Transcript of remarks from Dean Barry Bloom and CDC Director Julie Gerberding
Harvard School of Public Health 83rd Commencement
June 8, 2006
WELCOME FROM DEAN BARRY BLOOM
Dean Bloom: Please be seated. It is my pleasure to welcome all of you to the 83rd Commencement of the Harvard School of Public Health. It has been my privilege to have met and gotten to know many of the graduates, and they are an extraordinarily interesting, diverse, and dedicated group of health professionals and scholars. And in my remarks I would like to share a little bit or a little something about the people who are some of the graduates that you’ll be seeing here today. Today is a day and this afternoon is an occasion to celebrate you, our graduates as official new entrants into the world of public health.
Let me tell you something about your class that you may or you may not already know, but your friends, families, and parents may not. This year we will award 449 graduate degrees in public health, 240 Masters of Public Health, 162 Masters of Science, 3 Doctors of Public Health, 47 Doctors of Science, and 23 PhD’s in the Biological Sciences and Statistics. Of this class of 2006, 53% are women and 47% are men. We are privileged to have 30% of our graduates this year from 58 different countries, from every region of the world, from Africa, Western Europe, Latin and Central America, South Asia, and graduates this year will be coming from such extraordinary places as Argentina, El Salvador, Ethiopia, Iraq, Iran, Lesotho, Morocco, Mongolia, Nepal, Nigeria, United Arab Emirates, and Vietnam. Each of them has specially enriched our community. From the United States we’re pleased to say that we have graduates coming from about 30 states within the United States. Some of our graduates now have as students brought unusual experiences, and plan to do some unusual things. And I thought I would cite just a few.
Laura Lynn McKernan came to the School of Public Health as a public health service trainee, spent two years as a resident student, and then finished her research in pieces while back at her full-time position at CDC and NIOSH, evidence of the very strong connections we have, Julie, with your wonderful agency. She was deployed to New Orleans during the Hurricane Katrina response effort, and she conveyed public health and occupational health information to Latino workers in New Orleans, a population that was rather under-served by the relief effort. She also provided technical assistance in mold remediation activities in buildings in the County, and during the time that she was doing all of that, she had a baby, and finished her thesis. My congratulations on both counts. Following graduation, she will be serving as an environmental health officer at the National Institute For Occupational Safety and Health in Cincinnati.
MaryAnn Dakkak is dedicated to international service. She has spent time in Lesotho, Sarajevo, Mexico, and Haiti. She’s been conducting women’s health needs assessments for Cap Haitien and Konbit Sante, an NGO based in Portland, Maine. Out of some 500 applicants, MaryAnn has been selected by Catholic Relief Services as one of their 25 International Development Fellows for the next year, and she will begin her first assignment in Chad.
Timothy Mah, in the Peace Corps in Gambia, has given him a realistic understanding of international health issues in Africa. Building on field experience, he has been working on a systematic condom policy and its implications in Zimbabwe. And he’s been selected as a Saltonstall Innovation Funds Graduate Associate at the Harvard Center for Population and Development Studies.
Stephanie Rosborough was raised in rural Alabama where a country doctor apparently inspired her to pursue a career in medicine. During her undergraduate years at Harvard, Stephanie worked as a travel writer for Let’s Go Travel Guides. After receiving her medical degree at my old institution, the Albert Einstein College of Medicine, Stephanie pursued a career in emergency medicine. During the past two years she has managed a fellowship in International Emergency Medicine while completing the MPH Program. She delivered a baby in a taxicab in Nepal; she stitched up a man off the remote island of Madagascar, after being attacked by an angry lemur. She has visited refugee camps in Tanzania, and last fall she spent a month working in one of the mountainous villages of Pakistan hit hard by the earthquake there. She will become Director of International Emergency Medicine Fellowships at our neighbors at the Brigham and Women’s Hospital.
And finally, let me mention Amber Johnson and Jami Rothman, who contributed to what we would call a groundbreaking study on the relationship of the number one preventable cause of death and disability in America and our famed 2004 World Series Champions. They demonstrated unequivocally that our beloved Red Sox chewed more tobacco than any other World Series team. We can only hope that the Red Sox players and their management are listening to us across the Fenway today and take heed of the very negative health message sent to youth about chewing tobacco when sports players use it.
