Harvey Vernon Fineberg
Dean, 1984-1997

In 1984, while serving out his final months as dean of Harvard’s Faculty of Arts and Sciences, Professor Emeritus Henry Rosovsky began compiling a crash-course in university administration for his successor. Later published as the essay "Deaning," Rosovsky’s collection of anecdotes, caveats, and helpful hints offers a witty glimpse into the intricacies of running an academic institution–a "peculiar art," he wrote, for which few presidents, provosts, and deans arrive prepared.

The same year Rosovsky passed the baton of leadership in Cambridge, across the Charles River a 38-year-old health policy professor named Harvey Vernon Fineberg became the sixth dean of the Harvard School of Public Health. The youngest, by a good decade, of all the School’s deans, Fineberg had only recently earned tenure and his only administrative experience to date was a three-year stint directing the School’s Graduate Program in Health Policy and Management.

On the other hand, few people could claim as intimate a knowledge of the university as Fineberg. He’d been at Harvard for two decades and held degrees from three different university faculties. Under the tutelage of some of the University’s leading lights–including statistician Frederick Mosteller, Kennedy School political scientist Richard Neustadt, Business School decision science guru Howard Raiffa, and former HSPH Dean Howard Hiatt–Fineberg had earned a reputation as an enterprising scholar with a particularly wide intellectual bandwidth.

"One of the things that’s most impressive about Harvey is the breadth of his brilliance. He has a gift for thinking in other arenas," says colleague Milton Weinstein, Henry J. Kaiser Professor of Health Policy and Management, who, as a junior faculty member in the 1970s, co-taught a course with Fineberg and collaborated on several studies.

Among those who recognized Fineberg’s intellectual talents was former Harvard President Derek Bok: "Harvey exemplified the kind of bold, energetic, young scholar (former HSPH dean) Howard Hiatt had championed" during his tenure. In the winter of 1983, shortly after Hiatt announced his decision to step down as dean, Bok asked to meet with Fineberg. Fineberg was expecting to be asked who he thought should lead the School. Instead, Bok offered Fineberg the deanship.

"In retrospect, one can see that it wasn’t totally out of character for him to turn to someone like me, but it still struck me as quite stunning at the time," says Fineberg.

Fineberg, who had seen his friend and mentor Hiatt buffeted by faculty dissension during his tenure, had few illusions about the potential pitfalls of leading the School. While the internal furor had subsided, Fineberg, says that his baseline expectation was that his life as dean would be "filled with noise and thunder." What he got, however, was water–several million gallons of it. Three months into his deanship, and just 10 days before the start of the 1984-85 academic year, the School’s water main burst, flooding the Kresge Building’s lower levels and causing massive damage to Snyder auditorium, the building’s mechanical room, and several administrative offices. Photos from the time show wrecked offices, damaged files and equipment, and a patchwork of salvaged carpet remnants laid out to dry in the Kresge courtyard. In weathering this baptism by water, Fineberg displayed a talent for turning crisis into opportunity that would serve him well throughout his deanship.

"We worked day and night to get the place ready for the students," he recalls. "I remember standing in the Kresge lobby the day before registration as they were repainting the walls and putting on some finishing touches. Suddenly, the father of a new student came over, shook my hand, and told me how impressed he was with all the polishing up we did, and the personal attention that I was giving to it."

With equal diligence and aplomb, Fineberg presided over a remarkable period of prosperity at the School during his 13-year career as dean. By any objective measure–dollars raised, growth in educational and research programs, expansion of facilities–his tenure has been a spectacular success. When he took the helm, the School’s total budget was $35 million: in his final year it topped $135 million. He led the School into its first-ever capital campaign, which so far has raised more than $130 million and added 10 endowed professorships (bringing the total to 30) and more than 150,000 square feet of new and renovated laboratory, office, and classroom space. The centerpiece of this expansion is the seven-story François-Xavier Bagnoud Building at 651 Huntington Avenue, a keel-shaped edifice of polished granite, concrete, and glass that is a fitting monument to Fineberg’s deanship: efficient, contemporary, deftly blending form and function.

