UCLA Public Health Magazine - Summer 1985 by UCLA Fielding School of Public Health

Volume 5,

UCLA Public Health

Summer 1985

The China Connection

Chi na and the Schoo l of Public Health have become partners in educational exchanges.

The Limi tless Ho rizons of the Navajo Reservation

Without ever lea\'ing the United States, students arc gaining fi rsthand experience in a different culture.

A Broader Car e Plan for the Envi ronment

The Endronmental Sciences and Engineering doctorate program is producing much-needed professionals to help care for the em·i ron ment.

Davida Coady Assists Ethiopi an Relief Efforts

Dr. Davida Co:1d~·. adjunct professor, tells of her three weeks in l-larbo, one of the hardest hit areas of the famine in Eth iopia.

Are Small Families an Advantage?

Professor Judith Blake discusses her research about the influence of family size o n achie\'ement.

The CLA Campaign: An Investment in the Future

UCIA launches a campaign to raise 200 millio n in pri\'ate funds by June 1987.

On tbe col'er: A close-up of o ne of the Chi nese characters for " health." The complete sym bo l is reprod uced on page 4, the beginning of the article 'The China Connectio n."

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Alumni News

Dean's Message

UCL/\ l'11blic I lealtb is published by I lealth Sciences Communications, UCIA Public Communications/ Public Affairs, for the l 'CIA School of Public I lealth. It is issued twice a ,·ear for the alumni , facult\', staff and frie.nds of the Scl1<x>I. · Charles E. ' '<>ung, Cba11cellor Roger Dctd s, Dean l\lichad T l\ lcl\lanus. Assis/C/11/ Vice Cba11-

cel!01; l'11blic Co1111111111icatio11s j ohn Pontarel Ii, Directo1; I /ealtb Sciences

Co111111111 !icatio 11s Editor: Jud i Good friend \Vriter:Judy Hosenfr.:ld Art Director:.Juliet 13eynon Desip,11er: 1\laureen Erbe

Pbotop,rapby : ASL!Cl.A Photography, Terry O 'Donnell, Nor m Schindler, pages 20, 26, I lenry Blackham, pages 16. 23, DeHa Breslow, page 5, j ane Simpson, page 8, Wo rld \'ision, Oa,·id Ward, Page 14 tl/11s1ra1io11: ,\ taureen Erbe, page 12 Editorial Board: De lfoger Detels. Dr. Juel Janis, Dr. Snehendu Kar, E'·elyn Fassberg. Bruce Shih, Tom Zeko, j ohn Pontarelli

© Copyrip,bt 1985 /~)' Tbe Rege111s of tbe L'nirersi~v of Cal{/omia. Per111issio11 to repri/1/ c11~) ' portion of UCLA Public Health 11111s1 be obtained ji'0/11 tbe edi101: Co111ac1 1-!ealtb Scien ces Co11111111nica1ions, \Veyburn Ce111e1; Suite 344, Center for tbe 1-!ealtb Sciences, UC/A, Los Angeles, California 90024 (213) 206-1960.

UCLA PUBLIC HEALTH SUMMER 1985

collaborative research projects. More than one dozen of the School's faculty have lectured or consulted in China. They have found that the fie ld of pub1ic health in China is in a state of transition. During the Cultural Revo lution much of the educatio n in China was politicized, and China re mained behind Western natio ns in many med ical and scie ntific areas. Now, however, the Chinese are reemphasizing the basic scie nces, and have rescinded many academic degrees granted during the Cultural Revolution. Hoag Tao Hu, a visiting Chinese scho lar studying population socio logy at the School, says, "We have to catch up, as you can see." Hu, a teaching assistant in the Nanjing Center fo r Family Planning Personnel, is part of rhe delegatio n of nine scho lars at the School from China studying fam ily planning organization and technology. Despite the ir re lative isolation, the Chinese have made remarkable progress in public health. "The Chinese have dramatically lowered their infant and maternal mortality rates, and they have made these great strides alo ne. Only in the past few years have they asked for he lp to accelerate the process," says Dr. Alfred Neumann, professor of pub!ic health. In 1983, Dr. Neumann lectured in populatio n planning, systems analysis and research at the Bejing Medical School and also at the Nanjing College for Family Planning Pe rsonnel unde r WHO/UNFPA auspices. His course outline was translated into Chinese and is now widely used in d1e Nanjing Cente r, which has sent fo ur of its faculty to the School to study statistics, epidemio logy, behavioral science and program manageme nt. They will also work with faculty from the School to develop a college program involving arts, human itie~ and family planning administration. "Our input has the potential to reach a great many people," Dr. Neumann notes. " It's the kind of project that we feel is very worthwhile." Dean Roger Detels, who has also visited China, is e nthusiastic abo ut d1e growing UCLA-China collaborations. "l'm pleased that faculty involvement is spreading throughout the School," he says. "Chinese scholars who have studied here often return to very promine nt positions in China, so we really feel that

we are making an impact o n health care there." Dr. Detels adds d1at Zhang Kung-Lai, the first Chinese scho lar to study at the School, is now chairman of epidemio logy at the Capito l Medical College of Peking. The China connections have multiplied rapid ly as public health scho lars fro m East and West d iscover the learning opportunities each has to offer. Whe n Dr. Robert Haile, assistant professor of e pidemiology, lectured at Bejing Med ical College as a visiting faculty member, he sparked interest among the Chinese in comi ng to UCLA to study cancer epide miology. Dr. Wang TianGen became the second Chinese scho lar to come to UCLA to study at the School and attended Dr. Haile 's lectures. Dr. Wang is now the dean of the public health program at Bejing Medical College. Other Chinese scho lars are expected to e nte r doctorate programs in genetic epidemio logy in the School beginning ne>.'t fall. Dr. Haile has been collaborating with the Chinese for several years in cancer epidemio logy, a burgeoning fie ld in China. The contrast in the types and prevalence of cancer fo und in the United States and China has provided a fruitful research ground for the School. "When the Chinese began doing mortality studies, they learned that cancer was one of the leading killers, with stomach cancer having the highest mortality rate o f all d1e cancers," Dr. Haile explains. "Stomach cancer is very high in underdeveloped countries including China, and rates of stomach and esophageal cancer, anothe r common cancer in China, are striking ly different depending o n geographic locations. " With one billion citizens, the issues of overpopulation and family planning have been a crucial priority of the Chinese governme nt since the mid-1970s. The de legatio n from the Nanjing Center illustrates the commitment to educate the Chinese public about family planning and contraceptio n. The efforts have paid off: The Chinese have cut birth rates d ramatically fro m an average offive children per couple in 1960 to two children per couple today. Hoag Tao Hu reports that population regulations vary fro m province to province, but that about 30 percent of the population is restricted to one child per couple. In rural areas, where overpopulation is not as serio us as in the urban

areas, and where families depend on children to help in farming work, couples are allowed to have more childre n. Health care utilization and insurance, especially among the rural population, is another new focus of attention in China. When collective farming was still the norm, health care services for rural residents were paid for from Commune Welfare Funds, set aside from the profits on collective farming and industry Now, China is moving toward a free market agricultural system. Collective enterprises and Commune Welfare Funds are disappearing. Dr Shan Cretin, associate professor of pub Iic health, recently returned from China as part of a team studying this issue under the auspices of the World Bank. During the next six months, Dr. Cretin will work with officials from the Sichuan Provincial Health Bureau to evaluate curre nt health care utilizatio n patterns of both insured and uninsured rural residents. The World Bank evaluation project is designed to encourage the Chinese to formulate a more equitable health care access program, says Dr. Cretin. Eighty percent of the Chinese population live in rural areas, and have extremely limited access to health care. Urban dwellers, who comprise the other 20 pe rcent, have access to 40 pe rcent of available hospital beds and 43 percent of the health workers. Some government workers have 100 percent health insurance coverage and spend 10 times as much money as rural reside nts on health care. Geography complicates the problem: Rural residents may live a seven-hour bus ride from the nearest hospital, while urban dwellers may be as close as a five-minute walk from health care resources. Still, rural Chinese fare better than the rural populatio ns of many other developing natio ns, Dr. Cretin observes.

