Findings, The Roads We Take

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> The Hen Medic p. 12 | False Starts, Plot Twists, Surprise Endings p. 20 | Innovation and Equity p. 26

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From the Dean Choosing the Right Road

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From Our Readers

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On the Heights

Connect with SPH Links at sph.umich.edu.

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Alumni Network 32 The Unexpected Politician

33 Class Notes

34 A Diverse Toolbox

35 In Memoriam

36 Perseverance

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Research News

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Events

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Front cover: Illustration by James Steinberg Back cover: Images from SPH graduations dating back to 1943

What Does It Take to Change The World?

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findings Volume 32, Number 2 Spring/Summer 2017

10 Fe ature Articles

The Roads We Take 10

Trees of Life

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The Hen Medic

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Road Work

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A fusion of past and present, personal and professional, leads one scientist to find his voice How a “petticoat surgeon� advanced the prestigious field of medicine For these scientists, highways and byways are keys to health

False Starts, Plot Twists, Surprise Endings

The sometimes unpredictable roads that can lead to a career in public health

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Innovation and Equity

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Simply Connecting

Changing the face of health care leadership

New momentum for the Griffith Leadership Center

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FROM THE DEAN

Choosing the Right Road

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or those engaged in public health work, the chase to make discoveries and solve problems is both invigorating and maddening. Public health is messy—it’s unpredictable. But that is what draws us in.

By nature, we are sorters and organizers. We want to define the problem and then find better solutions to the problem. We seek to embed ourselves in the communities where we can make a difference. At our best, we aim to anticipate where problems might arise and prevent them from happening.

Martin Philbert To operate at our optimal level, we cannot travel alone. In public health, our journeys require a collaborative spirit, a unified will, and a ceaseless empathy for people. It is hard not to think of Aristotle’s “the whole is greater than the sum of its parts” when reflecting on when public health is at its best.

As we will learn in this issue of Findings, Aristotle’s words ring true, as does Cervantes’s “it takes all kinds to make a world.” There is no right or wrong way to discover public health and its incredible power (and duty) to change lives. The stories—and the people—who fill these pages will amaze you.

The unique personal experiences, acquired skills, and internal motivation that lead individuals to public health ensure they are the right person to be in public health. It seems illogical to concede “if you are in public health, you’re meant to be here.” It is a bit like saying “you must want Italian food because you now find yourself in an Italian restaurant.” The logic seems slipshod.

But there is really no right or wrong way to get into public health. That can be puzzling for a scientist, which in part explains my own fascination with how I ended up in public health. Looking back, I began my studies with the notion that I would become a physician. As it turns out, some fateful detours paved a new road for me.

Everything I had learned about science during my studies was to “control the variable.” But public health is about optimizing many, many variables simultaneously and without necessarily having any control over them. It can be a confounding lesson for someone like me, who grew up staring into a microscope and feeling rather at home in that setting.

One of the clearest routes to optimization is to collaborate. Here at Michigan, we believe in a fully interdisciplinary approach. We are in the carpool lane of health, as it were.

There is a collective drive to our mission. We must optimize health for the individual, and the family, and the neighborhood, and the community, and the region, and the nation, and the entire globe. There are many, many ways that we care for people’s health—food safety, clean air, sewage systems, and vaccine programs to name a few. A discovery in one area might help fight a problem in another. We must always be looking out to the shifting landscape, searching for new routes.

When your life’s work is about caring for people across the world, with people across the world, progress can be iterative. Once in a while, we get to leap. But frequently it’s a slow, steady, dogged search for the truth as the data leads us to it.

Herein lies the dynamic challenge of public health work: Whether we are marching or leaping, not everyone else is traveling down the same road toward optimal health at the same velocity. Disparities emerge no matter how perfect the road you have charted.

Even if I create the best solution to a problem, not everyone has access to it. There are economic and geographic impediments in place. This is what makes public health an invigorating and maddening discipline.

Our shared responsibility is embodied in the policies we influence and create. We must partner with communities, health authorities, the public sector and the private sector, and we must lead better decision making. We must be the drivers of our interdisciplinary approach.

And the impact of our approach?

We must lead inexorably toward shared responsibility and governance.

The challenge that lays before us— now more than ever—is how we work together to be more effective. Not just in the science, not just in building the body of evidence, but in convincing people who are not experts—but who have the power to make decisions—that there is a better way. As we close our 75th year, this is of paramount importance.

Each time we reach the edge of the horizon, the road extends further out in front of us—twisting in new and perhaps unpredictable ways. We must continually ask ourselves, “Where are we going, and why?” That will keep us pointed in the right direction and committed to the right objectives.

Gazing down the road, we must look forward and continue striving to be in the right place, with the right people, ahead of time. <

The challenge that lays before us is how we work together to be more effective.

Martin Philbert Dean and Professor of Toxicology

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world—polio vaccines, water fluoridation, health insurance, etc. The one old tradition you didn’t list was the Friday Afternoon “TG,” as in TGIF. They rolled a keg into Mary Markley cafeteria, charged $1 for a paper cup, and it was all the beer you could drink.

Frederick C. (MPH ’75) and Linda Bradshaw (MPH ’75) Matz Coatesville, Pennsylvania

What It Means, Why It Matters:

The Anniversary Issue

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> The history gene p. 14 | Past legends, present inspiration p. 16 | From cornerstones to croissants p. 24

Fond Memories > We really enjoyed the anniversary issue (fall/ winter 2016) of Findings. The articles on the school’s history brought back fond memories.

In this time of uncertainty, it is nice to look back on the SPH history and see those major public initiatives that have truly changed the

> The article “75 Things You May Not Know about SPH” (fall/winter 2016 Findings) brought back fond memories, including the pig roast of Professors Peter Meier and Rolf Deininger, and the article on the Huron River lab course taught by Professors Meier and John Gannon.

Although I was pursuing a doctorate in epidemiology, not environmental and industrial health, my lab and some of the offices where I worked on my dissertation were down the hall from these professors. Perhaps it was my avocation for fly fishing—and my ensuing attraction to water quality and the insects that live in water— but I especially appreciated the times when Dr. Meier allowed me to sit in on his lectures about aquatic entomology.

The item closest to my heart in the article, however, was the picture of the peony gardens next to SPH, because that’s where I proposed to my wife.

Michael Warzynski, PhD ’79, MS ’73 Grand Rapids, Michigan

When I was in college and working summers in the virus lab, I actually brought home two “hatched” chickens.

> The 75th anniversary issue of Findings brought back lots of very old memories. When my family moved to Ann Arbor in 1941—as the SPH building was being built—my father was located in a funny, little, old building on a side street close to the hospital. I think I remember visiting the monkeys there. After the school settled into its own building in 1942, I remember going with my father on weekends and always wanting to visit the animals: the sheep, the monkeys, the ferrets, the mice, and the chickens which had hatched from unattended eggs.

When I was in college and working summers in the virus lab, I actually brought home two “hatched” chickens. It was fun to watch these little fuzzy yellow things traipse around after our black cocker spaniel in the backyard—until the chicks got too big and had to be returned.

Also, this issue had me remembering those early faculty—the truly elegant Nate Sinai, always a fashion plate of the first order. Even as a child, I was awed by him. Of course, the first dean, Henry Vaughan, was my “Uncle Henry” and his wife, my “Aunt Grace.” They were always very much a part of our lives as children, their children being significantly older. I remained in touch with them until they were no longer with us. They were very proper and always carefully dressed, as were my parents. But those days seem long gone.

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mong the most special things about the roads we travel are those we meet along the way.

All of our journeys have been enriched by Leslie Stainton over nearly twenty years.

Leslie served as editor of Findings and guided our beloved magazine with creative flair and deep knowledge of the School of Public Health. Leslie retired in December and will dedicate her time to pursuing her own research and writing projects and to teaching in the U-M Residential College.

In her time here, Leslie received many awards for her work and—most importantly—helped shape the conversation about public health here at Michigan and beyond. Now we wish her “happy trails!” On behalf of the entire SPH community—thank you, Leslie. —Martin Philbert

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I love seeing how the school has evolved today— engaging, educating, training in the evergrowing dimensions of concern and care for the public’s health. Clearly the nation’s health is in good hands and benefitting from those who the school prepares to serve in the future.

The Rev. Dr. Mary Jane Francis, PhD ’70 Seattle, Washington The writer is the daughter of the late U-M SPH Professor Thomas Francis Jr.

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FROM OUR READERS

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Pay It Forward

A Lead-Free Pioneer

> Congratulations on a phenomenal issue of

> Thank you for an informative fall/winter 2016

Findings (“The Anniversary Issue,” fall/winter 2016). While every issue is jam-packed with interesting articles and information, this one is a “keeper.” It sends a great message about our heritage as a school of public health and the achievements that have been realized at Michigan. It shouts out to all about the obligation we each have to make sure we are improving the health of those we serve using all the resources we can muster. And it speaks to the need to translate scholarly efforts into practical ideas so that each of us can gain value from the research conducted at SPH.

Findings! I like the piece on unleaded gasoline (“75 Years of Public Health Achievement”), highlighting Professors Bertram Denman and Jerome Nriagu. U-M graduate Alice Hamilton (1869–1970), MD, considered the “Mother of Industrial Medicine [now ‘occupational medicine’] in the U.S.A.,” was an expert on the toxicity of lead. I have long admired her pleasant perseverance in making the workplace safer, with a bent toward social justice, and I am building a website (http://DrAliceHamilton.com) in her honor.

In May 1925, two years after auto manufacturers began adding lead to gasoline, Hamilton testified in a federal investigation of tetraethyl lead, “I am utterly unwilling to believe that the only substance which can be used to take the knock out of a gasoline engine is tetraethyl lead.” Over 100 representatives of labor, oil companies, academia, and government agencies, were present.

Although the investigation lapsed, Hamilton viewed it as victory, establishing a precedent of government and scientific influence over industrial hazards.

I am a proud graduate in health management and policy and health administration. I have continuously learned from the faculty and students with whom I have come into contact and have been blessed to have two mentors (Gail Warden and Howard Berman) who have helped me throughout my career. The faculty (John Griffith, Avedis Donabedian, Si Berki, among many others) have challenged my thinking both as a student and as a health care executive.

Now we alums must pay it forward by making sure SPH remains the best through our philanthropic contributions and interactions with students. The school’s future graduates are the “new and improved version” of those of us who came before. Thanks so much for a wonderful journey through the history of SPH. Wayne M. Lerner, DrPH ’88, MHA ’73 Board Member, Sinai Health System Chairman, U-M Griffith Leadership Center Glenview, Illinois

Deborah Salerno, PhD ’98, MS ’95 Ann Arbor, Michigan

R e co g n iti o n The two most recent issues of Findings, “Our Common Journey” (spring/summer 2016) and “What It Means, Why It Matters: The Anniversary Issue” (fall/

We love hearing from you!

winter 2016), each won

Post comments online; email us at sph.findings@umich.edu; or send a letter to Findings, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109-2029; fax 734.763.5455.

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a gold Addy award for

Back Issues Back issues of Findings are available upon request. Visit sph.umich.edu/findings to review past issues. To request print copies, specify which issue and email sph.findings@ umich.edu.

publication design in the 2017 American Advertising Awards competition sponsored by the AAF/ Greater Flint Ad Club and the American Advertising Federation.

Findings is published twice each year by the University of Michigan School of Public Health Office of Marketing and Communications.

Dean Martin Philbert Director of Marketing and Communications Emily Ford Editor Josh Messner Contributing Editor Andrea LaFerle Contributing Editor Laurel Thomas Gnagey Project Manager Michael Kasiborski Video Editor Brian Lillie Creative Director Beth Miller Social Media Editor Eric Zanotti Art Director Aimee Andrion Findings Art Direction/Design Hammond Design

Copies of Findings may be ordered from the editor. Articles that appear in Findings may be reprinted by obtaining the editor’s permission. Send correspondence to Editor, Findings, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109-2029, or phone 734.936.1246, or send an email to sph.findings@umich.edu. Findings is available online at sph.umich.edu/ findings. ©2017 University of Michigan To opt out of receiving the print version of Findings and read our publication exclusively online at sph.umich.edu/findings/, email us at sph.optout@umich.edu.

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Regents of the University of Michigan Michael J. Behm, Grand Blanc Mark J. Bernstein, Ann Arbor Shauna Ryder Diggs, Grosse Pointe Denise Ilitch, Bingham Farms Andrea Fischer Newman, Ann Arbor Andrew C. Richner, Grosse Pointe Park Ron Weiser, Ann Arbor Katherine E. White, Ann Arbor Mark S. Schlissel, ex officio The University of Michigan, as an equal opportunity/ affirmative action employer, complies with all applicable federal and state laws regarding nondiscrimination and affirmative action. The University of Michigan is committed to a policy of equal opportunity for all persons and does not discriminate on the basis of race, color, national origin, age, marital status, sex, sexual orientation, gender identity, gender expression, disability, religion, height, weight, or veteran status in employment, educational programs and activities, and admissions. Inquiries or complaints may be addressed to the Senior Director for Institutional Equity, and Title IX/Section 504/ADA Coordinator, Office of Institutional Equity, 2072 Administrative Services Building, Ann Arbor, Michigan 48109-1432, 734.763.0235, TTY 734.647.1388. For other University of Michigan information call 734.764.1817.

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Innovation in Action’s five-month, university-wide entrepreneurship challenge concluded in March. Student teams focus on broad topics in public health and education to address realworld problems and to learn more about social innovation in an experiential-learning framework.

This year’s public health competition first-prize winner was Canopy, a web-based application that facilitates “the conversations about the end of life that we aren’t having but maybe should be.” The simple app walks users through questions and answers they might need someday to help clarify their wishes with the people they love. Canopy was developed by students Ann Duong of the School of Information and SPH, Brandon Keelean of the Stamps School of Art and Design, and Elisabeth Michel of SPH.

Service Day

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First Undergrad Cohort

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SPH in Bangladesh

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Feingold Award Winner

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Brandon Keelean, Ann Duong, and Elisabeth Michel discuss app development and presentation details at the Stamps School of Art and Design.

Inset left: Duong, Keelean, and Michel with IIA Competition judges receiving $11,000 to launch Canopy. Inset right: Canopy’s current homepage.

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O n the H ei g h t s Beginning a Great Tradition More than 200 SPH community members volunteered their time and energy on Saturday, April 1, as part of the school’s first-ever Service Day to honor our 75th anniversary. The volunteers—comprised of alumni, students, staff, and faculty—completed a variety of tasks at eight different sites around southeast Michigan, including three in Ann Arbor, two in Flint, and one each in Detroit, Southfield, and Ypsilanti. These eight host communities welcomed our volunteers with open arms and rolled-up sleeves.

