Frontlines Spring/Summer 2011
Quick updates about the latest public health news from across the School and beyond.
An Idea That Will Change the World
In its March 17, 2011 issue, Time magazine called the concept of the “demographic dividend”—pioneered by David Bloom, Clarence James Gamble Professor of Economics and Demography, and chair of the HSPH Department of Global Health and Population—one of the “Ten Ideas That Will Change the World.” The “demographic dividend” is the economic boost that countries can receive when they shift from high rates of fertility and mortality—women having lots of children, many of whom die young—to low birthrates and longer life expectancies. When this demographic transition is taking place—thanks to improvements in health and other forces—the resulting temporarily large share of working-age people can, under the right circumstances, fuel a strong economic transition as well. Others at HSPH who have contributed to the development of this idea include David Canning, Günther Fink, Jocelyn Finlay, Salal Humair, Larry Rosenberg, and Jaypee Sevilla. Learn more
Clooney and HHI Shine Light on Civil Strife in Sudan
Casting light on the potential for disaster in strife-torn Sudan, actor George Clooney’s human rights organization, Not On Our Watch, collaborated earlier this year with Harvard’s institution-wide Harvard Humanitarian Initiative (HHI) on a new human rights initiative called the Satellite Sentinel Project. The project analyzed near real-time satellite imagery and crowd-sourced data to monitor potential human rights violations following Sudan’s January referendum on independence for oil-rich southern Sudan. Also participating are the Enough Project, the UN, Google, and others. This was the first major effort to monitor security threats along a geographic border to help prevent humanitarian disaster. Averting civil strife has wide public health implications—including heading off civilian injury, disease, malnutrition, starvation, and the disruption of crucial NGO services. Learn more
Is Medical Liability a Major Cost Driver or Not?
It’s hard to separate fact from fiction when the fiction is loudly trumpeted while the facts remain scarce. In the case of the U.S. medical liability system—and its impact on overall medical costs as part of the health care reform debate—Michelle Mello, professor of law and public health at HSPH, and other researchers analyzed how much malpractice insurance overhead expenses, claims, legal fees, and “defensive medicine” tactics actually add to health care costs. Their research, published in the September 2010 Health Affairs, showed that these costs totaled just 2.4 percent of annual health care spending—suggesting that we must be, in Mello’s words, “realistic about what medical liability reform can achieve in terms of health care cost control.” That 2.4 percent is still $55.6 billion a year, Mello notes, “so there are good reasons to want to improve it” as well. Learn more
Reinventing the Wheel: Biking for Weight Control
Biking’s not just for fun anymore, according to a new study by HSPH researchers. Their research suggests that bicycling is also a good tool for premenopausal women looking to control weight—so good, in fact, that as little as five minutes of biking a day helps curb weight gain, though more bicycling is better. Brisk walking can do the trick, too. Slow walking, not so much. The study appeared in the June 28, 2010, Archives of Internal Medicine. Learn more
Mending A Broken System: Hsiao Proposes Single-Payer Plan to Vermont
Vermont’s governor and state legislature asked an HSPH faculty member to help them overhaul their health care system—and William Hsiao, K. T. Li Professor of Economics at HSPH, enlisted a team of graduate students to help him in this monumental task. In January, Hsiao reported his team’s findings and presented to a joint session of the legislature three alternative health plans for Vermont lawmakers to consider: single payer, a public option, and a reform plan of his own design. In March, he published an article in the New England Journal of Medicine explaining that his team of health system analysts found that “the system capable of producing the greatest potential savings and achieving universal coverage was a single-payer system.” Vermonters are considering their next steps. Stay tuned. Learn more
Diabetes and Depression: A Two-Way Street
Does type 2 diabetes lead to depression? Or does depression lead to type 2 diabetes? Yes, and yes. According to researcher Frank Hu, professor of nutrition and epidemiology at HSPH, the two conditions are “both the causes and the consequences of each other.” Hu and fellow researchers followed 65,000+ women ages 50 to 75 in the Nurses’ Health Study based at Brigham and Women’s Hospital over a 10-year period and confirmed the strong link between these two serious, often debilitating conditions. Even accounting for risk factors for diabetes and depression frequently found in both groups—such as overweight and inactivity—the link held. The research was published in the November 22, 2010, Archives of Internal Medicine. Learn more
Time for a Gut Check
Inflammatory bowel disease (IBD), in forms such as Crohn’s and ulcerative colitis, creates chronic misery for more than 1 million Americans—and increases sufferers’ risk of developing colorectal cancer. HSPH researchers, led by Wendy Garrett, assistant professor of immunology and infectious diseases, have identified specific species of microbes that appear to work together with microbes living in the gut naturally to inflame the colon and lead to IBD. They are also studying how microbial communities not only contribute to IBD and cancer but also how microbes can be used to treat these diseases. Some of their recent work was published in the September 16, 2010, issue of Cell Host & Microbeand the October 19, 2010, issue of PNAS. Learn more
Combination Drug Raises Hope for Babies and HIV-Positive Moms in Africa
In Africa, HIV-infected pregnant women face a life-or-death dilemma: the standard medication that helps prevent HIV infection in their newborns raises the risk of the mother’s own drug-resistant infection later on. Shahin Lockman, assistant professor of immunology and infectious diseases at HSPH, has found a way to sucessfully treat African mothers with AIDS who’ve previously received the antiretroviral (ARV) drug nevirapine during labor. Lockman and other HSPH researchers have identified other, more successful combinations of ARVs to use instead of the standard nevirapine-based treatment, giving moms a better chance of fighting their own HIV/AIDS after giving birth. Their findings, together with a second report by a team from HSPH and Dartmouth, have led the World Health Organization to change its guidelines for treating HIV infection in certain women and children. The two studies, and an editorial, appeared in the October 14, 2010, New England Journal of Medicine. Learn more
Lifting HIV/AIDS Patients’ Depression Improves Odds for Treatment Success
It’s well known that many HIV/AIDS patients suffer from depression. What’s surprising is the extent to which their depression is “massively underdiagnosed and undertreated,” says Alexander Tsai, psychiatrist and Robert Wood Johnson Health and Society Scholar in the Center for Population and Development Studies at HSPH. Tsai led a team of HSPH researchers studying people living with HIV/AIDS in San Francisco. The team’s work provided the first confirmation that receiving antidepressant medication helps many people living with HIV/AIDS take their antiretrovirals faithfully, which in turn is critical for suppressing the virus. The study appeared in the December 2010 Archives of General Psychiatry. Learn more
Off the Cuff: Walter Willett, Chair, HSPH Department of Nutrition
Q: How would you improve the USDA 2010 Dietary Guidelines for Americans?