UCLA PUBLIC HEALTH SUMMER 1985

"They have immunization programs, water purification, and good maternal/ child health statio ns with midwives," she says. Much of the groundwork for the UCLA-China connectio n was laid by Dr Lester Breslow, dean eme ritus of the School of Public Health, who visited China for the sixth time in April. Dr. Breslow is now director of cancer control research in the j o nsson Comprehe nsive Cancer Center at UCLA and professor of publ ic health. Like many othe r faculty me mbers in the School, Dr. Breslow has been consiste ntly impressed by the commitme nt and progress made by the Chinese in public health. "It has been very he lpful to us to see o ne quarter of the world's populatio n, with a different set of public health proble ms, tackle those problems with great success. In the past 35 years they have dealt with extre me poverty, overpopulation, infectious diseases and lack of technology. Their successes in these areas are truly some of the most momento us achievements in pub1ic health during this century," he says. Dr Breslow cites as examples the reductio n of poverty, better food distribution, and the sharp decline of venereal disease bro ught about by the re habilitation of prostitutes and severe penalties for the ir customers. The Chinese have also developed a map of the country that illustrates the distribution of different kinds of cancer found in Vdrious regions. "They d id it largely by hand, whereas we in the United States were pleased that we produced a similar map at about the same time with advanced compute r technology," he notes. American health scientists, Dr. Breslow adds, can learn a tremendo us amount from the Chinese. "The pattern in the United States in developing health services is highly individualistic and not subject to natio nal consensus on what sho uld be done to advance the welfare of the people," he says. "The Chinese are strongly committed to a

mo re planned approach to how health services sho uld be organized and delivered and are concerned not only with people living now, but also with those to come. That commitment seems remarkable to most Americans." China-bo rn Dr. Virginia Li, professor of pub Iic health who is actively involved in several UCLA-China projects, agrees with that assessment. She has studied rural Chinese medicine and has also consulted for the World Health Organization (WHO) on public health projects and taught at the Shanghai First Medical College in China. Dr. Li reports that although China is still plagued by such basic health proble ms as dysentery and hepatitis, the Chinese have accomplished a great deal through their motto of "prevention first. " The Chinese citizenry, she notes, share responsibility fo r publicizing immunization programs and e ncouraging participation in these programs. This spring, Dr. Li returned to China as a consultant to WHO and the Shanghai Municipal Ministry of Health to help imple me nt a demonstration program o utside of Shanghai. The clinical trial involves workers in heavy machinery plants and will work to reduce the incidence of hype rte nsion, cigarette smoking (which is a growing problem among me n), and bacillary dysentery. One advantage of working with the Chinese population in studies of this kind, Dr. Li says, is that the population is relative ly stable geographically, allowing researchers to fol low a cohort population for many years. Dr. Li has also been invited by the Chinese State Family Planning Commission to develop a 10-year plan for family planning personnel and manpower development. Curre ntly, she directs the China scho lar training program for family planning and public health in the School of Public Health. The warm relatio nship between Chinese health scientists and the UCLA School o f Public Health has fostered mutual admiration and a sincere interest to learn from o ne anothe r. Given the history of the last few years, more and mo re people from East and West are likely to reap the fruits of the UCLAChina exchange.

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o n weekends and ho lidays. Several graduate students from the UCLA School of Publ ic Health have been granted an even closer inspection o f the reservation thro ugh a preceptorshi p program estab lished in 1980 between the School and the Indian Health Service at the Gallup I ndian Medical Center in Gallup, New Mexico. "When students tel I me they want co go abroad for their clinica l experience, I cell chem that going co an Indian reservat io n is like goi ng overseas," says Ruth Richards, adjunct lecrurer in the Divisio n of Behavorial Sciences and Heal th Educatio n, who serves as the students' advisor during their intern ship.

Student experience Cherie Kam , 1\11.P.I I. Âˇ34 (Behavorial Sciences and H eal th Education ) , was the fi rst student fro m the School co spend time on the Navajo Reser vation. During the summer o f I 983, she hel ped the Gallur Indian Medica l Center, the largest center serving the NavJjo popu latio n, develop a heal th education program fo r their Family Medicine Clinic. A-; pan o f her internship, she prepared several pamphlets to teach Ind ians abo ut serious yet commo n conditions on the reservation, such as diabetes and hypertension. " I reviewed the government-issued pamph lers about these illnesses and realized that the readibility level was too high fo r the avajo populat ion. ( Most of the o lder Navajos do not speak English. ) Also, they had difficulty relating to the illustrations," Kam explai ns. Instead she tailo red the text roan elementary school reading level w ith more relevance to the reser vatio n environment. " For instance, when we to ld people with diabetes that they could keep on w ith their daily activi ti es, we gave examples such as chopping wood and herding sheep," she says. Kam enlisted the help o f an I ndian artist to illustrate the pamphlets w hich were xeroxed on colo red paper and stapled together. " In two m onths, you are no t going co change patterns o f yea rs and years, but at least it was a start," Kam says. When she first arrived, Kam says she was awestruck at the task that lay ahead of her : developing a health education program in family m ed icine where none existed. I3ut she pl unged in and her accomplishments gave her a newfo und confidence that she is certain help ed her land the job as director of

healch educacio n ac che Redondo Beach ledical Group afcer graduacion. 'Just like ac the Gallup I ndian Medical Center, at Redo ndo I am starring a pacient educatio n and heal ch promo tio n program w here none existed befo re," she says. Elmer G. Renegar believes in treat ing students as heal th education associates, allowing them to wo rk as professionals immed iately. lknegar, who ser ves as the students' precepto r whi le they are at Gallup Indian Medical Center, is chief of health education at the medical center and health educatio n coordinator fo r the Navajo area for the Ind ian I lealth Ser vice. I le and Ruth Ri chards knew each other when both \\Âˇere commissioned officers in the Public I Ieal th Ser vice ( PHS). Richards, who was in the Pl IS for 30 years befo re coming co UCLA in I 976, is known for her pio neer ing work in the 1960s in patient education. Together, chey designed the affi liacion betw een the Gallup Ind ian Medical Center and the UCl..A Sdiool o f Puhl ic Heal th. Richards and Henegar encourage students who are interested in cross-cul rural settings, rural health and pacient/family education, to spend t ime o n the reser\rn ion. Dr. Timothy Fleming, directo r o f the Gallup Indian J\ledical Center, says o f the UCLA students w ith who m he has worked , '"They are a credit to their profession and are \\Âˇel I received by o ur staff and pati ems... Dawn Toyama, currently in a joint master 's program in the D ivision of Populatio n and Famil y I Iealth and the Division of Behavo ria l Sciences and I lealth Educatio n, spent 12 weeks in Gallup last summer and returned again this spring fo r another three months. As did Cherie Kam, Tbyama I ived in student quarters at the Gallup Ind ian Medical Cemer. Although the students do not receive stipends, they are provided roo m and board and are free to travel o n weekends. O n her first visit, Toyama helped develop goals and objectives for the medical center 's d iabetes program. Diabetes has become a majo r concern o n the reservation over the last two or three decades as Indians have been influenced by Western culture. Their high carbohydrate d iet coup led w ith a changing lifestyle that has reduced exercise have caused a greater prevalence of obesity Toyama found the Ind ians resistant to losing weight since heaviness

UCLA PU l3LIC l IEALnl SUMMER 1985

is considered desirab le in their culture.

Hom e visits Cherie Kam recalls r iding in a truck onto the reser vation o ne clay w ith a physical therapist from the Gallup Indian Med ical Center as he made home visits. " Most of the people we saw were diabetic patients and o ne had had a leg amputated. I cou ld see that self-care really had to be emphasized," she says. A year later, w hen Toyama arrived o n the scene, she agreed. " One problem with d iabetes is that patients may feel numbness in their legs and feet. They may step o n things unknow ingly o r develop sores they don 't know abo ut. If they do not inspect the botto ms of their feet and keep them clean, they can de\'elop gangn: ne that can result in amputation," she explains. Some o f the goals and objectives Toyama de! ineated fo r the d iabetes program, therefore, included teaching about foot care, d iet, risk factors, and enco uraging nurses to teach patients how to inject insulin and test urine for blood sugar levels. When Toyama return ed to Gallup chis pasc March, she p lanned to help the Child I lealth Clin ic establ ish a parent educacion program in preventive health for their children. " In 1955, when the Ind ian Heal th Ser vice began , our big health educatio n push was to get people to come to the hospitals. \Y/e did such a good sell ing job that now we are swamped . ow we are trying to encourage mo re prevention and mo re respo nsibility for one's own health ," Renegar explains. Toyama 's first step wi 11be to assess the number o f telepho nes ancVor accessib ility to pho nes o n the reservation so parents can cal l into the clin ic w ith quest ions. I ler fcasibil iry study before develop ing an actual p rogram w il l serve as her research project for her master's degree. Intrigued w irh the Indian culture, Toy-ama has applied to the Indian I lealth Ser vice fo r a position w hen she graduates this year. The avajo Reser vatio n is a sovereign natio n with iL-; own government, but it is also under the jurisdictio n o f the U.S. federal government. As part of treaty ob l igatio ns, the health care o n the reservat ion is free. The Ind ian Health Service d ivides the Navajo reser vation into eight sectio ns, and each has a hospital w irh o ne o r tw o health educators a'isignecl to it. Gallup Indian Med ical Center is a

138-bed hospital that serves outpatients and inpatients. Altho ugh it is a referral medical center w ith a staff of 50 physicians, the majority of care is provided at the prima1y level. The medical center has a community outreach program , but a I imited number of people can be reached because of che great d istances that must be traveled o n the reservat ion. Travel ing w ith a nurse one day through the dirt roads of the reser vat io n, Toyama was o nly able to see four patients in nine ho urs.

