fall 2004 - living long, living well - public health

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p. 9 Training Tomorrow’s Physicians to Care for an Aging Population

p. 12 Report From the Field: Fighting Disease and Heartbreak in Brazil

Public HealthUniversity of California, Berkeley

L I V I N G W E L LL i v i n g L o n g

This issue of our magazine highlights a topic of growing importance to everyone: healthy aging. Aging, of course,begins at birth, and the correlates of healthy aging involve a complex interplay of biological, behavioral, and envi-ronmental factors operating over our lifetime. As such, the topic serves as a primary example of our School’s broad-based ecological approach to human health. Throughout this issue you will read examples of our faculty’s innovativeresearch on the interaction of biological, behavioral, and environmental forces that influence the aging process.Importantly, you will also read about how we work to ensure that the results of this research are used in everydaypractice to maintain and enhance the health and independence of older citizens. While the primary focus of thisissue is on older citizens, we are also working on achieving a better understanding of the determinants of health atconception, birth, and the early stages of life that provide the foundation for healthy living at later stages. Some ofthese exciting discoveries will be highlighted in future issues of the magazine.

In this issue, we also celebrate a number of awards received by our faculty and alumni for their contributions to thepublic’s health. Three of our faculty and three of our alumni received major awards from the American Public HealthAssociation (APHA). Among the faculty, Barbara Abrams, professor of epidemiology and associate dean for studentaffairs, received the March of Dimes Agnes Higgins Award; Mark van der Laan, professor of biostatistics, receivedthe Mortimer Spiegelman Award; and Richard Scheffler, Distinguished Professor of Health Economics and director ofthe Petris Center on Health Care Markets & Consumer Welfare, received the Carl Taube award. (See sidebar, p. 20.)It is unprecedented for faculty from a single school to sweep all three of these awards in a given year.

Among our alumni, Marion Nestle, professor at NYU and the School’s most recent Alumna of the Year and commence-ment speaker, received the David P. Rall Award; Larry Green, visiting professor at the School and former director, Office of Science & Extramural Research at the CDC, was honored with the Mayhew Derryberry Award; and Pat Crawford, co-director of the Center for Weight and Health at UC Berkeley, received the Catherine Cowell Award. (See sidebar, p. 29.)

In addition, the School is singularly honored by the announcement that three of its recently retired professors emeritireceived The Berkeley Citation award from the University. This highly selective and prestigious honor is given to Berkeleyfaculty who have made significant contributions over the course of their careers at the University. Professor LeonardDuhl was honored for his intellectual leadership in developing the concept of healthy cities and healthy communities,which has now spread worldwide. Professor Teh-wei Hu was honored for his lifetime work in health economics, partic-ularly in regard to the examination of the effects of taxation on smoking. Professor Zak Sabry was honored forhis contributions to the field of nutrition, and particularly for his longitudinal work on the examination of diet in adoles-cent minority populations. These awards are, indeed, an “embarrassment of riches” for the School and provide furtherevidence of the quality of our faculty and graduates and the growing impact of their work on the public’shealth. I know that you join me in expressing our congratulations and pride in their accomplishments.

Finally, I am pleased to end this fall message with a warm welcome to our new chancellor, Robert Birgeneau. Anaccomplished physicist and academic leader who served as dean of science at MIT for nearly two decades and as presi-dent of the University of Toronto for the past three years, Professor Birgeneau is extremely well qualified to build onthe success of his predecessors in leading UC Berkeley to even greater heights in the years ahead. We look forward toworking with him on this journey.

Stephen M. Shortell, Ph.D., M.P.H.Dean, School of Public Health

Blue Cross of California Distinguished Professor of Health Policy & Management

Professor of Organization Behavior

From the Dean

Dean Stephen M. Shortell

Building a Foundation for Healthy Aging

Cover: Students in the UC Berkeley-UCSF JointMedical Program meet regularly with resi-dents of continuing care retirement facilitiesto learn about geriatrics. At Oakland’sPiedmont Gardens, student Kevin Marsee(left) meets with resident Irene Hasenclever(center) and preceptor Dr. Claudia Landau,while Dr. Landau’s dog, Lucy, lends support.

1Public Health

DeanStephen M. Shortell, Ph.D., M.P.H.

Assistant Dean, External Relations and DevelopmentPatricia W. Hosel, M.P.A.

EditorMichael S. Broder

FeaturesUnderstanding Aging: Biology, Behavior, and Environment 2by Vivian Auslander How do we maintain our health, vitality, and independence as we grow older? Faculty explore the needs of our nation’s rapidly aging population and suggest how we can marshal our resources appropriately.

Training Tomorrow’s Physicians to Care for 9

an Aging Populationby Michael S. Broder By incorporating an innovative geriatric curriculum, the UC Berkeley-UC San Francisco Joint Medical Program responds to an anticipated critical shortage of health professionals trained to care for the elderly.

DepartmentsPast, Present, FutureSheldon Margen: An Amazing Passion for Learning and Teaching 11by Dale A. OgarA legendary professor emeritus with a brilliant, curious mind makes his mark at the School.

Report from the Field: Fighting Disease and Heartbreak in Brazil 12by Krisztina SzaboFor one graduate student, a fieldwork fight against infection-causing bacteria leads to rebuilding a collapsed schoolhouse—and transforming her world view.

Scholars in New Program Explore Health and Society 14by Michael S. BroderSix visiting Robert Wood Johnson scholars seek to understand why some groups of people are healthier than others.

Faculty NewsResearch HighlightA new study suggests maternal diet is linked to lower childhood leukemia risk. 17

Faculty News and Notes 18

Meet the New Faculty 21The School welcomes two new members to its faculty: William Dow and Darlene Francis.

Partners in Public Health 23Four new Policy Advisory Council members bring a wealth of experience to the School.

Alumni News 26Alumnus Spotlight: Peter Szutu 27A commitment to teamwork, prevention, maintenance, and intervention help the president and CEO of the Center for Elders Independence to leave no senior behind.

Alumni Notes 28

In Memoriam 30

Public HealthUniversity of California, Berkeley

Associate EditorJohanna Van Hise Heart

DesignArcher Design, Inc.

ContributorsVivian Auslander, Michael S.Broder, Johanna Van Hise Heart,Linda Neuhauser, Dale A. Ogar,and Sarah Yang.

PhotographyPeg Skorpinski, cover, inside front cover,pp. 9–11, 14–16, 18–22, 25–26, 28(Brown), 29 (Nestle), and back cover;courtesy of Robbi Pengelly, The SonomaIndex-Tribune, p. 2; Getty Images, p. 5;istockphoto.com, pp. 6 & 8; courtesy ofKrisztina Szabo, pp. 12–13; RobertAichinger, p. 17; Patricia W. Hosel, p. 24;Vivian Auslander, p. 27; Michael S.Broder, p. 29 (Crawford, Green); cour-tesy of the Reeves family, pp.30–31;

Karl Peace p. 32 (Hsu); George McKray,p. 32 (Reshetko).

Communications Advisory BoardW. Thomas Boyce, Patricia A. Buffler,Margaret Cary, Helen A. Halpin,Meredith Minkler, Linda Neuhauser, LeeRiley, Beth Roemer, Stephen M. Shortell,Robert Spear, and S. Leonard Syme.

UC Berkeley Public Health is publishedsemiannually in the spring and fall bythe University of California, Berkeley,

School of Public Health, for alumniand friends of the school.

UC Berkeley School of Public HealthOffice of External Relations and Development140 Earl Warren Hall #7360Berkeley, CA 94720-7360(510) 642-9572

© 2004, Regents of the University of California. Reproduction in whole or part requires written permission.

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2 University of California, Berkeley2

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Understanding Aging:

BioloË, Behavior, and EnvironmentBy Vivian Auslander

Dr. Armand P. Gelpi monitors the heart rate and breathing of Helen McKenna at different levels of exercise as part of the Study ofPhysical Performance and Age-Related Changes in Sonomans.

How do we maintain our health, vitality and independence as we grow older? What special needsdo we have as a nation whose population is rapidly aging, and how can we marshal our resourcesappropriately? Our faculty is exploring these questions from a wide variety of perspectives.

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Staying ActiveFor William Satariano, Ph.D., professorof epidemiology and community health,helping people to stay physically active is“the ideal public health intervention.”

Satariano has focused his research atthe intersection of health and behaviorfor more than 20 years, with a specialinterest in how we function as we age.His work ranges from studying theimpact of cancer on physical activityamong the elderly to the impact ofthe “built environment”—that is, howthe characteristics of the neighbor-hoods in which older people live helpor hinder their ability to maintainactive lifestyles.

With colleague Ira Tager, M.D.,M.P.H., and others, Satariano has beenstudying 2,100 people aged 55 andolder in the town of Sonoma, Calif., tolearn about their physical performanceas they age. The Study of PhysicalPerformance and Age-Related Changesin Sonomans (SPPARCS), now in itstwelfth year, is funded by the NationalInstitute on Aging.

Satariano’s area of focus in SPPARCShas been an assessment of the reasonsolder people give for limiting or avoid-ing physical activity.

“Men were more likely to say they didn’t engage in physical activity becausethey didn’t want to,” says Satariano.“Women were much more likely to limitor avoid physical activity because theydidn’t have anyone to do it with. Amongwomen 55 to 64 years old, the absence ofan exercise companion was the leadingfactor for not engaging in physical activi-ty. This finding is important, because itindicates that a key determinant forengaging in physical activity is social.”

With increasing age, the reasons men andwomen gave for limiting or avoiding

physical activity became more similar.“Health problems were a major factor,fatigue was a factor, and, interesting-ly, fear of falling was a major factorfor both men and women,” Satarianosays.

His latest work on the Sonoma studyfocuses on how the health of one spouseinfluences the health of the other. “Weknow, for example, that depression clus-ters in families," he says. “I would like tounderstand this process.”

The Sonoma study is typical of what ittakes to investigate people’s health andwell-being effectively today, Satarianosays. “Researchers in a multitude ofdisciplines—biological, social, epidemi-ological—need to come together totake a comprehensive look. We haveincreasing evidence that all those fac-tors are important, and we need tounderstand the relationship betweenthem more clearly.”

Healthy Aging Research NetworkSatariano and colleague Susan Ivey,M.D., M.H.S.A., direct UC Berkeley’sparticipation in the Healthy AgingResearch Network, a national coalitionestablished by the Centers for DiseaseControl and Prevention (CDC) to learnwhat keeps us healthy as we age and tohelp translate research results into action.

Ivey, who holds adjunct facultyappointments at UC Berkeley and UC San Francisco, recently completedthe first phase of a survey designed tolearn what resources exist in AlamedaCounty for older adults who wish to

engage in physical activity and whatbarriers there are to serving them. Shewas surprised to find that catering toseniors “was not on the radar screen”for many organizations, even thoughthey could have targeted services toolder adults.

Based on her preliminary findings, Ivey,working with the City of Berkeley’sChronic Disease Prevention Program,has produced a guide to places in theBerkeley area that offer programs ofphysical activities for older adults—everything from parks to pools tochurches. (The guide is available throughthe City of Berkeley’s Department ofHealth Services.) Ivey is continuing thiswork by piloting a second survey todevelop better ways to measure thesupply and demand for such programs.

Environmental FactorsSatariano and Ivey are also studyingneighborhoods to determine whetheror not they have characteristics thatencourage older people, particularlythose with functional impairments, to walk and remain physically active.They will conduct “environmentalaudits” to analyze, for example, theextent to which a neighborhood pro-vides benches, rest rooms, and trafficlights that give slow walkers enoughtime to cross the street.

“The more physically active you are,the less likely you are to have chronicdiseases or to be depressed, and themore likely you are to maintain flexibilityand balance and to recuperate from illnessor injury more quickly,” Ivey says.

“The more physically active you are, the less likely you are to

have chronic diseases or to be depressed, and the more likely

you are to maintain flexibility and balance and to recuperate from

illness or injury more quickly.”

4 University of California, Berkeley

What happens to the brain as we age?If you’ve ever joked about having a “sen-ior moment,” you should be aware thatthe implications of the joke are scaryand profound. Is memory loss inevitablewith aging? Can we tell the differencebetween “normal” change in the brainover time and change due to diseasesthat cause dementia?

With colleagues throughout thenation, William Jagust, M.D., profes-sor of public health and neuroscience,is seeking answers to these questions. Hehas received a $1 million grant from theNational Institute on Aging to participatein the Alzheimer’s Disease NeuroimagingInitiative, a five-year national studyseeking better ways to predict who willdevelop Alzheimer’s disease and to assesspeople’s response to treatment.

For Jagust, the timing couldn’t be moreimportant. “We’re behind the curve withAlzheimer’s disease,” he says. “The BabyBoom generation is just starting to learnabout it. If we don’t either come up withpublic health measures that have aneffect or drugs that have an effect, we’regoing to be in big trouble.”

Jagust is particularly interested in whathe calls “the border zone” between agingand Alzheimer’s disease: He wants to know how the brain changes with agingand what factors lead to Alzheimer’s disease. He has pioneered the use ofpositron emission tomography (PET)

and other imaging techniques to analyzebrain structure and function. PET scan-ning helps scientists explore how thebrain works by taking high resolutionpictures of chemicals in the brain.

The Alzheimer’s disease initiative isexamining the effectiveness of imagingtechnology and other techniques foranalyzing changes in the brain. Jagust iscoordinating the work of all the researchcenters conducting PET scanning testsfor the study.

“Many of us believe that, in the next fiveyears, we will have drugs that are effectivefor slowing down the progress ofAlzheimer’s disease,” Jagust says. “Whenthat happens, we will need reliable meas-ures for testing them. Right now the onlymeasure we can make is a score on amemory test. What we’re hoping to do isto use some of these imaging methods.”

Some 800 people are enrolled in thestudy throughout the United States. Thelargest group consists of people withmild cognitive impairment (MCI)—they don’t have Alzheimer’s disease butthey do have memory loss.

“We know these people are at high riskfor developing Alzheimer’s disease,”Jagust explains. “We want to find outhow effective our imaging tests are atpredicting who is going to get

Alzheimer’s disease in this group. Wewant to be as accurate as we can. Whenwe do have these drugs, we will want togive them to the people who will benefitthe most, and we will want to do thisbefore they are really sick, because oncea person has Alzheimer’s disease it maybe too late to reverse the disease.”

Diabetes and Dementia:The SALSA StudyMuch of Jagust’s research involvesvolunteers with specific problems thatcan affect the brain, like vascular dis-ease. To learn more about the generalimplications of his findings, he par-ticipates in epidemiological studies inwhich volunteers are drawn from abroader population.

For example, with epidemiologist MaryHaan of the University of Michigan,he recently completed a study of cogni-tive impairment and dementia among1,800 older members of the Hispaniccommunity surrounding Sacramento.The Sacramento Area Latino Study onAging—SALSA for short—was the firstto look at risk factors for cognitivedecline in the Hispanic population,an important demographic group inCalifornia and the nation.

