Public health is a vital function that is in trouble.
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"It was made painfully clear last April that Los Angeles - our local community- is beset with deeply rooted social problems. These are our problems, and our challenges."
hus we were warned by the Institute of Medicine's Committee for the Study of the Future of Public Health in 1988. In a report that continues to reverberate through our field, the committee lamented that "public health in the United States has been taken for granted, many public health issues have become inappropriately politicized, and public health responsibilities have become so fragmented that deliberate action is often difficult if not impossible." The IOM report went on to define public health's mission - " ... assuring conditions in which people can be healthy" - and lay the foundation for accomplishing that end. Of particular interest were the committee ' s recommendations regarding the roles schools of public health could play, including: • Establishing firm practice links with state and local public health agencies; • Serving as resources in the development of public health policy; • Teaching the political and management skills needed for leadership in the field; and • Finding solutions to practical public health problems through research. As this issue of UCLA Public Health will show, we take the IOM report seriously in looking at the future direction of our school. For the last four years, we have had an ongoing dialogue among our faculty, students and administration concerning what we could do to put ourselves in the best position to help meet the objectives set out by the IOM committee. Out of those discussions several conclusions emerged. As a premier school of public health, we must ensure that our curriculum is community- and problem-based in order to address the key public health issues facing society and provide the training necessary for our students to assume leadership roles in the field. On the research side, we must redouble our efforts to shift the emphasis to issues of particular interest and importance to our community constituents. To successfully do so, we must strengthen our ties with the practice side of public health - particularly with our local health department. It was made painfully clear last April that Los Angeles - our local community - is beset with deeply rooted social problems. These are our problems, and our challenges. Nowhere else is there the degree of mix among different peoples and cultures that we have here in Los Angeles. We are an experiment for the rest of the country; our city faces the responsibility of showing that a multiethnic community can live together and prosper through its diversity. Indeed, excellence through diversity is becoming one of our operating principles at the UCLA School of Public Health. The transformation under way at our school, details of which appear in the following pages, is the top priority as I begin my second five-year term as dean. I welcome the advice of every one of our constituents students, staff, faculty, alumni and the community- as we shape our future, both as a school of public health and as a contributor to a healthy society.
C. Dr. Abdelmonem A. Afifi
UCLA PUBLIC HEALTH Volume 11, Number2, Fall 1992
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Charles E. Young Chancellor Abdelmonem A. Afifi, Ph.D. Dean Richard Elbaum Director. Health Sciences Communications
SPECIAL SEalON: COMMUNITY
6 ANEW DIRECTION Editorial Board Abdelmonem A. Afifi, Ph.D. Dean Susan C. Scrimshaw, Ph.D. Associate Dean for Academic Programs Nathaniel Schenker, Ph.D. Assistant Professor, Biostatistics Steven P. Wallace, Ph.D. Assistam Professor, Community Health Sciences Karen August Director of Developmelll Diana Caldwell, B.S. '81 Alumni Association Len Finocchio 1991-92 President, Students' Assn. Richard Elbaum Director, Health Sciences Communications Vicki Beck Assistant Director, Health Sciences Communications
The school looks inward to determine how to become more responsive to public health's natural constituency.
8 EMPOWERMENT A school of public health, a local health department and two impoverished communities have joined forces-and bucked tradition-to change their worlds.
11 Q &A: LESTER BRESLOW ON COMMUNITY EMPOWERMENT
12 PUBLIC HEALTH AND POVERTY: DO THEY MIX? 13 ONE STUDENT'S PERSPECTIVE: uCAN WE GET ALONG?" 14 FIGHTING ADEADLY EPIDEMIC The Southern California Injury Prevention Research Center.
2 Dan Gordon Editor Kimberly Barbis Designer/Art Director Jacquie Michels Associate Editor Ramon Aninag Administrative Assistant
NEWS
16 RESEARCH
17 INTRODUCTIONS
18 FACULTY UCLA Public Health is published by Health Sciences Communications, UCLA University Relations, for the alumni, faculty, students, staff and friends of the UCLA School of Public Health. Copyright 1992 by The Regents of the University of California. Pennission to reprint any ponion of UCLA Public Health must be obtained from the editor. Contact UCLA Health Sciences Communications, 1100 Glendon Avenue, Suite 1501 , Westwood Center, Los Angeles, California 90024-1708. (310) 206- 1960.
20 ALUMNI ON TifE COVER: Children such as these at Holmes Avenue Elementary School in SouthCentral Los Angeles are an integral part of the UCLA School of Public Health's agenda as the school reexamines its curriculum and priorities. Cover photo by David Siegle. PHOTOGRAPHY: David Siegle ("Dean's Message," "Special Section," Afifi in" A New Direction," "Empowerment"); Terry O'Donnell (Winting in "News," "A New Direction," "Q & A," "One Student's Perspective," "Research," "Introductions," "Faculty").
AFIFI OUTLINES VISION FOR SCHOOL, LAUNCHES STRATEGIC PLANNING PROCESS
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s he begins his second fiv eyear term as dean of the UCLA School of Public Health, Dr. Abdelmonem A. Afifi has launched a two-year strategic planning and impl ementation program designed to shape the direction of the school fo r the next several years. At a meeting with the school's fac ulty last May, Afifi outlined his vision for the school and called on all fac ul ty, as well as students, alumni, other community members and senior management staff, to provide input and assistance with the effort. The first year, he announced, would be devoted to planning; the second to implementation. Afifi stressed his belief that "public health education should serve public health practice and should seek to achieve the public
"Public health education should serve public health practice. Our curriculum should be community-based and problembased." health m1ss10n: assuring conditions in which people can be healthy." "My view is that our curriculum should be community-based and problem-based," he added. "Our graduates should leave us 2
UCLA PUBLIC HEAL TH
with the tools necessary to perform the three basic functions of public health practice - assessment, policy-setting and ass urance. They should get some practice in the community so they can hit the ground running." Afi fi fu rther sa id th at the school' s research and curriculum should be dri ven by the needs of publ ic health practice; that diversity would be "the route to excellence"; and that the school should address whether it is making optimal use of its resources.
Samuel and Audrey Tibbitts
TIBBITTS FUND ESTABLISHED FOR HEALTH SERVICES RESEARCH
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he UCLA School of Public Health has received a gift of $ 100,000 from Sam ue l and Audrey Tibbitts to establish a fu nd for health services research on issues related to access, cost containment, and quality of care.
Dr. Ron Andersen, the Fred W. and Pamela T. Wasserman Professor of Health Services and associate chair of the Department of Health Services, will direct the research activities supported by the Tibbitts fu nd. Samuel Tibbitts (B.S . '49), who has been in hospital administration for more than four decades, is chairman of UniHealth America, the second-largest multihospital system in California, and chairman of PacifiCare Health Systems, an HMO with more than 950,000 members. He has served on the UCLA School of Public Health Dean's Advisory Board since its inception in 1988, and has chaired the board since 1990.
ALUMNI ASSOCIATION MAKES PLANS AIMED AT INCREASING NETWORKING The UCLA School of Public Health Alumni Association, meeting at its annual summer retreat in September, developed the following strategies designed to increase networking among alumni, students, health professionals and faculty : • The association will continue with "The Future of the Health Care Industry - Opportunities and Challenges," its joint program with UCLA's Anderson Graduate School of Management Alumni Association. Professional organizations in all areas of health will be encouraged to work together to promote the expansion of employment opportunities. • The association will work with the student association and faculty to start a schoolwide mentoring program, such as that in place at the university undergraduate level and in the school's health services department. Professional alumni and senior graduate stu-
Anyone interested in becoming an active member of the alumni association or being added to its mailing list should contact Carol Burrows at (310) 825-5119.
dents will serve as mentors for the school's graduate students. For more information, call Marta Sorini at (310) 825-4506. • The Career Seminar Series will be held during the winter and spring quarters. Dr. June Millet, director of the UCLA Placement and Career Planning Center, will discuss approaches to interviewing, resume writing and successful techniques for getting the "perfect job." For information, call Lejeune Lockett at (310) 373-1635. • The association continues to work with the student association on the Border Health Project. The project will make available to students and alumni opportunities to work with agencies such as the Flying Samaritans in providing health care in clinics south of the Mexican border. For more information, call Julie Matsumoto at (310) 202-1642. • To compensate for the impact of university budget cuts on the alumni association's budget, the association is looking for sponsorship. Anyone interested in sponsoring an event, project, or schol-
arship should contact Dan iel Barzman at (818) 407-6059. The association ' s board is now as follows: Lester Reams, Dr.P.A., President; Belinda H. Jenks , Ph .D. , Past-President; Daniel Barzman, M.S.P.H., President-Elect; Joyce Garcia, M.S.P.H., and Carmen Mendoza, M.S.P.H., Co-Vice Presidents of Programming ; Lill y Grossman,Dr.P.H., Secretary; Lisa Irskens, M.S.P.H., Treasurer; Julie Matsumoto, M.S.P.H., Chair, International Affairs ; Lejeune Lockett, M.S.P.H., Chair, Career& Job Placement; Mark Dubow, M.B.A., M.S.P.H., Chair, Private Sector; Elaine Batchlor, M.D., M.P.H., Chair, Legislative Affairs; Eve Rubell, M.P.H., Chair, Job Resource Network; Janet Blai r, M.P.H., Chair, Minority Affairs; Lynn Creelman, M.S.P.H., Representative, Environmental Health Sciences; Marta Sorini, M.P.H., and Jane Valentine, Ph.D., Faculty; and Ruth Richards, M.P.H., Veronica Abernathy, M.P.H. , Nancy Monk, M.B.A., M.P.H., Victoria Corbell, M.B.A., M.P.H., David Katzin, M.D., Ph.D., and Carolyn Katzin, M.S., Members-at-Large.
