HPH NOW, June 16, 2004, HSPH Commencement

Speeches Sound Theme of Widening Gaps in Health and Social Disparities


Paul Farmer

A global outcome gap–in which there is an ever-widening disparity between wealthy and poor countries in access to the benefits of science and other resources–is the biggest problem facing public health practitioners today, said medical anthropologist and physician Paul Farmer, in a sometimes humorous but always passionate address offered at HSPH Commencement on June 10 in the Kresge Courtyard.

Farmer is an attending physician in infectious diseases and chief of the Division of Social Medicine and Health Inequalities at Brigham and Women’s Hospital. He is The Maude and Lillian Presley Professor of Social Medicine at HMS and the medical director of a hospital, the Clinique Bon Sauveur, in rural Haiti.

A webcast of Commencement is available at
www.hsph.harvard.edu/commencement2004/
webcast.html.


	Dean Barry Bloom

HSPH Dean Barry Bloom opened the ceremony, noting that among 413 graduates, 54 percent were women. Reflecting the School’s international public health interests, 31 percent of this year’s graduates come from 48 different countries.

Each year, Dean Bloom noted, he meets with students to ascertain in their view what the School does well and areas for improvement. "Invariably, every year and in every meeting, the best thing in the students’ perception about the School of Public Health is the other students here. They are such an extraordinary group of people." He highlighted the accomplishments of a few students from the talented class of 2004, including Ondrej Mach, who will join the CDC’s epidemiology intelligence survey program, and Annemarie Sparrow, who has won a Millennium Award and will work with an HSPH alumna in the area of humanitarian assistance.

"Each and every one of our students has a special contribution to make, and it is a privilege to get to know so many of you," said Dean Bloom.


	Jillian Catalanotti and Andrew Michael James Cavey

Establishing a theme about health and global disparities that Farmer would continue, Dean Bloom described numerous startling facts. While the average life expectancy in the U.S. is about 77 years, the average life expectancy in eight other countries now languishes at under 40 years. Statistics are also discouraging within the U.S. According to the Global Burden of Disease Study, initiated by Christopher Murray, Richard Saltonstall Professor of Population Policy, life expectancy for Japanese-American women in Bergen County, NJ, for example, is 88 years, but across the Hudson River in the Bronx, African-American men can expect to live only 61 years.

"Our greatest challenge in public health, I believe, focuses on the disparities in health within this rich country and between countries of the world," said Dean Bloom.


Annemarie Sparrow (l) and Geetanjali Datta

Echoing Dean Bloom’s concern, Farmer–whom Dean Bloom called "the poor people’s doctor" and a man with "a passion for lost causes"–cited the extreme seriousness and dire consequences of inequities, whether experienced locally or transnationally. The growing outcome gap is related to an income gap, said Farmer.

"Even scientific progress threatens to be undone by global inequality and a commensurate failure to invest in protecting the health of the poorest," Farmer said. "Those with access to the fruits of science live longer and healthier lives, while those without lead shorter and more painful ones. AIDS has sped up the process. We can see how fast and miserably the medical have-nots can die."

Author of more than 100 scholarly publications, Farmer is an expert on the treatment and control of tuberculosis. He has spent much of the last 20 years working in the world’s poorest countries, building community-based treatment programs, most often for AIDS and multi-drug resistant tuberculosis.

Addressing the students, he added: "You are called to ask hard questions about the real incompatibility between violence–including war–and public health, between unfettered accumulations of wealth and persistent poverty. Asking these questions might not win you any popularity contests, but public health practitioners are called to stand with the sick, and those who might become sick."


	Katarina Mucha (l) and Martha Hunt receive an award from James Ware, Dean for Academic Affairs

Farmer cited three primary issues that current and future public health practitioners will face. One is social justice. "We need an equity plan if we are to get life-saving interventions to those who need them most." Public health, he observed, is well suited for such a task. He said: "No one framework will lead us through the quagmire of terrorism; Iraq; the proper treatment of prisoners in this country or in any other; the need for national health insurance," he said. "There is no single compass for as diverse an endeavor as public health as you will practice it across this broad world."