“This community has some unique char-acteristics that we thought might give usclues about dementia,” Jagust says. “Forexample, we knew that diabetes might berelated to dementia in the non-Hispaniccommunity and that there is a highprevalence of diabetes in the Hispaniccommunity, so we wondered if diabeteswould be an important risk factor tolook at in regard to dementia. We foundthat it was. Our study showed that therisks for dementia and Alzheimer’s dis-

ease in the Hispanic community aredifferent from those in the non-Hispaniccommunity. In the non-Hispanic com-munity, one of the important risk factorsfor Alzheimer’s disease is genetic. In ourstudy population, the important risk fac-tors were diabetes and stroke, as opposedto genetics.” Jagust is currently following

Feature

In a comparisonof PET scans ofthe brain’s glucosemetabolism in anormal olderadult and a person withAlzheimer’s

disease (AD), the Alzheimer’s patient showsreductions in glucose metabolism (darker areas)in posterior brain regions. These abnormalitiesmay be diagnostically useful in detecting AD andin predicting who may later develop the disease.

“It’s becoming increasingly evident that all the things that are bad

for your heart and vascular system are also bad for your brain.”

up with a smaller group of the SALSAstudy participants to learn how wellbrain imaging techniques will predictwho is going to get dementia over time.

Prevention Possibilities?So, if you are worried about “seniormoments,” is there anything to do,while Jagust and other researcherspush ahead to have a better under-standing of the brain?

“We have two kinds of approaches toimproving health in later life—thepublic health approach and the molec-ular neuroscience approach—and Ibelieve in both of them!” Jagust says.“The molecular neuroscience approachasks what has gone wrong in the brainand then develops a drug or a chemi-cal to make it better. The publichealth side looks at the risk factors forhaving difficult times as you get olderand asks how we can fix that. It’sbecoming increasingly evident that allthe things that are bad for your heartand vascular system are also bad foryour brain. And there is increasing evi-dence that participating in mentallyand physically stimulating activitiesmay be helpful as one gets older. Thestudies aren’t perfect, but in theaggregate, they suggest that gettingexercise, not becoming overweight,eating a balanced diet with antioxi-dants and lots of vegetables, stayingphysically and mentally active andnot smoking will benefit your cognitiveability in later life. I certainly want tobelieve it—I ride my bike to work!”

Aging at the WheelContrary to popular myth, older adultsdon’t all move to Florida—most remainin the same homes in which they haveraised their children.

“The real dilemma coming up in thenext decade or two will be all thesemillions of people aging in places

where they are far from public trans-portation and highly dependent onthe automobile. That’s going to be areal crisis, because many people willhave to drive in order to function,”says David Ragland, Ph.D., M.P.H.,adjunct professor of epidemiology anddirector of UC’s Traffic Safety Center.

For most adults, driving is the key tomobility and independence, Raglandsays. Indeed, his research with coll-eague William Satariano and othershas shown that older people who stopdriving are more likely to becomedepressed than those who remainactive drivers. This finding is consis-tent with other research showingadverse consequences when peoplehave to stop driving.

Yet elderly drivers (roughly those aged70 or older) are more likely to beinjured or killed in a crash and aremore likely to be involved in crashesthan any other age group except theyoungest drivers.

Ragland has been studying the prob-lems drivers face as they age with an eyetoward helping older drivers maintaintheir mobility while improving theirsafety and performance on the road.

“Our work indicates that the vastmajority of older people limit theirdriving voluntarily—they are notbeing forced,” he explains. The keyreason why older adults limit theirdriving is problems with vision.

“The basic lesson of our studies is that,if we can identify medical or functionallimitations, we can remedy some ofthem,” Ragland says. “Improving visionis obvious, but there might be otherremedies that can compensate fordeclines in function.”

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Dementia orAlzheimer’s Disease?

Alzheimer’s disease and dementiaare not the same. As ProfessorWilliam Jagust explains: “Dementia,commonly called senility, is the lossof cognitive function—cognitivedecline. Alzheimer’s disease is themost common cause of dementia,but it’s not the only cause. For exam-ple, you can get dementia from havingmultiple strokes.Alzheimer’s diseasestarts with loss of memory, but itprogresses to loss of virtually every-thing—language ability, judgment,abstract thinking, spatial aware-ness. The major theory for the causeof Alzheimer’s disease right now isthat there is an abnormal proteincalled amyloid that is deposited inthe brain. This amyloid protein,many people believe, hurts or killsbrain cells. Most of the researchefforts now are directed towardsdrugs that will target amyloid.”

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Pedestiran safety measures, such as installing sidewalks, would encourage seniorsto walk and remain active.

Upcoming ConferenceScience & Society:Living Longer, Living Better?

Wednesday, April 20, 2005Berkeley City Club

Each year, the Center for HealthResearch hosts a conference focusingon one aspect of the nexus betweenscience and its impact on society. For itsthird conference, “Science & Society:Living Longer, Living Better?,” anoutstanding faculty of speakers, bothnational and from the Berkeley campus,will discuss the nation’s changing—andaging—population and the implicationsfor medicine, technology, the economy,governmental programs and policies,and even personal attitudes towardgrowing old. What will be the issuesthat we face—individually and collec-tively—as our nation grows older?How can we assist, change, and enrichour own lives and the lives of thosewe love as we age? Is it only aboutliving longer, or can we also livebetter? Join us for a lively explorationof these issues.

If you would like to be notified whenregistration for the conference begins,please send a message by e-mail [email protected].

Ragland sees three approaches toproviding this help:

• Improved roadways. Larger, clearer road signs and less clutter at intersections will help drivers compensate for declining vision.

• Improved vehicle design. Better mirrors, clearer dashboard dials, anddevices that warn drivers if other vehicles are approaching will help older adults with functional difficulties such as difficulty turning their head and, thus, limited peripheral vision.

• Training and rehabilitation. Better information about factors that limit driving and new training opportu-nities will help people understand and deal with the changes they are experiencing with age.

Working with researchers in theCollege of Engineering and other cam-pus groups, Ragland and the TrafficSafety Center team are investigatingthese approaches and designing solu-tions to extend the safe driving years.

Beyond the AutomobileRemedies for functional decline canonly go so far, of course.

“At some point,” Ragland says, “all ofus will no longer be able to drive, nomatter what environmental or engi-neering improvements we make orwhat training opportunities are avail-able. Ultimately, we need alternativesources of mobility—everything fromimproved public transit systems tocommunities designed so that we haveaccess to goods and services withouthaving to use automobiles.”

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A major element of this vision is encour-aging and enabling people to walk and totake transit, he says, and to do that, “weneed to make walking safe and conven-ient.” To this end, the research he directsat the Traffic Safety Center has a secondmajor thrust: conducting safety studies toidentify and evaluate hazards and recom-mend changes that will improve pedestri-an safety in high-risk traffic zones.

Ragland hopes that this work will makeit easier for older people to step outfrom behind the wheel and onto thecurb. And he wouldn’t object if it wouldalso help to address other critical publichealth concerns, such as reducing pollu-tion from vehicles and helping thenation to slim down.

Raising Families a Second Time AroundMore than 2.4 million older Americansare raising their grandchildren, a phenomenon that has increased dra-matically since the 1970s and has onlyrecently begun to level off, according toMeredith Minkler, Dr.P.H., professor ofhealth and social behavior. Californiahas the highest number of grandparentsproviding this care.

“When my colleague Esme Fuller-Thomsen of the University of Torontoand I did our first national study ofgrandparent caregiving in the mid 1990s,we were shocked to find that more thanone in 10 grandparents had raised agrandchild for six months or more atsome point in their lives,” says Minkler. In one-third of the homes where grand-parents are raising their grandchildren,they are doing so alone, because theirown children are addicted to drugs, men-tally ill, or otherwise unable or unwillingto help, Minkler says. While many grand-parents are relieved to be able to step in,their caregiving duties can take a heavytoll, including loss of income, a loweredstandard of living, increased costs, physi-cal problems, and depression.

Minkler first helped alert the nation tothe struggles of grandmothers as care-givers more than a decade ago in agroundbreaking book, Grandmothers As Caregivers: Raising Children of theCrack Cocaine Epidemic, written withcolleague and alumna Kathleen Roe,Dr.P.H. ’85, of San Jose State University.Minkler has continued to provide in-depth analysis of the problems caregiversface in “skipped generation” house-holds, and her research often providesthe background for policy and legisla-tion to address these problems.

Last year, for example, Minkler andFuller-Thomsen published researchshowing that, of the quarter of a milliongrandparent caregivers living below thepoverty line in rental housing, 60 per-cent spend about one-third of theirincome on rent, and three out of 10 livein overcrowded conditions. These andother findings were used to help makethe case for passing the federal AmericanDream Down Payment Act, which giveslow income grandparent caregivers andothers access to adequate housing.

Generations United, a national coalitionof 250 organizations representing chil-dren and older people, draws heavily onMinkler’s work to lobby for legislation to support grandparent caregivers. Thecoalition used her research four years agoto help argue successfully that some ofthe funding provided by the NationalFamily Caregiver Support Act should beearmarked for grandparents caring forchildren. Currently, the coalition is seek-ing passage of the Kinship Care SupportAct in the U.S. Senate, which wouldestablish programs in large urban areasto help grandparents and other familycaregivers make better use of social andhealth care services.

The gap between the needs of grandpar-ent caregivers and public policies toaddress those needs is still very wide, saysMinkler. Grandparents receive less finan-cial support for raising their own kin thanfoster parents get, for example. But therehave been some positive changes.

“Many state legislatures know there is a problem and are making an effort toincrease equity for grandparents raisinggrandchildren,” she says. “WhenCongress instituted welfare reform in1996, it mandated that the CensusBureau begin collecting data on thisgrowing population to learn whatimpact the welfare reform might have.

One of the nice things that happened isthat I got a call from the Census Bureauasking me if I would like access to the

Ethyl Molo, a peer mentor and spokesperson for grandparent caregivers, cares for her grand-daughter, Sheena.

“We were shocked to find that more than one in 10 grandparents

had raised a grandchild for six months or more.”

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8 University of California, Berkeley8

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Resource Center on Aging Under the leadership of Guy Micco, M.D.,director, and Diane Driver, Ph.D., aca-demic coordinator, the Resource Centeron Aging is the coordinating mecha-nism for activities in aging on the UCBerkeley campus and serves as aclearinghouse for information on aging activities both on and off campus.It maintains affiliations with organiza-tions in aging which provide resources forfield research and current information on issuesin aging in the community.

The center disseminates information on education, research, grants, publications,fellowships, internships, job opportunities, and community resources in aging. Itmaintains a lending library open to students, faculty, staff, and the general public. Thecenter is also home to the Academic Geriatric Resource Program. For more informa-tion about the Resource Center on Aging, visit http://socrates.berkeley.edu/~aging/.

Center for Community WellnessThe Center for Community Wellness, headed by professors Linda Neuhauser,Dr.P.H., and S. Leonard Syme, Ph.D., translates research findings into practicalprograms to improve health for people of all ages. The center’s faculty and staffuse an innovative approach in which consumers and health experts “co-design”and test information resources. Research shows that these “user-designed”programs are successful in helping seniors take more control over their health.The center’s programs now reach over 500,000 seniors in the United States and overseas:

• The UC Berkeley HMO Guides (in English and Spanish) provide information to help seniors navigate health care systems, learn about patient rights, and connect to health resources. The guides, funded by the California Office of the Patient Advocate, are distributed to 300,000 members of California health maintenance organizations.

• The UC Berkeley Chinese Wellness Guide is a bilingual resource distributed to 100,000 Chinese American families in California that includes information about eldercare and senior health resources.

• In a joint effort with the state of Pennsylvania, the center is co-developing the first statewide initiative to help seniors prevent falls.

• The center worked with the Australian government to design the Carers Guide,which provides information to caregivers of elders.

For more information about the Center for Community Wellness, visithttp://www.berkeleyhealth.com/.

Aging Resources and Information at the School of Public Health

Understanding Aging...continued from page 7

Bureau’s full American Community Survey for my research—it’s anembargoed data set that includes850,000 households. I was also invit-ed to provide input on the shaping ofa few of the questions they were plan-ning to ask grandparents.”

Minkler has been using this extensive,detailed data set ever since. She and col-leagues recently completed the mostdetailed national study to date of AfricanAmerican grandparents raising grandchil-dren, to be published in the Journals ofGerontology in 2005.

Minkler believes strongly in using herresearch to help the communities she isstudying. In the course of her career, shehas founded a national grandparentinformation center and local and region-al coalitions on grandparent caregiving.The proceeds from her book with Roewere used to support one of the nation’sfirst respite centers for grandparents rais-ing grandchildren.

“In many of the nation’s largest cities,including San Francisco and Oakland,grandparents raising kids are saving thefoster care system from collapse,” shesays. “Many grandparents receive nofinancial support for raising their grand-children, because they are not connectedto the system. And our studies show thatgrandparents caring for their grandchil-dren delay care for themselves. They areturning their lives upside down to raisesome of the most vulnerable kids in thenation—nearly six percent of allAmerican children. As grandparents copewith this difficult role, they need anddeserve our support.”

The number of older adults in theUnited States will increase dramati-cally as the members of the BabyBoom generation become senior citi-zens. According to the Alliance forAging Research, older Americanswill double in number from 35 mil-lion today to 70 million by the year2030. The number of health profes-sionals trained in caring for the elderly is inadequate even to meettoday’s need—and with the anticipat-ed growth in the elderly populationnationwide, this shortage constitutesan impending crisis.

The UC Berkeley-UC San Francisco JointMedical Program (JMP) is addressing this gapthrough an innovative geriatric curriculum that matches medical students with elderlypatients. Instituted last year, the curriculumbrings students into continuing care retire-ment facilities to meet face-to-face with theresidents and follow them over the course ofthree years. Unlike most medical degree pro-grams, which usually introduce geriatrics latein a student’s medical education and often asan elective, this curriculum is required andbegins in the student’s first year.

The Joint Medical Program, which started in1974, is a partnership between UC Berkeleyand UCSF; the five-year program of study leadsto a master of science degree and a medicaldegree, with students spending the first threebasic science years on the Berkeley campusand the remaining two clinical years at UCSF.

“Geriatrics is going to be the new paradigmfor medicine in the future,” says Guy Micco,M.D., clinical professor in the JMP and direc-tor of UC Berkeley’s Resource Center on Aging.“The demographics are going to force us to look through the eyes of a geriatrician, becauseour patients are going to be geriatric patients.”

Response to an Urgent NeedRecognizing the desperate need for healthprofessionals trained to care for the state’solder patients, the state of California hasmandated geriatric education for medical

students: In 1984, the California StateLegislature passed AB 2614, which calledfor increased educational programs in geri-atrics and gerontology. Sixteen years later,the Geriatric Medical Training Act of 2000was also passed, requiring training in geri-atric care for licensure as a physician andenhancement of geriatric training inCalifornia medical schools.

