Howard Haym Hiatt
Dean, 1972-1984


It wasn’t president Kennedy’s speech at Berlin’s Brandenburg Gates, but history was made on a local scale on a warm spring day in 1979 when Howard Hiatt stood to address a group of Mission Hill residents inside Boston’s Mission Church. Perched on a low bluff overlooking Harvard’s sprawling Longwood Medical Campus, the Church stands at the foot of the working-class, multi-ethnic Mission Hill neighborhood. Hiatt, a tall, august man then in his seventh year as dean of the School of Public Health, spoke about the importance of building partnerships between the School and the Mission Hill community. But the substance of his talk was, for the most part, eclipsed by the man himself: although Harvard’s medical and public health schools had stood shoulder to shoulder with Mission Hill for several decades, to the best of anyone’s memory, Hiatt was the first dean of either school to venture inside the Mission Church.

Director of Community Programs Bruce Smith, who accompanied Hiatt that day, recalls the importance of the visit to the community and the School: "At the time, Mission Hill residents were up in arms about the expansion of the Peter Bent Brigham Hospital and about Harvard’s plan to build a new energy plant on Brookline Avenue. A lot of folks were worried about the health implications, and there was a general feeling that Harvard wasn’t listening." In March, community activists had sent Hiatt and medical school Dean Daniel Tosteson angry letters threatening to disrupt graduation to protest the energy plant’s construction. Hiatt, in characteristic fashion, responded swiftly, appointing Smith, then supervisor of the School’s mailroom and a Mission Hill resident, as community liaison and authorizing a series of outreach efforts that brought together faculty, staff, and Mission Hill residents. Even after the immediate crisis passed, Hiatt continued to push for meetings with community representatives, says Smith.

"Hiatt didn’t just talk about it, he got out there and got involved," he says.

The chance to get involved was what had brought Hiatt to the School of Public Health in the first place. A brilliant physician and scientist, Hiatt was a professor at the medical school and physician-in-chief of Beth Israel Hospital when new University President Derek Bok offered him the School’s deanship in 1972. It was a bold move for Bok–Hiatt was an outsider to public health–and a risky gambit for Hiatt, who would be giving up a high-profile career in medicine for a much less certain future. In the end, Hiatt says he accepted the deanship because it offered the opportunity "not only to shape an institution, but to focus an entire field."

During his 12-year tenure, Hiatt went a long way toward realizing these goals. With the help of colleagues from throughout Harvard University, he transformed the School’s Departments of Biostatistics and Health Policy and Management and in the process made public health the watchdog and conscience of medicine. Through a series of brilliant and controversial appointments, he imported the powerful new research tools and methodologies of molecular biology and the quantitative social sciences into the School’s traditionally strong research on tropical diseases, cancer, toxicology, and environmental illness. He aggressively broadened the School’s training programs in health policy and management by introducing two-year master’s degree programs and executive courses for mid-career professionals. And he authorized a series of outreach activities that brought the School into closer contact with the community right outside its front doors.

"I think Howard was responsible for bringing schools of public health into the modern era," says Milton Weinstein, Henry J. Kaiser Professor of Health Policy and Management. Weinstein, an economist, was one of several scholars Hiatt recruited who have become pillars of the School’s present-day research and training mission. Another was a young decision scientist from Harvard’s Kennedy School of Government named Harvey Fineberg, who would eventually succeed Hiatt as dean.

"One of Howard’s most important legacies to the School of Public Health was the quality of appointments he made to this faculty, at every level," says Fineberg, who joined the School’s faculty in 1972. "He brought leading scientists and scholars into the field, and attracted outstanding young talent to our ranks." Yet in attempting to redraw the boundaries of public health, Hiatt met with resistance from traditionalists, including some of the School’s most respected faculty members, and found himself at the center of a conflict that to some degree clouded his many achievements as dean.