A number of our graduating students like the place so much that they will continue their work for advanced degrees or fellowships. Others will return to academic medical centers to complete their medical training, take public health practice positions in state and local governments, join consulting firms, HMOs, NGOs, or embark on academic and research careers. Let me mention just a few who have chosen to embark on careers in public service.
Mara McAdams will be a fellow of the U.S. Food & Drug Administration. Tara Das will become a research scientist at the New York Department of Health and Mental Hygiene. Corrine Williams will join CDC in their epidemiological intelligence service as a fellow. Debbie Cook will be a Presidential Management Fellow, and Elizabeth Hsu and Goli Samimi will be cancer prevention Fellows at the NCI, the National Cancer Institute, and Takahiro Hasegawa will be Section Chief in the Ministry of Environment in Tokyo and Yuji Otake will be Section Chief in the Ministry of Health, Labor, and Welfare in Tokyo. And Deborah Bako will be Medical Officer in the Federal Ministry of Health in Abuja, Nigeria.
Each and every one of our students has a special contribution to make, and it has been an enormous privilege to get to know so many of you. We began this year by welcoming Tulane and Louisiana State University students in the wake of the Hurricanes Katrina and Rita, to attend school here. They were a wonderful group. They were welcomed by you into our school and we, I think, all benefited spiritually and academically from having them in our community. I wanted to thank you in particular for your warmth and hospitality to them.
Our students and faculty responded to the hurricanes and to the earthquakes in Indonesia and many have worked with Harvard School of Public Health alumni around the globe to react to health needs in countless communities within this country and abroad.
As a community, we have shared the loss of family members and friends. Fernando Colmenero, one of our doctoral students, tragically passed away this April. His loss is felt by all of us and our hearts go out to his wife and family. I’m deeply touched to be able to say that his wife, Veronica Dussel, who deferred her admission to HSPH to care for Fernando will now join us as a student this summer, and we all want to wish her well and great success here.
There was another loss to our community, the tragic sudden death of Dr. J.W. Lee, the Director General of the World Health Organization. He was a great friend of public health, a champion of AIDS prevention and treatment, globally, and a long-time personal friend of mine.
We appreciate that most of you and your families have made great sacrifices to come to this School and to pursue your studies. Behind every graduate I know there is a story of commitment, of dedication, and sacrifice and behind most of you, debt.
All of us on the faculty truly wish the School had the capacity to offer more scholarships and financial aid, and we have enormous admiration for how you have managed to put things together, to finance your educations here. The Harvard School of Public Health community is a richer and more interesting one because of what each and every one of you has contributed and we thank you. As always, in my commencement speeches, I conclude by reminding you that engraved on the FXB Building is the preamble to the World Health Organization Charter: The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social conditions.
Our greatest challenge, in my view in public health is the disparities in health within this rich country, within other countries, and between countries of the world. I would like to share with you some very recent data that was compiled by our Burden of Disease Unit, working with the Chronic Disease Unit in CDC.
If we start with the premise that life expectancy is the absolute crudest measure of health, ie., whether you’re dead or alive, while life expectancy at birth in the United States is 77.6 years, healthy life expectancy, a metric recently developed by our people in 2000 year indicated that healthy years of life, on average, in the U.S. was 69.3 years. In Japan that figure would be 75 years. And in Sierra Leone it would be 28.6 years. Healthy life expectancy is below the age of 40 in 19 African countries at this time. And we could say that’s a faraway place in a different circumstance, but let me remind you that in the United States life expectancy in 7 counties of Minnesota is 81.7 years in 2001. And these are data with the help of CDC that we could bring forward. That life expectancy is 13 years higher than life expectancy in 7 counties of South Dakota--where our keynote speaker happens to have been born. It is 9 years higher than the average life expectancy in our nation’s capitol, and it is 12 years higher than the average life expectancy for people born in Baltimore City where I have heard there’s another school of public health.