A: The guidelines took baby steps in the right direction. For example, they are very clear about what foods should be increased: whole grains, fruits, and vegetables. They also said we should reduce refined grains—but the ideal diet would have almost no refined grains in it, because refined grains convey calories we don’t need, have adverse metabolic effects, and contribute to weight gain and heart disease and diabetes. The guidelines also recommend low-fat dairy and low-fat red meat—but they don’t say to eat less of the regular versions of red meat and dairy. One of my colleagues who’s a senior government official said, ‘You can talk about reducing red meat consumption, but if we say that, we’ll have senators from half a dozen western states on our doorsteps the next morning.’ Dairy is probably the area with the most controversy and complexity of the evidence. The major justification for consuming large amounts of milk—three servings a day—is that it will reduce bone fracture risk. But there is, in fact, no evidence that consuming more milk reduces fracture risk. The requirement of 1,000–1,200 mg of calcium a day for adults is almost certainly too high.
Get more advice on healthy eating from HSPH’s The Nutrition Source.
Guns & Politics: David Hemenway Takes Aim at Gun Violence
David Hemenway is Professor of Health Policy and Director of the Harvard Injury Control Research Center. He is also the author of Private Guns, Public Health, which describes the public health approach to reducing firearm violence, and While You Were Sleeping: Success Stories in Injury and Violence Prevention, which portrays more than 30 heroes who have made the world safer.
Q: We’ve had a series of high-profile mass shootings recently in the U.S. What policies might prevent these assaults?
A: Many simple and sensible policies could help prevent and reduce the harm from these attacks. Every one of the more than two-dozen nations considered “high-income” by the Organization for Economic Cooperation and Development has figured out a way to have fewer of these shootings than the United States. For starters, you don’t let people buy guns with high-capacity magazines that allow them to fire scores of bullets without reloading. You make it very hard rather than very easy for questionable people such as the Tucson and Virginia Tech shooters to gain access to firearms. For example, you can have serious background checks. The Tucson shooter would never have passed a comprehensive background check because of past drug use, or been readily granted firearms by most other developed nations.
A Molecular Switch for Aging
As we get older, why do our bodies tend to “turn off” cellular processes that protect against metabolic diseases like type 2 diabetes or heart disease? Chih-Hao Lee, associate professor of genetics and complex diseases at HSPH, along with graduate student Shannon Reilly and other colleagues, has discovered the off switch: it’s the protein SMRT. In studies on aging animals, SMRT switched off the protective work of certain other proteins called PPARS that help our bodies burn fats and reduce damage from oxidants. These findings, published in the December 1, 2010, edition of Cell Metabolism, may open doors for new drug treatments to stop or slow the development of metabolic disease. Learn more
Frenk and Knaul featured in Science
HSPH Dean Julio Frenk is featured in Science magazine’s March 25, 2011, special issue on the “Cancer Crusade at 40.” The article, “A Push to Fight Cancer in the Developing World,” highlights the work of Frenk and his colleagues on the Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries to move cancer up on the global health agenda. The article also features Felicia Knaul, who leads the Task Force Secretariat and is director of the Harvard Global Equity Initiative. The profile describes her experience as a woman living with cancer and global advocate for expanded access to cancer care, and Frenk and Knaul’s work as a couple. Learn more
South Africa’s Health Minister Speaks on AIDS
In South Africa, “HIV is a disease suffered by women but caused by men. Most of the young girls who are HIV positive are actually orphans. It becomes a vicious cycle. You’ve got women dying of AIDS and leaving their children alone. They become vulnerable to older men with money because they cannot survive. We’ve got lots of orphans who are developing HIV because they had sex at an early age with a married man. That’s a problem we are struggling with.”
—The Honorable Dr. Aaron Motsoaledi, MBCHB, Minister of Health, Republic of South Africa, delivering a Dean’s Distinguished Lecture at the Harvard School of Public Health on March 30, 2011. Learn more