Even with the early legislative mandate,“geriatrics was primarily elective before thenew curriculum was instituted,” says DianeDriver, Ph.D., academic coordinator of theResource Center on Aging at UC Berkeley,noting that this is still the case in most ofthe nation’s medical schools.

The JMP is now taking an aggressive pathwith its new curriculum, starting with students who entered the program in aca-demic year 2003–2004. By academic year2005–2006, students in all three years ofthe program at Berkeley will be participat-ing in the new training. “In addition to thegeriatric patient encounters, our goal is torigorously infuse our teaching—which iscase-based—with the geriatrics curriculumthat we’ve developed, evaluate it, andpublish our experience in a way that can aidother medical schools in developing a simi-lar curriculum,” says JMP director JohnSwartzberg, M.D.

Longitudinal Exposure to aContinuum of CareLast year the students began seeing patientsat Salem Lutheran Home, Mercy RetirementCenter, and Piedmont Gardens, all continuingcare retirement facilities located in Oakland.In addition, this year students will see inde-pendent living patients at the Center forElders Independence, an East Bay community-based clinic. The students are assigned, onaverage, two patients per semester, one ofwhom they will follow over their three yearsat Berkeley in order to get to know an elderand to see firsthand the complexities of geri-atric care over time. Other residents will beseen in a variety of settings.

An interdisciplinary committee composed ofmedical administrators, clinical faculty, geri-atricians, students, and others chose thesites. The committee’s selections were basedon two major considerations: First, the com-mittee felt it important that students inter-act with and learn about both independentelders and frail elders. A continuing careretirement facility, as opposed to a nursinghome, provides a continuum of care com-prising independent living, assisted living,skilled nursing, and dementia care. Second,the committee felt students should beexposed to exemplary facilities, the conceptof which they can carry with them into theirpractice of medicine.

9Public Health

Feature

Training Tomorrow’s Physicians

to Care for an Aging Population By Michael S. Broder

Student Kevin Marsee (right) takes the medical history of Irene Hasenclever (left), while preceptorDr. Claudia Landau observes.

Feature

“What’s exciting about it, besides the fact thatstudents are getting the exposure to geriatricpatients, is that they’re getting a longitudinalexposure,” says Swartzberg. “So they’ll beable to see how a person lives in that kind ofsetting and what issues arise. Some of thesefolks, unfortunately, because of their age aregoing to die in the interim, and the studentswill be dealing with death. But they’ll be get-ting to know people over time, which is theway doctors need to know people to reallyadequately care for them.”

“My favorite experience has been with mylongitudinal patient,” says Shirley Wu, asecond-year student who plans to practicegeriatrics. “I see this patient at her assisted-living apartment, and I feel very privileged tobe there, surrounded by her favorite photosand gifts from her grandchildren. I think thatsense of respect for the trust that patientswill give you as their physician comes acrossso strongly when you are invited into yourpatients’ homes to learn from them.”

Teaching TeamworkBoth Micco and Swartzberg stress that team-work is essential to teaching and practicinggeriatrics. “A major role of this curriculum isto not just teach medical students how to bebetter doctors for the patient, but that to ade-quately care for anybody, and especially theelderly, you have to be part of a team,” saysSwartzberg. “Other people—social workers,physical therapists, speech therapists, and soon—are taking care of other parts of thepatient’s life too. It’s trying to reorient themedical student away from being the solerepository of knowledge about how to care

for a human being to being part of a teamthat cares for that person. This needs to bedone not just in geriatrics, but in all of medi-cine, in my opinion,” says Swartzberg.

With the overall dearth of geriatricians, findingpreceptors for the curriculum is challenging.“They need to be pretty savvy in geriatrics,”says Driver.

Micco elaborates, “They don’t necessarilyhave to be geriatricians, because therearen’t enough to go around to precept ourstudents. But we need people who have ageriatric mindset.”

One preceptor for the geriatric curriculum isClaudia Landau, M.D., Ph.D., medical directorof Piedmont Gardens. “Geriatrics requires goodsynthetic thinking,” says Landau. “In geriatrics,there is a lot of knowledge that’s being accu-mulated, a lot of research, and people have dis-eases about which there is much historicalknowledge. But the process of putting all ofthat together—integrating what is known andwhat is not known—is something that isn’ttaught well in medical school. This program hasa fabulous curriculum in that regard.

“Learning how to take a history with elders isa challenge, because there’s a huge history,”says Landau. “Students come up against a lotof their own attitudes, belief systems, biases,things with which they might be uncomfort-able, and learn how to deal with that effec-tively. And they learn it over time, becausethey’re taking care of someone longitudinallyfor three years. Learning and developing a relationship, not just for a moment, but overtime, is extremely important.”

Helping Patients Live with IllnessAccording to Micco, teamwork is one elementof the “geriatric mindset;” another is an ability

to look beyond trying to cure certain problemsand focus on how patients can live with theirconditions. “Many of the problems that olderpeople have are not going to be cured,” saysMicco. “They have to live with them. And itbecomes really important to think about howpeople are living with their chronic diseases. Alot of the activities of daily living are forgottenin a standard medical interview, and that’s apart of geriatrics that I think is really importantfor all of medicine to take on.”

Wu has learned this lesson over the course ofher training. “One of the most importantaspects of the approach to geriatric care thatwe have learned in the new curriculum is theemphasis on function, assessing someone’smedical status in terms of what will helpthem live as independently as possible,” shesays. “For example, the ability to walk inde-pendently depends on so many differentaspects of health that physicians can try tohelp with, from obvious things like types andcombinations of medications, to nutrition andthe home environment—simple things likeremoving floor rugs and telephone cords andhaving enough bright light. I’ve learned that ageriatric approach to medicine really is aboutseeing people in their own context—what it'slike for them at home, how all their differentmedical problems fit together and affect theirdaily lives.”

The students may or may not go on to becomegeriatricians, but the knowledge gainedthrough this curriculum will help them inwhichever area of medicine they choose topursue. “Geriatrics is emblematic of the waymedicine should be practiced in some ways,”says Landau. “You really need to use a psycho-bio-social and spiritual model to take care ofsomeone, and philosophically that’s impor-tant for all of medicine. It’s important to startteaching this to students early.”


“One of the most important aspects of the approach to geriatric

care that we have learned in the new curriculum is the emphasis

on function, assessing someone’s medical status in terms of what

will help them live as independently as possible.”

11Public Health

At the age of 13 he had read the works ofEuclid and was arguing with his highschool geometry teacher over how to solvetheorems. When he was 15 he enrolled atUCLA. By the time he was 20 he had amaster’s degree in zoology and experimentalembryology, and four years later he graduat-ed at the top of his medical school class fromUCSF. With a photographic memory and apassion for learning and teaching, he hasbecome an acknowledged expert in fieldsranging from medicine, to nutrition, toendocrinology, to biochemistry, to statistics,to public health, to ethics, and ultimately towhat has become known as “wellness.”

Between 1951 and 1972, SheldonMargen, M.D., was a practicing physi-cian in the Bay Area and the head ofSolano Laboratories, which he turnedinto the first fully automated and com-puterized clinical laboratory in thewestern United States. In 1962 hejoined the faculty of the Department ofNutritional Science at Berkeley and wasthe cofounder of the groundbreakingresearch facility known as The Penthouse.Along with Doris Calloway, Ph.D., hedirected more than 20 human nutritionstudies on a wide range of subjects,including protein, energy, and trace min-eral requirements of healthy adults. Theresults of this work ultimately became thebasis for many of the dietary recommen-dations still in use today.

In 1979, when Ruth Huenemann,D.Sc., retired as chair of the PublicHealth Nutrition Program in the Schoolof Public Health, Margen was appointedto fill her position. Up to that point, onlyone doctoral degree had ever been award-ed in public health nutrition. One ofMargen’s first acts was to revitalize thedoctoral program, and in the first twoyears of his chairmanship, he had 12doctoral students working under hissupervision. Over the course of his career,he has directed the research of dozens of

students in both nutrition and publichealth. Many of them have now becomeestablished leaders in their fields. Oneof his former students, associate deanBarbara Abrams, Dr.P.H., refers toMargen as “an amazing mentor whoasked the hard questions and inspiredyou to find the answers. His incessantcuriosity was absolutely infectious.”

Margen has worked extensively overseasas a consultant to major governmentaland non-governmental agencies. Heserved as a member and chair of the U.S.Japan Malnutrition Panel of NIH, and asa consultant to the Agency for Interna-tional Development, the World HealthOrganization, the Pan American HealthOrganization, and the government ofIndia. On the domestic front he served asa member and cochair of the Food andNutrition Board of the National Acad-emy of Sciences and as a consultant to theMcGovern Senate Select Committee onDiet and Disease and was instrumental inestablishing the first set of Dietary Goalsand Guidelines for the United States.

In 1982 Margen was approached by apublisher from New York with an ideafor a newsletter on health promotion anddisease prevention. Two years later thefirst issue of the University of California,Berkeley Wellness Letter was published.Margen became chair of the editorial

On October 1, 2004, the public health library at 42 Warren Hall was named the Sheldon Margen PublicHealth Library. At the naming ceremony, Margen’s colleagues paid heartfelt tribute to the legendary professoremeritus, who then took the podium himself to offer thanks and expressions of admiration to his manyfriends and family members gathered there. Above: Dean Shortell (left) presents Margen with a commemo-rative plaque. Below: Margen (seated, right) is surrounded by his family at the naming ceremony.

Past, Present, Future

Sheldon Margen: An Amazing Passion for Learning and TeachingBy Dale A. Ogar

Continued on page 12

Reprinted with permission of the UC BerkeleyNewsCenter (http://newscenter.berkeley.edu)and edited from its original form.

Over the past several months, I have been inSalvador, Brazil, collaborating on an infectiousdiseases research project and fulfilling myfieldwork requirement for my infectious dis-ease master’s in public health program at theUC Berkeley School of Public Health.

Tonight as I write, I am fortunate to be able towatch one of the amazing Brazilian sunsetsoverlooking the Baia de Todos os Santos frommy apartment window in the city of Salvadorda Bahia.The gigantic fluffy clouds reflect thesun’s rays in hundred ways in a huge mango-orange swirl. I feel very lucky every day to liveand work in this close-to-paradise place forthree months. Salvador, once a capital of Braziland today the center of Afro-Brazilian culture,will mesmerize you with the rhythms of afroxé,the dance-martial art capoeira, and the spiritu-ality of Candomblé, the Afro-Brazilian religion.The only thing bothering me now, though, is myfever and the muscle aches from a mild case ofdengue—a mosquito-borne illness endemic inBrazil and in tropical environments.

How did I get it?

Well, certainly not from my well-situated apart-ment at Laderia da Barra overlooking the bay.Most likely I got it in Pau da Lima, a shanty-town or favela with over 12,000 residentswhere I work several times a week. What is afavela? It’s an urban slum created by social

inequality. Brazil went through a 350 percentincrease in urban population in the last 30years. One consequence of this urbanization isthe favelas, which are found in all major citiesof Brazil. More than 30 percent of the world'spopulation live in shantytowns and subsist onless than $1 per day. One characteristic of afavela is that despite all its residents, it does notexist on any map. Pau da Lima does not existbecause it’s located outside of one’s peripheralvision, down in a very steep valley with densevegetation, narrow passages, mud, a hugenumber of stray dogs, open sewers, garbage,and rats. But most importantly, it is filled withthe visible poor encountering visible diseases. Itis also filled with spirited people, children play-ing on the fields with homemade toys, barefoot,but with huge smiles on their faces. It is alsofilled with volunteers, scientists, and doctorswho work in this community with all theirhearts. The faces of children and people are thefaces of poverty that become part of you.

Open Sewers, Rats, and LeptospirosisMy work is a combined effort between theOswaldo Cruz Foundation in Brazil, UCBerkeley professor Lee Riley, and CornellUniversity professor Albert Ko. I came to workon a disease called leptospirosis, a life-threat-ening bacterial infection transmitted throughcontact with urine from infected animals,mainly rats. It is one of the most commonzoonotic (communicable from animals tohumans) diseases in the world, and in Brazilalone there are over 10,000 cases of lep-tospirosis per year. It is a disease of povertythat can be easily treated with inexpensiveantibiotics, but mortality remains high,about 15 percent due to delayed treatment.Consequences of delayed treatment are severekidney and liver failure with pulmonary bleed-ing. Delayed treatment can also result from itsdiagnostic confusion with dengue, the disease Icontracted after working in Pau da Lima. Pauda Lima with its open sewers and high numberof rats, makes it an ideal location for thetransmission of Leptospira because people liveand work very close to open sewers with avery high number of rats in the community.

Due to problems with delayed treatment, weare studying if early diagnosis can improve disease outcome.The project team identified a new Leptospira protein called LigB thatappears to serve as a sensitive target for anti-body-based diagnosis. The team wishes tosimplify the use of this antigen-detectionmethod, apply it at community level, and see ifearly diagnosis will lead to early antibiotic inter-vention and prevent severe disease outcomes.



board, a position he held until September, 2001, when he turned overthis responsibility to John Swartzberg,M.D., director of the UC Berkeley-UCSF Joint Medical Program.

The Wellness Letter has not onlybecome one of the most highly

respected publications of its type in theworld, but it has generated nearly $11million dollars in royalties to theSchool—funds which Margen insistsbe used for student support. His closefriend and colleague, former deanJoyce Lashof, M.D., comments, “Hisabsolutely brilliant mind, coupled with

his attention to detail have never ceased to amaze me. Without Shelly therewould have been no Wellness Letter.”

Report from the Field: Fighting Disease and Heartbreak in BrazilBy Krisztina Szabo

Krisztina Szabo holds a Brazilian infant.

Sheldon Margen...continued from page 11

— Dale A. Ogar is managing editor of the University of California,Berkeley Wellness Letter.

13Public Health


The Salvador team also identified risk factors for severe disease afterinfection, which can be due to differences in exposure levels to theorganism, host factors, or the pathogenicity of the infecting Leptospira.When it rains in Salvador, it pours in Pau da Lima. When a person walksthrough rainwater or stands in a sewer contaminated by rat urine,Leptospira corkscrews through his skin, causing systemic disease.Preliminary studies have shown that living in close proximity to opensewers and sighting more than five rats in a previous week are signifi-cantly associated with severe disease because a person gets greaterexposure. The first time I experienced rain in Pau da Lima while working,I was scared. Sewers flood and houses located at the bottom of the val-ley are flooded with sewage. The houses, which are located higher upoften collapse from the mudslide.

We also hypothesize that naturally-acquired immunity develops after a pre-vious infection, which reduces the risk of developing severe disease out-comes following reinfection. If a previous infection is found to be protectivefor subsequent disease, a possibility for the effectiveness of a vaccine canbe demonstrated. I am analyzing epidemiological data collected over threeyears to look at the baseline prevalence and seroconversion of participantswith Leptospira in a period in an open cohort study.