When Hiatt took over as dean in the fall of 1972, the 50-year-old School of Public Health was at a crossroads of sorts. In some respects, the institution had never been stronger, with three new buildings–courtesy of Hiatt’s predecessor, John Crayton Snyder–and a distinguished senior faculty and alumni body that had made signal contributions to the understanding and control of disease. Yet public health as a field had, to a great extent, fallen victim to its own success. The remarkable global gains against measles, smallpox, polio, and malaria had fostered a perception that infectious diseases–the traditional locus of public health research–were on the brink of elimination. Federal funding for public health education and research had begun to dry up. Why support more research and programs on problems that would soon be irrelevant? When policymakers and the public at large thought of health care, they thought primarily of doctors and hospitals, not departments and schools of public health.

Meanwhile, the revolution in molecular biology unleashed by the discovery of DNA-manipulation techniques was transforming the health sciences. Increasingly, the search for the causes and cures of illness focused on the spiraling genetic matrix that governs human biology and physiology. And, for the most part, this search was being conducted in hospitals, medical schools, and independent laboratories, not schools of public health. Hiatt, a leading proponent of this "new biology," had spent the past decade adapting its tools and techniques to clinical research with great success and felt that public health could reap similar benefits, particularly in combating tropical diseases, environmental toxins, and cancer. But Hiatt was by no means wedded to the bench. Twenty-five years as a practicing physician had made him acutely aware of the shortcomings in American medicine–its penchant for expensive, high-tech treatments; the lack of rigorous evaluation of new clinical practices; the growing numbers of patients excluded from the system; the lack of emphasis on prevention.

"I saw that many of my fellow doctors were not thinking about what they did from a broad perspective," he says. "For example cardiac surgeons understood very well what the underlying defect was in the coronary patient, but had little knowledge of the effectiveness of their treatments."

He had recently returned from a one-year sabbatical at London’s Imperial Cancer Research Fund, where, while honing his bench skills, he had taken a close look at the British health-care system. What he observed crystallized his belief that doctors alone could not solve America’s impending medical crisis, but would need the help of economists, policymakers, statisticians, lawyers, and a variety of other professions. In public health, Hiatt saw the ideal arena in which to achieve this marriage of medicine and social science. And in Derek Bok, he found a colleague who shared his enthusiasm for collaborative, cross-disciplinary research.

"Howard reached out and got many people around the university interested in and excited about public health issues as an area of applied scholarship," says Bok. "I think this was exactly the right strategy to employ."

Hiatt was certainly not the first person without a degree in public health to hold the office of dean of the School. In fact, of the six permanent deans in the School’s 75-year history–David Linn Edsall, Cecil Kent Drinker, James Stevens Simmons, John Crayton Snyder, Hiatt, and Harvey Vernon Fineberg–only Simmons, S.D.’39, had graduated from a school of public health. Hiatt, however, was unique in never having worked within a traditional public health arena. But throughout his career as a clinician, researcher, and teacher, he had distinguished himself as a man of searching vision who defined health and health care in the broadest possible terms. He had also cultivated strong ties with faculty across the university, and he had earned a reputation for making things happen. Bok says Hiatt combined "imagination and high academic standards" with a "capacity to inspirit and inspire young faculty."

"Howard is a real bearcat about getting things done," says long-time colleague Frederick Mosteller, who chaired the departments of biostatistics and health policy and management under Hiatt. "He’s very decisive about moving forward, and he works hard at the hardest parts of any job."

"Bearcat" seems an unlikely appellation for the soft-spoken, 72-year-old former dean. Tall and trim, with handsome, aquiline features and a refined, almost genteel demeanor, Hiatt is a congenial and charismatic presence. Interviewed recently in his office at Brigham and Women’s Hospital, he hardly looked a day older than when he retired from the School in 1984–and even then he looked more like a man in his forties than his fifties. He is variously described by friends and colleagues as "light-hearted," "gentle," an "extraordinarily kind and caring person," and someone who "spreads credit around very generously." In conversation he shifts comfortably between discussing his latest professional forays–among other things he is heading up an effort to look at the quality of life of terminally ill patients and an American Academy of Arts and Sciences task force on problems affecting children–and the achievements of his three children and eight grandchildren.