BRESLOW LECTURER To SPEAK ON TEEN V10LENCE's IMPACT ON THE NATION' s HEALTH-CARE SYSTEM
Dr. Deborah Prorhrow-Stirh
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ne of the nation's leading public health experts on violence prevention will deliver the keynote speech for the UCLA School of Public Health Alumni Association's 19th Annual Lester Breslow Distinguished Lectureship, scheduled for Friday, January 29, at the UCLA Faculty Center. Dr. Deborah Prothrow-Stith, assistant dean for government and community programs at Harvard's School of Public Health,
will discuss the impact of adolescent violence on the health-care system. The first woman and, at 33, the youngest person - to serve as state commissioner of public health in Massachusetts (1987-1989), ProthrowStith created a violence prevention curriculum for adolescents that is used by 5,000 schools in 48 states and seven nations. Her 1991 book, Deadly Consequences: How Violence Is Destroying Our Teen age Population and a Plan to Begin Solving the Problem, is billed as the first to present a comprehensive public health perspective on violence to a mass audience. The speech will begin at 7:30 p.m., and will be preceded by a reception at 5:30 and dinner at 6. For more information, call Carol Burrows at (310) 825-51 19.
''Those who claim that violence is never justified would do well to study the American Revolution."
Liza Pennywirt Taylor
NEW THRILLER HAS A FAMILIAR AUTHOR, TOPIC
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he wife of a UCLA School of Public Health associate professor has written a novel based on the true story of epidemiologist John Snow and his discovery of cholera in 19th-century London. Liza Pennywitt Taylor's The Drummer Was the First to Die (New York: St. Martin 's Press, 1992) blends Snow's historic work with a suspenseful tale of romance. Herself a former AIDS immunology researcher at UCLA, Taylor is the wife of Dr. Jeremy Taylor, associate professor of biostatistics.
-Dr. Milton I. Roemer, professor emeritus of health services, speaking at "Beyond the Rodney King Verdict," a panel discussion sponsored by the UCLA Public Health Students' Association in May.
"The technical advice, resources and networking that UCLA offered to us in the grass-roots community were like an answer to our prayers. Finally, here was an institution powerful enough to open doors." -Val Rodriguez, community organizer for the South El Monte Health Promotion Council, on the role played by four UCLA professors (including two from the school of public health) on a project in which all decisions
V. Gale Winting
WINTING BRINGS NONPROFIT EXPERIENCE TO Assoc1ATE DEAN PosT
Winting, who holds a master's degree in clinical psychology and a master's of divinity in pastoral counseling, believes his experience in the nonprofit sector has laid a strong foundation in community-based problem-solving. "I feel that both my administrative and community-based experience will be an asset to the school in its development of a strategic plan and a public health practice program," he says.
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ale Win ting has joined the UCLA School of Public Health as associate dean for administration. Win ting comes to the school from United Way, Inc. of Greater Los Angeles, where as vice president he developed and managed programs in administration, strategic planning and public affairs. He previously served as nonphysician manager for the City of Long Beach Health Dept., where he was responsible for all fiscal and programmatic activities and was division manager of several public health programs.
are made and carried out by community residents.
"A lot of students don't want to just sit in classrooms learning about 30-year-old theories when they can be out actually practicing public health in the communities." -Greg Oliva (M.P.H. '92), a recent health services graduate who now works in the L.A. County Department of Health Services' public health programs and services planning division.
"As professionals and future leaders in the field of public health, you may find yourselves amidst other individuals working in your field who do not have your academic training. However, never lose sight of the
Dr. Reed V. Tuckson, president of the Charles R. Drew University of Medicine and Science , deliver ed the keynote address at the UCLA School of Public Health commencement ceremony in June. His topic: "TheDawnofaNewDay."
value of practical training that can be learned from your peers and co-workers at all levels in the field." - Dr. Belinda Jenks, president of the UCLA School of Public Health Alumni Association, speaking to new graduates at the commencement ceremony last June.
"Public health must be a political movement. Without organized intervention into our unjust health-care system, those who are systematically denied care become systematically disempowered, powerless to contribute to promoting a just society." -Len Finocchio (M.P.H. '92), 1991 -92 president of the UCLA Public Health Students ' Association, speaking at the commencement ceremony. UCLA PUBLIC HEALTH
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reams are the preferred currency on the blacktop at Holmes Avenue Elementary School, and during recess one day the trading is heavy. At this South-Central Los Angeles school - located in the heart of the Pueblo de! Rio housing projects, in an area where drive-by shootings are not uncommon - reality can be harsh, so dreaming helps. A group of 10- and 11-year-olds take a break from their kickball game to approach a contingent on hand from the UCLA School of Public Health. "Where are you from?" one boy asks. "UCLA." "I'm going there," he offers, matter-of-factly. His friends are quick to agree. "Do you know where UCLA is?" "Nope." That tenuous link between university and community is at the top of the agenda for change at the UCLA School of Public Health. Major efforts are under way to send students and faculty into the community more often and in greater numbers, and to bring the community to the school - literally and figuratively. This movement - and the ways in which it benefits all parties - is the subject of this special section.
UCLAPUBLI C HEALTH
The school looks inward to determine how to become more responsive to public health's natural constituency
BY
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omething big is happening at the UCLA School of Public Health: A dramatic change in the zeitgeist, building for several years, has reached a zenith - the point at which thoughts are turned to actions. It seems that no matter whom you talk with these days, the subject gets around to community. You'll hear it from students. Len Pinocchio (M.P.H. '92), last year's UCLA Public Health Students' Association president, explains: "There
"We want to apply the skills we learn at the school to real-life problems." - Jef!Cabal/ero, 1992-93 President, Public Health Students' Association
was a general frustration that here we were, isolated in Westwood, when some of the most pressing public health problems in the country were happening within 10 miles of UCLA." . You' ll hear it from faculty, many of whom strive to spend time in the community in order to effect positive change and bring more of those experiences to their students - but who concede that institutional demands make it easy to lose touch with the outside world. You 'll hear it from the dean, who took to heart a 1988 Institute of Medicine report suggesting that schools of public health had come to resemble large academic research centers with insufficient links to practice. "I am convinced that the direction the IOM encouraged is the right one, for the field and for our school," says Dr. Abdelmonem A. Afifi. You can see it for yourself in the form of visitors to the school, ranging from local public health officials and community activists to elementary schoolchildren from South-Central Los Angeles, brought in variously to lecture, exchange ideas and learn. And increasingly, you can see it in the community itself, where students, faculty and administrators are spending more time than before. 6
UCLA PUBLIC HEALTH
As the UCLA School of Public Health begins its fourth decade, an unprecedented level of change is being discussed and, in some cases, already implemented. The seeds were sown at least as far back as 1988, when an influential Institute of Medicine report (The Future of Public Health ) was released. Momentum built two years later, when students formall y presented their desires for community action to the school ' s administration. And last spring, with the move toward greater community emphasis already afoot, the social unrest in Los Angeles underscored - to put it mildly - the importance of the work that had begun. What, when the dust clears, will the change involve? Following are some possibilities: More Extensive Field Work for Students. The typical field requirement for master's students is 10 weeks - not enough time to become familiar with an organization, develop relationships and make a real contribution, many argue. Says Dr. Snehendu Kar, professor of community health sciences: "You automatically eliminate many important activities that can't be completed in that time." Jeff Caballero, 1992-93 president of the Public Health Students ' Association, argues that yearlong field internships would serve a dual purposenot only facilitating more meaningful projects, but also enriching the courses by allowing students to bring their outside experiences into the classroom, sharing them with other students. Greater Community Applications in Course Assignments. Students have complained that they're often asked to write grants and conduct qualitative research only as academic exercises, while countless organiza-
"It's easy to become so tuned in to university rules and norms that you lose touch with the community." --Dr. Deborah Glik, Assistant Professor, Community Health Sciences
tions need help writing proposals, assessing needs, taking surveys and educating the community. "We want to apply the skills we learn at the school to real-life problems," says Caballero. New Courses. Beyond shifts in the structure of current courses, new courses will include public health topics of keen interest to community residents that currently aren ' t being adequately covered, if they're offered at all - drug abuse, violence, gangs and mental health, to name a few. Faculty Diversity. The wide assortment of ethnicities and cultures represented in the school's student population is not mirrored by its faculty, though it's not for lack of trying. "For full-time, tenure-track public health faculty, the pool is just too small," says Afifi. His short-term plan is to bring in more representatives from the county health department and community organizations to teach part-time; eventually, he hopes ongoing efforts to attract minority students into the program will lead to a broader faculty pool. The Community as Teachers. Of course, inviting community leaders to lecture does more than add to the diversity of the faculty . When students requested an experimental course on women and AIDS
"We do have an obligation to the community in the research we select." -Dr. Susan C. Scrimshaw, Associate Dean for Academic Programs and Professor, Community Health Sciences
last year, Cleante Rich, a social worker from the Watts Health Foundation, was hired to teach it. "We want to do more of that," says Dr. Susan C. Scrimshaw, associate dean for academic programs, noting that portions of established courses could benefit from communitybased guest lecturers as well. Political Activism. A major part of what public health is about is politics, goes the argument. Since many of the school's students go on to positions where they can shape policy, it is essential that the curriculum emphasize the political skills that will help them as advocates. Should the school as an institution become more vocal on health issues? Yes and no, says Scrimshaw: "There' s a fine line that we have to avoid crossing. You don't want to risk losing your objectivity, your credibility and your scientific validity. On the other hand, when we choose a topic to study, we've already made a_ subjective decision. And we do have an obligation to the community in the research we select. So to simply denounce President Bush, for instance, would be a mistake. But taking one of his policies and explaining what the effects are for a particular community is completely appropriate." Faculty Activities. The problem, most everyone agrees, is that the demands and the reward system for tenure-track faculty at a major academic institution do little to foster much of the above. "It's easy to
"I am convinced that the direction the !OM encouraged is the right one,for the field and for our school." -Dr. Abdelmonem A. Afifi, Dean
become so tuned in to university rules and norms that you lose touch with the community," says Dr. Deborah Glik, assistant professor of community health sciences. "An institution such as UCLA has rigorous demands for faculty to produce original research, and that can take all your time and energy." With these pressures, notes Dr. E. Richard Brown, professor of community health sciences and health services, it's difficult for faculty to find as much time to work in the community as they would like. "There isn't a lot on campus that facilitates it," he says, "and except for pats on the back, there isn't much that encourages it. " Many hope that the decision last July by the UC Regents to increase the emphasis on teaching when making faculty promotions will help. Moreover, the campus has made strengthening community ties a priority: Scrimshaw and Dr. Charles E. Lewis, director of the school's Center for Health Promotion and Disease Prevention, were among those appointed to a campuswide task force on public policy. And Afifi has asked faculty to move in that direction, pointing out that publishable papers can come out of applied community work. What Afifi calls "a new way of thinking in our school" asks faculty to be conscious of how they can direct their research to maximize its benefit to the population it concerns. But equally important, he and others argue, is what the researcher does with the community before, during and after the project is completed. When he and other representatives from the school first began meeting with South-Central community leaders in 1991 to discuss the Community Empowerment Initiative (see page 8), Afifi admits, the UCLA contingent was viewed with suspicion. "The people from the community needed to be reassured that our intentions were not to use the communities as laboratories but to work with them," he explains. Such trepidation, Afifi notes, is based on too many past experiences in which university researchers have collected data from communities, published their findings, and moved on. It's summed up by Val Rodriguez, community coordinator of the South El Monte Health Promotion Council: "If we don't know what to do with the research, it does us no good." Rodriguez made the comment while participating in a panel discussion organized by the Public Health Students' Association after the social unrest. Ten experts (half from the community, half from the school of public health and elsewhere in the university) spoke, and there was ample input from the students and faculty assembled in the auditorium. The topic was Los Angeles' future following the King verdict and aftermath - and the appropriate role for the school toward building a better future . "That discussion was definitely needed," Finocchio recalls. "The whole fabric of Los Angeles had changed, and a lot of students had a hard time just going back to class and doing their assignments as if nothing had happened - particularly since many of us had come to the school because we wanted to have an impact on the community." The school's new direction promises that students, faculty and the institution itself will increasingly have an impact on the community - and vice versa. • UCLA PUBLIC HEALTH
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BY DAN GORDON .
