbers of low-income workers and older adults on fixed incomes. “Often people will say we shouldn’t rebuild, that these are dangerous places, but to these residents this is their community and might be the only place they can afford to live,” Eisenman says.

Eisenman has learned that there can be significant longterm mental health effects from wildfires, even for people who experience no noticeable physical effects or property damage. When he was in Arizona immediately following the 2011 Wallow Fire, the largest in that state’s history, Eisen-

courage in getting on the roof to put out embers,” Eisenman says. “From the public health perspective, if this is going to become more of a phenomenon we should better understand the risks for everyone involved.”

The mental health effects of surviving a wildfire or other natural disaster tend to endure long after the television cameras have left. Vickie Mays, a professor in the Fielding School’s Department of Health Policy and Management, spent five years as part of a response and resiliency team that helped to rebuild the mental health infrastructure after Hurricane Katrina devastated New Orleans. “Being there several times a year over the course of several years provided a perspective on some of the scars that are left from these types of events,” Mays says.

She notes that in the weeks following a disaster, much of the focus is appropriately on tending to people’s short-term needs through counseling and social services, but long-term mental health consequences are too often overlooked. In many cases, Mays says, these relate to actions residents take during and immediately after the event. “It’s heartbreaking to see people haunted over decisions about whether to evac-

“During these fires in California, we see pollution levels that are more like Beijing, China, or New Delhi, India.”

— Michael Jerrett

man was struck by the strong attachment residents of the affected communities felt to the surrounding area that had been burned. “Everywhere we went, people said essentially the same thing — ‘I am mourning for the loss of the forest,’” Eisenman recalls. “What they meant was that they had moved to this beautiful U.S. Forest Service land to be part of nature, and it felt like they had lost something very deep and close to them.”

In the aftermath of the Wallow Fire, Eisenman and his colleagues found that “solastalgia” — a term referring to the loss of the solace people derive from their environment when it is damaged — was a strong predictor of poor mental health.

“This is important to recognize because in the case of wildfires, it can take a long time for the land to return to that level of function and beauty that brings the solace back to people,” he says. “And as climate change causes more and more longterm alterations to the environment, we might see solastalgia in other forms.”

Eisenman notes that during the Woolsey Fire, many residents chose to stay and defend their homes despite the urgings of public officials and firefighters that they evacuate.

“These are people who might not have had any firefighter training or done anything to make their properties less flammable, but for the most part they are being applauded for their

uate, particularly if it ends up going awry and affects other members of their family,” Mays says. After the disaster, she notes, survivors are often forced to quickly reach decisions about rebuilding, and many end up making commitments they later regret.

The level of cohesiveness within a community is a key factor in the post-disaster healing process, Mays adds. “When people’s lives are upended, the extent to which they are able to cope, make good decisions and return to normalcy has a lot to do with how well the neighborhood pulls together and supports each other,” she says. Support is needed not just for homeowners and renters, but also for others who are integral to the community but tend to be forgotten, including members of the informal economy such as gardeners and housecleaners, Mays adds.

Given all of these realities, Mays believes public health efforts should emphasize planning to assist people in making informed judgments during and after a disaster, and to ensure that neighborhoods build the social infrastructure that will facilitate a successful recovery process.

“Offering counseling right after a disaster is certainly important,” Mays says. “But from a public health perspective we can do more by preparing communities in ways that limit the damage and enhance the recovery from these events.” ph.ucla.edu

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Above And Beyond L.A. County’s move toward renewable energy, critical to slowing climate change, would bring an added benefit — cleaner air. FSPH researchers are calculating the potential public health gains.

UCLA’S SUSTAINABLE LA GRAND CHALLENGE aims to lead Los Angeles County into a future in which it obtains all of its energy from renewable resources by 2050 — a transition viewed as essential to the effort to slow the effects of climate change. And if any more incentive to fulfill the ambitious target is needed, a Fielding School-led study underway as part of the Grand Challenge will lay out the significant public health gains that are expected to result from replacing conventional fossil fuels with renewable energy.

Yifang Zhu (PhD ’03), FSPH professor of environmental health sciences and the study’s principal investigator, explains that the shift toward complete reliance on renewable energy — the county was at 22 percent renewable energy usage as of 2015 — is likely to bring an important co-benefit: improved regional air quality. “The sources contributing to the greenhouse gases that drive climate change are the same sources that are contributing to air pollution,” explains Zhu, who also serves as the Fielding School’s associate dean for academic programs. “Additionally, hotter temperatures create conditions that enhance ozone formation, an important pollutant for L.A. smog. For both of these reasons, we expect to find that the process of reducing carbon dioxide emissions in the transition to renewable energy will result in cleaner air.”

At the population level, cleaner air means better health.

A substantial body of research has documented the public health impact of air pollution — it is linked to increased risk of respiratory and cardiovascular diseases, neurological problems, certain cancers, and adverse pregnancy outcomes, and contributes to an estimated 8.9 million premature deaths worldwide each year, Zhu notes. Although air quality in Los Angeles has significantly improved over the last several decades thanks to environmental strategies to reduce harmful emissions, Zhu points out that much of L.A. County remains out of compliance with the National Ambient Air Quality Standards for fine particles and ozone, which are associated with the adverse public health impacts.

For their Grand Challenge study, Zhu and her colleagues — including Michael Jerrett, professor and chair of FSPH’s Department of Environmental Health Sciences, as well as researchers from UCLA’s Department of Atmospheric and Oceanic Sciences and the Jet Propulsion Laboratory — will 12

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employ state-of-the-art atmospheric chemistry models to estimate future emission trends under different renewable energy scenarios. They will then calculate how those emission reductions would translate into improved regional air quality, and the public health benefits that would result from such improvements.

“Our study will show the extent to which going to renewable energy can not only reduce the impact of climate change, but also have positive health effects by improving air quality,” Zhu says. “The methods we are developing and the knowledge we gain can also help us to address these same questions in other parts of the world that have significant emissions and air pollution concerns, such as China.”

“Conventional cost-benefit policy analyses value future benefits at a discounted rate,” Jerrett notes. “But if our study demonstrates that efforts to mitigate climate change will also save lives in the short term, the policy incentive becomes more compelling.”

CLIMATE CHANGE AND HEALTH

RISING TIDES AHEAD

Higher sea levels pose a long-term threat to coastal wetlands and the populations of their adjacent communities. FSPH’s Richard Ambrose is studying potential responses.

BEYOND THEIR NATURAL BEAUTY, the wetlands along the Pacific and other coastal regions serve valuable purposes for animals and humans alike. Ecologically, they provide a natural habitat for wildlife, including many endangered species and commercial fish. Less appreciated is their public health and environmental protection role — from filtering our water to buffering coastal communities against the effects of storm surges and flooding.

But climate change poses an existential threat to these tidal ecosystems. As the planet warms, the melting ice sheets and glaciers in Greenland and Antarctica, along with thermal expansion caused by the warming of the oceans, will raise the sea level to alarming heights, says Richard Ambrose, FSPH professor of environmental health sciences. The increases are expected to be modest through the middle of this century, then accelerate — rising by as much as a meter, and possibly more, by the year 2100. “That’s much more than we’ve seen so far, and it’s going to put a lot of communities at risk for flooding and destruction of infrastructure, as well as making some places uninhabitable,” Ambrose says. Already, lower-lying coastal areas in Florida and along the Gulf Coast are feeling the effects, as are parts of California during very high tides.

As part of his effort to assess the implications of climate change on coastal ecosystems, Ambrose recently co-authored a study evaluating the effects of sea-level rise on tidal wetlands along the Pacific coast. Even when applying conservative scenarios, Ambrose and his colleagues concluded that by the end of the century, the majority of marsh habitats would be submerged, resulting in an extensive loss of habitat.

Ambrose is currently evaluating a potential method for reducing these impacts. His research team added 10 inches of sediment over nearly 8 acres of salt marsh in the Seal Beach, CA, National Wildlife Refuge, and will monitor the results over a five-year period. “The idea is that adding that height will help the marsh adjust its elevation to keep up with the sea-level rise,” Ambrose explains.

Stormwater management systems help to reduce runoff and improve water quality through a process in which the stormwater is absorbed by soils and plants and treated.

In separate research, Ambrose is studying their ability to offer a co-benefit — moderating the temperature in urban environments. “These systems are being built all over Los Angeles to deal with water quality, but the ones I’m studying also serve as a type of green space,” Ambrose says. “We want to see if this can reduce the heat coming into urban areas, which could help to reduce the health effects from rising temperatures.”

When Ambrose started studying the impact of climate change on California’s coastal communities, it was difficult to convince city managers and other public officials to think about a problem whose major effects were decades away.

Today, when he gives talks he is inundated with questions.

“The science that’s been done in the last 10 years is really compelling,” Ambrose says. “As a result, there is now considerable interest in finding ways to address these problems.”

AMBROSE’S TEAM APPLIED SEDIMENT TO THE MARSH SURFACE IN SEAL BEACH, CA, TO REDUCE THE IMPACT OF SEA-LEVEL RISE.

CLIMATE CHANGE AND HEALTH

CONCERNING CLIMATE Few nations are as vulnerable to the health effects of climate change as Bangladesh, where a research institute headed by FSPH’s Dr. John Clemens is helping to define the challenges and develop solutions.

HIGHER TEMPERATURES, extreme weather events, sea-level rise and more frequent outbreaks of vectorand water-borne infectious diseases are among the effects of climate change that threaten the health of populations in many parts of the world.