A School That Transforms LivesMy first visit on my first day of work at Pau da Lima, however, was not tocollect data for the leptospirosis project. I went out for a site visit with vol-unteers to an escolinha (small school) that collapsed due to heavy rains.They were going to design a new school and rebuild it. While at thedestroyed school, I experienced one of the most memorable moments ofmy life. There, I met Nivaldina, the teacher of the collapsed escolinha. She isnot a conventional teacher by any means. She finished the third grade andtaught the children the alphabet, the numbers and read them the Bible forthree years. Money for supplies and food came from the community and

Children in Pau da Lima, Brazil, were left without a school after heavy rains causedtheir escolinha to collapse.

from volunteers. There was a need to teach at least 200 children, butthere was just not enough funding. This school is critical to the commu-nity, where there is high drug use and trafficking, and other criminalactivities. The school had kept kids out of trouble and away from danger.About 40 kids per day, ages 1–7, stayed here with her every day. When I first stepped into the escolinha with only its walls remaining, thechildren’s happy drawings were still on the wall. I walked out with tearsin my eyes and I knew then that I would have a very hard, emotional,but rewarding experience working in Pau da Lima.

My mind was racing with questions. Why don’t these children just go toanother public school? Why is this school so important? The more Italked to Nivaldina, the simpler the answer became. Most children andtheir parents don’t have the legal documentation required to attend areal school. They are too poor to have identification and in the eyes ofthe Brazilian government they simply do not exist.

We are currently searching for funding support to help reconstructthe escolinha. Any amount of support would be welcome. Thoseinterested in doing so can contact me at [email protected].

Why did I choose to do this public health project in Brazil? My dreamto help others began in a small village in Hungary, tagging along withmy mother, a nurse during the hard times of a totalitarian govern-ment in the early 1980s. Working in the community there allowed meto see the health needs of people ranging from the very young to thevery old, no matter where they live. Brazil was my first opportunity towork in South America. I was excited, hopeful, and scared of theunknown. I knew that this would be public health in action, somethingyou learn about in your textbooks but seldom see in the United States.

But the question that nags at me as my internship comes to an end inBrazil and Pau da Lima is, what will happen to the escolinha without areal financial and organizational structure? I came here with manyquestions and uncertainties in my mind about how much one canreally help in this environment. I have learned that the escolinha andthe work of Nivaldina are transforming the lives of many amid thiscacophony of poverty. I know in my heart that I will come back to Pauda Lima and see the escolinha functioning once again.

In fact, I must come back and work again with my friends. To me thishas been a formative moment: I want to live my life to work withthose who are voiceless. In Pau da Lima, I had an opportunity toscratch the surface of my dream, and to become part of the lives ofothers and to learn from them. I realize that to truly understand theforces of poverty and disease, and to improve the health and well-being of thousands, one must work with others and change things lit-tle by little. What I don't know yet and must still learn is whether thiscan be done through science as a form of advocacy for social change.

Second-Year FellowsA pediatrician bytraining, DouglasJutte, M.D., M.P.H. ’03,received his medicaldegree from HarvardMedical School andcompleted his resi-dency at Stanford.Following his resi-

dency, Jutte joined Stanford’s Division ofGeneral Pediatrics.

“Most of my work after finishing myresidency was in low-income clinics,mostly serving Mexican American,Spanish-speaking immigrants,” he says.“After a few years of working there, it wasincreasingly clear to me that many of theproblems of the families I was seeing werenot due to health necessarily, but rathersocial, non-medical issues—their povertyor cultural barriers.” His interest in look-ing at the big picture in health led him tothe UC Berkeley School of Public Health,where he earned an M.P.H. in epi-demiology—and then to the RobertWood Johnson program.

Jutte’s research interests include resiliencein high-risk children and the biologicallinks through which social contextualfactors contribute to a child’s long-termmedical, psychosocial, and cognitive out-comes. “When I heard about the RobertWood Johnson program, it seemed like a perfect match of quantitative sciencewith a real attention to the social side of health,” he says.

During the first year of his fellowship, he began work on two projects. In oneproject, he is working with ProfessorTom Boyce to start a pilot study of theeffect of family and parenting styles on achild’s brain development. In the other,he is using a population health registryin Manitoba, Canada, to see how Apgarscores, which are given to newborns as a measure of autonomic nervoussystem function, interact with socialenvironmental factors to determinelong-term health.

“Programs like this are important becausethey encourage physicians to participatein more of a public health or populationhealth focus on health,” he says. “I also

think this program is important becauseit is going to produce physicians who canspeak across disciplines, the languages ofpublic health, epidemiology, psychology,sociology, and economics.”

“I truly believe thatthe environments inwhich we function,such as the neigh-borhoods we livein, the places inwhich we work,and our homes, canfoster either healthy

or unhealthy individuals and popula-tions, and that health and social poli-cies help facilitate such environments,”says Amani M. Nuru-Jeter, Ph.D., M.P.H.“I believe that in addition to the moretraditional social and biomedical riskfactors, it is the interaction of peoplein their places that can either promoteor impede health and well-being.”

Nuru-Jeter earned her M.P.H. in mater-nal and child health from the GeorgeWashington University School of PublicHealth and her doctorate in health policyand management from the BloombergSchool of Public Health at JohnsHopkins University. Her dissertationexamined the role of race and residentialsegregation in the relationship betweenincome inequality and mortality in met-ropolitan areas in the United States. Shehas also explored doctor-patient raceconcordance and its effects on satisfactionwith and utilization of health care servic-es, the cumulative effects of multiplesocial risk factors on susceptibility forpsychological distress, and the influenceof racial discrimination on populationhealth outcomes.



The Robert Wood Johnson Health and Society Scholars Program at UCBerkeley and UCSF began last year with three scholars, now in their secondyear of the two-year program. Three new scholars have joined them this year.A national program of The Robert Wood Johnson Foundation, the Health andSociety Scholars Program is designed to build the emerging field of populationhealth, which takes a broad approach to understanding why some groups ofpeople are healthy and others are not. The goal of this interdisciplinary pro-gram is to improve health by training scholars to investigate the connectionsamong biological, behavioral, environmental, economic, and social determi-nants of health; and develop, evaluate, and disseminate knowledge and inter-ventions based upon integration of these determinants. Program codirectorsare Ray Catalano and Bill Satariano at the School of Public Health, andNancy Adler and Hal Luft at UCSF.

Scholars in New Program Explore Health and Society

“When I heard about the Robert Wood Johnson program, it seemed

like a perfect match of quantitative science with a real attention to the

social side of health.”

“The fact that this scholars

program is a joint effort between

UCSF and Berkeley adds a richer

element to my training.”

By Michael S. Broder

“The fact that this scholars program is ajoint effort between UCSF and Berkeleyadds a richer element to my training,because while UCSF is a traditionalhealth sciences campus and has all thebenefits of biomedical sciences, theBerkeley campus adds another element,facilitating a truly interdisciplinary envi-ronment with public health, sociology,demography, psychology, and public poli-cy all on the same campus,” she says.“That has made my experience here richand diverse and will allow me to con-tribute more to the field of populationhealth in the long run.”

Though it was not her original goal, shenow says that her future is in academia. “Iintended to go back out into the field anddo local health policy work and grassrootshealth advocacy, because that’s where mypassion was,” she says, “and I still have apassion for that. But at the same time,I’ve learned through my doctoral programthe importance of academic research andhow that research helps to inform policiesthat affect populations and communitiesof people.” Ideally, she hopes to have thebest of both worlds—to engage in aca-demic research and use her skills workingin communities.

“I was interested inthis program becauseit reflects a truly mul-tidisciplinary effort atall levels—the pro-gram leadership atthe national level, thedirectors at each pro-gram site, as well as

the scholars,” says Constance Wang, Ph.D.

Wang earned her Ph.D. in epidemiolo-gy with an interdisciplinary backgroundin biometry, biological, and behavioralsciences at the University of Texas Schoolof Public Health in Houston. She is inter-ested in improving the ways in whichhealth researchers study multilevel riskfactors and relate them to distributions

of diseases in the population, with theprimary aim of prevention. “So accord-ingly, my efforts have been devoted toapplying and extending novel statisticalmethods for modeling high dimensionaldata to characterize complex population-level factors, such as population-levelhealth status,” she says. “I hope to comeup with a more causally consistent model,one that incorporates a cumulative lifecourse approach, in how we study causa-tion of disease in populations.”

Currently, under the guidance ofProfessors Len Syme and Bill Satarianoand collaborating with faculty at theSchool, Wang is characterizing cohortaging profiles and studying the deter-minants of typical aging profiles, usingdata from the Study of PhysicalPerformance and Age-Related Changesin Sonomans, a community-based lon-gitudinal study of the epidemiology ofaging, health, and functioning.

First-Year FellowsJulian Jamison, Ph.D., has been an assis-tant professor of managerial economicsand decision sciences at NorthwesternUniversity’s Kellogg School of Manage-ment. He received an M.S. in mathe-matics from the California Institute ofTechnology and his Ph.D. in economicsfrom the Massachusetts Institute ofTechnology. Jamison is interested in gametheory and the formal modeling of inter-actions between agents; choices over time;experimental economics; and measure-ment of health outcomes.

“How do people with different healthoutcomes make decisions?” asks Jamison.To find answers, he wants to conductexperimental games. “To an economist,that means you get a bunch of subjectsin a laboratory and set up an artificialgame of some sort. You see what theydo, you see how it accords with the the-oretical prediction. If not, why does itdiffer?” Jamison would like to involvesubjects with various clinical conditions,such as brain lesions, Alzheimer’s disease,and clinical depression, and comparetheir behaviors to learn about their deci-sion-making processes.

Jamison has alsoworked in the areaof measuring healthoutcomes in orderto facilitate cost-effectiveness analy-ses. “Measuring theburden of disease isa big issue,” he says.

“Both death and disability need to bedivided up to determine where we putour resources. For instance, which isworse: one death from tuberculosis ortwo cases of blindness from polio? It’sunpleasant to think about, but unfor-tunately resources are limited and poli-cy makers must decide how to spend.The measuring is very difficult, interms of how you calculate both deathand disability.”

As a Health and Society scholar,Jamison plans to continue delving intothese issues. “What really attracted meto this program was this sense of itbeing a new field,” says Jamison.“There are still people working on try-ing to figure out the right questions,

15Public Health


“I hope to come up with a more

causally consistent model, one

that incorporates a cumulative

life course approach, in how

we study causation of disease

in populations.”

“What really attracted me to this

program was this sense of it being

a new field.”


the right way to approach them and answer them. I feel like we can have alittle bit of an impact on guiding whereit goes and seeing what some of theanswers are.”

“I am a cultural psy-chologist by train-ing,” says Janxin Leu,Ph.D. “The field is anoutgrowth of people who are in psychology and

anthropology—inter-ested in issues of mind,

behavior, and individuals—but who also feel that we can’t understandindividuals until they are situated in abroader social context.”

“From a top-down perspective, an indi-vidual who eats badly, smokes, orengages in risky behavior is a partici-pant in social structures that createincentives for—or fail to provide alter-natives to—unhealthy behavior.Disease has its roots in society, not justin individual biology. But the domi-nance of a biomedical perspective tostudying disease in the United Statesmakes it challenging to argue for theprimacy of social causes of diseases.”

Leu received her doctorate in socialpsychology along with a certificate oftraining in cultural anthropology fromthe University of Michigan and anM.A. in social psychology fromStanford University. She has examinedthe influence of cultural models of selfand well-being on cognition and emo-tion. By applying her background topublic health issues, she hopes tobroaden the impact of her work.

“Currently, psychological, social, andcultural theories of population healthhave a limited impact on U.S. healthpolicy,” says Leu. “This may change by

demonstrating the pathways by whichsocial experience comes to be embod-ied. For example, how does the wearand tear of life from being poor orchronically stressed get under the skin?I’m interested in examining social stres-sors on the immune system as anotherway of explaining illness and its unevendistribution across groups.

“At Berkeley and UCSF, I am working tobuild a discourse about population healthacross the social and biomedical sciences,”she says. “I think the best way to furtherthe discussion is through empiricaldemonstrations of a mind-body connec-tion, making the point that social experi-ence interacts with biology to patternhealth and illness at the population level.”

Michelle McMurry,M.D., Ph.D., is anadjunct assistantprofessor of health policy at GeorgeWashingtonUniversity, whereher research focuseson the role

of biomedical research in disparities inhealth and health care. She has alsoserved as health and social policy legislative assistant to Senator JosephLieberman (D-Conn.) and senior healthpolicy advisor for the Lieberman forPresident Campaign.

McMurry received her M.D. and Ph.D.in molecular immunology from DukeUniversity as part of the NIH MedicalScientist Training Program. While atDuke, her graduate work focused on theregulation of chromatin structure and

gene recombination during T-cellreceptor gene rearrangement. Shereceived her undergraduate training inbiochemistry at Harvard University.

“The research that I’m going to be work-ing on is an offshoot of legislation thatI’ve been working on in D.C., which islooking at how federal policy impactsbiomedical research—federal funding,biomedical research—and how thatemphasis on certain disease topics versusother disease topics impacts health dispar-ities downstream,” she says.

One of the issues that interests McMurryis how funding for different diseaseissues has been determined over time.“Basically, if you look at the top tendiseases that affect the country by mor-tality, and look at the top ten spendingpriorities for the National Institutes ofHealth, the lists don’t match. If we’renot basing our biomedical researchspending on total disease burden, whatis impacting the decision? Perhaps thereare very valid and useful criteria for set-ting those top ten spending priorities,but it’s not been very clear. That’s whereI want to start.

“I see my role as bridging academicresearch in health policy and popula-tion health with policy makers so thatwe can impact health care spending,general federal spending, and state-levelspending on health care and health-related issues,” she says. “But there’s a

disconnect between what policy makerson the Hill, and throughout D.C.,need, and what academics produce. I have a background to bring thistogether, because I have experiencewith both.”


Scholars in New Program Explore Health and Society, continued

“Disease has its roots in society, not just in individual bioloË.”

“I see my role as bridging academic research in health policy and

population health with policy makers so that we can impact health

care spending, general federal spending, and state-level spending on

health care and health-related issues.”

17Public Health

A new study led by researchers at the University of California, Berkeley,suggests that women who eat more vegetables, fruit, and foods con-taining protein before pregnancy may have a lower risk of having achild who develops leukemia, the most common childhood cancer inthe United States.

The study, published in the August 2004 issue of Cancer, Causes andControl, is the first time researchers have conducted a systematic surveyof a woman's diet and linked it to childhood leukemia risk.

The researchers compared 138 women who each had a child diag-nosed with acute lymphoblastic leukemia with a control group of138 women whose children did not have cancer. The children of allthe women in the study, which is part of the Northern CaliforniaChildhood Leukemia Study, were matched by sex, age, race, andcounty of residence at birth.

After comparing the women’s diets in the 12 months prior to pregnancy,the researchers found that the higher the intake of vegetables, fruit,and foods in the protein group, the lower the risk of having a childwith leukemia.