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tudents of Dr. Snehendu Kar's Communications in Health Promotion and Education class had a most unorthodox lecture last June 3. The topic: gangs, drugs and graffiti. The lecture format: poster presentations, short speeches and an original rap song. The teachers: the fifth- and sixth-graders of Holmes Avenue Elementary School in South-Central Los Angeles. For two months, five of Kar's students had paid regular visits to Holmes to help the kids with the project. They talked about forming coalitions, prioritizing problems, getting information, effecting change. But just as important was what they didn't do - they left selecting the topics, forming the groups and developing the presentations to the kids. It's that kind of thinking that drives the Community Empowerment Initiative, a project developed by the school, the L.A. County Department of Health Services, and community leaders and residents. "Traditionally, we come to a class and lecture children about gangs and drugs," says Kar, professor of community health sciences and the school's faculty representative on the Community Empowerment Initiative's board of advisers. "Empowerment means going to the kids and saying, 'You design a program yourself.' We didn't care how good the posters were. When the kids design the program, it forces them to think about the problem they identify and develop the skills to do something about it." Around the same time, a group of adults from the same community was meeting to identify needs it would address as part of the same initiative. Some suggested that the residents, many of whom were Latino, could use English-as-second-language courses . Charles Stewart, principal of Holmes Avenue Elementary School, pointed out that such classes already existed. But who would take care of the
kids while their parents attended them? The answer came from another resident, who volunteered to help facilitate child care. They were on to something. Child care is crucial not just for parents interested in ESL courses, but also for those in the workplace. Moreover, a child-care center would create jobs in a community that desperately needed more of them. What would such a center entail? Notes Dr. Caswell A. Evans Jr., director of public health programs and services for the L.A. County Department of Health Services: "If all we did through this program was create a DHS/UCLA child-care center for people to come and dump their kids for the day, we'd really be missing the boat." Instead, the goal is to help the community develop the capacity to run its own high-quality center where children receive immunizations, are monitored for health problems, and participate in enriching academic and recreational activities. For the school and the health department, empowering the Pueblo del Rio and Rosecrans neighborhoods means helping to build that community structure, linking the community with organizations that can assist, and imparting necessary skills. The institutions' role is advisory - not to analyze data, decide what's needed, march in and solve the problem, but to listen, consult and work alongside members of the communities. It means the communities themselves identify and prioritize their needs, form the coalitions, conduct the surveys, analyze the data and lobby the politicians. "The medical services are not at all the most important thing we're offering," says Harold Goldstein, associate director of public health planning for the county and a UCLA School of Public Health doctoral student. "We're working with people to give them the sense that things can change, that they can make a difference in their own lives." "/saw someone from the Pueblo de/ Rio housing project giving a tour and showing all ofthe bullet holes, things I had never seen before. Then I met
Above: Len Finocchio and Jodi Leslie were among five UCLA School of Public Health students who made weekly trips to Holmes Avenue Elementary School last spring, working with a class offifth- and sixth-graders on a project in which the kids identified problems in their community and learned how to effect change. Opposite page: The end result was a presentation at Dr. Snehendu Kar' s Communications in Health Promotion and Education class. UCLA PUBLIC HEALTH
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The wellness centers' components: • Family-Centered Health Promotion/Health Protection, offering health education and preventive services, including mental health, immunizations, physical exams, optometric care and dental care; • Multiple Risk Reduction Activities for Youth, the after-school component, designed to provide desirable alternatives to unhealthy behaviors by developing skills and creativity and building self-esteem. The older kids run the program with the help of adult preceptors, choosing the activities and serving as tutors and support-group leaders; and • Adult Empowerment Activities, with peer counselors (supported by preceptors) running courses teaching job skills, civics and language, as well as providing job application and placement assistance, a job resource center and child care. "It was important for us to show the communities that we are interested in the problems they define, and that we are sincere in our commitment to helping them. In this sense, we were helped tremendously by our student representatives. They were a breath of fresh air - clearly a committed group of men and women with noble intentions who were there to do something, not just talk about it." -Dr. Abdelmonem A. Afifi, Dean UCLA School of Public Health
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One of the top priorities expressed by community residents was for an after-school program that would provide enriching activities and build self-esteem. Such a program now exists at the Pueblo de/ Rio site; on this day, kids decorate T-shirts.
all of these incredibly motivated people from the community. When you think about the level of violence and the will and spirit of the people ... It's hard to put those two things together."
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- Ed MacDonald, Administrative Analyst Dean's Office, UCLA School of Public Health
ar points out that previous community-based public health models have often been built around largely white, middle-class populations. The two neighborhoods chosen for the Community Empowerment Initiative, by contrast, are culturally diverse and highly impoverished. Rosecrans is made up of approximately 40,000 primarily Latino, African-American and Samoan residents living in homes around General Rosecrans Elementary School in Compton, an incorporated city with its own school district. Pueblo de! Rio refers to the Pueblo de! Rio housing project and the adjacent Holmes Avenue Elementary School in SouthCentral Los Angeles, made up primarily of Latinos, African-Americans and Cambodians. In neighborhood forums that included representatives from the L.A. County Department of Health Services, the UCLA School of Public Health and the Coalition for the Enhancement of Minority Youth (social-service providers representing area agencies), the two communities came up with markedly similar goals: job training, child care, primary health care, and an after-school program for children. "Over and over again, parents told us their kids are exposed to drugs and violence because they have no place to go in their free time," Kar says of the latter, which was perhaps the most loudly voiced. Once they had set their priorities, the communities both resolved tc establish their own "neighborhood wellness center," based in the Holmes and Rosecrans elementary schools, as the hub for empowerment activities. IO UCLA PUBLIC HEALTH
en Finocchio was one of five students in Kar' s class who made weekly trips to Holmes. Three of the students, including Finocchio, worked with the children, while two others met with the children's parents, discussing the concerns their kids had raised. "It was the most realistic part of my education," reflects Finocchio, who received an M.P.H. in June. "The issues these kids identified as problems in their community were insightful and profound. "We drove them home after they came to UCLA and saw their houses, their neighborhoods. You see that these are communities like any others, except they have realities that we don't deal with. You see that they have dreams and hopes just like we did as kids, and you know that a lot of those dreams will not be realized because of the conditions they face." Never was that reality more apparent than on April 29, 1992, when Los Angeles erupted. For the consortium members who had been developing the Community Empowerment Initiative, the events of that day were particularly chilling. "We'd been up late the previous two nights working on the project," says Goldstein. "I came home, turned on the TV, and first saw the riots. I was stunned. Then I reread the introduction to the plan we had just written, and it was as if we'd written it after the riots." Dr. Deborah Glik's Communications and Media Development class had to cancel its scheduled visit to the Rosecrans site on April 30, the day after the social unrest began. Her students were in the midst of an educational project they and the schoolchildren had developed on nutrition, a need identified by the school's principal and teachers. "We went back the next week," Glik recounts. "It was an important learning process - that just because everything falls apart doesn't mean you stop doing what you do. And the students found that people in the school were appreciative that no matter what happened, we would continue to work with them." In the same sense, Afifi notes, continuity is fundamental to the program. "We'll have a stream of students coming through to do their internships, with one student carrying out a piece that gets picked up by the next student, and so on," he explains. "This program is modern in that it focuses on current and future problems, but it's really rooted in the basic traditions of public health. FrankContinued on page 12
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LESTER , BRESLOW
ON
COMMUNITY EMPOWERMENT Community empowerment has proved effective in South El Monte, a Latino-dominated community of 25,000 located east of downtown Los Angeles. For the last four years, a council of South El Monte residents has met monthly to define the health needs of the community and to plan and carry out appropriate actions. A recent conference highlighting the council's achievements attracted attention from well-placed public health officials and academics throughout the country. The project was started by a UCLA group headed by Dr. Lester Breslow, professor emeritus of health services at the UCLA School of Public Health and former dean of the school. (Also involved: Dr. E. Richard Brown, professor of community health sciences and health services at the school of public health; Dr. Jack Rothman, professor in the school of social welfare; and Dr. Hector Myers, associate professor of psychology in the college of letters and science.) "It' s been very heartening to see how people will define their own health problems and do something about them," says Breslow. "As academics and public health professionals, we do not appreciate enough the tremendous energy, motivation and knowledge of people like those in the South El Monte community." Q.