Life expectancy for Asian American women in 2001 for Bergen County, New Jersey, was well over 90 years of age. And more than 20 years longer than life expectancy for an African-American man a stone’s throw across the Hudson River in the Bronx, in New York. For me, this remains the biggest public health agenda. I would ask you to remember it well, and I will leave you with the wish that you remember the values that brought you into public health and brought you here and remember the values that brought you through here. Thank you very much.
INTRODUCTION OF HSPH COMMENCEMENT SPEAKER
Dean Bloom: It is my pleasure now to welcome our Commencement speaker, nominated by the graduating students, Dr. Julie Gerberding, Director of the Centers for Disease Control and Prevention, best known to us as CDC, to share her vision of the future of public health. We appreciate tremendously her taking the time to join us today and we understand the necessity for her to return shortly after her speech to get back to the CDC.
Born in South Dakota, Julie Gerberding received her BA and MD from Case Western Reserve University in Cleveland and her Masters in Public Health from the University of California at Berkeley. In San Francisco she worked with HIV patients at the very beginning of the AIDS epidemic and pioneered studies on HIV infections in health care workers and created the early prevention guidelines that became the basis, ultimately, of the Universal Guidelines for Healthcare Workers.
As acting Deputy Director of the National Center for Infectious Diseases at CDC, Dr. Gerberding responded heroically to the 9/11 attacks and the anthrax bioterrorism scares of 2001, and all of us remember seeing her addressing the nation in a clear and forceful way.
In July of 2002 she was appointed by the President as the first woman director of the Centers for Disease Control. As you know, CDC is a unique institution in the nation and the world, and we are proud to say that six of her predecessors have been graduates of the Harvard School of Public Health.
Dr. Gerberding is also an Associate Professor in Departments of Medicine and Epidemiology and Biostatistics at UCSF and an Associate Clinical Professor of Medicine at Emory University. In 2004 Time Magazine referred to Dr. Gerberding as one of the "most powerful people in the world," and in 2005 Forbes Magazine voted her one of the 100 most powerful women in the world.
Dr. Gerberding is a Member of the Institute of Medicine and was awarded the Health Leader of the Year Award in 2004 by the United States Public Health Service Commissioned Officers Association. Admired by people of all backgrounds, Dr. Gerberding has garnered respect and attention internationally for her leadership of CDC and particularly in the anthrax and SARS crises.
She oversees a budget of $8 billion, and here I feel the need to editorialize: the increased attention and resources for urgent threats and potential threats are entirely appropriate. Avian influenza, biodefense preparedness, are clearly entirely appropriate and high priorities. But we are radically underfunding and otherwise neglecting what one would have to call urgent realities. We continue to emphasize disease treatment and in particular, the increased financing of treatment, while we tend to overlook and underfund the principle focus of public health, which is disease prevention promoting health and protecting the public.
I’m really very sorry on this occasion to have to say that our nation’s premier health prevention and protection agency has experienced a major budget cut this year for the first time in 25 years, and many of its crucial core programs that adjust the problems that threaten people’s health every day have either not scaled to meet the expanding needs or have actually been reduced since 9/11. Preventing diabetes–which is now costing this nation about $120 billion a year–cardiovascular disease, the largest cause of death–sexually transmitted diseases, occupational injuries, these preventable illnesses and injuries supporting research, training, and effort in those areas would have huge impacts on the lives of millions of people and would, in the end, be enormously cost effective.
The challenge that President Summers put to the Deans five years ago was to ask the question: "What 25 years from now, or 50 years from now, we would look back and ask, what should we have been doing in 2006 that would have made a real difference in the world 25 or 50 years from now?" We cannot forget the time wasted in the early years of the HIV epidemic resulting from our failure to address the problem with a full arsenal of weapons available, policy changes, traditional public health measures, funding, that now seem so short-sighted and tragic. Will we be saying the same 25 or 50 years from now about our inattention to obesity, preventable diabetes, and cardiovascular disease and injury?
We need your voices to champion the value of what CDC and we all in public health do and strive to do for the American public and the people of this world. Julie Gerberding’s leadership, courage to make institutional change and commitment to public service in public health in very challenging times, and deeds serve as an inspiration to all of us and I am honored and pleased to welcome her as your commencement speaker.