Yet scratch the stately surface, and you find a man of formidable intensity and drive. "Howard’s very passionate and principled in his beliefs," says long-time friend Barbara Rosenkrantz, professor of the history of sciences emerita at Harvard University. In the late 1970s and early 1980s, Hiatt was one of only a handful of physicians to speak out against the continuing nuclear weapons build-up, which he called, memorably, "the final epidemic." Professor John David, chair of the Department of Tropical Public Health, credits Hiatt with "bringing a moral character to the debate on nuclear arms" in the early 1980s, and says that "one of Hiatt’s strengths was his willingness to speak out on controversial issues. I congratulate him on that."

Born in 1925 in Patchogue, New York, Hiatt grew up in Worcester, Massachusetts, where his father, who had immigrated from Lithuania a decade earlier, settled after serving in World War I. He entered Harvard College in 1944, and, after only two years, won entry to Harvard Medical School as part of an accelerated program to supply doctors to the armed services. By the time he earned his medical degree, however, World War II was over, so the 23-year-old M.D. embarked on a fairly conventional career path: internship and residency in inteRNAl medicine at Boston’s Beth Israel Hospital followed by a research fellowship at Cornell Medical College and a faculty appointment at the University of Chicago Hospital. In 1950, however, with the outbreak of the Korean War, he joined the U.S. public health service and was posted to the National Institutes of Health, where he got his first taste of bench science, studying cellular metabolism in the laboratory of biochemist B.L. Horecker. Energized by the experience, Hiatt returned to Boston and Beth Israel at the invitation of the hospital’s legendary physician- in-chief, Herrman L. Blumgart, to set up one of the nation’s first medical oncology research and training units.

Throughout the 1950s, Hiatt’s research focused on endocrinology and neoplastic growth–how normal cells turn cancerous. In particular, Hiatt was studying the synthesis of a sugar molecule called ribose, a building block of ribonucleic acid, or RNA. This work would lead him to France’s Pasteur Institute, where he worked with two of the luminaries of modern biology, future Nobel Laureates Jacques Monod and François Jacob. As a traveling fellow in Monod’s laboratory in 1960-61–a period Hiatt describes as the "heyday" of molecular biology–Hiatt was on the research team that discovered messenger RNA. This discovery, which provided a critical link in understanding how information encoded in dna is used by the cells, has been described as a "monumental scientific event." And, at 35 years old, Hiatt was still a relatively young scientist. "It was very heady stuff," he says.

Back at Harvard, Hiatt continued his rise through the medical school’s ranks. In 1963 he was named Herrman L. Blumgart Professor of Medicine and physician-in-chief at Beth Israel Hospital, where, according to colleagues, he was instrumental in creating a cutting-edge biomedical and clinical research program looking at the molecular roots of disease. And yet the higher he rose in medicine, the more troubled he was by what he saw as a system in crisis. Making sense of this system and fixing some of its glaring gaps would become one of the major themes of his deanship at the School of Public Health.

During his first year as dean, Hiatt convened a series of panels to examine the School’s research and teaching programs and evaluate their ability to meet the public health challenges facing the nation and world. As a result of this analysis, he says, he came to the somewhat radical conclusion that public health wasn’t a discipline per se, but a set of complex problems each of which required a slightly different blend of skills to resolve. "Since many of these problems had not only biological and clinical bases, but political and economic and anthropological and historical underpinnings, it seemed to me that, to address them, you would need input from these other areas," says Hiatt. While many of these disciplines fell outside of the traditional public health canon, the expertise did exist elsewhere at Harvard; the question was how to tap into it.

One of Hiatt’s first acts as dean was to initiate, with Mosteller, a University-wide Faculty Seminar in Health and Medicine to begin looking at the many problems plaguing the nation’s health care system. The seminar, which met bi-weekly, was modeled on an earlier effort by Mosteller and Kennedy School Professor Daniel Patrick Moynihan. It was an instant hit, drawing more than 100 participants from Harvard’s various faculties and teaching hospitals, including physicians, economists, lawyers, management experts, biologists, and engineers. At the same time, Hiatt launched the interdepartmental Center for the Evaluation of Clinical Procedures (later renamed the Center for the Analysis of Health Practices), which would be the focal point for an innovative health-care policy research and training effort that would be one of Hiatt’s primary legacies to the School and the field. Led by Professor Howard Frazier, the center was a model of interdisciplinary scholarship, bringing together clinicians with decision scientists, economists, statisticians, and policy analysts.

