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Public Health at Center Stage for Yale’s 75th AYA Assembly

November 20, 2015
by Michael Greenwood, Jennifer Kaylin and Denise Meyer

Hundreds of Yale alumni from around the world gathered Thursday as part of the 75th Association of Yale Alumni Assembly and delved into some of the most pressing public health challenges facing the world.

Presented by experts from the Yale School of Public Health, alumni grappled with issues as diverse as the international refugee crisis, legalization of marijuana, deadly transnational epidemics, global warming, health disparities and widespread obesity.

While the news is often daunting, there are reasons for optimism. The public health movement has improved life for millions of people and there is a growing movement to spread these benefits further and to address emerging global health challenges in the 21st century.

“Public health can and should lead the way,” Jeannette Ickovics, a professor at the Yale School of Public, told the gathering in Harkness Auditorium at the Yale School of Medicine.

This year’s assembly—To {Y}our Health: Yale and Public Health in the 21st Century—coincides with the school’s ongoing centennial anniversary. Public health at Yale was created in 1915 by C.-E.A Winslow. Today, the Yale School of Public Health is one of the oldest accredited schools of its type in the country and its research partnerships and alumni network span the globe.

Innovation is Key

In his keynote address, Peter Singer, M.P.H. ’90, CEO of Grand Challenges Canada, noted that innovative approaches to lingering public health problems are crucial to finding solutions and improving health for millions, especially in resource-poor settings.

His organization was created five years ago and has since provided $235 million in funding for programs and research around the world. Some initiatives are simple and relatively easy to implement; others are technical and time consuming. Regardless, the approach is making a tangible difference both in lives saved and the quality of life for many.

In Nepal, Singer’s organization is seeking to lower newborn mortality. One innovation is the introduction of an antiseptic that is used when the umbilical cord is cut. This simple measure helps avoid infection and prevents many untimely deaths.

In Cambodia, meanwhile, iron deficiency is widespread and causes a range of complications for pregnant women and their offspring. Grand Challenges Canada helped introduce a chunk of iron—shaped like a local river fish that is believed to bring good luck—that is dropped into cooking water and releases the life-saving mineral.

In the area of mental health, a public health problem that goes unaddressed for many, especially in developing countries, Grand Challenges Canada is working with local health workers in Zimbabwe to create Friendship Benches. The project provides a place where people with common mental health disorders can talk with a health worker. For those with lower level disorders, such talk therapy can make a significant difference in their mental health.

“The focus is on impact. These are the kind of changes that can really change the world,” Singer told the assembled alumni. “You can really get results by investing in innovation.”

Innovation at YSPH

Such innovation, said Dean Paul Cleary, defines the School of Public Health as it prepares for its second century.

The school today has hundreds of dedicated students and expert faculty who collaborate across the university and beyond to identify the health solutions needed to address current and future public health challenges. Their efforts are buttressed by more than 5,000 alumni who work in virtually every public health field in more than 70 countries around the world.

Cleary told alumni about a new program at the school—Climate Change and Health @Yale—that has been created specifically to address the health problems attending changing weather patterns around the world and which are expected to disproportionately affect the poor. The multidisciplinary program is one of the first of its kind.

Cleary also related how YSPH faculty led a multinational effort to decode the genome of the tsetse fly. The small insect, about the size of an ordinary pill, is solely responsible for the transmission of African sleeping sickness, a disease that continues to devastate people and livestock in a large swath of Africa.

The genome project took nearly 10 years to complete and involved some 140 scientists from around the world. The decoded genome will open the door to new research and understanding that could lead to the disease’s eventual eradication. The accomplishment was so significant that it was featured last year on the cover of Science magazine.

“We bring together all kinds of expertise,” Cleary said. “We want to have an impact.”

At the local level, he described the work of CARE: Community Alliance for Research and Engagement, a research group based at the school. CARE has worked for years in New Haven’s most underserved neighborhoods to address—and reverse— disproportionately high rates of chronic diseases. The program is led by Ickovics.

YSPH Students

Five students from the School of Public Health provided the alumni gathering with general overviews of their work, leaving many so impressed that they continued to talk about the presentations hours afterward.

