Strengthening public health systems in the Pacific Northwest

3Qs with Alexander Wu, ScD, MPH ’18

A man in a blue shirt and blazer smiles
Alexander Wu, ScD, MPH ’18

Dr. Wu is currently a Senior Advisor for Epidemiology, US COVID-19 Response at Resolve to Save Lives, an initiative at Vital Strategies. Until recently assigned to the Northwest Portland Area Indian Health Board to assist tribes in Oregon, Idaho, and Washington with public health research and response, Dr. Wu’s main tasks with the CDC included evaluation of public health surveillance systems, public outreach, chronic disease research, and infectious disease outbreak response. He assisted with the measles outbreak in Washington State in 2019, deployed to Africa as a member of CDC’s polio eradication team, and helped states and tribes with their COVID-19 outbreak response as part of CDC’s COVID-19 incident management tribal support unit task force. (Note: Due to confidentiality concerns, the names of the specific tribes have not been included here.)

Q1: As an EIS field officer, how did you work with Pacific Northwest tribes to prepare for and prevent COVID-19 outbreaks?

The main mission was to assist counties, tribes, states, and local jurisdictions with disease investigations and anything related to public health. I went out to assist a tribe in Washington with a number of things related to the response to COVID-19 on their reservation and to be a technical advisor and a public health consultant for tribal health. I helped organize their incident command branch and trained their staff to do contact tracing. I also helped them develop public health worker protection guidance should they have to visit a probable or confirmed COVID-19 patient at home. About a week after I completed my work with the tribe, the spike in cases occurred, and they were prepared.

Q2: How are tribes in the Pacific Northwest responding, and has that response differed from the rest of the country?

COVID-19 does affect different groups of people, including tribes, differently. Fortunately, the area where I was deployed had very few cases of COVID-19 and were more focused on being ready for a spike in cases. The 43 federally recognized tribes in the Pacific Northwest, from what I’ve seen, have a good relationship overall with states. Perhaps because Washington and Seattle had some of the first reported COVID-19 cases, they continue to be on the cutting edge of the response. Whether it’s through federal agencies like the Indian Health Service, CDC,  FEMA, states, counties or the Northwest Portland Area Indian Health Board, tribes overall have been able to keep up with the latest information. Other areas may be looking at what the Pacific Northwest is doing and what tribes are doing to see how that could fit into their own response.

Q3: How do existing health disparities affect public health efforts like pandemic response among Native tribes? 

The value of having strong public health systems is something that I’ve definitely learned, having seen firsthand how well they protect public health and save lives. And I’ve also seen the flip side of that and the challenges that can come from it. We’re probably not talking enough about the most vulnerable. There are places in the U.S., unfortunately, where people live without running water or electricity or sanitation systems. Globally, indigenous people suffer from higher rates of chronic illnesses and have risk factors that are related to worse outcomes among people who get sick with COVID-19. There needs to be greater awareness for American Indian and Alaskan Native people throughout the pandemic. A recent study by CDC and tribal epidemiology centers found that the confirmed COVID-19 incidence rate among American Indian and Alaska Native people is 3.5 times that of non-Hispanic white people.

Putting Public Health into Policy

3 Questions for Dr. Richard Pan, MPH ’98

A man with dark hair, a blue shirt, and glasses smiles
Dr. Richard Pan, MPH ’98

As a California State Senator and Chair of both the Senate Committee on Health and the Senate Budget Committee on Health and Human Services, Dr. Richard Pan, MPH ’98, guides California state policy on pandemic preparedness and COVID-19 response and educates the public about COVID-19 prevention and mitigation.

Q1: What challenges is California’s health care system facing with COVID-19?

Primary care and outpatient practices have had a dramatic drop in visits, which is how health care professionals get paid. We’ve also had an increase in expenses because we need PPE and so forth. We’re expecting 2 million more people on our Medi-Cal program. How do we be sure we have enough people to take care of them?

Immunization rates have [also] fallen, and we don’t need another outbreak of something else on top of COVID-19. And what if we can boost our flu vaccination rate from 40% to 70% or 80%, for example? That would reduce the number of beds that we’ll need for flu, in case we need more beds for coronavirus.

