Harvard School of Public Health Annual Report 2003

Department of Biostatistics
The department continued to bring innovation to the design and analysis of clinical trials in cancer and AIDS, as well as to studies in genetics, genomics, psychiatry, and environmental health. With colleagues at Dana-Farber Cancer Institute, members advanced their work in computational biology, using patients' genetic and protein profiles to diagnose disease and predict its progression. The department also joined with Harvard's Graduate School of Arts and Sciences to establish a PhD program that promises to enhance graduate education in biostatistics and bioinformatics across the University.

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Department of Environmental Health
Seeking to blunt an epidemic of asthma in adults and children, researchers are exploring biologic mechanisms that might explain the link between this inflammatory airway disease and obesity. A study in the Journal of Applied Physiology led by Stephanie Shore indicates that obese mice are more sensitive than lean mice to atmospheric ozone, a common asthma trigger. Evidence hints that the hormone leptin, which is produced by fat cells and markedly elevated in the obese, heightens susceptibility to inflammation caused by air pollutants, and may constitute at least part of the mechanistic link between obesity and asthma.

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Department of Epidemiology
Megan Murray and Marc Lipsitch made an important contribution to understanding and controlling Severe Acute Respiratory Syndrome (SARS) by quickly producing a computer model to estimate the disease's potential to spread. The model demonstrated that SARS was only moderately transmissible and that its spread could be successfully controlled by isolating individuals who were infected or had likely been exposed. These findings, which were released within weeks of submission through Science Express, the web version of Science, confirmed the strategy that was ultimately used in quelling outbreaks, which occurred in 29 countries.

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Department of Genetics and Complex Diseases
This new department, chaired by Gökhan Hotamisligil, brings together faculty members who aim to unlock biologic mechanisms by which genes and the environment interact to cause complex diseases such as cancer, diabetes, cardiovascular disease, and obesity. Through wide-ranging biochemical and genetic studies, researchers are examining molecular pathways that regulate adaptive responses to environmental factors--toxins, stress, nutrients--at the level of molecules, cells, organisms, and populations. This knowledge can ultimately be applied to humans in the search for improved treatments and preventive strategies.

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Department of Health Policy and Management
As Canada's experience with quarantine during the recent SARS epidemic illustrates, tension between upholding the rights of the individual and the government's need to protect the public's health is a rising concern. To better prepare U.S. lawyers for work in the public health arena, department members Michelle Mello and Troyen Brennan worked with Harvard Law School faculty to develop a joint JD/MPH program with HSPH. Instead of earning the JD in three years and the MPH in year four, students can now earn both degrees at once, within three years.

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Department of Immunology and Infectious Diseases
Tuberculosis (TB) continues to be a leading killer worldwide, and the rise of multi-drug resistant strains of the bacterium Mycobacterium tuberculosis poses a considerable global challenge. Because existing antibiotics combat TB by disrupting only a very small number of cellular processes, researchers have been using genetic methods to try to expand that number to the fullest extent possible. In studies published this year in Molecular Microbiology and the Proceedings of the National Academy of Sciences, Eric Rubin and colleagues identified hundreds of intracellular targets, opening doors to the development of more effective antibiotics for TB.

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Department of Nutrition
Research led by Eric Rimm with colleagues in the departments of Nutrition, Epidemiology, and Genetics and Complex Diseases showed that men with high blood concentrations of adiponectin are at lower-than-normal risk of heart attack. Adiponectin, a recently discovered peptide produced in fat tissue, is believed to be involved in regulating insulin sensitivity and lipid oxidation. The findings, published in the Journal of the American Medical Society, were based on a six-year study of men in the Health Professionals Follow-up Study who were free of cardio- vascular disease when the study began. Determining how adiponectin influences the risk of coronary heart disease will require further investigation.

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Department of Population and International Health
Experts have long debated the impact of population growth on economic development. In their new book, The Demographic Dividend: A New Perspective on the Economic Consequences of Population Change, David Bloom, David Canning, and Jaypee Sevilla argue that age structure, not total population numbers, is most important for the economy. In developing countries, health improvements and falling infant mortality, followed by declines in fertility, produce a baby boom generation that dominates the age structure. As seen in East Asia and Ireland, provided appropriate policies are in place, the surge in labor supply and savings produced by this generation as it matures can fuel a remarkable economic growth spurt.

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Department of Society, Human Development, and Health
This new department, created from the merger of the departments of Maternal and Child Health and Health and Social Behavior, will explore the social and behavioral determinants of health throughout the cycle of human
development, from infancy to old age. Chaired by Lisa Berkman, the department will explore the social, psychological, and behavioral conditions that influence health; design, test, and implement health-enhancing interventions; and evaluate the impact of public-service programs and social, economic, and educational policies on health and human development. There is a particular focus on exploring the origins of disease in view of environmental exposures.