“Fetal exposure to nutritional factors has a lot to do with what Momeats,” says Christopher Jensen, Ph.D., a nutritional epidemiologist atUC Berkeley and lead author of the paper. “These findings show howvital it is that women hoping to get pregnant, as well as expectantmoms, understand that critical nutrients in vegetables, fruit, and foodscontaining protein, such as meat, fish, beans, and nuts, may protect thehealth of their unborn children.”

The few studies that have been conducted on maternal diet and child-hood cancer risk looked only at specific foods or supplements, andresults have been mixed. This study is the first attempt to capture awoman’s overall dietary pattern—using a 76-food-item question-naire—and its relationship to the development of leukemia in a child.

Within the fruit and vegetable food groups, certain foods—includingcarrots, string beans, and cantaloupe—stood out as having strongerlinks to lower childhood leukemia risk. The researchers point to thebenefits of nutrients, such as carotenoids, in those foods as potentialprotective factors.

“This finding is consistent with research about the benefits of a diethigh in fruits and vegetables in preventing adult cancers,” says studyprincipal investigator and coauthor Gladys Block, Ph.D., UC Berkeleyprofessor of epidemiology and public health nutrition. “The positivemessage here is that mothers may be able to transfer some of thosebenefits to their children.”

One of the more surprising results of the study is the emergence of protein sources, such as beef and beans, as a beneficial food group inlowering childhood leukemia risk. “The health benefits of fruits and veg-etables have been known for a long time,” says Block. “What we foundin this study is that the protein foods group is also very important.”

The researchers looked further and found that glutathione was thenutrient in the protein group with a strong link to lower cancer risk.Glutathione is an antioxidant found in both meat and legumes, and itplays a role in the synthesis and repair of DNA, as well as the detoxifi-cation of certain harmful compounds.

National guidelines recommend that people eat at least five servings offruits and vegetables every day, and two to three servings of foods fromthe protein group.

A growing number of scientists believe that genetic changes linked tocancer later in life begin in the womb. Prior studies on children diagnosedwith leukemia have found that blood samples taken at birth tested posi-tive for the same genetic markers that were later found in the cancer.

“It goes back to the old saying to expectant mothers, ‘You’re eating fortwo,’” says Patricia Buffler, Ph.D., study coauthor, dean emerita,professor of epidemiology, and head of the federally funded NorthernCalifornia Childhood Leukemia Study. “We’re starting to see the impor-tance of the prenatal environment, since the events that may lead toleukemia are possibly initiated in utero. Leukemia is a very complexdisease with multiple risk factors. What these findings show is that thenutritional environment in utero could be one of those factors.”

Other coauthors of the paper are Xiaomei Ma at the Yale UniversitySchool of Medicine, Steve Selvin Ph.D., at UC Berkeley’s School ofPublic Health, and Stacy Month of Kaiser Permanente in Oakland, Calif.Funding from the National Institute of Environmental Health Scienceshelped support this study.

New Study Suggests Maternal Diet Linked

to Lower Childhood Leukemia Risk

Research Highlight

— Sarah Yang


Lisa F. Barcellos,Ph.D., assistantprofessor of epi-demiology, andcolleaguesat the UCSFDepartment ofNeurology and

Roche Molecular Systems in Alameda,Calif., have recently found strong evi-dence for the involvement of the NOS2A(nitric oxide synthase) gene on chromo-some 17q11 in multiple sclerosis (MS), as reported in the June 2004 issue of theAnnals of Neurology. Full genome scan-ning efforts in families with multiple MSpatients and follow up studies have iden-tified several genomic regions linked todisease susceptibility, supporting the viewthat the MS-prone genotype results fromvariation within multiple independent orinteracting genes, each exerting small ormoderate effects. Barcellos and colleaguesperformed a large candidate gene study of34 genes from inflammatory pathwaysin well-characterized MS families andobserved a strong association with a com-mon variant in NOS2A. In order tofurther characterize the involvement ofNOS2A in MS, Barcellos and colleagueshave recently performed resequencing ofthe NOS2A gene to identify all potentialvariants in coding and promoter regions.Comprehensive studies of these variantsare now underway in large collaborativestudies with U.S. (UC Berkeley andUCSF), British, and Swedish MSresearchers, involving more than 6,000individuals. Barcellos presented resultsfrom additional analyses of NOS2A hap-lotypes in three MS datasets at the annualmeeting of the American Society ofHuman Genetics in Toronto, Canada,in October 2004.

Also, Barcellos was recently awardedfunding from the National Institute of Allergy and Infectious Diseases for“Immuno-genetic Studies in Auto-immune Disease” to study the role ofmaternal-fetal HLA (human leukocyte

antigen) relationships in susceptibility tothree common autoimmune conditionsthat disproportionately affect women:multiple sclerosis, systemic lupus eryrthe-matosus, and rheumatoid arthritis.

In the largest study of its kind to date, Michael Bates, Ph.D., M.P.H., adjunctprofessor of epidemiology, and co-researchers in New Zealand analyzed 20years of health outcome data for 20,000members of the New Zealand DefenseForce for whom detailed dental treat-ment records were available. Theyfocused on the association betweendental amalgam fillings containing mer-cury and diseases of the kidney and thenervous system, the main known tar-gets of inorganic mercury exposure. Thestudy should help to allay concernsthat chronic exposure to the mercuryin these fillings may lead to kidney dis-ease or chronic fatigue syndrome (CFS),as the researchers found no association.However, the study suggests a possiblerisk for multiple sclerosis, a findingwhich will require further exploration.

The National Institute of EnvironmentalHealth Sciences has awarded an addi-tional $6.7 million to the NorthernCalifornia Childhood Leukemia Study,directed by Patricia Buffler, Ph.D.,M.P.H., dean emerita and KennethHoward Kaiser & Marjorie WitherspoonKaiser Endowed Chair in CancerEpidemiology. Buffler and colleagues areexamining the genetic and environmentalinfluences on childhood leukemia.

The International Commission onOccupational Health honored Ralph

Catalano,Ph.D., M.R.P.,professor ofpublic health at UC Berkeley,and HarveyBrenner of theJohns Hopkins

School of Public Health, for their con-tributions to research into the healtheffects of unemployment and economicdislocation. The researchers were citedat a September 2004 conference inBremen, Germany, for their combinedhalf century of intellectual leadership.The two, often characterized as thefield’s principal antagonists, made a jointplenary presentation that highlightednot only their disagreements over thelast quarter century, but also the conver-gence in their work.

Paul J. Gertler, Ph.D., professor of healthservices finance at the School of PublicHealth and professor of economics at theHaas School of Business, has beenappointed chief economist in the WorldBank’s Human Development Network.

Jodi Halpern, M.D., Ph.D., assistantprofessor of bioethics in the UC Berkeley-UCSF Joint Medical Program, published“The Partners in Care Approach to EthicsOutcomes in Quality ImprovementPrograms for Depression” in the May2004 issue of Psychiatric Services. Thestudy describes an approach to addressingpatient centeredness and equity in a ran-domized trial of quality improvement fordepressed primary care patients. The arti-cle shows in measurable ways how man-aged care can serve ethics goals like socialjustice and patient autonomy.

A geneticallyengineered liste-ria bacteria basedon a strain creat-ed by DanielPortnoy, Ph.D.,professor of

Faculty News and Notes

Faculty News

Michael Bates looked at health effects of amalgamfillings, visible in this x-ray as bright spots.

19Public Health

Faculty News

public health and molecular and cell biology,has led to an experimental cancer vaccinethat shows great promise in animal studies,successfully treating new cancers that havespread into the lungs of mice. The mousestudy is reported in the September 21, 2004,issue of the journal Proceedings of the NationalAcademy of Sciences by scientists at CerusCorp. in Concord, Calif., and coauthorPortnoy. Buoyed by the success of the newcancer vaccine, Cerus scientists now areaiming for human trials.

Malcolm Potts, M.B., B.Chir., Ph.D.,F.R.C.O.G., Bixby Professor of Population andFamily Planning, coauthored “Partner reduc-tion is crucial for balanced ‘ABC’ approach toHIV prevention,” published in the April 10,2004, issue of the British Medical Journal.The article stresses the importance of partnerreduction as a component in approaches toHIV prevention that have primarily focusedon abstinence or use of condoms.

Arthur Reingold, M.D., professor anddivision head, epidemiology, was named tothe World Health Organization (WHO)’sScientific Advisory Group of Experts(SAGE), a committee that advises on allkey vaccine-related matters. SAGE was estab-lished by the WHO to review, from a scien-tific and technical standpoint, the content,scope, policies, and operations of both theChildren’s Vaccine Initiative and the GlobalProgramme for Vaccines and Immunization.

James C. Robinson, Ph.D., M.P.H., professorof health economics, published “Reinventionof Health Insurance in the Consumer Era” inthe April 21, 2004, issue of the Journal of theAmerican Medical Association. The articlelooks at how the backlash against managedcare has caused the private health insuranceindustry in the United States to change itsproducts and policies.

Stephen M. Shortell, Ph.D., M.P.H., BlueCross of California Distinguished Professor of Health Policy & Management and dean of the School, delivered the Ozmun Lecture

Three Public Health Faculty Receive Berkeley Citations

Three faculty from the School of Public Health were recently recognized with the dis-tinguished Berkeley Citation, which is awarded to individuals or organizations whoseattainments significantly exceed the standards of excellence in their fields and whosecontributions to UC Berkeley are manifestly above and beyond the call of duty.

Leonard Duhl, M.D., professor of public health and urbanplanning, has radically changed thinking about the conceptof health and the role of cities in maintaining or compro-mising the health of their residents. His early work on thisidea, presented in his 1964 book, The Urban Condition,provided the beginnings of the conceptual and strategic

frame for the global movement that is today known as“Healthy Cities.” He later prepared the crucial background

papers that led to the establishment of the World Health Organization “HealthyCities” project in Europe. Since that early work, nearly 7,500 “Healthy Cities”projects have been created in countries around the world.

Teh-wei Hu, Ph.D., professor emeritus of health eco-nomics, has served as a consultant to the World Bank,the World Health Organization, the National Institutes of Health, the Institute of Medicine, the Agency forHealth Care Policy and Research, the RAND Corporation,and the Ministry of Health of the People’s Republic of

China. Hu had a leading role in reforming the health caresystem in the People’s Republic of China and helped China

establish its first senior executive health systems training program. His specificwork on tobacco control through demonstrating the impact of tax policies islikely to lead to thousands of lives saved throughout Asia.

Zak Sabry, Ph.D., professor emeritus of public healthnutrition, directed the Food Policy and Nutrition Divisionat the Food and Agriculture Organization, where hisvision led to increased investment of resources in theproblem of malnutrition in developing countries and to anew emphasis on the relevance of nutrition to national

development. He helped set up training and developmentprograms in the Philippines, Egypt, and Australia. Within the

United States, he has been the lead investigator on a seminal ten-year multi-center longitudinal study involving the growth and development of AfricanAmerican and Caucasian girls. This study has led to greater understanding ofthe role of behavior, as well as social and economic factors, in the developmentof cardiovascular risk factors.



Faculty News

in Management at the Mayo Clinic in Jacksonville,Fla. The title of the lecture was “Crossing the QualityChasm: Evidence-Based Medicine Meets Evidence-Based Management.”

Kirk R. Smith, Ph.D., M.P.H., Brian and Jennifer MaxwellEndowed Chair in Public Health, contributed to a specialreport, Health Effects of Outdoor Air Pollution in DevelopingCountries of Asia: A Literature Review, produced by theBoston-based Health Effects Institute (HEI). The reportsummarizes the current and projected Asian situation withregard to urban population, economy, health, and air pollu-tion. Smith is among those who influenced HEI to extendits research into Asia.

Smith has also worked on a study of babies born to motherscooking with wood, dung, or straw, which confirmed earlyreports of an association between household use of biomasscooking fuels and reduced birth weight. Working with aninternational research team at the East-West Center inHonolulu, he analyzed demographic, socioeconomic, andhealth information for a random sample of mothers inZimbabwe who had given birth in the years 1993–98, find-ing that babies born to mothers cooking with biomass fuelweighed about six ounces less than babies whose motherswere using propane, natural gas, or electricity. The studywill be published in the Annals of Epidemiology.

Eric Stover, Ph.D., director of the UC Berkeley HumanRights Center and adjunct professor of public health,received an honorary degree in humane letters fromColorado College on September 6, 2004, for his scholar-ship in the areas of health and human rights, war crimesinvestigations, and the medical and social consequencesof landmines worldwide.

Harvey Weinstein, M.D., M.P.H., clinical professor in theUC Berkeley-UCSF Joint Medical Program, coauthored of“Trauma and PTSD Symptoms in Rwanda,” published inthe August 4, 2004, issue of the Journal of the AmericanMedical Association. The study assesses the level of traumaexposure and prevalence of post-traumatic stress disordersymptoms and their predictors among Rwandans anddemonstrates that traumatic exposure, PTSD symptoms,and other factors are associated with attitudes toward socialjustice and reconciliation. This is the first study to lookbeyond prevalence of trauma symptoms after mass violenceto see how those symptoms may influence the processes ofrebuilding societies.

American Public Health AssociationHonors Berkeley Faculty

The following faculty were among those receiving honors at the American Public Health Association’sannual meeting, held in November 2004 inWashington, D.C.:

Barbara Abrams, Dr.P.H., R.D.,associate dean for student affairs andprofessor of epidemiology and publichealth nutrition, received the Marchof Dimes Agnes Higgins Award formaternal and fetal nutrition research,

presented jointly by the March ofDimes and the American Public Health

Association (APHA). The award honors indi-viduals who have made substantial contributions in research,education, and clinical services in the field of maternal-fetalnutrition. The award is named for the late Agnes Higgins ofthe Montreal Diet Dispensary, who advanced the under-standing of diet as a crucial factor in healthy pregnancy andprevention of low birthweight.

Richard M. Scheffler, Ph.D.,Distinguished Professor of HealthEconomics & Public Policy and director of the Nicholas C. PetrisCenter on Health Care Markets &Consumer Welfare, received the Carl

Taube Award for distinguished con-tributions to the field of mental health

services research. Presented by APHA’sMental Health Section, the award memorializes Carl A.Taube, a longtime staff member of the National Institutesof Mental Health who played a major role in creating thefield of mental health services and policy research.

Mark van der Laan, Ph.D., professor of biostatistics, receivedAPHA’s Mortimer SpiegelmanAward. The Spiegelman Awardwas established in 1969 and ispresented annually to a young stat-

istician for outstanding contributionsin health statistics.

Faculty News and Notes...continued from page 19

21Public Health

Faculty News

Meet the New Faculty

William H. Dow, Ph.D.Associate Professor of HealthEconomics

“There are many different influencesthat drew me into health,” says healtheconomist William Dow. “Health is oneof the basic human rights that peoplemention universally as being important,in all different social strata. It’s some-thing that resonates with people

throughout the world and that has huge amounts of inequalitythroughout the world as well.”

Dow, most recently an assistant professor at the School of PublicHealth at the University of North Carolina, Chapel Hill, started atBerkeley as an associate professor in fall 2004. His research areas are health economics, international health, and economic demography.Much of his research focuses on developing countries and under-served and indigent U.S. populations. He has extensive internationalexperience, having studied in the Dominican Republic, England,France, Mexico, Japan, Cote d’Ivoire, and Costa Rica.