"Howard was one of the people who realized early on the importance of the quantitative social sciences to public health," says Rosenkrantz, whom Hiatt brought to the School in 1976 to teach the history of public health to health policy students. Rosenkrantz’s appointment reþected Hiatt’s penchant for pulling in scholars from outside the traditional public health canon to bring new perspective and skills to bear on complex problems. Among the long list of eclectic appointments made by Hiatt were population biologist Richard Levins, now John Rock Professor of Population Sciences (see Richard Levins: Dialectics of Disease); management expert Nancy Kane, a business school graduate and lecturer in the Department of Health Policy and Management; economist and former usaid head David Bell, now professor emeritus; and former insurance actuary William Hsiao, now K.T. Li Professor of Economics and Health. (Another Hiatt appointee, the late Herb Sherman, a former M.I.T. engineer with a genius for solving complicated problems, has been described as the "guru" of the clinical practice evaluation group.)

"One of Howard’s strengths is his ability to appropriate expertise from other disciplines to solve a problem," says Mosteller. "He sees many parallels between fields."

Even when he stayed within the traditional bounds of public health, Hiatt often broke fresh ground. Mosteller, whom Hiatt lured from his post as chair of Harvard’s statistics department to build up the School’s biostatistics department, would later chair the Department of Health Policy and Management (previously the Department of Health Services Administration). In both cases, Mosteller would guide the development of strong research programs focused on improving aspects of health-care delivery. To introduce molecular biology and immunology techniques into the School’s tropical disease and toxicology, Hiatt recruited former medical school colleagues John David and Armen Tashjian, both leaders in their respective fields. In a similar vein, Hiatt appointed distinguished biochemist John Cairns, whom he had worked with at the Imperial Cancer Research Fund, to strengthen the School’s budding cancer biology effort. To lead an interdisciplinary program in the environmental health sciences, Hiatt secured former Manhattan Project chemist Donald Hornig, who had recently stepped down as president of Brown University.

Hiatt also showed a discerning eye for young talent: in addition to Fineberg and Weinstein, the list of budding scholars that Hiatt brought to the School who have gone on to assume key posts includes Nan Laird, chair of the Department of Biostatistics; Arnie Epstein, chair of the Department of Health Policy and Management; and Max Essex, chair of the Department of Immunology and Infectious Diseases.

Hiatt says his goal was "to bring together the best and brightest minds available to work on major public health challenges." His vision for the School, outlined in his 1975 dean’s report, was of a flexible, truly interdisciplinary institution that drew on outside expertise on an as-needed basis to confront specific problems. Not everyone agreed with this approach, however. A sizeable portion of the faculty, including some of the School’s most senior professors, viewed Hiatt’s efforts to refashion the School as high-handed and dismissive of past and present achievements. This was partly a clash of powerful personalities, aggravated by severe financial stresses that had forced Hiatt to make some unpopular administrative decisions. (Between 1972 and 1977, the School lost an estimated $1.5 million in revenue due to the elimination of federal public health training grants.) But at heart, it was a struggle to define the fundamental mission and priorities of the School–indeed of public health as a field. Hiatt’s vision was broadly inclusive; but to some members of the faculty, the School’s burgeoning work in clinical trials of treatment drugs, assessment of medical procedures, the economics and organization of health-care systems in the United States and abroad, immunology and molecular biology, however impressive, just wasn’t public health.

