Ah-Ha! Moments

Ah-Ha! Moments

Reflections on the revelations behind the work of public health.

One of my first “ah-ha” moments was when I was about eight years old, and I was sitting on the living room couch while my mother read a story to my sister and me. I was looking at my mother’s hands holding the book, turning the pages, when I noticed that their shape was familiar to me—where had I seen those hands before? I looked down at my own hands and realized that my hands had the same shape, my fingers had the same tilts and proportions, and that everything seemed exactly the same as my mother’s hands. I made her stop reading so that I could compare our hands more closely, and then being the hypothesis-tester I was even back then, I started looking at my sister’s hands (which were not at all like mine or my mother’s). I then went on to check the hands of my other family members. But it was in that moment that I realized the connections between people, connections created by genes passing from parent to child. I didn’t know scientific details, but I did know how amazing it felt to have my mother’s hands lliving through my hands.

For me, genetics is very personal, connecting me to my family, distant ancestors, and well, frankly, all people on the planet—we all share these remarkable bits of humanness. I use this moment almost daily as a touchstone to keep me grounded in what genetics is really all about.

Sharon Kardia
Associate Professor, Department of Epidemiology; Director, Public Health Genetics Program

This past summer, I went shopping for my new stepdaughter for the first time, to purchase the dress she would wear as my junior bridesmaid, and I thought, this is really real. This beautiful nine-year-old, for whom I am responsible, can’t fend for herself, but she’s mine now, and I hope that all the things I’ve ever done can contribute to her happiness.

I’ve known what it is to be responsible for people on a large scale. I was the first person in the White House Situation Room on 9/11, trying to figure out what in the heck had happened in New York and getting ready for what eventually became two more aircrafts that crashed into two more places. In that split second, you say, how did I miss that? You always question yourself. Could I have done more? Could I have worked another half-hour last evening and seen the writing on the wall? Could I have done something personally to have prevented that? Not a day goes by that I don’t question what I could have done to avoid that ever having taken place.

Very few people knew that there were people like us out there, trying to stop bad guys from doing bad things, which is exactly the way I liked it. I was there so that the public, who knew there was a national security team taking care of them, could go about their business without worrying about their safety or security.

Now all of a sudden, six years later, here I am up front and center, and this little person relies on me to keep her safe in a different way. And I think, wow, I wish I could do more so that she’ll never endure what we had to endure, so she’ll never have to be aware of those real kinds of horrors. It brings everything from this macro, do-whatever-you-can-to-keep-people-free-and-safe-and-secure, down to this micro, I'm-responsible-for-this-human-being, level. I’ve been pretty much responsible for myself alone, and all of a sudden now I am responsible for another human being, for her care and feeding and love, and I like it. It’s a different kind of feeling.

Lisa Gordon-Hagerty
M.P.H. ’86; President, LEG Inc.; Former Director, National Security Council Staff, Office of Combating Terrorism, The White House (1998–2003)

By the time I was a college senior, I was bored with physics and chemical engineering, and intrigued by organizations. So I thought I would join a chemical company and rise in management. As luck would have it, my first summer job offer was from a large soap company, and in June I started making soap.

What I learned was that conformity was highly prized, appearance was more important than substance, and managers always stayed till 5:05. (It was considered unseemly to be out the door with your subordinates, who departed much faster than zebras fleeing lions.) Midway through the summer, an older rank-and-filer sat next to me at the lunchtime softball game.

“Son,” he said, “I’ve been watching you. You need to know something about [he used the company nickname]. There’s only one reason why we work here.”

“What’s that?” I said, the perfect nerdy straight man.

“The paycheck,” he said, and walked away.

I thought about that all the way home that night. By the next morning, I’d concluded that no matter what happened, it would be something with more rewards than a paycheck.

John Griffith
Andrew Patullo Collegiate Professor, Department of Health Management and Policy; Director, Griffith Leadership Center

My magic moment came sometime during the morning of March 10, 1953: suddenly and finally I managed to stop smoking. Up to that day and moment, all through World War II and also, I’m still ashamed to say, as a medical student, life had been sustained through endless periods of ennui by a delightful succession of tobaccos. Not even the airdrop of those dreadful, wartime cigarettes called Victory Vs, all the way from Calcutta by the Fourteenth Army DC3 supply aircraft, to an obscure jungle clearing near the Chindwin River in Burma, caused more than a brief hiatus until supplies of real cigarettes got through!

Back again to March 10, 1953. Already there was incontrovertible, epidemiological evidence that smoking caused lung cancer. As well as science being on my side, I had the added economic motivation at that time of having to pay for gas to put in the tank of my newly purchased Ford Popular motor car.