What is your definition of community empowerment?
A. For health, it means ensuring that members of a commu-
formed the council - the overwhelming majority of whom are simply residents of the community and interested in health. The steering committee has since served in an advisory capacity. Those of us who are professionals are there just to offer whatever expertise we have on the problems that the community group decides are priorities. Sometimes they take our advice, other times they don't. Often their ideas are a lot better than ours.
What kinds of adions has the council taken? One of the first ideas the council members advanced was to publish a community health-services directory. I protested that notion on the grounds that they needed health services more than they needed a directory. They responded that they knew that very well, but first they wanted to know what was available so that when there was a health problem they would at least know what agency might be able to help. So, with the help of a class of students from the UCLA School of Public Health, they developed such a directory - published in Spanish and English, and distributed very effectively by the council throughout the community. In response to a measles epidemic, the council members organized a vaccination campaign in the community, since the nearest health department facility was 10 miles away. They arranged for the Child Health Development Program, which operates out of vans over much of the county but wasn't getting to South El Monte, to come into the community and provide examinations. The council members made transportation and payment arrangements for more than I 00 women who wanted to go to the county facility for pap smears. Upon going, they found that few of the people at the facility spoke Spanish, the language spoken by most of those who were using the services, so they systematically offered their time as volunteer translators and other aides. They operated a health fair. ... These are just a few examples.
"Sometimes they take our advice, other times they don't. Often their ideas are a lot better than ours."
nity have an opportunity to examine their own health problems, make their own decisions about the priorities among those problems, and involve the community as widely as possible in the solution of those problems - calling upon expertise from inside or outside the community as deemed appropriate.
How was your group's approach different? The typical approach by a health agency or a university is to decide what the program should be and proceed to "reach out" to the community. Outreach clearly implies that there is a base from which the resources emerge and from which the decisions are made, and that in some manner there will be arms extended out to the community to deal with the problems that some outside agency or university has defined. Our approach has been to go to the community and assist it in developing its own resources for dealing with health problems it defines.
How was the South El Monte Health Promotion Council formed? Our first step was to approach the local government, churches, schools and health department to enlist their endorsement and support of the effort. We worked with them in forming a steering committee made up primarily of representatives from those agencies. Through a grant from the Centers for Disease Control, we hired a community organizer, who
Why did you feel the need for this type of approach? Having been in public health for more than 50 years - in a local health department, a state health department and a school of public health- I've had the opportunity to see the effects of our profession all over the world. And I have been especially struck by the fact that we're not being as effective as I think is possible in the inner cities of metropolitan areas. In searching for a new approach, this evolved. I still believe health departments themselves need to be vastly strengthened. One of our hopes is to develop a strong link between community organizations of people interested in health and their local health departments. You can'tjust have the community health agency; you've also got to have a governmental structure that is capable of responding to what a community organization sees. • UCLA PUBLIC HEALTH
11
Continued from page 10 ly, it's what we should have been doing all along." -Dr. Caswell Evans, director of public health programs and services L.A. County Department of Health Services
T
here's another side to all this, Evans notes. In order to effectively empower their community constituents, the school and the health department must reevaluate themselves. For the school, Evans contends, "this is really a reminder that we all do this because of the health of the people in the community, and that the textbook is a vehicle to get there as opposed to an end in and of itself." For its part, the department is now training its staff to make prevention a focal point of every community interaction, and to step up the level of interaction while allowing communities to set their own priorities. The department also intends to establish a Public Health Practice Institute, which will offer continuing education and mentoring designed to direct public health professionals to community practice. The institute will depend on support from the school - an example, Evans points out, of the good that can come out of stronger ties between practice and academia. "The amount of collaboration between local health departments and schools of public health has been marginal," Evans says. "How many local health departments have people who are adjunct faculty in a school of public health? How many times have faculty from the school come to the health department to lecture? How many papers are written jointly? How many course curricula are put together with input from the people who are on the front lines providing community public health?" Afifi finds himself asking the same questions, and wanting the answers to change. "The county health department is a natural avenue for our students and graduates," he says, "and it makes sense for us to use such a good model - the largest local health department in the country - for our students to learn from and learn in. Moreover, it makes sense for us to attract people from the department to come and teach, and for us to impart the latest scientific developments to the department's employees. "That synergy is bound to help the main constituency that we and the department of health services share, which is the community." •
Ben Marte (left) of the Coalition for the Enhancement of Minority Youth holds regular meetings designed to empower parents at the Pueblo def Rio housing project.
12 UCLA PUBLIC HEALTH
PUBLIC HEALTH AND POVERTY: DO THEY MIX? It doesn ' t take a public health education to know that the woeful health conditions plaguing inner-city communities are no coincidence, that poverty and poor health are not unrelated. Recognizing this, the Community Empowerment Initiative purposefully blurs the line between health issues and social issues. Says UCLA School of Public Health dean Abdelmonem A. Afifi: "Beyond the specific programs, I hope our broader impact is to create in children's minds an image that being a student or a professor at UCLA is within their reach. If you instill this expectation in them, they will see it as a realistic and attainable dream." Will the initiative succeed? "I have no doubt," says Harold Goldstein, associate director of public health planning for L.A. County. "My sense is that there are a lot of people waiting to be empowered, who just need someone to say 'Go for it. I'm on your side, I'll support you in what you do. ' " Such assertions wreak havoc with conventional perceptions of the role of public health. Isn ' t it about sanitation and disease prevention? What does self-esteem have to do with it? Among other things, answers Charles Stewart, the principal of Holmes Avenue Elementary School, "If you have high self-esteem, you 'll want to improve your health."
"For too long, we've been saying poverty doesn't involve us." Which leads to more questions. Should it be public health 's role to help create jobs where they ' re lacking? Should public health address the social injustices, issues of racism and distribution of the wealth, that mire inner-city communities in poverty? Goldstein thinks so. "For too long, we ' ve been saying poverty is a social issue that doesn't involve us," he asserts. "But if you look at an overlay of where the poverty is in the county and where we have the highest rates of tuberculosis, sexually transmitted diseases, homicide ... The major public health issues are directly tied to poverty. We have to be willing to take on these social issues if we want to have an impact." "Public health has been defined as relating to the set of conditions that will allow health to improve and flourish," agrees Dr. E. Richard Brown, professor of community health sciences and health services. "Therefore, all of these problems are not only within the range of what public health may have as concerns, they should be. How can people be healthy if they live in conditions of poverty, unemployment, crime that keeps them isolated, or environmental conditions that are directly detrimental to their health?" Not that the broader approach guarantees success. No one claims, for instance, that the Community Empowerment Initiative will eradicate poverty in the two affected communities. "In the absence of any other change in our society, it' s going to be hard and it will take a long time," says Dr. Susan C. Scrimshaw, professor of community health sciences and associate dean for academic affairs. But, she continues: "You can tell yourself that whatever you do isn' t going to change the world - which is true - or you can say, 'What I'm going to do is a drop in the bucket, but if each of us puts in a drop, the bucket will fill up.' This project can give people tools, skills, and energy, and that can make a tremendous difference." -D.G.
ONE II
STUDENT
1
S
PERSPECTIVE:
CAN WE ALL GET ALONG?''
Ca/lisha Eldridge-Bell, a second-year M.P.H. student in community health sciences, was born and raised in the Crenshaw District of Los Angeles, where she lives today with her husband and son. The following (portions of which first appeared in a paper she wrote for her Qualitative Research Methods course, taught by Dr. Susan C. Scrimshaw) is her account of how events beginning on the afternoon of Wednesday, April 29, 1992, affected her life. I had just finished studying for my Environmental Health midterm when a friend asked me if I had heard the Rodney King verdict. "No," I said. "What happened?" To my surprise, she said that the officers had been BY CALLISHA found "not guilty" on all but one pending count. I could not believe (or did not want to believe) that the "system" had failed my people again. I have never felt so hopeless and so filled with rage as I did at that moment. I knew that this could not really be happening - maybe she got her facts confused. Then, two middle-aged African-American women came out of two different offices. I had never seen them before, but we all looked at each other and said, "Can you believe it?" One woman said, "You just have to laugh to keep from crying." I noticed that we were standing in the middle of the corridor where four hallways joined. I wondered if we were symbolically in the crossroad of decision-making. Which route would I take? Would I drop out of school, because people might continue to see me only for my complexion and not for my individual accomplishments? Would I stay in school and get my doctorate to gain the prestige and respect that so many of my African-American people had not received? Would I respond in rage and do something that I would later regret? Or would I stand by my people and prove to the world that. we are a people who need to be heard? I left the school of public health and drove to my son's preschool. I wondered if he would be faced with the same types of injustices. When we arrived home, my husband and I both looked at our son. We wondered why we had brought this little person into a world of so many problems. What did he have in store? Would he be a victim of racism? Would he be on a video 20 years from now? We agreed that we would do whatever it took to make sure our son got the best life had to offer. I had always thought civil rights stories were my mother's stories. I had envisioned her as an elderly woman, sitting down and telling my son of the struggles that she faced in her generation. I never dreamed that I would see this level of injustice and civil unrest. I had overcome all of those obstacles (or so I thought). Yes, I had endured racist remarks over the years. Yes, I had taken my then-10-month-old son to an elitist "baby gym" and heard a white man ask him to "give me five, man!" I had chosen to overlook these situations and interpret them as a few isolated instances, but what I began to see completely changed my mind.
