Our world class hero and Lasker laureate William Foege was directing a small medical center in Nigeria in 1966, when smallpox broke out in a nearby community. Vaccine was in short supply, and there was no time to get more. In what would become his claim to fame, Foege dreamed up a daring strategy of inoculating only susceptible people in surrounding areas as quickly as possible. This technique, called “surveillance and containment,” became standard protocol for infectious disease outbreaks and eventually led to the global eradication of naturally occurring smallpox in 1979. It was only the first of many creative strategies Foege has tried to ensure health for all. Now Presidential Distinguished Professor of International Health at the Rollins School of Public Health, Foege received the Mary Woodard Lasker Award for Public Service this past fall for his role in global health and disease prevention. The coveted Albert and Mary Lasker Foundation awards, sometimes called America’s Nobels, have for 56 years honored scientists, physicians, and others who have played pivotal roles in combatting diseases.

“Not one of us can do much alone. The power is in the accumulation of every last one of us, bound together in shared goals, adding our paltry daily allowance.” —William Foege

The Lasker selection committee honored Foege because his “entire career has been defined by an unwavering optimism that global diseases can be conquered; the willingness to risk professional reputation on untried, creative strategies; and the determination to do whatever was necessary, even at great personal cost, to improve the health of people.”

Foege’s acceptance speech echoed a philosophy that has improved the lives of millions. “What is better than science?” he asked. “Better than science is science with heart, science with ethics, science with equity, science with justice.”

He called for international cooperation to combat the public health threats of disease and starvation that kill 30,000 children under the age of 5 worldwide every day.

“Not one of us can do much alone,” said Foege. “The power is in the accumulation of every last one of us, bound together in shared goals, adding our paltry daily allowance . . . the contributions of millions of people in research and academics.”

After Foege’s successes in Africa, he was named head of the smallpox eradication program at the Centers for Disease Control and Prevention and later director of the entire agency. During his tenure, from 1977 to 1983, CDC researchers discovered toxic shock syndrome’s link to tampons, and Reyes syndrome’s association with aspirin use in children. Foege also established the first task force on AIDS, led by James Curran, now dean of the RSPH.

In 1984, Foege formed the Task Force for Child Survival, a working group for the World Health Organization, UNICEF, the World Bank, the United Nations Development Program, and the Rockefeller Foundation. The group increased childhood vaccination rates worldwide significantly in just six years. He later became the executive director of The Carter Center, helping combat diseases from Guinea worm to river blindness.

In 1999, he became senior medical adviser to the Bill and Melinda Gates Foundation, the world's largest philanthropic organization, which has given $1.9 billion so far to health-related projects around the world.

Fourteen new faculty and staff housed in the RSPH Department of Health Policy and Management promise to transform the school into a powerhouse of health services research with the establishment of the Emory Center on Health Outcomes and Quality. Part of the Woodruff Health Sciences Center, Emory recently acquired this unique team of researchers from Aetna, Inc, where it was called the USQA Center for Health Care Research. It specializes in outcomes research—the study of what works in health care. Projects range from examining the quality and cost-effectiveness of health care to designing and evaluating interventions to improve health outcomes.

The group was established in 1992 as the Prudential Center for Health Care Research under the leadership of former CDC director Bill Roper. Jeff Koplan then led the group before he became director of CDC. The group later moved to Aetna, the largest managed care organization in the nation, as part of Aetna’s purchase of Prudential Health Care.

Kenneth Thorpe, director of the new center and chair of Health Policy and Management, says this highly accomplished group looks forward to collaborating with Emory researchers on a wide variety of health services research studies.

“This group has published prolifically on chronic diseases like diabetes and heart disease and cancer screening, reproductive health, health literacy, and barriers to immunization, among many other topics. “What distinguishes this particular type of research is that it aims for results.”