The imprint of Fineberg’s leadership also can be seen in the myriad interdisciplinary centers and programs that have arisen during his watch–including the Harvard AIDS Institute, the Harvard Center for Cancer Prevention, the Center for the Prevention of Cardiovascular Disease, and the Harvard Center for Children’s Health–which, collectively, define some of the most critical areas of contemporary public health research. He’s been particularly adept at steering the School toward new areas of inquiry–health and human rights, molecular epidemiology, health communications, and public health practice–that seek to stretch the very boundaries of the field.

"Harvey’s very good at the ‘wheeler-dealer’ aspects of public health," says friend and former colleague Barbara Rosenkrantz, professor of the history of sciences emerita at Harvard. Mark Rosenberg of the Centers for Disease Control and Prevention, who has known Fineberg for 27 years, says the driving force behind Fineberg’s success is his "relentless optimism"and penchant for "new, creative approaches" to age-old problems.

In action, Fineberg projects the unhurried authority of a man who knows precisely where he’s going and how long it will take to get there. A methodical and patient planner, he manages to keep a sharp eye on the details without losing sight of the big picture. And while he prefers to leave nothing to chance, he’s able to shift gears abruptly without breaking stride when the situation demands it. "You get the impression that Harvey can handle anything. He’s equally composed whether the building’s on fire or he’s getting an award," says Deborah Prothrow-Stith, professor of public health practice.

Fineberg especially excels at the "toastmaster" aspects of deaning, his genial wit and unforced eloquence playing equally well in large lecture halls and intimate dinner parties. "Harvey’s so charming, so erudite," says Weinstein. "He’s never at a loss for words, and he rarely makes mistakes." And whether through practice or predilection, he has learned to strike just the right balance of gravity and hopefulness, urgency and assurance to win broad-based support for a field that has traditionally failed to capture the public imagination.

In his rare free moments, Fineberg relaxes by playing the piano and tinkering with computers. A self-confessed "techno-phile," he enjoys taking his laptop out for a spin on the Internet and has also tried his hand at electronic composing. (Fineberg’s wife, Mary Wilson, says that if he could choose any other profession, he’d probably be a composer). And while his professional demeanor is the essence of level-headed discretion, he is not without a waggish side. For his sendoff from the faculty–billed as a celebration of the occasion "Fineberg Crosses the Charles"–Fineberg and Wilson came costumed as George and Martha Washington, powdered wigs and all. And on a recent trip to Japan, Fineberg purportedly sampled the much-prized but occasionally lethal delicacy known as fugu–but only after doing a quick risk-benefit analysis that took into account the chef’s reputation, the number of physicians at the table, and the distance to the nearest emergency room.

Fineberg was born in 1945, the second of three sons of Saul and Miriam Fineberg, in Pittsburgh, Pennsylvania, in the comfortable, middle class neighborhood known as Squirrel Hill. As a schoolboy, Fineberg participated in the first trials of the Salk polio vaccine, an experience he still vividly recalls. He came to Harvard in 1963 and has been here ever since. As an undergraduate, he lived in Lowell House, majored in psychology, did thesis research on the sleep habits of birds, practiced piano in the Lowell House tower, and played trumpet in the marching band. By his junior year he had decided on a career in medicine. (He confesses to being unaware, at the time, that Harvard even had a School of Public Health.) Although by the time he graduated, student protest had reached a fever pitch–the following year Cambridge police officers would be called in to evict student activists from University Hall–Fineberg’s politics, in spirit and practice, were shaped more by the constructive "ask what you can do for your country" ethos of the Kennedy era than by the angry, anti-establishment mood of the Vietnam War years. "We looked back at the fifties as a time when students were complacent and just looking to get ahead in life," he says. "By the mid-sixties, hippie-dom had arrived and people were dropping out. But for my peers, the sense of liberation and possibility was very palpable."