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Division of Biological Sciences
Division member Ali Sultan, director Dyann Wirth, and colleagues from the Harvard Malaria Initiative led a workshop in advanced bioinformatics at the new Bioinformatics and Genomics Center at the Universite Cheikh Anta Diop in Dakar, Senegal, sponsored by the ExxonMobil Foundation, the Ellison Medical Foundation, and the John E. Fogerty International Center of the National Institutes of Health. Attracting scientists from within Senegal as well as Burkina Faso, the Gambia, Mauritania, and Niger, the workshop offered hands-on tutorials in applying advanced computer technologies to research on the genetics of malaria and HIV, the leading infectious disease killers in West Africa.

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Division of Public Health Practice
The Division welcomed as its new director Howard Koh, formerly commissioner of the Massachusetts Department of Public Health and a noted cancer- and tobacco-control specialist. Later in the year, the Division and the John F. Kennedy School of Government received funds from the Centers for Disease Control and Prevention to launch the National Preparedness Leadership Initiative. This model training program, directed by Leonard Marcus at HSPH, will prepare senior government officials to effectively thwart and respond to public health emergencies, from bioterrorist attacks to emerging infectious diseases. The Initiative will also serve as a national convening platform for debate, policy making, and research on preparedness issues.

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Center for Health Communications
A generous grant from the MetLife Foundation launched the Harvard-MetLife Foundation Initiative on Retirement and Civic Engagement. This project aims to strengthen community life in the U.S. by mobilizing the time and talents of 77 million baby boomers as they reach retirement. The first wave of boomers will turn 60 in two years. The Initiative will promote strategies to expand the contributions of retirees to civic life by identifying new opportunities to tap this enormous reservoir of talent. The project will also focus on reshaping public attitudes and beliefs regarding the meaning and purpose of the retirement years.

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François-Xavier Bagnoud Center for Health and Human Rights
The Center's Sofia Gruskin was appointed to chair a new, independent advisory body mandated to incorporate human-rights perspectives into the work of the Joint United Nations Programme on HIV/AIDS (UNAIDS) and its cosponsors. This group is the first ever assembled by the UN to examine human rights in the context of a specific health issue. Its mission is to build evidence for the effectiveness of using rights-based approaches to address HIV/AIDS; to establish human-rights indicators for monitoring populations' vulnerability to HIV/AIDS and assessing the disease's impact; and to guide UNAIDS, governments, and other organizations in integrating human-rights principles into their responses to AIDS.

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Harvard AIDS Institute
The Institute initiated the first HIV vaccine trial ever launched concurrently in a developing country--Botswana--and the U.S. Under the auspices of the HIV Vaccine Trials Network, it was also the first such trial in Southern Africa, which has the highest HIV prevalence in the world; the first to be conducted where HIV-1C, the world's most prevalent HIV subtype, predominates; and the first to HLA-type volunteers, as in organ transplantation, to ensure that all participants have the potential for an immune response to the vaccine. This sophisticated testing was carried out in Gaborone at the Botswana-Harvard HIV Reference Laboratory.

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Harvard Center for Cancer Prevention
Broadening its outreach efforts, the Center partnered with Self magazine to create a cancer risk assessment tool for young women; secured funding for a culturally appropriate Spanish-language version of the Your Cancer Risk website; launched a web-based resource aimed at African Americans on the Black Entertainment Television website, BET.com; and continued to collaborate with the Susan G. Komen Breast Cancer Foundation, updating its website, About Breast Cancer, for lay and professional readers. Graham Colditz, the Center's education director since 1994, assumed the role of director. He succeeds David Hunter, now head of a new program in Molecular and Genetic Epidemiology.

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Harvard Center for Population and Development Studies
With the Department of Population and International Health, the Center launched a new policy research study within the AIDS Prevention Initiative in Nigeria (APIN). Led by Michael Reich and colleagues at the University of Ibadan and the Nigerian Institute of Social and Economic Research, the study will assess the flow of funds for AIDS control; estimate treatment costs; assess the socioeconomic impact of AIDS; evaluate the state's capacity to implement controls; examine ethics in research; and explore AIDS as portrayed in the Nigerian media. APIN, directed by Phyllis Kanki of Immunology and Infectious Diseases, also formed the AIDS Policy Working Group, a policy-issues forum.

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Harvard Center for Society and Health
While the health and lifespans of white Americans have improved steadily, racial and ethnic disparities in disease and mortality rates are now greater than in 1950. In part because these inequities are poorly defined, many health care providers do not believe they exist--a dilemma, given that health policy changes result from pressures of public opinion. The Center hosted a Symposium on Racial/Ethnic Health Disparities Research, bringing together faculty and students from across Harvard University to forge collaborations. Participants concurred that naming the problem, thinking clearly about how racism harms health, and methodically testing ideas through research are key to addressing pervasive health inequalities.

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Center for Biostatistics and AIDS Research
A study by the AIDS Clinical Trials Group, designed and analyzed at the Center (CBAR), investigated six initial treatments for HIV infection. The surprising result, reported in the New England Journal of Medicine, was that one combination--zidovudine, lamivudine, and efavirenze--was superior to the others, even though individually these drugs were not more potent than drugs used in other regimens. This suggested that the drugs were interacting in novel ways related to the mutation of the viral genome. To explore how drug-resistance gene mutations develop and affect the efficacy of various drug combinations, CBAR proposed creating a multi-institutional HIV resistance and clinical database.