Meeting the rapidly growing need for public health professionals

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First Undergrad Cohort Arrives This Fall S

SPH Service Day connected participants more deeply with key goals of our school like promoting health and engaging communities. Groups and individuals volunteered in their local communities while representing SPH and connecting with each other outside of classrooms and labs. Planners chose projects that could make a noticeable impact in a single day.

Check out hashtag #Servingfor75 on Twitter to see more photos. And stay tuned for information on how to participate in Service Day 2018, which will expand beyond Southeast Michigan. n

PH’s first class of undergraduate students will begin coursework this September.

The U-M Board of Regents approved the new program in Public Health in September 2015, and more than 75 students are now enrolled for the fall. Gary Harper, professor of health behavior and health education, is SPH’s first director of undergraduate education.

Using ASPPH’s current curricular recommendations, Harper and his team have developed BS and BA majors geared toward upper-level students. SPH recruited broadly for this first cohort and has admitted a diverse class representing several U-M schools and colleges and transfer students from other institutions.

SPH undergraduates will take a variety of courses to build general public health skills and to develop a broad interdisciplinary approach to the profession. Students will choose from two majors—public health sciences, and community and global public health—and both majors will require a field learning experience, with study abroad and other international experiences encouraged. “Our new BA and BS degrees are designed to help undergraduates move into a public health career holistically,” says SPH Undergraduate Program Coordinator Jillian McConville, “preparing them to expand their work into more technical areas during

their graduate study.” Faculty from each SPH department will be developing and teaching courses in the program.

The new programs demonstrate SPH’s ongoing commitment to academic excellence and to serving local, national, and global communities. Offering undergraduate degrees keeps SPH competitive with the top 40 public health schools in the country—only five of which do not have an undergraduate major.

“With mass retirements only a few years away, demand for public health education is at an all-time high.”

Expanding degree offerings and student demographics meets the rapidly growing need for public health professionals. “With mass retirements only a few years away,” says Harper, “demand for public health education is at an all-time high. SPH’s new undergraduate program is a significant step toward addressing those tremendous needs.” < —Laurel Thomas Gnagey

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SPH Faculty Recognized with Collegiate Professorships

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wo SPH professors were appointed to collegiate professorships by the U-M Board of Regents in March 2017.

Marc Zimmerman is now the Marshall H. Becker Collegiate Professor of Public Health. Zimmerman is a professor of health behavior and health education and psychology as well as a research scientist for the Center for Human Growth and Development. He joined the SPH faculty in 1989.

“Marc Zimmerman has for a long time been an outstanding and leading scholar in the area of adolescent health and resiliency,” says Martin Philbert, SPH dean. “His insights into community interventions that promote adolescent resilience to threats to human health—such as drug abuse, precocious sexual behavior and school drop-out rates—form the basis for evidence-based policies that promote health in the young and prevent disease as they age. I am delighted that his scholarship Marc Zimmerman and dedication to the fundamental precepts of public health have been recognized by this collegiate professorship.”

Marshall Becker’s research related to compliance with medical regimens and factors influencing preventive and disease management actions placed him in the forefront of health behavior research. His legacy includes fundamental contributions to the establishment of the Health Belief Model, a theoretical framework for predicting health behavior widely employed in health-related research and practice. Becker, a professor of health behavior and health education at SPH, was recognized by the University of Michigan with a Distinguished Faculty Achievement Award and was elected to the Institute of Medicine. He passed away in 1993.

“He didn’t take himself too seriously, but he took his work very seriously. When he gave a lecture, you would laugh but also learn something.”

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Higgins was a researcher with the groundbreaking Tecumseh Community Health Study, for which she studied high blood pressure, breast cancer, and chronic respiratory diseases.

“It is a great honor to be named a collegiate professor,” says Kardia.

“I chose Millicent Higgins because she worked within my own field of cardiovascular disease epidemiology. In addition, after nearly 20 years on the University of Michigan faculty, she went on to become the deputy director of the Epidemiology Division of the NHLBI and helped establish the major longitudinal cardiovascular epidemiology studies that most of us still use today. On a more personal note, she is a complete delight. Every year I get to see her, she is always telling the most wonderful stories of the school’s early successes in protecting the public’s health, whether it was pertussis or polio.” <

“It’s always great when your colleagues —the people you work with every day—give you an honor like this,” says Zimmerman. “I am flattered and humbled. Marshall Becker was a mentor of mine early in my career and a beloved, iconic character. He didn’t take himself too seriously, but he took his work very seriously. When he gave a lecture, you would laugh but also learn something.”

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Sharon Kardia is now the Millicent W. Higgins Collegiate Professor of Epidemiology. Kardia is a professor of epidemiology and senior associate dean for Administration at SPH. She joined the faculty in 1998.

“Sharon Kardia has been a pioneer in the use of statistical genetics to probe gene-gene and gene-environment interactions in studying the epidemiology of the etiology of common chronic diseases,” says Philbert. “Her innovative use of existing and development of Sharon Kardia new analytical strategies for understanding the complex interrelationships of intrinsic and extrinsic risk factors across multiple ‘omic’ platforms holds promise for the creation of populationlevel interventions that will alleviate the burden of disease.”

A highly regarded teacher and mentor for public health students, Millicent Higgins taught epidemiology, and her principal research activity was in Tecumseh, where her interests included studies of high blood pressure, breast cancer, and chronic respiratory diseases. She was a consultant to the National Institutes of Health and served as the chair of the clinical trials review committee of the National Heart, Lung, and Blood Institute(NHLBI).

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SPH Leaders Visit Bangladesh to Explore Collaborations

Far left: Martin Philbert and SPH colleagues visit Bagdumur, a rural village.

Above: Philbert in a Dhaka clinic discussing public health initiatives in the capital.

Left: Bangladeshi mothers discussing vaccination.

Photos by M. Ponir Hussain

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overty, infant mortality, and chronic health issues are just some of the issues in Bangladesh that SPH researchers hope to address with research partnerships. A group of leaders were in the South Asian nation last month to explore collaborative opportunities.

“The visit to Bangladesh was a study in contrasts,” says SPH Dean Martin Philbert, a professor of toxicology. “Undeniable poverty and its consequences were counterbalanced by the creation and implementation of innovative solutions aimed at the sustainable improvement of health and well-being for the most vulnerable in society.” Philbert and SPH faculty members Matthew L. Boulton, Mousumi Banerjee, and Elizabeth King visited urban and rural clinics and the International Centre for Diarrheal Disease Research in Bangladesh. They examined pressing public health issues like maternal and child health, rising chronic health problems, and the need for a cancer registry.

The group also met with various nonprofit organizations including BRAC, the world’s largest nongovernmental development organization dedicated to empowering people living in poverty. Last year BRAC’s founder, Sir Fazle Abed Hasan, received U-M’s Thomas Francis Jr. Medal in Global Public Health for his leadership of the organization. SPH has

had deep international ties since the early 1970s, when the school started its global partnerships. There are now more than 90 SPH faculty working in 75 countries around the world.

While maternal and infant mortality have been a focus for many health organizations in Bangladesh, malnutrition and lack of timely vaccination also affect maternal and child health, says Boulton, senior associate dean for global public health at SPH and professor of epidemiology, global public health, and health management and policy.

With high population density, many environmental challenges such as groundwater contamination and flooding are becoming a grave concern for the world’s eighth-most populous nation, he says. “There are tremendous opportunities for SPH global scholars to collaborate with health organizations in Bangladesh,” says Boulton. “We have a longstanding commitment to assist our international partners in building public health

infrastructure, data collection, analysis, and research.”

The team also visited Bagdumur, a village outside of the capital Dhaka.

The village has been adopted by Moushumi Khan, a graduate of the U-M Law School. Khan gave up a thriving law career to work in the village in memory of her father Abdul Majid Khan, who grew up in Bagdumur and was an alum of U-M’s College of Engineering. Khan’s organization, Foundation for Charitable Activities, in Bangladesh is striving to turn Bagdumur into a smart village with clean energy, sustainable health, and livelihood needs.

Helping her in this quest is Banerjee, a research professor of biostatistics at SPH, who conducted the first public health survey of the village to better understand the health needs of its residents. “In a country like Bangladesh, there are tremendous public health needs, and a little investment goes a long way,” Banerjee says. “We can make a

There are now more than 90 SPH faculty working in 75 countries around the world.

real difference in people’s lives.” <—Mandira Banerjee, Michigan News

On the Heights

O’Neill Receives Feingold Excellence in Diversity Award

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arie O’Neill, associate professor of environmental health sciences and epidemiology, was awarded the Eugene Feingold Excellence in Diversity Award. Her nomination received overwhelming support from students, faculty, and staff.

O’Neill’s research often focuses on vulnerable populations. She works on vegetation and heat vulnerabilities in Detroit and air quality and birth outcomes in Mexico City. International funding organizations such as the Health Effects Institute cite O’Neill’s scholarship as a model for furthering objectives of health equity.

O’Neill’s research consistently brings together scholars, practitioners, and community partners to explore common issues. She employs community-based participatory research (CBPR) methods and is committed not only to publishing results but to translating and promoting findings into action.

In 2009 she and her team published a prototype heat vulnerability map, a public health and urban planning tool that has spawned further research on the topic. She received NIH and more recently NSF fundO'Neill works on vegetation and ing to study heat, comfort, and heat vulnerabilities in Detroit and health equity issues. air quality and birth outcomes in “Public health success Mexico City. depends on creating spaces for ideas to be freely shared among students, faculty, and members of communities that are most adversely affected by health challenges,” said Sharon Kardia, senior associate dean for administration and professor of epidemiology, “and Professor O’Neill has worked tirelessly toward this goal.”

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atthew L. Boulton, professor of epidemiology, global public health, and health management and policy, received the Association for Prevention Teaching and Research’s (APTR) Special Recognition Award at the organization’s annual meeting this April in Savannah, Georgia. The award recognizes an individual or organization that has provided outstanding service to the APTR, its members, and the field of prevention and public health.

Boulton’s lifetime contributions to the field and commitment as the current editor-in-chief of the American Journal of Preventive Medicine were key factors in his selection. Boulton is also senior associate dean for global public health and professor of preventive medicine and internal medicine at the U-M Medical School.

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Alums Take First, Second Place in Ford’s Go Detroit Challenge

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wo public health-focused start-ups launched at SPH received top prizes in Ford Motor At left, SPH alumni Greg Wnuk and Stacey Matlen Company’s Go Detroit Challenge, a six-month challenge that engages community members and asks participants to identify and create innovative solutions to mobility challenges faced by Detroiters. Led by SPH alumni Stacey Matlen and Greg Wnuk, Cart—which increases access to health-enabling resources like grocery stores by connecting people to affordable, reliable transportation—placed first, receiving a $15,000 prize. Caravan—a social mobility enterprise that improves Detroit’s needs-based transportation network by increasing access to services like healthcare, education, and employment—is led by U-M graduate students Kenny Fennell and Benjamin Morse and took second place in the competition, winning a $7,000 prize. Both Cart and Caravan got their start with Innovation in Action’s entrepreneurship challenge.

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his past February, Nichole Burnside began her role as Diversity, Equity, and Inclusion program manager in SPH, where she will head up implementation of SPH’s DE&I strategic plan. Burnside’s passion for diversity began back in high school, when she helped form a group called Cultural Outreach that would reach out across demographic lines to make people feel included.

“I’ve always had a passion for treating everyone the same,” says Burnside. “To know that people can be discriminated against because of something they have no control over is disheartening.

I am very concerned with making a world for our children that is more empathetic.”

Burnside has been at U-M for 15 years, including six years at the Michigan Institute for Clinical and Health Research (MICHR), where she helped increase enrollment of underrepresented groups in clinical and health research and assisted community groups in writing research proposals. More recently she worked for the Institute for Social Research, where she was a key contributor to ISR’s strategic DE&I plan.

Burnside works tirelessly to ensure that DE&I values become a permanent part of workplace expectations rather than a secondary consideration.

“A structure is not sustainable without a foundation,” she says. “That’s how we need to operate with DE&I. We can’t build an inclusive workforce for today’s community and tomorrow’s leaders without DE&I. I am encouraged by the spirit at SPH. People want to be here. I want to enhance that love for this community and bring more exposure to the work being done here.”

Burnside is the first to acknowledge that SPH’s commitment to DE&I does not begin with her arrival.

Many others have laid the foundation for developing and beginning to implement SPH’s strategic plan. And SPH’s is only one of the 49 plans published across the U-M community over the last year or so. The primary goal of SPH’s particular plan is to “create an environment within the School of Public Health that allows for positive contributions from all of those engaged in public health and that maximizes equity and inclusion among our stakeholders.”

Burnside is eager to have conversations about diversity, including the difficult conversations. She wants to see all SPH students trained in diversity as a way of life. “They will be faculty and practitioners someday,” she reminds us, “and will be teaching the next generation of public health professionals, hopefully in new and more equitable contexts.” <

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“We can’t build an inclusive workforce for today’s community and tomorrow’s leaders without DE&I.”

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Trees of Life

How a fusion of past and present, personal and professional, led one scientist to find his voice.

Trees of Life

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by Kevin Boehnke

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y life is at a flex point. I am finishing my PhD in water quality, recently became a new father, and am deciding what to do next.

If I were on the classic academic path, my next move would be to get a postdoc in a related field of study, publish extensively, and scramble like hell to find positions that might (eventually) get me on the tenure track.

These moves seem so straightforward, simple, logical. It’s almost like looking at a classic tree of life—full of rigid, extending branches that move linearly and inexorably toward a set endpoint.

Yet when I speak with people who seem the most satisfied with their lives and career choices, this simplified path is the one least taken. They have traversed winding roads—full of unexpected turns, struggles, and joyous coincidences. When I visualize their lives, I conceive of a tree with graceful looping branches—past experiences bringing understanding and nuance, rather than a rigid path from A to B. It’s not unlike the theory of endosymbiosis: one organism becoming encapsulated and a part of another, bringing increased complexity and functionality to the new chimeric being.

I believe that the search for a meaningful life is too individual to make broadly applicable sweeping statements. However, this idea of incorporating the past—the melding of these moments of joy, struggle, and clarity—has been invaluable for thinking about my career. My own journey into public health can only be explained by making my health public.

“You have fibromyalgia.” These words, a diagnosis during my senior year of college, scared but relieved me. I had spent the past 13 months afflicted by mysterious pain that started in my hands and had quickly spread throughout my body. Now I had an answer, but it wasn’t one that I wanted. Fibromyalgia? A lifelong pain condition affecting both body and mind that has no straightforward treatment?