And of course, continuing to ramp up our testing and getting the tests to the right people, and getting our contact tracers out there. We’re going to have a problem with people actively resisting contact tracing. That’s going to be a challenge. Then we have to have places to isolate people safely.

[I’ve been] trying to draw more attention to the need to better fund our public health system. We may not know what the outbreak’s going to be, but there’s always going to be an outbreak of something every year. We need to build our infrastructure.

Q2: What other problems resulting from the pandemic will you and your colleagues be working on?

The outbreak is underlying a lot of different things. Millions of people have lost their jobs. We have small businesses that are closed. We have food being grown in the fields but people without enough food in the cities. You have kids at home who can’t go to school. But at the same time you have essential workers who need to go to work. What do they do when they have no school or child care? Being an elected official is the ultimate generalist job, because everything comes at you, from all sorts of different directions. So how do you try to coordinate, but also be sure you prioritize?

California began as a success story. We’ve flattened the curve but didn’t bend it downward enough. We need the number of cases to drop to shift from mitigation to containment. Then, how do we make that shift in a way that doesn’t cause a big spike in the number of cases and deaths? Of course now the big thing is with the economic downturn, figuring out a state budget at a time when people need more and we have a lot less money.

Q3: What have been the challenges in getting the public to understand and follow guidelines?

We have competitors who are actually trying to spread disinformation very intentionally. We have the WHO being undermined. We have the CDC being silenced. Then on social media, we have people protesting against every public health intervention that we need to employ to slow the spread of this disease, and even actually trying to attack the very data that we use.

As public health advocates, we’ve got to figure out some strategies to turn this around because otherwise we’re in big trouble. Some of my time is spent on Twitter and Facebook and other social media, trying to push back on the disinformation. I’m doing a lot of press interviews. I’m part of a radio show weekly. We did telephone town halls and now I do a podcast. As an elected leader I am sort of in the center of this, but I think it’s important that other leaders in public health, including in academia, lend their credibility and their efforts to fighting this.

The Impact of Financial Aid: Transforming Health Through the Goldsmith Fellowship

In 2004, Richard and Ronay Menschel established the endowed Horace W. Goldsmith Fellowship, which has helped several students every year since then pursue their education at the Harvard Chan School. Because of the ripple effect of financial aid, fellowships benefit not only the students themselves but also the lives they will touch throughout  their public health careers. In the video below, we hear from the Menschels about why they contribute to financial aid and from three Goldsmith Fellows about the impact of this support.

 

Read more stories on the impact of philanthropy

A Footprint in India

India—a study in contrasts with a population of 1.3 billion people—is a compelling place to carry out public health interventions and research. While key health indicators such as life expectancy have improved, India is also home to one-third of the world’s poorest people. Undernutrition and health care disparities are now coupled with the challenges of an epidemiological transition leading to an increased prevalence of cancer and diabetes.

The establishment of the India Research Center represents a natural progression toward creating mutually beneficial collaborations between partners in India and the Harvard Chan School. The center opened in December 2015 through a generous gift from Swati Piramal, MPH ’92, and her husband, Ajay Piramal, a graduate of Harvard Business School.

This transformative gift allowed the School to build upon its half-century of work by establishing a new physical presence in Mumbai. With the vision of promoting research, training, and knowledge translation, the center aims to build local public health capacity across the health sector in India. Through research and collaborations with Indian public health entities like the Ministry of Health & Family Welfare, the center is working closely with Harvard faculty and researchers on diverse public health issues such as policy communication, implementation science, quality of care, tobacco control, nutrition, and mental health.

“By building capacity, translating evidence, and helping in designing scalable interventions that improve the health of both the poor and emerging middle class,” says Kasisomayajula “Vish” Viswanath, Lee Kum Kee Professor of Health Communication and director of the India Research Center, “we can not only make a difference in India, but also show that solutions to public health problems in India can potentially be used in middle-income countries around the world.

A Doctorate with Lofty Goals

Training in leadership, management, communications, and innovative thinking—and advanced education in public health—are the hallmarks of Harvard Chan School’s four-year-old doctor of public health (DrPH) degree. The lofty goal of the program, with 33 graduates to date, is to prepare students to become senior government health officials, executive directors of nongovernmental organizations, and leaders of major health care organizations around the globe—people with the high-level leadership skills necessary to bring about significant change in public health and health care.