Ruchit Nagar, who is in the final year of the joint BS/MPH program offered by the school, is one of the founders of Khushi Baby (which translates to “happy baby”). The student group created a necklace with an embedded electronic chip that records the vaccination history of the person wearing it.

Reliable vaccination records can be hard to come by in many developing countries and children who receive incomplete inoculations are at heightened risk for disease and death. The necklace has been introduced in India and immediately lets health workers know which vaccines have been administered and which remain. Its public health potential is enormous.

The intervention has been rolled out in 100 villages and is being used by more than 1,000 children, Nagar said. Khushi Baby won the inaugural Thorne Prize at Yale in 2014 and received $25,000 in seed capital to further develop and implement the idea.

Other students outlined their work on the health consequences of marijuana legalization (Hannah Kaneck); building creative health care organizations for quality improvement (Yuna Lee); creating mathematical models to slow the spread of disease outbreaks such as Ebola (Laura Skrip) and the development of a simple electronic pill dispenser that notifies family members or medical staff if a patient fails to take their medications (Alex Rich).

Fireside Chats

In the afternoon, alumni selected from a series of “fireside chats” addressing 10 current public health issues, each of which was led by a School of Public Health researcher.

The plight of global refugees drew a large group to a discussion led by Associate Professor Kaveh Khoshnood. Many criticized attempts by some politicians to block Syrian refugees from entering the United States in the aftermath of the recent terrorism in Paris.

The number of refugees from Syria is tiny and those being admitted have undergone extensive background checks. Still, governors in many states (not including Connecticut) have publicly said that Syrian refugees are not welcome.

“How un-American!” said panelist Chris George, executive director of Integrated Refugee & Immigrant Services, a New Haven-based agency that helps incoming refugees settle in Connecticut. “Governors should know better.”

Another session focused on the health threats posed by climate change. Moderator Durland Fish, professor emeritus, started the conversation by asking, “What are the major health effects of climate change?”

Morbidity and mortality from heat waves, floods, hurricanes and other disasters, answered panelist Robert Dubrow, professor at the school. “And we know that the frequency of these events is going to increase.”

The group also discussed the dearth of research funding to study climate change as it relates to public health and how the resultant uncertainty plays into the hands of climate change “deniers.”

A session led by Melinda Pettigrew, associate professor, addressed the ongoing controversy surrounding vaccinations, despite scientific consensus that they are safe and effective.

Vaccines, many of which are administered during early childhood, can prevent seventeen diseases. While the Centers for Disease Control and Prevention sets the bar of recommendations, each state is responsible for overseeing its own public health campaigns. Enforcement comes as requirements to enroll in public schools and summer camps, but laws vary from state to state.

A rigorous and robust scientific process is used to evaluate data before any changes are made to vaccine recommendations in this country, said Marietta Vazquez, associate professor of pediatrics and nursing, who recently served on the CDC’s Advisory Committee of Immunization Practices. The committee reviews mountains of data and listens to viewpoints of hundreds of people during public hearings.

“It is heartbreaking to hear parents’ stories of children who have died from vaccine-preventable diseases,” said Vazquez.

Other sessions included preparations for future epidemics; the Affordable Care Act; the influence of social networks on health; old age and health; stigma, racism and health; nutrition; and making mental health services more accessible.

Attendees then participated in a series of interactive sessions that ranged from a walking tour of New Haven (with a public health theme), how works of art can inform public health education and thinking and a visit to Yale’s “brain museum,” a collection of some 500 human brains that have been carefully preserved and documented.

Michael Bracken, the Susan Dwight Bliss Professor of Epidemiology and Professor of Neurology and of Obstetrics, Gynecology, and Reproductive Sciences, led a conversation based on his 2013 book, Risk, Chance and Causation–Investigating the Origins and Treatment of Disease, that explores the creation of truly objective epidemiological studies in language that is accessible to the general public.

Bracken described the gold standard for epidemiological studies—double-blind randomized control trials—where neither the patient nor the clinician know who is receiving a treatment and who is receiving a placebo. However designing such studies can be tricky and bias can creep in at many levels.

“We even blind statisticians in our studies,” said Bracken, who is also founder and co-director of the Yale Center for Perinatal, Pediatric and Environmental Epidemiology.

Submitted by Denise Meyer on November 20, 2015