Simultaneously, though, I was relieved. In those 13 months, I had slogged through the medical system, received multiple unhelpful diagnoses, gone to a chiropractor and physical therapy, changed my diet, and tried many other approaches. My parents generously supported my ballooning health care costs, and my girlfriend tried to buoy my mood.

Nothing really helped. But now, with a real diagnosis, perhaps there was a chance for useful treatment. And as I learned, there was.

Through trial and error, I started developing a toolbox of management approaches. I practiced yoga, ate healthier, worked on sleep hygiene, and occasionally used medication—all of which helped manage my pain.

My health slowly improved. Getting this under control represented a moment of irreversible fusion—an encapsulated experience that would shape everything to come.

I finished my BS in biology in 2009 and started working at NSF International (NSFI), testing water filters and their contaminant removal capacities. During this time, I continued modulating my lifestyle: I exercised daily, ate carefully, and, with my wife and friends, started a communal vegetable garden and raised chickens. I now understood how health could be bolstered by the interplay between personal change and external support systems, including societal ones. But how could I synthesize these ideas into a fulfilling career?

This thinking bled into my approach at NSFI, where I realized how the burden of water pollution falls unequally on disadvantaged people and communities. After the 2011 Fukushima Daiichi nuclear disaster, my lab tested whether existing technology could remove iodine from contaminated water in Japan. These experiences looped into my psyche and cemented my career focus: doing actionable research that is responsive to people’s needs and helps build tools for improving public health. I started my PhD in 2012, studying drinking water contamination with Helicobacter pylori—the primary cause of stomach cancer.

For my dissertation, I embarked on an interdisciplinary project to elucidate and mitigate effects of waterborne H. pylori in Lima, Peru. While working on this project, I recognized the importance of tailoring research and language to communicate meaningfully with various audiences. To practice, I took a class on science blogging, and was delighted to learn that I loved writing.

Finding my writing voice helped me become more honest about myself. I became more open about my health issues, and was thrilled by the empathetic reception and better relationships that followed. I realized how good communication builds common understanding for meeting shared challenges. This, and the support of fellow science writers, inspired me to start submitting pieces to various outlets—a few of which were published by Science magazine. Some of my blog posts got noticed by the media, and I did radio interviews—an exciting new way to communicate. Combining my interests in communication and health, I pursued yoga teacher training to help others regain control over their lives, as I had.

This unplanned branching out wasn’t on the traditional academic path, but it gave me a hands-on application for my interest in health. In a sort of intellectual endosymbiosis, my fragmented interests were melding together into a new worldview.

During this time, I used my own experiences as a springboard to start learning about chronic pain, and realized that I was one of 100 million Americans with chronic pain. My previous struggles with the medical system were not unique, but commonplace. I met with Dr. Daniel Clauw at the Chronic Pain and Fatigue Research Center at the University of Michigan Medical School. We discussed the lack of support for less invasive chronic pain treatments like diet, exercise, and cognitive behavioral therapy. Soon after, we conducted a study, showing that patients with chronic pain who use medical cannabis report reduced medication use and side effects, as well as better quality of life. This study changed my future research path. I realized that I had found a research area that allowed me to exercise both my personal and scientific voice. I had come full circle.

As Faulkner wrote, “The past is never dead. It isn’t even past.” My path was not unique. As with so many others who found their way to public health, it was about fusion of experience, with formative events becoming inextricably interwoven with the present, changing the direction of the future. May we all remember that as we traverse the paths to come. <

Finding my writing voice helped me become more honest about myself.

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Kevin Boehnke will finish his PhD in environmental health sciences at U-M SPH in 2017. He is fascinated by the intersection between science, education, and policy, especially as it relates to chronic pain, water, and food.

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H en Medic I

had never heard of a woman physician,” wrote Bertha Van their area of practice and were largely available only for those who could Hoosen in her memoir about the moment she stumbled afford them. This gave wealthy urban women more options, but poor, across not one but two women studying medicine at the rural women or immigrants or people of color had little help. In the

University of Michigan in 1884. impoverished area of Hells Kitchen, New York, at the turn of the century, Students Mary McLean and Harriet Barringer, who were living in a for example, newly appointed health inspector Dr. Josephine Baker boarding house across the street from Van Hoosen, were a wonder not just to discovered that 1,500 newborn babies died in the district every week.

Van Hoosen—but to society writ large. Women had been admitted into the Even when medical expertise was available, it was questionable. university little more than a decade prior, in 1870, to the distaste of many.

Sanitation and hygiene concerns, myths about women’s reproduction, and U-M’s first president, Henry the use of tonics and addictive Philip Tappan, wrote to a friend painkillers like opium often saying giving women an educamade women’s reproductive tion would “disturb God’s order” health more art than science. and “produce monstrosities.”

Added to this were gender The idea that a woman norms that kept women from could not only attend college seeing a male physician for but also advance the prestimodesty reasons. Van Hoosen gious field of medicine was wrote in her memoir that she downright revolutionary. Into believed women were sufferthis prejudice stepped Bertha ing and dying because “they Van Hoosen, who was born couldn’t submit to an examinaand raised on a small farm in tion by a male physician.”

Stony Creek, Michigan, and During her decades of would later say that her study of work, Van Hoosen would pioanatomy—her favorite subject— neer advancements that made was “begun in the [farm’s] back childbirth healthier for women yard at hog-killing time.” everywhere and improved Van Hoosen’s U-M degree women’s heath overall. From was the first step in a long career implementing sanitation stanpioneering the advancement of dards to educating physicians health for mothers and babies. and women in the community She would go from not even directly, she was a tireless understanding that a woman teacher and healer—beginning Van Hoosen (far left) with U-M medical school classmates , ca. 1885. physician could exist to blazing in 1888 when she graduated trails for future generations. from U-M’s medical school to It was a critical time for her death in 1952. such a role. The average AmeriThrough a can woman in the 18th and 19th Surgical Door centuries had seven live births At U-M, Van Hoosen and her in her lifetime. Data suggests female medical colleagues that 10 percent of mothers and were called “hen medics” 14 percent of babies died during or “petticoat surgeons,” the the birth process in the late 19th latter of which became the title of her memoir. She writes about being century. Even if the mother survived, there was a high likelihood that lacdemure in school—“I exercised care never to raise my eyes from the erations, tears, and injuries during birth would lead to pain, incontinence, ground going to and from class, and when in class I directed my attenand difficulty with future pregnancies. Creating life was a public health tion at the professor”—and in her first few positions after graduation, crisis that produced injury and death. she describes being tentative, overwhelmed by “the responsibility for At the turn of the century, physicians were slowly replacing midwives the life of a patient.” in attending women in childbirth. However, they rarely traveled outside

At U-M, Van Hoosen and her female medical colleagues were called “hen medics” or “petticoat surgeons,” the latter of which became the title of her memoir.

by Lara Zielin

The Hen Medic

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When Bertha Van Hoosen was a medical student at U-M in the late 1800s, womenâ&#x20AC;&#x2122;s health was a public health crisis.

The pioneering Van Hoosen helped change that through life-saving science.

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fter working and training for four years at the Women’s Hospital at the Michigan State Asylum for the Insane and the New England Hospital for Women and Children in Boston, Van Hoosen packed up and moved to Chicago to open her own practice. Patients were still wary of a female physician, and money was tight. So when she was asked to serve as the emergency physician for three days during the Chicago World’s Fair in 1893, she readily agreed.

There, a German immigrant came to see her with a sick child, and Van Hoosen treated the baby. After she sent them on their way and promised to call on them later, a male physician berated her, arguing that immigrants never listen and that the best course was always to give them a placebo—“sugar or bread pills”—because they were too ignorant to do what a physician told them. Concerned and upset, Van Hoosen tracked down the family that evening, only to find the baby much improved.

The German mother told all of her neighbors about Van Hoosen’s skills, and the problem of clients in her private practice was solved. “From then on, like a spring, [patients] almost burst upon me,” Van Hoosen wrote.

Van Hoosen’s career was Van Hoosen with medical bag in Chicago, ca. 1910. a mix of private practice and hospital appointments in obstetrics and gynecology, while always keeping surgery as part of her work. “Because I am a woman, to specialize in obstetrics would brand me as a midwife,” she wrote. She decided to enter obstetrics “through a surgical door.”

However, early on Van Hoosen witnessed many of her patients contracting fevers after surgery, which prompted her to teach sterilization techniques. “I discovered that nurses did not understand how to sterilize sponges, or properly prepare the operating room.”

For years, Van Hoosen would sterilize much of the operating equipment herself at home, then pack it into her buggy and transport it to the surgery. Before any operation, she would arrive and “[wipe] all the furniture with lysol solution,” doggedly fighting infection and imploring others to do the same.

Van Hoosen was also determined to relieve women of the pain and “lift the centuries-old fear” of childbirth. Beginning in the mid-1800s, ether was a popular anesthetic, but it could also stop uterine contractions and drug—or even kill—newborns. Chloroform was also used, but this too stopped contractions, and Van Hoosen wrote that it was “bad for the liver” and could harm infants.

By 1915 Van Hoosen had written a book on scopolamine morphine— a drug first pioneered by Dr. Emil Ries, a Chicago surgeon—which kept From the archives of Rochester Hills Museum at Van Hoosen Farm

“I took no vacations, never read the newspapers, I limited my reading to medicine, and seldom allowed my thoughts to wander from my professional duties.”

The medallion above and the American Medical Association convention pins on these pages are evidence of both Van Hoosen’s dedication to her career and the growing acceptance of women as medical professionals by male colleagues.

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From the archives of Rochester Hills Museum at Van Hoosen Farm

the mother conscious during childbirth but didn’t lessen contractions.

By 1902 she was a clinical gynecology professor at the Illinois University It alleviated pain and also left the mother with “no memory” of the Medical School, but the male students revolted when she tried to give them childbirth. This was coined as “twilight sleep,” and Van Hoosen was an exam—overturning furniture and nearly rioting. The faculty at one point its evangelist for decades, arguing against convention that it was safe refused to let her move a patient from the surgical “theater” back into the enough to use in home births as well as hospitals. hospital. The dean, Dr. William Quine, told her, “They do not want a woman Also in 1915, she helped establish the American Medical Women’s surgeon on the faculty, and have watched for an opportunity to balk you.”

Association—this in spite of petitions that were circulated by male physiIn spite of these obstacles, Van Hoosen was determined. “I took no cians condemning the organization. She served as the organization’s vacations, never read the newspapers, I limited my reading to medifirst president. cine, and seldom allowed my thoughts to wander from my professional In 1918 Van Hoosen was duties,” she wrote. offered the position as acting Van Hoosen never married head and professor of obstetrics and was the single breadwinner at Loyola University Medical for her family back in Michigan.

School—and became the first Her father had passed away, leavwoman to hold such a position at ing her mother and her widowed a co-ed medical school. When she sister, Alice, along with Alice’s arrived, she was horrified to find daughter, Sarah, to run the farm that a large number of seniors, by themselves. Sarah would go on the cusp of graduation, “had on to attend the Agricultural never seen a confinement case, College at the University of much less assisted in a birth.”

Wisconsin–Madison and become Van Hoosen worked steadthe first female “master farmer” fastly to educate men and women in Michigan and one of the first in in obstetrics, gynecology, and the United States. Today, the Van women’s health everywhere she Hoosen farm is the site of Michiwent. She taught the pioneering gan’s Rochester Hills Museum. technique of caesarian-section surVan Hoosen wrote her memVan Hoosen (circled) taking part in a surgical demonstration, 1905. gery, which saved mothers’ lives in oir, Petticoat Surgeon, at the age of difficult births, and she was deter84. When she died in 1952 at the mined to help train up the next age of 89, she was the oldest pracgeneration of women surgeons, ticing woman doctor in the United whom she often referred to as “her States, and by that year, the infant surgical daughters.” In rural areas mortality rate had dropped to especially, Van Hoosen made the around 3 percent. From 1900 to rounds with women physicians in 1997, the maternal mortality rate their communities, helping with declined almost 99 percent—cerbirths, surgery, and much more. In tainly due in no small part to her Chicago public schools, she lectured about sex education to hundreds of contributions. In 2016, the Institute of Health Metrics and Evaluations high school senior girls, arguing that “ignorance on no other subject could reported that the maternal mortality number was on the rise again and be more productive of bad results.” likely had been since 2000, especially among poor black women. <

The idea that a woman could not only attend college but also advance the prestigious field of medicine was downright revolutionary.

Sources for this article: Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report (October 1, 1999)

“An Opportunity to Balk You”

Not that it always went smoothly. Early in Van Hoosen’s career, in 1901, the position of professor of obstetrics and gynecology opened at U-M. Van Hoosen traveled from Chicago to Ann Arbor to visit Dr. Victor Vaughn, whom she knew from her days as a medical student. He told her directly that she couldn’t have the position because she was a woman, to which Van Hoosen replied, “If my own university will not administer justice to my sex, I will find some other school that will.”

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Institute for Health Metrics and Evaluation, Sustainable Development Goals (2015) Judith Walzer Leavitt, Brought to Bed: Childbearing in America 1750–1950 (Oxford University Press, 1986) Bertha Van Hoosen, Petticoat Surgeon (Chicago: People’s Book Club, 1947) O F

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Road Work For these scientists, highways and byways are keys to health.

by Sara Talpos

Road Work

From House to House

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n the summer of 2014, Kate Helmick, MPH ’15, spent a lot of time walking down roads in rural Thailand. She was part of a U-M SPH team collaborating with Thai scientists to understand an outbreak of skin lesions in an area of 16 villages. Nearly 30 years earlier, residents of those villages had learned that they were exposed to arsenic through contaminated well water. Their homes were situated in the southeast Asian tin belt, and work in the nearby mines had been unearthing arseniccontaining residue. The arsenic didn’t pose a health threat underground, but once exposed to oxygen it leached its dangerous inorganic form into the local groundwater.

In the 1990s a Thai university researcher had helped identify homes with contaminated wells, recording her data on a three-by-fourfoot map. That research helped connect arsenic exposures to various cancers and skin lesions—evidence that persuaded the Thai government to pipe in safe water to the community. The arsenic was never removed from the groundwater, however, and to this day the well water continues to contain unsafe levels of arsenic. Some people drink the water, and most use it for other purposes, such as bathing.

Today, individuals living in the same village, and even in the same household, may experience different types and severity of skin lesions.

No one knows what accounts for the differences, but researchers suspect that epigenetics could play a role. Thai scientists therefore reached out to epigenetics experts at Michigan in 2014 to see if they could help find answers.