Later that evening, I began to smell smoke and hear helicopters flying overhead. I watched as the news showed many neighborhoods of all economic levels being looted and burned. I looked at my son as he said, "Mommy, fire!" - a word he had not known just a few hours earlier. On that Saturday, my husband and I went out to help clean the community. It was hard to believe that our community, the Crenshaw District, was one of the hardest-hit areas. This was a very nice, middle-class African-American community. We helped clean up a store that had been burned. It was a very hot day and the work required a great deal of energy. Approximately 16 of us -AsianAmericans, African-Americans, Chicano-AmeriELDRIDGE-BELL cans, and Anglo-Americans - were present, all working together. I felt a sense of belonging and hope as all of us humans worked toward a common goal. During a break, my husband and I talked with a friend of ours who had also come to help. I laughed and told them that I hadn't worked that hard since I was in labor with my son. As we resumed working, I looked around and pondered what I had just said. There were, in fact, parallels. As we stood together, cleaning what had been destroyed, we were symbolically giving birth to a new generation. A people who stood united, regardless of what had previously ocWl curred. A people who worked and sweat together for a common goal. I believe that if we use our energy to produce a collective good and come together as humans and not as races, nothing will be impossible for us to achieve. After several hours of working together, the site was clean. "All right!," my husband yelled. "We did it!" Everyone started clapping and screaming as leftover ash covered our hair and a black film covered our clothes. We all smiled, hugged, and went our separate ways. Although I did not learn the names of these people or find out where they lived, I will never forget them. We touched each other's lives and proved to the world in that short span of time that all people of different origins can work together if we have a common goal and vision of hope. I have learned a great deal about myself these past months. I have reaffirmed my vows as a born-again Christian and realized that Jesus and racism on any level do not mix. I have also seen a tremendous change in the African-American community. The people seem increasingly unified. I am encouraged by the school's involvement in the Community Empowerment Initiative. I know that it is a small step, but it is a step in the right direction of empowering the African-American and Latino communities. I only hope that faculty, alumni and students will do their part in going into the field and making a positive public health intervention. I am dedicated to helping all people, not just my people. I strongly believe that every individual possesses the ability to make a difference. Each one can reach another one and help make our university, community, city, and world experience a better today and a brighter tomorrow. •
"I/we come together as humans and not as races, ¡ 'ff b no th zng e impossible."
UCLA PUBLIC HEALTH
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... and not what you mi¾;ht think. Studies at the UCLA School of Puhli<¡ I lcalthhascd Southern California Injury Prc\'cntion Hesearch Center spotlight a leading cause of death that has nothing to do with disease.
IGHTING A DEADLY EPIDEMIC ... /J
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r
.I A C Q If I h' J/ I C II E /, S
pril 29. Los Angeles erupts into five days and nights of violence. While the longstanding problems that pushed a community to the edge are considered by civic, religious and business leaders, UCLA's Southern California Injury Prevention Research Center, based in the school of public health, has another perspective on the situation. "The riots opened entirely new questions with regard to injury prevention and the overall effectiveness of our emergency systems," says Dr. Jess Kraus, professor of epidemiology at the school and director of the center. "For example, how did the violence spread? Did the community's emergency services respond adequately to people's needs? What types of injuries were reported? How many lives were lost because emergency services were delayed or unavailable? And how many more never sought treatment for injuries at all?" There will never be an accurate count of the number of injuries directly related to the riots because of the high rate of injury over any five-day period in Los Angeles. And Los Angeles isn't alone: Nationally, injuries resulting from incidents such as homicide, suicide, automobile crashes, work-related incident and drownings are the leading cause of death in all people under age 45 . "Though they may be called accidents, many of these incidents have a risk pattern to them, and could be minimized in frequency or severity through proper safety procedures," says Kraus. UCLA's Southern California Injury Prevention Research Center is one of eight such centers in the nation funded by the Centers for Disease Control. Kraus and colleagues at the center examine the risk patterns associated with various forms of injury and advise manufacturers, legislators, health-care providers and the public about their findings. The goal is to save lives and minimize damage when injury does occur. 14 UCLA PUBLIC HEALTH
In just three years, the center has made its presence known in the injury field. Last June, it was designated by the World Health Organization as a WHO Collaborating Center for Traumatic Brain Injury Prevention, Care, and Rehabilitation. While the center is prohibited from lobbying due to the nature of its funding, members do serve in an advisory capacity to legislators who are drafting or considering bills. For example, studies have shown that those who have a firearm in their home are 47 times more likely to have the firearm used against them, to use it against a friend or family member, or to use it against themselves than to use it against an intruder. "Our goal in this case would be to increase awareness of the real dangers of handguns in the home," Kraus says. Many factors can mitigate the likelihood, type, frequency and severity of an injury. "There is increased risk associated with certain population groups, certain products and certain situations," explains Dr. Susan Sorenson, an epidemiology researcher and associate director of the center. "It is disturbing but not necessarily surprising that certain ethnic groups are at higher risk for many kinds of injuries because of the products and environments they may contact." For example, poor African-Americans and Latinos may be more seriously injured in auto crashes because they often drive older, less safe vehicles without proper seat and shoulder harnesses. Risk of homicide increases in certain poor neighborhoods ridden by crime and gang violence. The leading cause of death for non-white men ages 15 to 34 is homicide, notes Sorenson; for white men in that age group, the leading cause of death is automobile crashes. According to Kraus, the center must address the reasons for the disproportional number of fatalities and serious injuries in poor socioeconomic areas and underserved populations. "While the answer may be
something as simple as differences in exposures, we need to find out what specific exposures are causing the problem," he says. Another of the center's main priorities is to increase injury research throughout Southern California. In its first year ( 1989), the center funded 23 research projects done by colleagues at King-Drew Medical Center, Rancho Los Amigos Rehabilitation Center, USC, Cal State Long Beach, and Daniel Freeman Hospital, to name just a few. "We're fostering injury research in many areas of the community, not just here at UCLA," Sorenson says. She notes that physicians and others in the community often see the effects of injury firsthand, which increases their interest in addressing the problem at the source. "Trauma physicians, for example, see mostly people who have been injured in accidents," Sorenson explains. "They get tired of being behind the issue, and have a real commitment to research that may prevent injuries." Projects currently in progress at the center (see accompanying box) cover the gamut of injury-related issues from gang violence to the impact of radio traffic reports on hazard perception. "Those reports are intended to provide risk information, yet they are presented in a 'beer commercial' format," Sorenson contends. "This study is looking at the impact of such incorrect value framing." The center maintains a strong focus on community-based research and programs. It's currently working with a community-service organization on a school-based violence prevention program. Explains Sorenson: "One of the elements is bringing appropriate role mcdels into the school system so that African-American and Latino kids see people like them who have made positive choices and, as a result, have different life-styles than if they hadn't." Another community-based program is a collaboration between the center, the county health department and a community-based organization doing gang-prevention work. This will involve evaluation of a summer employment program for young men ages 15 to 34 considered at risk for gang involvement. Sorenson, whose research focus is on intentional injury such as homicide, suicide and abuse, recently completed a study of child homicide.
(OST OF INJURY COMPARED TO OTHER HEALTH PROBLEMS
.....
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• Work-Related Fatal Injuries Dr. Jess Krous, UCLA School of Public Health • Injuries Due to Battering by an Intimate Ors. Susan Sorenson and Down Upchurch, UCLA School of Public Health • Injury Risk and Perceptions Folowing a Major Earthquake Dr. Lindo Bourque, UCLA School of Public Health • Carpal Tunnel Syndrome in Selected Populations Dr. Hal Morgenstern, UCLA School of Public Health • Freeway Design and Motor Vehicle Crashes Dr. Jess Krous, UCLA School of Public Health • Homicide of Los Angeles ChUdren Dr. Susan Sorenson, UCLA School of Public Health • Redudng Repetitive Poisoning in ChUdren Dr. Lorry Boroff, UCLA School of Medicine • Dentists' Recognition of ChUd Abuse and Injury Dr. Stephen Blain, UCLA School of Dentistry • Use of MAST Suits in Emergency Transport Dr. Arthur Fleming, King-Drew Medical Center • Value Framing of Radio Traffic Reports Dr. Sandro Boll-Rokeoch, USC Annenberg School of Communications • RehabUitatian Outcome in Minority Males with a Spinal Cord Injury Dr. Robert Waters, Rancho Los Amigos Medical Center
She examined Los Angeles Police Department records from 1980 to 1989 for children 14 and under, with a focus on ethnic risk patterns. Both the police department and the Department of Children's Services have reviewed the findings. INJURY RESEARCH EXPENDITURES COMThe information will also be released to the PARED TO OTHER HEALTH PROBLEMS scholarly and scientific communities, as well as to practitioners. \;;' On the other side, Kraus' s research centers on 1111: 200 unintentional injuries such as motorcycle and 0 auto crashes. He is currently involved in what he a 175 expects to become the most definitive study to ~ date on the impact of legislation to prevent fatal I150 0 "' head injuries in motorcycle crashes - particu1111: larly relevant in California, with the state's new cc 125 IA.I motorcycle helmet law in danger of being re>IA.I pealed. "Research in this area is very important :::; 100 1111: now since we know that wearing helmets saves IA.I A. lives," he asserts. 75 IA.I "' 1111: As for the social unrest in Los Angeles, ::::) IKraus says: "I don't propose to comment on 2i so z what precipitated it. But obviously, there were IA.I A. substantial reasons for what happened. These >< 25 IA.I ::c events were not whimsical or spontaneous. '-' 1111: There are and have been warning signs for years. 0 cc IA.I "What is clear is that we are losing too much IA.I INJURY CANCER CARDIO"' 1111: potential, in the form of our young people, to VASCULAR DISEASES injury. It is time to address this problem at its Source: CDC. core."•
....
