UCLA Fielding School of Public Health Magazine - June 2013

JUNE 2013

PUBLIC HEALTH The UCLA Fielding School of Public Health Magazine

Pathway to Progress: influencing

GLOBAL PUBLIC HEALTH through policy

dean’s message THIS IS AN EXTRAORDINARY TIME to be working together on public and population health, with immense opportunities for effective research, training and programs. Today we know more than ever not only about the impact of poor social and environmental conditions on health, but also about the tools to change these conditions. In the United States, universal health care is being rolled out for the first time; globally, we are seeing and participating in a new commitment to ensuring public health and health care for all around the world.

The Fielding School community of faculty, staff, students and alumni is doing invaluable work in public health in Los Angeles, across the country and abroad together with extraordinary partners in the community and in government. I am thrilled to be part of a community that is increasing our understanding of the best approaches to solving major public health problems, while at the same time ensuring that the knowledge gained is translated into change that transforms people’s lives.

We are incredibly fortunate that we can do this at a time when we don't need to choose between deep commitments locally and equally strong ones globally. We are able to work hand in hand with colleagues in Los Angeles as well as with public health researchers and program leaders around the world. We can share lessons from local successes and challenges with others around the world facing similar problems, and learn from them about innovative approaches taken to common problems.

In this issue we have taken a more thematic approach to the magazine content.

We look forward to sharing more of these stories in a wide range of areas as our community continues to make a difference together with our partners at home and abroad.

Sincerely,

Jody Heymann, M.D., Ph.D. Dean

PUBLIC HEALTH Jody Heymann, M.D., Ph.D. Dean, UCLA Fielding School of Public Health

Sarah Anderson Assistant Dean for Communications

Carla Wohl Assistant Dean for Development and Alumni Affairs

feature

Dan Gordon Editor and Writer

Martha Widmann Art Director

in every issue

E D I TO R I A L B OA R D Thomas R. Belin, Ph.D.

31 NEWS BRIEFS

Professor, Biostatistics

Pamina Gorbach, Dr.P.H.

33 FACULTY

Professor, Epidemiology

Moira Inkelas, Ph.D. Associate Professor, Health Policy and Management

Richard Jackson, M.D., M.P.H. Professor and Chair, Environmental Health Sciences

Michael Prelip, D.P.A. Professor, Community Health Sciences

May C. Wang, Dr.P.H. Associate Professor, Community Health Sciences

Kelsey Ferguson and Harmony Larson Co-Presidents, Public Health Student Association

Beatriz Solis, M.P.H. ’96, Ph.D. ’07 Public Health Alumni Association

3 FIELD OF VISION Laws and public policies at the national and local levels play a critical role in the health of the population, particularly in low and middle-income countries. In a package of articles introduced on the next page, we spotlight the work of Fielding School faculty, students, alumni and international partners in informing global public health policies.

34 FRIENDS 36 STUDENTS

f e a t u r e

c o n t e n t s 4 Changing Children’s Chances For the first time, the policies of 193 nations on matters critical to kids’ ability to reach their potential can be easily accessed and compared. By shining a spotlight on the leaders and the laggards, Jody Heymann is moving countries to change.

9 Building a Leadership Network to Fight HIV/AIDS in Asia

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From the beginning, the leaders of the efforts to combat the epidemic in Southeast Asia and China have disproportionately come through Westwood and the UCLA/Fogarty AIDS International Training and Research Program, led by Roger Detels.

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12 Acting Boldly: Dispatches from the HIV/AIDS Battlefield

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The UCLA/Fogarty AIDS International Training and Research Program has prepared many leaders in the battle against the epidemic in Asia. The experiences of three of the program’s alumni illustrate some of the challenges these leaders have faced.

16 A Tale of Two Cities As Beijing grapples with record levels of air pollution, Yifang Zhu and her UCLA colleagues are teaming with Peking University scientists to guide policy makers, drawing lessons from Los Angeles.

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18 Improving the Health of China’s Population – from Near and Far

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Zuo-Feng Zhang got his start providing preventive care to China’s rural poor as a barefoot doctor. As an epidemiologist at the FSPH, he continues to influence the health of his native country.

20 Mexico’s Experience with Health Care Reform

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Well before the U.S. passed the Affordable Care Act, Arturo Vargas-Bustamante was part of his country’s successful effort to move toward universal health coverage.

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22 African Partnerships

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Four Fielding School students spent the bulk of the summer of 2012 in four different African nations conducting health policy-related work as part of their field study requirements.

27 Home Is Where Their Heart Is UCLA Fielding School of Public Health students come from more than 35 nations, some driven by a desire to improve lives in their country of origin through more effective public health policies.

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28 Setting Priorities Doctoral student Andrew Siroka aims to promote a more scientific and cost-effective approach to allocating scarce global public health resources.

PHOTOGRAPHY Reed Hutchinson / TOC: Siroka, Shimoga, Vargas-Bustamante; p. 16; p. 18: Zhang in lab; pp. 20-21, 27-30 Sarah Anderson / p. 31: graffiti Todd Cheney, ASUCLA / p. 31: Hall of Fame; p. 33: Pebley; p. 36 Vince Bucci / p. 32: Solis Margaret Molloy / p. 32: Coeytaux Christelle Nahas, UCLA Newsroom / p. 34: Yancey memorial recess Christopher Pillitz/Gettyimages / p. 13 Chau Doan/Gettyimages / p. 14 iStockphoto © 2013 / TOC: Two Cities; pp. 10-11: network bkgd; pp. 16-17: Beijing; pp. 18-19: China map; pp. 23-26: Africa maps © Images.com/Corbis / Cover Courtesy of: Jody Heymann / TOC: Children’s Chances; pp. 4-7; p. 8: map • Nhu To Nguyen / TOC: Fogarty; p. 12 Tanarak Plipat / p. 15 • Zuo-Feng Zhang / TOC: Zhang; p. 18: barefoot doctor • Lauren Goodwin / p. 23 Eric Leas / TOC: Africa; pp. 22, 24 • Roch Nianogo / p. 25 • Kat Stoneham / pp. 3, 26 UCLA FSPH / Dean’s Message; TOC: Field of Vision; p. 33: bookshelf; p. 34: Yancey; back cover • UCLA / TOC: Detels; p. 9

UCLA Fielding School of Public Health Home Page: www.ph.ucla.edu E-mail for Application Requests: app-request@admin.ph.ucla.edu 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 2013 by The Regents of the University of California. Permission to reprint any portion must be obtained from the editor. Contact Editor, UCLA Public Health Magazine, Box 951772, Los Angeles, CA 90095-1772.

Phone: (310) 825-6381.

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Field of Vision: influencing

GLOBAL PUBLIC HEALTH through policy

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EVERYONE WANTS TO BE HEALTHY – and to a certain extent, the decisions people make for themselves and their families contribute to whether they are. But much more important to the health of individuals are the determinations made by people they are unlikely to ever meet. Laws and public policies set at the national and local levels play a vital role in the health of the population, whether by reducing exposures to toxins in the workplace, ensuring clean air and water, or designing a health care system that provides access to prevention and other health care services for all citizens. And it’s not only health-specific national choices that matter: Laws and public policies on social concerns such as poverty, discrimination, education and parental care typically affect health more than any visit to the doctor, important though that may be.

Nowhere are decisions about policies more important than in low and middle-income countries, where scarce resources and huge public health challenges mean that the steps governments take can make a difference to millions of people – often in life-or-death ways. Crafting measures that optimize the health of the population requires vision, including the foresight provided by public health experts who bring their research and experience to the process. In the following pages, read how UCLA Fielding School of Public Health faculty, students, alumni and their international partners are shaping global public health policy.

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Changing Children’s Chances

For the first time, the policies of every nation on matters critical to kids’ ability to reach their potential can be easily accessed and compared.

By shining a spotlight on the leaders and the laggards, Jody Heymann, who leads the ambitious project and is the new dean of the Fielding School, is moving countries to change.

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Dr. Jody Heymann points out that until recently, anyone with Internet access could easily find out the price of vanilla in countries all over the world, or compare the cost of a McDonald’s Big Mac across the dozens of nations where the fast-food giant operates. On the other hand, anyone wondering where parents could stay home and care for their sick child without fear of getting fired was out of luck.

Left: Dr. Jody Heymann, visiting working families in Bangalore, India, led the UCLA World Policy Analysis Center effort to compile comparative data on countries’ laws and public policies in areas affecting children’s opportunities to thrive. The first-of-itskind data can be found in Heymann’s book Children’s Chances and on an interactive website (childrenschances.org).

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It’s not that the information wasn’t out there. “The United Nations, for example, had done a phenomenal job at collecting all of the world’s labor laws,” says Heymann, dean of the UCLA Fielding School of Public Health. “But for a simple question like that, you would have to read 20,000 pages of labor legislation in a half-dozen UN languages. And if you wanted to answer something as simple as ‘Where is high school free?’ you had to read 193 country reports – thousands of pages, very dry, presented differently, also in multiple languages.

For all intents and purposes, this information was inaccessible.”

That changed in February when the UCLA World Policy Analysis Center, founded and led by Heymann, released never-before-available comparative data on the 193 UN countries’ laws and public policies in the areas of poverty, discrimination, education, health care, child labor, child marriage and parental care. In their book Children’s Chances: How Countries Can Move from Surviving to Thriving and through an interactive website (childrenschances.org), Heymann and co-author Kristen McNeill tell the story of what countries around the world are doing to ensure – or limit – children’s opportunities to reach their full potential.

The report includes full-color world maps and tables offering insights into global policies on a range of topics, such as how long each country protects girls from marrying compared with boys, which countries offer paid leave for new mothers and fathers, and which provide inclusive education to children with disabilities. The maps expose the countries that charge tuition for secondary education – thereby making it out of reach for poor children (38 do); and, on the positive side, the ones that prohibit hazardous work before the age of 18 (46 do).

Making all of this information publicly available and easily accessible through the Children’s Chances Initiative was a huge undertaking that involved seven years of work. Implicit in the effort is the understanding that national action, laws and public policies fundamentally affect children’s ability to thrive.

“All of us shape the lives of our children by how we raise them,” Heymann says.

“But there is no doubt that the context in which we live dramatically affects the opportunities for our kids. If you are a low-income family in a setting where everyone gets prenatal care because it’s universally provided, you are much better able to ensure a healthy start for your child. If primary, secondary and university education are free, the chances of your child attending all levels go up dramatically.”

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CHILD MARRIAGE Girls are particularly vulnerable to early marriage, which can often result in their being taken out of school.

In 54 countries, they are permitted to marry between one and three years before boys.

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While social concerns such as poverty and access to education warrant addressing on their own, Heymann points out that they are also inextricably linked to health. “When you look at why people get sick and how they fare once they become sick, this is determined by their environment and their social conditions much more than by what we do in the health care sector, as important as that is,” she says.

At a time when representatives from governments around the world are setting global goals that all nations should strive toward – the so-called “post2015” agenda – Children’s Chances urges a transformational shift from focusing solely on survival to targeting children’s full and healthy development.

Beyond the specific questions that can be answered about which countries advance what policies of consequence to children, Children’s Chances shines a spotlight on the leaders and the laggards, and enables comparisons among nations in the same region or at similar income levels. With a few clicks on the Children’s Chances Initiative website, citizens of any country can learn about their rights on a host of issues, and ultimately can hold their governments accountable for policy shortcomings. Heymann notes that within the first few weeks after the information was made available, people from more than 150 countries had visited the site.

Previously, no one had compiled this type of information in such an easily accessible way for several reasons, Heymann says. First, it’s a monumental task. Among other things, the researchers had to develop a framework enabling fair comparisons across different political and social systems

and cultures. An international, multilingual team had to sift through thousands of pages of documents to ensure rigorous analyses. “Like all large endeavors, something like this is best embarked on when you have no idea how much work it will take,” Heymann says, smiling.

There is also a much greater demand for the information – and, in the age of technology, much more utility to such a project. “Twenty years ago, we couldn’t get the information out to the whole world in a split second,” Heymann says. “That was simply not possible when countries from around the world first came to the UN in 1989 and agreed, under the Convention on the Rights of the Child, to make the lives of children around the world better.”

And finally, Heymann notes that the gaps in information were convenient for the laggard countries, and as a result, institutions not as insulated from politics as the university faced pressure to keep citizens and advocates for children in the dark.

“This information, when simply presented, is very powerful,” Heymann says.

Powerful enough to propel change, she believes – and Heymann already has evidence to support that contention. One of her center’s first publications pointed to the nearly universal availability of paid maternity leave throughout the world. In the African country of Lesotho, policy makers took note and passed paid leave. The next time the list of countries that don’t mandate paid maternity leave was published – including reports in the New York Times and other mainstream media outlets pointing out

--CHILD LABOR AND MINIMUM WAGE Six countries have no legislated minimum age for employment.

