In realms from diet to smoking, AIDS to obesity, motor vehicle safety to health care reform, the Harvard School of Public Health has led dramatic advances that have influenced millions around the world. Following is a sampling of the School's achievements. For a more complete list, visit the HSPH website at www.hsph.harvard.edu/about.html#history

POPULATION SCIENCES

Redefining the Healthy Diet
Dispelling dietary myths with scientific evidence, studies by HSPH epidemiologists have revolutionized how health experts worldwide give nutritional advice and forced a rethinking of the U.S. government's food pyramid. In addition to demonstrating that whole grains are more beneficial while refined sugars are less so, these studies demonstrate that not all dietary fats are "bad fats." Plant oils are beneficial, for example, while artificial lipids in foods known as trans fatty acids are a major cause of heart attack and other risks to cardiovascular health. Many U.S. food companies have eliminated trans fatty acids in foods or are endeavoring to do so. These and other findings concerning the nutritional determinants of disease come from two of the largest and longest running studies of human volunteers in the world: the Nurses' Health Study and the Health Professionals Follow-up Study, launched 28 years ago by HSPH collaborators at the Channing Laboratory and Brigham and Women's Hospital. Learn more

Air Pollution and Disease
With the Six Cities Study, begun in 1974 in response to the U.S. energy crisis, HSPH researchers prompted major revisions to the federal Environmental Protection Agency's Clean Air Act and set a standard for evidence-based decision making in environmental regulation. The study found that air-pollution-related cardiopulmonary problems in children and adults were occurring at levels of exposure below existing standards; that the most dangerous components of air pollution were microscopic bits of solid matter (particulates) produced by combustion of fossil fuels; that indoor air pollution was sometimes a far more significant risk than outdoor pollution; and that second-hand smoke had significant effects on the respiratory health of children. The Six Cities Study helped define the field of environmental epidemiology and spawned related studies around the globe. Recent research has clarified the biologic mechanisms linking particulate exposures to disease and death. Learn more

Diseases of Aging
HSPH researchers devised statistical methods to surmount the enormous challenge of identifying genetic predispositions for chronic diseases that arise late in life, including Alzheimer's disease. Because genetic material from the parents of the elderly is generally unavailable for study, the researchers created new methods to analyze the genes of siblings to draw inferences about their inheritance and association with Alzheimer's disease--and with this methodology, discovered a new gene strongly associated with the risk of developing late-onset disease. Their discovery of the protein encoded by this gene, alpha 2-macroglobulin, provides important new insight into the mechanisms by which Alzheimer's develops. Learn more

Smoking and Cancer
The groundbreaking epidemiological finding by HSPH in 1981 that exposure to second-hand smoke posed a risk to non-smokers for lung cancer served as the scientific basis for changing public policy and public attitudes about smoking in public spaces. Perhaps equally important, it initiated a change in public perceptions from "smoking is cool" to "smoking by anyone threatens everyone exposed," and was a major stimulus and justification for efforts to control tobacco use in the U.S. and abroad. Learn more

Disease Risk and Prevention
The Your Disease Risk website at (http://www.yourdiseaserisk.harvard.edu/) allows people to estimate their personalized risks for 12 cancers, as well as their risks for chronic diseases such as diabetes and cardiovascular disease. Grounded in 25 years of epidemiologic data, the website provides information on how people can reduce their risk by modifying lifestyle choices and behaviors--smoking, diet, and exercise, for example. The site also urges people to consult a physician if their risk profiles indicate they should have concerns about their health.