“We know that there are huge inequalities in distribution of income with-in and across countries,” he says. “We see this in health as well, but thereare certain conundrums where some poor countries have excellenthealth. This is one of the things that has always intrigued me.”

Dow is studying the case of Costa Rica, where the per capita income andper capita health expenditure are a fraction of that of the United States,“but the life expectancy is the same, or even slightly higher,” he says.

“First, what we really need to understand is, do people smoke less, dopeople have better nutritional habits, is there more physical activity, isthere less stress, is the environment somehow better, is there better airquality in Costa Rica? We really don’t know. The next step will be tounderstand what forces have shaped these risk factors."

To obtain the data necessary to test different hypotheses, Dow andcolleagues in Costa Rica have begun a new survey, with funding from theWelcome Trust in the U.K. The Costa Rica Healthy Aging Survey is a longi-

tudinal survey that will follow individuals for at least five years.

“In addition to the usual socioeconomic data, we are collectingextensive biomarkers of health, and we will be the first devel-oping country survey to collect allostatic load indicators ofcumulative lifetime physiological stress,” says Dow. “It’s amultidisciplinary project involving economists, demographers,sociologists, epidemiologists, physicians, et cetera.”

“The merging of different disciplinary groups is crucial to under-standing the question of how you produce better health,” saysDow. “This is one of the reasons why I find the intellectualenvironment so attractive within the School of Public Health.Economists have for a long time used the term ‘health pro-duction.’ The discipline has much to contribute to thinkingabout the ecological framework that Berkeley public health hasembraced, but at the same time I am excited by the chance tolearn from the terrific non-economist colleagues here as well.”

The international scope of UC Berkeley was one factor that drewDow to Berkeley, along with the caliber of the faculty. He will beteaching a master’s level health economics course, a doctoralresearch methods course, and potentially a doctoral-level healtheconomics course.

Education

Ph.D., Economics,Yale University, 1995

B.A., Economics,Cornell University, 1991

Selected ExperienceAssociate Professor of HealthEconomics, School of Public Health,UC Berkeley, 2004–present

Assistant Professor, Department ofHealth Policy and Administration,School of Public Health, Universityof North Carolina at Chapel Hill(UNC-CH), 1998–2004; AdjunctAssistant Professor of Economics,Department of Economics, 2004

Faculty Research Fellow, NationalBureau of Economic Research,2002–present

Fellow, Carolina Population Center,UNC-CH, 1998–2004

Fulbright Senior Scholar, Universityof Costa Rica, 1998

Consultant, RAND, 1997–2000

National Institute on AgingPostdoctoral Fellow, RAND,1995–1997

Selected Honors

John D. Thompson Prize for YoungInvestigators, Association ofUniversity Programs in HealthAdministration, 2001

8th Annual Keith J. Arrow Award,International Health EconomicsAssociation, 1999

“The merging of different disciplinary groups

is crucial to understanding the question of

how you produce better health.”

Darlene D. Francis, Ph.D.Assistant Professor ofPsychology and Public Health

Although she works primarily with ratsand mice, Darlene Francis’s work is verymuch about people. Through her workwith laboratory animals, she is examininghow a person’s early life environmentaffects his or her neurobiologicaldevelopment. “What happens early in

life really plays a role in wiring your brain, and ultimately, behavior,” shesays. “I am looking at how early life regulates who you become, inessence, in adulthood.”

As an undergraduate, she worked with mice in a stress lab looking atgenetic differences and predisposition to stress. It was there that she fellin love with science and lab work. In graduate school, she continuedworking in a lab where animal models were used. “We did differentthings to the animals early in life, let them grow up, and then looked athow they differed in terms of their stress response,” says Francis.

However, her real interest was in human beings, and when she began tofeel that her work in the lab had little connection to the real world, sheleft the lab and spent two years as a youth counselor for the Department

of Social Services in Canada. That experience helped reinforce her interestin how early life affects development. “I was working with kids, lookingat four- or five- or six-year-old kids whose lives were on completely differ-ent paths from the average kids that you see, and I’d wonder what hap-pens so early in life that puts these kids on these paths.”

To find answers, Francis returned to the lab, where she discovered shecould focus on those kinds of questions, using animal models to under-take research that would not be possible in human subjects. “I got to dothe experiments I really wanted to do, using rats and mice, and some-times monkeys, and have it all be relevant to kids.”

Much of her research focuses on the interaction between mothers andoffspring and how changes to the maternal environment affect the off-spring. “We know that maternal stress has an impact on a kid,” she says.“The stress axis of people is not so different from the stress axis of ratsand mice. A lot of our work with the animal models shows that if youstress the mother, that pops up in negative effects in the offspring, andwe can look at the biological basis for that.”

She has also looked at how interventions can compensate for apoor early environment. In rats, an intervention might meanimproving the environment through stimulation and socialenrichment. “I’ve been able to take animals that would be onthis trajectory over here and drag them over there by an environ-ment intervention, and then look at their brains to see the directeffects of what those interventions have done to the biology.”

Francis will join the Berkeley faculty in January 2005 with a jointappointment in the School of Public Health and the Department ofPsychology. As an assistant professor in the School’s Divisionof Community Health and Human Development, she will be work-ing closely with the division’s chair, Tom Boyce; together they planto design a course on developmental programming of behavior.

She notes that scientists are often forced to become increasinglyfocused on one specific area at the expense of the broaderview. The School’s ecological perspective and interdisciplinaryapproach appeal to her because they allow her to look at the bigpicture. “My interests are much bigger than the research that Ido. Funneling and becoming more reduced with respect to what Ido is not what I’m looking for—so the School of Public Health isideal for me,” says Francis. “It’s my dream job.”

EducationPh.D., Neurological Sciences, McGillUniversity, 2000

B.S., Carleton University, 1992

Selected Experience

Assistant Professor of Psychologyand Public Health, UC Berkeley,starting January 2005

Research Associate, NeuroscienceDivision, Yerkes Research Center,Emory University, 2003–2004

Postdoctoral Fellow, Center forBehavioral Neuroscience, EmoryUniversity, 2000–2003

Student Research, Douglas HospitalResearch Center, McGill University,1992–1994 & 1996–2000

Selected HonorsCenter of Excellence for EarlyChildhood Development, award forone of the top ten articles on child-hood development, 2003

Health and Emotions, University ofWisconsin, Madison, Scholar TravelAward, 2001 & 2003

International NeuroendocrineFederation Travel Award, 2002

International Society forDevelopmental Psychobiology, NIHTravel Award, 2001

Cure Autism Now, YoungInvestigator Award, 2001

“What happens early in life really plays a

role in wiring your brain, and ultimately,

behavior.”


Meet the New Faculty

Faculty News

— Michael S. Broder

23Public Health

Policy Advisory Council Welcomes Four New Voices

Partners in Public Health

Dean Stephen Shortell recentlyannounced the addition of four newmembers to the School of PublicHealth’s Policy Advisory Council, agroup established in 1993 for thepurpose of advising the dean andsupporting the School in its efforts toattain the highest level of quality inprofessional education, research, andservice in all aspects of public health.

“We are blessed to have fourextremely talented individuals jointhe council to provide us with bothvisionary and practical advice as wecontinue to move the School for-ward,” says Shortell.

Raymond J.Baxter, Ph.D., hasearned a nationalreputation for hiswork in communityhealth, health sys-tems reform, policydevelopment, andorganizational

change and strategy. He has worked as anexecutive, consultant, and researcher withingovernment and in the private sector at state,local, and national levels. He has more than20 years’ experience managing public health,hospital, long-term care, and mental healthprograms, including heading the San FranciscoDepartment of Public Health and the NewYork City Health and Hospitals Corporation.

In May of this year, Baxter was appointedinterim president for the Kaiser FoundationHealth Plan, Inc., and Kaiser FoundationHospitals for the Southern California Region(KFHP/H). Baxter is also the senior vice presi-dent, Community Benefit, for KFHP/H at thenational level.

Before joining KFHP/H, Baxter led The LewinGroup, a health research, policy, and

management consulting firm headquarteredin Washington, D.C. While with The LewinGroup, Baxter directed a national initiativeinvolving stakeholders within the Americanautomotive industry and headed numerousmajor foundation projects, including the 12-sitecommunity tracking initiative of the Centerfor Studying Health System Change and amultiyear evaluation of the W.K. KelloggFoundation’s community health grant making.

Baxter served on two Institute of MedicineCommittees: the Committee on the SafetyNet and the Committee on HIV Prevention.In 2001 the School honored Baxter with aPublic Health Hero Award for his workwhile director of the San Francisco HealthDepartment to fight the AIDS epidemic.

Baxter serves on the American Public HealthAssociation’s (APHA) California Campaign toEliminate Racial and Ethnic Disparities Exe-cutive Committee, the Advisory Committee forRAND’s “Enhancing Public Health Prepared-ness” project, and the American HospitalAssociation’s Ad Hoc Committee on Paymentfor Health Services. He also is a board memberfor the Chabot Space & Science Center, theNational Public Health and Hospital Institute,Boston College Center for Corporate Citizen-ship, Iris Alliance Fund, and the CaliforniaBusiness Roundtable.

As a medical offi-cer with the WorldHealth Organiz-ation in the 1970s,Larry Brilliant,M.D., M.P.H.,helped manage thesmallpox programin India and South

Asia. Brilliant was a leader of a team ofmore than 100,000 workers, which overthree years successfully searched out the last cases of variola major, eradicatingthe last vestiges of the disease. Inspired bythis experience, Brilliant and his wife returnedto the United States and founded the Seva

Foundation, a nongovernmental internationalhealth organization that restores sight to hun-dreds of thousands of people annually in Asiaand Africa. By conducting national surveys ofcataract-related blindness and establishinglocal self-sufficient eye-care hospitals, ophthal-mology training programs, and manufacturingplants to produce low-cost interocular lenses,Seva’s projects have made possible more than2 million operations and restored more sightthan any entity in the world.

Seva also helps Native American communitiesdevelop and implement their own preven-tion programs to combat the growing diabetesepidemic. In addition, Seva works with indige-nous peoples of Chiapas and Guatemala toprovide training and resources to help themdeliver healthy babies, secure clean water,learn to read and write, and gain economicself-sufficiency.

Currently Brilliant is chairman of the SevaFoundation; board member of several nonprofitorganizations and technology companies; anda consulting physician epidemiologist with theCDC, for whom he has been a volunteer“first-responder” in the event of smallpoxbioterrorism. The School honored Brilliant lastspring with its Public Health Hero Award.

During the last 30 years he has served theWorld Health Organization, the NationalInstitute of Health, the CDC, and the WhiteHouse in many capacities, contributing hisexpertise in the areas of smallpox, blindness,and AIDS vaccine policy. He has served on thefaculties of the University of Michigan and the University of California, Berkeley, and publishedtwo books and dozens of articles on interna-tional health and the epidemiologies of small-pox and blindness.

His broad interests have led to collaborationswith eastern theologians, musicians, andpolitical activists. His acumen for technologi-cal innovation as the founder of The Well, anearly Internet online community, has wonhim nomination to the Internet Hall of Fame.


Martin A. Paley,M.P.H. ‘58, receivedhis M.P.H. in healtheducation from UCBerkeley. He subse-quently was activein planning forhealth services andhospitals in San

Francisco and throughout the Bay Area. Hewas president and CEO of an internationalconsulting organization, which, at the time,was a wholly owned subsidiary of Arthur D.Little, and led the firm in a variety of program-and facility-planning projects largely involvingmedical schools.

In 1974, he became director of The SanFrancisco Foundation with a wide and diversi-fied grant making program involving five Bay

Area counties. When Paley left the foundation,its assets were in excess of $600 million withinterests in the arts, education, health, urbanaffairs, and the environment. Its annual awardsapproached $40 million.

In the early 1990s, Paley went on to managethe capital campaign to furnish the new SanFrancisco Main Library, raising $30 million inthree years. He has served as an adviser onorganization and management issues toKQED, Kaiser Permanente, the AlamedaCounty Board of Supervisors, and other non-profit and governmental agencies. He hasconsulted with foundations and arts organi-zations nationally, including the NationalHumanities and Arts Endowments.

Paley has served on the boards of the Inde-pendent Sector, the Council on Foundations,

the Graduate Theological Union, the BerkeleySymphony Orchestra, the University ofCalifornia Press, and the Berkeley CommunityFund. He is a longtime resident of Berkeley,where he resides with his wife Muriel, anexhibiting painter.

L. James Strand,M.D., M.B.A.,has been withInstitutional VenturePartners (IVP) since1986, where he hasinvested in the lifesciences sector firstas a venture partner

and now as general partner. Prior to joiningIVP full-time, Strand was president ofAdvanced Marketing Decisions, a biomedicalmarketing and product development con-sulting company serving pharmaceutical,emerging biotechnology, and device compa-nies. Previously, he was vice president ofmedical affairs and director of marketingplanning at Syntex Laboratories, medicaldirector and chairman of the ProductAssessment Committee at Alza, and CEOand director of both DDI Pharmaceuticalsand Laserscope.

Strand currently serves on the boards of direc-tors of several private companies, includingIconix Pharmaceuticals, Innercool Therapies,and Point Biomedical. He also follows IVPinvestments in Alere Medical, Dominion Dental,and Idun Pharmaceuticals, and led or repre-sented IVP’s investments in Arthrocare, Aviron,Biopsys, Biometric Imaging, Microcide,Presidium, Prograft, Amira Medical, Orquest,and Accordant Health Services.

Strand is board-certified in internal medicineand gastroenterology and is a fellow of theAmerican College of Physicians. He was assis-tant professor of medicine at the University ofTexas Southwestern Medical School in Dallasand has been in private medical practice.

Margaret Cary, M.D., M.B.A., M.P.H.(Chair)Deputy Chief Business Officer for VA+Choice, Veterans Health Administration

Raymond J. Baxter, Ph.D.Interim President,Southern California RegionNational Senior Vice President,Community BenefitKaiser Foundation Health Plan and Hospitals

Larry Brilliant, M.D., M.P.H.Founder and Chair, Seva Foundation

Peter F. Carpenter, M.B.A.Founder, Mission and Values Institute

Alfred W. Childs, M.D., M.P.H.Physician

Linda Hawes Clever, M.D., M.A.C.P.Chief, Occupational Health, CaliforniaPacific Medical Center,Founder, RENEW

Abla A. Creasey, M.P.H.Vice President, Biological Sciences,ALZA Corporation

John W. Eastman, Ph.D., M.P.H.President, Public Health Alumni Association

Lauren LeRoy, Ph.D.President and CEO, Grantmakers in Health

Nancy K. LuskChairman of the Board, The Lusk Company

Martin Paley, M.P.H.Management Consultant

Arnold X. C. PerkinsDirector, Alameda County Public Health Department

J. Leighton Read, M.D.General Partner, Alloy Ventures

L. James Strand, M.D., M.B.A.General Partner,Institutional Venture Partners

Kenneth S. Taymor, Esq.Managing Member, Synexis CG, LLC

Barbara S. Terrazas, M.P.H.Executive Director, Catholic Charities of the East Bay


School of Public Health Policy Advisory Council


Policy Advisory Council...continued from page 23

25Public Health


Your tax-deductible contribution to the School of Public Healthensures the viability of valuable School of Public Health programs,such as scholarships and recruitment efforts. Support the future ofpublic health.