The turning point in Fineberg’s education came after his second year at Harvard Medical School, when he took a year off to participate in an experimental public policy training program at Harvard’s newly re-christened Kennedy School of Government. The program was developed and taught by a faculty "dream team" that included Mosteller, Neustadt, Raiffa, game theorist Thomas Schelling, economist Francis Baton, and (as junior course assistants) Graham Allison, Richard Zeckhauser, and Henry Jacoby. The program would introduce Fineberg to many of the academic disciplines–statistics, economics, decision sciences, cost-benefit analysis, and health-care policy–that would underpin his subsequent career. In an era when success in academic medicine was determined primarily by one’s laboratory pedigree, Fineberg’s request to take a year off to study something as ephemeral as public policy raised eyebrows. He recalls explaining his decision to the dean of students, who sifted through Fineberg’s academic file and said, somewhat perplexedly, "But your record here isn’t all that bad!"

(Despite the program’s all-star cast, Fineberg says that, at the time, public policy was seen as such a fly-by-night field that initially only students from professional schools "who would have a profession to fall back on if the whole thing was a bust" were admitted to the program.)

Fineberg calls his time at the Kennedy School "the most interesting, intellectually stimulating year that I could have dreamed of." Although he would go on to earn his medical degree and practice as a primary care physician for 10 years in two Boston-area neighborhood health centers, his intellectual center of gravity already had shifted away from treating individual patients to broader questions related to improving the function of the health-care system as a whole. As it happened, these were some of the same questions on the mind of Howard Hiatt, who became dean of the School of Public Health the same year Fineberg began his medical internship at Boston’s Beth Israel Hospital. Hiatt recalls running into Fineberg one afternoon outside of BI and listening as Fineberg described his burgeoning interest in society and health.

"I really wanted to work with him," says Hiatt. "And I told him, with the things you’re interested in, you should be at the School of Public Health." After finishing his residency, Fineberg accepted Hiatt’s offer to join the School as an assistant professor in the Department of Health Services Administration (later renamed the Department of Health Policy and Management). Over the next decade, the two worked closely together, co-authoring one article, developing a curriculum for training graduate students in health care policy, and collaborating broadly with colleagues in the landmark Center for the Analysis of Health Practices.

"I learned a great deal from Howard, especially about the value of interdisciplinary work," says Fineberg today. "I was always inclined to it, but Howard (Hiatt), Howard Frazier, and Fred (Mosteller) showed me how to make it happen."

Perhaps the greatest sacrifice involved in Fineberg’s accepting the deanship was putting his scholarly ambitions on the back burner. At the time Fineberg was a rising star in the School’s Department of Health Policy and Management. His research and writing on the uses and effectiveness of diagnostic technologies–including the influential 1979 New England Journal of Medicine article, "Evaluation of medical practices; the case for technology assessment," co-authored with Hiatt–had helped launch the field of medical technology assessment. He was a co-founder and one of the first presidents of the Society for Medical Decision Making and had co-authored, with Weinstein, the textbook Clinical Decision Analysis.

Fineberg recently had gained national repute as co-author, with his former Kennedy School mentor Richard Neustadt, of The Epidemic That Never Was, a brilliant analysis of the decision-making process behind the government’s controversial 1976 swine flu vaccination program. The book was based on a confidential study commissioned in 1977 by Secretary of Health, Education, and Welfare Joseph Califano. Along with Neustadt, Fineberg interviewed many of the principals, including polio- vaccine pioneers Jonas Salk and Alfred Sabin, both of whom endorsed the swine flu program, and Centers for Disease Control Director David Sencer, M.P.H.’58, who initiated the program and ultimately took the blame for its failure.