Children may be put to work as young as 12 or 13 years old in five countries, at age 14 in 29 countries, and at age 15 in 63 countries.

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that the United States is one of the few not to – Heymann received an email from a representative of the Lesotho government, complaining of still being listed. “What we’ve found is that when countries see where they stand, they care,” Heymann says. “The ones that think of themselves as leaders have contacted us to ask how they measure up, and some of those that have fallen behind have taken this as a time to move their policies.”

CALL TO ACTION Children’s Chances calls on world leaders to consider the following recommendations, among others, in shaping the post2015 agenda: EDUCATION • Make education free, especially secondary education. Quality secondary education and the employment opportunities it provides are key to lifting young people out of poverty.

• Increase educational-attainment requirements for teachers, accompanied by improved salaries and training to ensure that enough qualified teachers are available.

LABOR AND WORKPLACE • Protect children and youth from working long hours, which interferes with success at school.

• Ensure that minimum wages are high enough to lift families out of poverty without relying on child labor to supplement family income; provide financial assistance to low-income families supporting children.

• Ensure that workplace policies are in place that enable working parents to care for their children — especially critical in the context of changing global labor-market conditions.

MARRIAGE • Establish a minimum age for marriage that is the same for both sexes and that is high enough to allow children and youth to complete secondary education.

PARENTAL CARE • Countries that have not yet done so should guarantee paid maternity, paternity and parental leave, as well as leave to care for children's health needs.

CHILDREN WITH DISABILITIES • Address the specific needs of children with disabilities, including their access to inclusive education and the provision of supplementary income to meet their special needs.

While universal free primary education has become a reality for most of the world's children (in 166 of the 174 countries from which data were available), 61 countries still charge tuition for all or some secondary education.

Part of the mission of the Children’s Chances Initiative is to focus global attention on which countries have or haven’t adopted policies for which the evidence of the impact on children’s welfare is overwhelming. Heymann points to education as an example. “We know that if you have access to secondary schooling you will be healthier as a youth and as an adult,” she says. “As an educated parent, your children will be in better health. Education results in higher income, which is also related to health. And the evidence is strong that tuition makes it less likely that poor children and, in some societies, girls will attend. So with that policy, the most important thing we are doing is mapping where it is in place and where it isn’t.”

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FIGHTING DISCRIMINATION • Ensure that legal and constitutional provisions create a strong foundation against discrimination for all children and adults across the lines of gender, ethnicity, employment, religion and sexuality.

EDUCATION

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But the initiative also enables Heymann and her colleagues to measure the impact of policies about which less is known. “It was accepted that paid maternity leave could make a difference, but it wasn’t known how much time you needed to provide, or what the specific impact was on infant or child mortality,” Heymann says. “With this information, we did a study showing that an additional 10 weeks of paid maternity leave lowers infant mortality by 10 percent – a huge impact.” Another study showed that simply raising the minimum age at which children can work to 15 leads to a marked increase in the percentage completing secondary school.

MATERNITY AND PATERNITY LEAVE

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While the vast majority of countries provide maternity pay for new mothers – just eight do not, including the United States – far fewer make similar arrangements for fathers.

Only 81 countries provide paid leave that can be taken by men, either through paternity leave (67 countries) or through leave-time available to either parent.

Heymann points out that it’s possible to make a dramatic impact through policies that cost little. An example is the reduction or elimination of child marriage. “Too many countries around the world allow girls to be married off three years younger than boys,” she notes. “Eliminating that disparity brings tremendous health, educational and other lifelong benefits not only to the girls, but to their children when they are adults.”

Other areas, such as making education free and providing universal prenatal care, require governments to spend money. But the Children’s Chances Initiative data can identify which countries are under-investing compared to their level of wealth.

Moreover, Heymann notes, the many resourceconstrained countries that are ahead of the curve provide hope that significant change is feasible.

Indeed, while the scale of the problems facing the world’s children can seem overwhelming, Children’s Chances points to recent history as evidence that massive progress is possible on problems that once seemed unsolvable. Within the last 25 years, the proportion of people living in extreme poverty globally has been cut in half, the number of children under age 5 who die each day has dropped by more than 12,000, and the percentage of girls attending school has climbed from just three in four to more than 90 percent.

“Progress over the past few decades demonstrates that where there is a will, there is a way to make dramatic changes in children’s lives, from survival to basic education,” Heymann says.

“However, our findings show how far nations still have to go to realize a world where all children have a chance to thrive, not just survive.”

From the beginning, the leaders of the efforts to combat the epidemic in Southeast Asia and China have disproportionately come through Westwood and the UCLA/Fogarty AIDS International Training and Research Program, led by Roger Detels.

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Building a

LEADERSHIP NETWORK UCLAFIELDING PUBLIC HEALTH

to Fight HIV/AIDS in Asia

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Twenty-five years ago,

Asia had relatively few reported cases of HIV/AIDS. But Dr. Roger Detels knew from his experience on the continent and his understanding of infectious disease epidemiology that an epidemic was near. So when the Fogarty International Center issued a request for applications for capacity-building HIV/AIDS training programs to assist lower-income countries, Detels, a professor of epidemiology at the UCLA Fielding School of Public Health, decided to apply.

And while the majority of his U.S. colleagues crafted programs to assist countries in Africa, where the epidemic was rampant, Detels decided to concentrate on Asia.

others. Most of the HIV/AIDS prevention and control programs in China and Southeast Asia have been run by the program’s alumni. The program’s impact extends beyond HIV/AIDS prevention and control. Graduates have also gone on to highranking policy leadership positions, including two who became ministers of health: Shiing Jer Twu in Taiwan and Katalin Rapi in Hungary. Many have also conducted research – often in collaboration with Detels – that has influenced policy. (For an update on the careers of three UCLA/Fogarty alumni, see page 12.)

From the start, the program’s objective has been simple: to build the leadership capacity of the overseas institutions to control HIV/AIDS by preparing trainees in sophisticated epidemiologic techniques and research methods. Given that mission, Detels was adamant on two counts.

First, trainees would have to promise to return to their home institution at the completion of the program. And second, trainees would be required to complete the fieldwork for their master’s thesis or doctoral dissertation on their home turf, tackling an HIV-related problem with immediate policy relevance. “You want the trainees to be involved in projects that are going to inform the epidemic in their country and contribute to policies that effectively address the problem,” Detels says.

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“You want the trainees to be involved in projects that are going to inform the epidemic in their country and contribute to policies that effectively address the problem.”

It wouldn’t take long for Detels to prove prescient. Beginning in 1988, just after the UCLA/ Fogarty AIDS International Research and Training Program (AIRTP) was funded, there was a sharp increase in injection drug use in the countries bordering Southeast Asia’s infamous Golden Triangle, long known for its opium production.

By the following year, high proportions of injection drug users in Thailand, Myanmar, China’s Yunnan Province, and northeast India were found to be infected. Thailand’s early surveillance program, implemented in 1989, documented the spread of HIV/AIDS from the injection drug-using population to commercial sex workers, and from there it moved outside the highest-risk groups and into the majority heterosexual population.

For as long as HIV/AIDS has been a major issue in Southeast Asia and China, something has been particularly striking about the leaders of the programs aiming to combat the epidemic in those regions: the large number who have trained at the UCLA Fielding School of Public Health through the UCLA/Fogarty AIRTP (one of the original eight in the country funded; eventually there would be more than two dozen). In 25 years, the Detels-led program has provided education and training leading to a master’s or doctoral degree for more than 100 health professionals from low and middle-income nations, as well as informal training to countless

As the UCLA/Fogarty program was being launched in the late 1980s, many of the collaborating nations were grappling with their first reports of rapidly spreading HIV. Not wanting to pull leaders out of their country for a 2-4 year program at such a time of need, Detels traveled abroad and offered 1-2 week in-country trainings as an alternative.

The short courses had the dual benefit of helping the low and middle-income nations get their HIV/ AIDS control programs up and running while strengthening UCLA’s relationships with the collaborating institutions. Detels was often afforded the chance to meet with government officials, and he never passed up an opportunity to urge them to recognize and invest in addressing their epidemic’s root causes.

HIV initially spreads through high-risk groups – in Asia, it most commonly started in sex workers and injection drug users – before moving into the general population. The most effective way to prevent the spread of the disease is to protect these

11 the ministry implemented a vigorous nationwide quality control program, including better training.

There have been many similar instances in which research by Detels and his trainees have helped to guide HIV/AIDS policies. In Vietnam, Detels and one of his trainees demonstrated that the epidemic in commercial sex workers was driven by injection drug use, not by exposure to clients; as a result, the government is now investing more heavily in methadone maintenance clinics. On the basis of research by two UCLA/Fogarty trainees, En Wu Liu and Chun Ching Lin, on the barriers to successful retention rates in methadone maintenance programs in China, the government stepped up staff training at the clinics. In Beijing and northern Thailand, Detels and UCLA/Fogarty trainees Guo Ben Zhao and Preecha Prempree found that the majority of people with sexually transmitted diseases don’t frequent government clinics, leading to fundamental changes in the focus of STD prevention programs.

Through the contacts he’s made over the program’s 25 years, Detels is often brought in to consult with government and public health officials in the countries where his trainees have become policy leaders.

When he isn’t collaborating professionally with his former protégés, he remains in regular email contact with many of them. Even more important, says Detels, the program has produced a network of public health professionals throughout China and Southeast Asia – former UCLA/Fogarty trainees who communicate with each other, providing advice and support.

The revelation in 1995

by Detels and Wu led China’s Ministry of Health to move swiftly, shutting down all commercial plasma centers.

The issues UCLA/Fogarty alumni are facing in the fight against HIV/AIDS have changed considerably in the quarter-century since the program started, and many of the graduates are now involved in other public health efforts. But Detels stresses that the basic principles that he teaches the trainees are unchanged. “My intention was always that these trainees would go on to deal with issues other than HIV,” he says. “If you are skilled as an epidemiologist and a methodologist, you can apply that skill to any public health problem.”

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marginalized, high-risk populations – politically not always an easy task. In the early years, Detels and UCLA/Fogarty alumni encountered resistance from government officials who refused to acknowledge that they had a population of sex workers, to openly promote condom use, or to distribute clean needles to injection drug users. But there were successes. In Thailand, aggressive campaigns for clean needles, condom distribution and education are believed to have reduced the number of infections by hundreds of thousands. The country responded swiftly to the first sign of a problem, establishing an early-warning system with assistance from Detels and one of his early collaborators, Kumnuan Ungchusak; then following up with bold strategies, including a strict edict requiring brothels to ensure that condoms were used by every client. New cases of HIV infection dropped by 80 percent. While other countries in the region attempted to suppress commercial sex, driving the trade underground and making it more difficult to track the high-risk population, Thailand, followed by Cambodia, put economic pressure on brothel owners by threatening to shut them down unless all clients in their establishments used condoms.

Indeed, for Detels one of the most exciting aspects of the UCLA/Fogarty legacy is the impact the research of the program’s trainees and alumni has had in guiding policy. “The distance between research and policy in China and Southeast Asia seems to be much shorter than in the United States,” says Detels. “The governments tend to be more receptive to implementing the results of research, and we have seen many examples of our work leading directly to policy changes in the response to HIV and AIDS.” One of the most prominent illustrations of this impact involves work by Detels and one of his early trainees, Dr. Zunyou Wu, in providing the first reports of an HIV epidemic among a population of plasma donors in China – poor rural villagers who would sell their blood to commercial centers as many as 2-3 times a week. The revelation in 1995

by Detels and Wu that many of these individuals were infected – most likely through contaminated equipment used in the collection of plasma and reinjection of blood cells – led China’s Ministry of Health to move swiftly, shutting down all commercial plasma centers. The ministry then asked Detels and Wu to evaluate the safety of the blood supply in rural areas. When the pair identified problems with laboratory testing at the local and provincial levels,

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Acting Boldly: Dispatches from the HIV/AIDS Battlefield

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Since the earliest reports of the spread of HIV/AIDS through China and Southeast Asian countries, the UCLA/Fogarty AIDS International Training and Research Program has prepared many of the leaders in the battle against the epidemic. The experiences of three of the program’s alumni illustrate some of the challenges these leaders have worked to overcome.

“They realized that the detox approach was failing, saw the benefits of methadone maintenance … and wanted to apply it to Vietnam.”

Dr. Nhu To Nguyen (above, center)

In 1998, the year Dr. Swarup Sarkar started as director of the South Asia region for UNAIDS, the Joint United Nations Programme on HIV/AIDS, the consensus held that the epidemic was headed the way of Africa – generalized across the population to an extent that, as Sarkar remembers hearing it, “you had to do everything everywhere to try to stop it.”