Few countries are as vulnerable to these effects as Bangladesh, where Dr. John Clemens, Fielding School epidemiology professor, serves as executive director of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), one of the world’s leading global health research institutes.

“Bangladesh is among the most climate-vulnerable countries in the world,” Clemens says. “The combination of high and increasing population density, geography, poverty and weak infrastructure make Bangladesh especially vulnerable to the adverse impacts of climate change.”

The icddr,b team on addressing climate change, led by senior scientists Dr. Quamrun Nahar and Dr. Peter Kim Streatfield, is grappling with wide-ranging concerns. In Bangladesh, the mean temperature increase per year between 1970 and 2010 was significantly greater than the global average, with an accompanying decrease in the number of cool nights and an increase in the number of warm nights during the country’s hot and cool seasons. In analyzing five decades of mortality data from Matlab, icddr,b’s major rural field site in Bangladesh, in conjunction with daily weather data, icddr,b researchers are learning about the health impacts of high temperatures and the physiological adaptation to exposure to heat waves.

Sea-level rise is also accelerating 14

at a much faster rate in Bangladesh — two to five times the global average, Clemens notes. This is a particular problem given that Bangladesh sits in a low-lying region at the intersections of the Ganges, Meghna and Brahmaputra rivers in the Ganges-Brahmaputra delta, and its southern coast lies on the Bay of Bengal, making it susceptible to increased flooding related to storm surge and sea-level rise. In the Global Climate Risk Index for 2019, the annual report issued by the Berlin-based environmental organization Germanwatch, Bangladesh ranked seventh among the nations most affected by extreme weather events over the last 20 years; a tropical cyclone hits the country once every three years on average.

Beyond these risks, the sea-level rise is having a major impact through saltwater intrusion in the drinking water aquifer — affecting approximately 20 million people living along the coast. Clemens’ group has begun exploring the links between the highly saline drinking water and the risk of hypertension among populations living in coastal areas of Bangladesh. The rising salt level in the coastal soil is also damaging agriculture, which is driving more people from the coastal areas to the already dense urban centers.

Climate change is increasing the risk of vector-borne diseases — infectious diseases that are transmitted between humans or from animals to humans by insects, most commonly mosquitoes — in many parts of the world, including Bangladesh. Dhaka, the country’s capital and home of icddr,b, has seen a significant emer-

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gence of dengue in recent years, and 2017 saw the first major outbreak of chikungunya, another mosquito-borne infection. “Studies done in Bangladesh showed that transmission of malaria and dengue is associated with variability in temperature, rainfall, and humidity,” Clemens says. His group is investigating the influence of climatic factors on dengue in Dhaka, and has long-running surveillance systems monitoring malaria and kala azar in specific regions of Bangladesh to determine how weather variables contribute to outbreaks of these diseases.

The icddr,b team has carried out detailed studies for decades on the environmental correlates of the waterborne infectious disease cholera, which have produced evidence that cholera outbreaks in Bangladesh are associated with increases in sea-surface temperatures, another effect of climate change. This appears to be a consequence of the fact that higher sea-surface temperatures result in a greater concentration of phytoplank-

ton, which is associated with cholera outbreaks, Clemens explains.

A variety of adaptation activities — efforts to prevent or reduce the harmful effects from climate change — are being supported by icddr,b.

The organization has plans to work with the country’s Ministry of Health and Family Welfare to develop more effective responses to heat waves, including training hospital staff in the recognition and management of heat stress and/or heat stroke symptoms, and working with parents and other caregivers of newborns, who are at high risk for dehydration during heat waves. “Agricultural and other outdoor workers will also need specific interventions to reduce exposure to high midday temperatures,” Clemens notes.

His group is set to work with partners on approaches to desalinating drinking water in coastal and adjacent areas, and has plans to support efforts to improve the reporting of outbreaks of major vector- and water-borne diseases. The icddr,b group has also

forged a partnership with researchers at the University of Hawaii to work toward more accurately forecasting changes in monsoon rainfall patterns, floods and droughts as a way of better preparing residents of coastal and low-lying areas for the consequences of extreme weather events.

“The substantial investment thus far in climate change in Bangladesh has been, understandably, directed through the environmental organizations that tend to focus on disaster response and management — construction of embankments and cyclone shelters, for example — as there is great experience in these areas,” Clemens says. “But there is a need to channel the funds more broadly into areas that include building more comprehensive disease surveillance systems to provide vector-borne and water-borne disease outbreak data in real time, as well as efforts focused on community adaptation and the redesigning of health systems to be more responsive to the coming threats.”

BANGLADESH’S KEY CLIMATE IMPACT SECTORS AND VULNERABILITIES INCLUDE:

PHYSICAL HEALTH • Increased heat stress • Higher prevalence of infectious diseases • Injury and death from cyclones and floods

WATER RESOURCES • Decreased potable water supplies • Changes to river flows • Decreased irrigation water

AGRICULTURE AND FOOD SECURITY • Reduced crop yields • Fishery and livestock losses • Increased food insecurity

ECOSYSTEMS • Biodiversity loss • Loss of livelihoods • Reduced natural flood protection

ENERGY • Increased demand for energy • Damaged energy infrastructure • Decreased hydropower capability

Source: U.S. Agency for International Development, 2018: “Climate Risk Profile: Bangladesh.”

CLIMATE CHANGE AND HEALTH

Degrees of Influence These FSPH doctoral students are using research to better understand how they can promote health in the face of climate change.

Jonah Lipsitt FEW STRATEGIES ARE AS IMPORTANT to a long, healthy life as physical activity: It’s associated with a lower risk for heart disease, stroke, Type 2 diabetes, depression, some cancers and obesity, according to the U.S. Centers for Disease Control and Prevention.

Efforts to steer urban populations away from their sedentary ways have focused, among other things, on building pedestrian- and bikefriendly environments. But as the climate warms and uncomfortably high temperatures become more commonplace, how will that affect the ability of such initiatives to succeed?

Jonah Lipsitt, a PhD student in FSPH’s Department of Environmental Health Sciences, has studied the public health and environmental benefits of active transportation, and is now using geographic information systems as a tool to examine differences in the effect of heat on rates of physical activity across different parts of Los Angeles, and the extent to which access to green space helps to reduce the negative impacts. “As climate change makes extreme heat more prevalent, and our population remains largely physically inactive, this research could help inform how we respond, adapt to, and mitigate these impacts,” Lipsitt says.

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Christina Batteate THE TRANSPORTATION SECTOR is one of the largest contributors to carbon emissions worldwide, which makes promoting more active forms of transportation a key part of the effort to reduce the greenhouse gases that are driving climate change. Christina Batteate (MPH ’12), a PhD student in the Fielding School’s Department of Environmental Health Sciences, studies ways to promote

Gregory Watson

active modes of travel such as walking and biking. “In addition to being emission-free

WITH CLIMATE CHANGE contributing to a hotter and drier California,

ways to get around, walking and biking stim-

the record-setting wildfires that devastated parts of the state last year

ulate physical activity, boost social interaction

might be a harbinger, raising the likelihood that a growing number of

and improve mental health,” she notes.

people could be affected by wildfire smoke in the years ahead. Under-

Batteate has been interested in quantify-

standing the dangers of wildfire smoke and who is at greatest risk are

ing the amount of physical activity garnered

difficult scientific problems, notes Gregory Watson (MS ’11), a PhD stu-

from active travel in Los Angeles and

dent in FSPH’s Department of Biostatistics. “The population at risk can

assessing the safety and quality of the routes

be immense, and many factors influence health,” he explains. “Sophis-

where it takes place. She is part of a team

ticated statistical and machine-learning tools can help, but most were

currently analyzing travel data on more than

developed for use on less complicated data, and naively applying them

450 UCLA commuters, with a particular focus

to public health wildfire data can be misleading.”

on the impact of the rollout of Bruin Bike

Watson is part of an FSPH group that is developing, comparing

Share — part of an integrated network of 830

and applying state-of-the-art statistical and machine-learning mod-

GPS-connected bikes stretching from Venice

els to the analysis of public health wildfire data. The team is devel-

Beach to Hollywood — as well as e-scooters

oping rigorous statistical procedures for evaluating the performance

across campus. “Demonstrating the power

of these models on complicated data — such as that on wildfires and

of sustainable transport to improve not only

public health — as well as new models tailored to the complexities

planetary health, but also individual health, is

of this type of data. “These advancements will enable us and other

critical in changing attitudes, infrastructure

public health researchers to better understand and combat the dan-

and policies,” Batteate says.

gers of wildfire smoke,” Watson says. ph.ucla.edu

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CLIMATE CHANGE AND HEALTH

Living Off the Changing Land FSPH alum Nelida Duran explored the Arctic Region to discover how indigenous communities are adapting to climate change, and how globalization is encroaching on traditional ways of life.

AS A DOCTORAL STUDENT in the Fielding School’s Department of Community Health Sciences, Nelida Duran (PhD ’15) spent months at a time living with the Yellowknives Dene First Nation in the Northwest Territories of Canada. There, in a remote region bordering the Arctic, indigenous populations such as the Yellowknives rely on a traditional food system — hunting and harvesting animals and plants native to the land — as well as commercially available foods for their health, security and well-being.

“Indigenous peoples residing in the Arctic Region are experiencing major economic and cultural impacts, and are particularly vulnerable to climate change,” notes Duran, a registered dietitian who is now an assistant professor of family and consumer sciences at California State University, Northridge. “This is due to the influence of the Arctic’s natural resources on their economic and nutritional status, sociocultural identity, and spiritual and physical health.”