The report’s initial release in 1978 had provoked a squall of controversy within the public health community. Some influential persons objected to the book’s characterizations and conclusions and accused the authors of undermining future preventive vaccine programs. Among the most vocal critics, says Fineberg, were the deans of the nation’s schools of public health. For his part, Califano says Fineberg and Neustadt did a "fantastic job" of maintaining objectivity and drawing critical lessons from the program’s failure. "Nothing like it has been done in public health since," he says.

Califano especially praises Fineberg’s ability to "instantly grasp the difficulty of making decisions in a political context." (Interestingly, neither the Swine Flu report nor its authors were anti-immunization; indeed Fineberg went on to be something of a champion of immunization. In 1990-91 he co-chaired an Institute of Medicine panel that studied the safety of pertussis and rubella vaccines and concluded that the slight risk of adverse reactions to the vaccines was outweighed by their broader benefits in preventing childhood disease.)

Fineberg has continued to publish at a prodigious pace since becoming dean–some 30 scholarly articles, 5 books, and more than a dozen editorials and book chapters in all–a truly remarkable output given the hectic schedule a dean must keep.

"Harvey has the ability to block out all distractions and focus completely on what he’s doing," says Wilson. "Even on a crowded airplane, he can just sit and work as if nothing else were happening."

No account of Fineberg’s career would be complete without mentioning the special partnership he shares with Wilson, his sometime collaborator and wife of 23 years. A native of Indiana and former graduate student in English literature, Wilson is chief of infectious diseases at Mount Auburn Hospital in Cambridge and a faculty member in the Departments of Population and International Health and Epidemiology.

They met in 1972 while doing their residencies at BI (as a second-year resident, Wilson was his superior) and dated for a couple years before getting engaged. In the spring of 1975, in the midst of planning a wedding on Cape Cod, they were invited to join a medical delegation on a 22-day tour of the People’s Republic of China–one of the first groups of Westerners allowed into the country since the onset of the Cultural Revolution. On the last leg of the trip, while waiting out a four-hour layover in the Shanghai airport en route to Canton, one of the Chinese guides turned to Fineberg and asked if he were married. (Fineberg says this was the first time during the journey that any of the guides had asked any personal question of their guests.) Fineberg replied that he was unmarried, but engaged to marry the woman sitting next to him. "In fact," Fineberg continued in an uncharacteristically impulsive way, "if we could, we’d love to be married here in China." ("We’d never even discussed it," says Wilson.) A few days later members of the delegation arranged a wedding ceremony at the hotel in Canton. The Chinese hosts provided a cake and a silk wedding scroll. As part of the celebration, the newlyweds were asked to sing a song to their hosts. Uncertain what would be appropriate in communist China, the couple serenaded the group with "I’ve Been Working on the Railroad."

In recent years, Fineberg and Wilson have collaborated on a series of studies of the effectiveness of BCG vaccine in controlling tuberculosis. They have also co-authored articles on the social dimensions of disease and the risk to travelers of contracting AIDS.

After the flood that christened his deanship, Fineberg turned his attention to a more subtle challenge facing the School: what marketing consultants would call an identity problem. Both within the faculty and out in the general public, says Fineberg, there was little consensus about what public health was and, by extension, what schools of public health should be doing. "When I first became dean, I remember wondering, ‘What was the mission? Where was a succinct statement of what we were all about?’" he says.

Since then, Fineberg has devoted a considerable part of his time and energy to articulating a common mission and set of objectives for the School and, by extension, for public health as a field. It wasn’t easy. Fineberg says that "just getting his arms around everything that was going on at the School" was a challenge. He wisely enlisted the faculty to help define the School’s priorities by instituting annual faculty retreats, and he beefed up the School’s internal and external communications efforts. Most importantly, he relentlessly reasserted his message in print, speech, and conversation. "I wanted it so you could take anybody in the School, wake them up in the middle of the night, and they could blurt out the School’s mission," he says. This may seem a modest objective, but at an institution where molecular biologists, physicians, economists, and statisticians tended to regard each other with mutual incomprehension, a single, shared phrase–advancing the public’s health through learning and discovery–provides a critical thread of cohesion and coherence.