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“We went house-to-house with this big map. It was a very old-school map,” recalls Helmick, who believes it was drawn by hand.

Each house with a contaminated well was marked with a red X and assigned a number, which Helmick later used to label the samples taken from residents of the houses.

She collected saliva to analyze an individual’s epigenetics and toenails to analyze chronic exposures to arsenic. “It was not the most glamorous assignment,” says Helmick.

Although she’s no longer involved with the study herself, the research in Thailand is ongoing. Additionally, Helmick’s work on the study fostered her interest in water sustainability. “I really saw how not having clean water can impact your life,” she says. She is now in her second year of a research fellowship at the Environmental Protection Agency, where she works with the NetZero program, which tests new technology designed to help communities and military bases reach net zero energy waste and water use.

Highway Pollutants

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s a graduate student, Sara Adar recruited senior citizens to ride a diesel-powered bus so she could monitor their bodies for physiological changes. What she discovered was startling: “We could see changes within five minutes,” says Adar, the John Searle Assistant Professor of Epidemiology at SPH, who researches the impact of road traffic on human health. The seniors’ nervous systems shifted to a stronger sympathetic (sometimes called “fight or flight”) response almost immediately, and they later exhibited greater inflammation in their lungs and blood.

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In an earlier project, Adar had worked with an EPA scientist to compare indoor pollutants of houses in the suburbs with houses in rural and urban areas. Specifically, they looked at indoor concentrations of polycyclic aromatic hydrocarbons, a group of chemicals released from the burning of organic substances such as gasoline. “We found that there was a clear pattern,” says Adar. Urban houses had the highest levels of pollutants, followed by suburban, and then rural.

More recently, Adar has been working to determine whether traffic jams and congestion are linked to adverse health outcomes.

In a forthcoming paper, she and her students show that, for people living next to a highway, there was an increased risk of dying from stroke on days with more nearby traffic congestion as compared to other days.

Air quality standards are important, according to Adar, because they have tangible effects on human health. Research has found, for example, that following initiation of the Clean Air Act in 1970, the drop in air pollution from 1980 to 2000 was associated with a seven-month increase in life expectancy. “It has been said that the Clean Air Act is one of the most costeffective regulations we have because it saves so many lives, prevents disease, and reduces health care costs. Estimates from the Office of Management and Budget have said the benefits of the Clean Air Act outweigh the costs by 30 to 1 and save up to $400 billion annually,” says Adar.

Adar also studies ways to reduce the health impacts of air pollution from vehicle exhaust and other sources. She’s currently collaborating on a study in Detroit to measure the effects of placing air purifiers in the home. So far, other studies suggest that air purifiers do reduce concentrations of pollutants in the home, but this reduction has not been conclusively linked to an actual improvement in residents’ health.

As an undergraduate, Adar studied environmental engineering. She credits a required toxicology class with stimulating her interest in public health. “The idea that things we couldn’t see, that we experienced in our regular lives—in the air, in the water, in our household products—could impact health just really struck a chord with me.”

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Predicting the temperature in a given spot is not straightforward.

Asphalt islands

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eat is the leading cause of weatherrelated deaths in the United States.

Exceptionally hot days bring increased mortality and hospital admissions. Urban areas are especially vulnerable to high heat because they contain a relatively large amount of “impervious surfaces,” such as roads, driveways, and parking lots. These surfaces are made with impenetrable materials that, instead of helping to cool the surrounding area, often create urban heat islands—regions that are significantly warmer than their surrounding rural areas.

As the climate changes, it’s important for public health practitioners and city planners to be able to predict which regions are most susceptible to high heat so that they can apply interventions: planting trees in affected areas, for example, or opening cooling centers for residents.

But predicting the temperature in a given spot is not straightforward. You’ve probably watched your local news and seen the meteorologist report that it’s, say, 85 degrees in Detroit.

But there is often a significant temperature range above and below what one sees on the Detroit weather map. “It’s going to be hotter if you’re standing on an asphalt parking lot vs. some place with trees,” says Marie O’Neill, associate professor of environmental health sciences and epidemiology at SPH. O’Neill’s former student Jalonne WhiteNewsome (PhD ’11) led a study to see whether satellite imagery might help researchers more accurately predict heat vulnerability. White’s

team monitored the temperatures at 19 homes across metro Detroit and then compared those temperatures with satellite images displaying impervious surface levels surrounding those homes. Higher ground temperatures were correlated with a higher precentage of impervious surfaces, suggesting that maps including these satellite images could help in identifying at-risk areas for public health interventions.

Despite the relevance of impervious surfaces, O’Neill cautions that other factors also contribute to temperature variability. For example, she and her research team have found that elderly people living in high-rise apartment buildings experienced indoor temperatures in the 90s, even when outside temperatures were in the 80s.

hidden costs

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ow will building a road affect a remote and isolated community over years, and even decades? That’s the question Joseph Eisenberg aims to answer through his research in Ecuador. His goal is to better understand the dynamics of how roads change communities, so that the costs and benefits of development can be more equitably distributed.

Since 2000, Eisenberg, professor and chair of the SPH Department of Epidemiology, has been conducting research near Ecuador’s northern coast. The region’s commercial center is located at the confluence of three rivers, in a town called Borbón. Prior to 1996, Borbón was populated by a tight-knit community of subsistence farmers. It was geographically isolated and could only be reached through a network

of rivers. In 1996, a road was built, connecting town to coast. Soon other roads appeared, opening up the region to the rest of the country.

Eisenberg’s research tracks a variety of outcome measures for communities along the road, including diarrheal disease, antibiotic resistance, dengue, and nutrition. He has found, for example, that increased movement of people by road has led to an increased risk of infection and disease, likely due to the introduction of novel strains of pathogens among the previously isolated population. He has also found that, although in theory the region’s increased accessibility should provide better access to health care, this hasn’t been the case. “They’re just now building a hospital in Borbón,” says Eisenberg, noting that residents have had to wait over 20 years.

In the meantime, the road system has made it possible for corporations to extract resources.

Deforestation and gold mining, in particular, have affected the region’s water flow and climate, both of which affect local water quality.

Social conflicts are increasing, too, as new immigrants move into a region already suffering from poverty and unemployment. Additionally, government subsidies for fuel in Ecuador have made fuel an attractive commodity to smuggle into Columbia. “We’ve seen movement of petroleum barrels that are going out of the delta and into Columbia,” says Eisenberg.

He and his team have also been looking at other measures, like social cohesion and social capital, and their impact on health. They’re finding that there’s less of both in the road communities vs. the remaining remote communities.

This is a potential problem for locals because positive social bonds serve as a protective factor against poor health.

“We’re not here to say that roads are bad,” says Eisenberg, acknowledging that Borbón’s roads have made transportation cheaper, and individuals have some opportunities for better pay. Instead, he hopes to identify the downsides of development so that such downsides can be proactively addressed in Ecuador and other developing regions. Right now, “a lot of the benefits of the road are being exported.” <

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The road system has made it possible for corporations to extract resources.

Deforestation, in particular, has affected the regionâ&#x20AC;&#x2122;s water flow and climate, both of which affect local water quality.

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False Starts, Plot Twists, Surprise Endings The sometimes unpredictable roads that can lead to public health.

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y the end of her nine-year career as a professional chef, Julia Wolfson had worked in three-star Michelin and top-rated Zagat restaurants. She could make foie gras torchons and shrimp-filled ravioli, sauté a dozen different fish dishes simultaneously, and butcher whole pigs, goats, and lambs. Scarcely prepara-

Julia Wolfson

SPH Faculty HMP & NS

by Leslie Stainton

public health grad school

Chef

tion for a career in health policy, Wolfson admits—although the School of Public Health assistant professor concedes her sausagemaking skills have probably contributed to her understanding of the policymaking process.

SPH is filled with people like Wolfson who set out on one career path but wound up on another.

Assistant Professor Marisa Eisenberg thinks it has to do with the interdisciplinary nature of the field. “It’s one of the things I love most about being at SPH—so many faculty and students who come from completely different areas.”

For Wolfson—who exchanged her chef’s toque for graduate degrees in public policy and public health, and now specializes in food policy, obesity, and diet-related disease prevention—the past and present are hopelessly, but fruitfully, linked. “When I look back,” she says, “the seeds were always there.

But I didn’t see them at the time.”

Interdisciplinary Inspiration

Marisa Eisenberg started out wanting to be an artist, turned to math and science in college “for fun,” and now models infectious

Wolfson still has dreams that she’s standing in front of nine burners inside a Manhattan restaurant with 12 pieces of fish to prepare.

False Starts

diseases at SPH. Like many of her colleagues in epidemiology, she loved math and made it a foundation of both her undergraduate and graduate studies. A postdoctoral fellowship in the National Science Foundation’s Mathematical Biosciences Institute followed. But a trip to Haiti in 2011 changed her path, and Eisenberg “switched over,” as she puts it, to public health.

Eisenberg had offered to help colleagues track the outbreak of cholera in Haiti. The experience opened her eyes. “I had been modeling math in several different contexts, but there had never been an opportunity where people were actually going to do something useful with it,” she remembers. “I came away thinking maybe public health and epidemiology is where I want to be.”

Fellow SPH epidemiologist Andrew Brouwer tells a similar story. For years he struggled to reconcile his love of pure math with his desire to effect positive social change. At one point, thinking he might want a career in biosolids management, he mucked manure in rural New York. But math retained its grip. The lightbulb moment came around 2011 when Brouwer discovered the University of Michigan’s program in interdisciplinary mathematics —one of the only programs of its kind in the country. Brouwer signed on for a PhD. Midway through his studies, he heard presentations by two SPH epidemiologists. Brouwer followed up with both and later joined them on studies of infectious-disease transmission. In November, he became a research investigator at SPH.

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At one point, thinking he might want a career in biosolids management, Brouwer mucked manure in rural New York.

Andrew Brouwer

SPH Research Investigator

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math

“I’ve found a place where my strengths can be applied for good,” he says.

For Jon Zelner, who joined the SPH faculty this year, the route was even more winding. His undergraduate degree in sociology led to volunteer work with an AIDS service organization, which led to a flirtation with law school, graduate training in social work, and eventually a PhD in sociology at U-M, where he got interested in complex systems and established ties with the SPH epidemiology department. Zelner wound up doing his dissertation on infectious-disease transmission.

But the path afterward was no less meandering. Postdoctoral fellowships he thought were a

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shoo-in went to other applicants, while fellowships at Princeton and Columbia—long shots—came through. Meanwhile, he and his wife had their first child, and Zelner applied for tenure-track faculty posts. “Not a rip-roaring success,” he notes wryly. But in January the stars aligned, and Zelner became an assistant professor of epidemiology with an appointment in the U-M Center for Social Epidemiology and Population Health, where he studies the social and environmental determinants of infection risk.

“Besides being just a little bullheaded and naïve,” he says of his serpentine career path, “I’ve been very, very lucky in terms of the mentors and collaborators

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Marisa Eisenberg

SPH Faculty Epidemiology

Haiti cholera research

math & science

art

Eisenberg had offered to help colleagues track the outbreak of cholera in Haiti.

The experience opened her eyes.

and friends I’ve had. They’ve made all the difference.”

Not everyone succeeds, of course. But that doesn’t mean you should give up. Brouwer has friends who thought themselves failures because they hadn’t found their “passion” as undergraduates. When you’re in college, he says, “you haven’t experienced enough. If you have that passion, great. But if not, it doesn’t mean you’re a failure.”

Jon Zelner

SPH Faculty Epidemiology

Forks in the Road

When it comes to passion, Geila Rajaee has never wavered. At 35, the first-year MPH student in health behavior and health education admits to feeling old compared to her peers in the classroom, but she’s also wise—the result of years of hands-on experience as a chaplain.

“I have earned my gray hair,” she laughs.

A graduate of Princeton’s Theological Seminary, Rajaee has worked in an inner-city level-one trauma center and at the Seattle Cancer Care Alliance (part of the Fred Hutchinson Cancer Research Center), where she counseled stem-cell transplant patients. She loved her work. “I can think of mornings where I would walk into a room, and someone would be openly distraught, and by end of our visit they were far more calm.”

But eventually she wanted new challenges. Last September, Rajaee embarked on an MPH as one of eight nationwide recipients of a Transforming Chaplaincy Fellowship from the John Templeton Foundation. Rajaee hopes her SPH training will help her find “a way to better incorporate

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sociology chaplaincy care into health care.”

As the daughter of a Christian mother and Muslim father, Rajaee is all about being cross-disciplinary.

She believes chaplaincy—which she defines as “working within individuals’ existential structures, whether it’s inside or outside of organized religion”—can benefit health care in a range of ways, including financial.

The cross-fertilization of disciplines also drew Elizabeth King to public health. An assistant professor of health behavior and health education at SPH, King

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majored in psychology and Slavic languages and literature during college. Wanting to help address domestic violence and child abuse, she planned to get a PhD in psychology, coupled with a law degree, so she could advocate for a stronger “system.” “But what system?” she kept asking herself.

Meanwhile, an undergraduate fellowship with a community organization introduced King to the concept of prevention, which in turn “opened my eyes toward thinking about public health.” Her thinking deepened during several years in Russia, where King volunteered in a homeless shelter and worked on domestic violence issues while honing her knowledge of the country’s language and culture.

She came back to the US, got MPH and PhD degrees in public health, and now works on HIV prevention and treatment and gender-based violence, with a focus on Russia.

Not only is public health interdisciplinary, King says, but “the field itself keeps changing, which can shape careers. The more

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psychology & slavic studies in-depth you go, the more you understand the complexity and layers of public health issues—not only the problems, but responses that are needed.” The field is so dynamic, she believes—it can easily nudge a person from one area of specialization into another.

Revelations

Rudy Richardson, the Dow Professor of Toxicology at SPH, says he can’t imagine many people answering the question “What do you want to be when you grow up?” with “public health worker.”

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SPH Dean Martin Philbert, a toxicologist, once studied music at the Royal Academy of Music in London.

Richardson was headed toward a PhD in chemistry when a faculty member at Harvard’s School of Public Health spotted his name on a list of chemistry undergraduate majors and invited Richardson to apply to Harvard’s toxicology program. For a variety of reasons, Richardson instead decided to pursue a chemistry PhD at SUNY Stonybrook. But midway through his program, he pulled Harvard’s letter out of his files and phoned the school to see if its offer still stood. It did, and Richardson’s public health career was born. He suspects his story “is far from unique.”

SPH Dean Martin Philbert, a toxicologist, once studied music at the Royal Academy of Music in London.