Traditional food systems and sources have already been disrupted in the region, creating volatility in daily nutrition intake and leading to less-secure livelihoods, particularly for communities DURAN (CENTER) AT A YELLOWKNIVES-SUPPORTED YOUTH TRADITIONAL SKILLS TRAINING AND MENTORSHIP PROGRAM.

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that still depend on the land for sustenance, Duran A YELLOWKNIVES DENE FIRST NATION ELDER HARVESTS FISH TO SUPPORT BOTH explains. In order HIS HOUSEHOLD AND OTHER COMMUNITY MEMBERS IN NEED. to better understand their lived experiences with climate change and its effect on nutrition and health, Duran, under the direction of her faculty adviser, Dr. Charlotte Neumann, — Nelida Duran collected data and conducted intertakes into account not only the loss of views with 14 Yellowknives who harvest biodiversity and impaired functioning and use traditional foods, such as caribou of the ecosystem, but also rapid lifestyle meat and stews, fresh fish and bannock. and cultural shifts — on population There was uniform agreement among health in the region. Duran’s in-depth participants that climate change is interviews with community memoccurring, Duran says. All have observed bers brought to light the tension many changes in the land, water, fish, wildlife experience in trying to maintain their and plants, which have contributed to cultural identities and traditional ways greater costs in both time and money to of life in an ever-changing environment. harvest traditional foods.

And as climate change increasingly Duran found that warmer climates affects global food systems — for examhave brought new species into the Arcple, through the higher costs of whole tic Region, introduced more predators foods, fruits and vegetables available and insects, and led to a decline in in grocery stores — many in the Yelcaribou, the traditional hunting source lowknives community find themselves for much of the population. The appearcaught between two clashing worlds, ance of acid rain has also diminished both of them associated with mounting plant populations that caribou eat, and expenses and diminishing returns. has fueled worries of contaminated Duran believes her research profood. A diamond rush and booming vides an important perspective for mining industry have contributed to health promoters and policymakers in scarcer hunting grounds, the degrathe region. “Ultimately,” she says, “a dation of local lands and waters, and wider body of knowledge about Arctic concerns over growing urbanization indigenous peoples’ food and nutrition and economic development. systems contributes to policy and action In her research, Duran focuses on the to strengthen ecosystem sustainability, impact of global environmental change nutrition and health for the Yellow— which includes climate change and knives community and beyond.”

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“Indigenous peoples residing in the Arctic Region are experiencing major economic and cultural impacts, and are particularly vulnerable to climate change.”

CLIMATE CHANGE AND HEALTH

A CALL TO ACTION Fielding School faculty member Dr. Richard Jackson, who has held state and national public health leadership positions, says climate change demands new approaches.

THE MOUNTING HEALTH THREATS POSED BY CLIMATE CHANGE, both current and anticipated, are challenging public health professionals to constantly reassess their level of preparedness and, where appropriate, take bold actions, says Dr. Richard Jackson, professor emeritus of environmental health sciences at the Fielding School.

Jackson, who has served in both national and statewide public health leadership positions — as director of the U.S. Centers for Disease Control and Prevention’s National Center for Environmental Health and state public health officer of the California Department of Health Services — argues that the public health community has vital roles to play not only in readying itself for the prospect of more frequent and severe natural disasters, heat, and other climate-related concerns, but also in proactive efforts to prevent or reduce climate-related health effects by working with policymakers and leaders in other sectors.

In California, the deadliest and most destructive wildfire season in the state’s recorded history last year served as a reminder that climate change raises the stakes on multifaceted disaster planning efforts. “The wildfires had an impact well beyond the people in their direct path — including the loss of power, the need to evacuate hospitals, and the fact that much of the population couldn’t go outside for days because of the health hazards,” Jackson says. Disasters tend to fray even the best-prepared public health response systems and require outside support, Jackson says, underscoring the importance of advance coordination and emergency drills.

Local public health agencies are also increasingly developing heat emergency plans and warning systems, Jackson notes. Among the goals: ensuring that isolated and vulnerable populations, including the elderly and homeless, have access to air-conditioned spaces.

While cooling centers represent a short-term solution, Jackson believes more focus is needed on developing green spaces and — Dr. Richard Jackson tree canopies, which can both reduce carbon dioxide emissions and cool the local climate.

Any long-term strategy, he says, must also include building redesign that promotes energy efficiency and healthful indoor environments.

All public health professionals will need to be well versed in the impact of climate change on health and how those threats apply locally, Jackson says, adding that an informed public health workforce can encourage residents to leave cars at home and walk to work or to public transit — strategies that are healthy for individuals as well as for the climate.

“A decade ago there was very little activism on the part of the public health community around climate, but we’ve seen a dramatic shift,” Jackson says. “The science has become profoundly more robust, and as a profession that promotes population health, we have a responsibility to be out front on this issue.”

“As a profession that promotes population health, we have a responsibility to be out front on this issue.”

ph.ucla.edu

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A

AND

HEALTH EFFECTS OF CLIMATE CHANGE FSPH professor and chair of the Department of Environmental Health Sciences Michael Jerrett addresses what’s happening, what’s projected, and the direct connection between planetary and human wellness.

MICHAEL JERRETT

AS A LEADING SCHOLAR IN HIS FIELD — named to the Thomson Reuters List of Highly Cited Researchers, indicating he is in the top 1 percent of all environment/ecology authors when it comes to citations by other researchers — Michael Jerrett has assessed the health impacts of climate change from many angles. Jerrett, professor and chair of the Fielding School’s Department of Environmental Health Sciences, spoke with FSPH’s Public Health Magazine about climate change’s health implications and the role for public health in limiting the negative effects.

Q: Climate change has often been associated with events that are removed from people’s everyday lives. Beyond the threat to our natural environment, why is climate change a health issue that everyone should be concerned about?

A: Right, many people don’t fully appreciate the health implications. They think it’s only an issue of shrinking glaciers, melting ice caps and endangered species, like polar bears.

It might seem like it’s solely happening far away, or that the negative effects to the planet are many years off. In fact, climate change has very real implications for human health, both here in the United States and in other parts of the world. Those effects will become more severe with time if we don’t dramatically reduce the emissions that are driving climate change, but the effects aren’t just long term; many are being felt today, and will grow as public health concerns within our lifetimes.

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Q: The Earth has warmed 1 degree Celsius — 1.8 degrees Fahrenheit — since the 1800s. Why is this a big deal? In the absence of dramatic steps to reduce greenhouse gas emissions, how much warmer is it likely to become, and why does this matter?

A: The Paris Agreement — in which nearly 200 nations pledged to take steps that would keep the global mean temperature increase well under 2°C [3.6°F] through the end of this century — was premised on the goal of avoiding severe change, which is categorized as more than 2.5°C [4.5°F] above preindustrial levels. We’re currently exceeding all of the worst-case emission scenarios that were used in those models, so it appears likely that we’re headed for increasingly severe types of events involving extreme heat, flooding, wildfires, hurricanes, droughts, famines, and infectious disease outbreaks.

Q: What are some of the likely health consequences?

A: In the near term, the most certain effects are that we’re going to experience an increase in the number of extremeheat days. That’s going to affect things like how we conduct agricultural harvesting and planting, as well as construction work and other outdoor jobs. If you look at parts of the world that are already very hot, like India, and then add 30-40 more really high-temperature days each year, the ability to conduct work outside is going to be curtailed substantially, because there is a temperature beyond which the human body simply can’t function properly and people start to experience heat stress and heat stroke.

We are also likely to experience fairly dramatic changes to the water cycle. The reason we now call it climate change instead of global warming is that, while the mean temperatures are going up, the variability is also increasing substantially, which affects the hydrological cycle and is going to mean that much of our water will come in bigger storms at unusual times of the year, where you don’t get the same infiltration and recharging of the groundwater.

It means longer periods during which it will be very dry, followed by heavy rain. In California this could result in more

large wildfires over a longer season. We’re also seeing more extreme weather events like large storms and hurricanes, and although it’s uncertain whether that is attributable to the changing climate, it could have to do with the higher temperatures increasing the moisture in the atmosphere from the evaporation of the sea surface, and creating additional energy as it moves toward North America.

Obviously, more fires and floods are going to have health effects. Then there’s the whole issue of sea-level rise, which is predicted to be around a meter by the end of the century but won’t be felt evenly — some areas are going to experience 2- or 3-meter rises. This will especially affect the low-lying coastal areas.

There is a good chance we will see more air pollution as well. The majority of models predict a so-called climate penalty within the next 30-50 years, with conditions that will become more conducive to the formation of secondary particles — nitrates, sulfates and organic carbon — that are associated with negative health effects. It’s also possible that if we do see longer, hotter, drier seasons, the ozone could become worse because it requires more sunlight to form.

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CLIMATE CHANGE AND HEALTH

“Many people don’t fully appreciate the health implications [of climate change].

They think it’s only an issue of shrinking glaciers, melting ice caps and endangered species, like polar bears.”

Q: What are some examples of public health strategies to combat current and future health effects from climate change?

A: You’re referring to what we call adaptation — to the extent that the climate is changing and that’s associated with negative health consequences, how can we adapt to either prevent or reduce these impacts? Adaptation includes strategies such as avoiding development in flood-prone coastal areas because of the threat from hurricanes and sea-level rise. It also includes strategies in the category of ecosystem services — ensuring that where possible, cities are building infrastructure that takes adaptation into account. One example would be managing stormwater so that as precipitation is coming from more intense storms, cities have more areas that can absorb the water either naturally or through something like retention ponds. In addition to preventing flooding and retaining water that could be used for other purposes, these ponds could have aesthetic and mental health value in the form of stress reduction.

