A New Leader for International Health Lobbying 101 Virginia S. DeHaan Lecturer   puts Health Education in Context Charles C. Shepard Award Winner

n announcing the appointment of the new chair of the Department of international Health in June, Dean James Curran described Reynaldo Martorell as "a gifted researcher, teacher, and colleague whose dedicatio n to international health will lead the department into the next century." Recognized worldwide for his work in nutrition, Martorell, the Robert W. Woodruff Professor of International Nutrition, says, "I've been involved in many activities of universities related to both research and teaching. This is an opportunity to make a contribution in a different area." Martorell is well credentialed to take on the task of overseeing the growing department. He currently serves as president of the Society for International Nutrition Research of the American Institute of Nutrition and on the steering committees of UNICE F's State of the World's Children as well as the Global Initiative for Effective Nutrition Programs. He often is sought as an adviser on nutrition to international groups and currently is a committee member on several distinguished boards. At Emory, his w ork in nutrition also extends to the PhD program of the Graduate Program in Nutrition and Health Sciences, which he co-directs. As chairman of international health, Martorell wants to further develop the department's areas of excellence, including nutrition and infectious diseases. Whereas students may now pursue a nutrition concentration in their MPH program, the Department of International Health will develop a master of science in public health (MSPH) for those wishing to devote more of their studies to nutrition. In the area of infectious diseases, the department will substantially increase its faculty, courses, and researc h offerings. A top priority for Martorell will be the recruitment of young, tenure-track faculty, "who are the future leaders of public health." These recruits will complement the department's distinguished senior faculty, including William Foege (profiled in related article). Another strength of the department, which Martorell will continue to cultivate, is its interdisciplinary perspective. The department has ties to faculty in history, anthropology, and other departments in the school and at Emory University as well as At lanta-based institutions such as the Centers for Disease Control and Prevention, the American Cancer Society, and CARE. For example, Deborah McFarland, former chair of the Department of Health Policy and Management, has accepted a joint appointment in int ernational health. Yet another of Martorell's goals is to increase opportunities for student travel fellowships. "We want to be able to send more students into the field to capitalize on the tremendous opportunities to do international research," he says. Glen F. Maberly, previous chair of the department, oversaw its growth from a center into a full-fledged department. Beginning with fewer than 25 students, Maberly built the department to a record 185 students and established ties with international age ncies. As director of the Program Against Micronutrient Malnutrition, he will continue to teach and do research in the department. Martorell finds leading the "youngest department at the school" to be an "exciting challenge. I have been a professor at more mature institutions, where there were fewer opportunities than here. Because we are so new, many things are possible," he says . "As a young department and a young school, we need more resources, but the ideas are here."

Internationally known Professor Reynaldo Martorell already has made his mark on the field of nutrition. Now, he's taking on the chairmanship of the school's Department of International Health.

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he two young people making the presentation had the look of legislative lobbyists. In crisp blue shirts, navy pants, and burgundy ties, they sported the cleanly cropped haircuts of politicians. They spoke th e lingo of the capitol, easily reeling off numbers of Senate and House bills. They had done their homework and were well versed on their topic. They knew the voting records of the house members they were trying to influence. They had written the appropria te letters. Despite appearances, these presenters are not professional lobbyists. Rather, they are masters students enrolled in a legislative advocacy class at the Rollins School of Public Health. The class, taught by a team of experts--Arthur Kellermann, director of the Center for Injury Control, Dawna Fuqua-Whitley, senior research associate at the center, and Deborah McFarland, of the Department of Health Policy and Management--took a hands-on approach to learning how to influence legislation. "Being able to navigate successfully in political waters is an important asset to a public health professional," Fuqua-Whitley says. "In this class, we put theory to the test in a real-world application to legislate for improved health for the citizens of Georgia." The class tackled two proposed bills. The first, which successfully passed the Georgia Senate on March 20, established graduated teenage drivers' licenses in the state. The law establishes curfew restrictions for 16- and 17-year-old drivers, prohibitin g them from being on the road between the hours of 2 and 6 am, unless they are traveling to work. Full drivers' licenses are being withheld until the age of 18. To influence lawmakers, students extensively researched the bill's background. They developed a rapport with secretaries and clerks to ease their access to legislators. They spoke with legislators in person as well as implemented a letter-writing campa ign to encourage the bill's passage. They also took their arguments to the press. In fact, on the day of the bill's passage from the Senate to the House, the students were meeting with Senator Mary Margaret Oliver for a tour of the State Capitol, where th ey were able to see Oliver interact with the press about the bill's impact on health. "In general, the sentiment of the legislators was that this bill needed to pass," McFarland says, "but it kept getting bogged down with details." "In hindsight, this bill looks like it has everything going for it, but it had a tortured road to passage," Kellermann says. "It had failed to pass before, but the media attention broke the back of that difficulty." The second piece of legislation, House Bill 681, sought to repeal a mandatory motorcycle helmet law in Georgia. The bill had strong support from ABATE (American Bikers Acting Toward Education). These proponents argued that motorcycle helmet use is a pe rsonal choice affecting only individuals. While the students acknowledged that Americans value freedom of choice, they countered that the state has a compelling reason to protect the lives of its citizens. In addition, taxpayers often become responsible for the cost of injuries to riders who f ail to wear helmets. The students' research on helmet policies throughout the United States revealed that 22 states require helmet use for those under 18 years old, 25 states require helmet use for all ages, and three states have no law regarding helmets. Although Georgia has had a mandatory helmet law for many years, little data exists on the number and costs of injuries in Georgia related to uninsured motorcycle riders who fail to wear a helmet. Nonetheless, the students still managed to swing the argument to their side. The bill was defeated in committee. "The students are two-for-two," says Kellermann.