The m e d icine m an The med icine man stil l plays an important ro le in avajo healing arts. The tribe be! ieves in " har mo ny with nature" in both health and religion. The staff at the Gallup Med ical Center respect these bel ief.-; and the med icine man is welcome in the hospital. " If a physician o r heal th professional comes here and does no t respect those bel iefs, it w ill be d i fficult to be accepted," Renegar says. Isolated fro m other centers o f academia ( the University o f New Mexico is 140 m iles away), Renegar last year invited Ruth Richards and Emil Berkanovic, professor and head o f the Division of Behavio ra l Sciences and Health Educatio n, to lead a three-clay sessio n o n innovatio ns in health education. "O ur purpose was to bring to d iffer ent pan s of the reser vat ion new approaches to wo rking w ith people and developing heal th education programs," Richards says. The sessions were attended by health educato rs, nurses, sanitarians, nutritionists and admin istrato rs fro m all over the avajo Reservatio n. Through the years, UCLA Pub lic Heal th students have gained their cl ini cal experi ence on other Indian reservatio ns as we! I. They have go ne to the San Carlos, Zuni , Gila and Pi ma reser vatio ns, each d iffering from o ne another in size as well as culture. At present, the Navajo imerchange is the most active. Al though I ife o n the avajo Reservatio n is o ne far fro m the realm of most Amer icans, Cherie Kam says she learned to understand the Ind ians. " ! learned to appreciate their way of life," says Kam , who grew up in Haw aii and had never I ived anywhere but o n the islands befo re coming to UCLA. " The internship allowed me to b roaden my hori zons."

n the last few years, Lhe American pub I ic has become aware o f dangerous toxic substances in the enviro nment, products of industri al waste which can seep into o ur drinking water and into the soil w hich nu nu res our food supply. Environmental specialists admit thaL hazardous waste ( materials fro m industr)' usually deposited on the land) and toxic substances ( more broad ly defined as chemicals and materials that can cause acute o r chron ic illness, includ ing cancer ) have been over looked until recently. O nly in the past five years have government programs such as Superfund and the Resource Conser vation and Recovery Act ( RCRA) been enacted, prompted largely by the discove1)' o f massive chemical waste dump sites at the Love Canal in 1976. Stricter federal and state laws governing toxic substances have fostered a boom in a new industry. The job market for environmental specialists who know how ro deter m ine dangers of rox ic waste, dispose of it safely and respond to environmental emergencies involving such waste has rapid ly expanded in the last five years and continues to grow. The need fo r highly trained people ro work at local, state and federal levels and in private indust ry is greater than the supply. In 1982, the UCLA School of Public Heal th adopted o ne of the o nly programs in the nat ion to prepare these environmental special ists at the doctorate level. The Environmenta l Science

A BROADER CARE PLAN FOR THE ENVIRONMENT byJudy Rosenfeld

and Engineering Program (ES&E), now under the direction of Or. Wil liam Glaze, has to date trained 80 graduates who work aL all levels of government and indusny These professionals are directly affecting the care of the environ ment thro ugh careful study and consul tation o n hund reds o f environmenLal projects. Many design and supervise hazardous waste disposal programs, and their expertise also guides public pol icy on enviro nmental issues. From the early 1970s unt il 1982, the ES&E program existed with no formal affiliation wilh any school or department. It was a free-floating program and reported directly ro the Chancello r. ln 1982, however, it was establ ished in the School of Pub lic Health. lt is stil l managed by an interdepartmental committee w ith facu l ty representatives from atmospheric sciences, bio logy, chemislt)', engineering, geology, and public health. The m ultidiscipl ina111 program leads to the Doctorate of Environmental Science and Engineering (D.Env.) degree. Unlike most doctorate degree programs, the ES&E curr iculum and projects stress a general ist approach to environmental issues. Students are requ ired to have a sound background in science and eng ineering and to have a master's degree in public heal th, engineer ing or science to enter the program. Dr. Glaze emphasizes that he is looking for specific types of students to enroll in the ES&E program. "As with all UCLA programs, our standards are ve111 high," he says. " Students in the program tend to look at things holistical ly and want to make a contr ibut ion to the b roader domain. They are interested in real world problems." The program involves three stages. In the first phase, students study a broad range of subjects. The average course load during this year wou ld include

lion natural gas treatment p lant near mathematics, chemistry, biology, eart h and atmospheric sciences, engineering, Santa Barbara that complied w ith Californ ia hazardous w aste laws. ( Dr. Sostek law and social sciences. Students are notes that California's laws tend to be also expected to keep up w ith the curmore str ingent than fede ral and many rent I iterature, from professional jouro ther state laws on waste management.) nals to the daily newspaper. In the second year, students team up The internship project, aside fro m dealto tackle fu l l-time problem solving proing with a practical environmental issue, also became the topic for his docjects. Working w ith at least rwo faculty toral paper: Altho ugh students don't members, the students analyze the powri te dissertat ions per se, they must tentia l impact of a chosen industrial pro ject. Right now a team is trying to write a detailed fina l repo rt on a major project they worked on during thei r inpredict the impact of introducing genetically engineered products in the ternship. Dr. Sostek recal Is the benefits of havenvironment. One such product would ing been able to critically evaluate his work as a pesticide, and another would deter frost o n potato plants. own contributio ns to an important enDr. William Dritschilo, adju nct assis,·iron menta l project. Not o nly did he learn about the technical points of imtant professor o f environmental science plemen ting the hazardo us waste plan, and engineeri ng, and Dr. William Kastenherg, professor of eng ineering and he also critica lly assessed portions o f applied science, are leading the stuCalifor nia ·s hazardous waste regu lat ion program. dents through their analyses. They reSte\'e Kahane (0.Env. 7 8, M.P.H . 74) view the histo ry of the introduction of is vice president for environmental and new substances into the enviro nment, and guide students through sophisticathazardous waste programs for Jacobs ed data gathering and risk analysis Engineer ing, o ne of the largest engineering construction fi rms in the Unitmethods. Along the way, students must ed States. Most o f his work involves hazkeep in mind the g lobal repercussions ardo us waste site investigation and of the project: not only how it w ill affect the environment , bu t the legal and eco- clean up. Dr: Kahane, who is also a visiting lecturer o n environmental heal th in no mic implicat ions as well. After having completed their academ- the School, oversees a staff of 100 working througho ut the natio n involved in ic courses and problem-solving course, all phases o f environ mental engineerstudents enter internships for o ne and one-half to two years, working in an ining. Dr. Kahane·s staff is involved with sevdustrial o r government sett ing. Twenty interns are currently working in sites all eral programs fo r the EPA, including over the natio n, including the Library o f providing technical support fo r EPA Congress and the Environmental ProSuperfunc.I enforcement clean-up and tect io n Agency in Seattle. emergenc~· response programs. The}' Todd Sostek, D.Env: '84, M.P.H. '76, is have worked in mo re than 200 of the the president of the ES&E Soci ety, the most critical hazardous waste sires. alumni association of the program, and (Supcrfund is a government-super vised staff engineer for toxic substances at the and industry- funded t<Lx pro ject to clean Southern Cal ifornia Gas Co. During his up abandoned hazardous waste sites.) internshi p (also at the Gas Co .), Dr. Sos- Dr. Kahane's staff is also involved wi th tek developed a hazardous waste manair quaI ity and o ther enviro nmental agement plan fo r a brand new $120 m ilemergency respo nse projects.