As we think about adaptation from a public health perspective, we will need to focus those efforts on socially disadvantaged communities and populations, because they are less likely to have the resources to adapt — to be able to afford central air conditioning in their homes, for example, as a way of adapting to the extreme heat.

Q: What actions can be taken to slow or reduce the extent to which the climate is changing?

A: We call that mitigation, and that’s where the effort is being made to limit the mean global temperature increase to 2°C. That means reducing the emissions of greenhouse gases and other short-lived climate-forcing pollutants. The biggest contributor, and the key reduction point, is fossil fuel burning. Switching to renewable

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energy that’s more carbon-neutral is a key mitigation strategy. And in agricultural areas, the livestock put out a significant amount of methane through flatulence. Another category has to do with large-scale landscape changes. When we deforest large areas, for example, it reduces the Earth’s ability to store the carbon, so we have to be concerned about that.

One public health strategy that helps with both mitigation and adaptation involves the greening of cities. Greening public areas, as well as encouraging homeowners to have more plant cover in their yards, can have a significant cooling effect.

Large studies have found that when cities have more vegetative cover as a buffer against the heat, it can make a difference of between 1.5° and 4°C. In fact, adding green space is a triple-win — potentially improving emissions, cooling cities in the face of a warming climate, and bringing health benefits by promoting physical activity and reducing stress.

Q: A report by the U.N. Intergovernmental Panel on Climate Change released last October warned that the world has a little more than a decade to turn things around. What do you say to those who feel helpless that more isn’t being done to treat this as a crisis?

A: There are steps we can take, both as individuals and within our communities [see page 23]. And beyond the specific public health strategies I’ve mentioned, we can make it clear to policymakers that effective action to move toward zero carbon emissions is needed. For those of us in public health, we must continue to lead the way in conducting research and disseminating the scientific knowledge we gain from that research in ways that will lead to the types of policies that will make a difference for the health of the planet and the human populations that inhabit it.

CLIMATE CHANGE AND HEALTH

FIGHTING CLIMATE CHANGE: WHAT CAN I DO? Climate change is occurring on such a large scale that it’s easy for individuals to feel helpless to stop it. In fact, according to two Fielding School experts, although the government and private sector bear significant responsibility for taking the bold actions needed to combat climate change and adapt to its effects, there are steps individuals can take to ensure they are participating in the solution rather than contributing to the problem.

TRANSPORTATION IS A KEY CONTRIBUTOR TO CLIMATE CHANGE. Individuals can reduce their carbon footprint by limiting air travel, shifting to energy-efficient vehicles, and minimizing the amount of time they spend in their cars, including through such strategies as carpooling.

“If it’s feasible and safe to do so, actively commuting — on bicycle or on foot — or taking public transit is a great way to have a positive impact,” says Michael Jerrett, professor and chair of FSPH’s Department of Environmental Health Sciences, who makes his daily commute to the

In Transit

Fielding School by bicycle. Active commutes have an individual benefit as well, of course.

“It’s much healthier to burn fat than it is to burn fossil fuels,” says Dr. Richard Jackson, FSPH professor emeritus of environmental health sciences.

THERE IS EVIDENCE THAT EATING MEAT — particularly beef, pork and lamb — adds to carbon emissions. “It’s been said that our modern agricultural system is really about taking fossil fuels and converting them into food energy, because of the role of petrochemicals in our agricultural system,” Jerrett says. Another dietary strategy: Buy local. “The average piece of food on an American’s plate has come from 1,100 miles away,” Jerrett notes. “It’s not always possible in much of the country, especially in winter, but whenever you can buy locally sourced foods, it

At Meals

makes a positive impact.” Jackson adds that for those who can, growing food in a home garden is ideal both as a carbon-limiting strategy and for its physical and mental health benefits.

AN INTEGRAL PART OF ANY STRATEGY to fight climate change involves reducing consumption of fossil fuel-based energy. Where feasible, change standard lightbulbs to energy-efficient versions and unplug appliances that aren’t in use. A side benefit is that these changes can also save money. Beyond conservation measures that many can employ, homeowners can install energy-efficiency improvements in the form of energy-saving appliances, and even switch to solar-powered water and heating, Jerrett notes. If a homeowner also has outdoor space, keeping it green is preferable to paved for two reasons — green

At Home

spaces serve as a “carbon sink,” absorbing carbon dioxide rather than releasing it into the atmosphere, where it contributes to climate harm; and for the cooling effect. “Concrete and other structures absorb heat at a higher rate than the natural environment, creating an urban heat island effect, so it’s important not to unnecessarily pave over areas that would otherwise be green,” Jerrett says. ph.ucla.edu

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IMMIGR ATION POLICIES

Barriers to Health

Amid deportation threats, exclusionary policies and inflammatory rhetoric, an FSPH study examines how immigrants’ lived experiences affect their access to care.

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MORE THAN 800,000 undocumented young people brought to the United States as children, along with 300,000-plus foreign-born individuals who have lived and worked here for upward of two decades, face an uncertain future as the Deferred Action for Childhood Arrivals (DACA) and Temporary Protected Status (TPS) programs hang in the balance. The national discourse includes references to “caravans” of migrants headed toward the border, depictions of undocumented immigrants as killers, and appeals for a wall along the Mexican border. As the rhetoric is ratcheted up, millions of immigrants live with the constant fear that they or a loved one could be deported under an immigration enforcement infrastructure that has grown over the last decade.

These and other developments contribute to a social context with wide-ranging public health implications for all immigrants and their family members — and, by extension, for the overall well-being of the communities across the nation in which immigrants reside, according to Steven P. Wallace, professor of community health sciences and associate director of FSPH’s UCLA Center for Health Policy Research (CHPR), and Maria-Elena Young (PhD ’18), a research scientist at the center and a Chancellor’s Postdoctoral Fellow at UC Merced. Starting in September 2017, with funding from the National Institute on Minority Health and Health Disparities, a team led by Wallace embarked on RIGHTS (Research on ImmiGrant HealTh and State policy), a five-year study to better understand how Asian and Latino immigrants’ experiences with policies in California affect their access to health care.

Although the federal government oversees who can legally enter the country, states have considerable discretion in determining immigrants’ rights, protections and eligibility for social and economic resources, notes Young, the study’s project director.

Policies relating to Medicaid and food stamps eligibility, employment and labor issues, university tuition and

“One important issue that this study can address is whether experiences with exclusionary policies lead immigrants to avoid public services, which would include seeking medical care in a timely way.”

— Steven P. Wallace scholarships, eligibility for driver’s licenses, and immigration enforcement all shape what it means to be an immigrant in a particular state, she explains.

“We know that eligibility or ineligibility for health services is going to have an impact on health, but there is also a growing recognition that the overall environment in which people live, including the level of discrimination they face and their economic and educational opportunities, affects their health,” Young says. “We believe all of these policies contribute to the overall social climate, and that if you are an immigrant living in an environment that is more inclusive, that’s going to affect your sense of belonging, sense of safety, and willingness to reach out to institutions, pursue opportunities and seek health care.”

The RIGHTS study builds on research Wallace, Young and others have collaborated on for several years.

As part of her FSPH doctoral dissertation, Young found that states with more inclusive social and policy environments for immigrants had smaller disparities in access to care between citizens and noncitizens than states with less inclusive environments, even when setting aside specific policies related to health care access.

“There is evidence that state policies have an impact on immigrants’ health and access to health services, but we don’t know much about the actual experiences of immigrants under these

policies and how those experiences influence their access to care,” Wallace says. “That’s what we are now studying.”

RIGHTS involves a follow-up to CHPR’s California Health Interview Survey (CHIS), the largest state-level population health survey in the country.

A total of 1,000 Latino and 1,000 Asian immigrants who answer questions about their health through the CHIS survey are being interviewed in-depth about their experiences in the areas of health care, social services, labor and employment, law enforcement, and education, as well as about their general perceptions of what it’s like to live as an immigrant in California.

Young notes that California has the nation’s most inclusive policy environment for immigrants, but there is wide variation at the county levels. As part of the study, 60 one-on-one interviews are also being conducted with Mexican and Chinese immigrants living in Los Angeles and Orange counties to provide a detailed understanding of the impact of these county-level differences. Los Angeles is one of the state’s most inclusive counties — providing health coverage to anyone regardless of citizenship status, for example; by contrast, Orange County has contracts with U.S. Immigration and Customs Enforcement (ICE) and helps with the deportation of immigrants, in defiance of the state’s sanctuary law.

“We’re looking at the manifestations of these policies,” Wallace says. “People may not know whether their local police collaborate with ICE, but they do know if someone has been deported, or if they’ve been injured at work and not reported it, or if they worry about driving through certain parts of town.

One important issue that this study can address is whether experiences with exclusionary policies lead immigrants

to avoid public services, which would include seeking medical care in a timely way.”

Nationally, it’s easy to make the connection between certain policies and immigrant health, Wallace says.

DACA and TPS, for example, provide work permits, and the ability to be gainfully employed means individuals are more likely to have health insurance, earn livable wages, and have a stable environment, all of which are health promoting. The uncertain future of those policies represents a threat to both the mental and physical health of their recipients, Wallace notes.

