Glorian Sorensen believes that the best place to change people's health habits may not be in a doctor's office or at a health club, but at work and in the community. A newly tenured professor in the Department of Health and Social Behavior, Sorensen has spent her career testing workplace- and community-oriented health interventions. "I can't imagine a more exciting place to be right now than here at the School," says Sorensen. "I came here from a medical school environment where I felt like a fish out of water. I was always having to justify my community focus."

Sorensen, who is also director of the Center for Community-Based Research at the Dana-Farber Cancer Institute in Boston, came to the School a little over six years ago from the University of Massachusetts Medical School, where she was an assistant professor. While at the School, her research has focused primarily on designing and testing workplace interventions that are aimed at changing health-related behaviors such as smoking, poor dietary habits, and not getting enough exercise. According to Sorensen, on-the-job communication of public health information is proving to be an effective way to reach vast numbers of people. At the same time, she says that the workplace is an intrinsically politicized environment that requires finding the right balancing point among the interests of workers, employers, customers, and the larger community. Employers may be interested in smoking cessation and nutrition programs for their workers but often want little to do with health protection measures, notes Sorensen, while workers tend to be distrustful of interventions that seem to place the onus for change exclusively on their shoulders.

"Workers will say, "Look, what's the point of my quitting smoking when every day I'm exposed to all these toxic chemicals?'" Sorensen says. "Well, we thought about that for a while and came to the conclusion that their skepticism actually meant that they were already thinking holistically about their health. It was something to build on."

What Sorensen and her colleagues have built is an ambitious research program called the WellWorks Project that links health protection, which emphasizes workplace safety, to health promotion, which emphasizes healthy lifestyle changes. Two projects have studied mostly blue-collar workers, employed at a total of 39 Massachusetts workplaces. By acknowledging the double jeopardy faced by many industrial workers, and by linking health education with workplace safety, this research has been able to gain the support of previously skeptical workers and their unions, along with the cooperation of sometimes-reluctant employers, says Sorensen.

Because the current WellWorks Project is a long-term study, it is too early to draw conclusions about how effective it is. However, results from a larger preliminary study, the nationwide Working Well Trial, showed a five percent decrease in smoking when the efforts of health educators and occupational health and safety advocates were integrated. "Five percent may not seem like much at first glance," says Sorensen, "but when considered across many work sites, five percent represents a lot of smokers."

Such real-world research requires a combination of diplomacy and leadership. Karen Emmons, an associate professor in the Department of Health and Social Behavior and a colleague at Dana-Farber, says Sorensen possesses these qualities in spades. "She's a gifted leader. The people who work with her all feel recognized and part of something larger. I've never known anyone better at getting people to work together."

Sorensen has high hopes for a School-based research initiative aimed at assessing health promotion programs and the effect they have on cancer rates in multi-ethnic, working class communities. This initiative includes three studies linked by this common theme. In collaboration with the Bowdoin Street Community Health Center in Boston, she is leading a project that will apply the WellWorks model to small businesses. Emmons is working with Harvard Pilgrim Health Plan to start health-promotion programs targeting low-income families at the H.M.O's neighborhood health centers. Then it will fall to Milton Weinstein, Henry J. Kaiser Professor of Health Policy and Management, to assess the impact of these interventions on cancer morbidity and mortality.

Sorensen argues that attacking health problems at a community level only makes sense because so many determinants of health are embedded in communities and, more generally, in the social structure. "We know, for example, that in low-income neighborhoods, stores are less likely to carry fresh produce. And what there is, costs more," she says. "And many families in low-income communities do not have access to safe physical activity."

"There are tremendous opportunities here at the School for crossover among people who are looking at race, class, gender, and the public health impact of social inequalities," says Sorensen. "Working together we can begin to integrate our insights, design more effective interventions, and help shape public policy."

- Richard Hoffman