Give online at https://colt.berkeley.edu/urelgift/public_health.html or mail your gift (payable tothe “School of Public Health Fund”) to:

University of California, BerkeleySchool of Public HealthExternal Relations & Development140 Earl Warren Hall #7360Berkeley, CA 94720-7360

For additional information about makinga gift to the school, call Pat Hosel, assistantdean, external relations and development,at (510) 642-9654.

Help Preserve Access to Quality Education

Support the Annual Fund

“When I went to the School of PublicHealth in 1963 and 1964, most of us hadU.S. Public Health Service stipends. Ireceived enough to live on and all my feeswere paid. Those stipends are no longeravailable. Nowadays, students have tosupport themselves while going to school.When I got my degree, I vowed to payback what I had received.

“I think it would be a great tragedy if astudent qualified for the School of PublicHealth, was committed to the publichealth profession, and couldn’t attendbecause he or she couldn’t afford it.

“Working in the field of health education Ihave met the finest, most compassionategroup of individuals I have ever known. Ihave made wonderful friends, and wehave all supported each other.

“Giving to the School is one way I offerthis support.”

—Rosalind R. “Bobbie” Singer, M.P.H. ’64,health education consultant and contributor to the School of Public Health for nearly four decades


John W. Eastman

Public Health Alumni AssociationBoard of Directors

John W. Eastman, Ph.D., M.P.H. ’80(President)

Carol A. Clazie, B.S. ’62 (Vice President)

James H. Devitt, M.P.H. ’77 (Secretary)

April Allen Watson, R.D., M.P.H. ’98(Immediate Past President)

Philippa Barron, M.B.A., M.P.H. ’94

Lucinda Brannon Bazile, M.P.H. ’94

Julie Brown, M.B.A., M.P.H. ’85

Brandon DeFrancisci, M.P.H. ’96

David Harrington, M.P.H. ’88

Leslie Louie, Ph.D. ’90, M.P.H. ’85

George A. McKray, M.S., M.P.H. ’57

Lisa Tremont Ota, M.A., M.P.H. ’90

Beth Roemer, M.P.H. ’76

Jan Schilling, M.P.H. ’91

Sarah Stone-Francisco, M.P.H. ’03

John Troidl, Ph.D. ’01

Dear Colleagues,

Welcome, and congratulations to our new alumni from the class of 2004! The class has set a fineexample. As their class gift, the graduates made three-year pledges of contributions to the Schoolof Public Health Fund. Matching contributions were provided by the School’s Policy AdvisoryCouncil. The members of the alumni board, following the example set by the graduating class,voted at their last meeting that they too would each make a three-year pledge. Not everyone maybe aware that the greater the number of alumni who give, the higher the School ranks in someevaluations, and the dollar amount is not always critical. We can hope that this 2004 class pledgewill inspire more alumni to participate, even with a small donation.

The alumni board addressed several important issues at its summer retreat. New and old boardmembers had an opportunity to meet and exchange thoughts about the board’s future. Newmembers “rolled up their sleeves,” proving they were ready to continue the fine work of theirpredecessors and tackle the new year’s agenda. We welcome the following new members to thealumni board: Philippa Barron, Lucinda Bazile, Julie Brown, David Harrington, Beth Roemer,Jan Schilling, and Sarah Stone-Francisco.

The board of directors formed three small working groups that focused their discussions on different topics.

One group discussed alumni participation in School affairs. It recommended that we continueour active participation in the Student Welcome and Career Café, as well as other School events.It also suggested that the board should continue to promulgate the benefits available to alumni,such as the @Cal and School of Public Health web sites. In return, all alumni should beapproached for some financial support. We could take advantage of the workplace where alumnimay have personal and professional contacts with other Berkeley graduates, not only for fund-raising, but also to identify job and internship opportunities.

A second group at the retreat addressed multicultural and diversity concerns. The Schoolof Public Health aims high, as does the rest of the Berkeley campus, but achieving the goals iselusive. Goals include increasing the proportion of underrepresented students who apply, areadmitted, and matriculate. Some of the objectives proposed to achieve the goals are: to fund afull-time diversity coordinator, to provide more financial assistance and support for applicantsand students, and to strengthen community outreach.

A third group focused on evaluating the annual performance of the Public Health AlumniAssociation. Performance indicators, such as the percentage of alumni making an annual gift andthe average amount of yearly giving, were examined from year to year. The good news is that forthe past three years, the number of participating alumni has been on the upswing. The bad newsis that, even in 2003, the percentage of alumni contributing to the School of Public Health wasonly 12.07 percent. The visibility of the alumni association may be an issue. Some headline fea-ture would help to make the alumni association more conspicuous, like a special scholarship thatwould have a substantial value.

Any thoughts? We’d love to hear from you. You can reach any of the directors by contactingEileen Pearl, associate director, external relations, (510) 643-6382, [email protected].

Sincerely,

John W. Eastman, Ph.D., M.P.H. ’80President, Public Health Alumni Association

President’s Message

Alumni News

27Public Health

“Our teams meet every morning to discussthe participants they are responsible for,” hesays, “and they follow each individual inevery facet of their lives, including theirenvironment. If we need to dip the dog—tokill the fleas that cause the lesions that getinfected that cause the hospitalization—wedip the dog.”

The second weapon is an intense commit-ment to the principles he learned in theSchool of Public Health: prevention, mainte-nance, and early intervention.

“If you are able to prevent, then you don’thave to pay the hospital bill,” Szutu says. “Ifyou can maintain a person’s muscle tone andstrength, that person will not fall as frequently.If you can get on that cold before it becomespneumonia, then you avoid hospitalization.We practice those types of interventions inorder to achieve the results we get. Ourpopulation is the 10 percent-most frail ofthe Medicare population, yet our inpatienthospital utilization is less than half of theMedicare average. Investing in prevention,maintenance, and early intervention works.It’s not academic. It works.”

Suturing up patients at the Ellington Air Force Base in Texas was a routine task forPeter Szutu. True, he wasn’t a doctor—hadn’t even finished college at that point—but, as a medic in the late 1960s, he was called upon to provide, shall we say, awide range of care. And he didn’t hesitate. With a father who was a distinguishedsurgeon and a mother who had been a dean of nursing in his native China beforehis family escaped to the United States, Szutu had been exposed to medicine andmedical procedures throughout his youth.

After developing his clinical skills at the Air Force outpatient clinic for four years andfinishing college in 1972, he looked around for a way to combine his interest in med-icine and his desire to bring medical care to many people. He found his answer—andthe start of a pioneering career in public health—at the Beach Area CommunityClinic in San Dingo, serving the poor and the medically disenfranchised.

Community clinic workers had to be versatile in those early, freewheeling days, andSzutu quickly discovered he could run “a fairly good size community-based organiza-tion” that had 20,000 visits a year. “I found a different part of myself there,” he says.“Instead of treating one person at a time, I could treat a population.”

When Szutu arrived at the School of Public Health in 1979, elderly populationswere not on his mind. He intended to get formal training and head right backto his surfers in San Diego. But his path changed when Grey Panther LillianRabinowitz, cofounder of Alameda County’s first day health care program forolder adults—Community Adult Day Health Services (CADHS)—asked him toserve on the board.

His commitment to CADHS took him from board membership to leadership ofthe organization into which it evolved. Today, Szutu is president and CEO of theCenter for Elders Independence (CEI), the first program in the East Bay to incor-porate a long-term health care service that enables frail seniors to live at home foras long as medically and socially feasible. Modeled after On Lok, a pioneeringhealth care program in San Francisco’s Chinatown, CEI has grown since the early’90s to include three centers with more than 360 participants and an annual budgetof over $20 million.

Unlike other nonprofit health care services, which must limit what services can be pro-vided or how long those services can be provided, CEI provides whatever services par-ticipants need—from home care to any medical specialist—for as long as they need it.

This care is very expensive, but Szutu has built a successful program based on two not-so-secret weapons. The first is dedicated interdisciplinary teamwork—involving a fullspectrum of specialists, from physicians to nutritionists to transportation personnel.

Peter Szutu

Alumni News

Alumnus Spotlight

Peter Szutu, M.P.H. ’81

— Vivian Auslander

“If you can maintain a person’s muscle tone and strength, that person

will not fall as frequently. If you can get on that cold before it

becomes pneumonia, then you avoid hospitalization. We practice

those types of interventions in order to achieve the results we get.”


Alumni Notes

Alumni News

1950s

John E. Brockert, M.P.H. ’58 “Retired fromUtah Dept. of Health in 1996.”

1960s

D.J. Hansen, M.P.H. ’62 “Delightfully retiredand an active volunteer with public TV, RedCross, and Kaiser Permanente.”

Bradley E. Appelbaum, M.D., M.P.H. ’64”My retirement as maternal and child healthmedical consultant, U.S. Dept. HHS, in 2002has allowed me to be more involved in state/local advocacy programs. I have retainedcontacts at state MCH programs and amconsultant to my former employer, HRSA -MCH Bureau.”

Hazelle Junker Walker, M.P.H. ’66 “I am livingin a retirement center in Scottsdale, Ariz.”

1970s

John Avery Palmer, M.P.H. ’71 ”OrdainedEpiscopal minister; police chaplain, Santa ClaraPolice Department; 30+ year service awards:Santa Clara County, American Red Cross/Cancer Society/Lung Association; member(knight) Order of St. John of Jerusalem; knighthospitaller chaplain, Order of St. Luke’s; hospi-tal, AIDS & JAM chaplain.”

David B. Crouch, M.P.H. ’73 “Thirty-one yearsof formulating and managing environmentalpolicy and programs for four multinationalresource companies, including five years onFederal Advisory Committee for EPA, chair ofNational Mining Association Solid WasteCommittee, 12 years. Thanks to Bob Spear,Ph.D., for his support and inspiration.”

Jack Geissert, M.P.H. ’75, is director of EHS& site services at Wyeth Biopharma inAndover, Mass.

Arnold Milstein, M.D., M.P.H. ’75, receivedthe 2004 Keystone Award from WorldatWork,a nonprofit professional association dedicatedto knowledge leadership in compensation,benefits, and total rewards. Milstein, themedical director of the Pacific BusinessGroup on Health, received the award inrecognition of his efforts to improve healthcare programs for large purchasers,providers, and government.

Geoffrey F. Cole, M.P.H. ’79, has been namedpresident of Norwalk Hospital, a 366-bedteaching affiliate of the Yale University Schoolof Medicine. For the past 10 years he waspresident of Emerson Hospital in Concord,Mass., during which time he oversaw thecompletion of a new cancer center, two satel-lite facilities and a critical care unit.

1980s

Terrie L. Kurrasch, M.P.H. ’80, has been pro-moted to associate at Ratcliff, an architecture,interior, and planning firm in Emeryville, Calif.She joined Ratcliff from Alta Bates SummitMedical Center in Oakland, where she servedas director for implementation. At Ratcliff, herprojects include the program and remodel ofJohn Muir Medical Center in Walnut Creek.

Ann Sandven, R.D., M.P.H. '81, is currentlyworking as development officer and farm-worker outreach manager at Terry ReillyHealth Services, Nampa, Idaho. Recent proj-ects include grantwriting to start new primarymedical and dental clinics in southwest Idaho,as well as a pediatric overweight communitycollaborative proposal.

Ann de Peyster,Ph.D. ’83, hasbeen named inter-im director of theGraduate Schoolof Public Health atSan Diego StateUniversity.

Pamela S. Turner, M.P.H. ’83, has writtena book, Hachiko: The True Story of a LoyalDog, based on a Japanese story about a dogwho faithfully waited for his owner at a trainstation years after the owner’s death. Turnerbecame aware of the story when she and herfamily lived in Tokyo.

Julie M. Brown,M.B.A., M.P.H.’85, recentlycoauthoredLeaders SpeakOut on EmotionalIntelligence, asummary reportfrom a study on

leadership, emotional intelligence, and per-sonality type. Brown is the principal of Julie M.Brown and Associates, which provides man-agement consulting services in the areas ofoperational performance improvement andleadership development. She uses her experi-ence as a former hospital CEO to supportclients navigating the whitewaters of organiza-tional change.

Rhys Jones, M.P.H. ’85, is a senior managerin the Healthcare Consulting Practice atPricewaterhouseCoopers in Tampa, Fla. Hiscurrent work focuses on implementationissues relating to the Medicare ModernizationAct (the prescription drug bill) and helpingclients understand and assess its businessimpacts and opportunities. He also continuesworking with HIPAA privacy issues andMedicare Advantage health plans.

Evelyne de Leeuw, M.P.H. ’86, hasaccepted a position as head of school at theSchool of Health and Social Development atDeakin University in Melbourne, Australia.

Vivian Lin, Dr.P.H.’86, is chair ofpublic health andhead of school atLa Trobe Universityin Australia. Sincearriving in Australiain 1982, she hasworked for NSW

Health, the Victorian Health Department, theNational Occupational Health and SafetyCommission, and the CommonwealthDepartment of Health and Family Services.

Shawn E. Chandler, M.P.H. ’88 “I traveledto Addis Abba, Ethiopia, January 2004, tofinalize the adoption of Tizibt, my five-year-old daughter. Tizibt’s adjustment to life in theU.S.A. has gone very well.”

Irva Hertz-Picciotto, Ph.D. ’89, M.P.H. ’84“Launched $5 million study of environmen-tal epidemiology of autism as central proj-ect in new NIEHS-funded children’s centerfor environmental health. Also principalinvestigator of birth cohort studies of PCBsin Slovakia and childhood health in relationto air pollution in Czech Republic. Serve on

29Public Health

Alumni News

EPA’s Science Advisory Board, Board of Scientific Counselorsfor National Toxicology Program (NTP), and chaired the IOMCommittee on Vietnam Veterans and Agent Orange.”

1990s

Priscilla Enriquez, M.P.H. ’92, was appointed senior pro-gram officer for the Community Technology Foundation ofCalifornia, which supports community technology for access,equity, and social justice. She is responsible for managinggeneral grants and key initiative programs.

Susan Lehrman, Ph.D. ’93, M.P.H. ’79, has been namedpresident of the newly formed Graduate College of UnionUniversity. The Graduate College was created this fall fromthe former Center for Graduate Education and SpecialPrograms at Union College, of which she was dean of grad-uate education.

Stephanie Bender-Kitz, Ph.D. ’97, M.P.H. ’91, her husbandand two children have moved to in Boise, Idaho, after sevenyears abroad. She is cofounder of a new company providingan integrated, multidisciplinary team approach to assistingcaregivers with consulting, resources, and advice.