After ordering a careful analysis, Sarkar concluded otherwise. In Asia, he found, HIV infection was concentrated in specific populations. The best way to control the epidemic was not to spread precious resources around but to focus them on efforts targeting these high-risk groups.

This was much easier said than done.

“We were talking about making an investment in neglected populations, including gay people, sex workers and people who use drugs for recreation,” Sarkar recalls. “Asking politicians and other policy leaders to provide funds for these groups was difficult.

They were much happier spending money on families and ‘good young people.’ But with our analysis we were able to convince them to change policy.”

Dr. Nhu To Nguyen has seen how stigma can work against efforts to control the spread of HIV. In Vietnam, where Nguyen is associate director in charge of drug use intervention and HIV prevention for the nonprofit organization Family Health International (FHI 360), the prevailing view of drug addiction as a moral failure rather than a public health issue was reflected in the illegality of methadone treatment until 2006 – even as the sharp rise in heroin addiction fueled a growing HIV/AIDS epidemic. But the last seven

but needs to be managed,” Nguyen says. “They realized that the detox approach was failing, saw the benefits of methadone maintenance – both for treating heroin addiction and for reducing the spread of HIV through sharing of syringes – and wanted to apply it to Vietnam.”

Methadone maintenance clinics were well established in Thailand by 2001, the year Dr. Tanarak Plipat started as chief of the national HIV/STI/TB surveil-

Vietnam had a nationwide system of compulsory residential detoxification rehabilitation centers. These centers received repeated Human Rights Watch and UN criticisms for ineffective treatment models, forced labor and risks of exposure to HIV and other infections. Post-discharge heroin relapse rates were acknowledged to be higher than 90 percent.

By the time Nguyen began working for FHI 360, the organization, with support from PEPFAR and others, had been lobbying Vietnam’s Ministry of Health for several years, bringing high-ranking officials to other countries to meet with experts and visit successful methadone maintenance programs.

“This helped them to understand that addiction is a chronic brain disease and that it can’t be cured,

lance unit. An epidemic of HIV among drug users had spread through both China’s Yunnan Province and northern Thailand in the late 1980s. Unlike their Chinese counterparts, the Thais had responded swiftly to the first sign of a problem, establishing a sentinel surveillance (early warning) system with assistance from Dr. Roger Detels, professor of epidemiology at the Fielding School and director of the UCLA/Fogarty AIDS International Training Program, where Sarkar, Nguyen, Plipat and many other leaders in the fight against the HIV/AIDS epidemic in China and Southeast Asia would train. Bold strategies targeting marginalized populations – including a strict edict requiring brothels to ensure that condoms were used by every client – were credited

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In Thailand, bold strategies targeting sex workers and other marginalized populations early in the HIV/AIDS epidemic are credited with preventing hundreds of thousands of new infections.

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years have seen a dramatic paradigm shift, thanks in part to the efforts of Nguyen and her FHI 360 colleagues, as well as international organizations such as UNAIDS, PEPFAR and the World Health Organization.

HIV prevalence has been highest in Vietnam among injecting drug users, most of whom are addicted to heroin. Overall, about one-third are infected, and prevalence is estimated to be as high as 50-56 percent in some provinces. Prior to 2008,

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“If you’re saying let’s open up a clinic in the brothels, run by the sex workers … and give them money to administer the program, that’s a radical shift.

But that’s how to make sure people who need the services are reached.”

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Dr. Swarup Sarkar

The introduction of methadone maintenance programs in Vietnam starting in 2008 has successfully addressed HIV infection as well as heroin addiction. At this clinic in Hanoi, patients are provided comprehensive HIV services in addition to daily methadone treatment.

with preventing hundreds of thousands of new infections. Before long, public health leaders in other Asian countries were visiting Thailand to learn about the system and adopt similar strategies.

Plipat used his UCLA/Fogarty training to improve on Thailand’s strategies to control the epidemic. When he arrived, the HIV surveillance system had three components: an AIDS case reporting system, HIV sero-surveillance and HIV-related behavior surveillance. “The system had shown the path of HIV transmission – from injecting drug users to female sex workers to their male clients to the general female population, and finally to babies born from HIV-positive mothers,” Plipat says. “It also helped confirm the decline of HIV spread after the introduction of the 100-percent condom program.”

Plipat initiated new surveillance strategies in response to patterns the early-detection system had identified. A perinatal HIV outcome monitoring system was established to track the effectiveness of a program to prevent mother-to-child HIV transmission. In 2003, the epidemic was first seen taking hold among the population of men who had sex with men (MSM). Plipat’s unit responded by adding a system to monitor HIV status and HIV-related behavior among the MSM population, including a new sampling technique using hand-held computer

devices and HIV saliva testing at the venues they frequented. And with the epidemic rising among non-venue-based female sex workers, Plipat established a similar system to monitor HIV status and behavior among that population.

In December 2006, Vietnam’s parliament passed an HIV/AIDS prevention and control law that made methadone a legal harm reduction approach, and Nguyen and her FHI colleagues began working with the Ministry of Health to develop the pilot methadone maintenance model and provide technical support.

Since 2008, FHI 360 has helped to implement programs or provide oversight at more than 60 clinics in 20 provinces, supporting 13,000 patients. The results have been dramatic. FHI 360 conducted an evalua-

tion of the first 1,000 patients at the pilot clinics over a 24-month follow-up period and found a sharp reduction in heroin use, with 84 percent testing negative for the drug. The patients who continued using heroin were significantly less likely than previously to share needles. The study cohort practiced safer sex and reported substantial improvements in quality of life, physical health and employment status.

Only one patient converted to HIV-positive.

Implementing the programs hasn’t always been easy. “Methadone is an addictive substance, and many people think we should be promoting abstinence,” Nguyen says. She notes that some authorities continue to view addiction as both criminal and a social evil rather than focusing on the need to provide care. Government funding for the methadone maintenance program is still limited compared with funding for the compulsory rehab centers.

But even with these concerns, the paradigm shift in drug treatment has been a resounding success.

“The communities have seen immediate benefits from the programs – from patients being able to stop using heroin after several weeks, and from reductions in crime,” says Nguyen. “Many heroin-dependent individuals want the treatment, but the program is not yet widely available.” As a result, the Ministry of Health has ambitious plans to expand the methadone maintenance programs so that they will serve up to 80,000 injection drug users in 30 provinces by 2018.

“The system had shown the path of HIV – from injecting drug users to female sex workers to their male clients to the general female population, and finally to babies born from HIV-positive mothers.”

Dr. Tanarak Plipat (above right, with Dr. Paijit Warachit, permanent secretary of the Thailand Ministry of Public Health)

15

UCLAFIELDING PUBLIC HEALTH

Sarkar’s UNAIDS group successfully pushed South Asian countries not only to focus prevention services and strategies on these marginalized groups, but to do so in non-traditional ways. He argued, for one, that for the services to reach at-risk communities, the communities themselves had to run them. “If you’re saying let’s open up a clinic in the brothels, run by the sex workers – who were often illiterate – and give them money to administer the program, that’s a radical shift,” Sarkar notes. “But that’s how to make sure people who need the services are reached.”

The second major shift was to create what Sarkar’s group would call an enabling environment.

“You have to address the barriers that are keeping people from accessing the services,” Sarkar explains.

When developing HIV prevention strategies for the non-governmental organization Care International in Bangladesh, Sarkar’s group had asked sex workers how they could best be helped. The responses were unexpected. The sex workers hadn’t been allowed by police to wear shoes in their community so that they could be easily identified – and also extorted for money. They sought permission to wear shoes, and wanted access to education for themselves and their children. “These things that seemed to have nothing

to do with health had everything to do with whether the population would use the health services,” says Sarkar, now an advisor to the director of UNITAID, a Geneva-based initiative of the World Health Organization aiming to lower the cost of medicines for HIV/AIDS, malaria and tuberculosis in low and middle-income countries. “The sex workers wanted to be treated as humans and not be discriminated against – a strategy that often involves not money but social adjustments.”

Sarkar’s leadership in moving Asian countries toward these types of investments for high-risk, traditionally neglected populations had a ripple effect.

“Other than countries in sub-Saharan Africa, the epidemic was concentrated in these neglected groups in most parts of the world,” he says. “Soon, our approach in Asia became the standard almost everywhere. Now, globally for every dollar spent on antiretroviral treatment, almost two dollars is spent on non-medicinal interventions. People with HIV can come to the clinic, have their own organization, and the stigma surrounding them is addressed.”

16

As Beijing grapples with record levels of air pollution, Yifang Zhu and her UCLA colleagues are teaming with Peking University scientists to guide policy makers, drawing UCLAFIELDING PUBLIC HEALTH

lessons from Los Angeles.

A TALE OF

TWO

OUTDOOR AIR POLLUTION played a role in an astounding 1.2 million premature deaths in China in 2010, according to the 2010 Global Burden of Disease Study, published in the British journal The Lancet. Even more ominous is the likelihood that the problem has escalated in the three years since. Earlier this year, the Chinese government reported that particulate pollution was 30 percent higher than for the same period in 2012. Nowhere is the situation more urgent than in Beijing, where in January the U.S. Embassy measured fine particulate matter in the air and found it to be 35 times the World Health Organization’s recommended standard.

Air pollution, especially particulate matter measuring 2.5 microns or smaller in diameter (PM2.5), has become a high-priority topic among policy makers in China. In March the government announced it would spend 100 billion yuan (the equivalent of $16 billion) over the next three years to tackle Beijing’s pollution woes.

Dr. Yifang Zhu, associate professor at the UCLA Fielding School of Public Health, is part of a group of researchers at UCLA and Beijing’s Peking University who are collaborating on a series of studies on particulate matter pollution, including how motor vehicle emissions affect air quality in Beijing. The goal is to provide guidance to policy makers as they grapple with an issue of growing concern. “The Chinese government has begun to invest significant resources in air quality research, hoping to use the science to develop policies that will lead to improvements,” Zhu says.

Peking University, one of China’s leading academic institutions, boasts an active research program focusing on air pollution in Beijing. But the partnership with Zhu and colleagues – forged through the Joint Research Institute in Science and Engineering, which promotes collaborative work between UCLA and Peking University faculties – has particular value. “Beijing can draw lessons from the experience of Los Angeles,” says Zhu, who has studied air pollution in both cities. “Thirty years ago, Los Angeles was just as bad as today’s Beijing.”

In Los Angeles, Zhu notes, rapid economic development in the 1970s contributed to dangerously high levels of particulate matter. But aggressive regulatory measures – including changes in fuel and vehicle emission standards – led to dramatic improvements in air quality, even as the traffic volume increased substantially.

In Beijing, the major source of concern is with the levels of PM2.5, which come mostly from combustion sources and are considered to be a greater public health threat than larger particles because they penetrate the human respiratory system more deeply. “These are suspended particles in the air that people breathe, with a variety of respiratory, cardiovascular and other effects that have been documented in the research literature,” Zhu notes. “When their concentration is high, they also dramatically reduce visibility, which is when most of the public perceives the problem.” The U.S. Environmental Protection Agency first adopted a national ambient air quality standard for PM2.5 levels in 1997. PM2.5 is not currently regulated in Beijing, but the Chinese government is moving toward establishing a national standard.

CITIES

importance of understanding the characteristics of local pollutants so that you know where to focus resources, and then developing policies that reduce emissions in a cohesive way.”

Despite these differences, Zhu says, there are plenty of lessons Beijing can draw from the experience of Los Angeles, particularly when it comes to the issue of motor vehicle emissions.

Zhu explains that there are three approaches to tackling the problem: 1) improving the quality of the fuel, so that each gallon burned emits less; 2) improving the technology of the vehicles, so that each gallon of fuel stretches more miles; and 3) reducing the number of vehicle miles driven in the basin through strategies such as public transportation, carpooling and other incentives to reduce driving.

In Los Angeles, Zhu notes, the first two approaches have played a much larger role in improving air quality than the third; in fact, her group measured particulate matter emissions around a busy section of Interstate 405 near UCLA in 2001 and again in 2011, and found a dramatic reduction despite increased traffic volume over the 10-year period. “This is not to say that we shouldn’t work on reducing vehicle miles traveled,” Zhu says. “But changes in fuel and vehicle technology can be implemented much more easily at a societal level. In Beijing, more stringent vehicle emission standards and cleaner fuel could produce many benefits.”

Beijing’s Environmental Protection Bureau lacks the regulatory infrastructure of the South Coast Air Quality Management District and U.S. Environmental Protection Agency, which can enforce policies under the Clean Air Act. But Chinese government actions in advance of the 2008 Summer Olympics in Beijing, which dramatically lowered emissions – albeit temporarily – show that change is possible, Zhu says.

Cultural differences, including the much greater preponderance of smokers in Beijing than in Los Angeles, also present a challenge.