Rosenkrantz, who has studied the evolution of public health in the United States, says that the field, by virtue of the diversity of problems and professional and scholarly disciplines it embraces, has always been vulnerable to inteRNAl divisions. "Public health is a contentious area," she says. By the middle of the 1977-78 academic year, the debate had turned acrimonious, and in June the undercurrents of dissension spilled over: right after commencement, a group of faculty sent a letter to President Bok demanding Hiatt’s removal from office. Within the polite confines of the academy, this was tantamount to a coup d’etat. Hiatt, who was vacationing in Europe at the time, was caught off-guard and deeply wounded by this turn of events.

In his 1978 dean’s report (by tradition submitted at the start of the next academic year), Hiatt made public many of the details of the previous spring’s events, in the hope that airing the dispute would speed the healing process and help the School move forward. The report notes that on August 24, after spending the summer reviewing the situation, Bok called a special meeting of the faculty to announce his decision: he was sticking with Hiatt. (According to a faculty member who was present, the announcement was greeted with utter silence.) Hiatt was vindicated, but the faculty remained divided, and Hiatt’s dream of a fully integrated institution was cut short. The 1978 dean’s report begins with the question "What are the boundaries of public health?" and ends with the sober acknowledgement: "a definition of public health that would attract unanimity has not been achieved, nor is it likely to be, for it almost surely must undergo continuing change as contemporaneous health problems change."

Hiatt continued as dean for another five years and continued to push forward on a number of important fronts, including sowing the seeds for some of the School’s most successful community outreach efforts–Project life and the Longwood Medical Area-Mission Hill Food Drive. He spearheaded the creation of the interdepartmental Division of Biological Sciences, which sought to coordinate and strengthen research and training in the biological sciences at the School. Tashjian, whose work has helped redefine toxicology research, says that Hiatt’s commitment to strengthen basic biologic research represents one of his most important legacies to the School and the field of public health. David, whose department is now developing diagnostic tools and vaccines based on immunologic and molecular biologic techniques, agrees: "This has added an important new dimension to tropical disease research. In this respect, Hiatt’s vision has absolutely succeeded."

Equally noteworthy are the many curriculum reforms Hiatt introduced at the School. Early in his deanship, he introduced an experimental, university-wide course in health policy and management designed to prepare bachelors-level students for careers in medical management. He also launched the executive programs in health care management and a two-year program in health services administration, both of which sought to provide sound management skills to hospital administrators.

At age 73, Hiatt reamins active as a senior consultant in medicine at Brigham and Women's Hospital.

In 1984 Hiatt stepped down as dean, passing the mantle to his former protegé, Fineberg. He remained on the School’s faculty until 1994, and, in conjunction with Brigham and Women’s Hospital, where he still serves as senior consultant in medicine, he initiated and later led the Harvard Medical Practice Study, which provided some of the first information about the risks of being injured during hospitalization and the inequities in the way malpractice claims were resolved. He also launched the Clinical Effectiveness Fellowships, in an effort, he says, to "push" physicians into the School to learn the basics of medical evaluation.

There are few parts of the School today that do not bear some imprint of Hiatt’s leadership. Yet Hiatt himself has somehow faded, slipped off the screen. Bok says that Hiatt "showed great courage and perseverance" in leading the School through a difficult but necessary period of transition and "deserves enormous credit" for laying the foundations for the School’s present-day research and training. Mosteller says the passage of time has validated Hiatt’s long-term vision of public health: "It seems to me now even more far- seeing than at the time."

Hiatt, however, is circumspect in discussing his long career at the School, treading carefully around sensitive issues, conscious that his opinions are likely to be seen as self-serving or defensive. He is, as Mosteller said, gracious in crediting others for the many successes of his deanship, from Levins ("an extraordinary population biologist who has enriched the field immeasurably") to Tashjian ("he revolutionized the field of toxicology") to Bruce Smith, who accompanied him on that spring day in 1979 and whom Hiatt refers to as "one of the School’s unsung heroes." As for his own contributions, however, he prefers to let time and others judge.

"I consider myself very lucky," he says with a smile. "Many of these achievements are just an evolution. It didn’t happen because I was there. It was only because I was around at a time when they were in currency that I could take advantage of the widespread interest."

-Kevin Sottak