A'> a n.:sult of the ES&E program, Dr. Kahane notes, he is able to manage a cross-section of d iscipl ines concerned \Vi th erwiro nmental issues and has a keener appreciation and understanding of those issues. ·· ow that I am in management, I see how impo rtant it is to train people co respond to growing environmenta l needs," Dr: Kahane says. "Today people are much more sensitive to the effeccs of the environment o n health." For Toe.Id Sostek, the real strength of the ES&E program "is that it teaches you to work effectively in many areas of environmental management, whether it's air and water pol lution, hazardous waste, o r other areas. You look at things from a variety o f perspectives. You become a competent technician and learn to synthesize the contr ibutions of peop le from many different disciplines: law, engineering, social sciences." The true test of the ES&E program's mettle, however, is in the marketplace. There are now jobs for every graduate, and Dr. Glaze plans to increase enrollment from its current 15 studencs on campus per year to about 35. He adds that the program could place "rwice that many" hut does not yet have the resources. Dr. Glaze emphasizes that the ES&E program is really the legacy of the late pro fessor Dr: Wi llard Libby, obel laureate fro m UCLA who fo resaw the need for this program and was best known for developing a system of carbon dating. I !is wife, Dr. Leona Libby, is adjunct professor of p ubI ic heal rh and teaches in the ES&E program. Yet the ES&E program is an oddity in academ ia, Dr: Glaze says. "Universities as a whole tend to devalue these kind of general ist programs," he says. "They wony that they aren't well defined or demanding enough. But this program works, and 80 graduates who are out there making a difference prove it. "

UCLA P BLI C 1IEALTI I SUMMER 1985

ast winter, the world's attention was riveted on shocking photographs and newsca<>ts of the victims of the Ethiopian fam ine, one of the worst such disasters in histOI)'. According to Catholic Relief Services (CHS), an o fficial overseas rel ief and development agency of the American Cathol ic community, 300,000 Ethiopians died of starvm ion in the last year. Although census figures for that nation are not exact, CHS estimates that between 6 to 10 million of the nation's 32 ro 38 mil lion people are at risk of death by s1arvat ion. Many hu manitarian agencies w irh experience in Third World nations have been raising money and send ing food , medical suppl ics and people 10 assisr w ith rel ief eft<.ms in Erhiopia. One such agency, C01 CERN, asked Dr. Davida Coady, adjuncr professor in rhe Schools of Public I teal th and ~ l edicine, to assess rhe situat ion and help o rganize med ical relief efforts. Dr. Coady has organized and worked in refugee health programs in Biafra, Bangladesh, Thai land, Uganda and Honduras. In 1969, she was the only woman on the Aid to Biafran Children Project. Iler exper ience in global healrh programs is vast, and includes work for the Peace Corps in 1970 when she worked in 11 African and Lalin American countries crcari ng nutritiona l and fami ly planning centers, and as an epidem iologist for the World 1 lealrh Organizarion. In Los Angeles, Dr: Coady also treats children at the Venice Fam ily Cl inic. (A featu re on Dr. Coady when she received

L Davida Coady Assists Ethiopian Relief Efforts byJudy Rosenfeld

15 the "Wonder Wo man Aw ard " appeared in the Spring 1984 issue of UCLA Public !-lea /th.) Altho ugh she has seen firsthand the resu lts of many Third World emergencies, " the famine in Ethiopia was the worst situation I've ever seen," she says. Dr. Coady was flown to Ethiopia in December 1984 under the auspices of CONCER , a no npro fit, no n-deno minational relief and development agency based in Ireland. She spent three weeks in Harbo, a town felt to be o ne of the hardest hit by the famine and located about eight hours by car no rtheast of the Ethiopian capitol of Add is Ababa. CO CERN already had a ream of 28 people, includ ing 14 nurses w ith public health training and Third Worl d experience, in a cam p set up to feed and treat 6,000 fami ne vict ims. Only those w ith at least one child below 70 percent average weight for height (the definitio n of severe malnutrition), o r a child or adult felt to be otherwise cr itically il l, were admitted to the camp. CONCERN fed 4,000 others in three feeding stations o utside the camp fo r those less severely malno ur ished. The Harbo camp also attracted people from surrounding mountain areas. Despite weeks of feed ing and administering med ical care, hundreds were st ill dying in the camps, thus frustrating and baffli ng the medical ream. One of Dr. Coady's first prio r it ies was to learn the reason behind the mysterious deaths. "When I arrived at the camp we aver aged about 40 deaths per day, and one

UCLA PUBLIC H EALTH SUMMER 1985

day the toll went up to 124," she recalls. Dr. Coady, a peel iatrician and epidemio logist special izing in tropical pub I ic health, discovered many problems aside from severe malnutrition in the camp. Almost all 6,000 fam ine victims suffer ed from intestinal parasites and diarrhea, and many had pneumon ia or bronchitis. Some d ied simply because they could no lo nger fight off infect ious diseases. But others d ied of poisonings. ''Many had eaten certain p lant roots that peop le o nly eat when they are starving. They had ergot poisoning from the roots. O thers may have died from med icines given by nat ive medical practitioners," Dr. Coady says. The number of people who d ied of po isoning was o ne o f the most striking aspects of this med ical emergency, accord ing to Dr. Coady. "Th is was something l hadn 't had to contend w ith befo re,'' she says. Dr. Coady had another troub ling and iron ic problem. " Many adults also were too sick and depressed to eat. They had given up,'' she says. Aside from not feed ing themselves, some parents fed only their healthy children and didn't encourage their ill children to eat. Faced with this roadblock, Dr. Coady and the rest o f the medical team set up six forced feeding tents for child ren and adults. Some began eating after being o rdered to do so; others had to be feel th rough a naso-gastric tube. " Several were with in 24 ho urs o f death,'' Dr. Coady says. " Fo rced feeding may sound cruel but it was li fesaving. " Another area of the camp was o rganized for children at high r isk w ho needed roundthe-clock super visio n and feeding. Dr. Coady worked w ith an Irish physician fro m CONCERN who supervised a makeshift " hosp ital " of fo ur tents w hich held 200 people. Mats became " beds" in this desert ward, yet Dr. Coady commends the high quality of med ical supp lies, most o f w hich were donated by U !CEF, with aiding the successfu l med ical treatments. Ninety percent of the donated food in the area was distribu ted by Carho l ic Relief Services, with additional food supplies from OXFAM. Each day, she and the other physician hurried through " rounds" of the entire camp to see who might need to be hospital izecl , who sho uld be force fed , and w ho was at risk of not eating or recovering. " Ro unds" took abo ut an hour and a half. "When we felt we had the worst of them in the hospital, we let the

nurses go on rounds," Dr. Coady says. CONCERN's medical team also trained Ethiopians to help make sure that food was distr ibuted and that feedings were adm inistered properly. Other Ethiopian wo rkers helped in the intensive feed ing centers and the hospi tal. In all, about 250 young Ethiopians were on the " payroll" to help o ut in the camp. Al I were paid w ith food. Dr. Coady and 15 others stayed in a three-room schoolhouse close co the camp that CONCERN had been given for the staff. During her stay, Senato r Edward Kennedy visited the camps in Ethiopia and remained for several days, learning abo ut the situatio n, Dr. Coady says. (When she fi rst ar r ived in Addis Ababa, she met with the senator as \vel I as w ith acto r/politi cal activist Dick Grego1y, Martin Luther King Ill, and an official from CARE (Cooperative fo r Ameri can Rel ief Everywhere), al I of whom had come to learn about the emergency needs of the Ethiopian people.) 13y rhe time that Dr. Coady left Harbo three weeks later, the clailv death rate in the camp had been cut in.hal f. Many of these deaths were new add it ions to. the camp w ho suffered from severe malnutrition as wel I as from intestinal parasites. Dr. Coady estimates that tho usands survived because of the camp's feeding and medical care. " But they stil l have a ways to go," Dr. Coady says. " Ethiopia is a d iffi cult country to wo rk in , with d ifficul t terrain. In addition, the educational level of the rural people is low." However, Dr. Coady found the Ethiopian govern ment very cooperative w ith rel ief efforts and feels they are committed to alleviating the suffering. She says that upon leaving she fel t that " I d id mo re than I tho ught I'd be able to do and that l had accom plished something. l know I left the camp in very professional hands. "

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Figure l Total Year s of Education

umber of Sib lings

White Black Race

Figure I: Total years of ed11catio11 by 1111111/Jer ofsibli11p,s.for ll'bite 111ales. compared to ed11catio11for ll'bite a nd /Jk1cl.! 111a/es i11 tbe pop11/atio11 os a //'bole.