::c 180
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1111:
INJURY PREVENTION RESWCH (ENTER:
....
225
::::)
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ASAMPUNG OF PROJECTS FUNDED BY THE SOUTHERN UUFORNIA
....s
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....0s ....a0
WORKS IN PROGRESS
INJURY
CANCER
CARDIOVASCULAR DISEASES
UCLA PUBLIC HEALTH
15
A sample of studies ongoing at the UCLA School of Public Health.
Oral Health and the Elderly Dr. Ronald Andersen, the Fred W.andPamelaT. Wasserman Professor of Health Services, is the principal investigator of "Determinants of Oral Health in Older Persons" and "UCLA/RAND Health Services Training Program," both funded by the Agency for Health Care Policy and Research.
Natural History of AIDS Dr. Roger Detels, professor of epidemiology, is heading the study "Natural History of Acquired Immune Deficiency Syndrome (AIDS) in Homosexual Men," a five-year, $12.6 million grant from the National Institute for Allergy and Infectious Disease. He is the program director of the UCLA/ Indonesia/Myanmar HIV/AIDS Training Grant, funded by the World AIDS Foundation to provide courses in Myanmar and In-
donesia on sentinel surveillance and evaluation of programs for HIV/AIDS; program director of the UCLA/Fogarty International Training Program in Epidemiology of HIVIAIDS, which provides training for health professionals from the Philippines, Thailand, Indonesia, Myanmar, China, Hungary and Brazil; and program codirector of the National Cancer Institute-funded Cancer Epidemiology Training Grant to provide pre- and postdoctoral training in cancer epidemiology.
Family Planning in Kenya Dr. Ralph Frerichs, professor and chair of epiqemiology, spent the summer firsi in Nairobi, Kenya, conducting policy-related research on the use of family-planning services to reduce fertility among Kenyan women; then in Yangon, Myanmar, doing field testing of a saliva collection device for the assessment of HIV infection; and finally in Rio de Janeiro, Brazil, leading a workshop on rapid surveys for HIV/AIDS investigations.
FOCUS: DIVISION OF POPULATION AND
FAMILY HEALTH Dr.Judith Blake is continuing her research on "Number of Siblings and Personality." Dr. Linda Bourque is principal investigator of "Policy Implications Derived from Descriptive Analyses of Survey Data - Loma Prieta Earthquake," part of an interagency agreement with the California Office of Emergency Services and the Bay Area Regional Earthquake Preparedness Project. Dr. Osman Galal is beginning two recently funded projects. One, funded by the Binational Fulbright Commission, is a faculty exchange partnership program between the UCLA School of Public Health and the High Institute of Public Health of the University of Alexandria in Egypt. The program will establish organized collaborative activities between the two schools, including exchange of scholars for teaching and research in educational methods and health sciences, opportunities to expand on international health activities, and information on health problems in the Middle East. The sec-
16 UCLA PUBLIC HEALTH
ond project, supported by the U.S. Department of Agriculture, aims at documenting food consumption patterns in Egypt, developing a monitoring system for that purpose. Dr. Deidre Gifford is working on "Management and Outcomes of CqUdbirth PORT," funded by RAND's Agency for Health Care Policy and Research. She is conducting a survey of postpartum mothers to see how those who have had cesarean sections and those who have had vaginal deliveries differ, and has participated in an extensive review of the research literature on appropriate use and clinical outcomes of cesarean sections. With Dr. Audrey Saftlas of the Centers for Disease Control and (temporarily) the Division of Population and Family Health, Gifford is studying pre-pregnancy weight and gestational weight gain in relation to pregnancy outcome. Dr. Neal Halfon is the co-principal investigator of "Evaluating National and State Strategies for Improving Children's Access to Health Care," funded by the Rob-
ert Wood Johnson Foundation through February 1995. Dr. Gail Harrison is developing a core resource in the area of body composition within UCLA's Clinical Nutrition Research Unit, a multidisciplinary unit focused on nutrition and cancer prevention, one of three in the country funded by the National Cancer Institute. She recently conducted a field test in Egypt of several appropriatetechnology scales foruse in weighing newborn infants by traditional birth attendants (funded by the Seattle-based Program for Appropriate Technology in Health in collaboration with the Child Health Department of the National Research Center in Cairo, Egypt). Patrice E. F. Jelliffe is on the preparation committee for a book on the expanding role of nurses and midwives as nutrition educators, and is part of a review committee on the nutritional significance of colostrum's role. She is working on the implementation of the WHO/UNICEF Jelliffes' A ward and will be responsible for setting criteria for suitability of candidates to receive fellowships.
Dr. Alfred K. Neumann is continuing studies of the sustainability of international technical assistance projects and integrated primary health-care programs. At home, he is involved in health promotion and disease prevention programs for Santa Monica schoolchildren. Dr. Charlotte Neumann recently completed the final report of analyses from the Kenya Project of the Nutrition Collaborative Research Support Program, based on a comprehensive study of functional implications of malnutrition carried out from 1984 to 1986. She has traveled to Kenya and Uganda in support of ongoing research activities in maternal and child health, and is engaged in longitudinal collaborative studies of Santa Monica schoolchildren. Dr. Susan C. M. Scrimshaw's Rapid Anthropological Assessment Procedures Manual (with coauthor Elena Hurtado, M.P.H. '78) has just been published in Chinese by UNICEF. The publication is also available in English, Spanish and French, with Portuguese and Arabic editions in progress..Aver-
High-Risk Industries Dr. John F roines, professor of environmental health sciences and director of UCLA's Center for Occupational and Environmental Health, was the principal and sole investigator of "A Ranking of Hazardous Industries in California," funded by the State Compensation Insurance Fund from December 1991 through August 1992 to update the OSHA Integrated Management Information System (IMIS) and develop a list of high-
Photos from left to right: Linda Bourque, Osman Gala/, Deidre Gifford, Neal Halfon, Gail Harrison , Patrice E. F. Jelliffe, Alfred K. Neumann , Susan C. M. Scrimshaw, Dawn Upchurch. Not pictured: Judith Blake, Charlotte Neumann .
sion adapted for research on AIDS/HIV has also just been published by the United Nations University. Scrimshaw's work with Drs. Dunkel-Schetter and Lobel on factors affecting pregnancy outcomes such as birth weight and weeks gestation was published this year in Health Psychology. She is beginning new research on the content of prenatal care with Dr. Deidre Gifford, adjunct assistant professor of community health sciences. Dr. Dawn M. Upchurch is currently conducting a series of studies on women ' s life-course transitions, using dynamic statistical techniques. She has conducted several studies on the impact of fertility on school enrollment. In one recent study, she examined the relative impact of the timing of a birth and marriage on college entrance and enrollment. In another, she demonstrated the heterogeneity between groups of adolescent mothers and high school dropouts. She is beginning a study exploring the interrelationships between family formation (i.e. fertility, marriage, divorce) and educational enrollment.
risk industries using IMIS and other data. He is the principal investigator of "Worker Health and Safety Conditions in the U.S. Maquiladoras Auto Parts Industry," funded through November 30 by the U.S. General Accounting Office.
Effects of Santa Monica Bay Swimming Dr. Robert Haile, associate professor of epidemiology, is designing an epidemiological study of health effects of swimming in the Santa Monica Bay, funded by the Environmental Protection Agency through a contract with the Santa Monica Bay Restoration Project.
Industrial Hygiene Training Dr. William C. Hinds, professor of environmental health sciences, is the principal investigator of the "Industrial Hygiene Training Grant," which provides program and financial support to 17 students in the environmental health sciences department. The grant, now in its ninth year, is a component of the NIOSH Southern California Educational Resource Center, one of 13 such centers established for training in the field of occupational health.
Immigration Experience and Quality of Life Dr. Snehendu B. Kar, professor of community heal th sciences, heads "Immigration Experience and Quality of Life," a cross-national study of Japanese and Koreans in Los Angeles; Sao Paulo, Brazil; Seoul, Korea; and Tokyo, Japan. The study, funded by the UC Systemwide Pacific Rim Research Program, is looking at the effects of immigration and acculturation on quality of life. He is also the principal investigator of "Indo-American Experience and Quality of Life," sponsored by UCLA's Asian American Studies Center and the National Federation of Indian American Associations to assess the effects of immigration and acculturation on IndoAmericans' quality of life.
Alcohol/Drug Surveillance Dr. Robert 0. Valdez, associate professor of health services, is the lead researcher on "Feasibility Studies for California Alcohol and Drugs Surveillance Efforts" (sponsored by the California Department of Alcohol and Drugs Programs); "Cervical Breast Cancer in Hispanic Women" (Agency for Health Care Policy and Research); "Costs of Passive Smoking on the Health of Children" (University of California Tobacco-Related Research); "AdjustmentofSalvadorean and Filipino Immigrants to Life in Los Angeles" (The Ford Foundation); and "Californians' Health Insurance Coverage" (various sponsors, including Blue Cross, Robert Wood Johnson Foundation, California Policy Seminar, Kaiser Family Foundation).
Drinking Water Consumption Dr. Jane Valentine, associate pro-
fessor of environmental health sciences, is working on "Drinking Water Consumption Estimates of Population Groups," an ongoing project from prior-collected data.