ADDRESS BY DR. JULIE GERBERDING
Dr. Gerberding: Congratulations! I love being the first one to say it. This is just a terrific honor for me to be here and to have a chance to address you on this very, very important day in your career. I also congratulate the parents and the families, the loved ones and the friends who come to witness this occasion. It really represents a wonderful milestone, and it represents, I think, the future of health in our country.
I have a little 3X5 card posted on my computer at work, and I look at it as often as I can because it reminds me of something very, very important and it’s very humbling. It says: "Leadership is a privilege." And it is a privilege. It’s a privilege to be here today and to have a chance to address you. It’s a privilege to be at Harvard, really one of the brightest hubs in the web of public health. I’m so pleased that CDC is a part of some of that web of excellence. I got a chance over the lunch hour to meet with people from the Centers of Excellence and Prevention Research, in Injury, in Public Health Preparedness, and in many other domains that are so vital to providing the science that we need to do the work that needs to be done domestically and internationally to protect people’s health.
It’s also a privilege to be here in a room where people actually know what public health is. This is not common and that’s one of the things we’ve all got to work on. Sometimes I think if we graduated from schools of health protection people would understand better that we were about health promotion, prevention, and preparedness.
Today, I got up this morning. I hadn’t quite finished my speech and I realized that it was probably time to get to it. So I did some things many of you would do on a daily basis. I got out my Blackberry; I searched the web for a couple of factoids that I needed to fill in a couple of blanks. I emailed my office to ask someone else to get on Wikipedia and look up a couple of things. We Googled for some information and just in a few seconds I could put my hands on the knowledge base of public health of the world because our world really has changed. Many of you have probably read the book, The World Is Flat, by Thomas Friedman. It’s a description about how the advances in communication and technology have created a whole new world of empowerment and opportunity on an unprecedented and global scale. It’s a world that allows us to do things in the global connected and fast way that even 10 years ago we couldn’t have imagined. Just think about this: Wikipedia, the online free, ever-evolving encyclopedia, gets 2.5 billion page views a month. Two million children in America have their own website. Twenty-nine percent of kids between kindergarten and third grade have an email address. A new blog is created every 7 seconds and the number of blogs online doubles every five months. There’s an exciting internet site called uTube which is where people can create their own videos and upload them so that anyone else can participate in their creativity, humor, and sometimes inappropriate conduct. Google hosts right now today 1 billion searches a day and it has the mission in mind of being the world’s repository and organizer of all knowledge. Ask yourself by the year 2010 how many Google users will speak Mandarin? And then think about the flat world in which we live.
This is an incredible change for us and I don’t think we have even begun to imagine what possibilities those changes have wrought. Nor have we really come to grips with the threats those changes may wrought. All you have to do is think about the SARS outbreak. SARS is a flat-world disease. It spread from a hotel in Hong Kong where one doctor carrying the virus had contact with a handful of travelers. And by the way, that doctor was staying in Room 911. Had contacts, somehow, that we have never been able to decipher, for 48 hours and over the next two weeks those handful of travelers took SARS to Hanoi, to Singapore, to Vancouver, to the United States, to Germany, and to many other countries of the world. A problem that was very local became an instant global threat in a very, very short period of time.
Imagine a flu pandemic in that context. Our connectivity means that pathogens can move at the speed of the internet, not at the speed of government.
We also live in a world where some of the flat-world opportunities have resulted in amazing and sinister capacities, such as those demonstrated by the terrorists in Canada or the terrorists who used a highly distributed network of information flow to plan and execute the 9/11 attacks. So the same tools that make us better are also the tools that can threaten us in new and alarming ways.
There’s another dimension to this flat world that we have to say and address and you heard Dean Bloom mention it and you will see evidence of it wherever you look in the world of public health and that is, the world is not flat for everyone, and it is not flat everywhere. And in particular, the world is not flat in the domain of public health and health protection. Let me just give you a few examples of the disparities that we experience: in this country among people with cardiovascular disease the risk of death is 30% greater in African Americans. Thirty percent of Caucasians have their blood pressure well controlled and only 18% of Hispanics. Neither of those statistics is particularly good, by the way. Of the new HIV infections in the United States, 50% are among African Americans, even though 12% of our population is African American.
