How do the School’s rising stars envision public health’s next 30 to 50 years?
Interviews by Michael Blanding / Illustrations by Mike McQuade
Public health has always pointed to the future: in its defining mission to prevent disease and suffering, in its quest to understand how the conditions that create illness can be altered, in its determination to apply the latest science to timeless problems. Guided by this future orientation, public health expands the frontiers of science and society.
This year, Harvard T.H. Chan School of Public Health Dean Michelle A. Williams, ScD ’91, affirmed this forward-looking vision by framing her strategic and research priorities in terms of five Harvard Chan Frontiers: Reimagining Aging, Overcoming Violence, Confronting Climate Change, Cultivating Well-Being and Nutrition, and Conquering Epidemics.
How will these key fields of research play out over the coming decades? To find out, we asked the scientists who will help make the groundbreaking discoveries: some up-and-coming stars in the School’s faculty. What are their hopes and fears for the future? How could breakthroughs in public health unlock scientific secrets and human potential? What would it take to bring to fruition their biggest and boldest ideas?
While these promising young scientists speak optimistically about the School’s five Frontiers, they also stepped back to articulate their hopes and concerns about today’s trends in public health.
Many, for example, are buoyed by technological breakthroughs. “We’re going to see, within a decade, trials on diseases which are currently considered incurable,” says Jeff Wagner, postdoctoral fellow in the Department of Immunology and Infectious Diseases (IID). “My personal favorite as a first pass would be cystic fibrosis. It is caused by a single gene. We know what mutation causes the problem in humans. And it’s a really rough disease: Most patients don’t live past 50 and typically die of a massive bacterial infection of the lungs.”
Adds Iain MacLeod, research associate in IID: “One of the biggest issues in access to drugs is the price of the pharmaceuticals—and that’s related to the R&D [research and development] cost. If machine learning and artificial intelligence can accelerate R&D, a broader range of drugs will be available in a shorter time span and at a much lower price. That will drive global equity in health care.”
Other colleagues voice worries about the future financial stability of public health programs. “To make these predictions come true, we need to democratize technology. It must be inexpensive and easy and straightforward to use,” says Yonatan Grad, the Melvin J. and Geraldine L. Glimcher Assistant Professor of Immunology and Infectious Diseases. “To accomplish that, you need buy-in from large-scale funders. Governments and nongovernmental organizations must decide that this is an infrastructure worth investing in, because of the potential public health benefits.”
Jessica Cohen, the Bruce A. Beal, Robert L. Beal, and Alexander S. Beal Associate Professor of Global Health, notes similar concerns in her research specialty. “If you’re funding a malaria-control program in a country, and you get malaria down to 1 or 2 percent prevalence, you are likely to assume that you can shift to other funding priorities. But once funding is withdrawn, malaria can jump right back,” she explains. “We need to create more creative financing—such as an earmarked tax or an endowment fund—so that there are more stable and predictable funding streams for malaria control. A big achievement would be to find a way to keep funding streams predictable while continuously innovating on technologies such as a vaccine.”
Other young Harvard Chan researchers have turned their attention to the wider public health landscape. Ben Sommers, associate professor of health policy and economics, highlighted the inescapable role of government in ensuring health care for all. “In the U.S., the ultimate question for the next 50 years is: Will there be a point at which the political calculus changes and politicians decide there’s a role for government in ensuring universal coverage and in regulating prices to make health care more affordable? If you look around the world at nations that are economically similar to the U.S., most have variations on universal coverage, whether it’s public insurance, private coverage heavily subsidized and regulated by the government, or a combination. There is no shortage of models. But they all have one thing in common: They require more government involvement in health care.”
IID’s Iain MacLeod reflects on health care globally. “I see a lot of countries taking a protectionist approach, only looking after their own. Countries seem to be turning inward, away from their neighbors, and that could have a severe impact on global health. People will pull funding from international development projects and reverse the progress of the last couple of decades.”
Other faculty members have examined the role of public health practitioners like themselves. “My hope is that gender diversity will be celebrated and embraced in 50 years in a way where it’s no longer something to be afraid of or to be stigmatized. Moving forward, the biggest need is to go to communities, talk to communities, find out what they need, find out what works best for them, and then leverage that in public health,” says Sari Reisner, assistant professor in the Department of Epidemiology. “I question the distance today between the research population and the researcher. I believe that distinction is a false one.”
According to Tamarra James-Todd, Mark and Catherine Winkler Assistant Professor of Environmental Reproductive and Perinatal Epidemiology: “We need to recognize that even though we’re in academia, we’re training people who can move beyond academia. They may make the greatest policy impact by going beyond these walls.”