Outcomes–oriented researchers
Julie Gazmararian says too many patients misunderstand their doctors’ orders, cannot comprehend the instructions on prescription bottles, and suffer poor treatment results because of it. Indeed, she authored a landmark study in the Journal of the American Medical Association in 1999 that concluded that a third of Medicare patients enrolled in a managed care plan had inadequate health literacy. Gazmararian was the director of research for the USQA Center for Health Care Research and led the center for a time before its transition to Emory. She has extensive experience with issues relating to women’s health, particularly reproductive health, domestic violence, and depression. She finds conducting research that can directly affect a patient’s welfare especially rewarding. “Our focus is on applied research and using the results to change things for the better,” she says. “That makes what we do applicable to so many different areas of health.” Tracy Scott has always been fascinated by how social forces shape people’s everyday lives. Since earning a PhD in sociology from Princeton, she has focused on the social aspects of health care, particularly how social factors and individual health beliefs may influence preventive health behaviors. While working for the USQA Center for Health Care Research, she studied how to disseminate information about best practices to key organization leaders. She continues to conduct health services research and is poised to investigate other important social questions, such as whether patients feel discrimination in the health care system based on gender, race, ethnicity, or social class.		Verna Lamar Welch has become increasingly aware of the high rates of death from stroke and heart disease in the Southeast. As a native of Georgia and an epidemiologist who specializes in cardiovascular disease, she has an abiding interest in studying the factors that may be contributing to this excess mortality. She mentions socioeconomic status, lifestyle choices, access to health care, and genetics as possible culprits. Through her research Lamar Welch hopes to contribute to the understanding of this phenomenon and ultimately “help get to the root of this problem and find new strategies” to reduce this burden. She holds a masters degree in biostatistics from RSPH and a PhD in epidemiology from the University of North Carolina at Chapel Hill. Diane Green was drawn to epidemiology after an initial career in the corporate world because it combines her interest in analytical methods, biological science, and research. “I love having the opportunity to conduct applied research with the goal of improving the delivery of health care,” says Green. As a health services researcher for the past five years, she has studied prenatal care, unintended pregnancy, arthritis, and patients’ trust in their physicians in managed care populations. She earned her masters and doctorate degrees in epidemiology from RSPH. Green’s research focus is on women’s health and issues of aging.

As a health education specialist at Grady Memorial Hospital, Kara Jacobson trained doctors to simplify communication and counsel their patients about risk factors. Jacobson, who earned an MPH from RSPH, now studies education of providers about asthma, health literacy among commercially insured diabetes patients, and electronic communication among providers.

Environmental Impact During the past decade, banana companies razed acres of tropical forest along the Caribbean coast of Costa Rica to make room for colossal banana plantations. The bananas grew like kudzu, but so did malaria, on-the-job injuries, and the incidence of pesticide poisoning. Village water supplies downstream from plantations were contaminated by fertilizer run-off. Deforestation provided the perfect habitat for banana trees, but it also changed the landscape of the community’s health. Indeed, one rift in the web of life creates ripples felt throughout. A new MPH program in Global and Environmental Health (GEH) at the RSPH trains students to understand these inherent connections. The program is a joint endeavor of the departments of International Health and Environmental and Occupational Health. Impetus for the program came from students, says Rick Rheingans, co-director of the program and a professor in both departments. Howard Frumkin, chair of Environmental and Occupational Health, also co-directs the program.

Although environmental health challenges are more obvious in poor countries, they ultimately affect the whole planet, says Rick Rheingans, co-director of the GEH program.

“We’ve had students interested in environmental health issues in developing countries and international health students who realized that many of the health challenges in developing countries are environmental,” says Rheingans.

Globally, population growth and increasing demand for natural resources directly and indirectly affect climate and biodiversity. They in turn affect the availability of food, clean air, and clean water, as well as disease risks. On a regional scale, patterns of urbanization, agriculture, transportation, and natural disasters affect health with their impact on food supplies, water, air, wastes, injury risks, and toxic exposures.

Although environmental health challenges are more apparent in poor countries, they ultimately affect the health of the whole planet. “These are not just issues of developed countries versus underdeveloped countries,” Rheingans says. “So many of these issues, such as climate change and natural resource demand, are truly international.”

Rheingans predicts an increasing demand for environmental health scientists with an international focus. “There is a lack of workers trained to deal with these challenges,” he says. “There are so many organizations and government agencies that need someone to look at the health aspects of their projects. For example, there are a lot of irrigation projects ongoing in developing countries. Someone needs to ask how these projects increase the risk of floods, how they affect local vectors for diseases, and whether they move people into environments where they have contact with disease vectors.”

Remembering a continuing plague More than 20 years have passed since the Centers for Disease Control and Prevention published its first report ever about Pneumocystis carinii pneumonia among homosexual men in the Morbidity and Mortality Weekly Report. That article cited the beginning of the AIDS epidemic that rages on today around the world.

On November 29, three former CDC epidemiologists who were there at the beginning—including RSPH Dean James Curran—sat on stage at the Emory University Hospital auditorium. They swapped stories between clips from the movie And the Band Played On. Like much research involving AIDS, the event to commemorate World AIDS Day was an Emory-CDC collaboration. Panels from the AIDS Quilt of Remembrance hung from the walls, and every seat was filled. By the end of a program that dealt with both the scientific challenges of HIV and its human impact, hardly an eye was dry.