Figure 2 Percentage Graduating High School

status, and mainrenance o f an intact marriage. Also, studies of young people ( usually based on school populations) have been subject to bias because, as we shat I see, dropping out of school is related to family si ze. This selection bias has been particula r~' acute when research was confined to aptitude scores among prospeccive college appl icants. Nonetheless, since so much of national and international family plann ing policy is based on the assumption chat small fa mi l ies benefit the children in\ulved, it seems important Lo know whether the assumptio n has a basis in fact. After al I, the superi o rity o f the small famil y cannot be simply assumed, since some people here and abroad he1ieve that being brought up with many sib lings is beneficial, providing more oppo rtun ity for challenging and maturing interaction among the sihl ings. J\l oreover, opinion su rveys indicate the only child is widely regarded as d isad\~ tnlaged. Is the idealization of che large fam ily simply romance? A bit like the idealization of the small town and the family farm? ls the aversion to having an only child based o n actual disadvantages evident among si ngle children? Are two-child famil ies " better'" childrearing un its than families of four, o r si x o r more?

Translating ques tions into research

Number o f Siblings

Wh ite

Black

Race

Figure 2: Percentage graduating.from bigb sci.loo/ by 1111111ber flj si/Jli11gs for ubite males, compared to bigb sc:/Joo/ grad11atio11 )or wbite and hlack males iu tbe population as a wbole. Source: Sample of ubite A111erica1t men ap,ed 20-65 ill 1973, and U.S. ce11s11s data for u>bites aud blacl.!s in 1976

To translate questio ns such as these into research requires a strategy concerning what should be studied firsr and how ro proceed. These tasks \Yere made easier for me by the existence of a large body of prior social science re.search showing chac people's educarional attainment is the most impon anr determinant of their occupations in the United Scates, and , hence of their socioeconomic status. le thus seemed chat one could nor go too far wrong initially by looking at the effects o f family size on educational outcomes. Al.so, some of che be.st national surveys in the United Stares contain data needed fo r studying the "family size connection" w ith ed ucation - rhe respondent's number of siblings, education and age, plus important characteristics of the respondent's parents co be used as controls ( their educatio n, occupations, whether che respondent was

19 brought up o n a farm , and w hether the parents' marriage remained intact during rhe respondent's upbringing). These surveys had cosl many mill io ns of do llars and tho usands o f ho urs when they were done, and o riginal investigators had used rhem for purposes quire d ifferent from the one chat interested me. Thanks co the fact rhat Lhe lnsricuce for Social Science l~esea rc h on the UCLA campus had already collected and archived hundreds of surveys on computer tapes, I cou ld begin Lo translate a theoretical imerest into a research project based on over 150,000 cases. Since research on such a scale involves an extensive kno\vledge o f p re-existing literature o n the subject, the formu latio n of scores of hypotheses, the creation of unique methodologies, and years of seal isl ical analysis on computers, subsrant ial financial support was needed. This was provided by the Russel l Sage Foundation. the arional Science Foundati on, the Fred 11. Bi xby Foundation, and the Nat ional Institute o f Child I lealch and I luman Development. This funding also made ir possible co engage docto ral stu c.lenrs in both the School of Public I lealth and the Deparrment of Socio logy to work with me on this extensive project.

Family size and IQ Because the early resul ts on education were so intriguing, the analysis was expanded to include the effects o f family size on IQ among young people, on " under " and ''over " achievement in school, o n sociability, behavior problems, self-confidence and self-esreem, uses o f time, and chances of rising above their father 's educational level. Is there a simple way of summar izing the results and of answering rhe o r iginal questions abour rhe presumed ac.1varnages of smal I versus large famili es? Fortunately, the answer is yes, al though like all scientists I became intrigued by nuances, complexities, and unexplained fi ne.lings requiring fu rther investigat ion. And, I ike al I readers, you wi 11probably soon cl iscc)\'er that you are nor real ly satisfied with rhe simpl ifiec.I " bottom line" after all. The simple answer is that, with respect to educat ional ach ievement among adul ts and ability among child ren, coming fro m a smal l versus a large fam ily is unequivocally more advanrageous even after control I ing for

UCLA PUBLIC li EAffl-1SUJ\lMER1985

many of those parental characteristics that are associated both with family size and with successful childrearing. The only child typ ically is the highest achiever in rerms of IQ , and often in terms of vears of education, o r at worst does app.roximately as well as those fro m C\vo-child families. For white men in the 1970s, being from a two-child family as opposed Lo a family of seven or more cranslacec.I into 3.4 years of additional total ed ucat ion ( Figure 1). Being from a one- o r rwo-ch ild fam ily added approx imately 40 percentage points 10 the proportion grad uat ing from high school compared to coming from a fam ilv of seven or mo re ( Figure 2). Even Âˇwith com rols fo r parents' backgrounds, rhe d i fference was almost rwo \'Cars of coral education, and a 21 perc:cntage po int spread in high school gradual ion. To give a sense of the relative social impo rtance of these d ifferences, Figures I and 2 also show comparable educat ion data fo r black men and white men nat ionall y duri ng the mid-1970s. A white man coming from a large versus a small fami ly in the mid- l 970s was at rwice as much of an educatio nal d isadvantage as black males. Even with contro ls fo r parental characteristics among the white men in o ur samples, the diffen.~ nce in coral years o f educatio n between those fro m large and smal I families equals the b lack.-w hite difference in the male popu latio n as a whole.

white men 1 have srudied came from fam ilies of four or more children. This d isjuncture between the number of child ren per mother and number of sibl ings per person has been verified in census data as wel I. I low do these results square with the fact that there seem to be many highlyeducatec.I people from large fami lies? There is no corn rad icLi on. First of all, as we have seen there are many more peop le in general from large than from small fam ilies, and the variability in educat io nal attainmem is greater among large than among small fam il ies. In orher wore.ls, nothing in o ur data precludes finding a share of high ly-educated people fro m large fa mi l ies. What is harder to find is poorly-educated peop le from smal I ones!

Parents' intellige nce

Is it possible that these find ings are simp ly d ue to the fact that parents of smaller families are mo re intelligent and, therefore, the association of more education wirh small families results from the association of inherited IQ and smal I fami l ies? That is admitted ly a troub ling quest io n and one for which I do not have an unequivocal answer. I lowever, there are some answers. First, there is no firm evidence of an associ~11ion beC\veen fam ily size and heritable parental IQ. Second, we contro l for rhe pare111s' education (and occupations). If one believes char IQ was impo rtant co the respondenr's educat ion, rhen one Pe rsonality, behavior, musr believe that IQ was important co happiness the parents' educat ion. In add itio n, What of personality characrer isrics, those aspects of IQ , such as verbal abil ibehavior problems, school perfo rties, which are most responsive ro inmance, self-rated happiness and satistense inreracrion with adul ts and also faction' Dues fam ily size make a d iffer- most pred ictive of ed ucational success, ence in these areas' With regard co just are the ones most strongly associated about anything one can ident ify along wi th nu mber of siblings. So, it appears that, in addi tion to introducing some th ese lines, those fro m small families either come o ut ahead , o r there are no controls, we can iso late an important differences by number o f siblings. component of intelligence that is borh I t wou ld be surprising if such simpli - respo nsive to paremal attention and fied answers d id not give rise to many pred ictive of educat ional success. further questio ns. Fo r example, aren't Is it possible that the parents of smal I the numbers o f people in these samples fam il ies were mo re achievement-oriw ho come from such large fami l ies ented fo r thei r chi ld ren and this is why very sma l I? o, o n the contraty. Althe couples decided to have fewer chilthough fam ily size per woman, o r per d ren? Also, what abo ut birth o rder and 11101be1; has been relatively smal I since spacing between child ren' \Xlhat abour early in the cenrury, mosr people come ... ? Enough' If I tel I you everything from fam ilies that are fa irly large. This now, you 'I I never read the book! is because each new generation is composed d isp ropo rtio nately o f the offspr ing of the most pro l ific mothers. Fo r example, 60 percellt o r mo re of the

THE UCIACAMPAIGN :AN INVESTMENT IN THE FUTURE hy Jud i Goodfriend ast Novembe1~ UCLA launched The UCLA Campaign, an ambitious effort to raise 200 million in private funds by June 1987. In planning for che campaign, UCLA conducted an exhaustive campus-wide as~essmcnt of the amb itions and objectives o f each o f its sch o ls and col leges. From this careful analysis emerged a derailed 1ist of needs that UCLA must meer O\'er rhe next decade to strengthen fur d1er its intel leccual leadership in America and throughout the world. An enthusiastic pan icipant, the School of Public Heal th prepared a I ist of prio rities w ith a goal of ra ising $5 mill ion to support facu l ty research and student scholarships. Dean Roger Detels has designated $2.5 m il l ion to estab lish endowed research fu nds in me areas of environmental and occupational heal th, epi demio logy, heal th ser\"ices and po l icy management, health promotion, heal th education, ado lescent health, maternalchild health , health info r mation and data-based management, and publ ic heal th nutrition. "The earned interest from endowed funds enables the School to provide critical start up monies fo r promising research. This support is especially valuable w hen government agencies and foundat ions are mo re apt co support research projects based upon an hypothesis chat has been validated first on a small scale,'' Dean Detels explains. The Richard D. Weisman fam ily, for example, presenred the School w ith this kind o f resource last fall for the Division of Epidemio logy. Th ro ugh their genero i ty, the division is now guaranteed approximately $50,000 per year in interest income from the $500,000 endowment. The interest w ill be d irected to impo rtalll new and continuing research projects unt il the necessary majo r fund ing can be secured.