Other connections are less obvious, and would require additional research to validate — including whether reports of fewer domestic violence calls to police in immigrant communities could be related to fears about immigration enforcement, or to what extent concerns about working without legal documents or driving without the ability to get a license affects the ability of undocumented adults to earn a living and provide a stable, health-promoting environment for their families. Similarly, Wallace and Young point out, research can help to inform the ongoing national debate over comprehensive immigration reform by providing data on the potential public health benefits of enacting a path to citizenship for the more than 10 million undocumented immigrants living in the U.S. “Immigrants are an important part of the fabric of our communities and our nation,” Young says. “As public health researchers, we want to make sure that policymakers have access to information about who is being excluded and what impact that has, as well as how inclusionary policies could make our society healthier.”

“We want to make sure that policymakers have access to information about who is being excluded and what impact that has, as well as how inclusionary policies could make our society healthier.” — Maria-Elena Young (PhD ’18) ph.ucla.edu

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HIV AND SUBSTANCE USE

Addressing the Opioid Crisis An FSPH team is leading a key national resource in the fight against the U.S. opioid epidemic for populations affected by HIV/AIDS, and bringing together Southern California leaders for combined prevention efforts.

AMERICA’S OPIOID EPIDEMIC, well into its third decade, continues to devastate individuals, families and communities.

In March, the U.S. Centers for Disease Control and Prevention (CDC) described what it calls the third wave of the public health crisis — a crisis that claimed nearly 400,000 lives nationally between 1999 and 2017. What started in the 1990s with prescription opioid painkillers was followed by a second wave, beginning in 2010, which was marked by increased heroin use as many who had become addicted to prescription pills began to seek out a substitute that was cheaper and easier to obtain. The third wave, traced to late 2013, is characterized 26

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by significant increases in overdose deaths involving synthetic opioids, particularly illicitly manufactured fentanyl.

If nothing is done, the CDC report concluded, as many as 650,000 more people will die from opioid overdoses in the next decade — more than the population of Baltimore. “ The opioid epidemic is affecting people across the spectrum — young and old, regardless of ethnicity or socioeconomic status,” says Pamina Gorbach, professor of epidemiology at the Fielding School. “Along with the terrible problem of overdose deaths, there can be long-term disabilities caused from the experience of being addicted, worsened for those who overdose repeatedly.”

For people who are HIV-positive or at high risk for HIV infection, the epidemic raises particular concerns, Gorbach notes. “Several states have reported outbreaks of HIV among injection drug users, pointing to the potential for opioid use to drive the HIV epidemic in highly vulnerable populations,” she explains. “In addition, people who use opioids may struggle with adherence to their HIV treatment, which can lead them to be able to transmit their HIV sexually or through sharing injection equipment.”

To learn more about the intersection of HIV and substance use, the National Institute on Drug Abuse (NIDA) brought together the research teams from its longstanding cohort studies to establish the Collaborating Consortium of Cohorts Producing NIDA Opportunities (C3PNO), under the leadership of Gorbach and Suzanne Siminski of the nonprofit data management and analysis organization Frontier Science. C3PNO includes cohort researchers with wide-ranging expertise and rich data repositories going back as far as 25 years, representing cities that have had varied experiences with the opioid epidemic. Through cutting-edge scientific approaches powered by nine cohorts’ combined sample size of more than 12,000 participants, C3PNO facilitates the study of high-priority research questions that would be difficult or impossible to address at a single study site. “ The work of C3PNO is foundational to measuring longterm consequences of addiction and which interventions have a public health impact,” says Amy Ragsdale, administrative director of FSPH’s Biobehavioral Assessment Research Center and C3PNO project director. “It’s helping us to learn from the experiences of other groups so that we can be nimble and responsive to this evolving epidemic.”

High on NIDA’s agenda for C3PNO is to contribute science that will be used to shape the agency’s public health messaging on HIV transmission for the injection-drug using population. Since 2016, the U=U (Undetectable Equals Untransmittable) campaign has promoted the evidence-based concept that people living with HIV are not at risk of sexually transmitting the virus if, through antiretroviral therapy, they maintain an undetectable viral load (the amount of HIV in the blood). “That message is transformative for people living with HIV because if they stay on their medications and in care, they can overcome the stigma of HIV and have less anxiety about transmitting the virus,” Gorbach says. “The question is, does substance use compromise either of the U’s? For drug users, injecting or not, it is harder to get to and keep an undetectable viral load, and we also know that HIV is transmittable through injection as well as sexually.

Our charge is to investigate whether the U=U message should be modified for substance-using populations, especially for those using injection drugs.”

Gorbach, along with Steven Shoptaw, a UCLA professor of family medicine and psychiatry and biobehavioral sciences, are the principal investigators of mSTUDY, funded since 2013 by NIDA to learn more about the intersection of HIV and substance use in a cohort of young Los Angeles Latino and African-American men who have sex with men (MSM).

The FSPH-based study is one of the nine cohorts funded by NIDA in the U.S. and Canada that are collecting laboratory, clinical and behavioral data on substance use in HIV-positive and at-risk populations over time in C3PNO. Gorbach notes that thus far, the opioid epidemic hasn’t exploded in Southern California the way it has in other parts of the country. In an effort to better understand the contours of the problem in the state and to determine the best strategies for preventing an outbreak mirroring what has occurred elsewhere, Gorbach, Shoptaw, and Ricky Bluthenthal, a professor and associate dean for social justice at USC’s Keck School of Medicine, convened a multidisciplinary group of experts

“Unfortunately, this crisis has hit at a time when we’re working toward the elimination of HIV, and it represents one of the final major challenges to that goal.”

— Pamina Gorbach at UCLA last November. The meeting, cosponsored by the UCLA Center for AIDS Research and UCLA Center for HIV Identification, Prevention and Treatment Services, included academics, public health officials, community service providers, and representatives from the U.S. Drug Enforcement Administration, Los Angeles County Department of Medical Examiner-Coroner, and L.A.-area crime labs.

In addition to reaching a consensus on the need for proven strategies such as expanding access to needle-exchange programs, medication-assisted treatment, and the opioid overdose-reversal drug naloxone, the group discussed some of the unique characteristics of the region’s at-risk population.

“In our study group young men who have sex with men tend to get exposed to fentanyl not through opioids but through stimulants,” Gorbach says. As part of the mSTUDY, her group is testing participants for fentanyl and surveying them to see if some are consuming it inadvertently, as well as providing educational materials and fentanyl test strips as a public health service so that members of the community can ensure that their supply doesn’t include the lethal ingredient.

Gorbach believes a key lesson to be drawn from the way the opioid epidemic has unfolded is the importance of all sectors working together to identify and prevent potential outbreaks.

“The opioid crisis began with the overprescription of opioids, which led to many people moving on to use illicit substances, and public health didn’t move quickly enough to recognize the problem,” Gorbach says. “Unfortunately, this crisis has hit at a time when we’re working toward the elimination of HIV, and it represents one of the final major challenges to that goal. Through C3PNO, we can address high-priority research questions that will contribute to proactive steps to overcome that challenge.” ph.ucla.edu

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TR AINING GLOBAL LEADERS

NETWORK OF ADMIRERS After leading pioneering research on the unfolding HIV/AIDS epidemic in the U.S., Dr. Roger Detels went on to train scores of HIV/AIDS leaders in Asia who remain in close contact with one another and their mentor.

IN CHINA AND ACROSS SOUTHEAST ASIA, an informal Fielding School alumni network thrives — public health leaders, many of them veterans of the earliest days of fighting the HIV/ AIDS epidemic, whose actions and insights helped to save countless lives.

The group includes individuals who have held high-ranking government positions, including two ministers of health; the founders of two public health schools, as well as deans and professors of others; the current or former leaders of many of the HIV/AIDS prevention and control programs in the region; and researchers whose findings have profoundly influenced national policies. Many have expanded their portfolios to address other public health challenges, but they continue to collaborate and consult with one another, and with their former teacher.

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Dr. Roger Detels, professor of epidemiology at the Fielding School and founding director of the UCLA/ Fogarty AIDS International Training and Research Program — through which more than 100 of these public health leaders received FSPH master’s or doctoral degrees and many more benefited from short-term training — speaks with the affection of a proud parent about his network of protégés, the legacy they have built, and how that has reflected on the school whose faculty he joined nearly a half-century ago. “We have attained a reputation in that region for excellence in public health,” Detels says.

By the time he established the UCLA/Fogarty program in 1988, Detels was already well known as a leader of one of the earliest and most important studies of HIV/AIDS in the United States. The Multicenter AIDS Cohort

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Study (MACS) was launched at four sites in 1984 before it was even known that the disease had a viral origin. Detels continues to head the Los Angeles site of MACS, which has followed approximately 2,000 gay and bisexual men since the dawn of the epidemic.

His retirement this year, effective in June, will not stop Detels from continuing his work on MACS, which was just extended for another seven years by the National Institute of Allergy and Infectious Diseases. In fact, Detels remains busy as ever, working on the seventh edition of the Oxford Textbook of Global Public Health, an encyclopedic overview of the field presented in three volumes and more than 1,000 pages. Detels was co-editor of the first two editions and has been senior editor of each one since.

It’s been a monumental career, particularly for someone who admits, with

characteristic modesty: “I was totally awed by science and research right up through medical school.”

Detels had entered medical school intending to become a practicing physician, but was introduced to the field of epidemiology during a six-month elective period at the Naval Medical Research Unit in Taipei, Taiwan. “I realized from that experience that seeing one patient at a time didn’t have anywhere near the impact I could have going into public health research,” he says.