Thinking he wanted to pursue a career in psychology, Marc Zimmerman did a stint as a fellow for a congressional agency before

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Today, nearly two decades after quitting college, Metz is about to complete her first year of graduate school.

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realizing “my training and world view fit in public health.”

Mike Boehnke loved math but knew early on that a career in pure mathematics “was not for me.”

He toyed with going to law school, was active in Oregon state politics, volunteered in an ecology lab, and spent a semester in Germany on a Fulbright before a colleague suggested he go for a doctorate in mathematical biology.

“I haven’t had a class in biology since the seventh grade,” Boehnke said.

“Who cares?” his colleague countered. Thirty-five years later, Boehnke, the Richard G. Cornell Distinguished University Professor of Biostatistics at SPH, is piloting groundbreaking research in the genetic underpinnings of complex diseases.

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As an undergraduate, Aisha Langford flirted with medical school but so hated her huge biology and chemistry classes that she majored in English instead. After graduation, she worked at a PR agency in Manhattan and an adult-literacy organization in California, but still hankered to do something related to health. Out of the blue, a friend from church suggested she consider public health.

“What’s public health?” Langford asked.

Today Langford holds an MPH from Saint Louis University and a PhD (’13) from Michigan and is an

assistant professor of population health at the New York University School of Medicine. Her research explores how health communications affect medical decision-making. In her spare time, she does freelance writing for publications like iPhone Life magazine and Inside Higher Ed. In some ways, Langford says, she’s gone “back to where I started.” The undergrad who dreamt of medical school is now working in one. Her advice to undergraduates who are worried about their futures? “I would just say, relax, it’s going to be OK.” It’s a lesson Liza Metz learned years ago. The first-year student in nutritional sciences at SPH quit college after her freshman year, because she wasn’t ready.

She came home to Ann Arbor and worked at the Campus Inn, where she waited on luminaries like Gerald Ford and Madeleine Albright.

“I thought this was it,” she says.

But after five years on the job, she saw that low- to mediumskilled service jobs were not for her, and she enrolled in Wayne State University as a history major.

“This time, college worked,” she says, “at least to get me over the finish line.” After graduation, Metz continued to work in food service, slowly realizingthat’s where she belonged—in the food business, but as a registered dietitian. Today, nearly two decades after quitting college, she’s about to complete her first year of graduate school.

“It feels more and more the right choice,” she says.

Looking back, Metz wishes she’d taken things more seriously

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earlier in her career. “But I also know that it’s not a straight line for anybody. Even people who are very successful have stumbled along the way—a direct trajectory is sort of a Hollywood notion.”

Few know this better than fellow SPHer Julia Wolfson, who also went from a career in the food industry to one in public health. For Wolfson, as for countless others, the old life fuels the new—even if the old life never fully goes away.

Wolfson still has dreams that she’s standing in front of nine burners inside a Manhattan restaurant with 12 pieces of fish to prepare. And when that happens, she says, she’s got a sure-fire antidote. “I make a big multi-course dinner.” <

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Count on Failure Mike Boehnke

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Pick Up the Phone Even a world-renowned researcher like Mike Boehnke, the Richard G. Cornell Distinguished University Professor of Biostatistics, knows how it feels. Scary, he says.

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As part of a global research team, Boehnke spent a decade laboring, without significant results, to identify the genetic variants that contribute to type 2 diabetes. “In terms of our primary objective,” he says, “we failed for ten years.”

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In the first five-year phase of their study, he and his colleagues typed genetic markers across the genome on 800 families. They found “exactly nothing.”

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“When students ask how they can get to do what I do, I smile and say they have to make sure they answer the phone on Sundays.”

How did they persevere? “We kept going because the people who were working on this liked each other and had fun together,” Boehnke remembers. During once-ayear gatherings, usually at his home, members of the team would eat, talk science, play the guitar, and sing.

But above all, he says, his colleagues were smart, and they liked and respected one another. “If anybody was going to solve that problem, we were going to do it, or at least be among those who did.”

To those in a similar situation today, Boehnke has this advice: “Do what you love. Do what you think is important. Know that success almost always requires failure.” Most of all, “try hard to be lucky. Weight the dice so there’s a good chance they’ll come up in your favor.” That means surround yourself with good colleagues—and keep working. <

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At his first board meeting, the mayor’s liaison took Citrin aside and informed him that, according to the city charter, because he’d been appointed to serve out the term of a recently deceased senior member, Citrin was now president of the board.

At the time, Citrin recalls, the health board was so powerful it ran two Detroit hospitals. Shortly after Citrin became board president, one of those two, a hospital specializing in tuberculosis, made headlines when the media reported on alleged drug and prostitution rings operating inside the facility.

Citrin found himself in a media storm.

But he fell in love with public health.

Early in his tenure, he launched an initiative for board members to accompany public health nurses on their daily rounds. The experience showed Citrin the complexity of the determinants of health, and he was hooked. Soon he was asked to join other boards and task forces and to chair a commission charged with writing Michigan’s first public health code. A faculty appointment at SPH followed in 1980.

The project leaders all had tenure, which meant job security. They held onto funding, which meant they could support their teams. They had other research to buoy them.

And they were lucky. “That didn’t mean I didn’t wake up at 3 a.m. in a cold sweat, wondering what we were going to do next,” Boehnke recalls.

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The next thing he knew, Gribbs had put the city’s health commissioner, George Pickett, on the line. It’ll only take three to four hours every month, Pickett assured Citrin. You’ll have to attend a monthly meeting and read background material, but that’s all.

OK, Citrin said.

They spent several more years sharing findings with researchers around the world who were doing similar work.

Again, Boehnke says, they found “absolutely nothing.”

It wasn’t until technology caught up with them—chiefly in the form of the Human Genome and HapMap Projects, which together shed light on the common patterns of human genetic law & politics variation—that Boehnke and his colleagues tasted success. In 2007, they identified nine different places on the math human genome associated with a risk for type 2 diabetes. Time magazine hailed it as one of the top ten medical breakthroughs of the year.

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In 1970 lawyer Toby Citrin was contentedly working in a family business when his phone rang one Sunday afternoon.

It was Roman Gribbs, Detroit’s newly elected mayor, and he was calling, at the recommendation of a mutual friend, to see if Citrin would serve on the Detroit Board of Health.

“I don’t really know anything about public health,” Citrin said.

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“When students occasionally ask how they can get to do what I do,” he says today, after 46 years in the field, “I smile and say they have to make sure they answer the phone on Sundays.” <

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Ebbin Dotson, Gyasi Chisley, and Christopher Clarke, program director for the Collaborative.

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or someone as successful as Gyasi Chisley (MHSA, MBA ‘00), you might think he would spend all his time looking forward, down the road to what’s next.

At only 40 years of age, Chisley already has two decades of managing hospital operations under his belt. He was the youngest CEO to date at Methodist Healthcare North in Memphis (within the Methodist LeBonheur Healthcare System) and has just begun a new position in Minnetonka, Minnesota, with UnitedHealthcare as senior vice president of Clinical Integration, Care Transformation, and Strategic Initiatives, where he will lead the development of innovative health programs and services. Before his time in Memphis, Chisley served as president and site administrator for Mercy Health Anderson Hospital in Cincinnati, which was named a Truven top 100 hospital twice during his tenure.

Chisley is deeply committed to transitioning health care from volume to value, and he pushes a platform that includes growing outpatient practices, improving physicianpayer relations, and creating viable patientcentered environments.

Turning Back Despite all the planning and forward thinking that goes into executive leadership, Chisley believes that true success in public health depends on leaders always turning back—looking back in gratitude and going back in service to the communities that helped them succeed.

Chisley credits the SPH faculty not only for forming his academic skills but for encouraging and pushing him to develop his leadership abilities.

“Getting across the stage of the University of Michigan is not the product of me, it’s the product of the people around us and the communities that formed us,” says Chisley. When strictly applied, academic curricula, in Chisley’s view, can be rigid and fail to foster innovation.

What he experienced at SPH was different. He saw faculty blurring the lines between class-

room and world and encouraging students to draw on the knowledge, wisdom, and energy of their home communities.

Chisley has modeled much of his approach to hospital management on SPH’s community approach. So when he began looking for a specific way to give back, SPH’s new Health Equity Leadership Pipeline Collaborative (aka, the Collaborative) became the perfect choice.

Launched in January 2017, the Collaborative fosters innovative research to address health disparities and nurtures students as they grow into tomorrow’s health care leaders.

Changing the Face of Leadership The Collaborative developed out of the University’s Summer Enrichment Program (UMSEP), an internship program that educates student leaders committed to eliminating racial, ethnic, and socioeconomic health inequalities. For the past 30 years, the UMSEP has brought dozens of undergraduate students from across the country to the Ann Arbor campus to research equity in health care and to collaborate on solutions.

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We want to bring together collaborators passionate about health equity.

Ebbin Dotson (MHSA ’01, UMSEP ’98), assistant professor of health management and policy and director of the Collaborative, says that the UMSEP will remain deeply connected with the Collaborative, which provides a formal relationship between UMSEP operations and innovative research on community public health.

“The Collaborative,” says Dotson, “is the next ideal step in the evolution of SPH’s commitment to changing the face of health care leadership.”

When Dotson and Chisley discussed what the Collaborative needed now to succeed, how it could realize its goal of providing both intellectual and physical spaces for addressing health equity concerns, Chisley was most interested in the Collaborative’s ability to connect students with external leaders in the field. In February, Chisley gave a gift that helped create the Collaborative’s new Innovation Hub, a physical venue in SPH for, as Chisley says, “mobilizing and galvanizing the creative spirit of students from diverse backgrounds on the road to innovation.”

Looking back on his own student years at U-M, Chisley credits the SPH faculty not only for forming his academic skills but for encouraging and pushing him to develop his leadership abilities. In discovering his capacity to lead and to inspire others, he gained the confidence to step out as a community leader and eventually as an entrepreneur.

Chisley believes that true success in public health depends on leaders always turning back.

Gyasi Chisley judging student presentations during the 2017 SPH Innovation in Action competition.

A Place to Innovate Chisley wants the Hub to be a place where student leaders dream about and then realize ways back into their communities of origin, to serve them and to continue learning from them.

Just a few months ago, the Innovation Hub was an unremarkable room on the third floor of SPH II. Now it looks like a hip work space full of new computers and printers, open desk and table surfaces, lots of light, a fresh interior design, and a large white board already full of ideas.

The Innovation Hub is a space for SPH students, staff, and outside partners to foster the creative work and entrepreneurial spirit that Chisley embodies.

Chisley remains hopeful for the future of public health, “a field that impacts our mental, physical, spiritual, and economic wholeness.”

Community health care at its best can be a great equalizer across disparate populations.

Chisley plans to continue his push for health care systems that measure, as he says, “not only the transactional but also the transformational.”

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A Direct Relationship

Chisley is confident that SPH, with its reputation as a magnet for innovative and interdisciplinary excellence, will have a decisive voice in the chorus calling for and enacting health care equity. As some communities brace for actual regression in health care quality, Chisley tells students that wherever they are on their path to becoming public health professionals, they can make a difference now.

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Several upcoming projects—including the Authentic Leadership Project, which partners with the National Association of Health Services Executives—will examine diversity gaps within business management and other organizational leadership.

As Dotson points out, recent studies show a relationship between increasing racial and

Successfully introducing transformational approaches to health equity depends on the kinds of research and initiatives the Collaborative can produce.

Faculty and students at the Collaborative have already designed and rolled out the Leadership Pipeline Project, a study to evaluate the impact of diverse leaders in executive positions within health care organizations.

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ethnic diversity in providers, administrators, and degree programs and achieving health equity. He hopes this will mean more direct funding streams for health equity research and greater workforce diversity efforts in health care, both in academia and in the private sector.

As SPH welcomes its first cohort of undergraduate public health majors this fall, Dotson wants to keep the research model simple. “We want to bring together collaborators passionate about health equity. We are excited to be a resource for undergraduates interested in public health and especially happy to welcome undergraduates this fall to learn about health equity related research.”

They might need a second Innovation Hub. <

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Richard Jelinek and John Griffith in New York City at Jelinek’s 80th birthday celebration.

New Momentum for the Griffith Leadership Center

Simply Connecting John Griffith influenced my family, my career, and the world I live in,” says Richard Jelinek (BSIE ’61, MBA ‘62, PhD ‘64), whose recent gift to the Griffith Leadership Center (GLC) was motivated in large part by his affinity for his mentor and friend.

“My passion for John is rooted in what he’s done for me and what he stands for. In addition to being our teacher, he became a mentor to dozens of us in the field and maintained contact with us throughout our careers, never losing interest and always available to discuss aspirations or concerns.

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s you might expect from a mentee of John Griffith, Jelinek’s support for the GLC and SPH stems from his broader vision for the field. “Health policy and management,” says Jelinek, “is becoming more important with time. Populations are growing, our medical needs becoming more complex. Public health takes into account every human system imaginable, from lifestyle and safety to water and food systems to energy, housing, and transportation.

And you need great leaders to address those systems competently and successfully.”

Griffith was the leading voice of SPH’s Master of Health Services Administration program for decades. The GLC embodies Griffith’s legacy by connecting research, teaching, and practice in a variety of innovative ways. The story of Jelinek’s gift to the Center is itself a tale of connections that begins, naturally, with Griffith and continues with Gail Warden, the Jelinek family, and many others.

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John Griffith

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Heading in the Same Direction

John Griffith’s passion for hospital operations began in his youth, watching his father run the Delaware Hospital, the largest hospital in the state at the time. His father would tell him that good management was just as vital to effective medical care as were the skills and dedication of the medical staff. “I hold thousands of people’s lives in my hands every day,” he would tell his son.

Griffith studied industrial engineering at Johns Hopkins in the early 1950s, focusing specifically on organization management.

Griffith completed a health care-oriented MBA program at the University of Chicago in 1957, then began work in administration at Strong Memorial Hospital, the teaching hospital for the University of Rochester in upstate New York. In 1960 he moved to Michigan and began teaching at U-M’s Business School, focusing on research and teaching about running acute care hospitals.

In 1958, Richard Jelinek was beginning a bachelor’s degree in industrial engineering at U-M. In his second year of the program, he took a class with Clyde Johnson in the College of Engineering on connecting industrial engineering with hospital systems management.

While still a student, the university hospital hired him as an industrial engineer to assist with numerous staffing projects, further developing his interest in health management.

Griffith continued his study of hospital management, aided by research grants from the Kellogg Foundation to explore new methods of organizing acute care, including the emerging “intensive care units.” He helped Jelinek win faculty appointments in the U-M Schools of Business and Engineering and later assisted in moving Health Management and Policy (HMP) from the School of Business to SPH in 1967.

