Joining CSIS soon after graduating from Bennington College, Brundage quickly moved into high-level policy work, including briefing members of Congress on global health issues and leading a commission whose work was cited in a speech by Secretary of State Hillary Clinton as a convincing argument for U.S. engagement in the world.

Although she loved her job, Brundage began to feel pulled toward helping the U.S. health care system become the best it could be. “The global health community has so much energy and creativity behind it,” said Brundage, who is earning her degree in health policy and management. “Seeing how diverse groups were coming together to reduce health disparities globally always made me think about what could be done domestically in places like the Mississippi Delta, parts of Appalachia, or in inner-city low income neighborhoods.”

In order to gain more insight into how health systems work, she decided to pursue a degree in public health.

During her first year at HSPH, Brundage had the opportunity to take the final course taught by William Hsiao, K.T. Li Professor of Economics, who has assisted the state of Vermont, as well as China, Mexico, and other countries in their health systems reforms. “He was very inspiring,” Brundage said. “He spoke a lot about how important it is to be really passionate about what you’re doing, to have a very ethical approach to your work and to be driven by the desire to do good in the world.”

She has also conquered her fear of economics and discovered a new passion that brings together many of her interests: improving the quality of children’s health care.” During Winter Session, Brundage traveled to Wyoming to evaluate maternal and child health home nursing programs as part of a course jointly offered with the Centers for Disease Control and Prevention. This summer, she will intern with Nationwide Children’s Hospital in Columbus, Ohio in the Center for Pediatric Innovation.

And as she heads into her second year, Brundage is feeling well-versed in the language of domestic health. “I’ve become more comfortable talking the talk, and also understanding where my past experiences in global health apply.”

— Amy Roeder

Photo: Aubrey La Medica

For the weekend, Harold Parker State Forest in North Andover, Mass., was transformed into a Sub-Saharan border region beset by extreme weather, food shortages, and militia violence. Students were assigned to teams representing non-governmental organization such as CARE and Save the Children, and worked to develop a plan to provide services for the region’s refugees. The goal of the simulation exercise is to prepare students to work in crisis situations such as the aftermath of the 2010 earthquake in Haiti.

— Amy Roeder
Photos: Aubrey La Medica

Now Tontz—most recently chief of aerospace medicine at Mountain Home Air Force Base in Idaho—is slated to earn an MPH in health policy and management from Harvard School of Public Health (HSPH) in May 2013. He hopes the degree will help him develop strategies that promote better health among the pilots and their families who are his patients. He also plans to use what he learns at HSPH about health care policy and management to implement smarter, more efficient health care systems for the Air Force.

“The idea of a leaner, more efficient military machine is the future,” Tontz said. “We have great medical systems in the Department of Defense and the Veterans Administration, but how to better integrate the two is a work in progress.”

Tontz said he decided to concentrate on health policy at HSPH “to learn from the great policy minds like Professors [Robert] Blendon and [Nancy] Turnbull and leadership gurus like Drs. [Barry] Dorn and [Leonard] Marcus.” He added, “With all of the changes in health care going on in the civilian world, military health care has to keep up and stay current. I wanted to know more about policy so that I can better understand what goes on ‘at the big table’ where the decisions are really made.”

Tontz, a board-certified family medicine physician, said he’d like to help ensure that he and other Air Force health care providers “have enough time with our patients to be able to establish strong relationships—like those of the general practitioner, who used to know your kids, your family, your medical background. People have to come first. The more efficient our practice of medicine becomes, the safer and more personal our care can be.”

A long line of veterans

Tontz came to HSPH as part of the U.S. Air Force’s Residency in Aerospace Medicine (RAM), a three-year program that includes a master of public health, a year of aerospace medical training, and a year of either occupational or preventive medical training. As soon as he finishes at HSPH, Tontz, his wife Kara and their two young children will head to Wright-Patterson Air Force Base in Dayton, Ohio so that he can complete the remainder of the RAM program. “The physicians that come through this program become the medical leaders of the Air Force,” Tontz said.

