Deborah Allen, S.M.'80, S.M.'86, S.D.'98, seems so settled in her job at the Massachusetts Department of Public Health, she gives no hint of the circuitous route that led her there. Before rising to the head of the agency's Division for Special Health Needs, Allen pursued an acting career, campaigned against nuclear power and the Vietnam War, and considered going to law school. But it may just be the diversity of her background that makes her so good at what she does today.

A small, friendly woman in a mauve business suit and practical shoes, Allen looks much more the policymaker than a thespian or activist. She currently oversees the effort to expand a health program for children with disabilities into a state agency that attends to the medical needs of adults with disabilities as well. Still, Allen believes that her days fighting the Seabrook Nuclear Power Plant propelled her into the world of public health. She speaks of how the campaign "empowered" people in a way that allowed them to push for change. "The thing that I found absolutely fascinating about the antinuclear movement was the extent to which ordinary people became incredibly sophisticated in their knowledge of physics, the law, and environmental regulation and hydrology," she says. "It wasn't just empowerment in the sense of 'I'm going to speak up for my rights,' but empowerment in the sense of 'I'm going to master the facts and I'm not going to be daunted by somebody's Ph.D. or professorship'."

Now, more than 20 years later, Seabrook is up and running, and Allen is one of those people with the advanced degree. But she still believes that consumers have the capacity to make sense of complicated health issues that touch their lives. She's seen it in her work with families living in homes with lead paint, with parents tending to children with hiv, and now with people with disabilities trying to get access to basic health care services. And Allen has tapped into their potential. Her agency created a senior staff position that is reserved for a consumer--the parent of a disabled child. Other parents serve on staff and participate in advisory panels and training programs.

Allen's energy, strong sense of compassion, and ability to look at problems in the context of larger systems make her just the kind of person you want working in public health, according to friend and boss Deborah Klein Walker, associate commissioner for programs and prevention for the Massachusetts Department of Public Health. "She's made a big impact," Walker says. "Debbie has the capability to see the big picture in a big universe and realize that there is not one simple solution."

Public health was not even on Allen's radar screen when she left New York City to study drama, and later English, at Brandeis. Around that same time, she joined the anti-war movement, getting her first taste of activism. Still, Allen says she felt "adrift" career-wise after leaving the theater. She finished her undergraduate degree, married, and had a child. She toyed with getting an advanced degree in English but was discouraged by the job market for academics. So, she put her energy into the Clamshell Alliance, a 1970s-era group that tried to prevent the construction of a planned nuclear power plant on the New Hampshire coast. There she found a new calling in environmental health.

More interested in "thinking about policy than modeling water flow," she got a master's degree in health policy at the Harvard School of Public Health. One of her first jobs sent her door to door in the Jamaica Plain section of Boston looking for apartments with lead paint. It turned out to be a good lesson in how seemingly unrelated factors--like the housing market--can influence the public's health. Allen found that some families were unwilling to ask landlords to remove the toxic paint for fear of being evicted. "We were sort of trying to use the individual family as a wedge to clean up the environment," she says. "It was a real struggle. The individual family didn't always see it as a good trade-off."

By then, Allen had a toddler, a teenager, and a growing focus on children's health issues. While working on her S.D. at the School, she took a job with the state as the policy director for maternal and child health in 1989. One of her first assignments was a report on children with HIV. Allen was once again struck by the tenacity of families faced with threats to their health. In sometimes-squalid flats, she encountered parents carefully tending to their children, which often meant learning complicated medical procedures like inserting a feeding tube. Friends asked if the work was depressing. Yes, sometimes, she said. But Allen also found it inspiring. "The parents had often mastered things that you would never dream anybody but a nurse could do," she recalls. "Here were these people who were not content to say, 'You're the expert. You do it'."

Within a few years, Allen was promoted to what was then the Division for Children with Special Health Care Needs. The office, which traces its roots back to Title V of the 1935 Social Security Act, collects information on children with disabilities and runs placement and early intervention programs. It funds projects like after-school programs for disabled youth, hearing tests for newborns, and financial aid for families with disabled children who can't pay their medical bills.

The agency's primary mission is to ensure kids with disabilities have access to health care. But, while also running a similar program for adults, Allen and others realized the agency had to think beyond childhood. "It became clearer and clearer that a lot of the things we did for children were also things that adults needed, but there was no federal funding stream equivalent to the Maternal and Child Health Block Grants that addressed the health needs of adults with disabilities," she notes.

So the agency changed its name and its mission to become the Division for Special Health Needs. "We made a decision to really commit ourselves to a program that serves the needs of people throughout their lifespans and pays attention to primary and preventive needs as well as the specialized needs of people with disabilities," she says. "We worry a lot about whether all the primary prevention programs acknowledge the need to make prevention available to people with disabilities, which is not something that public health has done historically. The question of whether public health acknowledges that will have a lot to do with whether women in wheelchairs have access to mammography."

Allen finally finished her s.d. in 1998 and has been making her way down her post-graduate "to do" list. She's learning to play the baby grand piano that graces the living room of her Victorian house in the Roslindale section of Boston. She also ran in this year's New York Marathon. However the business-suited state official hasn't completely abandoned her activist past, as evidenced by copies of the liberal weekly The Nation scattered around her house and her recent involvement with the state abortion rights organization, Mass naral. Saving the world is somewhere on Allen's "to do" list, but she hasn't quite gotten to it yet, she says with a laugh. But, in the meantime, she notes, she would be satisfied if all of the state's hospitals were accessible to people in wheelchairs, if parents of children with disabilities could get the home nursing and care they need, and if public health recognized that people with disabilities have a full range of primary and preventive health needs.

Tinker Ready