“It can be harder to sell the importance of clean air to someone who smokes a pack of cigarettes a day,” Zhu says. Nonetheless, she believes public sentiment on behalf of change has grown as the air has gotten dirtier: “People are not happy about what’s going on,” Zhu says. “These are not easy problems, but the experience of Los Angeles shows that they are solvable.”

UCLAFIELDING PUBLIC HEALTH

Los Angeles and Beijing are different in many ways, Zhu notes. Los Angeles’ unique topography and climate – surrounded by mountains and regularly bathed in sunshine, making the basin susceptible to ozone and oxidized particulate matter formation – combine with its car-dominant culture to present significant air quality challenges. “In Los Angeles, we are dealing with emissions from our own basin that get cooked by the sun,” Zhu says. “But in Beijing, they are subject to their own sources as well as industrial emissions from surrounding cities.”

While motor vehicle traffic is also a major concern in Beijing, other lifestyle factors are important, including how residents cook and use their energy. Zhu and her UCLA and Peking University colleagues are in the early phases of their research, but already they have made a surprising observation – that a significant portion of particulate matter in Beijing, even near roadways, comes from cooking activities. “The hightemperature wok style of cooking all over the city generates a large number of particles in the air,” Zhu explains. “Our finding illustrates the

17

18

Zuo-Feng Zhang got his start providing preventive care to China’s rural poor as a barefoot doctor.

UCLAFIELDING PUBLIC HEALTH

As an epidemiologist at the FSPH, he continues to influence the health of his native country.

WHEN DR. ZUO-FENG ZHANG WAS 15, he was one of more than 16 million students sent to the Chinese countryside to accept “re-education.”

The year was 1969, and China was in the midst of Mao Zedong’s Cultural Revolution. Zhang was soon chosen by farmers to become a “barefoot doctor,” bringing basic preventive medicine to the rural poor under a Rural Cooperative Medical System program.

More than four decades later Zhang is an epidemiologist at the UCLA Fielding School of Public Health and his native China operates under a far different political structure. The barefoot doctor and Rural Cooperative Medical System were eliminated by 1980, along with most of the other

Maoist reforms. “The thinking was that as a product of the Cultural Revolution, it couldn’t be good,” says Zhang. “But it was a very effective system. For only a small amount of money, farmers could get basic treatment and preventive measures for common problems such as headache, cold and diarrhea. Once the system was abolished, a lot of people couldn’t afford to pay for medical services.”

Zhang’s life today appears far removed from his days as a barefoot doctor. Rather than treating Chinese peasants for everyday ailments, he’s using the latest molecular approaches in his UCLA laboratory to identify tumor markers, genetic mutations and inherited susceptibilities. But if the techniques are more sophisticated and the target populations much larger, Zhang remains focused on prevention – and on the health concerns in his country of origin.

While at UCLA, Zhang has continued to devote a portion of his time to conducting research in China on the major risk and protective factors for four of that country’s leading cancers – lung, stomach, esophageal and

liver – and targeting preventable risks that could be influenced through policies, including smoking, alcohol consumption, diet, indoor air pollution and water pollution.

In 2004, he went to China to serve as a consultant charged with making policy recommendations to the World Health Organization (WHO) and Chinese government on noncommunicable disease prevention and control.

Zhang spent four weeks as a WHO consultant on non-communicable disease (NCD) prevention and control in China. “NCDs account for 60 percent of deaths worldwide but more than

improving

CHINA’S HEALTH, from near & far

Among the recommendations of Zhang’s report: • The national government should play a proactive role, with a stable budget for NCD research, prevention and control.

• The State Council or Ministry of Health should publish an annual report on risk factors for major NCDs. • The Ministry of Health should consult with national and international experts in establishing a national plan for NCD prevention and control, integrated with medical system reform.

• Existing demonstration projects to monitor and evaluate interventions aimed at reducing the NCD burden should be continued and expanded.

One of the major emphases of Zhang’s report was tobacco prevention and control. China is home to 350 million smokers; an estimated 1.2 million Chinese die each year from smoking, and many more become disabled. The issue is politically sensitive in China, which owns the tobacco industry and derives a considerable amount of revenue from tobacco sales.

Zhang recommended a first-of-its-kind 0.5 yuan per pack tax, with the money going to NCD prevention and control research; along with publication of an annual report on smoking and health, similar to the U.S. Surgeon General’s report.

Although Zhang’s report was only one of many contributing factors, change on the issue of tobacco control was swift for a country that had long shied away from acknowledging the problem. In October 2005, less than a year after Zhang’s report, China ratified the landmark WHO Framework Convention on Tobacco Control. China started the International Tobacco Control Policy Evaluation Project the following April, and in May 2007 the Ministry of Health released the first annual report on tobacco prevention and control, as Zhang had recommended.

In 2011, the Ministry of Health launched a ban on smoking in indoor public spaces.

When the Chinese Ministry of Health and 14 other ministries and state administrations issued the China National Plan for NCD Prevention and Treatment (2012-2015) in May 2012, many of the plan’s key features followed Zhang’s 2005 report, including its strong emphasis on integrating prevention with treatment and emphasizing primary health care. “This is a plan that indicates a critical national policy change,” Zhang says.

“I was very pleased to see that the report referred to some of my recommendations.”

Zhang has another reason to be pleased: The medical system reform into which the NCD prevention and control program is being integrated includes the New Rural Cooperative Medical System (NRCMS), established in 2005 to make health care more affordable to the rural poor.

Zhang hopes that the new focus on NCD prevention and control within the Chinese medical system will help to ensure continued funding for the NRCMS, which draws heavily on lessons from the barefoot doctor era that launched Zhang’s career.

UCLAFIELDING PUBLIC HEALTH

80 percent of deaths in China, and thus should be a high priority of public health policy,” Zhang says. “But at the time there was no plan.”

During his stay, Zhang organized a four-day WHO training course; visited national, provincial and local Chinese Center for Disease Control and Prevention offices and reviewed reports from various sources on NCD prevention and control efforts in China. His final report, issued to both the WHO and the Chinese government, made the case for an integrated national NCD prevention and control effort. “NCDs kill many more people than all other diseases combined, and should be considered the highest priority for prevention,” Zhang argued, adding: “The majority of NCD deaths are preventable through effective behavior intervention measures such as tobacco cessation, reduced alcohol consumption, improved diet and physical activity levels, and weight and blood pressure control.”

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20

Well before the U.S. passed the Affordable Care Act, Arturo Vargas-Bustamante was part of his country’s successful effort to move toward universal health coverage.

A NEW POLITICAL PARTY ASSUMES POWER with the election of a highly popular president who is expected to institute major policy changes, not the least of which is reforming a failing health care system. But the effort to pass landmark legislation ensuring universal access to care meets with considerable resistance from the political opposition in Congress and powerful special interests. In the end, a law passes that most public health advocates view as representing significant progress, although it doesn’t go as far as they might have hoped.

If this sounds like a description of the events leading to the approval and implementation of the U.S. Patient Protection and Affordable Care Act of 2010, that’s because Mexico’s earlier experience in passing the 2003 System of Social Protection in Health legislation – which included Seguro Popular (popular insurance), a program designed to bring universal coverage to a nation in which half of the population was uninsured – bears remarkable similarities to what would unfold in the United States by decade’s end.

Dr. Arturo Vargas-Bustamante joined the administration of Vicente Fox when he was elected president of Mexico in 2000, and for the next two years Vargas-Bustamante, now an assistant professor at the UCLA Fielding School of Public Health, worked for the Financial Protection Unit in Mexico’s Ministry of Health, conducting research that helped to shape Seguro Popular’s development.

Vargas-Bustamante was charged with comparing potential approaches to reform with the experiences of other countries in Latin America, and analyzing the types of health insurance coverage that could be integrated within the design of the program. “The idea was to project the outcomes of each scenario being considered,” he explains. “We would take an ambitious proposal, a middle-of-the-road proposal, and a conservative proposal and brief the minister of health on what was likely to occur based on each – taking into account the political, legal and economic consequences.”

Faced with a country in which half of the population – nearly 50 million Mexicans – was uninsured, the government set out to pass legislation that would achieve universal coverage. “The major issue was funding,” Vargas-Bustamante says. “How were the funds allocated to this proposal going to be used to reach those who most needed to benefit?” Another question the policy makers had to consider was one the United States would later face: how to maximize participation in the new insurance plan. What incentives should there be to enroll – a mandate or subsidies? Finally, how would health care services be delivered under the new insurance plan – in public clinics, private clinics, or a mixture of the two – to ensure that the people who enrolled received quality care?

Looming over the development of Seguro Popular were the political realities. Fox’s election had broken the 71-year uninterrupted rule of the Institutional Revolutionary Party (PRI), raising expectations for radical change. But the Mexican Congress remained dominated by the PRI, many in Fox’s administration were linked to the old party, and interest groups that benefited from the status quo were poised to dig in. “We had to find that middle balance between knowing that the population wanted major reforms, but also being aware that there was going to be political resistance,” VargasBustamante recalls.

If that aspect of the Mexican experience was similar to what the Obama administration faced beginning in 2009, other factors made the policy environments quite different.

On the one hand, Mexico is a considerably poorer nation than the United States, with far fewer economic resources to allocate to health care. Yet in other ways, structural factors made the task of passing and implementing reform in Mexico easier.

A centralized, publicly managed government health plan is the main provider and financer of public health services in Mexico, whereas the private sector is the primary provider in the United States, with public financing divided between the states and the federal government.

The legislation that passed in 2003 – essentially shifting the existing public program to an insurance-based system – fell short of what Vargas-Bustamante might have considered ideal. Nonetheless, Vargas-Bustamante notes, the financial incentives for the poor – access to health services that are virtually free – make enrollment “a no-brainer.” VargasBustamante’s group also hoped to emulate the experiences

Mexico’s Experience wi

21 of nations such as Colombia and Chile, where public financing is used to spur competition among public and private health care providers for health plan enrollees. That proposal was shot down by various interest groups, although a compromise provision enables plan administrators to outsource with private-sector providers when public clinics are unable to deliver the services guaranteed in the plan.

th Health Care Reform

UCLAFIELDING PUBLIC HEALTH

The primary goal of Seguro Popular was to improve access to care for vulnerable populations that were uninsured and unable to obtain health coverage under the previous system.

By that measure, the program, which was first implemented in 2004, has succeeded. Every Mexican is eligible to enroll, and doing so guarantees a wide range of basic health services, as well as medications and coverage of major illnesses. Fees are based on income; for the majority of enrollees, though, the cost is next to nothing.

To be sure, there have been problems, notably with uneven quality and inefficiencies in the delivery of Seguro Popular services.

“The health care system is still segmented, like it is in the United States, which promotes the accumulation of benefits in very privileged sectors of society,” says Vargas-Bustamante.

“The best approach to reform would have been to unify the health care system. But that is controversial. A lot of people benefit from the way it is now.”

According to the Mexican government, the country reached its goal of universal health insurance coverage in 2012. Vargas-Bustamante notes that research indicates the poorest families have benefited most from the program through reduced out-of-pocket expenditures.

“The policy wasn’t the ideal way of expanding coverage,” Vargas-Bustamante says. “But it is probably the best we could have done politically, and it has helped millions of families.”

22

AfRiC an PFoarutrnerships

UCLA Fielding School of Public Health students spent the bulk of the s ummer of 2012 in four

different African nations conducting health policy-related work as part of their field study requirements. All four received funding support from the school–

Lauren Goodwin & Roch Nianogo from the Bixby Program in

Popu lation and Repr od u ctive

Eric Leas & Kat Stoneham fromthe Drabkin/Neumann Health;

UCLAFIELDING PUBLIC HEALTH

Global Public Health Field Experience Endowment.

In all cases, the

experiences made a

lasting impact, as the students recount here.

23

Lauren Goodwin United States Agency for International Development Ethiopia

UCLAFIELDING PUBLIC HEALTH

ETHIOPIA HAS A CHRONIC SHORTAGE of highly skilled physicians, and nowhere is this more painfully evident than in rural communities. With physicians concentrated in urban centers, many rural residents have almost no access to complex and specialty care. Telemedicine (the use of technology to provide care and training at a distance) offers a potential solution – a means to bridge the gap in rural communities’ access to health services and strengthen the capacity of the health system by training physicians.

During my internship at the United States Agency for International Development (USAID)/Ethiopia, I interviewed and surveyed telemedicine implementers and used their programmatic information as the basis for a status report on telemedicine programs. The report included a comprehensive literature review of telemedicine programming in Ethiopia, which helped illuminate common successes and challenges. Successes included international partnerships and simple software design for fast upload time; among the challenges were slow Internet speed and connectivity, as well as a recent ban on free-use Voice-over Internet Protocol (VoIP) programs for businesses, such as Skype.

