Bill Marine and Tom Sellers
Growing the Rings
of a Public Health Tree
A timeline of public health at Emory
Fall 1972-Fall 1973
September 19, 1974
n 1973, Tom Sellers and Bill Marine, preventive medicine faculty at the Emory School of Medicine, went to Dean Arthur Richardson with an idea. They wanted to start a training program within the medical school with an emphasis on community health.
In the previous decade, many innovative federally sponsored programs in community health and health care financing had sprung up, including Medicare and Medicaid. If these programs were to be viable, they needed trained leaders capable of administration, program planning and evaluation, and health care research, Sellers and Marine told Richardson. Other medical faculties around the country were recognizing the growing importance of prevention, and in fact, two universities (Roch ester and Utah) were launching new programs in public health.
Sellers and Marine brought their argument closer to home. At Emory, the preventive medicine and community health faculty were required to have masters degrees in public health as well as MDs as part of their specialty training. Many in the group were i nterested in the study of populations. Several Emory medical students also had expressed interest in pursuing a degree with an emphasis on communities, one that humanized their medical training. Finally, Sellers and Marine said, with the Centers for Disea se Control (CDC) next door, Emory was a natural location for a public health program.
Their arguments found a receptive audience, and the dean agreed with the proposal, with one caveat: the venture was to be firmly grounded in the medical school. "He wanted to make sure the program was not a separate effort, not a separate school," Sell ers, now a professor emeritus, says these many years later.
Marine, who at the time was visiting Sellers from Colorado, chimed in: "None of us were thinking about a school then."
Marine, a graduate of Emory College and Emory School of Medicine, first met Sellers at Grady Memorial Hospital when he was a senior medical student. He completed two years of an internal medicine residency at New York Hospital at the same time Sellers was there working on a fellowship in infectious diseases. The two hooked up again when Marine finished his training and returned to Emory, where Sellers had become the head of preventive medicine in the School of Medicine. In Sellers, Marine found a willing sponsor for his idea for a public health program.
The idea also found resonance in the Atlanta community. David Sencer, who was then director of the CDC, took an active interest in the program's development. At Georgia State University, the director and faculty of the Institute of Health Administratio n signed on to help develop the new program. Even in its infancy, the program sprouted an informal interdisciplinary group composed of members from throughout Emory, as well as others from public and private, federal, and state organizations involved in c ommunity health.
By June of 1974, this group attained landmark status - and a long title - when the medical school formally recognized it as the Interdisciplinary Group in Community Health and Health Care Delivery. It included members from Emory's business school, the CDC, Georgia State, and the Georgia Department of Human Resources, among others. The group elected Marine as its chair, and five members of an executive committee: Sencer; Sellers; George Wren of Georgia State; Abbott Ferriss, chair o f sociology and anthropology at Emory; and George Johnson, from Emory's business school.
The planning group came up with this objective: "In simplest terms, the objective of this proposed program is to educate individuals to perform successfully as problem solvers in community health and health care delivery. Building upon a foundation of progressional training and experiences, the curriculum will prepare the individual to provide effective leadership within the health system and the community by applying specialized technical (health professional), managerial, and human relations skills."
Marine's idea had taken off. It now had an objective and an administrative body. It had a clear focus on community health. It had a team of supporters drawn from Emory and public health enterprises in the city and state. On September 19, 1974, the Mast ers of Community Health (MCH) degree received the official endorsement of Emory's Board of Trustees.
Now all Marine needed was a curriculum, faculty, meeting spaces, and students. "I needed some help," he says.
Students and faculty from
an early MCH class
elp was what Marine got when he recruited Constance Conrad and Kathy Rufo to the burgeoning MCH program in the fall of 1974. Conrad was an assistant professor in the medical school's departments of preventive medicine and community health and gynecology and obstetrics. Rufo, a newly graduated educational specialist at the CDC, came to the program at the request of Sencer.
Recently, Conrad and Rufo met to discuss old times in Rufo's CDC office where she is now a deputy director. Conrad brought with her a treasure trove of papers from those early days, including lists of the first students, descriptions of courses, progra m summaries, and photographs. Rufo filled in with memories. As the two talked, sometimes finishing each other's sentences, it was apparent they had spent many hours working closely together.
"In designing this program, Emory wasn't going to reinvent the wheel," says Rufo. "There were so many resources already."
"We were resource rich and budget poor," says Conrad.
In developing the MCH, Marine's interdisciplinary team made a conscious decision to ground the program in community-based models. "We wanted it to be practical as opposed to theoretical," says Rufo. "Schools of public health at that time were criticize d for being too academic, for graduating students who didn't have the skills to cope with the real world. Today, too, there is a renewed emphasis on community health, but we were already voicing this approach 25 years ago."
"It was a lonely voice at times," Conrad says.
Conrad and Rufo worked side by side with Marine in the Steiner building at the Grady hospital campus. In the first nine months, they helped establish a curriculum, create administrative policies, find faculty to teach core courses and an interdisciplin ary seminar, develop application forms, prepare publicity materials, locate space for offices and classrooms, and recruit students. "It was like raising a child," Conrad says.
The program targeted early- to mid-career health professionals rather than graduates straight from college. "We believed that we could have a greater impact on solving health problems by furthering the knowledge of those already experienced in the fiel d," Rufo says. They worked on other guiding principles as well: that health care delivery requires an interdisciplinary approach and that they should build on existing resources. By June 1975, the first 16 students were starting their classes. "I think th ose early graduates deserve a lot of credit for the success of this program," Conrad says. "This was a new degree with a new focus. They took a chance on us."