Second, he urged graduates to find alternatives to what he sees as the "balkanization" of medicine and public health. "By integrating prevention and care, we make common cause between clinicians and epidemiologists; policymakers and scientists; activists, patients, and health researchers; [and] the rich and poor."

Third, public health practitioners must fight for more resources, Farmer asserted. He called upon public health practitioners to identify and use what he called "weapons of mass salvation," such as vaccines, sanitation efforts, and new medical technologies. He said, "There are enough resources on this planet to do the job and do it right."

He concluded: "We are going to have to pull together to develop an equity plan that is worthy of our weapons of mass salvation and the world’s great need for them. You are the generation charged with this task, and all of us here wish you well as you remake the world before it is too late."


Richard Allen

Student speaker and doctor Richard Allen, MPH ‘04, used a vivid metaphor of a car accident involving a pedestrian for how prevention can make a difference in the world. At the corner of Longwood and Brookline Avenues recently, Allen witnessed a pedestrian get hit by a car, flying into the air and landing with an injured and bloodied face. He and two other doctors who happened to be nearby ran to the woman. What could have prevented the accident, he asked himself–wider sidewalks, better driver education?

Public health, too, must consider how to prevent catastrophes. The speeding car in his analogy might stand for SARS, cancer, or poverty, he said. In providing treatment after the fact, the well-intentioned doctors, who included himself, could represent, "our flawed medical system, whose foundation is not prevention."

He said to his classmates, "You can stop the speeding car of disease and make safer the world where we stand–in whatever capacity you might serve, and I know you will."


	M. Cristina Leske

Allen queried whether the cost of tuition would have been better spent on helping to purchase much-needed AIDS treatment or food for poor families. But no, he asserted, investing in a public health education will reap far greater benefits than a finite donation. The skills and tools of research and prevention he and his classmates have learned might one day underpin efforts to save millions of people.

M. Cristina Leske, MPH ‘66, brought greetings from HSPH alumni. She is professor and chairman of the Department of Preventive Medicine at the School of Medicine for the State University of New York at Stony Brook.

Recalling the day she entered HSPH as a student from Chile, she said that she would forever be grateful for the "friendly and supportive new home [she found] among faculty, and [for the] kinship of purpose among students."


Public health messages on a mortarboard.

She said, "As future leaders, persevere in accomplishing the School’s mission in advancing public health. Let your path be led by public service."

Dean for Academic Affairs James Ware presented several special awards. Dr. Lachlan Forrow presented the Albert Schweitzer Award. For the list of winners, see below.

--PHC

Teaching, Mentoring, and Student Awards

Roger L. Nichols Excellence in Teaching Award: Yi Li of the Department of Biostatistics

Faculty Teaching Excellence Citations: Ichiro Kawachi of the Department of Society, Human Development, and Health; Richard Levins of the Department of Population and International Health; and Michelle Mello of the Department of Health Policy and Management

Teaching Assistant Award: Michael Reddy, Research Assistant in the Laboratory of Public Health Entomology in the Department of Immunology and Infectious Diseases

Mentoring Awards: Sue Goldie of the Department of Health Policy and Management and Karen Kuntz of the Departments of Health Policy and Management and Biostatistics

Albert Schweitzer Award: Geetanjali Datta, SD, Epidemiology, and Annemarie Sparrow, MPH–International Health

Student Recognition Award: Jillian Catalanotti, MPH–Family and Community Health

Dr. Fang-Ching Sun Memorial Award: Annemarie Sparrow, MPH–International Health

Gareth M. Green Award for Excellence in Public Health: Martha Hunt, MPH–Family and Community Health, and Katarina Mucha, MPH–Family and Community Health

Charles F. Wilinsky Award: Karen Pelley, SM, Health Policy and Management

Edgar Haber Award in Biological Sciences: Gregory Wellenius, SD, Environmental Health

Robert B. Reed Prize in Biostatistics: Lingling Li, PhD, Biostatistics

2004 François-Xavier Bagnoud Health and Human Rights Essay Award: Hussein Samji, MPH–International Health, for "Alone, Forgotten, and Ready to Die: The Health Impact of Incarceration at the United States Prison in Guantanamo Bay, Cuba"

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