Air Quality Dr. Arthur Winer, professor of environmental health sciences and director of UCLA's Environmental Science and Engineering Program, is the principal investigator of "Time-Resolved Measurements of Gas-Phase Indoor Air Pollutants by In-Situ Long Pathlength Spectroscopy" (funded by the U.S. Environmental Protection Agency); "Development of Intermedia Transfer Factors for Toxic Air Pollutants" (California Air Resources Board); "Analysis of Energy Efficiency and Air Quality" (CIEE/Lawrence Berkeley Laboratory); and "On-Board Vehicle Emissions Measurements" (South Coast Air Quality Management District - Office of Technology Advancement). â&#x20AC;˘
INTRODUCTIONS
Dr. Richard F. Ambrose, associate professor of environmental health sciences and a faculty member of UCLA ' s Environmental Science and Engineering Program, was an associate research biologist at UC Santa Barbara' s Marine Science Institute from 1985 to 1992. His major research interests include restoration of coastal marine environments; development and scientific evaluation of mitigation techniques; ecology of artificial and natural reefs; marine ecology; and interface between environmental biology and resource management policy. Ambrose earned a Ph.D. in biology from UCLA in 1982.
Dr. L. Donald Duke, assistant professor of environmental health sciences and a faculty member of UCLA's Environmental Science and Engineering Program, received a Ph.D. in civil engineering/resources planning from Stanford University last January. He has 12 years' professional engineering experience, most recently with Woodward-Clyde Consultants in Oakland, where he designed and implemented a countywide strategy for industrial storm water pollution prevention. Duke 's research interests also include hazardousmaterial s/hazardous-waste management and environmental policy and planning. UCLA PUBLIC HEALTH
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A sample of the publications, presentations and awards of the school's faculty . Dr. Judith Blake, the Fred H. Bix by Professor of Population Policy, was editor of volume 18 of the Annual Review of Sociology (Palo Alto, Calif.: Reviews, Inc., 1992). Dr. Roger De tels, professorof epidemiology, was co-editor of the second edition of vols. 1-3 of the Oxford Textbook of Public Health (Oxford, England: Oxford University Press, 1991), as well as the author or co-author of three of the recently released books' chapters.
DR. DERRICK
He has had more than a dozen AIDS-related articles published in medical journals in the last year, including "The effects on survival ofearlytreatmentofhumanimmunodeficiency virus infection" (New England Journal of Medicine). Dr. J ona than Fielding, professor of health services, wrote "Smoking: Health Effects & Control," a chapter in Public Health and Preventive Medicine, 13th Edition (Appleton & Lange, 1992). His recent presentations have included "Reform of the Health Care System" and "Reaching High Risk Employees at the Worksite" at the American Journal of Health Pro-
B. JELLIFFE, 1921-1992
Following is the eulogy delivered by Dean Abdelmonem A. Afifi at the May 26, 1992, memorial service for Dr. Derrick B. Jelliffe, professor emeritus of community health sciences at the UCLA School of Public Health. Jelliffe , an internationlly recognized expert on public health and nutrition , died last March. Ralph Waldo Emerson was quoted to say: If a man write a better book, preach a better sermon, or make a better mouse trap than his neighbor, though he build his house in the woods, the world will make a beaten path to his door.
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Derrick B. Jelliffe built his house in many parts of the world. He taught, practiced medicine, and wrote many a better book in London; in the Sudan; in Ibadan, Nigeria; in Mona, Jamaica; in Calcutta, India; at Tulane Medical School in New Orleans, Louisiana; at Makerere Medical School in Kampala, Uganda; and in Los Angeles, California. And wherever he lived, Dick made it his business not only to achieve professionally but also to know the culture and the people. In the process, he spoke many languages, including French, Yoruba, Swahili, Luganda, and colloquial Sudanese Arabic.
motion 3rd Annual Conference; "Benefits of Worksite Health Promotion" at the First National Confere nce on Federal Empl oyee Health and Fitness Programs; and "Incentives for Health Promotion: Increasing the Stimuli for Preventive Care" at Medicine for the 21st Century: Challenges in Personal and Public Health Promotion. Dr. Ralph Frerichs, professor and chair of epidemiology, has been selected the Public Health Alumnus of the Year by the Tulane University School of Public Health. Dr. John Froines, professor of environmental health sciences and
Dr. Jelliffe served scores of governments and international agencies including the World Health Organization, UNICEF and other U.N. agencies, USAID, the United States Department of Health, Education and Welfare, the Save the Children Foundation, and the U.S. National Academy of Sciences. Dr. Jelliffe, more than any other individual, has been responsible for the promotion of breastfeeding globally as a key element in child survival and child health through research, education, policy formulation and programs. His undaunted stand against inappropriate use of commercial infant formula has led many countries to institute infant feeding codes. His work has been an important factor in the resurgence of breast-feeding in the United States as well. Dr. Jelliffe's efforts have directly or indirectly resulted in a widespread improvement in the health of infants and young children and in the reduction of infant mortality. His innovative approach to pediatrics was based on the integration of nutrition, the consideration of social and cultural aspects of health and the use of appropriate technology and community
directorof UCLA's Center for Occupational and Environmental Health, hosted a visit in May by Drs. Adolfo Martinez-Palomo and Roberto Tapia-Conyer to the center to discuss possible collaboration with Mexico's Secretary of Health and National Academy of Medicine on international environmental health issues. Froines was recently appointed to the U.S. National Academy of Sciences ' Committee on Environmental Epidemiology. Dr . Michael Goldstein, professor of community health sciences , authored The Health Movement: Promoting Fitness in America
approaches, particularly in rural areas and among culturally diverse groups. This philosophy set a pattern for pediatrics departments in many medical schools, not only in Africa but also in other parts of the world. Professor Jelliffe was the founding and continuing editor of the Journal of Tropical Pediatrics since 1955 and was the editor of several other journals. He was the author or co-author of 22 books on breast-feeding, infant and child nutrition, nutrition and growth, as well as related topics. Many of his books were translated in various languages and several became classics that remain in heavy demand today. He also wrote six research reports, contributed chapters to 55 other books, and published close to 300 articles in journals and other scholarly proceedings. In addition, from 1972 to 1985, Dick wrote a weekly column on science, food and health for the Los Angeles Times with Professor Roslyn Alfin-Slater. Dr. Jelliffe received numerous honors for his contributions. In addition to his formal degrees, diplomas and fellowships, he was accorded an honorary M.D. from the University of Uppsala in 1982, theJelliffes' Award from the WHO/ UNICEF in 1990 and the Wihuri
•tNIHt• (New York: MacMillan!fwayne, 1992), in which he argues that three trends - dieting, exercise and nonsmoking - are best regarded as aspects of a simple social movement with a common underlying ideology, strategies and goals. Dr. Neal Halfon, associate professor of community health sciences, was the lead author on a number of recently published journal articles and book chapters, including"Children in foster care in California: An examination of Medicaid reimbursed health services utilization," "Mental health service utilization by children in foster care in California," and "Childhood asthma
and poverty: Differential impacts and utilization of health services" (Pediatrics); and "Health Care Entitlements for Children: Providing Health Services as if Children Really Mattered," a chapter in Visions ofEntitlement: The Care and Education of America's Children (New York: SUNY Press, 1992). Dr. Gail Harrison, professor of community health sciences, wrote "Obesity in North American Indians," a chapter in Obesity (Philadelphia: J.B. Lippincott, 1992). She was elected chair of the U.S. Committee for the International Union of Nutritional Sciences. Dr. Dean Jamison, professor of
Foundation Prize from the Finnish National Academy in 1979. But perhaps this man's most enduring legacy is that he directly and indirectly influenced thousands of students. Many came to UCLA specifically to study with him and then took his ideas back to their countries to form a vast network of Jelliffe's alumni. We here in the school of public health will always remember that Professor Jelliffe founded the Division of Population and Family Health, and recruited most of its faculty. He was also the division head for 18 years. In spite of all these stellar contributions, Dick Jelliffe once said that the smartest thing he had ever done was to marry Patrice. Dick and Patrice formed a team that was remarkable not only for the professional heights they reached but also for the happiness and harmony they always exuded. Patrice has recently been valiantly carrying out the tradition - completing manuscripts, giving lectures, attending meetings, and finishing so much unfinished business. The legacy Dick Jelliffe left behind will always remind us of this great man. I also remember Dick Jelliffe as a cultured man of the world. I think of him when I read Kahlil Gibran, especially his poem "The Song of the Flower."
I am a kind word uttered and repeated By the voice of Nature; I am a star fallen from the Blue tent upon the green carpet. I am the daughter of the elements With whom Winter conceived; To whom Spring gave birth; I was Reared in the lap of Summer and I Slept in the bed of Autumn. At dawn I unite with the breeze To announce the coming of light; At eventide I join the birds In bidding the light farewell. The plains are decorated with My beautiful colours, and the air ls scented with my fragrance. As I embrace Slumber the eyes of Night watch over me, and as I Awaken I stare at the sun, which is The only eye of the day . I drink dew for wine, and hearken to The voices of the birds, and dance To the rhythmic swaying of the grass. I am the lover's gift; I am the wedding wreath; I am the memory of a moment of happiness; I am the last gift of the living to the dead; I ama part ofjoy and a part of sorrow. But I look up high to see only the light, Andneverlookdowntoseemyshadow. This is wisdom which man must learn.
Dick Jelliffe will be missed, but never forgotten.
community health sciences, gave the keynote address on "The Impact of Tropical Disease" at the WHO/NIH Conference on the Future of Tropical Disease Research in April. He spoke at a WorldBanksponsored meeting of ministers of health in Bellagio, Italy, in June on "Disease Control Priorities in Developing Countries: A Cost-Effectiveness Assessment."