After three years as an epidemiologist in Taipei and two at the National Institute of Neurologic Diseases and Stroke, he joined the Fielding School faculty in 1971 and began applying his skills to wide-ranging health concerns, including hypertension, air pollution, multiple sclerosis and infectious diseases.

In 1981, UCLA physician Michael Gottlieb reported the first cases of a new disease affecting men who had sex with men. Detels, who had developed an interest in immunology through his studies of multiple sclerosis, worked with UCLA’s Gay and Lesbian Association to recruit members for a study in which anonymous participants would fill out a questionnaire and take a blood test to measure their immune cells.

“I quickly realized that to be effective, I had to follow these individuals over time, so when I called them with the results I said we need to do a follow-up study, and to do that I would need your name and a way to contact you, potentially for years,” Detels recalls. “This was the early 1980s. There was a high level of stigma against gay men, exacerbated to a huge extent by the appearance of this disease. These young men were scared, and their natural inclination was to stay below the radar. Yet, of the 200 students who participated in the original study, approximately 185 agreed to be followed over time. That was a colossal act of heroism in my opinion.”

The cohort evolved into MACS, with UCLA, under Detels’ leadership, running the largest site. MACS contributed some of the earliest evidence of the route of infection and risk activities for HIV transmission, along with the changes in the immune system

DETELS (RIGHT) WITH FORMER TRAINEE DR. ZUNYOU WU (MPH ’92, PHD ’95), CURRENTLY CHIEF EPIDEMIOLOGIST FOR THE CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION AND AN ADJUNCT FSPH PROFESSOR, AFTER DETELS RECEIVED THE PRESTIGIOUS CHINESE GOVERNMENT FRIENDSHIP AWARD IN 2016.

in response to the virus. Detels also published a landmark study showing that some men were resistant to HIV infection. Since the advent of effective treatment, MACS has focused on the genetic impact of the therapy, and on the susceptibility of HIV-positive individuals to other infections.

Detels launched the UCLA/Fogarty program, focusing on China and Southeast Asia, to build the leadership capacity of overseas institutions to fight the then-unfolding crisis by preparing trainees in state-of-the-art epidemiologic techniques and research methods.

As the program began, the participating nations were grappling with some of the first reports of rapidly spreading HIV. In addition to the degree training offered at the Fielding School, Detels frequently traveled abroad to offer short-term trainings at collaborating institutions. While there, he often consulted with public officials, and assisted the governments of Thailand, Myanmar, the Philippines and Indonesia in the development of their systems to track the epidemic.

“Dr. Detels’ trainees have played a significant role in changing the course of the HIV epidemic in Asian countries.”

— Dr. Zunyou Wu (MPH ’92, PhD ’95)

Many of Detels’ trainees played pivotal roles in fighting the epidemic.

Dr. Zunyou Wu (MPH ’92, PhD ’95) collaborated with his mentor to provide the first reports of an HIV outbreak among plasma donors in China — a revelation that led China’s Ministry of Health to shut down all commercial plasma centers. Wu and Detels have gone on to collaborate on more than a dozen studies. “Dr. Detels’ trainees have played a significant role in changing the course of the HIV epidemic in Asian countries,” says Wu, currently the chief epidemiologist for the Chinese Center for Disease Control and Prevention, as well as an adjunct professor of epidemiology at the Fielding School. “Dr. Detels taught me not only about academics, but also the importance of hard work and integrity.”

Detels’ career highlights include five years as the Fielding School’s dean (1980-85), a slew of national and international leadership positions within the field of epidemiology, and numerous honors, including awards from the governments of Thailand, Cambodia, Vietnam and China. But he doesn’t hesitate when asked to name the most rewarding aspect of his career.

“It has to be the students and colleagues with whom I’ve worked over the years,” Detels says. “Many have been from places with poor conditions or corrupt political systems, but they continue to be incredibly devoted to improving public health. Getting to know them has been an extraordinary experience.” ph.ucla.edu

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INTERIM DEAN PROFILE

Making Numbers Count

Throughout his career, Ron Brookmeyer has used biostatistics to address some of the most pressing public health concerns of our time. Now he’s making an impact as FSPH’s interim dean.

AT THE PINNACLE OF A CAREER during which his studies have drawn worldwide attention to the magnitude of major public health problems such as HIV/AIDS and Alzheimer’s disease, becoming interim dean of the Fielding School was far from Ron Brookmeyer’s radar. But since graduate school, Brookmeyer has been driven by a desire to make a difference. And so, when asked

by UCLA’s campus leadership to take the reins of the Fielding School during the search process for a permanent dean, Brookmeyer, a professor in FSPH’s Department of Biostatistics since 2010, embraced the opportunity to make an impact in a new way.

Brookmeyer’s interest in consequential work can be traced to his days as a PhD student in statistics at the University of Wisconsin, when he chose to specialize in biostatistics as a way to address human health. At the time, his focus was on developing statistical methods to test the efficacy of new cancer treatments. Upon graduating Brookmeyer took his first academic position, in the public health school at 30

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Johns Hopkins University. His introduction to the field was eye-opening. “I had been studying whether a chemotherapy drug might help patients live a certain number of weeks or months longer,” Brookmeyer explains. “That’s obviously very important, but through public health I realized that if you could prevent the disease in the first place, that would be so much more powerful.”

It was 1981, the same year a UCLA physician reported the first cases of a complicated new disease that would later become known as AIDS. In 1984, the Multicenter AIDS Cohort Study was launched to learn the natural history of the disease at four sites, including Hopkins and UCLA. Brookmeyer became an active research participant at the Baltimore site. “At first, it wasn’t even known that AIDS was an infectious disease, and of course there was no test for HIV,” Brookmeyer recalls. “But as we started to look at it, we began to see that we might have a major epidemic on our hands.”

As the contours of the emerging epidemic became clearer, Brookmeyer set out to determine how widespread it was likely to become, applying the statistical methods he had used as a graduate student studying cancer survival. But with AIDS there was an important wrinkle — the long incubation period, or time between when an individual became infected and when he or she became sick.

With the discovery of HIV as the cause and the introduction of the test for the virus in 1985, Brookmeyer and his research colleagues calculated that the incubation period was, on average, close to 10 years. Brookmeyer then developed a method to estimate, based on the number of cases reported and the incubation period, how many people were carrying the virus and how widespread the epidemic was likely to become.

On December 6, 1986, he co-authored a landmark paper in The Lancet arguing that the 27,000-plus cases reported up to that point represented the tip of the iceberg. The study received worldwide attention, and the projections proved prescient.

It was the first foray into what would characterize Brookmeyer’s research throughout his career — immersing himself in the substance of a major public health problem and then using statistics, epidemiology and information sciences to develop models that gauge its current and future scope. “Data is power,” Brookmeyer says. “Attaching numbers to global health problems can have a huge policy impact, as long as the numbers are backed by solid science.”

His ability to use numbers for impact hasn’t been lost on his colleagues. “Ron Brookmeyer is a biostatistical leader whose hallmark has been to advance research at the interface of statistical methodology and major health impact,” says Karen Bandeen-Roche, the Hurley Dorrier Professor and Chair in Biostatistics at the Johns Hopkins Bloomberg School of Public Health, where Brookmeyer once headed the interdepartmental MPH program.

In 2001, in the weeks following the September 11 attacks, Brookmeyer was again called on to attach numbers to a high-profile public health concern. After letters containing anthrax spores were mailed to several news-media and U.S. Senate offices, Brookmeyer was asked to develop estimates of

how many people were exposed to the potentially fatal powder and the public health impact of initiating antibiotics for thousands of possibly exposed postal workers at mail sorting facilities. His mathematical models also helped to inform public health preparedness efforts, as did later studies about the utility of an anthrax vaccine.

By that time, Brookmeyer was deep into a research topic that continues to be a major focus — putting numbers on the looming epidemic of Alzheimer’s disease. Brookmeyer first gained attention with a study in the late 1990s in which he projected that the number of Alzheimer’s cases in the U.S. would nearly quadruple by 2050. His 2007 study forecasting the same quadrupling of the disease worldwide became the most widely cited of Brookmeyer’s career. Brookmeyer’s models also allowed him to project the potential impact of future therapies and other strategies to prevent or delay the onset of the disease and progression — Ron Brookmeyer of symptoms.

“Everyone wants to hit the home run — to find a cure, or be able to prevent all cases of the disease — but even if we could delay it a few years, given that it’s a disease of the elderly, it would have a huge public health impact,” he notes. Most recently, Brookmeyer published the first estimates of the numbers of Americans with mild cognitive impairment or preclinical Alzheimer’s disease, based on a newly developed imaging test that can detect changes in the brain that predate clinical symptoms.

Brookmeyer has had little time for his research since last November 1, when he assumed the role of FSPH’s interim dean. “It’s a different life,” he says, laughing. “But it’s given me an appreciation for the tremendous work taking place at our school, and has allowed me to collaborate with other deans and build bridges throughout the university. Public health is an interdisciplinary, problem-solving field, so having the chance to get involved in those kinds of efforts at UCLA is a great opportunity and honor.”

In his new role, Brookmeyer spends a fair amount of time explaining to outside groups the importance of the Fielding School’s contributions. In doing so, he conveys the same message he learned upon his introduction to public health at the start of his career. “If you want to have an impact on people and on society, this is a fantastic field,” he says.

“There will always be new challenges, but a strong foundation in core public health competencies allows us to address those challenges. Here at the Fielding School, we are providing that foundation.”