Tontz comes from a long line of military-trained health care providers; he grew up on military bases. His grandfather was a pediatrician in the Navy during World War II. One uncle was a Navy orthopedic surgeon, and his father and another uncle were both Navy dentists. Tontz jokingly said he chose the Air Force instead of the Navy because he “didn’t want to be stuck on a ship and the Air Force had better golf courses.”

Creating deeper understandings

Tontz chose HSPH from among several top public health schools partly for its reputation. He was impressed with Harvard’s history of training military physicians. And he is grateful for the university’s visible acknowledgement of the contributions of its military veterans, demonstrated by commemorative plaques around the campus, President Drew Faust’s publicly voiced appreciation for military service, and her reinstatement of ROTC on campus. “To see how Harvard appreciates its veterans is phenomenal,” he said.

Tontz said studying at HSPH has broadened his views about health care and has given him the “great opportunity to share in this culture of diversity.” Likewise, he has been able to share his own experiences with fellow students—and perhaps broaden their views as well.

One fellow international student told Tontz that his previously negative ideas about the U.S. military softened after meeting him. “I have to say, that has to be the biggest compliment I’ve received here at Harvard,” said Tontz. “Wearing a uniform you are always on display. I am very happy to have gained the respect of this international classmate of mine, and hope he and my other classmates understand a little better how much we in the military do care about the public’s health.”

– Karen Feldscher

photo: Aubrey LaMedica

This is just one example of the importance of “translational epidemiology,” Moyses Szklo told a Harvard School of Public Health (HSPH) audience in Snyder Auditorium on May 1, 2013. “It’s terribly important for epidemiologists to get involved with policy,” he said.

Szklo’s talk—the 157^th Cutter Lecture on Preventive Medicine—was titled “Semantic and Other Challenges in Translational Epidemiology.” Szklo is professor of epidemiology and medicine in the Department of Epidemiology at Johns Hopkins University. He is also principal investigator of two of the largest cohort studies of atherosclerosis (hardening of the arteries) and has been editor-in-chief of the American Journal of Epidemiology since 1988.

The Cutter Lecture is named for John Clarence Cutter, a graduate of Harvard Medical School, who left a bequest to Harvard to support a lecture series on preventive medicine. The first Cutter lecture was delivered in March 1912. The lectures are administered by HSPH’s Department of Epidemiology.

Defining translational epidemiology

Epidemiology is the study of patterns, causes, and effects of health in defined populations. Szklo defined “translational epidemiology” as the effective transfer of new knowledge from epidemiologic studies into the planning of population-wide and individual-level disease control programs and policies.

In addition to Snow’s famous work, Szklo cited a number of other public health policies influenced by epidemiologic findings, including cigarette advertising bans, food labeling requirements, and air pollution standards.

Szklo also discussed a variety of issues to think about when “translating” epidemiologic knowledge into interventions, programs, or policies. For example, he said, it is important to consider whether or not a particular association between one risk factor and a disease is “confounded”—if it is to some extent questionable because there are one or more other risk factors also at play.

“Translational epidemiology is not an exact science,” Szklo noted. “It’s judgment.”

In a question-and-answer session at the end of the presentation, HSPH’s Walter Willett, chair of the Department of Nutrition and professor of epidemiology and nutrition, asked what Szklo thought of the notion that epidemiologists should not become involved in policy because it makes them less objective in evaluating their data.

Szklo acknowledged that while such involvement might pose a problem, “I don’t think it’s possible to talk about development of [health-related] policies without strong input from epidemiologists.”

– Karen Feldscher

photo: Aubrey LaMedica

Lu’s work focuses on understanding how complex gene-environment interactions contribute to the development of human diseases. His current research addresses the regulation of cell surface receptors and how environmental exposures perturb receptor signaling and normal physiology.