After I interviewed telemedicine implementers, it became clear that a coordinated effort was needed. Multiple international and Ethiopian programs were operational, but a lack of communication limited the ability to share best practices and collaborate. My report serves as a baseline for telemedicine programming in Ethiopia and provides four policy recommendations: 1. Adopt a formal Ethiopian telemedicine policy 2. Provide a government waiver for not-for-profit telemedicine programs to use VoIP programs (Skype) to deliver programming 3. Establish a formal telemedicine committee to aid in sharing best practices 4. Develop formal public communication advertisements from key Ethiopian health leaders to educate the public about telemedicine services Prior to arriving in Ethiopia, I had a limited understanding of the possibilities presented by telemedicine. After dedicating a summer to learning from the talented people at USAID, the Ethiopian Federal Ministry of Health and several telemedicine partners, I have a deep appreciation for its power as a tool to bridge the gap in access to health care for rural communities.

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Eric Leas United States Agency for International Development Rwanda

UCLAFIELDING PUBLIC HEALTH

THREE WEEKS INTO MY 10-WEEK INTERNSHIP with the United States Agency for International Development (USAID)/ Rwanda, my field mentor was evacuated for surgery. In her absence I found myself forced to gain confidence in tasks I hadn’t felt qualified to perform a year out of a bachelor’s degree and a year into a master’s program.

My most difficult – and ultimately most rewarding – responsibility in Rwanda was developing guidelines for compliance with U.S. environmental policies in USAID/Rwanda’s health service activities. This was not a trivial responsibility. Rwanda’s high altitude, substantial annual rainfall, and large quantity of water in the form of lakes, rivers and wetlands create unique challenges. A breakdown in environmental protection could mean a flow of contaminants into Rwanda’s water supply – which, because of its geography, could cause contaminants to flow downstream to regions receiving water from Rwanda. Such activity could be destructive to biodiversity and/or pose biological, chemical and physical risks to human health in the huge swaths of Africa receiving water from the Congo and Nile rivers. My task was to document the potential environmental threat each USAID/Rwanda health service activity posed, leading to recommendations for the next steps in risk mitigation. I entered my internship with minimal experience in U.S. environmental policy but spent much of my time at the outset researching policy and learning as much as I could from the environmental officers at the mission. I looked at the threshold standards for environmental compliance established by the government of Rwanda and USAID and prepared documentation that ultimately identified the following as posing environmental and health risks resulting from USAID/Rwanda health service programs: 1. Activities and training involving treatment in health centers, blood testing, and generation of hazardous medical waste 2. Provision of equipment and supplies to health and education facilities; activities involving procurement, storage, management and disposal of public health commodities, including pharmaceutical drugs 3. Use of pesticides under indoor residual spraying and insecticide-treated bed nets 4. Water and sanitation activities; household water treatment and safe storage Ultimately, my work made a difference: USAID/Washington approved the documentation and the health programs flagged as having these components were required to take steps toward preparing risk mitigation plans.

25

Roch Nianogo African Network for Health Education Senegal

UCLAFIELDING PUBLIC HEALTH

IN MANY PARTS OF THE WORLD there is growing interest in the use of mobile devices for health promotion – so-called mHealth initiatives. I spent the summer of 2012 in Dakar, Senegal, mapping and evaluating mHealth initiatives in six Frenchspeaking countries of Africa (Senegal, Mali, Burkina Faso, Benin, Cameroon and Cote d’ivoire) through an organization called Réseau Africain d’Education pour la Santé (RAES), or African Network for Health Education. RAES is a non-governmental organization whose mission is to strengthen health, education and citizenship programs in Africa through information and communications technology.

Within RAES, the research is part of a project called Djobi, whose aim is to address maternal and child health using mobile technologies through local community health insurance systems. More generally, our research sought to respond to a global need stemming from the lack of evidence-based knowledge and practice on the effectiveness and sustainability of mHealth initiatives. It also aimed at addressing the scarcity of information on mHealth initiatives being conducted in French-speaking African countries compared with those implemented in English-speaking countries. The RAES research group, which included personnel from UCLA and the World Health Organization, recruited and electronically surveyed approximately 30 mHealth initiatives throughout the six countries. The study is currently in the final stages of analysis and report writing.

It wasn’t easy. Communication with the disparately located study participants via email was difficult, and the absence of an updated contact directory hindered telephone contact. But this type of evaluation research is well worth the effort. Public health professionals must keep the discussion going by conducting studies of this sort and organizing summits. The RAES group is striving to inform countries, stakeholders and researchers on evidence-based best practices for mHealth so that they can be replicated and scaled up while avoiding wasteful duplication of ineffective initiatives.

The greatest public health lesson I learned from my experience at RAES is reflected in the African proverb: “If you want to go fast, go alone. If you want to go far, go together.” Building partnerships and forming multidisciplinary teams are the keys to producing meaningful change.

26

Kat Stoneham Stop Malaria Project Uganda

UCLAFIELDING PUBLIC HEALTH

ARGUABLY NO PUBLIC HEALTH PROBLEM is as urgent in Uganda as malaria, the nation’s leading cause of morbidity and mortality. Malaria accounts for approximately 10 million cases per year and roughly one in 10 hospital deaths, many of them children. And the problem appears to be worsening. According to the 2009 Uganda Malaria Indicator Survey, for example, 30-50 percent of children ages six months to 5 years have malarial parasitemia observable by microscope.

To complete the practical component of my M.P.H. degree, I sought international experience and found it at the Stop Malaria Project (SMP). Supported by funding from the Drabkin Foundation, I was based for three months at the SMP Central Office in Kampala, Uganda. SMP is a five-year project of the Ugandan Ministry of Health, financed by the U.S. President’s Malaria Initiative (PMI). Operating in 34 districts of Uganda, it is focused primarily on implementing and improving prevention programs, strengthening laboratories to improve malaria diagnosis and treatment, and increasing the capacity of the national malaria control program.

During my internship I explored the availability and efficacy of rapid diagnostic testing (RDT). Confirmation by RDT is the gold standard for uncomplicated malaria diagnosis in facilities without laboratories in Uganda. But use of RDT and adherence to the result remains low. In an effort to improve malaria diagnosis and management, SMP is in the process of providing RDT education and training to health workers. To determine where the training falls short and identify additional barriers to RDT use, I attended Integrated Malaria Management Training and Data Quality Assessment training sessions and interviewed health workers to learn about their beliefs, attitudes and practices with RDTs. Additionally, I helped to develop a tool to determine health worker practice in reality.

Malaria need not be a fatal disease. It is possible to effectively treat even when the symptoms are minimal and non-specific, but the ability to treat starts with proper identification of disease. With an RDT, a diagnosis is possible in even the most primitive of facilities – running water and electricity are not necessary. And the diagnosis is rapid: Disease can be confirmed and drugs prescribed and delivered in less than a half hour. While the current policy supports RDT use, it is my belief – based, anecdotally, on visits to dozens of health facilities – that the supply of RDTs in facilities remains the limiting factor.

HOME IS WHERE

their HEART IS

27

“The recognition that many public health studies in China were not well designed reinforced my conviction to improve the quality of research.”

UCLA Fielding School of Public Health students come from more than 35 nations, some driven by a desire to improve lives in their country of origin through more effective public health policies.

UCLAFIELDING PUBLIC HEALTH

DONGLAN ZHANG was a master’s student studying health economics at Fudan University School of Public Health in Shanghai in 2008, the year China launched its most ambitious health care overhaul in decades. In 2009, Zhang came to the UCLA Fielding School of Public Health to start work toward her Ph.D. Before Zhang had completed her first year at the school, President Obama signed the Patient Protection and Affordable Care Act. To her surprise Zhang found that the two countries faced similar concerns, including lack of universal health coverage, health disparities and ever-increasing costs. In China, though, Zhang saw another problem – one that motivated her to pursue her Ph.D in Health Policy and Management. “In the recent health care reform, policies and programs were implemented with limited data to evaluate their effectiveness,” she says. “Evidencebased policy making has not yet been widely applied in China.” Zhang hopes to use her doctoral education to help change that.

The health issue that has attracted much of her attention is one that also affects the two countries: childhood obesity. For her dissertation, Zhang is using a computational simulation to model the effect of macro-level policies in changing individual dietary behaviors in the United States. She is also exploring the determinants of obesity-related health behaviors as a graduate student researcher with the school’s UCLA Health Forecasting group, which conducts analyses to support health policy decisions in Los Angeles County and California.

“Childhood obesity is no longer a problem that exists only in Western countries,” Zhang says. “Although it’s not yet as big of an issue in China as in the United States, it is a growing problem with the expansion of Western-style fast-food restaurants, sodas and processed food. China has much to learn from the U.S. experience.”

In the summer of 2010, Zhang returned to her home country to work as a research intern at the China Health Economics Institute. “The recognition that many public health studies in China were not well designed reinforced my conviction to improve the quality of research,” she says. In doing so, Zhang intends to bring her global perspective to problems, such as obesity, that affect China as well as high-income countries. “A global view is both helpful and necessary for us to understand health problems that happen locally,” she says. “There will surely be more collaboration on public health studies between American and Chinese scholars in the future.”

28

“The skills I’ve been fortunate enough to gain from my experience as a physician, and now from my public health training, are greatly needed in Nigeria.”

The way Nigerian-born NKEM CHUKWUMERIJE sees it, the primary public health problem facing his home country is a lack of leadership on policy development and implementation. Chukwumerije, a physician with Kaiser Permanente Medical Group and a student in the school’s Executive Master of Public Health program in the Department of Health Policy and Management, is doing what he can to fill the void.

In his role as president-elect of the Association of Nigerian Physicians in the Americas (ANPA), an organization of approximately 4,000, mostly U.S.-based physicians of Nigerian origin, Chukwumerije works closely with Nigeria’s Ministry of Health on public health policy concerns. Through its participation on a joint technical committee, the ANPA has the ear of the federal ministry and legislative leaders in Nigeria on health issues, and has used that access to influence policy – from initiatives to improve emergency response to current efforts to revise the country’s medical education curriculum. “There has been a proliferation of medical schools in Nigeria, but there is no standardization of testing to evaluate the competence of the trainees,” Chukwumerije explains of the latter. Seeking to improve the quality of practicing physicians, his organization has worked with the ministry and the Medical and Dental Council of Nigeria to establish a continuing medical education program that would be required for physicians to maintain their license to practice.

Chukwumerije moved to the United States in 1994, three years after graduating medical school, and has lived here ever since. Yet he continues to dedicate much of his time to efforts to improve the health of Nigerians. In addition to his leadership role with ANPA, Chukwumerije is president of Chidera Inc., which ships high-quality and competitively priced nutritional products to Nigeria for those in need; and is a board member of Faith Alive Foundation USA, a nonprofit organization supporting Nigeria’s FaithAlive Hospital, which delivers free medical and psychosocial care, particularly for HIV-infected individuals.

“Home is always home,” Chukwumerije says of his dedication to Nigerians’ welfare. “The skills I’ve been fortunate enough to gain from my experience as a physician, and now from my public health training, are greatly needed in Nigeria. There’s so much low-hanging fruit that even small improvements in policy will have a dramatic effect on the lives of many people.”

Setting Priorities Doctoral student Andrew Siroka aims to promote a more scientific

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and cost-effective approach to allocating scarce global public health resources.

GLOBAL HEALTH AID HAS MORE THAN TRIPLED since 1995, but the amount invested each year to improve health in low and middle-income countries – $30 billion – is less than half of what is needed to fight the myriad public health challenges these nations face, according to the World Health Organization (WHO). How to get the most out of limited health resources? Andrew Siroka is interested in conducting research that will help to set global public health spending priorities, while pointing policy makers toward the most cost-effective treatments.

Siroka, a second-year Ph.D. student in the school’s Department of Health Policy and Management, notes that such studies can facilitate a more rational approach to addressing global health needs. “Currently, these decisions are heavily influenced by lobbying groups and the popularity of combating certain global health issues,” he says. “Some funding priorities may be deemed sexier because famous people are promoting them or they produce more immediate results than investing in something like infrastructure, which might be more important in the long run. Given the scarcity of resources, a more scientific system of allocation is needed, based on the global burden of disease and efficiency of treatments.”

Siroka believes such research will underscore the cost-effectiveness of public health interventions for infectious diseases that disproportionately affect low and middle-income countries. For example, the WHOpromoted strategy to control tuberculosis, known as directly observed treatment, short-course (DOTS), enlists family members, friends and neighbors to help ensure that people with active tuberculosis adhere to their daily medication regimen. “This takes very little of the clinician’s time and helps to keep people from developing drugresistant tuberculosis, which can be very expensive to treat,” Siroka explains.