As Jelinek was beginning his teaching career at U-M, he saw the growing links between engineering systems and health management practices. Jelinek’s dissertation, which developed methods of monitoring patient outcomes of nursing care in hospitals, was a landmark quantitative study on nursing unit management. He landed research grants to apply his systems engineering work in increasingly detailed ways to health care systems.

Warden’s first job out of the Army was directing a unit-manager system at Presbyterian-St. Luke’s Hospital in Chicago.

The severe nursing shortage at the time had him thinking creatively about how to reorganize his staff to maximize resources and maintain quality of care. After just one year at Presbyterian-St. Luke’s, Warden was selected as vice president of administration and administrator of the hospital.

Gail Warden As a first-year student at Dartmouth in 1956, Gail Warden spent his evenings as an orderly in the student infirmary, which was attached to Mary Hitchcock Hospital. He eventually connected with Walter McNerney, founding director of U-M’s Program in Hospital Administration, and later President of the Blue Cross-Blue Shield Association and a major contributor to Medicare program design.

McNerney encouraged Warden to come to Michigan for graduate school. Warden’s very first course as a graduate student was taught

by Griffith, who was teaching his very first class as a U-M professor.

An ROTC participant at Dartmouth, Warden was assigned to the Medical Service Corps after graduate school. While awaiting the call to active duty, he worked at Blodgett Memorial Medical Center in Grand Rapids, first as a research fellow and then as its first director of medical education. He oversaw graduate medical programs and recruited new residents.

Two years later, Warden’s official service in the Army began, first with eight weeks of medical service school, then as an executive administrator at Fort Belvoir Hospital in Virginia.

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Three generations at HMP: Richard, son Rick, and grandson Kristoffer.

Jelinek finished his undergraduate work, began an MBA at U-M, and started hanging out with students and faculty in the Business School’s hospital management program (now SPH’s Master of Health Services Administration program) and volunteering around the office. He befriended John Griffith, who quickly recognized Jelinek’s academic abilities and became his mentor and champion. When Jelinek received an unexpected call offering him a W.K. Kellogg Foundation doctoral fellowship in U-M’s College of Engineering, he knew Griffith had something to do with it. Jelinek accepted the fellowship and as part of his doctoral work took classes in the hospital management program, including those taught by Griffith.

Warden, Jelinek, and other future industry leaders were frequent classmates in their management courses and developed close ties with one another. They were becoming deeply interested in the same thing—advancing the quality of medical systems management in the US.

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John Griffith’s passion for hospital operations began in his youth, watching his father run the Delaware Hospital, the largest hospital in the state at the time.

Groups of Leaders Griffith believes that organization problems are best solved by groups—that individuals, however talented, can accomplish only so much alone. For that reason, he always encouraged his students to stay connected to one another and to other leaders in the field. This lesson stayed with Warden and Jelinek and would shape their careers in profound ways.

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Jelinek speaking at Griffith’s last lecture in 2010.

Jelinek says he needed colleagues like Griffith and Warden and many others just as much as they needed his innovative systems.

In 1968 Jelinek secured tenured teaching positions in the Health Management Department and the College of Engineering. Jelinek’s academic work had established the complete dynamics of what nurses do over the course of a shift, how they operate within a unit, and how each unit affects other units in the system. His methods allowed hospitals to determine much more precisely how many nurses they would need in each unit during each shift. These methods became the foundation for models still in use today.

Jelinek and Karl Bartscht, a colleague in the industrial engineering department, began offering formal summer courses for hospital administrators on the application of computers in hospital management. Academics were publishing more and more about the use of computers in health management, but the research was not gaining a foothold in practice. Griffith and Warden were aware of the many innovative models Jelinek and other academicians had developed and encouraged Jelinek to share these with hospital administrators and help them put them into practice.

In the late 1960s, Jelinek began contemplating the business side of his teaching and research. In 1969 he and Ron Gue, a peer in the field teaching at Southern Methodist University, cofounded the Medicus Systems Corporation, which provided integrated software for financial administrators and health care managers. Their products enabled clients to process clinical, operational, and financial data to better manage organizational performance and to optimize resources.

When Jelinek pitched Medicus to Presbyterian-St. Luke’s, Warden had no hesitations about Jelinek’s ability to transform the hospital’s systems. Knowing Jelinek’s academic work, Warden was also confident that Jelinek’s company would evolve its products over time as the field changed, making this long-term investment decision even easier. PresbyterianSt. Luke’s became Medicus’s first customer for its management services program.

Warden was not the only former classmate Jelinek contacted. Jelinek solicited feedback from dozens of other health care managers around the country, many of whom he had met at Michigan. He was building a professional network of industry leaders—a human sounding board to help ensure that the management systems his company was engineering would actually work in the field.

“Good Old Industrial Engineering” Griffith, Jelinek, and Warden were true pioneers. Of the thousands of large hospitals in the nation, in the 1960s only a handful were attempting major changes to their management systems. But these three and a few others were boldly committed to radical change. They knew that managing workloads and personnel systems properly would create significant system-wide efficiencies while maintaining or even improving quality of care.

Their boldness was rewarded not only with happy customers but with institutional survival stories and fulfilled missions. At PresbyterianSt. Luke’s, “Jelinek’s good old industrial engineering,” as Warden says, transformed an organization and “made it financially viable and more competitive almost overnight.” Financial viability in turn allowed Presbyterian-St. Luke’s,

a large teaching hospital, to rededicate itself to its educational goals.

The analytic models and early computer programs provided by Medicus Systems Corporation and others were a valuable advance in acute care management. They helped hospitals make the transition to regulated payment systems while expanding clinical capabilities with intensive care units and advancing technology. The cost savings allowed teaching hospitals to preserve and expand their educational programs, allocate more resources for research projects, and take on more residents, interns, and fellows. “Looking back,” Griffith says, “these changes seem obvious and rudimentary. At the time, they brought new solutions to real problems. Many of today’s tools can be traced back to those models.”

Connect the Dots and Make Sure They Can Talk Jelinek says he needed colleagues like Griffith and Warden and many others just as much as they needed his innovative systems. Jelinek’s research always accounted for the detailed work of content managers, letting their interactions inform the system’s architecture. “If the dots can’t talk to each other,” says Jelinek, “what’s the point of connecting them?”

Jelinek attributes much of his success to his understanding of the human side of health care.

In the early 1980s, Jelinek took Mediflex—a spinoff of Medicus—public and has since taken several other companies public, including the original Medicus Systems Corporation. Jelinek attributes much of his success to his understanding of the human side of health care.

He understood that problems he can solve on paper and in theory have to work for actual people. Connecting the dots in a large system is one thing. But when the dots are people discussing highly detailed and often life-saving patient information, content is critical.

Beyond Richard and Gail’s ongoing work, the Jelinek and Warden families remain deeply engaged in health management. Richard’s

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son Rick Jelinek and Gail’s son Jay Warden are accomplished hospital executives. Richard’s grandson (Rick’s nephew) Kristoffer is currently a graduate student in HMP.

A “Simple” Formula Good public health requires highly functioning relationships within systems and between people. This is why HMP sought out top students, stayed interested in their careers, and remained committed to the same curricular principles for decades—to produce great leaders who could change the world. “It’s a simple formula,” Griffith says with a grin, “There is not a lot of complexity in my life.”

“The Center was designed to formalize many of the things these three men, especially John Griffith, did informally for years at Michigan.”

Simple or not, that formula anticipated one of public health’s deepest needs today— collaborative leaders who prioritize the effective delivery of care over their own interests.

The fluid and amorphous nature of public health demands the kinds of leaders SPH produces across all of its departments.

Griffith still offers advice and serves students and peers wherever he can. And he encourages them to help each other. “John’s legacy,” says Jelinek, “is making health management and policy professionals as good and as connected as they could be so that public health services in this country were as good as they could be.”

Asked about his accomplishments, Griffith steers the conversation back to his students, “Richard’s and Gail’s successes and interests drove me. Richard was an excellent engineer, very solid technically—so the innovative systems he was creating naturally possessed a certain pragmatism and were viable right away in the real world. Gail’s ability to work with various sectors and manage complex relationships is unparalleled.”

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Formalizing the Griffith Legacy The Griffith Leadership Center was launched in 2006 to institutionalize Griffith’s legacy— to develop leaders who will transform health care by strengthening the connections among research, teaching, and practice.

Warden served as founding chair of the GLC advisory board. “The Center was designed to formalize many of the things these three men, especially John Griffith, did informally for years at Michigan,” says Cathy Killaly, director of the GLC. The GLC’s initiatives bring students, faculty, and practitioners together in creative ways. HMP faculty can apply for funding to spend time immersed in the field, shadowing and learning from practitioners. They discover new practice-based teaching ideas and identify research projects of mutual interest with colleagues in the field.

At the GLC’s biennial symposium, over 300 alumni, faculty, and students come together from across the country to learn from each other and forge strong connections. The partnerships formed at the symposium last well beyond the event. Through the GLC’s online alumni forums, faculty are paired with alumni practitioners to address pressing public health issues, such as the opioid crisis and large scale policy changes to affordable health care.

Through the GLC’s Leadership Fellows Program, students interact formally with top practitioners through guest lectures, workshops, and individual encounters, learning about the careers, ideas, and mistakes of leaders in the field. “Student access to these highly successful people,” says Killaly, “is part of the Michigan difference, and making the most of the incredible HMP alumni network takes it to another level.”

A Lifelong Attachment to Graduates “The GLC’s core idea,” says Griffith, “is rare in academia—the assumption that we will maintain a lifelong attachment to our graduates and will actively help you in your public health career well after commencement.” Griffith sees robust alumni networks as one of the most important parts of today’s SPH curriculum.

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Jelinek’s recent gift ensures this commitment to connecting great leaders will continue well into the future. “Dr. Jelinek’s gift establishes a sense of permanence for the Center,” says Killaly. “We can now move forward with achieving our goals for expanding the Center as the world of health care management and policy presents new challenges and opportunities.”

The Jelinek gift of $2 million is part of a larger $5 million campaign to endow the Griffith Leadership Center. Jelinek hopes his gift will inspire others to support the endowment campaign and to ensure that Griffith’s legacy lives on.

A Margin of Excellence “The GLC’s ability to bridge the gap between academia and practice helps Michigan remain the place to get the most relevant education for today’s public health challenges,” says Wayne Lerner, chair of the GLC advisory board and recently retired hospital executive. “SPH students learn from faculty who are top scholars and who have experience in the operational outcomes related to their research.”

The GLC board—a collaborative team of national leaders—meets several times a year, Lerner explains, and always takes time to meet with departmental leadership and faculty to reinforce the academia-practice relationship.

“Philanthropy gives you a margin of excellence to execute ideas others can only dream of,” says Lerner, “dreams brought alive by gifts like that of Richard Jelinek.”

Lerner and Killaly are working on a long list of new ideas for continuing Griffith’s singular focus on fostering engagement between students, faculty, practitioners, and—ultimately—patients.

“We are all connected to the human health care networks Griffith, Warden, Jelinek, McNerney, and many others have assembled,” says SPH Dean Martin Philbert. “John Griffith’s students and their mentees form the core of today’s health care leaders at all levels. The GLC’s work serves this community and continues to identify and nurture new talent. We are grateful that John’s remarkable legacy has inspired Dr. Jelinek’s passion and generosity and hope that it will inspire others as well.” <

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The Unexpected Politician Honoring a family member’s legacy leads to a surprising change in plans for recent SPH graduate Abdullah Hammoud McKenna kept referring to “this thing” called epidemiology and how important it was to the field of medicine. At first, Hammoud had no idea what McKenna was talking about, but he was intrigued. After doing some research, he began to understand the essential role of epidemiology in disease prevention and decided to apply to SPH. His knowledge of the field expanded rapidly, and he earned his MPH in 2012.

“We are dealing now, to some extent, with a population that is not going to just take what we say as the Bible.”

Abdullah Hammoud takes the oath of office in January 2017.

Though he began working in the health care field after graduating, Hammoud still had pediatric oncology in his sights and was considering his next steps. He had even applied to some medical schools and MBA programs when tragedy struck his family. In October of 2015, Hammoud’s older brother passed away.

Hammoud says that this event caused him to “reevaluate the purpose of life.” As he processed what had happened, he reflected on how his

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bdullah Hammoud, a graduate from the epidemiology department, was elected as Michigan State Representative for the 15th District in the 2016 elections.

He is the first Arab American to hold this seat.

Hammoud had not spent years planning to run for office. Nor had he planned on attending SPH. Like many of us, Abdullah had dreams that shifted over time in response to the people and events around him.

Hammoud’s parents moved to the US and settled in Dearborn, Michigan, one of the largest predominantly Arab American cities in the country. Dearborn “gave my family everything,” he says, from financial opportunity to education.

His father provided for their family as a truck driver, and his mother, who had left high school to start a family, returned to her education and became a small business owner. Hammoud, meanwhile, was certain he wanted to become a doctor, specifically a pediatric oncologist.

With this goal in mind, he attended local public schools and went on to graduate from U-M Dearborn with a bachelor’s degree in biology.

In one of his undergraduate classes, taught by professor Brian McKenna, Hammoud first learned about public health.

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brother had always been his greatest advocate, never wavering in his support. What better way to honor him, then, than becoming an advocate for his own community? It was this insight that first inspired Abdullah to pursue public office.

On the campaign trail, he enjoyed the process of learning from his constituents about what was important to them and building his platform around their needs and aspirations.

But leading his own campaign had challenges. The sheer volume of work to be done was overwhelming at times. Hammoud, who likes to do things himself, had to realize that he needed help. He says the most important thing was building a team of people he trusted to be productive, efficient, and blunt with him when needed. “In the political sphere,” he says, “you don’t need to be the smartest person in the room. Instead, surround yourself with people that are smarter than you and use their guidance. These relationships are what will help you get things done in the end.”

Get things done they did! But now that he and his team have achieved their election goals, the work is just beginning. Hammoud is passionate about mental health issues, the environment, and supporting the Dearborn community so that it remains a “small business haven” where the middle class can thrive. Given the current political climate, much of his focus is also shifting to civil rights.

Hammoud expects his plans in office to evolve continuously based on the needs of his community and the situation in Washington.

Facing an unknown future, he is concentrating on living in the present, delivering on his messages to his constituents, and “being the best I can be every day.”