American Health Organization. She presented "Highlights of Recent World Legislation to Control Tobacco Use" at the 8th World Conference on Tobacco or Health in Buenos Aires, and was recently given an award of appreciation by the Los Angeles County Commission for Women and the Los Angeles County Board of Supervisors.
Dr. Snehendu B. Kar, professor of community health sciences, wrote "Factors Affecting Selection of Health Promotion Indicators," a chapter in Applications of Behavioral Sciences in H ea/th Policy and Research (Amsterdam: Elsiver Publications, 1992). He was elected a fellow of the American Psychological Society.
Dr. I.H. (Mel) Suffet, professor of environmental health sciences and a member of the Environmental Science and Engineering Program, is co-editing a book for the American Water Works Association Research Foundation, Treatment of Taste and Odor Problems in Drinking Water. He and three of his students co-authore five chapters in the book and presented two papers at the American Water Works Association annual meeting from chapters in the book. He also co-edited the book Influents & Removal of Organics in Drinking Water Treatment (Chelsea, Mich.: Lewis Publishers, 1992).
Dr. Alfred Katz, professor emeritus of community health sciences, in September received an award and gave the keynote address on "The Future of Self-Help" at the International Conference on SelfHelp and Mutual Aid in Ottawa, Canada. He was the senior editor of Self-Help: Concepts and Applications (Philadelphia: Charles Press, 1991), which includes 39 papers from the 1989 Conference on Self-Help and Life-Threatening Illnesses and an afterword written by Katz. Dr. Matthew Longnecker, assistant professor of epidemiology, presented "Results from a Large Multicenter Case-Control Study of Breast Cancer, and from MetaAnalysis" at Does Moderate Alcohol Consumption Affect the Risk of Cancer?, an American Society for Preventive Oncology symposium in Bethesda, Md., last March; and "Risk of Breast Cancer in Relation to Past and Recent Alcohol Consumption," at the Society for Epidemiologic Research in Minneapolis last June. Dr. Ruth J. Roemer, adjunct professor of health services, was a contributing author on Smoking and Health in the Americas, a 1992 report of the U.S. Surgeon General in collaboration with the Pan
Dr. Jane Valentine, associate professorof environmental health sciences, served on the Water Pollution Group at the EP A/NIEHS/ ATSDR workshop Equity in Environmental Health: Research Issues and Needs, in Research Triangle Park, N.C., last August. She co-presented "Daily Selenium Intake Estimates for Residents of Arsenic Endemic Areas" at the Fifth International Symposium on Selenium in Biology and Medicine in July. Dr. Steven P. Wallace, assistant professorof community health sciences, wrote "Getting by at home: Community based long-term care of Latino elderly" (Western Journal ofMedicine); "Community formation as an activity of daily living: The case of Nicaraguan immigrant elderly" (Journal of Aging Studies); and "The evolving status of adult day care: Evidence from Missouri" (PRIDE Institute Journal of Long-Term Home Health Care). • UCLA PUBLIC HEALTH
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Suzanne Dandoy, M.D., M.P.H. '63, recently became the deputy state health commissioner for the Virginia Department of Health. Miriam Kahan, M.P.H. '76, recently received her Ph.D. in education with an emphasis on educational psychology. Her research focused on helping behavior in the health professions. She is the assistant dean of the College of Allied Health at the Charles R. Drew University of Medicine and Science in Los Angeles.
POLICY PLAYER: JANET O'KEEFFE While working as a registered nurse in the 1970s, Dr. Janet O'Keeffe (M.P.H. '82, Dr.P.H. '88) spent a lot of time talking with patients about their problems - many of which, she found, could be addressed only at the policy level. So O'Keeffe decided she needed to take her patients' grievances all the way to the Supreme Court - or Congress, or anyplace else where public policy was made. She enrolled at the UCLA School of Public Health, earning first an M.P.H. and later a Dr.P.H., both in population and family health. And she sought policy positions where she could make a difference - as a research analyst and assistant project director with the California Lieutenant Governor's Task Force on the Feminization of Poverty; as a Congressional fellow and legislative assis-
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Fred Deharo, M.P.H. '80, was recently promoted to executive director of El Progreso del Desierto Inc. Family Health Center, a federally funded community/migrant health center serving the eastern Coachella Valley in Southern California. Arlene S. Cullum (Ross), M.P.H. '81, is the program manager over maternal-child health programs at Sutter Memorial Hospital in Sacramento.
tant to Rep. Barbara Kennelly (DConn. ); as legislative analyst for the American Association of Retired Persons; and, since 1989, in the public policy office of the American Psychological Association (APA) in Washington, D.C., where she was recently promoted to assistant director for public interest policy. In her current capacity, O'Keeffe is responsible for coordinating work on a number of issues, from family planning and AIDS to long-term care for the elderly and persons with disabilities. She has direct responsibility for women's health policy, disability policy, aging policy, and a range of other public health and mental health issues. "Our philosophy is that public policy should be based on available knowledge, and that psychological and behavioral research can contribute to the formulation of sound public policy," she explains. "We take positions on these issues only when we have the research to support them." And, O'Keeffe observes, since many of today's major health problems are related to behavior, she now finds herself right where she wanted to be when she left full-time nursing for the healthpolicy arena - in the thick of things: • In this year' s Casey v. Pennsylvania Planned Parenthood Supreme Court abortion case, O'Keeffe's office worked on APA's friend-of-the-court brief.
Renato F. Sison, B.S. '81, M.D., is a board-certified psychiatrist working with the Riverside Psychiatric Medical Group following stints with Kaiser Permanente and the U.S. Air Force. Monte L. Bible, D.O., M.P.H. '82, is a resident in occupational medicine in a USC/Los Angeles County/UCLA program. Jevin H. Kaplan, M.P.H. '82, M.D., is a board-certified family practitioner now practicing in
One of the APA's objections to the Pennsylvania law, O'Keeffe explains, related to the provision that, under the guise of informed consent, physicians be required to offer their patients a pamphlet describing the possible detrimental psychological effects of abortion. "APA's position was that such a requirement is biased and misleading because research shows that the majority of women who terminate an unwanted pregnancy experience relief and do not experience negative psychological effects," O'Keeffe says. "Additionally, while some women do experience negative effects, if the purpose of providing the information is to facilitate informed consent, then information about the possible negative effects of abortion alternatives must also be included - i.e., postpartum depression, and guilt, regret and depression after giving a child up for adoption." • On the issue of health-care reform, O'Keeffe's office works from the perspective of people with chronic illnesses and disabilities. "There are very few voices on Capitol Hill for those who need health care, or for people with mental health problems. Many of these people are deemed uninsurable by the insurance industry," O'Keeffe says, pointing out that the label "uninsurable" is applied not just to people with serious mental illnesses such as schizophrenia, but often to those "who see a therapist for 10-15 sessions
Temecula, Calif., where he integrates public health and preventive medicine principles. Doris Sarni, M.P.H. ' 84, graduated from the UC Davis School of Medicine last June and has begun a psychiatry residency training program at San Mateo County Hospital in San Mateo, Calif. Julie Berny Akabogu George, M.D., M.P.H. ' 87, completed Epidemic Intelligence Service training at the Centers for Disease
for treatment of depression following a death in the family." • In legislative discussions on long-term care for the elderly and people with disabilities, O'Keeffe says, much of her work is aimed at ensuring that eligibility criteria for long-term care programs don't exclude people with mental impairments. O'Keeffe is still licensed as a nurse and says she continues to work the occasional weekend shift in order to stay in touch with how the current problems in healthcare delivery affect direct patient care. Her interest in health policy was reinforced at the UCLA School of Public Health, she says, by Dr. Judith Blake's courses on population policy and fertility. "She had a genius for making the linkage between research and policy, in conveying the message that they are integrally related," O'Keeffe recalls, adding that Dr. Ruth Roemer's Law, Social Change and Health Service Policy course was another major influence. O'Keeffe says she received great satisfaction from "the realization when I first started this job that a great deal of what I Ieai:ned in graduate school was immediately relevant to my work." Her major frustration is "working with a divided government and an Administration that is unresponsive to public health concerns, particularly the need for major healthcare reform." --D.G.
Control and accepted an appointment with the World Health Organization's Global Programme on AIDS in the Africa Regional Office, Brazzaville, Congo. Karen P. Wells, M.P.H. '87, recently accepted a position as manager of managed care for Sutter Mental Health Services, part of the private, nonprofit Sutter Health delivery system based in Sacramento. Ellen Rosskam Konor, M.P.H. '88, after working for a year as a consultant for the International Labour Office in Geneva, Switzerland (the largest agency of the United Nations) on several occupational health and safety projects, has accepted a one-year position with the office's safety and health branch as a training officer. She asks that alumni coming to the area call her at (41) (022) 799-8815. Etsuji Okamoto, M.P.H. '88, teaches in the Kinki University Medical School Department of Public Health in Osaka, Japan.
THREE QUESTIONS: We need to know wltere you are, what you're doing and how you think we're doing. Please help IS by taking a lllOllellt to fl out the relevant sections below.
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Clydette Powell, M.D., M.P.H. '88, has worked since graduation with the World Health Organization in Cambodia and Fiji. He is now with the Boston-based Management Sciences for Health; his work has taken him to Swaziland, India, Morocco, Kenya, the Philippines and Ecuador. Kathryn Cavanaugh, M.P.H. '89, is a project director at Stanford University Department of Health Services Research. Marianne W. Davis, M.P.H. '90, recently received grant funding to remodel and stock the new PACE Patient Education Center at the VA Hospital in Sepulveda, Calif. She also wrote a funded TQI educational component for the hospital.
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Laurence B. Johnston, M.S. '91, is the statistics instructor at Cuesta Community College in San Luis Obispo, Calif., and is about to become a tenured member of the school's faculty. â&#x20AC;˘
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