The second component o f the School's campaign goal, fellowship and scholarship funds, represents a $2.5 mil l ion comrnitcment to students \\'ho are facing increasing educational costs and decreasing federal gmÂˇernmenr support. Whi le th is need has persisted rhroughouc the 25-year histo1y of me School, rhe gap has widened dramatical ly during the last fi\'C years, according to Dean Detels. Consequently, he is actively wo rking to establish major endowments to guarantee student support funds in perpetuity. The role of private support is now more critical than ever. Twenty years ago, state support undenYroce about half of UCL.A's budget; today the state CO\'ers sl ightly more than a third of UCLA's expenses. UCIA is a dramatic example o f '"hac private philand1ropy can accomplish in a pub lic inst itution. Since 1973, support from private sources has tripled. In 1980, UCLA became one of the three must successful public institutions at securing outside support fo r its work. This has al lowed UCLA co raise the number of endowed academic chairs from one ro 52. O ne such chair is the Fred 1-1. Bixby Chair in the School of Public I leal th, presently occupied by Judith Blake, Fred 11. Bixby Professor of Population. Academic chairs are professorships, secured by endow me r~ts sufficient to support research and attendant staff and services of a chosen professor. The UCLA Campaign will help build a broad base o f endowed support for the ent ire university. Eighty percent of che campaign's total w il l be per manently invested ro provide the income co sustain UCLA's continuing excel lence. Endowed fu nds wil l enable UCLA co build upo n its distinguished faculty, to attract the finest undergraduate and graduare students, and to strengthen its overal I resources for education and research.

News

UCLA PUBLIC HEALTH SUM/vl ER 1985

The Fo urth Wave ellow immigrants and descendants of imm igrants ... " were Dean Roger Detel's po ignant opening words at the Immigrati on and Community Health symposium held on the UCLA cam p~1s Februarv J . ·1 arional experts on immigrat ion and heal th joined the full -day conference, co-spo nsored by the Cal ifo rnia Department of I lealth Ser vices, Los Angeles County Department of Heal th Ser vices, Southern Cal ifornia Interfa ith Task r orce on Central America, UCLA Pub lic I lealth Student A-;sociation, and the Western Consortium for the Heal th Professions. .. We are in the midsr of a 'fourth wave ' o f immigrants into the United States, and uni ike the for mer three that brought peop le primarily to the East Coast, this o ne is attracting immigrants to the West Coast, particularly to Southern Cal ifo rnia,'· Dean Detels said . " Pre1960, most immigrants were from Europe. l<Klay, we are seeing many more A-;ians and Latin Americans seeking refuge in the U.S.·· Speakers addressed a variety of issues related to this new wave of immigrants includ ing cul tural barriers and access to mental, med ical and dental 1health care , irnpacr o n com muniry health, and resources for meeting immigrant heal th needs now and in the future. Congressman Edward R Roybal, the kevnote speaker, spoke about attempts to ·r eform immigratio n laws in California. The con ference, held in the Ackerman Student Unio n on campus, was attended lw mo re than 300 people. The sy;11posiu m was o rganized by the Communitv Affairs and Development Com m itte~ of the School of Public I leal th. Dr. Ravmo nd Goodman, adjunct associate professor o f heal th ser vices and chairman of the comm ittee, was assisted in planning the pub! ic lecture by Dr. Richard Goodman, assistant professor of epidemiology, and Dr. Dean 13aker, assistant professor of epidemio logy.

Cha nging Healtb Habits ne of che most d istin guished social psycho logists in the natio n, Dr. Nathan Maccob y, presented a lecture February 26 spo nso red by the School of Pub lic Heal th on "Changing Health Jlabits in Disease Preventio n." Dr. Maccoby spent a week at the School

as the Ralph Sachs Visiting Scholar. Dr. Macco by is the Janet M. Peck Professor of Internacio nal Communication ( Emeritus Act ive) at Stanfo rd University and associated ireccor of the Stanford Center for Research in Disease Prevention. In his lecture, Dr. Maccoby discussed health p ro motio n techniques based on research involving individ uals, communities and health care providers. Dr. Ralph Sachs has provided an endowment co allow an outstanding professional to participate in education and research activities thro ugh the Western Consortium fo r the Health Professio ns. The consortium , an independent, nonp ro fi t organizati on, includes UCLA, UC Berkeley, and the University of Hawaii . D r. Sachs has ser ved o n the faculty of the Schools of Public Heal th at UCLA and the University of I Iawaii , as well as the University of Southern Cal ifo rnia (USC) School of Med icine.

Faculty n otes The fo llowing is a capsu le of some of rhe activities of our facu lty during the past six months.

A.A. Afifi, professor of biostat istics, was elected a member of the WNAR Regional Committee of the Biometrics Societv 1985. I le is an associate editor of the Co111pu1a1ion a l Sta l isl ics and Data journal. Linda Bourque, associate professor of epidemiology, is co-autho r of a repo rt presented at the Academy of Ophthalmology annual meeting on fi nd ings from the Prospect ive Evaluatio n of Rad ial Keratotomy ( PERK) study Albert Chang, associate professor of population and fa mily health, was elected to the govern ing counci l of the Ameri can Pub I ic I Iealth Association for 1984-86. Potter Chang, professor of b iostatistics, p resented "Authent icity of Selected Variables in Subset Regression Analysis" at the Second Symposiu m of Statistics and Probab ilitv in Taiwan. Virginia Clark and A.A. Afifi, professors of biostat istics, have published a text , Comp1rter Aided M ultimriate Statistics. Joseph Coyne, assistant professor of health ser vices, has published three art icles on Multi -Insti tutional Organizations ( MIOs) in the Winter 1984 issue of Topics i11 I !ea/th Care Financing He

UCLA PUBLIC HEALTH SUMMER 1985

also pub I ished "Implementing Hospital Acquisition and Diversification Strategies" in Cases in H ealth Car e Financial Management (1984). William Cumberland, professor of biostatistics, has been appointed head of the D ivision of Biostatistics. Roger Detels, dean, Ralph Frerichs, professor of epidemio logy, Snehendu Kar, associate dean, and Milton Roemer, professor o f health services, are involved in a primary training program in Burma, under the auspices of the Western Consortium fo r the Health Professionals. The p rogram w ill last between three and five years. OliveJean Dunn, professor of biostatistics, retired after 31 years at the School of Public Health. Jonathan Fielding, professor of health ser vices, recently published a book entitled Corporate Health Management. Ralph Frerichs, professor o f epidemio logy, and John M. Chapman, emeritus professor of epidemiology, published Cardiovascula r Diseases in Los Angeles 1979-81, a study funded by the American Heart Association. The results were presented at a news conference February 20, 1985. John Froines, associate pro fessor of environmental and occupational health sciences, recently completed a pilot study on the health effects on Los Angeles City firefighters from exposure to diesel exh aust in the firehouse. He also completed a study, " Pro file of Occupational Health Experience in L.A. County," in which he makes recommendations fo r the development of specific data bases in order to more accurately identify high hazard industr ies. William Glaze, professo r of environmental and occupational health, has been appointed directo r of the UCLA Environmental Sciences and Engineer ing Program. JuelJanis, assistant dean and adjunct associate professor of health services, has been appointed to the National Commission on Unemp loyment and Mental Health. The nine person commission was formed by the National Mental Health Association to examine the long-term effects of unemployment. DerrickJelliffe, pro fessor, and PatriceJelliffe, adjunct lecturer of population and family health, have been consultants for the World Health Organization (WHO) in Geneva on " Feeding During and After Diarrhea." They were consultants fo r WHO o n nutrition in

primary heal th care at the EMRO (Eastern Med iterranean Regional Office) meeting in Somalia. Snehendu B. Kar, associate dean and chairman of the department of pub I ic health, is d irecting a project sponsored by the Centers fo r Disease Control designed to develop indicators of heal th promotio n actions at the societal and individual levels. This project involves the writing of position papers by national experts, followed by a national conference on indicato rs of health promotion to be held this fal I in Los Angeles. He is also directing a second project sponsored by the Wo rld Heal th Organization ( WHO), Geneva, designed co develop ind icators of community par ticipation for primary health care wh ich will include surveying experts from all WHO regions. Dr. Emil Berkanovic, pro fessor and head of the Division o f Behavioral Sciences and 1lealth Education, and several facu l ty members from the schools o f public health at UC Berkeley and the University of Hawaii are members of the research team. Jess Kraus, professor o f ep idemiology, was a visiting p ro fessor at the University of Occupatio nal and Environmental Health in j apan, September to December 1984, during which he participated in the Second International Neuroepidemiology Training Course in Bombay, India, and visited the Bejing Medical College, School of Public Health, fo r a series o f lectures. Alfred Neumann, professor of population and family health, was involved in the review of primary health care in Belize, Central America. He is also the co-principal investigator in the China Scho lars Program in Public Health. Ruth Richards, adjunct lecturer of behavorial sciences and health education, has been elected president of the Society o f Pub I ic Health Educato rs for 1984-