What follows are more quotes excerpted from our interviews with Harvard Chan researchers—women and men working at the five Harvard Chan Frontiers, and at the frontiers of their own scientific dreams.
By 2020, the number of people worldwide age 60 years and older will outnumber children younger than 5. This unprecedented demographic shift will bring dramatic changes in how people live, learn, and work. How can we ensure that aging individuals maintain their health and live up to their potential?
Harvard Chan researchers are digging deep into cellular mechanisms, analyzing statistical patterns across decades of health data, exploring how connection with others is protective, and tracking down other clues to healthier and happier aging.
Associate Professor of Genetics and Complex Diseases
Centenarians live to 100, but they also often live in a pretty healthy state well into their 90s. What the genetics-of-aging field wants to do is to mimic in those of us who are not centenarians the relationship between environment, genetics, and human disease risk that centenarians have—whether through pharmacological means or dietary interventions. It will require a combination of lab-based biological research, big-data, tech-based approaches such as machine learning, and personalized medicine to translate basic science into a therapeutic application.
For the last 20 years, we’ve seen the blossoming of the new field of the genetics of aging. Much of this work has been done in model species, and we can already successfully prolong healthy aging in organisms in the lab. But when we try to translate that to human clinical trials, we face the fact that aging is not really a disease. In the future, to take this work out of the realm of the lab and into the clinic, we will need collaboration between academia and industry, getting companies on board to run clinical trials. This requires working with the Food and Drug Administration, so that aging itself is considered an acceptable clinical outcome for drug approval.
Associate Professor in the Department of Epidemiology
Laboratories can currently measure thousands of biomarkers in blood or tumor samples. In the future, with continued expansion to an even bigger scale, we hope to understand how and why cancer occurs and be able to prevent cancer. For a woman who has a family history of breast cancer or who has dense breasts on a mammogram—factors that put her at higher risk—is there something that she can change about her diet or her exercise or her lifestyle to reduce that risk? We will also find the balance between detecting important tumors that need to be treated while avoiding overtreatment for tumors that ultimately are not going to be consequential.
Director of the Center for Global Cancer Prevention
Today, we can take blood samples and test blood sugar on an iPhone. In the future, this will be happening around many other biological markers. In the coming decades, I believe people will be able to regularly monitor their cancer risk over time. When a warning light goes off, doctors will be able to catch cancers early or prevent the cancers from occurring at all.
In a world where many forms of violence are seemingly on the rise—between individuals and across populations, from brutal physical assault to blinding social prejudice—researchers at the Harvard Chan School are using scientific rigor to understand how damage to the body and spirit can be prevented. They are also delving into how to repair the effects of violence and build resilience in the future. (To learn more about current Harvard Chan research to stem violence, read “Uncommon Ground.”)
Research Fellow in the Harvard FXB Center for Health and Human Rights
We’re seeing large population displacements today—forced migration from direct conflict, economic migration—and with climate change, we expect to see more. The current model of taking care of these displaced populations and providing them aid is wholly insufficient, because a lot of these displacements are protracted and sometimes permanent.
On the flip side, we have developed new methods to collect more accurate information from the field—crowdsourcing and crisis mapping have been very effective. In the future, we should expect better information flow, as well as information that is decentralized and widely available. It’s mind-boggling to think about the possibilities, over the next four or five decades, with cloud computing and mobile devices.
Assistant Researcher in the Signal Program on Human Security and Technology, Harvard Humanitarian Initiative
In humanitarian missions, drones will provide an accurate, real-time picture of what is happening on the ground. I see a future where this kind of geospatial information is quickly gathered and then uploaded to a collectively shared database or system. The data will be used in refugee-camp management and planning, and in assessing refugee movements. Drones will also be used in what we call pre-disaster preparedness. Drone maps will help create 3-D models to get a better sense of which areas are at more risk of floods or landslides or other natural hazards, so that we can build resilience before a disaster strikes.
Professor of Psychiatric Epidemiology
There was an inflection point during the 1970s and ’80s, when veterans were coming back from the Vietnam War, the women’s movement was strong, and the book Rape Trauma Syndrome came out. Clinicians were seeing a phenomenon that didn’t have a name but was similar across patients who had experienced different kinds of trauma. Today, we’re at a similar inflection point, driven by soldiers coming back from Iraq and Afghanistan, terrorism, reports on abuse within the Catholic Church. Once again, there’s attention in the public space on trauma and post-traumatic stress disorder.
In the coming decades, today’s research has the promise to pay off dramatically. We are gathering data from victims as soon as possible after the violent event and following people over time to understand the whole picture of what happens after a trauma. One of the goals is early diagnosis and prevention—because if we identify people early, intensive psychotherapy can prevent full-blown disease. We’re also trying to understand why, after any kind of trauma, a large proportion of people recover without any intervention. We will never prevent all trauma, but we are learning how to prevent some of the negative consequences.