“Attaching numbers to global health problems can have a huge policy impact, as long as the numbers are backed by solid science.”

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SCHOOL WORK Kaiser Permanente Chairman and CEO Named FSPH’s 2019 Commencement Speaker BERNARD J. TYSON, CHAIRMAN AND CEO OF KAISER PERMANENTE, will deliver the keynote address at the Fielding School’s commencement ceremony June 14 in UCLA’s Royce Hall.

Tyson leads Kaiser Foundation Health Plan, Inc. and Hospitals — known as Kaiser Permanente — one of the nation’s leading health care providers and not-for-profit health plans. He advocates for high-quality affordable health care as well as the elimination of health care disparities. Tyson has overseen efforts to increase patients’ access to mental health and wellness services and has announced plans for Kaiser Permanente to invest $200 million in initiatives aimed at creating more affordable housing and reducing homelessness in areas where its members live.

The commencement ceremony, which is scheduled to begin at 5:30 p.m., can be viewed via livestream at ph.ucla.edu/2019-livestream.

2019 LA MARATHON AND LA BIG 5K Team FSPH ran in the LA Marathon and LA Big 5k this spring and raised nearly $38,000, which will support more than 2,500 hours of student fieldwork. To support FSPH student fieldwork, please visit bit.ly/FSPH-give.

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45th Annual Lester Breslow Distinguished Lecture BARBARA FERRER, DIRECTOR OF THE LOS ANGELES COUNTY DEPARTMENT OF PUBLIC HEALTH (LADPH), delivered the 45th Annual Lester Breslow Lecture with a presentation titled, “A Pathway to Equity: Key Issues and Implications for Practice.” LADPH protects health, prevents disease, and promotes equity and well-being among L.A. County’s more than 10 million residents. The evening also featured a video produced by 2019 Lester Breslow Impact Fellowship awardee James Huynh, and recognized Impact fellows Dr. Yelba Castellon-Lopez (MPH ’18) and Lamar Hayes.

The annual event, held in honor of the late Dr. Lester Breslow — former Fielding School dean, professor and public health visionary — unveiled documents from the recently completed UCLA Library archive of Breslow’s numerous influential works

LEFT: LADPH DIRECTOR BARBARA FERRER. RIGHT: DEVRA BRESLOW, LONGTIME FRIEND AND SUPPORTER OF THE FIELDING SCHOOL AND WIFE OF DR. LESTER BRESLOW, WITH 2019 LESTER BRESLOW IMPACT FELLOWSHIP AWARDEE JAMES HUYNH.

over the course of his career.

2019 Ruth Roemer Social Justice Symposium and Alumni Hall of Fame Induction

PICTURED, LEFT TO RIGHT: L.A. COUNTY SUPERVISOR REPRESENTING THE FIRST DISTRICT HILDA L. SOLIS, FSPH’S 2019 RUTH ROEMER SOCIAL JUSTICE LEADERSHIP AWARD WINNER; FSPH ALUMNI HALL OF FAME INDUCTEES GOLEEN SAMARI, LUDLOW B. CREARY AND SANDER GREENLAND; AND RON BROOKMEYER, FSPH INTERIM DEAN.

HILDA L. SOLIS, LOS ANGELES COUNTY SUPERVISOR REPRESENTING THE FIRST DISTRICT, received the Fielding School’s 2019 Ruth Roemer Social Justice Leadership Award in April. The award is named after the late FSPH professor, who advocated for the importance of human rights in public health. Solis, county supervisor since 2014, was recognized for her contributions to improving the health and well-being of her constituents and reducing health disparities across the county.

The event included induction of three new members into the UCLA Fielding School Alumni Hall of Fame. This year’s honorees are Ludlow B. Creary (MPH ’73), co-founder and chairman of the Creary Family Foundation and former medical director of Visiting Angels - Beverly Hills/Los Angeles; Sander Greenland (MPH ’76, DrPH ’78), professor emeritus of epidemiology at the Fielding School; and Goleen Samari (MPH ’10, PhD ’15), public health demographer and an assistant professor at the Columbia University Mailman School of Public Health.

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BOOKSHELF HONOR ROLL 2018 The UCLA Fielding School of Public Health is pleased to honor our alumni, friends, students, staff, and foundation and corporate partners whose generosity strengthens our school and keeps us at the forefront of public health education. Please visit ph.ucla.edu/honorroll2018 to view the 2018 Honor Roll.

WELCOMING NEW FACULTY LIWEI CHEN, associate professor of epidemiology Chen’s primary research focus is on identifying effective dietary and lifestyle approaches to prevent and manage obesity, diabetes, hypertension and other cardiometabolic diseases. She also studies maternal and child health, with a particular focus on those at high risk for developing cardiometabolic diseases. Chen serves as grant reviewer for the National Institutes of Health, National Medical Research Council (Singapore) and Diabetes UK (United Kingdom), as well as reviewer for top journals including JAMA, Circulation, Diabetes Care and the American Journal of Clinical Nutrition.

DVORA JOSEPH DAVEY, adjunct assistant professor of epidemiology Joseph Davey applies her expertise in study design and use of epidemiological methods to inform interventions aimed at reducing the burden of HIV and related diseases on women, children and families. Her research focuses on the prevention and treatment of HIV and other sexually transmitted infections in peri-conception, pregnant women and couples, and other vulnerable populations.

Recent books by UCLA Fielding School of Public Health authors: Prelude to Hospice: Florence Wald, Dying People, and Their Families

By Emily K. Abel

Understanding Health Information Systems for the Health Professions

By Jean A. Balgrosky

Annual Review of Public Health, Volume 39 Edited by: Jonathan E. Fielding, Ross C. Brownson and Lawrence W. Green Annual Review of Public Health, Volume 40 Edited by: Jonathan E. Fielding, Ross C. Brownson and Lawrence W. Green DeVita, Hellman, and Rosenberg’s Cancer: Principles & Practice of Oncology Edited by: Vincent T. DeVita Jr., Theodore S. Lawrence, Steven A. Rosenberg Chapter: Dietary Factors, by Karin B. Michels and Walter C. Willett

STAY CONNECTED WITH UCLA FSPH FSPH’S STUDENTS OF COLOR FOR PUBLIC HEALTH organized lectures and activities to celebrate National Public Health Week in April. This year’s theme was “Rooted,” which highlighted grassroots initiatives that aim to empower and improve the health and well-being of communities of color.

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Visit us online: ph.ucla.edu

FACULTY HONORS & SERVICE

Sudipto Banerjee was named a 2018 fellow of the International Society for Bayesian Analysis and received the 2019 George W. Snedecor Award from the Committee of Presidents of Statistical Societies.

Jonathan Fielding was appointed chair of the National Academies of Sciences, Engineering and Medicine Committee on Challenges in Initiating and Conducting LongTerm Health Monitoring of Populations Following Nuclear and Radiological Emergencies in the United States; member of the National Academies Committee on a National Strategy for Cancer Control in the United States; and to the Board of Directors of TreePeople, a Los Angeles-based nonprofit fighting climate change.

Tom Belin was invited by the American Public Health Association to deliver the Lowell Reed Lecture.

Patricia Ganz received the Clinical Research Award from the Association of Community Cancer Centers.

John Clemens received the 2018 Prince Mahidol Award in the field of Public Health from the Prince Mahidol Award Foundation under the Royal Patronage of the Kingdom of Thailand.

Gilbert Gee, along with several former FSPH students, received the 2018 Award for Innovative Public Health Curriculum from Delta Omega.

Separately, Gee serves on the National Academies of Sciences, Engineering and Medicine Committee on Informing the Selection of Leading Health Indicators for Healthy People 2030.

Ron Andersen received an Albert Nelson Marquis Lifetime Achievement Award from Marquis Who’s Who. Onyebuchi Arah was awarded an Honorary Skou Professorship from Aarhus University in Denmark.

Kate Crespi was appointed to California’s Carcinogen Identification Committee and to the National Research Institute’s advisory panel. Crespi was also named a fellow of the American Statistical Association.

David Eisenman was appointed to serve on the Committee on Evidence-Based Practices for Public Health Emergency Preparedness and Response of the National Academies of Sciences, Engineering and Medicine.

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Oliver Hankinson received the 2019 Society of Toxicology Education Award.

Michael Jerrett was named among the world’s most influential scientific researchers in 2018 by Clarivate Analytics, based on most citations between 2006 and 2016.

Robert Kim-Farley received an Albert Nelson Marquis Lifetime Achievement Award from Marquis Who’s Who, and the Charles DeGraw Advocacy Award from the National TB Controllers Association.

Martin Lee received an Albert Nelson Marquis Lifetime Achievement Award from Marquis Who’s Who. Vickie Mays was reappointed as the congressional appointee to the National Committee on Vital and Health Statistics and was appointed to the Board of Public Responsibility in Medicine and Research. She received the Career Commitment to Diversity, Equity and Inclusion Award from the UCLA Academic Senate.

Andre Nel was named among the world’s most influential scientific researchers in 2018

by Clarivate Analytics, based on most citations between 2006 and 2016.

Ronald Hays was named among the world’s most influential scientific researchers in 2018 by Clarivate Analytics, based on most citations between 2006 and 2016.

Shane Que-Hee, on behalf of FSPH’s Industrial Hygiene Program, co-organized EHSsentials 2018 UCLA, a symposium devoted to trends in environmental health sciences.