Support for the program came from two significant gifts to Harvard Chan—a 2013 gift of $12.5 million from the Charina Endowment Fund and Richard L. (MBA ’59) and Ronay Menschel to help the School redesign its educational strategy (see page 51); and a 2016 anonymous $10 million gift, $1 million of which provided endowed funds for student scholarships.

Most public health doctoral programs are research-focused. According to Richard Siegrist, faculty director of Harvard Chan’s DrPH program, the School’s new degree fills a unique niche with its emphasis on real-world leadership skills. “If we really want to move public health forward in the future,” he says, “we’ve got to focus a lot more on how do we get things done.”

Adds Richard Menschel, “Better-educated public health leaders have the capacity to improve the health of us all.”

Harnessing Big Data

Medicine and public health are constantly evolving as research and technology open the doors to new ways to treat or prevent diseases. Randomized trials are the best way to assess what works. But when that’s not possible, people like Miguel Hernán, Kolokotrones Professor of Biostatistics and Epidemiology, try to replicate those trials using vast amounts of information, including massive health care databases.

“If we have several possible strategies to treat or to prevent a disease, we need to know which one works best,” says Hernán, who holds a faculty chair endowed by a gift from Wendy and Theo Kolokotrones, MBA ’70.
Hernán says supporting faculty is critical because it gives them valuable time to think and be creative—time that is often at a premium when researchers must raise most of their funding through grants. “That is not an ideal system to do high-quality science and develop strategies to improve public health,” he says. “Getting this money gives the School the possibility of allocating resources in a more rational way.”

The Kolokotroneses have also been champions of students, postdoctoral researchers, and junior faculty at the School by funding a regular series of meetings and symposia. These range from informal gatherings to larger events bringing in leading researchers in biostatistics and epidemiology. Hernán says these meet-ups have been valuable in increasing collaboration at the School—and driving innovative approaches to public health challenges. “The events bring together people working on the same problem who sometimes have never talked among themselves, even though they’re in the same town or same institution,” says Hernán. “Those meetings of the mind have opened new lines of research and collaboration.”

Boosting Service Learning

Ulaanbaatar, Mongolia

Students spend hours in class, doing homework assignments, analyzing samples or crunching data sets—work that can seem removed from the people they hope to help. Service learning helps fill that gap.

Education, deep cross-cultural exposure, hands-on experience, and service to others, are deeply intertwined, says Deborah Rose, SM ’75, a chronic-disease epidemiologist. In 2017, she made a $5 million gift to expand the Rose Traveling Fellowship Program—which has funded more than 50 epidemiology and biostatistics students—into the new Rose Service Learning Program, open to students and postdoctoral scholars from all departments of the Harvard Chan School. She says that combining an international experience with service learning “encourages a review of one’s most basic assumptions and deepens understanding.” Dean Michelle A. Williams ensured that service learning positions in the U.S. also were available.

Eighteen students received support this year for research projects and internships abroad or in the United States. Misbath Daouda, MPH ’18, studied the health effects of air pollution on children in Ulaanbaatar, Mongolia (photo at left). “It is one thing to read about [air pollution] in articles,” she says, “and another to experience how difficult it is to simply breathe in these conditions.”
In Boston, Tariana V. Little, DrPH ’20, helped launch a weekend food program for homeless public school students. She hosted several farmers market–style events for families, where she learned about their preferences and needs.
Rose says she hopes that reflecting upon and writing about their service-learning projects will deepen the students’ own understanding and guide them in how to communicate the lessons learned to others.

Understanding Chronic Metabolic Diseases

The increased global incidence of chronic metabolic diseases—including obesity, diabetes, and cardiovascular and liver diseases—has become one of the greatest global health threats of the 21st century. To tackle this crisis, Murat Ülker, a leading entrepreneur in Istanbul, contributed $24 million to the Harvard Chan School in 2014 on behalf of the Ülker family to establish the Sabri Ülker Center for Nutrient, Genetic, and Metabolic Research. The gift supports the work of Gökhan S. Hotamışligil, the J.S. Simmons Professor of Genetics and Metabolism, chair of the Department of Molecular Metabolism, and director of the center.