American Public Health AssociationHonors Berkeley Alumni

The following alumni were among those receivinghonors at the American Public Health Association’sannual meeting, held in November 2004 inWashington, D.C.:

Pat Crawford, Dr.P.H. ’94, R.D., receivedthe Catherine Cowell Award, sponsoredby the Food and Nutrition Section of theAmerican Public Health Association(APHA). The award recognizes excellenceand achievement in administration, plan-

ning, mentoring, and team building in pub-lic health nutrition, including meeting the spe-

cial needs of urban populations and young children. Crawford iscodirector of the Center for Weight and Health at the College ofNatural Resources at UC Berkeley.

Marion Nestle, Ph.D., M.P.H. ’86,received the David P. Rall Award, whichis presented to an individual who hasmade outstanding contributions to publichealth through science-based advocacy.Nestle received the award for her work to

shed light on the impact of food and nutri-tion policies on the nation’s health. She is

Paulette Godard Professor of Nutrition, Food Studies, and PublicHealth at New York University, the author of Food Politics: Howthe Food Industry Influences Nutrition and Health, and the 2004UC Berkeley Public Health Alumna of the Year.

Lawrence W. Green, Dr.P.H. ‘68, receivedthe Mayhew Derryberry Award for out-standing scientific contributions to publichealth education and health promotion.The award is named for former School fac-ulty member Mayhew Derryberry, who

established the Division of Health Educationin the U.S. Public Health Service and created

the Experimental and Evaluation Service before retiring fromfederal service and coming to Berkeley. Green is currently a vis-iting professor at the School.

Looking for former classmates?

Want to post or find a job?

Join Public Health@cal, the School of PublicHealth’s alumni community, and locate yourclassmates in the @cal database.

If you have a job to offer, you can also use@cal to tap into some of the brightestminds available.

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Steffi Kellam, M.P.H. ’98 “Josh and I arenow the proud parents of two beautifulgirls—Lucy Caroline was born January 21,2004. Katie is now almost three and adoresher little sister. I would love to hear fromEpiBiostat friends.”

Karen Sweeney, M.P.H. ’99 “Primary careprovider in family practice and women’shealth at a community health center servingpredominantly Latino-Caribbean immigrantsand their families. Also involved in an NIH-funded Latino diabetes prevention project.”

2000s

Richard Gosselin, M.D., M.Sc., F.R.S.C.,M.P.H. ’01 “I am fortunate to have a fingerin many different pies: war surgery withEmergency International and ICRC, orthope-dic surgery (mostly for underprivileged chil-dren) with smaller NGOs such as OperationRainbow or Orthopedics Overseas, technicalconsultancy on a trauma project with theWHO, needs assessment and programmaticevaluation with Handicap International, aresearch project with the Health and

Conflict section of the London School ofHygiene and Tropical Medicine Health PolicyDepartment, co-writing a chapter on theeconomics of surgical interventions in thedeveloping world for a World Bank/WHO-sponsored textbook, and even the occasion-al lecture at the School of Public Health.”

Victor Chen, M.D., M.P.H. ’03 “I decided inmid-December to return to Modesto, Calif.,where I took a position with the facultygroup of the family practice residency pro-gram in which I had trained. I was looking

In Memoriam

William C. Reeves, B.S. ’38, Ph.D. ’43,M.P.H. ’49, died September 19, 2004, atage 87. Widely regarded as the world’sforemost authority on the spread and con-trol of mosquito-borne diseases, Reeveswas a professor of epidemiology at UCBerkeley’s School of Public Health for morethan six decades, headed the School’s epi-demiology program from 1971 to 1985,and served as the School’s fifth dean from1967 to 1971.

Reeves distinguished himself early in hiscareer by leading the research team thatin 1941 isolated both western equine and St. Louis encephalitis viruses from a species of mosquito called Culextarsalis. This discovery confirmed for thefirst time that these viral diseases, whichhad been plaguing the western UnitedStates throughout the 1930s, were trans-mitted by insects. Public health officials

“In one lifetime, Bill Reeves both identified a major cause of death and disease in California—western equine encephalitis—and developed mosquito control programs to eradicate it.”

—S. Leonard Syme, UC Berkeley professor emeritus of

epidemiology and a close friend of Reeves’s for more

than 35 years

“The groundbreaking research that Bill and his colleagues did on the St. Louis encephalitis virus—a close cousin to West Nile virus—gave us a roadmap for understanding West Nile virus, helping us to predict how it would behave in North America. His death will resonate throughout the arboviral community.”

—Dr. Roy Campbell, chief of the surveillance and epidemiology

activity of the Arboviral Diseases Branch at the Centers

for Disease Control and Prevention in Ft. Collins, Colo.,

and a former student of Reeves’s

“He was a giant in his field whose work has had a pervasive impact for over six decades.”

—Stephen M. Shortell, dean,UC Berkeley School of Public Health

Alumni Notes...continued from page 29

31Public Health

were then able to effectively target a keysource of disease transmission.

One of only a few entomologists working ina field dominated by medical specialists,Reeves went on to isolate more arthropod-borne viruses and developed numerousinnovations. With his knowledge of whatattracts mosquitoes to animals, Reevesdesigned the first method to trap live mos-quitoes by using carbon dioxide and light.He also invented a way of tracking mosqui-toes by marking them with a fluorescentdust, which has enabled researchers to

study the mosquitoes’ life cycles, includinghow far they travel, how long they live, andother critical information used to designand evaluate mosquito control programs.

One of the more notable innovationsestablished by Reeves was the now-famous“sentinel chicken” disease monitoring sys-tem. Reeves discovered that chickens devel-op antibodies after being bitten by infectedmosquitoes, but they do not become ill norcarry enough of the virus to further transmitthe disease. Because chickens are kept inone place, positive blood test results mean

infected mosquitoes are in the vicinity. Thesystem has since been copied throughoutthe world and is used today in some areasto monitor the spread of West Nile virus.

Throughout his career Reeves discoveredseveral new species of insects and is creditedwith coining the term arbovirus, short for“arthropod-borne virus,” a name eventuallyaccepted by the World Health Organization.

Reeves officially retired in 1987 but continuedto actively advise from his campus office,participating in recent years in conferencecalls that the Centers for Disease Controlheld with state health departments. WhenWest Nile virus emerged as a new publichealth threat, Reeves became an invaluableresource for public health officials, many ofwhom were his former students.

Reeves is survived by his wife and three sons,and an extended family that includes fourgrandchildren and one great-granddaughter.

Donations in Reeves’s memory can be madeto the William C. Reeves Memorial Fundfor Students and mailed to the Office ofExternal Relations, UC Berkeley School ofPublic Health, 140 Warren Hall, Berkeley,California, 94720-7360. Gifts can also bemade online at https://colt.berkeley.edu/urelgift/public_health.html.

for an opportunity where I could beinvolved with resident teaching, practicemedicine in a community-based setting, thelocal public health department and the sur-rounding community. Currently, I’m basedin West Modesto in one of seven countyclinics….Our clinic gets strong communitysupport, and we have the opportunity tonot only develop a working model of com-munity-oriented primary care, but to serveas a resource and active participant in theWest Modesto community.”

Glenn Kan, M.D., M.B.A., M.P.H. ’03 “I am a preventive medicine resident withthe California Department of HealthServices (CDHS) and am in the home stretchof my practicum year….I was placed in aCDHS agency, the Office of ClinicalPreventive Medicine, and in the YoloCounty Health Department. In addition togetting exposure to a broader variety ofprojects with this state-county mix, seeingthe dynamics that occur between the twolevels of government with regard to particular

topics was particularly interesting…Myplacements have been both complementaryand skill broadening.”

Deborah S. Edelman, Dr.P.H. ’04, started apostdoctoral research fellowship position atJohns Hopkins’ Bloomberg School of PublicHealth this past summer. She is continuingher research on the role of media in publichealth, focusing now on Youth Radio.

Reeves with his wife, Mary Jane.

Faiga Fram Duncan, B.A. ’34, M.P.H. ’59, diedin April, 2004. One of the first students in UCBerkeley’s Department of Hygiene (the forerun-ner of today’s School of Public Health), Duncan’scareer included work in Sydney, Australia, andat San Francisco General Hospital. A dedicatedalumna, she shared a case-based curriculummodule with the School based upon her experi-ences working with TB patients, pregnantundocumented immigrants, and counties thatshirked care for the indigent. Recalling her ownfinancial hardships at Berkeley during the GreatDepression, Duncan proved a tireless volunteerfor the School, participating in annual telephonefundraising campaigns, recruiting volunteercallers, and personally making more than 500calls. She coordinated class reunions and soughtemployers to participate in the School’s annualcareer fair. In 1987 the California AlumniAssociation and the UC Berkeley Foundationpresented Duncan with the Trustees Citationrecognizing her as one of the campus’s 25 mostactive and supportive alumni.

Jiann-Ping Hsu,Ph.D. ’77, an inter-nationally knownscholar and scientistin biostatistics, diedFebruary 9, 2004, atage 56, after a longbattle with cancer.She is survived by

her husband, her parents, and four sisters.

Born in mainland China in 1947 and educatedin Taiwan, Hsu was a scholar of mathematicalsciences, earning a B.S. in mathematics at theNational Taiwan University, an M.A. in mathe-matical statistics at Columbia, and a Ph.D. inbiostatistics from UC Berkeley. She servedwith the Food and Drug Administration andsat on review panels for clinical trial grantapplications for the National Institute on DrugAbuse. Hsu held research positions with lead-ing pharmaceutical firms and became presidentof the Michigan-based BiopharmaceuticalResearch Consultants, Inc. Honored with manyprofessional awards, she mentored and trainedmore than 60 biostatisticians.

In January of 2004, the Jiann-Ping Hsu Schoolof Public Health at Georgia Southern Universitywas established and endowed in her name by

her husband, Dr. Karl E. Peace, director ofGeorgia Southern’s Center for Biostatistics. It isthe first school of public health in Georgia’s uni-versity system. Peace has also established theJiann-Ping Hsu Biostatistics Award for Excellenceat UC Berkeley’s School of Public Health.

Lola E. Reshetko,B.A. ’54, M.A. ’55,died July 8, 2004,at the age of 71.Born in Harbin,Manchuria, sheimmigrated withher family to SanFrancisco in 1940.

Reshetko spent much of her career teaching sci-ence at Mission High School in San Francisco,where she developed a program with local hos-pitals called “Mission Possible,” which offeredstudents actual experience working in the med-ical field. She was also an active fundraiser for“Close Up,” a program that sponsored studentvisits to Washington, D.C. She is survived by hercousins, George McKray of Alameda, Calif., andBoris Fedushin of New York City; and the familyof her partner, the late Col. Charles Kay.

Reshetko’s belief in the potential of studentsinspired her to establish an endowment sup-porting scholarships in both the School ofPublic Health and the College of Letters andScience at UC Berkeley. Gifts in her honor maybe made to the Reshetko Family ScholarshipFund, Office of External Relations & Develop-ment, UC Berkeley School of Public Health,140 Warren Hall, Berkeley, CA 94720-7360.

David Clement Riese, B.S. ’61, M.P.H. ’68, diedJuly 19, 2004. Born and raised in Martinez,Calif., he earned his bachelor’s degree in busi-ness administration from UC Berkeley, thenjoined the U.S. Army Reserve at Fort Ord in

Monterey. After six months of active duty hewent to work for the California Department ofHealth in 1961, taking a leave of absence in1968 to earn his M.P.H. Riese and his wife,Mary Huntley Riese, both worked for theDepartment of Health, first in Berkeley and thenin Sacramento, until their retirement in 1996.During his career with the Department of HealthServices, Riese played an instrumental role inthe creation and development of many of thestate’s health programs, including the TobaccoControl Program, Breast Cancer Program,Preventative Health Care for the Aging Program,Cancer Surveillance Section and the CaliforniaCancer and Nutrition “5-A-Day” Campaign. Hisfinal position was as deputy chief of the CancerControl Branch. Riese is survived by his wife, hissisters-in-law and brother-in-law, and manynieces and nephews.

Hedwig G. Taylor, widow of Professor EmeritusKeith O. Taylor, died July 3, 2004. She was as anavid reader who enjoyed lawn bowling, paint-ing, and playing Scrabble. The Taylors were gen-erous planned giving supporters of the UCBerkeley School of Public Health.

Veva Jeanne Winkelstein, wife of ProfessorEmeritus Warren Winkelstein, Jr., died September15, 2004, at the couple’s home in PointRichmond, Calif. She loved travel, her garden,music, opera, theatre, and the arts. She wasactive locally in the University Section Club andThe McInnis Park Women’s Golf Club and servedon the board of the Pt. Richmond MasquersPlayhouse. She had a successful career workingfor the University of California (San Diego,Berkeley, and San Francisco campuses). In addi-tion to her husband of 30 years, Winkelstein issurvived by her five children, three stepchildren,two sisters, and 13 great-grandchildren.


In Memoriam

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Single-Life Deferred Payment

Current Age 1st payment age Rate

50 55 7.050 60 9.355 60 7.355 65 9.860 65 7.660 70 10.665 70 8.365 75 11.5

33Public Health

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will give you a fixed and healthy return?

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for a gift of cash or other property to the School of

Public Health, you or the person of your choice

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A gift annuity offers the following benefits:

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For more information, contact the Office of Planned Giving at (800) 200-0575 or (510) 642-6300.

154 Women

From 20 states and 17 countries

University of California, BerkeleySchool of Public Health140 Warren Hall #7360Berkeley, CA 94720-7360

Address Service Requested

Non-Profit OrgUS Postage

PAIDUniversity of California

The School Welcomes the Entering Class of Fall 2004

This fall 203 new graduate students entered the School of Public Health, representing a wide range of backgroundsand academic interests. The new class comprises 154 women and 49 men, ranging in age from 21 to 60 years old.There are 156 students working on M.P.H. degrees (13 of whom are in concurrent or joint degree programs); 7 working towards an M.A. or M.S.; 10 students inthe Dr.P.H. program; and 30 Ph.D. students.

The students hail from 20 states (Arizona, California, Colorado, Connecticut, District of Columbia, Florida, Illinois, Indiana, Maryland, Massachusetts, Michigan,Minnesota, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Virginia, Washington, and Wisconsin) and 17 countries (China, Colombia, Germany,Great Britain, India, Israel, Ivory Coast, Japan, Korea, Kyrgystan, Mexico, Nepal, Nicaragua, Spain, Taiwan, Thailand, and the United States).

In addition, the School’s newly reinstituted undergraduate program is growing in popularity: 140 upper division undergraduate students havedeclared a major in public health.

Alumni share lunch with entering students at the student welcome picnic, held August 24 outside Warren Hall.

Ages 21 to 60

203 graduate students

49 Men

gloss coating

fall 2004 - living long, living well - public health

Documents

human health

thepublics health

professor of biostatistics

professor of epidemiology

professor leonardduhl

correlates of healthy

berkeley citation award

mayhew derryberry award