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Center for Quality of Care Research and Education
Visible jaundice caused by hyperbilirubinemia occurs in over half of all healthy newborns. Extreme forms of this condition in the first week of life, while rare, can cause a form of permanent brain damage known as kernicterus, most often within days after the transition from hospital to home. Given trends toward discharging newborns earlier, jaundice may go undetected until too late. This year, the Center's Making Advances Against Jaundice in Infant Care project published two studies in Pediatrics. One adapted "10 Simple Rules" developed by the Institute of Medicine for safely managing extreme jaundice in newborns; the other presented a strategy for measuring caregivers' performance against an exemplary care plan.

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Education and Research Center for Occupational Health and Safety
Concern persists about whether male reproductive health may be impaired by phthalates, a group of ubiquitous, hormonally active chemicals used in the U.S. in adhesives, plastics, and personal-care products. Russ Hauser and colleagues published two studies on phthalates' potential health risks: One, in Epidemiology, examined the semen of men from infertile couples and found an association between urinary levels of some phthalate metabolites and low sperm count and motility. A second, in Environmental Health Perspectives, reported a link between urinary levels of one metabolite and damage to sperm DNA. Further research will seek to identify gene variants that may confer susceptibility to phthalates.

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John B. Little Center for Radiation Sciences and Environmental Health
A record 300 radiation biologists and cancer biology experts attended the Center's fifth annual symposium on Cellular Mechanisms in Genetic Stability and Aging. During the two-day program, scientists examined the overlap between genetic changes that occur in aging and those that result from environmental exposures, including ionizing radiation. A major focus was alterations linked to longevity: In yeast, worms, and mice, very low-calorie diets induce gene changes that prolong survival by slowing metabolism, reducing free-radical production, increasing fat storage, and reducing the rapid cell division seen in cancer.

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Harvard Prevention Research Center on Nutrition and Physical Activity
With funding from a generous donor, the Center began developing new curricula for teachers of after-school programs and coaches and staff of school athletic programs and summer camps to improve nutrition and increase physical activity in children. This new initiative builds on a curriculum now used in classrooms nationwide called Planet Health, which encourages middle schoolers to exercise more and eat more healthfully while also strengthening their skills in language arts, math, science, and social studies. The initiative's long-term goals are to prevent overweight and lower the risk of diabetes, cancer, cardiovascular disease, and osteoporosis.

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Harvard Injury Control Research Center
Restricting the availability of guns--by locking them in safes, for example--may help reduce suicide rates, particularly in young people, according to research this year by Matthew Miller, Deborah Azrael, and David Hemenway. These Center investigators found that in areas with more guns, more people took their own lives. They also showed than over 90 percent of suicide attempts with firearms resulted in death, whereas intentional drug overdoses and methods involving cutting proved fatal less than 5 percent of the time.

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Harvard Center for Public Health Preparedness
This year, HSPH became part of a network of Centers for Public Health Preparedness based at leading schools of public health. The new Center at HSPH, led by Howard Koh, is working to construct a seamless web of people, institutions, resources, and information capable of protecting the public against bioterrorism and other threats. The Center has forged close partnerships with public health departments, bureaus of health, and medical institutions in the states of Massachusetts and Maine to ensure that residents will know how best to act and where to obtain information in times of crisis.

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Harvard Center for Risk Analysis
The Center (HCRA) named a new director in 2003: James Hammitt, professor of economics and decision sciences in the Department of Health Policy and Management. George Gray, who had served as the Center's acting director following John Graham's departure in 2001, assumed the role of executive director, with responsibility for HCRA's operational management. Hammitt's objectives for HCRA include helping government, industry, institutions, and individuals make sound decisions based on a careful analysis of the risks and benefits of differing approaches to environmental pollution, food safety, and the prevention, detection, and treatment of cancer, heart disease, and infectious diseases.

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Harvard Center for Youth Violence Prevention
A new book from Center co-director Deborah Prothrow-Stith and Howard Spivak argues that teen homicide and violence are problems that are indeed solvable. Murder Is No Accident: Understanding and Preventing Youth Violence in America (Jossey-Bass) chronicles a Boston-wide effort launched in 1982 that cut juvenile homicide and crime rates dramatically within 10 years. The authors describe interdisciplinary initiatives by community leaders, police officers, educators, activist teens, survivors and their families, and others to address major risk factors for youth violence with economic stimulus policies, teacher-training and peer-mentoring programs, after-school and recreation programs, conflict-resolution curricula, domestic violence screening, and other strategies.

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Harvard NIEHS Center for Environmental Health
The Harvard National Institute of Environmental Health Sciences (NIEHS) Center played a pivotal role in launching the innovative Harvard Children's Center for Environmental Health and Disease Prevention. Directed by Howard Hu and involving several members of the NIEHS Center's Metals Core, this new interdisciplinary collaboration will unite researchers from basic science, epidemiology, and exposure assessment in the study of metal mixtures and exposure and toxicity in children living at the Tar Creek Superfund site in Oklahoma. In addition, the NIEHS Center--at year 42, the oldest continuously funded center of its kind--received support for another five years.

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