“The Sabri Ülker Center will address this unsustainable trend by developing new strategies and approaches to prevent and treat such debilitating disorders,” says Ali Ülker, grandson of the late Sabri Ülker, in whose honor the center is named. “We hope this contribution to science will benefit humanity greatly, and we have every confidence in Professor Hotamışligil’s research and leadership.”

The gift has been transformational. “Until now, the majority of our research operations were run via a very challenging model of short-term research grant funding supporting long-term scientific aspirations,” says Hotamışligil. “But with this generosity, we can look further into the future, do risky things, undertake outside-the-box projects, and do so in an uninterrupted manner. We hope that one day these discoveries will inform mechanism-driven preventive and therapeutic efforts that will improve human health, save people’s lives, and increase people’s health span, not just their life span.”

The Center of Happiness

Center for Health and Happiness

Most public health research focuses on the underlying causes of death and disease. But at the Lee Kum Sheung Center for Health and Happiness at the Harvard Chan School, researchers focus on the opposite: the positive factors that maintain or even improve people’s health and well-being. A $21 million gift from the Lee Kum Kee family established the center in 2016.

“We almost never think about what is optimal functioning, and how to get people there and keep people there,” says Laura Kubzansky, Lee Kum Kee Professor of Social and Behavioral Sciences and co-director of the center. She says the center is helping shift the research paradigm to ask a new set of questions, such as: How can you measure well-being? What physical, emotional, and social factors contribute to it? Can interventions such as exercise or mindfulness or redesigning work bolster a sense of purpose or optimism?

The center is also focused on moving evidence on health and happiness into practice and policy. For example, center co-director Kasisomayajula “Vish” Viswanath, Lee Kum Kee Professor of Health Communication, studies both how communications—movies, television, advertising, and social media—affect health and well-being, particularly among vulnerable groups, and how evidence is translated to promote well-being. “Not every group is able to take advantage of the revolution in communications technologies,” said Viswanath, “so we are examining how to address those inequities. We can exploit these technologies to promote well-being uniformly across social groups.”

Sammy Lee, chairman of the LKK Health Products Group, says that happiness is a key element in the corporate culture of the Lee Kum Kee companies, a 130-year-old family business that produces sauces, condiments, and herbal supplements worldwide—and an unmet need in the world. “While most research funding goes to the curing of diseases, the Lee Kum Sheung Center for Health and Happiness can encourage scholars from a wide range of disciplines to work together towards the goal of creating more happiness in the world,” says Lee. Added David Lee, chairman of the Lee Kum Kee Family Foundation, “As the world’s leading institution of public health, Harvard Chan School can make the whole world aware of the importance of happiness in improving people’s overall well-being, as well as the measures that can help achieve this goal.”

C-CHANGE: Linking Climate and Health

Gina McCarthy

Climate change is one of our greatest public health threats—and one of our best opportunities to improve health. Philanthropic support is now helping drive the Harvard Chan School’s work to understand links between climate change and health, and to turn that research into solutions.

Campaign gifts proved instrumental in launching the Center for Climate, Health, and the Global Environment (C-CHANGE), led by former Environmental Protection Agency Administrator Gina McCarthy. “Climate change in many people’s eyes is seen as a faraway problem about the Arctic or polar bears, when really it is a fundamental public health challenge,” says McCarthy.

McCarthy notes that financial support from donors strengthens C-CHANGE’s ability to attract not only leading climate change scientists, but also students eager to do research that makes a difference. “We are nurturing a new generation of students who will be experts in science and research but also understand how to communicate in ways that turn that science into policy.”

This philanthropic support also enables C-CHANGE to explore new frontiers in climate change research—such as the ways a changing environment affects children’s health. “There’s a fairly robust body of evidence that air pollution is associated with a variety of neurological impacts, such as autism and ADHD,” says McCarthy. “Everybody needs to know that climate impacts health, and that health is about the future of their families and kids. When those connections are made, people will act.”