Research Scientist in the Department of Environmental Health
We know that child abuse has a profound effect on physical, mental, and behavioral health across the life course. We also know how to prevent child abuse, or at least reduce its likelihood.
My hope is that over the coming decades, the growing number of scientific studies will catalyze the political will to invest in families with young children, and to help people who might otherwise be abusive. I would love to see a common understanding—across the political spectrum—that childhood is a highly vulnerable period over which society has a huge influence. As researchers, we also need to show that it’s cost-effective to treat children—and adults—who have been victims of trauma, because kids who have been traumatized are at far higher risk of developing not only mental health problems such as depression and anxiety but also cardiovascular disease, some cancers, and autoimmune diseases. The effects of childhood abuse also cross generations, with children of women who experienced abuse at higher risk of autism, attention deficit disorder, obesity, and substance use.
CONFRONTING CLIMATE CHANGE
Climate change touches every aspect of our lives, from the air we breathe and the food we eat to the rising risk of epidemic disease and natural disaster—and the social upheaval that these crises trigger.
The Harvard Chan School is working to protect communities around the corner and around the globe—uncovering the human toll of misguided policies and the biological dynamics of a changing environment. Our scientists are crafting solutions that become possible when disciplines and
institutions join forces in a common purpose.
Research Fellow in the Center for Climate, Health, and the Global Environment
Climate change should be public health enemy number one. The irony is, if we don’t slow the rate of climate change, we may no longer get the luxury of imagining future public health achievements. It stands to undo the last 50-plus years of public health gains, and it’s hiding in plain sight through extreme wildfires, hurricanes, droughts, floods, etc. We can’t understate the risk of triggering a runaway feedback loop that induces a permanent disaster state.
But climate change also presents one of the greatest global public health opportunities of our time. Human health is one of the few shared values that transcend other societal constructs. We shouldn’t regret the age of fossil fuels—we should honor its passing by making sure we don’t undo all the good it’s done our species.
Research Associate in the Department of Environmental Health
My particular interest is using microorganisms to transform wastewater into fuel. Imagine that every city will be its own refinery, because it will transform the nutrients that we process in our bodies into fuel. That will reduce not only carbon intensity but also toxic emissions.
Associate Director of the Healthy Buildings Program; Center for Climate, Health, and the Global Environment
Climate change is this slow, rolling behemoth that will keep gathering momentum. Even if everyone does the right thing starting today, we’re still going to face the consequences. You can see that in the extreme weather events that we’ve had over the past few years. It can be a gloomy forecast, but it also sets up a big opportunity for public health.
Buildings use 40 percent of our primary energy consumption, so it’s a key area to target if we want to have an impact on climate change. If the grid becomes 100 percent renewable, then it’s not as important for buildings to be energy-efficient, because they’re essentially energy-free at that point. In the near term, however, building efficiency is hugely important, because it’s going to be a long time before the grid becomes fossil-fuel–free.
On the positive side, I think that the goal of 100 percent renewable energy on the grid will be a reality. Thirty years seems very doable to me. All the solutions are already on the table, and they could be implemented right away. The obstacles today are political inertia and lack of trust in technology.
Right now, 7 million people die each year from air pollution. I think that number will go down to zero by 2050, once the grid is completely fossil-fuel-free, transportation is decarbonized, and indoor sources of air pollution are removed. If you poll millennials, they are overwhelmingly in support of green-energy initiatives—and that support will not wane as millennials get older.
CULTIVATING WELL-BEING AND NUTRITION
From fast food to no food, from the worldwide obesity epidemic to social isolation and despair—humankind is plagued by barriers to thriving. Harvard Chan researchers are leading the way in understanding how genetics, lifestyles, and social forces interact to influence everything from metabolism to mental health. In this scientific pursuit, they are also finding new ways to measure well-being and empower individuals and communities.
Assistant Professor of Global Health and Population
Diabetes will be the signal disease for cardiovascular risk in the future, because most people with diabetes die from its complications, such as cardiovascular disease, heart attacks, and kidney failure. To address this, we cannot rely on voluntary actions from the food industry. Governments need to adopt strong regulations to protect citizens from the unhealthy food environments that are spreading across the globe.
I’m also concerned about the huge increase in consumption of animal-based products that we see all over the world, especially in Latin America and Asia, but soon in sub-Saharan Africa as it develops economically. For meat, chicken, and dairy, the carbon footprint, the water footprint, and the land-use footprint are significantly higher than [for] plant-based products. Animal products also tend to contain higher levels of environmental contaminants—such as PCBs, DDT/DDE, other lipid-soluble pesticides, and pollutants from industrialization—because they’re high in fat.