SANDHYA SHIMOGA traces her interest in public health to her upbringing. Shimoga grew up in a small college town in southern India where, as in most of the country, poverty and prosperity exist side by side. As a college undergraduate, Shimoga joined India’s National Service Scheme, a voluntary organization based in colleges. One of her first tasks was to conduct a local household survey on literacy and health. Talking with participants about their health habits and financial struggles proved eye opening. “I saw firsthand how a family’s health is affected by environment, education and income,” says Shimoga. She went on to become a management consultant in India, eventually transferring within the company to the United States. Working with health insurance and hospital industry clients, Shimoga was drawn to the complexities of the U.S. health insurance system and eventually decided to pursue a Ph.D. in Health Policy and Management.

Her focus is on behavioral economics: how individual preferences motivate people to practice health behaviors – particularly in low and middle-income countries, where it is still an emerging field of research. As part of her dissertation, Shimoga is examining the impact of Mexico’s conditional cash transfer program, which provides economic incentives for impoverished families to meet certain health behavior goals. She notes that behavioral economics principles could be critical to the success of policies that improve medication adherence for tuberculosis or HIV treatments in low and middle-income countries.

Shimoga hopes to apply her training in ways that can help to address the multitude of healthrelated problems faced by countries such as Mexico and Shimoga’s native India. “There is a lack of population-level data necessary to formulate effective health policy in lower-income countries,” she says. “This needs to be addressed as an integral part of any global public health policy so that successes and failures can be assessed and corrected in a scientific manner.”

Eventually, Shimoga hopes to study how income inequalities shape health outcomes in low and middle-income countries, an interest piqued during her National Service Scheme work in India. “Any global public health policy must include improving literacy in the country,” Shimoga adds, reflecting on that experience. “Without that, people are stuck in the lower rungs of socioeconomic status, which affects every aspect of their health.”

“Any global public health policy must include improving literacy in the country.

Without that, people are stuck in the lower rungs of socioeconomic status, which affects every aspect of their health.”

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During an internship with WHO’s STOP TB program in Geneva, Switzerland, Siroka helped to measure the global burden of the disease as well as evaluating national policies to improve treatment. “Delving into the data, it was shocking how many millions of people die from something that is totally treatable,” Siroka says.

“Seeing that hardened my resolve to do what I can.”

The application of cost-effectiveness to the U.S. health care system has often been underappreciated. “In the United States we’ve been slow to recognize the scarcity of resources, and coverage decisions aren’t supposed to be made based on cost-effectiveness analyses,” Siroka notes. “It’s very politically unpopular, having inspired talk of ‘death panels’ during the health care reform debate. People don’t want to get into pitting diseases against one another, and advocates for diseases that are better funded don’t want to lose their funding.” But Siroka, who prior to enrolling in the Ph.D. program conducted comparative cost-effective analyses in his job at the Health Economics Resource Center (part of the U.S. Department of Veterans Affairs), believes that given the fiscal constraints domestically and abroad, it’s just a matter of time before such studies are embraced. “This is about prioritysetting, not pitting diseases against each other,” he says. “And I’m hoping that by shining the light on how cost-effective some of these treatments are, we can help to increase aid.”

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30 GIFT WANGO remembers the times during childhood when her single mother had to carry her to a dispensary so that she could receive urgent care. Growing up in Kenya’s Rift Valley and Nyanza provinces with assorted ailments – including asthma, chronic anemia and multiple bouts of malaria – Wango had a firsthand view of the shortcomings of Kenya’s health care system. “It was just haywire at those public dispensaries, clinics and hospitals,” Wango recalls. “Patients shared beds and many died from lack of basic resources, including medication. Infection control was lacking.” After moving “Every time to the United States upon I go to Kenya graduation from high to volunteer school and going on to as a nurse, become a critical care I am reminded nurse, Wango decided of how different to enroll in the school’s it is for people who live executive M.P.H. proin a country gram in Health Policy without a strong and Management, and health care system. to use her education to I want to do contribute to improving my part to change that.”

Kenya’s health care system.

Wango hopes to conduct research that would provide empirical support for her belief that the Kenyan government must include non-governmental bodies, international programs and other entities within the broad health policy framework so that the core of the Kenyan system is strengthened, rather than having each entity working in parallel. She notes that this is particularly important as it pertains to donor funds. Kenya has faced substantial challenges to its health care and public health infrastructure since the 1990s, when HIV/AIDS spread rapidly through the population, nearly half of which lives in poverty. High rates of other infectious diseases such as malaria and tuberculosis, along with the emerging problem of chronic illnesses in the form of cancers, cardiovascular disease and diabetes, have only complicated matters. By 2006, funds from donor countries and private contributors amounted to nearly 15 percent of Kenya’s health spending.

But little progress has been made, and Kenya remains well short of the Millennium Development Goals established in 2000 at the Millennium Summit of the United Nations. “We are getting more donor funds and spending more on health care, but organizations are just doing their own thing, without coordinated efforts to strengthen the system,” Wango says.

In 2007 the government initiated the Kenya Health Sector Wide Approach, an attempt to align donor funding to match Kenya’s developmental agenda. But Wango believes the effort needs to be much more systematic to have the desired impact. She intends to pursue a Ph.D. and hopes to conduct research that will help to inform policies that would streamline non-governmental funding sources. “Every time I go to Kenya to volunteer as a nurse, I am reminded of how different it is for people who live in a country without a strong health care system,” Wango says. “I want to do my part to change that.”

Three Inducted into Alumni Hall of Fame

news briefs

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Fielding Scholars Recruited Three distinguished alumni were inducted into the UCLA Fielding School of Public Health Alumni Hall of Fame at the 39th Annual Lester Breslow Distinguished Lecture in February. The 2013 inductees are: ANTHONY RODGERS, M.S.P.H. ’76 (left) Rodgers has spent his career championing the health safety net and the underserved individuals who rely on it for care, successfully influencing health systems from both management and policy perspectives. He has more than 30 years of health care executive management experience. Rodgers is currently a principal with Health Management Associates (HMA), a national consulting firm. Prior to HMA, he was appointed by the secretary of the Department of Health and Human Services to the position of CMS deputy administrator responsible for the Center for Strategic Planning.

As part of a series of initiatives to make public health education affordable to students around the world, the school has initiated the Fielding Scholars program, enabling departments to offer talented students substantial funding for their first academic year and supportive funding for their second year.

The first Fielding Scholars are Xiaochen Lin, a Ph.D. student in the Department of Epidemiology studying research and genetic epidemiology; and Dimiter Milev, an M.P.H. student in the Department of Health Policy and Management, whose interests include the organizational determinants of quality of care and the effectiveness of delivery system innovations.

LISA RUBENSTEIN, M.D., M.S.P.H. ’81 (center) A general internist and geriatrician, Rubenstein has led or co-led more than 50 competitive health services and implementation research grants that have profoundly changed the quality of care that Americans receive. Much of her work has focused on improving the quality of care that veterans receive and advancing the science of quality improvement. A professor of medicine and public health at UCLA, Rubenstein directs the VA Health Services Research and Development Center of Excellence for the Study of Healthcare Provider Behavior.

MARC STRASSBURG, M.P.H. ’75, DR.P.H. ’81 (right) In a career that has taken him to more than 25 countries and spanned 40 years, Strassburg has been a leader in the global control of vaccine-preventable diseases. He served as a smallpox eradication worker in Ethiopia and was one of the principal architects of the successful elimination of polio in Latin America. His role was also central to China’s becoming one of the early worldwide successes.

At the Los Angeles County Department of Public Health, where he has served as chief epidemiologist and director of the immunization program, Strassburg has led innovative and highly regarded efforts to improve immunization levels.

UCLA FIELDING SCHOOL OF PUBLIC HEALTH ALUMNI & FRIENDS RECEPTION MONDAY, NOVEMBER 4, 2013 6:30 – 8:00 p.m.

Sauciety Restaurant, Westin Boston Waterfront During the Annual Meeting of the American Public Health Association, November 2 - 6 in Boston.

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S AV E T H E D AT E

PUBLIC HEALTH GRAFFITI – Though under renovation, the tunnel leading into the school has become bright and filled with graffiti-style public health messages thanks to Fielding School student ingenuity. Pictured from left to right: artist Adam Talan, Dean Jody Heymann, and Public Health Student Association co-presidents Harmony Larson and Kelsey Ferguson.

Dream Fund Leadership Program

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Solis Honored

HILDA SOLIS was honored by the school as a Public Health Champion at an April event. Solis, former secretary of the Department of Labor and member of Congress, has affected the lives of countless individuals and families by addressing many of the ways that social conditions affect health, including efforts to reduce poverty, raise the minimum wage, eliminate sweatshops, reduce domestic violence, improve conditions faced by immigrants and minimize environmental threats that disproportionately affect the poor.

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Student Competition Winners As part of the Fielding School’s 2013 student competition, five students were selected to deliver a five-minute oral presentation at the 39th Annual Lester Breslow Distinguished Lecture in February.

The topic: public health lessons learned from Hurricane Sandy and the students’ recommendations for reducing the health impacts of disasters in the future. The students, representing the school’s five departments, each received a $1,000 prize from Molina Healthcare Inc. A distinguished panel of judges selected the winner, Rachel Hornstein of the Department of Health Policy and Management, who received a $5,000 prize courtesy of the Breslow Student Fellowship Fund. Other students representing their departments included Asya Spears (Biostatistics), Tina Duyen Tran (Community Health Sciences), Harmony Larson (Environmental Health Sciences), and Stephanie Leonard (Epidemiology).

A $1 million gift from the Dream Fund will launch a new Future Public Health Leaders fellowship program, bolstering the Fielding School’s efforts to attract and train exceptional students to the public health workforce. The fellowship program will provide scholarships for top applicants to the school’s M.P.H. program, ensuring that cost is not a barrier to their receiving a UCLA public health education. In addition to covering the students’ tuition, the fellowship will fund an internship in an underserved community after their first year.

“We are extremely grateful for the vision and commitment of the Dream Fund in helping us begin this important program,” says Dr. Jody Heymann, dean of the Fielding School. “Our students are passionate, talented and committed to making the world a better and healthier place. This donation will help the school attract the best students to work with communities where the need is greatest.”

People in low-income and minority communities experience disproportionate disease burdens. In California and around the world, they live in the areas with the most severe health problems – the worst air quality, poorest nutrition and greatest exposure to environmental toxins – resulting in a life expectancy five years shorter than their more affluent counterparts. Thus, it is especially important that students from these communities have an opportunity to receive the best education and then return to their communities to effect change.

The Dream Fund was created in 2011 as a philanthropic partnership between UCLA and the Lincy Foundation.

Ruth Roemer Social Justice Leadership Award The UCLA Fielding School of Public Health Alumni Association presented reproductive health advocate Francine Coeytaux (M.P.H. ’82) with the Ruth Roemer Social Justice Leadership Award at the annual Ruth Roemer Social Justice Symposium May 23 in Los Angeles.

The award is given in honor of the late Dr. Ruth Roemer, who served on the school’s faculty for more than four decades. In a career spanning more than 50 years, Roemer made lasting contributions in areas that included reproductive health services, environmental health, tobacco control and health services organization. She remained an influential figure in public health well into her 80s.

Coeytaux is internationally known for her promotion of comprehensive reproductive health services, safe abortion services and the development of new reproductive technologies. In her 30-year career, she has called attention to the public health problems related to sexually transmitted diseases, adolescent fertility and abortion, and has advocated for comprehensive services to address these needs.

faculty

honors RON BROOKMEYER served on the Institute of Medicine committee to evaluate the President’s Emergency Plan for AIDS Relief (PEPFAR), at the request of Congress.

ROGER DETELS was chosen to deliver the 113th UCLA Faculty Research Lecture, an honor created to highlight the work of the university’s most distinguished scholars.

BRESLOW LECTURE – Dr. Anne Pebley, Fred H. Bixby Professor of Community Health Sciences and the Dean’s Distinguished Scholar for 2013, delivered the 39th Annual Lester Breslow Distinguished Lecture in April on “Changing Mexican and Mexican-American Health on Both Sides of the Border.”

JONATHAN FIELDING received the Fries Prize and was named 2012 Honorary Fellow of the Society for Public Health Education.

DEBORAH GLIK received the Everett Rogers Award from the Public Health Education and Health Promotion Section of APHA. RICHARD JACKSON received the Heinz Award from the Heinz Family Foundation.

JACK NEEDLEMAN was elected to the Institute of Medicine.

ANDRE NEL was awarded the Sandia National Laboratories Harry S. Truman Memorial Lectureship.

CHARLOTTE NEUMANN received UCLA’s 2012-13 Dickson Emeritus Professor Award for outstanding contributions to her field since retirement.

LINDA ROSENSTOCK received the Institute of Medicine’s David Rall Medal.

DONATELLO TELESCA received the Hellman Fellowship, a financial award given to help promising assistant professors further their research and creative endeavors.