Armen Tashjian was professor of toxicology, emeritus, in the Department of Genetics and Complex Diseases. He led the School’s toxicology program for nearly three decades. The Tashjian Research Award recognizes promising young faculty members and fellows at the School who are pursuing innovative research ideas in basic biomedical sciences.

There are too few opportunities for high school students to learn about public health and engage with professionals in the field, according to conference co-directors Claire Perkins, SM2 Health Policy and Management, and Jason Park, SM2 Epidemiology, student ambassadors for the Office of Diversity. “When most high school students think of jobs in health care, they only think of physicians and RNs. It is time we change that!” Perkins said.

“Public health often goes unrecognized,” keynote speaker David Hemenway, professor of health policy and management and director of the Harvard Injury Control Research Center, told the students. He compared the work of public health professionals to that of the nearly invisible elves in a popular children’s storybook who churn out shoes for a shoemaker while the shoemaker sleeps.

Hemenway described for the attendees some key public health advances over the last century. As one example, he told how deaths and injuries from car accidents have declined considerably since the introduction of safety enhancements such as the designated driver campaign (launched in the U.S. by HSPH to curb drunk driving), seat belts, driver education, safer car interiors, and highway speed bumps.

Public health is more prevention-oriented than traditional medicine, which is more geared to treating sick patients, Hemenway said. “The focus in public health is making sure people don’t get sick or injured,” he said. He described his passion for his own work in injury and violence prevention. The students appeared surprised to learn that among youth ages 12-19 in the U.S., the major killer is homicide, not disease.

Monica Wang, instructor in HSPH’s Department of Social and Behavioral Sciences, encouraged the students to start volunteering for local public health initiatives, ranging from Sociedad Latina, which works in partnership with Latino youth and families to end destructive cycles of poverty, health inequities, and lack of opportunity in the Boston community, to the Boston Collaborative for Food and Fitness. Ian Lapp, associate dean for strategic educational initiatives at HSPH, gave students an introduction to public health.

A number of HSPH students discussed public health specialties. They included Lear Brace, Lucas Chartier, Suzanne Brundage, Iny Jhun, Phillips Loh, Andrea Lopez, Perrine Marcenac, Natalie Meyers, Aaron Pervin, Sebastian Rodriguez, Nakul Singh, Rachel Susaneck, and Susan Tuite.

Following the talks, HSPH students Pervin, Chartier, Lopez, and Ali Chisti led students on tours of the School and the Longwood Medical Area.

Fenway High student Jude Baptiste said before the event he didn’t know much about public health. After hearing some talks he said, “I’m impressed by the emphasis of public health on prevention.”

– Marge Dwyer

The study appeared March 27, 2013 online in Nature Communications. Senior authors were Manoj Duraisingh, associate professor of immunology and infectious diseases, and Caroline Buckee, assistant professor of epidemiology at HSPH.

“We are excited to be able to culture this parasite for the first time in human red blood cells, but also to explore the population-level implications with mathematical models,” said Duraisingh. “This study identifies a likely mechanism for virulence evolution of a recent human parasite.”

The study is the first to provide a mechanistic explanation of the virulence of Plasmodium knowlesi, a macaque malaria parasite. This parasite usually proliferates poorly in human blood because it prefers only the youngest of red blood cells. (Red blood cells live for three months in the bloodstream.) But after studying the parasite in the lab and using mathematical modeling—an interdisciplinary approach that brought together experts in epidemiology and immunology and infectious diseases—researchers showed that, over a four-month period, the parasite can develop the ability to replicate efficiently in older red blood cells as well.

The parasite’s ability to adapt over time to thrive in older red blood cells as well as young ones—an adaptation with a likely genetic origin, the researchers say—may make P. knowlesi increasingly dangerous for humans. High levels of the P. knowlesi parasite in the blood could cause individuals to develop severe and possibly lethal malaria. High blood parasite levels also increase the risk that P. knowlesi could become a human-to-human pathogen. Given these findings, P. knowlesi in humans should be closely monitored in the future, the researchers said.