When asked what advice he might give to current SPH students as he reflects on the winding path that brought him to public service, he offers one of his favorite quotes: “If you want to change the world, read books by people with whom you do not agree.” Adhering to this principle, Hammoud says, will test the strength of your own convictions and better prepare you to argue for them. The wisdom in these words of advice is especially potent during times of division and uncertainty. Perseverance like Hammoud’s can offer hope that people and communities will unite behind values of inclusion and equality. < —Sydney Egan U N I V E R S I T Y

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The National Association of County and City Health Officials has awarded its annual Mo Mullet Lifetime of Service Award to Joan Ellison, RN, MPH ’73. Ellison’s career in local public health spanned 43 years, including 34 as public health director of the Livingston County (NY) Department of Health.  Marianne Karth, MPH ’79, lost her two youngest daughters, AnnaLeah (17) and Mary (13), in a truck underride crash in May 2013. Since then she has worked hard to raise awareness of this deadly public health problem and to promote needed change. She has drafted comprehensive truck underride protection legislation and is seeking a sponsor to introduce it to Congress.  Garry Lindsay, MPH ’77, is retiring in June from Federal Occupational Health, a component of the Program Support Center within the US Department of Health and Human Services. He previously retired from Mobil Oil Corporation (now ExxonMobil) where he led worksite health promotion with Global Medical Services from 1990 to 2000.  In December, Richard Murdock, MHSA ’76, retired from his post as executive director of the Michigan Association of Health Plans.

1980s

In November, New Orleans Mayor Mitch Landrieu named Marsha Broussard, MPH ’83, the city’s new director of health. Broussard was previously director of the school and adolescent health portfolio of the Louisiana Public Health Institute.  Formerly the global expertise director at Dow Chemical, Cherry Burke, PhD ’83, MPH ’78, is now the chemical industry practice leader at FACTOR, Inc., which provides solutions to risk-management problems in the transportation, energy, chemical, insurance, and public sectors.  Tony Denton, MHSA ’81, has joined the board of directors of Center for Healthcare Research and Transformation, a nonprofit organization housed at U-M. Denton is senior vice president and COO of Michigan Medicine.  Polly Paulson, MPH ’84, has been promoted to assistant director, Community Health and Wellness, Student Health and Counseling

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Services at University of California–Davis, overseeing health promotion initiatives for over 35,000 students. Polly enjoys leading her team of five MPH-trained staff and credits her outstanding education at SPH with the foundation for fulfilling her career goals. Polly and her husband, Walter, are now bicoastal empty nesters with two adult daughters— Tessa, a recent UC–San Diego graduate joining Americorps, and Emma, an NIH policy coordinator living and working in Maryland.

1990s

Robert Casalou, MHSA ’90, joined the board of directors of the Center for Healthcare Research & Transformation, a nonprofit organization housed at U-M. Casalou is president and CEO of St. Joseph Mercy Health System, Ann Arbor.  In January, Leigh Neumayer, MS ’93, became interim senior vice president for health sciences at the University of Arizona. Neumayer is the Margaret E. and Fenton L. Maynard Endowed Chair in Breast Cancer Research and the first woman to chair the UA College of Medicine Tucson’s department of surgery.

2000s

Lisa VanRaemdonck, MPH, MSW ’07, recently joined the University of Colorado Denver as Executive Director of the School of Public Affairs Institute. Her work is dedicated to supporting the intersection of the school and public service professionals through strategic partnerships, leadership development and training, peer networking, and capacity building.

2010s

Isabella Weber, MPH ’11, works for Planned Parenthood of Delaware where she coordinates and facilitates a sexuality education and healthy relationship program for individuals with developmental disabilities, their families, and the professionals who care

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A Diverse Toolbox Anica Madeo takes her broad experiences and public health training to the School of Pharmacy

with the MPH program in the health behavior and health education department of SPH. Many of Madeo’s peers had their sights set on a specific public health niche they wanted to pursue. Madeo did not. Though occasionally this discrepancy was a point of insecurity, she began to realize that her diverse interests and experiences had in fact given her a broad set of skills that she could apply in a variety of public health settings. When she earned her degrees in 2007, she did just that. Madeo took a job at a nonprofit where her responsibilities ranged from grant writing to program evaluation to training community health workers. The work required her to travel often, which eventually motivated her to seek a more stationary position so she could grow her family.

Soon, her professional life was able to fit her personal one when a half-time position at U-M’s College of Pharmacy became available.

At first, Madeo says, her impression of pharmacy was dominated by the negative connotations of “Big Pharma,” which made her feel like she was “selling out” and turning her back on her public health roots. But it did not take long for her to change her initial perception, which she now calls “shallow and inaccurate.” She

quickly realized how vital the roles of pharmacy and medications are in the health of populations and has found the College of Pharmacy to be “a great place with a lot of support for educational innovation.”

This openness to innovation allowed her to use her public health background to enrich the curriculum there. First, Madeo was able

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rom West Virginia to Central America and finally to Ann Arbor, Anica Madeo never expected a career in higher education, let alone joining the staff at the U-M College of Pharmacy. Looking back, she sees that each step along the way gave her the tools she now uses every day in her current position.

Madeo graduated from West Virginia University majoring in speech pathology and audiology, after which she spent five years “finding herself,” working odd jobs and traveling throughout the US and Central America. She worked with nongovernmental aid organizations in efforts such as teaching pregnant teens in a rural fishing village of Nicaragua and supporting the Nicaraguan Health Administration.

In hindsight, she says, this is where she first became interested in what she later recognized as the field of public health.

When she returned to the US, Madeo’s rationale for choosing Ann Arbor was that if she lived in a university town long enough, she would eventually go back to school. After spending some time waitressing downtown and working at the U-M International Center, her prediction came true when she was accepted into the dual program combining a master’s in social work

The way SPH students are taught to think is unique in and outside the field of public health.

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to work with professors to develop a servicelearning class, exposing pharmacy students to the principles of public health and social justice. By engaging deeply with important concepts like the social determinants of health, the course allowed pharmacy students to broaden their knowledge and enhance their careers. Since its first term, the course has opened up to students outside the College of Pharmacy, offering an even greater range of perspectives in the classroom.

This class was one of many strategies aimed at integrating various health schools across campus. Madeo was working more and more with student groups, encouraging perspective and knowledge sharing, when a serendipitous occasion gave these successful small-scale initiatives new funding. A grant from the provost’s Transforming Learning for a Third Century Initiative helped form the Michigan Center for Interprofessional Education at U-M, where Madeo now serves as the assistant director.

Today, Madeo not only draws on her public health knowledge in her new role but asserts that the center’s goals are themselves a public health intervention. “Training future health professionals is a public health issue,” she says.

“Intervening to broaden their perspectives and help them develop skills in collaboration is an investment in the future health of our populations.” The center focuses on student engagement because students are easily convinced of the importance of collaboration and intercultural skills. The more professionals entering professional life with this kind of training, the more equipped they will be to face major public health problems.

Madeo’s role at the center is not what she expected for her career, but she has learned from her nontraditional path that success does not depend on having life mapped out.

Because her public health background is rare in her current environment, she has realized what an asset it truly is. She encourages SPH students to recognize that the way they are taught to think is unique in and outside the field of public health. “Let your career surprise you,” she counsels, and “fill your metaphorical toolbox along the way with as many skills and relationships as you can so that you may draw on them in the future.”< —Sydney Egan

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for them. She also has two children—Micah (3) and Grace (9 months).  Kari L. Woloszyk, MPH ’13, is a public health consultant focused on improving the built environment to foster thriving communities around nutrition and physical activity. Woloszyk partners with the Michigan Recreation and Park Association and with Wayne State University on projects around food access and making public spaces healthier. Woloszyk resides in Rochester, MI, with her two dogs.  Kathryn Fischer, MPH ’14, is a research scientist with the California

Department of Public Health Office of AIDS. She is interested in becoming an H-Net mentor.  Kristin Harden, MPH ’16, is a health services analyst for the Research Group on Equity and Inclusion at the Mayo Clinic in Rochester, MN. She performs quantitative research on projects related to health care equity and quality and to clinical decisionmaking as related to health disparities. Her specialization in research methods in HBHE gave her the skills and background necessary for this position. <

IN MEMORIAM

1940s Ali A. Baghai, MPH ’49  September 11, 2016 Marjorie J. Bjork, BSPHN ’49  January 1, 2017 Elaine E. Fineran, BSPHN ’48  August 19, 2016

1950s Dolores A. Bryla, MPH ’59  January 17, 2017 Dorothy A. Gillig, BSPHN ’57  February 4, 2017 Kenneth R. Harrington, MPH ’57  February 16, 2017 William W. Joy, MPH ’53  August 28, 2016 Elmer L. Lashua, MPH ’53  September 16, 2016 Thelma C. Marshall, BSPHN ’54  January 24, 2017 J. Douglas McCluskie, MPH ’57  November 1, 2016 Henry J. Morris, MHA ’58  January 4, 2016 Tod Olson, MPH ’59  November 12, 2016 Val C. Vangieson, MPH ’58  October 14, 2016 Ayleen L. Wright, BSPHN ’57  December 11, 2016 1960s Lawrence F. Bennett, MPH ’68  November 6, 2016 Albert D. Castano, MPH ’67  September 22, 2016 Brents Dickinson, MPH ’66  February 21, 2017 Hermine Mcleran, MPH ’61  November 17, 2016 Henry S. Fisher, MPH ’69  November 8, 2016 Morris L. French, MPH ’66  September 7, 2015 John C. Golden, MPH ’64  November 15, 2016 Shirley A. Hollingsworth, MPH ’68  June 19, 2016 Charles E. Mortimore, MS ’64  September 15, 2016 Alice G. Mueller, MPH ’64 Michael J. Oliva, MPH ’64  November 3, 2016

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Goldie A. Niehaus, MPH ’65  August 22, 2016 David S. Ramsey, MHA ’62  July 25, 2016 Robert O. Shannon, MPH ’66  February 26, 2017 Walter G. Parker, MPH ’67  December 12, 2016 John W. Trotter, MPH ’67  November 6, 2016 Thomas P. Weil, PhD ’64  August 25, 2016 Harriet I. White, MPH ’66  January 18, 2017

1970s James M. Andre, MPH ’72  October 12, 2016 James J. Calderone, MPH ’74, Dr PH ’79  August 19, 2016 Margaret A. Child, MPH ’70  August 9, 2016 Michael J. Daly, MHA ’70  January 17, 2017 C. Ross McFarland, MPH ’70, Dr PH ’72  February 24, 2017 Diana M. Gurieva, MPH ’77  February 6, 2017 Georgia G. Hall, MPH ’72  December 4, 2016 Victor G. McDonald, MPH ’73  February 3, 2017 Michael J. O’Brien, M.S. ’75  December 15, 2016 John C. Ottenberg, MPH ’73  October 18, 2016 Catherine Perkins, MPH ’78  October 15, 2016 Jean H. Smelker, MPH ’79  January 17, 2017 1980s Eugene D. Imbrogno, MPH ’89  September 8, 2016 Maria G. Restuccia, MS ’88, Ph.D. ’93  February 23, 2017 Alice C. Robeson, MPH ’86  September 26, 2016

1990s Jane M. Perry, MPH ’92  September 30, 2016 Robert W. Graham, MPH ’94

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Perseverance How SPH graduate Pamela Pugh turned challenge into opportunity as a non-traditional student

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PH alumna Pamela Pugh was recently appointed chief health advisor to the city of Flint. An outside observer might assume a clear path from an advanced degree in public health to this role. But Pugh’s story of what brought her to her current position is filled with challenge, perseverance, and unending dedication.

As a high school student, Pugh was ambitious. She was concurrently enrolled in Saginaw High School and Delta College, where she earned an associate’s degree. As an African American woman excelling in math and science, Pugh was encouraged by her parents and teachers to pursue a degree in chemical engineering. She went on to Florida A&M University, knowing that this was a promising career path for her. Beyond these words from her mentors and her aptitude for the field was an interest in environmental engineering, to which she felt chemical engineering could serve as a gateway.

“Soak up everything you can from every experience. Make learning multifaceted.”

After her first year in the program, she became extremely ill and was diagnosed with multiple organ failure. The impact of this experience and the significant time she spent recovering in the hospital solidified her passion for the environmental health side of chemical engineering. When she resumed

taking classes, she says, her path to public health began to become definite in her mind.

After graduating, Pugh spent time working with several chemical companies, including working on a Dow Chemical radioactive cleanup project. In 1997 she returned home to begin work at the Saginaw County Department of Public Health, where she remained for 14 years, devoted to promoting health in her community. Here she saw firsthand what environmental health really looked like for people and how it affected their lives. She learned much from colleagues and community members and was inspired by their dedication. It was a “phenomenal experience,” she says.

Not long after Pugh began working in Saginaw, she attended a prospective student seminar at SPH. She met Professor Jerome Nriagu, who urged her to apply to the graduate program in Environmental Health Sciences. In 1999 she did just that. In keeping with her energetic and determined approach to life, Pugh decided to continue working at the Saginaw County Health Department while she earned her degree, taking advantage of SPH’s On Job/ On Campus program. She began as a master’s student, then continued her research in childhood lead poisoning and other neighborhood health factors in the DrPH program, earning her doctorate in public health in 2014.

As a non-traditional student, Pugh certainly faced challenges. But she believes that her decision to pursue a doctorate was right for her goals. And she found that working and getting hands-on experience while learning in the classroom truly enriched both her studies and her professional life. Pugh advises more traditional students to take advantage of a variety of learning experience to enhance their SPH education. “I’m not telling everyone to go out and get an illness,” she jokes, referencing her life-changing stint in a U-M hospital years earlier, “but soak up everything you can from every experience. Make learning multifaceted.”

She urges students not to take any experiences for granted, even when the path ahead is blurry.

Following her own advice, Pugh recently took the opportunity to volunteer in Flint, where she met Dr. Mona Hanna-Attisha—the pediatrician who exposed the Flint water crisis and the high levels of lead in Flint children.

Hanna-Attisha suggested that Pugh pursue the open position of chief health advisor to Flint. As she read the job description, Pugh felt as though she were looking in the mirror.

Every experience, every twist and turn her path had taken was reflected in the needs of this role. This was where she was meant to be.

She found that working and getting hands-on experience while learning in the classroom truly enriched both her studies and her professional life.