These are very urgent realities, as the Dean described. They require our immediate attention, and they require a scale of an investment and energy that we have yet to muster. But they’re not experienced as urgent by most people. They’re common; they affect people on an ongoing basis and we have been experimenting with ways to make these threats in this unflat world feel more ominous.
So let me try this way: today, while you are sitting here, commencing, 4,100 Americans will be diagnosed with diabetes for the first time. Two hundred and thirty people will have a leg amputated because of diabetes. One hundred and twenty people will start dialysis because of diabetes and 55 people will go blind, because of their diabetes, today, while we’re sitting here.
This is not a problem just for adults. While we are sitting here today 1,400 preemies will be born in these United States, many of them because of lack of prenatal care and proper nutrition. Eight hundred and fifty kids will get exposed to unsafe levels of lead. Thirteen hundred children will sustain a traumatic brain injury, 1,300 teenagers will attempt suicide; 3,000 teenagers will get a sexually transmitted disease, 3,800 will take their first cigarette puff, 14 will die an a motor vehicle accident, and 176,000 of them will have diabetes.
It’s not just a domestic problem, either, of course. The world is unflat in the domain of health everywhere. In the world today, while we are here, 1,200 kids will die of measles and 1,300 kids will die of rotavirus infections, two diseases that are now vaccine preventable. Almost 4,000 people will die of malaria, 5,500 people will die of tuberculosis, 8,200 will die of HIV infection, and I think an astonishing 42 million people on this earth do not have clean water to drink.
So despite our communication and our technology and the amazing ability that we have to do the impossible, we have not even begun to address the problem of the unflat world of health. And I think that really is the challenge for the Public Health School Class of 2006. We can no longer exist in our categorical siloed world. We have to embrace and make visible and public the incredible urgent disparities that exist along the dimension of health. Our mission is to really try and use the communication and technology tools that we have to enable the flat world and apply them to protect and improve the health of the whole world. We need to achieve our common vision, that vision of the best possible quality of health for everyone, and especially people who are vulnerable to health disparities across their entire life span, wherever they are.
You as Harvard graduates, have some wonderful assets to contribute to this. You have a great education; you have great credentials; and the Harvard brand is everything. This is the closest I will ever get to a Harvard degree, and I am thrilled to be here. You also have great opportunities. You can open doors; people will listen to you because you are a Harvard graduate. You will have access to leaders and opportunities to change things in ways that many, many people across this country could only dream of.
But you do have some big challenges. And I’d like to just share with you what I think the most important overarching challenge is that you will face might be: the first challenge might be the hardest, and that’s the challenge of complacency. We live in a world that when the problem is big and it’s complicated, and it costs a lot of money to fix, that we prefer to bury our heads in the sand and not deal with it until something forces our hand. Now, by the way, I was on Wikipedia and I looked up, bury your head in the sand. Of course, a picture of an ostrich appeared and a very important fact was associated with that website: it said that there is a presumed behavior among ostriches of putting their head in the sand when faced with a predator. However, that behavior has never been observed. And in fact, if an ostrich stuck its head in the sand, it would suffocate. So when I thought about that, I realized that was a very wise web entry because of course, if you stick your head in the sand you suffocate and we need to learn from that lesson.
When I was watching Katrina organize itself off the coast of Florida last summer, I went to the web, and I found a wonderful science article in The New York Times describing the consequences of a Category 4 hurricane striking the Gulf Coast and the city of New Orleans. It was a brilliant description of what would happen with the levees, with the flooding, the problems of evacuation, and basically turning the entire zone into a flood plain. The interesting thing was the article was written in 2002 and no effective action was taken between the time that this was widely distributed throughout the world and the time that Hurricane Katrina struck. That is an example of complacency in action. And I can name 100 examples of that, including the urgent realities that I mentioned earlier. But there is something that you can do when you see a big problem. You have a Harvard degree; you obviously have a lot of passion, and you have a voice. And we need your voice to point to these areas of complacency and identify the opportunities for initiative because when they are identified and when the voices speak together in one voice, things really can change.