While cross-species transmission of malaria parasites is rare, human activities in Southeast Asia such as logging and farming have led the macaque malaria parasite to become a “zoonosis”—an infection that jumps from animal to human. “The public health importance of zoonoses is increasing as habitat destruction and climate change continue to expose human populations to pathogens of wild animals,” Duraisingh said.

By providing the first mechanistic explanation of the virulence of P. knowlesi, this study generates a good working hypothesis for why some individuals suffer from severe disease with this strain. “Our model suggests that this type of adaptation could be an important determinant of virulence for other malaria parasites as well, including Plasmodium falciparum, the type that causes the most deaths,” said Buckee.

The team was also able to create new ways to culture the P. knowlesi parasite in the lab, which will enable further study of the parasite’s biology. “This work provides an important model system for studying malaria,” Duraisingh said. “The parasite can be grown in human red blood cells and be widely accessible to the malaria community.”

– Karen Feldscher

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It got Chisti thinking long and hard about health care access and inequities—and led him to take a break from medical school to study health policy and management at Harvard School of Public Health (HSPH).

Volunteering at a rural clinic

Chisti’s friend could have gone instead to the Bandon area’s safety-net health center—the Waterfall Clinic, which offers reduced rates based on financial need—but the friend didn’t know about it because it had no website and the phone line frequently gave a busy signal. Chisti later learned that the clinic was also critically short on providers and had no system in place for referring uninsured patients to outside doctors or specialists.

Chisti volunteered to help the clinic. “I realized I had the opportunity to impact the lives of my neighbors and friends by helping develop improved health care access and resources in rural Oregon,” he said. For the rest of that summer, Chisti helped the clinic build a website, http://wfall.org, which he still maintains, and laid the groundwork for a referral network of both physicians and dentists.

He returned to the Bandon area the following summer to work at the Bandon Community Health Center, as part of the Oregon Rural Scholars Program. The program, run by the Area Health Education Center of Southwest Oregon, provides grant support for students pursuing health care careers in rural areas.

Broadening his scope at HSPH

At HSPH, Chisti has gained valuable skills—both in classes and beyond. He learned how to evaluate a clinic’s finances in an accounting class with Howard Rivenson, senior lecturer on health management. And Chisti plans to use skills gained in a class on qualitative methods in program evaluation, taught by Kate Baicker, professor of health economics in the Department of Health Policy and Management, to evaluate the impact of an anti-smoking/drugs education program for 6^th-8^th graders he helped develop in Coos County, Oregon in 2011.

Outside of class—prompted by an interest in improving access to cancer care—Chisti did a practicum with a Harvard-affiliated organization called Global Oncology (GO), aimed at improving cancer care and research in resource-limited parts of the world. Chisti helped the group’s website become a platform where volunteers can manage and collaborate on cancer projects. He worked with a Harvard Medical School student to organize a March 28, 2013 talk about cancer care in southern Africa. And at a recent MIT “hackathon” focused on international development—a 28-hour, round-the-clock event that teamed Boston-area programmers with nongovernmental organizations looking to solve particular problems—Chisti helped with GO’s effort to create a crowdsourced interactive map of cancer care outreach around the world. His team won an innovation award from athenahealth, a Watertown-based health services company that cosponsored the hackathon. Now the GO team is developing the platform as a resource to align the global cancer efforts of federal government agencies, university medical centers, and community-based organizations or NGOs. Chisti hopes to use similar mapping software back in Oregon to document public health efforts throughout the state.

Chisti is now considering specializing in oncology when he returns to his final year of medical school in the fall. He hopes to one day join the faculty at Oregon Health and Science University and become a physician leader in public health.

For the near future, though, he’ll pursue an internal medicine residency once he receives his medical degree. “That way,” he said, “I will be able to see patients from the moment they enter the health care system and guide them through to get the care they need.”

– Karen Feldscher

photo: Aubrey LaMedica