Today Pugh strives to improve the health of the citizens of Flint, fighting inequity with strategies of community inclusiveness and a holistic approach to public health. As she completes her first year as chief health advisor to Flint, she also heads the company Regeneration LLC, which she started to create smooth, professional interfaces between neighborhood organizations and stakeholders with similar community health goals. And she serves on the Michigan State Board of Education, to which she was elected just months after her 2014 graduation from SPH. Much of Pugh’s zeal and her commitment to public health come from her desire to honor her parents and her SPH mentors, such as Nriagu. They “really took the time to help me succeed,” she says, and now she wants to pay it forward. Surely none would deny that she is doing that and more as she finds new ways to advocate for the health and well-being of the Flint community. < —Sydney Egan

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RESEARCH NEWS

Immigration Fears among Latinos Can Impact Baby Size at Birth

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ith deportation and discrimination fears currently on the minds of many in the US, a U-M study shows that the stress from an historic immigration raid is associated with Latina mothers delivering babies with lower birth weights. The U-M SPH and Institute of Social Research team found that after the federal immigration raid in Postville, Iowa, in 2008, Latino babies born in the 37 weeks after the event had a 24 percent greater risk of lower birth weight than babies born the prior year. There also was an increased risk in preterm birth among Latina mothers compared with non-Latina white women.

“While health disparities often are believed to be caused by differences in individual health behaviors, access to health care, or even genetics, our findings implicate the impact of racial/ ethnic stereotyping and related psychosocial stressors on health,” said Arline Geronimus, research professor at the U-M Institute for Social Research and a professor at SPH. Other U-M authors were Nicole Novak of the Institute for Social Research and Aresha Martinez-Cardoso of SPH. Their research is featured in the International Journal of Epidemiology.

In one of the largest single-site raids in US history, federal immigration officials used military tactics to arrest 389 employees of a meat-processing plant in a small Iowa community. Ninety-eight percent of those arrested, handcuffed, and held in various detention centers were Latino, as all were initially suspected to be undocumented immigrants. “In the wake of the Postville immigration raid, US-born and immigrant Latino families feared deportations and follow-up raids, and faced increased economic and social marginalization,” Novak says. “These stressors permeated the lives of both US-born and foreign-born Latina mothers, potentially activating harmful

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physiological responses that could result in the poor birth outcomes we documented among their babies.”

Psychosocial stressors can affect pregnant mothers by shifting stress hormone balances in ways that affect a developing fetus by triggering premature birth, leading to growth restriction and low birth weight even for babies born at full term, and by reducing social and material support networks that promote a mother’s health during pregnancy, the researchers said.

Low birth weight is associated with increasing a baby’s chance of dying or having long-term health and academic problems.

The researchers obtained all birth certificate data from 2006 to 2010, and their analysis focused on more than 52,000 births of Latina and non-Latina white mothers.

They classified infants as exposed to the post-raid environment if they were born in the 37 weeks following the raid. Those born in the same period a year earlier were classified as unexposed. Total numbers of births among Latina and nonLatina white mothers were nearly the same in the pre- and post-raid periods. No changes were observed in conventional risk factors for low birth weight for either group across the time periods studied. Prior to the raid, Latina and non-Latina white mothers had similar rates of low birth weight, at 4.7 percent, and preterm births at 7.5 percent. During the period following the raid, the rates actually went down for white mothers, continuing a nationwide trend started in 2006, but increased for Latina mothers.

This work was supported by the National Institutes of Health, U-M Rackham Graduate School and the Center for Advanced Study in the Behavioral Sciences at Stanford.

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researchDigest Percolation of Chemical Vapors Stuart Batterman, Professor of environmental health sciences at SPH and professor of civil and environmental engineering, and Edward Zellers, Professor of environmental health sciences, were featured in a story in The Detroit News about the public health threat posed by chemical vapors that percolate up from the ground of former industrial or commercial sites.

Cervical Cancer in Guatemala The study “Acceptability of Human Papillomavirus Self-Sampling for Cervical Cancer Screening in an Indigenous Community in Guatemala” was published in the Journal of Global Oncology. SPH doctoral students Anna Gottschlich and Christian Alvarez and Rafael Meza, assistant professor of epidemiology, collaborated on the study with a team of international colleagues. Gottschlich led the study in Santiago Atitlan, a Mayan indigenous community of 45,000.

Diabeteslinked DNA Changes Researchers from the University of Michigan, National Institutes of Health, Jackson Laboratory for Genomic Medicine, University of North Carolina, and University of Southern California have identified something that some diabetes-linked genetic defects have in common—they seem to change the way certain cells in the pancreas “read” their genes. Their new paper in the Proceedings of the National Academy of Sciences reports that many diabetes-linked DNA changes affect the ability of RFX to bind to specific locations in the genomes of pancreas cell clusters called islets, which in turn changes the cells’ ability to carry out important functions. The research team included Michael Boehnke, professor of biostatistics, and Ryan Welch, a researcher in the biostatistics department. <

Genetic Health Data Considered Useful — Not Alarming

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s consumers have been able to learn more about their genetic makeup in recent years through personal genomic testing, one big criticism has been that without someone to interpret it, the health information could be harmful to the receivers. Not so, according to a U-M study that shows that less than 2 percent of customers regret receiving such information, and only about 1 percent say they are harmed by the results.

Heart disease, breast cancer, and Alzheimer’s were the conditions of greatest interest for genetic risk information.

“These data suggest that many of the concerns and criticisms about putting this information into the hands of consumers may presume an exaggerated likelihood of harm,” said J. Scott Roberts, associate professor of health behavior and health education at SPH. Roberts said that one of the biggest pieces of data consumers were interested in was their ancestry—74 percent of the more than 1,600 participants were very interested in that information. Trait information and data about health risks each were rated as important by 72 percent.

Roberts serves as a principal investigator, along with Robert Green of Brigham and Women’s Hospital, on an NIH-funded Impact of Personal Genomics (PGen) study that measures perceptions and tracks behaviors of individuals who received direct-to-consumer genetic testing from two separate companies prior to FDA restrictions on the information provided to consumers. The team conducted three web surveys in 2012 to better understand who got tested and how they perceived the harms, benefits, and limitations of the data. Another goal was to examine consumer decisions to get tested. The survey found that nearly 40 percent did not consider at all the potential for unwanted information.

“This suggests a need for improvement in the

informed consent and pretest education process so that consumers appreciate the different types of information they might receive,” Roberts says.

After getting results, 59 percent of participants said the information would influence how they managed their health. Heart disease, breast cancer, and Alzheimer’s were the conditions of greatest interest for genetic risk information, with women and people with poorer self-reported health showing high interest in these types of information. In all, 93 percent felt genetic testing was a good decision, and 94 percent said they would do it again.

Other authors were from the U-M departments of Internal Medicine, Human Genetics, and Family Medicine; department of Pathology and Molecular Medicine, McMaster University; and the department of Medicine (Division of Genetics), Brigham and Women’s Hospital, Harvard Medical School.

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Pregnancy Weight and Cerebral Palsy

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eing overweight or obese during pregnancy increases the chance of having a child with cerebral palsy, according to new research led by U-M SPH and the Karolinska Institute in Sweden. And the more overweight mom is, the more likely she is to have a child that develops the neurological disorder characterized by a loss or impairment of motor function, says lead author Eduardo Villamor, U-M professor of epidemiology. “Each degree of obesity severity during pregnancy increased the chances a child would be diagnosed with cerebral palsy,” Villamor says. “Compared with women of normal weight, women with overweight had a 22 percent higher rate, whereas women with severe obesity had more than twice (more than 100 percent increase) the rate.” Women with overweight have a body mass index of 25-29.9 and those with obesity have a BMI of 30 or higher.

The study, believed to be the first to show the association between a mother’s weight

and cerebral palsy using data from an entire country, appears in the Journal of the American Medical Association. Villamor and colleagues say that maternal obesity increases the risk of neonatal asphyxia, which most likely explains the development of CP later in life. This applies only to full-term births. “One reason why it was not seen in children born preterm could be that preterm birth itself hugely increases the chances of CP and, in a way, it may leave little room for other risk factors like maternal obesity,” Villamor says. The team analyzed birth records of more than 1.4 million Swedish children from 1997 to 2011, tracking maternal overweight or obesity in early pregnancy. They then followed the children from birth to the age at which there was a diagnosis of CP, death, or the end of the follow-up in December 2012.

Cerebral palsy develops through a series of events before, during, or after birth. The cause remains largely unknown, but research-

ers have found that a lack of oxygen at birth has led to the condition in a percentage of children with the diagnosis. Other identified risk factors include premature birth, low birth weight, blood clotting problems, failure of the placenta to deliver oxygen and nutrients, and some infections of the mother or baby. Previous research by Villamor and colleagues using the Swedish Medical Birth Register has associated

Maternal obesity increases the risk of neonatal asphyxia, which most likely explains the development of CP later in life. maternal overweight and obesity with increased risks of preterm delivery, asphyxia-related neonatal complications, and congenital malformations. Mark Peterson, U-M assistant professor of physical medicine and rehabilitation, was a coauthor on the study.

Capitol Hill Briefing on U-M Health Insurance Initiative

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s Congress debates the next steps in national health policy, a briefing organized by two US representatives in February gave elected officials and their staff a chance to learn about an idea born at U-M that has gained bipartisan support. The event, organized by Representatives Diane Black (R-TN) and Earl Blumenauer (D-OR), featured Mark Fendrick, professor of health management and policy at SPH and professor of internal medicine at the U-M Medical School, and Michael Chernew, a former SPH faculty member now at Harvard University.

In their introductory remarks, Representatives Black and Blumenauer highlighted the rare bipartisan support for value-based insurance design (V-BID) and praised its role in improving the health of Americans and lowering health care spending. Both were enthusiastic about partnering on bipartisan legislation

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to expand V-BID in private and public payers.

Instead of a one-size-fits-all approach to copays and deductibles, V-BID allows insurers to align patient out-of-pocket costs with the value of services, so patients pay the least for the tests and treatments that will benefit them most, based on what health conditions they have.

V-BID could be a bipartisan, multistakeholder solution to improve quality, enhance consumer experience, and lower costs.

Diane Black (R-TN), Mark Fendrick, Earl Blumenauer (D-OR), Michael Chernew

Medicare Advantage health insurance plans in several states just began testing V-BID concepts among seniors, and the TRICARE insurance system that serves active-duty military and their families is poised to test it this year. At the February event, Fendrick and Chernew discussed how V-BID could be used

by high-deductible health plans and health savings accounts—two aspects of health insurance that are receiving wide attention since the new Congress began. They described how V-BID could be a bipartisan, multi-stakeholder solution to improve quality, enhance consumer experience, and lower costs.

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FINDINGS

Upcoming Events Summer Session in Epidemiology July 9–28, 2017

The Summer Session in Epidemiology has been one of the nation’s most highly regarded summer epidemiology programs for more than 50 years.

Taught by an international group of expert instructors, the curriculum is updated annually and focuses on principles, methods, and applications of epidemiology. The curriculum includes three-week and one-week courses. Give your career a boost and network with public health colleagues from around the world this summer. Learn more and register online at SummerEpi.org.

Griffith Leadership Center Symposium October 26–27, 2017

Thursday, October 26, 2017 Jack Roth Stadium Club, Michigan Stadium

The GLC hosts large national symposia in Ann Arbor that link teaching, research, and practice. National leaders from across a variety of health care sectors come together to share ideas about excellence in health management and policy. Events draw 300 to 600 participants—executives from health systems, insurance companies, law firms, foundations, public health and government organizations as well as faculty, students, and alumni from across the country. Mark your calendar now for the 2017 GLC Symposium.

Registration opens in May 2017.

Join us for a reception and dinner at the Big House to honor Peter Jacobson—professor of health law and policy and director of the Center for Law, Ethics, and Health—on the occasion of his retirement from the faculty of Health Management and Policy. Enjoy a special evening tribute with friends and colleagues and cap it off with some fun on the football field.

Attend the GLC’s biennial one-day symposium with over 300 colleagues to network, exchange ideas, and be inspired by forward-thinking leaders in the field of healthcare leadership. Part of the day will be an interactive problem-solving event that will excite and challenge you while rapidly augmenting your toolbox and your network.

“My experience was beyond all expectations. I strongly recommend this intensive summer program.”—Miki Akiyama, MD, Visiting Scholar, UC Berkeley

early learning and its impact on lifelong curiosity, discovery, and innovation.

It is hosted by the University of Michigan Children’s Centers, University Human Resources, U-M Dearborn School of Education, Health, and Human Services, the Stamps School of Art and Design, and the James and Anne Duderstadt Center.

The University of Michigan Bicentennial will be celebrated throughout 2017. Below are some selected features—check the comprehensive calendar of Bicentennial activities and events across U-M at bicentennial.umich.edu.

Exhibit: The Wonder of Learning June 15–August 27 | Monday-Friday, noon–5pm; Sunday, noon–6pm Slusser Gallery, Stamps School of Art and Design; Duderstadt Gallery, Room 1019, Duderstadt Center The Wonder of Learning is a national exhibit focused on the importance of

Friday, October 27, 2017 Sheraton Ann Arbor

UMich200 Summer Festival June 26–27 The Bicentennial Summer Festival will include a second Presidential Colloquium, a celebration of the vast contributions of U-M staff; and recognition of U-M’s towngown bonds with the City of Ann Arbor.

Exhibit: Detroit Historical Museum July 15-October 8 5401 Woodward Ave., Detroit detroithistorical.org An exhibition about the longstanding interactions between Detroit and the University of Michigan, built around the six themes of U-M’s bicentennial celebration.

Through words, images and artifacts, the exhibition will show how each community has been made stronger by the ideas and contributions of its members, from public health improvements and broadened civil rights to architectural design and compelling journalism.

Detroit Festival September 15 The Bicentennial Detroit Festival will commemorate the University’s 1817 founding in Detroit and will celebrate and reflect on U-M’s connections to the city.

UMich200 Fall Festival October 26–28 The Bicentennial Fall Festival takes place during Homecoming weekend and includes the ceremonial sealing of a time capsule; a third Presidential Colloquium; the Third Century Expo with a special nighttime finale; and a football game against Rutgers University.

> Do you have news to share— perhaps a new job or promotion?

Did you write a book or receive an award? Tell us about your latest academic or professional accomplishments so we can share your good news in the next issue of Findings. sph.umich.edu/classnotes > Update your SPH contact info at leadersandbest.umich.edu/ alumni_update. Or indicate changes on the address label and mail to the address on the back cover. > Want to share your real-world knowledge and experience with current or prospective students?

Need a job or have one to fill?

SPH Career Connection matches SPH students and grads with companies and agencies.

Check out umsphjobs.org or email sph.jobs@umich.edu. > If you would like to be part of Ask an Alum or Mentor a Student, email sph.inquiries@umich.edu.

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We are thinkers and doers. We are a diverse community of more than 1,000 students, 250 faculty and staff, and 14,500 alumni.

Together we are public health. Learn more about current SPH students, faculty, staff, and alumni at sph.umich.edu/stories.

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