85. Stuart Schweitzer, p ro fessor of health services, spent a year 's sabbatical at Oxford University w here he was a visiting academic at Nuffield College and also worked extensi vely in the university's Department o f Community Medicine. Paul Torrens, professor of health services, spent three weeks in the Yemen Arab Republic as a consultant to the Ministry of Heal th on the development of primary heal th care services in rural areas of that country. His monograph, Hospice Programs and Public Policy, was pub I ished by the American Hospital Association. Dr. Torrens was made an honorary member of the American

Academy of Medical Directors in recognition for his help in establ ishing their educatio nal programs for physician administrators. Barbara Visscher, associate professor and head of the Division of Epidemiology, Roger Detels, dean , and Virginia Clark, professor o f biostatistics, presented data from their three-year follow-up study of the male homosex'Ual population at the International Confer ence on AI DS, held in Atlanta, Georgia, April 14-17, 1985.

Notes from the Students Association he l~ublic Health Students Assoc1at1on (PHSA) has spent this year establishing a graduate journal, sponsoring a b lood d rive, hosting the ational Publ ic Health Student Caucus (NPHSC) at the American Public Heal th Association convention, and pl anning social events. The UCLA journal of Public H ealth now joins the ranks of 22 other graduate journals at UCLA. The Graduate Students Association has pledged $2,000 for printing, and the School has offered word processing and clerical assistance. The journal solicits submissions from graduate students and faculty from a variety of fields both at UCLA and other universities, emphasizing an interd iscipl inary approach to public health. During February, PHSA sponsored a blood drive, complete with a raffle prize for par ticipants, as this year 's o utreach program. At the API lA annual meeting, the association sponsored a special session on career placement in pub lic health for the next decade and another session of d ialogues among deans of public health from across the nation. PHSA sponsored for the second year the NPHSC newsletter which is distributed across the nation to all schools of public health. This year's PHSA officers incl ude: Bruce Shih, president; Dawn Toyam a, vice president of internal affairs; Mary Jo Hansell , vice president o f external affairs; Jessie Schnel I, secretary-treasurer; Therese McCluskey, vice president of internal affairs; David Gittelman, second vice president o f external affairs; Bekki Johnson, vice president of external affairs; and Sara Rigler, second vice president of internal affairs.

UCLA PUBLIC HEALTH SUMMER 1985

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D1'.

Ronald Schwartz

Angeles O ccupational Health and assistant director for medical ser vices for the City of Los Angeles, cementing a dedicated relationship with the field of by Judy Rosenfeld occupational health. De Schwanz, formerly adjunct assishere is no mistaking Dr. Ronald tant professor in the School, recalls that Schwartz's origin when meetwhile in private practice, " I began co ing him in his office. Two large recognize the need for broader conframed posters o f New Yo rk cepts of health care. I wanted to impleCity, several ashtrays and a mug, all ment health care as opposed to illness boasting of the Big Apple, decorate the care. After getting my M.P.H., I gave up private practice. " office. But since 1961, New York-bo rn Dr. Schwartz, M.P.H. '72, has called Los Since October 1984, Dr. Schwartz has Angeles home. been working as corpo rate med ical diFrom his Westwood office window, rector for Occidental Petro leum Corpohe can see the building where he was ration. He held a similar positio n at Atin private practice in internal med icine lantic Richfield Company for six years. for nine years, as wel I as part of the At Occidental, Dr. Schwan z is respo nsiUCLA campus, w here he received his ble for the health care o f employees public heal th degree and where he working in the United States and wor ked in the Student Health Service as abroad, including foreign natio nals. He d irector of heal th evaluatio ns. Dr. is actively involved in developing a Schw artz has also served as director of wide range o f health care programs, includ ing pre-employment and periodic medical ser vices for the County of Los

Corporate America Gets A Dose Of Wellness Care

UCLA PUBLIC HEALTH SUMMER 1985

eign respo nsibility is to Occidental e mmed ical evaluations and illness care programs. Or. Schwartz also plans to ad- ployees, he is interested in the health care within developing countries in ministe r such public health staples as which corporations have an interest. At stress manageme nt and smoking cessaa recent meeting of Asian-Pacific Public tion programs. Health professio nals, Or. Schwartz was Certainly it is a staggering challe nge involved in a discussio n of how multifo r Or. Schwartz to develop such programs given the sheer e normity and di- national corporatio ns might achieve versity of Occidental. One of the largest these goals. "At ARCO in Jakarta, for example, we corporations in Califo rnia, Occide ntal set up a good medical system fo r our has subsidiary companies in internaemployees that also inte rested the Jational oil and gas exploration and prokartan natio nals. We were influe ntial in duction, coal, che micals, and agribusiness. Domestic and overseas e mployees getting a similar program started for the m, too. We can't dictate how othe rs total approximately 42,000. should handle health care, but we want He explains, "I might have a terrific stress program ready for this area, but it to share the concepts of modern health care," he says. may not work fo r people in Oklahoma Dr. Schwartz acknowledges that his is or Kentucky. Eve rything has to be mod ireally "a selling job to business, to manfied for various backgrounds, sympaageme nt and to peop le ," convincing thies and occupatio ns. I have to rely o n the m t0 diet, exercise and in other ways othe r managers in the company to tell care for themselves. "Co rporate medime what the ir e mployees want and cal d irecto rs are really salesme n," he need." The positio n of corpo rate medical di- admits, "but we have a good product. I want to bring a program to the corpo rarecto r is a new o ne for Occidental. But tion that satisfies both corpo rate and Or. Schwartz is convinced that occupational health is not o nly good for the in- peop le needs, because I don't think they are diffe re nt. I think that people dividual, it is good for business. "Corporate Ame rica is already paying will live happie r, fulle r lives with the health care informatio n I can bring fo r your illness thro ugh insurance costs. Today a lot of corporations are re- che m. The company will profit by it while assuming leade rship in corporate alizing the need to invest in e mployee respo nsib ility." preventive health programs," he says. His theory is that aJI companies must be aware of the financial toll exacted o n The Network Begins the m by health care costs, as well as by absenteeism and lost productivity atucual support for alumni tributable to poor health. Preventive and students is a key goal med ical info rmation disseminated for the Alumni Association through the workplace, according to Or. this year, according to EveSchwartz, boosts the corporate bottom lyn Fassbe rg, chair of the Career and line. Or. Schwartz has written papers Job Developme nt Committee. "Effective and given presentations on occupation- networking begins with a consciousal health in the corpo rate setting and, ness of belonging to a group. Hence, while at ARCO, regularly prese nted the Alumni Associatio n has decided to seminars on health and lifestyle and establish the presence of the Alumni Asstress manageme nt. sociatio n in a mo re assertive way. We Or. Schwartz consults with medical urge you to participate in some of our directors of other multinational corponew programs listed below," Fass be rg rations, helping to create international says. medical networks fo r company employees working abroad. The d irectors share info rmation on the availability of Dinner of eight strangers medical resources in fore ign lands, ow about two or three alumwhich makes it easier for e mployees ni co-hosting a d inner for abroad to receive medical care. five, six, o r eight students? Although Or. Schwartz's primary forThe hosts would indicate a the me for the dinne r such as a specialized area of public health and students

would sign up for the dinne r in advance. If you are inte rested, please indicate o n the attached form and be sure to include your tele pho ne number.

Free membership he Alumni Association initiated a new pol icy last year by which new graduates can receive one year free membe rship in the associatio n. New graduates must inform the associatio n of their inte nt to take advantage of this o ffer.