Steve Horvath was named among the world’s most influential scientific researchers in 2018 by Clarivate Analytics, based on most citations between 2006 and 2016.

Beate Ritz was named among the world’s most influential scientific researchers in 2018

by Clarivate Analytics, based on most citations between 2006 and 2016. ph.ucla.edu

Linda Rosenstock received the 2019 Welch-Rose Award for Distinguished Service to Academic Public Health.

Marc Suchard was named among the world’s most influential scientific researchers in 2018 by Clarivate Analytics, based on most citations between 2006 and 2016.

Leah Vriesman was named the 2018 Faculty Member of the Year by the Association of University Programs in Health Administration, and was appointed to the peer review committee for the Fulbright U.S. Scholar Program.

Steven Wallace received the 2018 Aging & Public Health Lifetime Achievement Award from the American Public Health Association and the inaugural Mario Gutierrez Award on Migrant Health from the Health Initiative of the Americas.

Kenneth Wells received the National Academy of Medicine Rhoda and Bernard Sarnat International Prize in Mental Health and the Psychiatric Education and Research Foundation’s Advocate Award.

Fred Zimmerman was named president of the Interdisciplinary Association for Population Health Sciences.

KEEP IN TOUCH

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TRANSFORMATIVE INVESTMENTS

Giving in Gratitude An inspirational gift puts students on track to become leaders in shaping health care.

TOM GORDON (CENTER) AND DR. PAUL TORRENS (FOURTH FROM LEFT) AT THE FELLOWSHIP ANNOUNCEMENT DINNER, CELEBRATING WITH GORDON’S FORMER MENTEES (L. TO R.): JOSHUA MORRIS (MPH ’15), SUZANNE CHIPELLO (MPH ’14), TAMARA PARK (MPH ’13), HILARY BETTINELLI-OLPIN (MPH ’12), KRISTYN SANDERS (MPH ’11), MAYA KADEKODI (MPH ’09), AND KRISTY CHANG O’FALLON (MPH ’08).

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U C L A F I E L D I N G S C H O O L O F P U B L I C H E A LT H M AG A Z I N E

WHEN DEBORAH WU (MPH ’19) discovered she was the inaugural recipient of the Levin-Gordon Health Policy and Management Fellowship, the first thing she did was tell her mother, who had taken on a second job to support her daughter’s education.

“When I shared the good news, I could hear her relief,” Wu says. “In addition to the reduced financial burden, this fellowship affirmed my academic and professional pursuit of health care. It felt like someone was telling me I made the right decision and that I am on the right path.”

Wu is one of countless people whose lives have been touched by the generosity of Tom Gordon, a widely known and influential figure in health care management who is one of the Fielding School’s leading supporters.

Above all else, Gordon is guided by a love of family and a strong desire to give back. Married for 46 years, he and his wife Edna Gordon have two daughters and five grandchildren who call him “Opa,” German for “Grandpa.” Gordon credits his own parents — who survived Nazi occupation during World War II, then immigrated to the U.S. from Berlin when Gordon was 3 years old — with providing the support that made his success possible.

Gordon was a leader in the Cedars-Sinai Health System as executive vice president and CEO of Cedars-Sinai Medical Network Services for 22 years, and continues in an advisory role as consultant to the president. Throughout his career in medical management, he has touted the importance of putting people first, creating a culture of family while also staying focused on quality and value. Although Gordon graduated from UCLA with a BA in economics, it wasn’t until 1995 that he became involved with the Field-

ing School. That’s when his friend and mentor Dr. Paul Torrens, FSPH professor emeritus, invited him to deliver a lecture on strategic planning and forecasting the future of health care.

From there, Torrens invited Gordon to serve as a preceptor and guest lecturer in FSPH’s graduate programs in health policy and management.

Ever since, Gordon has maintained a strong presence at the school, receiving an honorary MPH and serving as an executive committee member of FSPH’s Board of Advisors. He has mentored more than 25 students pursuing careers as future health care leaders, many of whom interned at Cedars-Sinai as students, then went on to work with Gordon full time upon graduating. Maya Kadekodi (MPH ’09), a former Gordon mentee, worked at Cedars-Sinai for seven years after interning there when she was an FSPH student. “Tom taught us to take every opportunity to pass on to others what we’ve learned,” says Kadekodi, now director of strategic initiatives for DSL Construction Corp. and the Don Levin Trust, where Gordon serves as chairman of the board. “Not everyone takes the time to listen, coach and mentor like Tom Gordon has for so many of us.”

“These students could easily seek occupations with higher earnings,” Gordon says. “We need to support the students who wish to make a meaningful change and address issues affecting people’s health, and reward them for choosing this career.”

In 2016, Tom and Edna Gordon formalized this commitment, in conjunction with longtime family friend and Los Angeles land developer Donald S. Levin. Together, they established two endowed fellowships to support the financial needs of students in the Fielding School’s Department of Health

Policy and Management who demonstrate the potential to make significant contributions as future health care leaders. It’s a gift that will continue providing opportunities to study public health for generations to come.

For Deborah Wu, who is now set to graduate in a much better position to realize her career goals, it’s a dream come true. “Words cannot fully express my gratitude for your commitment to investing in students such as myself,” Wu said in thanking her benefactors.

“As you have paid it forward to me, I will continue to pay it forward to those around me. I hope to make health care more accessible, more affordable and more approachable with every step I take as an aspiring health care leader.”

In recognition of Tom Gordon’s long history of supporting the Fielding School, his outstanding leadership and service in health care, and his devotion to current FSPH students, he will receive the UCLA Health Policy and Management Alumni Association’s first-ever Lifetime Achievement Award at the 2019 Leaders of Today, Leaders of Tomorrow Annual Dinner. In yet another generous act of giving back, Gordon is dedicating the award to one of his own mentors and announcing a new gift to the school. In partnership with the Don Levin Trust, Gordon has pledged a lead gift to establish the Paul Torrens Chair in Healthcare Management, further strengthening FSPH’s role as a premier academic destination for health care leaders. Gordon is seeking additional partners to help endow this position in perpetuity. To join him in honoring Paul Torrens and his influence shaping the careers of public health students for more than 40 years, please contact Tracy Hough at though@support.ucla.edu or call (310) 825-3003.

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Overcoming Our Greatest Public Health Challenge:

CLIMATE CHANGE By

JONATHAN FIELDING, MD, MPH WHAT SCIENTISTS HAVE WARNED ABOUT

warming of the planet. But this critical action,

will require an unprecedented magnitude of

FOR DECADES is now unfolding for all to

referred to as mitigation, will not be enough

resources and changes in behaviors to build

see, on a global scale — extreme heat, severe

to offset the increased energy use by China,

resilience in the face of these threats.

droughts, intense storms, rising sea levels,

India and other industrializing countries amid

The worldwide crisis presented by cli-

and an expanding geographic range for vec-

a projected global population increase from

mate change calls for a broad paradigm that

tors that spread deadly infectious diseases

7 billion to nearly 10 billion by 2050.

emphasizes preparedness at all levels. Every

such as malaria, yellow fever and Ebola, to

Thus, in the short term we must also

sector of society has a role — individuals,

name a few. These alarming developments,

devote ample attention and resources to

families, communities, governments, busi-

which are likely to become increasingly prob-

adapting to the new conditions. More vigor-

nesses, civic organizations, and education,

lematic for the foreseeable future, have made

ous mitigation efforts could go a long way

both formal and informal. As public health

climate change the defining issue of the 21st

toward determining the severity of the effects

professionals, we come from a long tradition

century. The stakes couldn’t be higher: Our

from climate change, but even if we meet the

of bringing together stakeholders to develop

success or failure in addressing this issue

most ambitious emission-reduction goals, our

and implement solutions to some of the most

will determine whether we leave a habitable

near future is certain to include substantial

profound challenges faced by our society.

planet for future generations.

climate-related health threats. We will see

Meeting the challenge of climate change will

Climate change threatens the health

both droughts and severe storms. More heat

put our leadership to the ultimate test.

of all forms of life on Earth and demands a

waves and increasingly intense wildfires in

far-reaching and comprehensive response.

California and similar environments. Sea level

Ultimately, our top priority should be sup-

rises and related flooding in low-lying areas.

porting and preserving human health, and

Changes in where crops can be grown and

Jonathan Fielding, MD, MPH, is a distinguished

that means taking steps to pull the reins on

where infectious disease vectors can thrive.

professor of health policy and management

climate change by reducing our carbon foot-

Forced migration and armed conflicts over

at the UCLA Fielding School of Public Health,

print — the emissions of greenhouse gases

scarce resources. Fulfilling our top priority

and pediatrics at the David Geffen School of

that have contributed to the post-industrial

— supporting and preserving human health —

Medicine at UCLA.

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U C L A F I E L D I N G S C H O O L O F P U B L I C H E A LT H M AG A Z I N E

WHAT WILL YOUR

FOOTPRINT BE?

Philanthropy can alter the course of climate change and promote a healthier world for current and future generations. By supporting the innovative research, training and programs within the UCLA Fielding School of Public Health, you help address the links between human health and our shared environment.

TO LEARN MORE, PLEASE CONTACT publichealth@support.ucla.edu

Nonprofit Org. U.S. Postage PAID UCLA Box 951772 405 Hilgard Avenue Los Angeles, CA 90095-1772 www.ph.ucla.edu Address Service Requested

“A ruined planet cannot sustain human lives in good health. A healthy planet and healthy people are two sides of the same coin.”

— Dr. Margaret Chan Former Director-General of the World Health Organization