We are seeing the beginning of that with the interest in pandemic flu preparation. Now I will warrant you that we’ve been working on pandemic flu for a long time in the public health community, and it’s only when the H5N1 virus sent an imminent signal of potential threat that things began to scale up and speed up. But nevertheless, complacency can be overcome with leadership, engagement, and the attention of the whole network and community of responders.
The second challenge you have is the challenge that I refer to as capacity, some might say, scalability. It’s easy to do one project but in the words of Richard Klausner who chairs, or at least did chair, the Gates Foundation Global Challenge Fund, to solve big problems takes more than one person and more than one project, and we have got to learn how to scale our efforts commensurate with the scale of the threats that we’re facing. That scalability is something that we’re, again, just beginning to learn. We’re learning it with pandemic flu planning; we’re learning how hard it will be with the threats that face people every day.
But let’s just think about global HIV infection. Right now, the scale of HIV on a global basis is enormous, and it is going to take a very large-scale [effort] to turn the tide. UNAIDS reported this year that maybe, for the first time since the epidemic began, there was not an increase in the incidence of the disease and that perhaps it would be possible to imagine the day when we would truly see a measurable reduction. But that tiny little hopeful sign is only in the context of an unprecedented scale investment--the U.S. Government’s PEPFAR Fund, the Global Fund, the Gates Foundation, the Bilateral Support for Multiple Ministries of Health around the world, private sector support, faith-based support. We’re making the largest investment we’ve ever made, and we are just barely having an impact. The scale that will be required to solve a big problem like this is enormous. And as the Dean said, what a difference it would have made if we had made the same investment 25 years ago, we wouldn’t be sitting here today, looking at the number of deaths that we see.
The last challenge is the one that brings me full circle to the flat world and that really is the challenge of connectivity. And I don’t mean just being able to go on the internet and Google someone or blog someone. I mean the challenge of bringing together more than just the traditional public health partners. We’re very good at talking amongst ourselves. We understand each other; we know our culture; we know what we can do, what we should do, what we must do. But we can’t do it alone, in part because alone, we can’t overcome complacency and we can’t scale effectively. But we need to learn how to build a connectivity that includes people who are not like us, people in business, people in the faith-based sector, people in the health care delivery system, people who are the bill payers, people in government, people in governments that we don’t even like to talk about. We need to get all of the relevant parts of the health system to connect in powerful ways so that we can collaboratively scale and solve these big problems. And there is one absolutely essential requirement to our capacity to do this kind of scaled collaboration. I learned it here at Harvard. It’s the concept of meta-leadership. Now Dr. Marcus and David Gergen in the Kennedy School have put together something called the Public Health Leadership Institute to help government leaders figure out how we can work together better in times of national catastrophe. And I’d say they have their work cut out for them. But this concept of how you lead a network of people is absolutely the most important part of that learning experience. What we mean by meta-leadership is not just the ability to lead your organization. And that’s challenging. It means being able to lead somebody else’s organization when you don’t have control over their budget or their FTEs or their space. In order to do that you have to negotiate, you have to understand their priorities, their agenda, and you have to think about, how can you overlap these two worlds and create a whole that is greater than the sum of its parts. You need to be synergistic. That is very hard and it is particularly hard in an academic model where the tradition is one usually of competition, not collaboration. But as we understand the imperatives, the challenge of building connectivity and leading connectivity with leaders who are enlightened and understand that we need to think vertically but act horizontally, really will become the determiner of our success.
And I think those three challenges, the challenge of complacency, the challenge of capacity, and the challenge of connectivity are all intersected in ways that bring you, as the leaders who will have to solve these big problems, right to the forefront. You’ve had many experiences working in these dimensions at Harvard and I hope that when you leave here today, you leave with the concept of the kind of connectivity that you will always maintain with each other because I can tell you something–I know the brain power to solve these problems is here in this room today. You’ve got an extraordinary faculty, one of the most talented global classes of brilliant young people will ever be privileged to stand in front. So don’t ever lose that vision, and no matter what you contribute to the network, be sure that you put the highest priority on your unique role and your responsibility as a meta-leader. Because that will make all the difference.
So let me again just end by congratulating you, to saying what a privilege it is to be here and be part of your commencement and also, to say that I look forward to seeing you in the flat-world of public health in the future. Thank you.