PAUL TORRENS was appointed to the advisory board of the UC San Diego Health System.

ANTRONETTE YANCEY received the Association of Black Women Physicians’ highest honor of Lifetime Achievement Award and the APHA Award for Excellence.

WENG KEE WONG was selected as a Fellow of the American Association for the Advancement of Science.

bookshelf ...recent books by UCLA Fielding School of Public Health authors

Children’s Chances: How Countries Can Move from Surviving to Thriving

by Jody Heymann.

Harvard University Press.

National action, laws, and public policies fundamentally shape children’s opportunities. Drawing on never-beforeavailable comparative data on laws and public policies in 190 countries, Children’s Chances urges a transformational shift from focusing solely on survival to targeting children’s full and healthy development – telling the story of what works and what countries around the world are doing to ensure equal opportunities for all children.

(For more on Children’s Chances, see page 4.)

Industrial Policy in America: Breaking the Taboo

by Marco Di Tommaso and Stuart O. Schweitzer.

Edward Elgar Pub. In contrast to what observers have frequently argued, this book suggests that the concept of industrial policy is not alien to the American past and present.

The authors illustrate that contemporary markets continue to demand to be fixed by government policies, and governments continue to show how fixing-the-market policies might fail. They argue that it is time to break the taboo and discuss the nation's goals, targets, and tools to develop a new, effective American industrial policy.

The Inevitable Hour: A History of Caring for Dying Patients in America

by Emily K. Abel.

The Johns Hopkins University Press.

At the turn of the 20th century, medicine’s imperative to cure disease increasingly took priority over the demand to relieve pain and suffering at the end of life. Filled with heartbreaking stories, The Inevitable Hour demonstrates that professional attention and resources gradually were diverted from dying patients. The book challenges myths about health care and dying in America, and helps to explain why a movement to restore dignity to the dying arose in the early 1970s.

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NANOTECHNOLOGY DEMONSTRATION – Sharona Sokolow, a doctoral student in the Department of Environmental Health Sciences, demonstrates hands-on nanotechnology experiments during NanoDays at the California Science Center. NanoDays is a weeklong national celebration aiming to demonstrate the everyday impact of nanoscale science and engineering.

BEATE RITZ was elected to membership in the American Epidemiological Society.

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honor roll 2012

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CORPORATE AND FOUNDATION GIFTS AND GRANTS $1,000,000 A N D A B O V E BILL & MELINDA GATES FOUNDATION

Antronette (Toni) Yancey 1957 - 2013

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Dr. Antronette (Toni) Yancey, a professor at the Fielding School and a nationally recognized advocate for health equity and physical activity, died on April 23 at the age of 55.

Yancey was passionate about improving the health of vulnerable populations and devoted her career to eliminating health disparities. She created “Instant Recess,” a program dedicated to “making America healthier 10 minutes at a time.” Her idea to incorporate brief bouts of physical activity into daily routines, whether at school, work or worship, earned her numerous honors, including the 2012 Pioneering Innovation Award from the Centers for Disease Control and Prevention. She was one of a handful of national thought leaders asked to serve on the board of directors of the Partnership for a Healthier America, the nonprofit organization that guided First Lady Michelle Obama’s Let’s Move campaign.

Yancey co-founded the Fielding School’s UCLA Kaiser Permanente Center for Health Equity, through which she championed the cause of social justice. She was tireless in her commitment to ensuring that research findings would transform lives. For most of her professional career, Yancey promoted strategies to involve vulnerable populations in physical activity.

As director of public health for the City of Richmond, VA, she created and conducted the “Rock Richmond!” campaign to get every able-bodied adult in the city to engage in more physical activity. As director of chronic disease and health promotion for the Los Angeles County Department of Public Health, she inaugurated “L.A. Lift Off,” a 10-minute exercise break designed to involve mostly overweight, sedentary workers in low-impact dance moves at their work sites. The success of this endeavor evolved into “Instant Recess.”

A true renaissance woman, Yancey was also a poet and author, a former fashion model and, at 6’2”, a Division 1 basketball player during her undergraduate years at Northwestern.

INSTANT RECESS MEMORIAL – To honor Dr. Antronette (Toni) Yancey, more than 100 organizations nationwide participated in a simultaneous “Instant Recess.”

$200,000 - $999,999 ANONYMOUS BLUE SHIELD OF CALIFORNIA RESEARCH & EDUCATION FOUNDATION BREAST CANCER RESEARCH FOUNDATION THE CALIFORNIA ENDOWMENT THE EAST BAY COMMUNITY FOUNDATION KAISER FOUNDATION HOSPITALS LANCE ARMSTRONG FOUNDATION NSABP FOUNDATION, INC. THE ROBERT WOOD JOHNSON FOUNDATION THE SCAN FOUNDATION THE SUSAN G. KOMEN BREAST CANCER FOUNDATION $50,000 - $199,999 AMERICAN ASSOCIATION FOR THE STUDY OF LIVER DISEASES ASCO CANCER FOUNDATION ASSOCIATION OF ASIAN PACIFIC COMMUNITY HEALTH ORGANIZATIONS CEDARS-SINAI MEDICAL CENTER FRED HUTCHINSON CANCER RESEARCH CENTER MAGEE-WOMENS HOSPITAL, RESEARCH INSTITUTE & FOUNDATION RAND CORPORATION SAUDI ARABIAN CULTURAL MISSION UCLA HEALTH SYSTEM AND DAVID GEFFEN SCHOOL OF MEDICINE AT UCLA UNIVERSITY OF EASTERN FINLAND

$25,000 - $49,999 ADVANCED STERILIZATION PRODUCTS CHILDREN’S BUREAU OF SOUTHERN CALIFORNIA HEINZ FAMILY FOUNDATION $10,000 - $24,999 BLUE SHIELD OF CALIFORNIA BREATHE CALIFORNIA OF LOS ANGELES CALIFORNIA COMMUNITY FOUNDATION PARTICIPANT PRODUCTIONS FDN CEDARS-SINAI MEDICAL CARE FOUNDATION KAISER PERMANENTE MAXICARE RESEARCH & EDUCATIONAL FOUNDATION NORTHERN CALIFORNIA INSTITUTE FOR RESEARCH AND EDUCATION WITT/KIEFFER FORD HADELMAN AND LLOYD $5,000 - $9,999 DELOITTE & TOUCHE LLP MOLINA HEALTHCARE, INC. ORANGE COUNTY ASIAN & PACIFIC ISLANDER COMMUNITY ALLIANCE WILSHIRE HEALTH & COMMUNITY SERVICES, INC. $1,000 - $4,999 CALIFORNIA ASSN OF HOSPITALS AND HEALTH SYSTEMS CALIFORNIA HEALTHCARE FOUNDATION FRIENDS OF CABRILLO MARINE AQUARIUM INSTITUTE FOR PERFORMANCE EXCELLENCE INTERNATIONAL MEDICAL CORPS KANSAS HEALTH FOUNDATION MH3 CORPORATION OREGON PUBLIC HEALTH ASSOCIATION POMONA VALLEY HOSPITAL MEDICAL CENTER SOLARRESERVE LLC UCLA DEPARTMENT OF UROLOGY UCLA FIELDING SCHOOL HEALTH SERVICES ALUMNI ASSOCIATION

35 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. This Honor Roll gratefully acknowledges gifts and private grants made to the school from January 1, 2012, to December 31, 2012. Although space limitations allow only the listing of donations of $1,000 or more, contributions of every amount are of great importance to the school and are deeply appreciated.

GIFTS FROM INDIVIDUALS AND FAMILY FOUNDATIONS $50,000,000 KARIN B. AND JONATHAN E. FIELDING $1,000,000 - $4,999,999 SUZANNE AND RIC KAYNE $100,000 - $999,999 DIANE B. AND RONALD M. ANDERSEN RUSSELL AND CAROL FAUCETT CYNTHIA HARRELL-HORN AND ALAN HORN CHARLOTTE G. AND ALFRED K. NEUMANN $10,000 - $99,999 DEVRA M. AND LESTER BRESLOW CALVIN S. Y. CHUN CORNELIA DALY AND ARTHUR M. SOUTHAM PAULA G. AND SAM W. DOWNING ROBERT DRABKIN DEAN HANSELL MONICA SALINAS JANET M. AND THOMAS E.UNTERMAN LESLIE VERMUT AND THOMAS R. WEINBERGER PAMELA K. AND FRED W. WASSERMAN SHIRLEY AND RALPH SHAPIRO

$2,500 - $4,999 LINDA B. BOURQUE RITA B. FLYNN AND RALPH FRERICHS JANET A. WELLS-KAHANE AND STEPHEN W. KAHANE LAURIE AND GERALD KOMINSKI JANICE A. AND BENEDICT R. SCHWEGLER PAUL R. TORRENS $1,000 - $2,499 MARIANNE H. AND ABDELMONEM A. AFIFI LESLIE M. ALEXANDRE MARSHA L. AND IRA R. ALPERT SARAH ANDERSON AND MATTHEW KAGAN SONA AND HAROUTUNE K. ARMENIAN SANDRA AND CHARLES ARONBERG ROSHAN AND SHAROK BASTANI JOAN G. AND LEONARD I. BEERMAN DIANA BONTA AND FRANK MATRICARDI CLAIRE AND RALPH G. BRINDIS

COLE-BELIN EDUCATION FOUNDATION CLINTON COIL AND WILLIAM ROBB JULIE COLLIER AND MICHAEL C. KOLBER WILLIAM S. COMANOR BONNIE FAHERTY AND EDWARD G. FELDMAN NAM HEE AND PETER M. GILHULY ALISA GOLDSTEIN RAYMOND D. GOODMAN JENNIFER AND MARC P. HEENAN SUSAN D. HOLLANDER KING HOLMES KATHRYN JOHNSON CAROLYN F. KATZIN ANNETTE W. AND CHARLES R. KLEEMAN ELIZABETH M. SLOSS AND JAMES J. KORELITZ DAVID KRASNOW AMY AND RICHARD G. KRONICK SHERRY L. LANSING AND WILLIAM FRIEDKIN BARBARA A. AND GERALD S. LEVEY JOANNE L. AND MARC D. MOSER NANCY R. AND ALFRED E. OSBORNE, JR. ANNE PEBLEY JODY J. AND THOMAS M. PRISELAC JOSEPH PROVOST KENNETH J. RESSER BEVERLY AND ALAN G. ROBINSON SUSAN M. AND J. THOMAS ROSENTHAL PRATEEK SARKAR SEAN SHAO LINDA J. SHAW AND ROBERT G. HUGHES ATSUKO SHIBATA KAREN J. SIMONSON AND BARTON PHELPS HARRIET S. AND BART B. SOKOLOW DONNA J. TESI THUNEN FAMILY FOUNDATION PAUL A. TONKIN AYAKO UTSUMI CAROLE L. AND PAUL S. VIVIANO HAZEL G. WALLACE MAE-FAY YEH KOENIG

THE UCLA LEGACY SOCIETY honors alumni, faculty, staff and friends who have chosen to benefit UCLA through a will, living trust, charitable remainder trust, charitable gift annuity retirement plan or other estate planning arrangement.

Turning their individual passions into action, these donors have looked ahead to the needs of future generations.

They have effectively put “money in the bank” to fulfill countless opportunities that ensure excellence campus wide, from scholarships to life-changing research, fellowships to distinguished faculty recruitment.

The Fielding School of Public Health gratefully acknowledges the philanthropic leadership and foresight of the following Legacy Society members who have included the School in their estate plans.

If you have included FSPH in your estate plans and your name is not listed here, please contact us at (310) 825-6464 so we can recognize you and include you in special events for Legacy Society members.

ANGEL APPLETON DEVRA BRESLOW MARIANNE P. BROWN JOHN BROWNING MARYAN G. BUNGA DIANA AND ROBERT GHIRELLI JOAN JUBELIER AND JAMES ZIDELL LAURIE AND GERALD KOMINSKI DAVID KRASNOW JOSEPH LIVIO JEANETTE OREL JOYCE PAGE JEAN SANVILLE PATRICIA AND RICHARD E. SINAIKO GURDON SMITH DONNA AND WENDELL TRENT SUEBELLE AND DAVID VERITY

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It is important to us that we acknowledge your gift properly.

Every effort has been made to ensure the completeness and accuracy of this Honor Roll.

Please let us know of any omissions or errors in listing your name or gift by calling (310) 825-6464.