Bulletin Board large bullet in board, located near the Stude nt Affairs Office, will be used by che Alumni Associatio n to e nhance communications with future me mbers. A membe r of the committee wil I staff the project until a coordinator is fo und fro m among the alumni ranks. A different the me will be d isp layed each mo nth ("Organizations co Join," ''.Job Hunting," "Legislation co Watch," are some suggestions.) Communicatio ns fro m alumni are also welco me.

Take a student to lunch e want tO match up students and me ntors for at lease one exchange. Afte r that, you may sec up any type of arrangeme nt agreeable co both of you. If you have mo re students interested in meeting you than you can take to lunch, you might conside r inviting the group to your office for coffee and conversatio n. If you would be interested in becoming a hosrlme nto r, please fi ll out the accompanying Alumni Information Update fo rm.

Bioethics Discussed at Breslow Lecture ioethical Issues in Neonatology: Wil I the Beat Go On?" was the tOpic for the Lester Breslow Distinguished Lectureship, sponsored by the UCLA School of Public Health Alumni Association. The lee-

25 rure was held March 20 at 7:30 p.m. in the James E. Wesr Center on the UCLA campus. A receptio n was held immediately following the program. A panel of experts discussed the medical, legal and philosophical aspects of the bioethics issue. Speakers included D r Jeffrey J. Pomerance, d irector of neonato logy at Cedars-Sinai Medical Center and adjunct professor o f ped iatrics at the UCLA School of Medicine; Or. Bernard Towers, professor of anatomy and psychiatry at the UCLA School o f Med icine; and j ay N. Hartz, J D., a principal w ith the law firm of Weisberg and Aronson, Inc. The Lester Breslow Lectureship is presented annual ly and is supported by a gift from the Or. Raymond and Betty Goodman Foundation. Ir is nam ed fo r Or. Lester Breslow, professo r of public heal th and dean emeritus of the UCLA School of Pub lic Heal th.

Alumni Notes Suzanne Dandoy, M.D., M.P.H. '63, Epidemio logy, has been appointed the

UCLA PUBLI C HEALTH SUMMER 1985

directo r o f the Utah Department of Health. Richard M. Oksas, Pharm. 0 ., M.P.H. '71, Health Ser vices, is program director of the Medicatio n Information Service located at the South Bay Free Cl inic in Manhattan Beach, California. He is also the author o f a weekly drug news column syndicated in mo re than 100 newspapers nationw ide. M. Bashar Bakdash, D.D.S., M.P.H. '72 , Population and Family Health, who was awarded first prize in the 1984 American Dental Association's Periodontal Health Award, donated his $2,000 prize money to the Periodontal Resear ch Fund, School of Dentistry, University of Minnesota. I le is associate professor and associate chairman, Department of Periodontics, School of Dentistry, and associate professor, Dental Public Health Program, School of Public Health, University of Minnesota. Kenneth Kizer, M.D., M.P.H. '76, Epidemio logy, has been appointed by Governor George Deukmejian as state director o f health services in the California Department of Health Services. He had ser ved as deputy d irecto r of the de-

parrment since August 1984. Walter J. McCall, M.A. '78, M.S.P.H. '83, Po l icy and Planning, is marketing director of rhe PPO Alliance, a health care marketing corporation jo intly owned by the Adventist I Ieal th Systems-West, the Health West Foundation and the Lutheran Hosp,ital Society o f Southern Californ ia. Bryan Luce, M. P.H. '79, Heal th Services, senio r research scientist, has been appointed d irecto r of the Medical Technology Assessment Program at Battel le's Human Affairs Research Centers in Washington, O.C. Before joining Batte! le, Luce ser ved as di recto r of the Office o f Research and Demonstrations for the Heal th Care Financing Administration. Andrea Hassol, M.S. P.H. '83, Heal th Services, is a health policy analyst for the Prospective Payment Assessment Commission ( PROPAC).

Alumni Information Update The Alumni Association, along with the School and your peers, would like to know your current address, place of employment and personal news fo r inclusion in the Alumni Notes section of this magazine. Please take a moment to answer and comment on the following questions so we can further strengthen our alumni network. Did this magazine arrive w ith your current name and add ress' If not, please correct us. Name: - -- - -- - -- - - - -- - - - - - - - - - -- -- -- - -- -- - - - - - - - - - -- -

Telephone: - - - - - - -- - -- - -- - -- - - - - - -- - - - - - - - - -- - - - - -- - - - Year of Graduation:

Personal and Professional News: - - -- - - - - - - - -- - - - - - - - - -- - - - -- - - - - - -- -

(Be sure to include elates for special events, appointments, awards, honors, publications, etc. Use more paper if needed). Yes! I would like to become involved in one o r mo re of the networking activities, nam ely: _ _ _ _ __ __ _ _ _ _ __

Send the above information to the Alumni Association, School of Public Health, c/o Dean's Office, Center for the Heal th Sci ences, UCLA, Los Angeles, CA. 90024.

26 would I ike to share my pleasure Âˇwith the increased involvement of facul ty, students, alumni and the community in promoting the goals of the School of Pub lic I leal th. Al tho ugh facul ty have always been involved in the affairs of the School, there has been an increasing desire to think crit ically about the future of the School and its ro le in furthering research and teaching in public heal th. An examp le is the enthusiastic response of facul ty to the appo intment of a Lo ng-Range Planni ng Committee in Spring 1983. This committee, under the leadership of Professors Lester 11reslow and Virginia Clark, wrestled with the major issues facing pub! ic health and promu lgated both a lllissions statement and a set of priorities fo r the School for the next decade. This committee successfully involved the facu lty in its deliberatio ns. On reco mmendations of that comlllittee to elllphasize the areas of health promotion and health info rlllation systems, I have allocated a facul ty position to head the computer-based data area, fo rmed a Colllputer Committee to deterllline our future d irectio ns in this area, and appointed a committee to plan fo r a Center for I lealth Promot io n. Another outcome of their recommendations and of our successful accreditation visit was the formatio n of an ad hoc committee to outline the responsibil ities ofa new standing com m ittee, the Evaluat io n Committee for the School of Public I leal th. This committee w ill be responsible for reviewing the extent to which the teaching, research and community ser vice prograllls of the School meet our stated m ission and academ ic goals. There has also been a resurgence of interest by the facul ty in examining the o rgan izat ional structure of the School. A Reorganization Committee, led by Professor Paul To rrens, has been appo inted by the Facul ty Executive Collllll ittee to consider the advantages and cl isaclvanrages of changing the current one department structure or the School, and the merits of al ternative o rganizat io nal structures. Students are also actively participating in School srancling com mittees and d ivisional activities. They sponsored a booth at the fa ll APJIA llleeting, helped to plan a successfu l student-alumni parry and graduat ion activities. The Alullln i A-;sociat io n has sponsored a number of pub I ic lectures and conferences, wh ich brought o utstanding pu b! ic health figures to the School, and has developed a closer relati onship w ith the Public I lealth Student A'isociat ion. Fo r the first ti me, alumni w ill be serving on the Adm issio ns Pol icy Committee and the Educatio nal Policy Committee, adding an important perspect ive to deliberations. Professio na ls fro m the public heal th community part icipating in School activities incl ude Di: Ellen Alkon, directo r of rhe West Area of the Los Angeles Counry Department of I lea lth Services, who , in additio n to teaching in the School, serves o n the Educati onal Po licy Committee. Dr. Donald Lyman, M.D. , M.P. 11., deputy director, Public and Enviro nmental Heal th, Califo rnia Department of Heal th Services, and 13arbara Broide, M.P. H., assistant executive directo r, Los Angeles Chapter of the Alllerican Cancer Society, ser ved o n the acl hoc colllm ittee to develop a charge fo r the Evaluati o n Comlllittee. Many other pub I ic health professionals are also involved in the var io us p rograms of the divisions. A collabo rat ive project of the School w ith the Los Angeles Uni fied School Distr ict, the Los Angeles County schools, and the Los Angeles County Department of Health Ser vices to develop guidelines for a comprehensive school heal th progralll for Los Ange les County school children further strengthens these ties. Finally, there has been a hearrwarllling endorsement from the private secto i: The Ri chard and Veda Weisman fa mily have generously donated $500,000 to suppo rt the reaching and research programs of the Division of Epid ellliology, in honor o f Division I lead Barbara Visscher 's colllmt tlllent to academic public heal th. Thus, it is with considerable pleasure that I reflect on these examples of the increasing involvement of faculty, students, alumni, publ ic health professio nals and the community in helping the School of Publ ic Heal th meet its goals for the 1980s and the Âˇ1990s. Such commitlllent and involvement auger well for the future of academic pub I ic heal th at UCLA.

Roger Detels, M.D., M.S. Dean