BIOLOGICAL SCIENCES

HIV/AIDS
Laboratory scientists at HSPH discovered the major antigen of the HIV virus, gp120, providing evidence that AIDS was caused by a retrovirus. This finding became the basis for the worldwide diagnostic tests for HIV infection currently in use and demonstrated that the virus could be transmitted through blood and blood products. The second type of AIDS virus, HIV-2, the cause of most HIV infections in West Africa, was also identified at the School. Investigators showed that HIV-2 is less virulent and infectious than HIV-1, and that HIV-2 seems to offer some protection against HIV-1. Given that the genetic structures of these viruses are similar, this work may provide clues to understanding the pathogenesis of HIV-1 and hasten vaccine development. Through the Center for Biostatistics in AIDS Research, the School has since 1995 provided the services needed to guarantee the statistical integrity and quality of most government AIDS trials in the U.S. And it is worth noting that HSPH has one of the longest sustained HIV/AIDS programs in Africa of any institution in the world. Learn more

Infectious Diseases
For the first time, scientists at HSPH carried out the genetic engineering of parasites--initially that which causes leishmaniasis. This feat provided the scientific basis for the genetic manipulation of the parasite that causes malaria. HSPH researchers also determined that deer ticks transmit the agent that causes Lyme disease, described the life cycle of this tick, and defined the role of deer and mice in spreading this, and other, pathogens. Learn more

Obesity, Inflammation, and Diabetes
Within the School's newest department--Genetics and Complex Diseases, created in 2003--researchers have identified a fundamental, long-sought molecular link between obesity, chronic inflammation, and the "metabolic syndrome"--a group of related conditions that comprises obesity, insulin resistance, atherosclerosis, and type 2 diabetes. This finding opens a door ultimately to developing new drugs for preventing and treating these conditions, rates of which are increasing dramatically in both developing and industrialized countries. Learn more

POLICY AND SOCIAL SCIENCES--U.S.

Patient Safety
Researchers launched the "medical errors movement" with the Harvard Medical Practice Study, the first comprehensive measure of medical injuries and preventable medical errors in hospitals. Researchers found that approximately 45,000 to 98,000 people in the U.S. die unnecessarily due to medical errors each year. Their study provided data critical to prompting changes in hospital systems and practices, which in turn have reduced the risks to patients dramatically. Learn more

Disparities in Health Care
Seminal studies at HSPH showed that even when equal access to health care services exists and patients have essentially identical medical problems (kidney or heart disease), racial minorities and the poor receive care that is less appropriate and of lower quality than that which is provided to whites and those of higher socioeconomic status. Learn more

Health Care Reform
HSPH faculty created the Resource-Based Relative Value Scale (RBRVS), a new mechanism for calculating health insurance reimbursements based on the time and intensity of effort required to perform every medical procedure. The RBRVS replaced the traditional charge-based, fee-for-service payment by Medicare. By 1995, most public and private insurance programs in the U.S. had adopted the RBRVS model for paying for physician services. As of 2004, Australia, Canada, France, and private insurance plans in Britain also adopted the RBRVS. Learn more

Alcohol and Motor Vehicle Safety
HSPH launched the "Designated Driver" campaign in the U.S. to curb alcohol-related traffic crashes. This initiative, which made the concept of a designated driver socially acceptable among youth and adults all over the country, contributed to an estimated drop in automobile fatalities of more than 25 percent. Learn more

Health and Economic Development
HSPH faculty identified the "demographic dividend," a phenomenon that explains much of the rapid economic growth of the Asian countries over the last decade. As health improvements reduce infant mortality and children receive education, there is a one-time burst in the productive population that dominates the age structure and contributes significantly to the economy. If appropriate policies are in place, the resulting surge in both the labor supply and savings produced by these boomers as they mature can fuel a remarkable economic growth spurt--supporting the emerging view that "health makes wealth." Learn more

Global Burden of Disease
The pioneering Global Burden of Disease study, conducted by HSPH researchers in collaboration with the World Health Organization and World Bank, compiled data that for the first time identified the leading causes of death and disability in all countries around the world. The study revealed that while chronic diseases predominated in most regions of the world (except Africa) as modern disease burdens, clinical depression and injuries and deaths due to automobile accidents and violence were surprisingly found to be responsible for a major impact on health. By estimating the impact of 107 major disease and health hazards in nine global regions, this effort to collect meaningful data on health metrics and the quality of health care has provided evidence critical for holding governments accountable for the health of their people, and for prioritizing efforts to improve health. Learn more

Photos:

Nutrition: HSPH
Obesity and Diabetes: Corbis
Alcohol: Photodisc/Getty Images
Global Burden of Disease: HSPH