$5,000 - $9,999 LINDA B. BOLTON PAUL CALIENDO CHENG AND TSUI FOUNDATION SAM ELIAS AND DAVID D. CLARK RAE M. AND DAN A. EMMETT LORRAINE AND JERRY FACTOR LATIFEH E. AND FARHAD A. HAGIGI HAZEL L. AND M. ALFRED HAYNES JENNIE S. AND RAYMOND JING BARBARA AND SNEHENDU B. KAR DEBORAH A. LEVY AND ILONA BELL FLINT FOUNDATION RICHARD & AMY LIPELES PHILANTHROPIC FUND SANDRA V. NAFTZGER AND JEFFREY A. DRITLEY GAYLE PENROD AND MICHAEL R. GALPER VIRGINIA C. LI AND LEONARDO O. CHAIT PATRICIA S. SINAIKO AND RICHARD E. SINAIKO

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2012-13 student awards Abdelmonem A. Afifi Student Fellowship

Clinical Translational Science Institute Training Grant

Harmony Larson Environmental Health Sciences

Anna Davis Sarah Friedman Lauren Gase Erin Hahn Charleen Hsuan Jenna Jones Diane Tan Alice Villatoro Health Policy and Management

Advanced Quantitative Methods in Education Fellowship Lauren Harrell Biostatistics

Agency for Healthcare Research and Quality Fellowship Garth Fuller Selena Ortiz Peter Schweikert Andrew Siroka Joe Viana Adriane Wynn Health Policy and Management

American College of Rheumatology Research and Education Foundation/ Abbott Health Professional Graduate Student Research Preceptorship Priti Prasad Molecular Toxicology

American Industrial Hygiene Foundation Lawrence R. Birkner and Ruth K. McIntyre-Birkner Memorial Scholarship Michael Nguyen Environmental Health Sciences

American Industrial Hygiene Foundation Northern California Local Section Scholarship Michael Nguyen Environmental Health Sciences

Amgen Fellowship Adam King Biostatistics

Aaron Lulla Molecular Toxicology

BRESLOW AWARD — Rachel Hornstein of the Department of Health Policy and Management received a $5,000 prize for winning the 2013 Breslow Student Writing Competition.

Breslow Student Writing Competition Award Rachel Hornstein Health Policy and Management Harmony Larson Environmental Health Sciences Stephanie Leonard Epidemiology Asya Spears Biostatistics Tina Tran Community Health Sciences

Brown Social Justice Award Erryne Jones Health Policy and Management

Burroughs Wellcome Fund Inter-School Training Program in Metabolic Diseases

Ann G. Quealy Memorial Fellowship

Matthew Levinson Biostatistics Yan Song Epidemiology

Sheerin Barfeei Debbie Malek Health Policy and Management

California Wellness Fellowship

Arco Fellowship UCLAFIELDING PUBLIC HEALTH

Colgate Palmolive Graduate Student Award for Alternative Methods Research Training

Evelyn Alvarez Isabel Gracia-Rojas Malini Madhusudhan Sharona Sokolow Pu Yang Nu Yu Environmental Health Sciences

Bixby Doctoral Fellowship in Population Patience Afulani Community Health Sciences

Carolbeth Korn Prize Brent Langellier Community Health Sciences

Carpenter Memorial Fund Jennifer Pierce Heather Pines Epidemiology

Celia and Joseph Blann Fellowship Melissa Kelley Community Health Sciences

Certified Unified Program Agencies Student Scholarship Ciara Martin Molecular Toxicology

Chancellor’s Prize Siavash Banaee Environmental Health Sciences Lisa Barnhill Molecular Toxicology Charleen Hsuan Andrew Siroka Health Policy and Management

Charles F. Scott Award

John Diaz-Decaro Donna Ferguson Lori Viernes Environmental Health Sciences

Elizabeth Evans Community Health Sciences Kristin Yamada Molecular Toxicology

Cancer Epidemiology Training Grant

Child and Family Health Leadership Training Fellowship

Claire Kim Fong Liu Erin Marcotte Travis Meyers Fay Miles Erin Peckham Caroline Thompson Gina Wallar Epidemiology

Stephen Lee Sophia Snyder Health Policy and Management Jessica Reit Eduardo Zamora Community Health Sciences

Dart Container Fellowship Uyen Ngo Environmental Health Sciences

Dean’s Global Health Fellowships Laura Baetscher Annie Clarke Annie Fehrenbacher Natasha Graves Community Health Sciences Claire Bristow Rebecca Foelber Josh Quint Epidemiology Michelle Romero Environmental Health Sciences Adriane Wynn Health Policy and Management

Dean’s Leadership Grant Rawan Araj Liz Devietti Kriszta Farkas Dan Huynh Natalie Melendez Michael Nguyen Jessica Yim Environmental Health Sciences Hilary Aralis David Huang Yonas M. Lemecha Jonathan Maner Biostatistics Laura Baetscher Olga Berdysheva Laura Carter Ronaldo Jose Chavez de la Torre Hannah Coleman Amelia DeFossett Joanna Ekstrom Francisco Espinoza Gabriella Garibay Natasha Graves Jessica Roeckel Jaire Saunders Ashley Slight Jacquelin Scully

Willetta Waisath Miranda Westfall Jeffrey Williams Elizabeth Wong Shahrzad Yavari Community Health Sciences Sheerin Barfeei Molly Battiselli Jonathan Chang Eric Crapser Michele La Pointe Daniel Lee Tamara Park Mark Ramirez Partow Zomorrodian Health Policy and Management Joanna Burtner Rebecca Foelber Gingi Fulcher Rachel Landauer Melissa Morales Andrew Park Luz Pimentel Jenny Wright Epidemiology

Dean’s Outstanding Student Award Robin Jeffries Biostatistics Philip Massey Community Health Sciences Yelena Rivina Environmental Health Sciences Caroline Thompson Epidemiology Jessica Williams Health Policy and Management

Delta Omega National Poster Competition Award Sarah Cousins Melissa Kelley Community Health Sciences

Department of Health Policy and Management Community Partnership Fellowship Daisha Chung Karleen Gannitrapani

Dissertation Year Fellowship Tracy Becerra Po-Yin Chang Sona Oksuzyan Epidemiology Xiang Lu Xuyang Lu Biostatistics Hsin-Chieh Chang Philip Massey Kiyomi Tsuyuki Community Health Sciences

Dr. Ursula Mandel Fellowship

Graduate Research Mentorship Award

Patience Afulani Uchechi Mitchell Community Health Sciences

Earl Burrell Kaitlin O’Keefe Epidemiology Julie Castaneda Molecular Toxicology Geoffrey Hoffman Jeffrey McCullough Health Policy and Management Melissa Kelley Brittany Morey Goleen Samari Community Health Sciences

Bryan Moy Environmental Health Sciences Andrew Siroka Health Policy and Management

Eleanor J. DeBenedictis Award Nelida Duran Maria Pia Chaparro Lanfranco Community Health Sciences

eMPH Best Business Plan Award Ashkan Moazzez Trini Phan Indrid Trejo Health Policy and Management

Eugene Cota Robles Fellowships Stephanie Alberi Community Health Sciences Jessica Camacho Molecular Toxicology Isomi Miake-Lye Tanya Olmos Health Policy and Management Asya J. Spears Biostatistics

Faucett Catalyst Fund Reena Doshi Nicole Hoff Epidemiology

Fielding Scholars Xiochen Lin Epidemiology Dimiter Milev Health Policy and Management

Fielding School of Public Health Nonresident Scholarship

Graduate Summer Research Mentorship Fellowship Catherine Branson Chia-Hsin Cheng Elinam Dellor Uchechi Mitchell Brittany Morey Goleen Samari Community Health Sciences

Health Resources and Services Administration Traineeship Wongsiya Boon-Long Mekeila Cook Alexander Martos Community Health Sciences John Diaz-Decaro Lorfreda Viernes Environmental Health Sciences Martin Flores Asya J. Spears Biostatistics

Health Services Alumni Association Award Michelle Keller Allison Mangiaracino Health Policy and Management

Institute for International Public Policy Fellowship Tina Duyen Tran Community Health Sciences

Yichang Chen Austin Dean Molecular Toxicology

Judith Blake Award

Gates Millennium Scholarship

Juneal Marie Smith Fellowship

Tanya Olmos Health Policy and Management

Yan Song Epidemiology

Genomic Analysis Training Program

Kirschstein-NRSA Institutional Traineeship

Michelle Creek Eunjung Han Biostatistics

Brittnie Bloom Marianne Chen Francisco Espinoza Janell Moore Stephanie Wong Community Health Sciences

Brent Langellier Jacqueline Torres Community Health Sciences

Kolber Gift for Epidemiology Research in Developing Countries Jennifer Pierce Heather Pines Epidemiology

Maternal and Child Health Training Program Miranda Westfall Community Health Sciences

Parkinson’s Disease Foundation Summer Student Fellowship

Pu Yang Environmental Health Sciences

Karen Roque Community Health Sciences

Ciara Martin Molecular Toxicology

UCLA Affiliates Award

Michael Dukakis Fellowship

Raymond Goodman Scholarship

Uyen Ngo Environmental Health Sciences

Monica Salina Internship Fund in Latino and Latin American Health Francisco Espinoza Community Health Sciences

Multidisciplinary HIV and TB Implementation Sciences Training in China Training Grant Jie Wu Epidemiology

National Institute on Aging Predoctoral Training Program (California Center for Population Research) Frederick Harig Community Health Sciences

National Institute of Child Health and Development Predoctoral Training Program (California Center for Population Research) Annie Fehrenbacher Goleen Samari Community Health Sciences

National Institute of Environmental Health Sciences Training Grant in Molecular Toxicology Michael Davoren Aaron Lulla Ciara Martin

National Institute of General Medical Sciences Predoctoral Training Program (California Center for Population Research) Elinam Dellor Tabashir Sdegh-Nobari Community Health Sciences

National Institute for Occupational Safety and Health Southern California Education and Research Center Fellowship Ryan Babadi Siavash Banaee Eric Brown George Brogmus Kazue Chinen Shayna Kram Airek Mathews Katherine McNamara Kevin Milani Michael Nguyen Environmental Health Sciences

National Institutes of Health Predoctoral Individual National Research Service Award Heather Pines Epidemiology

Sona Oksuzyan Epidemiology Tyler Watson Kristin Yamada Environmental Health Sciences

Research Mentorship Program Shemra Rizzo Biostatistics

Samuel J. Tibbits Fellowship Heidi Fischer Biostatistics

Southern California American Industrial Hygiene Association Student Scholarship Eric Brown Kazue Chinen Gabriel Jasso Shayna Kram Kevin Milani Environmental Health Sciences

Southwest Region Public Health Training Center Award Rachel Brady Jamie Cassutt Marianne Chen Amelia DeFosset Joanna Ekstrom Karla Gonzalez Gabriela Labrana Katherine Lincicum Samantha Lupinetti Cynthia Mendez Alek Miller Andriana RomeroEspinoza Karen Roque Jasmine Smith Duyen Tran Willetta Waisath Miranda Westfall Stephanie Wong Jennifer Xiong Eduardo Zamora Community Health Sciences Justine Dam Sonia Djordjevic Kriszta Farkas Dan Huynh Environmental Health Sciences Kimberly Foster Edward Lan Caleb Lyu Paige Sheridan Elizabeth Traub Epidemiology Alice Nguyen Health Policy and Management

Texas Agrilife Research Fellowship Luz Pimintel Epidemiology

37

Aaron Chapman Molecular Toxicology Tamanna Rahman Environmental Health Sciences

UCLA Canadian Studies Graduate Award Ciara Martin Molecular Toxicology

UCLA Competitive Edge Jessica Camacho Molecular Toxicology

UCLA Dissertation Year Fellowship Mona AuYoung Selena Ortiz Jessica Williams Health Policy and Management

UCLA Integrated Substance Abuse Programs Predoctoral Training Program Catherine Branson Community Health Sciences

UCLA/Fogarty AIDS International Training and Research Program Min Aung Saipin Chotivichien Aritra Das San Hone Vannda Kab Xing Liu Nguyen Binh Nguyen Debottam Pal Alok Ranjan Giridhara Rathnaiah Babu Panithee Thammawijaya Dai Wan Jie Wu Weiming Zhu Epidemiology

USAID and Indonesian Educational Foundation Program Dirna Mayasari Community Health Sciences

Weisman Endowment Weiming Tang Epidemiology

Will Rogers Memorial Fellowship Shilpa Narayan Epidemiology

Wilshire Foundation Internship Fund Brittany Barba Vanessa Grau Michelle Keller Ana Poblet Community Health Sciences

UCLAFIELDING PUBLIC HEALTH

Graduate Opportunities Fellowship

Robin Jeffries Biostatistics

Tony Norton Fellowship

Max Factor Family Foundation Summer Internship Fund

Nonprofit Org. U.S. Postage PAID

UCLA

Box 951772 405 Hilgard Avenue Los Angeles, California 90095-1772 www.ph.ucla.edu Address Service Requested

Commencement

2013

ROGER I. GLASS, director of the Fogarty International Center and associate director for global health research at the National Institutes of Health, is the featured speaker at the school’s 2013 Commencement.