Professor of Public Health Policy
Looking ahead, we need to make very high-calorie foods with no nutritional value less accessible—either financially less accessible, in the case of beverage taxes, or physically less accessible, such as in the workplace. I predict that in 30 years, we will live in an environment where everything is nudging us toward healthy choices—as opposed to the environment we live in now, where everything conspires to get us to eat more and exercise less.
Research Scientist in the Department of Nutrition
For many decades, one of the challenges has been how to assess diet in our research. In the future, we will see growth in wearables and other technologies that can directly evaluate diet—such as people taking a picture of what they are eating with their smartphones and using an app that can break down the foods and their ingredients, and then transfer that information in real time to their computers. That will not only help research but also help consumers. People can scan a meal and know right away its nutrient profile.
Assistant Professor in the Department of Epidemiology
The issues that disproportionately impact LGBTQ people are HIV, sexually transmitted infections, and mental health and behavioral health concerns such as depression and substance abuse. A major unlock would be to have sexual orientation and gender identity as standard items on every demographic survey. We know that people are more likely to skip income questions than they are LGBTQ questions when we have added those questions to surveys. And if those were standard survey questions, we would be able to see trend data on mental health. What’s been working, and how can we target our efforts in the future?
Assistant Professor of Global Health
Over the next decades, we will see rapid development of the digital world and artificial intelligence in general—algorithms and digital tools that will help us better forecast and anticipate public health problems. We’re already seeing that in patient/provider interactions, but the trend will expand as we apply these tools to the environment, economic and health inequalities, and the factors that underlie pandemics.
The danger of a massive infectious-disease outbreak—whether of a known pathogen or a newly discovered agent—is high. As disease-causing organisms evolve to resist our front-line medicines, and as the risks of infection multiply with urban crowding, global travel, and a warming planet, there is no time to lose. Harvard Chan scientists are working on many fronts—from bench science to data mining to health policy—to make sure humanity is ready when the next outbreak inevitably arrives.
Associate Professor of Epidemiology
One of the key things you want to know about an infectious disease is where is it spreading, how quickly, to which populations? Traditionally, we’ve had very few sources of data about how people move around. But today, everyone has a mobile phone. And the data coming from these phones will increasingly give us insights into the population dynamics of millions and millions of people in real time. Digital devices will also be a way to connect with people for public health messaging, to tell them what’s going on or to provide important health information.
Melvin J. and Geraldine L. Glimcher Assistant Professor of Immunology and Infectious Diseases
In the future, our understanding of the diversity of pathogen species, and the interaction between host and pathogen, will improve. This understanding has the potential to shape what we do, both at an individual clinical level and at a population-health level: better vaccines for known pathogens, new vaccines for newly discovered pathogens, personalized vaccines. Someday, we may even create a “weather map” of pathogens. And with that map, we may design not just a surveillance system but interventions based on that surveillance, to help slow or control the spread both of pathogens and of antibiotic resistance.
Bruce A. Beal, Robert L. Beal, and Alexander S. Beal Associate Professor of Global Health
Over the next 30 to 50 years, a game changer would be a highly effective malaria vaccine. Right now, the best things we have to prevent malaria are insecticide-treated bed nets that hang over a sleeping space and protect people from being bitten by a mosquito. But these nets need to be taken up and down every day. They also wear out, they get holes, and there’s increasing evidence of mosquitoes becoming resistant to the insecticide in the nets. Meanwhile, lots of kids with malaria are misdiagnosed or undertreated. A vaccine would allow us to circumvent these many behavioral barriers.
Research Associate in the Department of Immunology and Infectious Diseases
In the future, the trend will be toward long-acting injectable drugs for HIV. Drug resistance arises in an individual because that person has been on medication and has forgotten to take his or her drugs, or the pharmacy has run out of drugs, or something has happened in their lives, such as a relative passing away. That gives the virus enough time to develop resistance. But with a long-acting injectable, the drug is at a continuous optimal level for weeks.
Postdoctoral Fellow in the Department of Immunology and Infectious Diseases
In the near future, we’re going to see rapid diagnostic tests: for example, a simple and cheap readout that says whether a person has Zika or dengue—two viruses with similar symptoms. Further in the future, genetic engineering will offer biological kill switches or fail-safe mechanisms so that we will create cheap, propagatable vaccines. We could see the end of TB, malaria, and other major deadly infectious diseases.
Interviews by Michael Blanding, Boston-based journalist and author of The Map Thief: The Gripping Story of an Esteemed Rare-Map Dealer Who Made Millions Stealing Priceless Maps.