Curran, Mary Guinan, and Harold Jaffe were members of the CDC task force that investigated the AIDS epidemic in its early years. Their stories told of an epic struggle to solve the puzzle of AIDS and make the world pay attention.

“Back then, you just didn’t tell people at a party that you worked in venereal disease,” said Mary Guinan, now the state health officer for Nevada. Some of their stories were bitter, and some were simply sad.

“When I recently visited an old friend from those days who is a doctor in San Francisco, he made a telling comment,” said Curran, director of the Emory Center for AIDS Research. “He said, ‘Now it’s mostly women out there marching in the parades. The men are all gone.’”

The annual World AIDS Day is the result of a call by the World Summit of Ministers of Health on Programmes for AIDS Prevention in 1988 to open channels of communication, strengthen the exchange of information and experience, and forge a spirit of social tolerance. Since then, this event has been endorsed by the World Health Assembly, the United Nations, and nations around the world.

Teen dating violence and exposure to X-rated movies among adolescent girls is more common than most people think. In the May 1, 2001, issue of Pediatrics, Gina Wingood, professor of Behavioral Sciences and Health Education, published two articles examining social factors that contribute to unhealthy sexual behaviors and sexually transmitted diseases among African-American adolescents. In one study, Wingood reported that nearly 30% of a sample of 522 adolescent females reported watching X-rated movies within the past 90 days. Those who were exposed to X-rated movies had more negative attitudes about using contraceptives, were twice as likely to have multiple sex partners, and had sex more frequently. Most worrisome, female teens who viewed X-rated movies were 70% more likely to test positive for chlamydia.

“Exposure to sexually explicit X-rated films that rarely show preventive behaviors like condom use may influence adolescents by modeling unhealthy practices,” says Wingood. She suggests that parents be educated about how viewing sexually explicit material can affect adolescents’ sexual health. Age limits required to attend, rent or purchase these films must be enforced as well.

The second article also surveyed African-American female adolescents. In this study, almost 20% of teens questioned reported having been victims of dating violence. Those with a history of dating violence were less likely to use condoms, more likely to have an unfaithful partner, and more likely to fear discussing condom use or pregnancy prevention with their partner. They also reported having less control over their sexuality and were more likely to think that their friends were not supportive of using condoms. They were also more likely to test positive for STDs.

“Adolescents with a history of dating violence think that having an abusive partner is the standard, and this affects their perceptions about safer sex and healthy relationships,” says Wingood.

She suggests that information on teen dating violence be included within HIV, STD, and pregnancy prevention programs aimed at adolescents. Although prevention programs are most often targeted to females, their male partners must be educated as well. Both studies were funded by the Center for Mental Health Research of the National Institute of Mental Health.

I decide how many children I have.... The number of children I have depends on God’s will alone.... The number of children I have depends on the effectiveness of my birth control.... If this pregnancy test is positive, will I be happy about it?

Women visiting public health clinics in Valley, Alabama; West Point, Georgia; and suburban Atlanta ponder these issues while they await their pregnancy test results. They are participating in a pilot project led by RSPH epidemiologist Carol Hogue, who hopes to better understand the effects of religious beliefs on contraceptive practices. The study also examines the determinants of unhappy pregnancies. The study is part of the “Sex, Marriage, and Family” project of the Emory Center for Interdisciplinary Study of Religion. Emory scholars from across campus are working together to understand how religion—specifically Christianity, Islam, and Judaism—affects family life.

“Examining a woman’s religious beliefs is a critical part of capturing a full understanding of her attitudes about an unintentional pregnancy,” says Hogue, the Jules and Deen Terry Professor of Maternal and Child Health and professor of epidemiology. “A woman may feel caught between her religious convictions and her feelings about an unhappy pregnancy.”

Public health professionals often assume a woman knows about contraception if she is giving birth, she says. “That’s an erroneous assumption. Women very often either don’t have enough information about contraception, or they don’t have access to it.” Access, she says, may be limited because of finances, religious constraints, or her partner’s attitudes.

“Unintentional pregnancies can mean unhappy pregnancies,” Hogue says. “In the United States, one in five women says she was unhappy about her most recent pregnancy. Unhappy pregnancies may open the door to future public health issues, like abortion, divorce, and reduced parenting resources for other children. This is primarily a problem for adult women, not teenagers. We need to do the basic, epidemiologic research to find out how to help women and their partners achieve happy parenting.”
– TIA WEBSTER