Among the graduate students who took legislative advocacy from the classroom to the state capitol are: (back row, l to r) Donalee Desai, Sheryl Magzamen, Wayne Chong, and (front row, l to r) Kareen Hall, Brigette Finkelstein, and Josh Sch iffman. In the two House and Senate bills they tackled, they managed to swing arguments to their side.

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n an era of health care where the focus is on time and money, Noreen M. Clark has proven that health education can actually reduce costs at the same time it improves health. "My strong conviction is that unl ess we attend to the social and behavioral aspects of our health problems, we will never see dramatic change," says Clark, dean of the University of Michigan School of Public Health. Clark, a noted researcher on self-management of chronic disease, delivered the annual Virginia S. DeHaan Lecture on Health Promotion and Education at the Rollins School of Public Health in the spring. She summarized her studies of asthma self-managemen t to demonstrate that educational interventions can decrease hospitalizations and medical emergencies. Her work has led to educational programs distributed nationally by the National Institutes of Health and the American Lung Association. In her lecture, Clark examined the broad context of public health work today, with demographics at the head of her list. "In the United States, we are becoming more diverse and pluralistic," Clark says. "In the 1990s, 85% of new entrants into the work force are people of color." The demographics of age also are rapidly changing. "We are seeing a broader range of ages," she says. "By the early 21st century, more than 1 million Americans will be 100 years or older. These demographic changes present chall enges for a society that will be simultaneously caring for children, parents, and even grandparents." Other contextual considerations that influence the field of public health, according to Clark, are the internationalization of the United States, environmental issues, and the growth of knowledge and technology. "Land, money, and guns drove our economy in the past," Clark says. "Ideas will drive it in the future." Although Clark outlined what she calls "stunning achievements in public health," she also discussed challenges to the field. She shared some alarming statistics. For example, 19 other countries have better infant mortality rates than the United States. Rates of immunization in this country need to be improved, a fact highlighted by the 40,000 US citizens who will die of influenza this year. Drug-related illnesses are rampant here, and the United States leads the world in suicide and homicide rates. "We are not going to realize change in these numbers until we change behavior," Clark says. "Interventions must focus on population-wide strategies, on behavior and the physical and social environment." Clark identified six areas in which public health professionals must be especially competent to enact change. In addition to an understanding of the intricacies of health care financing, they must be comfortable in business-oriented environments, "to w ork in the hard-nosed world of the bottom line while maintaining their humanism," she says. They need to be media and computer savvy and to know how to use statistics correctly. Finally, public health professionals need to be problem solvers who have the "people skills" to navigate cross-cultural and interdisciplinary fields, Clark says.

After her lecture on health promotion and education, Noreen M. Clark continued her dialogue with Professor Robert L. DeHaan (left) and Dean James Curran.

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or her master's thesis, Lisa Katz Elon examined factors that affect nonresponse rates of the Pregnancy Risk Monitoring System (PRAMS) survey. She found a high prevalence of physical and sexual violence among nonrespondents. Another factor affecting response was the number of children a woman had. The more children a respondent had, the less likely she was to participate in the survey. Elon's thesis earned her the Charles C. Shepard Award, presented annually to a graduating student who has demonstrated scientific excellence.