Of course, mission statements, however apt, are only part of the institution-building formula; equally important is a compelling cause around which to rally. For public health in the past decade and a half, that cause was acquired immune deficiency syndrome (AIDS), whose sudden appearance and rapid spread in the 1980s exposed the limitations of curative medicine, reinvigorated the concept of disease prevention, and brought a flood of attention and funding to schools of public health. Few scholars have become as involved in the struggle against AIDS on as many fronts as has Fineberg. To date, he has authored or co-authored 11 articles, 3 editorials, one book, and 5 book chapters on diverse aspects of the AIDS epidemic ranging from the ethics of compulsory HIV testing to the effectiveness of bleach programs in preventing AIDS transmission among IV drug users. Most of these are polite scholarly tracts written for fellow scientists; but one, a 1991 New York Times editorial decrying the government’s decision to bar HIV-infected travelers from entering the country, contains what, in academic circles, might be called fighting words. Dismissing the idea that the policy had any public health benefit, Fineberg wrote that "the real reasons behind the exclusionary policy are...irrational fear, misunderstanding and prejudice, salted by political opportunism and cowardice."

Fineberg says that any public health dean during the past 15 years would have had to contend with AIDS. "It wasn’t exactly a hard call," he says. But few would have taken it up as a personal cause, as he has. He’s been on the board of directors of the American Foundation for AIDS Research since 1986 and has served on AIDS-related advisory committees at the Centers for Disease Control and Prevention, the Institute of Medicine, and the U.S. Agency for International Development, among others. He’s been especially active in Mexico, where he has worked with hsph alumnus Jaime Sepulveda, S.D.’85, in drafting a national AIDS policy. Fewer still would have had the insight and influence to mobilize a university-wide response to the disease, as Fineberg did when he launched the Harvard AIDS Institute in 1988.

At the same time he aggressively confronted AIDS, Fineberg also broadened his–and the School’s–horizons on numerous fronts. With the late Sol Levine, former HSPH Professor and current Wellesley College President Diana Chapman Walsh, and new department chair Lisa Berkman, he reinvigorated the School’s Department of Health and Social Behavior. He was instrumental in garnering support for the François-Xavier Bagnoud Center for Health and Human Rights, which, under the direction of Professor Jonathan Mann, M.P.H.’80, has sought to redefine the relationship between human welfare and human rights. His most telling project for the School may be the Division of Public Health Practice. Launched in June during Fineberg’s final month as dean, the Division, under the direction of Prothrow-Stith, will promote collaboration between the faculty and students at the School and the many community-level agencies that underpin public health. A fitting capstone to Fineberg’s career, this school wide effort symbolizes his ideal of an institution dedicated equally to scholarship and service in pursuit of global gains in health.

"In my last year at Harvard, I spent a day meeting with faculty and students at the School of Public Health," says Bok. "It was a very exciting day. I had the impression of a range of problems being addressed with great enthusiasm and vigor. The feeling of shared commitment was tremendous."

On April 3, 1997, Harvard President Neil L. Rudenstine announced his selection of Fineberg as University Provost. The appointment, applauded by faculty, graduates, and administrators at the School, marked the end of Fineberg’s 13-year term as dean. Fineberg knows enough about "deaning" to give his successor a wide berth in which to develop his own agenda and vision for the School. But one senses that he also is confident that the imprint of his leadership is likely to remain visible for some years to come.

"I’ve tried to not so much instill as liberate the concept that we’re simultaneously doing scholarship and practical work, and to help people understand how what we’re doing here at the School makes a difference out in the world," says Fineberg. "As you look around at all the work being done today, I feel that this faculty is living out its mission."

- Kevin Sottak

 

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