"They kept us on our toes," Rufo says. "In today's terminology, we'd call what we developed a partnership -- a partnership of students and faculty."
August 30, 1976
ancy Thompson, a long-time faculty member at the Rollins School of Public Health (RSPH), was a member of that first class of 16 students. Her motive for joining the class is representative of the early gradu ates' mindset. "In those days, in our group, what you chose to do with your life was considered a very serious question," Thompson says. "There was a heightened social consciousness. As far as careers went, for instance, banking was a No. Business was a N o. Outward Bound was a Yes. Public health was a Yes."
Thompson took only one course her first summer because she had a full-time job at the CDC. Other students stayed for the entire summer, sitting from 9 to 4 in borrowed space at the law school, taking all three core courses: public policy and health res ource allocation, measurement sciences, and management and human relations.
The administrators offered the courses in the summer to allow for the enrollment of working professionals. In the fall, students took electives at participating universities throughout Atlanta. An interdisciplinary weekly seminar gave some cohesion to the program as its students scattered throughout the city to earn the required elective credits.
"Essentially you designed your own program," Thompson says. "I chose math and survey sampling courses and marketing." Thompson was enacting one of the program's undergirding philosophies, that practicing professionals knowing the gaps in their own educ ation as well as their own personal employment objectives were the ones best suited to tailor individualized programs. After they completed the three core courses and the interdisciplinary seminar, students chose electives that met their needs.
Sencer and Roland "Knob" Knobel of Georgia State were the first teachers of the health policy and resource allocation core. "We wanted a course that was not pedantic, one with lots of outside speakers," Knobel says. Sencer, as a former director of CDC, had many national connections, and other faculty remember the "parade of stars" that came to lecture at his request. Sencer himself, who had lost his job as CDC director over the handling of the 1976 swine flu epidemic, "used swine flu as a case study in health policy, right up to his losing his job," Rufo remembers.
Marine, who had accepted an offer to chair a preventive medicine department in Colorado, stayed on through the summer to teach the first measurement sciences course. After his departure Conrad became the course coordinator. By 1978, John Boring, curren t chair of epidemiology at the RSPH, inherited measurement sciences.
Richard Levinson was an early faculty recruit from Emory's Department of Sociology, teaching a course on human relations. Fred Kennedy came from the Atlanta Regional Commission to lecture on health planning and soon found himself teaching the introduct ion to health care management. Both are still with the school, now in senior administrative roles.
"Summer was a very intense time for us," remembers Kennedy. "We were either in class or preparing for class. The students spent the entire summer indoors, going through three weeks in Knob's class, where they got a lot of reading and speakers. Then the y had to shift from the qualitative to the quantitative for another three weeks. Then Dick Levinson and I got them for the final three weeks. There developed among the faculty and students a tremendous sense of camaraderie.
"Bonded?" Kennedy asks rhetorically. "Yes, we were bonded."
1518 Clifton Road
uch of that bonding took place in a small residence located at 1518 Clifton Road. The white, blue-shuttered house that served as faculty and program offices starting in the summer of 1975 is long gone. Today at the same address stands the Grace Crum Rollins Public Health Building, which gave the school its first permanent home. However, for those who worked in that first temporal school home for public health, the memories are strong.
"We had large roaches in that building," Kennedy says. "It was a major public health problem."
Levinson's office was a former sun porch, and on brisk days, he felt he was working in a wind tunnel. In the winter, ice sometimes formed on the inside of the windows.
With Conrad, Rufo, administrative assistant Sandy Kerr, secretaries Olive Mitchell and Norma Barnidge, plus a growing faculty pool all needing space, the program eventually outgrew the two-bedroom house. In the early 1980s, it expanded to fill two smal l houses nearby on Gatewood Road, one a former dentist's office and the other the old credit union. Kennedy's office in the credit union came with a large hole in the floor. "When something was really bad, I put it down the hole," he jokes. The other Gate wood house, all brick, was "posh" by contrast, says Levinson. The attic even offered a space for an unorthodox faculty conference room.
Behind the brick building, the university erected a trailer for additional faculty. "It had no plumbing," Levinson explains, "so we put the international health folks back there. We figured with their field experience, they could handle it."
With Marine's departure, Conrad took over first as acting director and then as director of the community health program in 1976. In addition to brokering space for faculty offices and classrooms, she was busy writing grants, overseeing day-to-day detai ls, and arranging teachers -- all on a part-time basis. Much of the teaching was voluntary, and she estimates that in the first two years of the program, approximately $20,000 of teaching time representing more than 140 sessions was donated by faculty.
Her grant writing was less successful. Whereas she had a long track record of garnering grants in family planning in medicine, only a single grant for community health was approved. Conrad's leadership, too, faced an uphill climb after the retirement o f Dean Richardson. He had blessed the program and given part of the initial seed money. After Richardson left, whether the program would continue to be funded by the medical school became a yearly question, says Kennedy. "There was a tightening of budgets , and we were under tremendous pressure."
Conrad was proud of what she'd helped build -- a solid foundation with strong community ties, a program that had been accredited in 1981 by the Council on Education for Public Health, special studies classes and a practicum that still exists in a simil ar form to this day. Yet, with the school running a deficit and with minimal support from the medical school dean, Conrad thought it was close to going under.
Her instincts were right. The program was in trouble, and it wouldn't be the last trouble it would face in growing to a school. However, the seeds had been planted in good ground, watered and fertilized well for a time, and they continued to grow despi te the change in climate.
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