To offset threatened physical and mental equilibrium during that long-ago March and April, I bought a 14-foot length of eight-inch-wide mahogany. When temptation to smoke threatened, I cut and carved and drilled and pinned that length of wood into a two-tier book and telephone stand with sliding plate-glass doors. Down the years a slight wobble did not diminish my affection for that fine piece of furniture in any way. Then, suddenly and mysteriously, it disappeared in a house removal.
So far, 50-odd years’ commitment to campaigning for anti-smoking has quite precluded any need for a replacement.

Victor Hawthorne
Professor Emeritus, Department of Epidemiology

In 1984, I was working as a program evaluator for the juvenile court in Minneapolis, but not quite sure what I wanted to do in my professional life. Sadly, my 55-year-old father, who had never smoked, had just been diagnosed with fatal lung cancer. This led me to read about other risk factors for lung cancer, which introduced me to the field of epidemiology.

As I sat in my father’s hospital room reading a recent issue of Science magazine, I learned that a group of social scientists at CDC had identified the behavioral risk factors associated with a new, deadly illness that was plaguing gay men and other groups. I said out loud to my father, “This is what I want to do!”

I knew immediately that I wanted to do research on the demographic, social, and behavioral factors that lead to different patterns of disease in population groups. What I wanted was a career in social epidemiology, although that term had not quite entered the public health lexicon.

Within a year, I was back in graduate school, working towards a Ph.D. in social demography and a master’s degree in epidemiology. Now, over 20 years later, I am still passionate about researching why patterns of health, illness, and mortality vary so much across social, economic, gender, and ethnic groups, and what public policy can do to address these health disparities.

Paula Lantz
Professor and Chair, Department of Health Management and Policy

After months of planning and fundraising, my friend and I arrived in Tanzania during spring break of my senior year in college to build an orphanage in the Olevolos village. We went in with a plan and an agenda for each day, but we got frustrated early, as the concept of time, wireless-money transfer, and appointments are not familiar or common practices in the village. Our hearts were getting restless, and we decided to spend a whole day with the children—pushing off any business plans for the next afternoon. We were greeted by 96 smiling orphans that morning, who ran up to us as we arrived.

There are so many things that don’t make sense to me in Tanzania. I don’t understand how children who are living in poverty, who have nothing but the sandals that are three sizes too small on their feet, a T-shirt full of holes, and the three pieces of candy that they will try to sell on the street later that night for money, smile all day long. It doesn’t make sense how two siblings whose parents have both died from AIDS, who don’t have a place to go home to at night, have the strength to hold each other’s hands and walk down the dirt road after school is over for the day. It blows my mind to watch 96 children who haven’t eaten for over 24 hours be so patient as to help the youngest children get their meal for the day before they get their own.

I have often wondered in this process how I can do more, in what way can I give something else up to give these children what any child deserves. But on that hot afternoon I realized that my love was the best thing I could give. We have so much to learn from one another to help make each part of this world a little better, but the first lesson Tanzanian children taught me is that love is the common lesson, and once we share in that, we can build from it.

Lindsey Cottrell
MHSA Candidate ’09; Assistant Director, The Olevolos Project

Sixteen years ago our daughter Julia, nine months old at the time, was in the hospital desperately clinging to life. Born healthy, she’d gotten ill when a chickenpox virus attacked and ruined her original heart. Her only hope was a heart transplant, but at the time, very few transplants had been performed on children.

The conversations each night at our family’s dinner table were not normal: “What’s the likelihood she’ll get a new heart?” “What will her life be like if she gets a new heart?” “Will she need another transplant some day?” “How will this affect our family? Our older daughter? Our marriage? Our finances?” We had a $1 million cap on our health insurance and were told this would run out by the time Julia was 12 years old. A friend asked the unthinkable question: “Would it be best for Julia and the rest of the family to just let her die?”

Late at night in the Medical School’s library, my father and I reviewed on a laser-disk reader dozens of research studies related to heart transplants. We pored over the very few pediatric studies and extrapolated knowledge from the adult studies. I could determine the studies that were most relevant to Julia from those that weren’t. Next morning I would bring a stack of information and new questions to Julia’s cardiologist. The information helped us determine a course of action for our daughter.

That night in the library, my father said, “You know, Vic, you’re pretty lucky.”

I responded thinking I must have misheard him. “Why am I lucky, Dad?”

“Because bad things happen to everyone, and almost no one in the world is able to do what you’re doing—to get all the information available to make a rational, informed decision.” Then he added, “Don’t you do this for a living?”

It struck me at that moment that information technology should allow anyone to make informed decisions about their health and wellness. Since then, my career has been devoted to building and disseminating accessible, interactive health programming to the public.

Thanks, Dad. By the way, our daughter Julia is now a junior at Ann Arbor’s Community High School.

Vic Strecher
Professor, Department of Health Behavior and Health Education; Director, Center for Health Communications Research; Director, Cancer Prevention and Control; Chairman and founder of HealthMedia, Inc.

I have moved offices several times since I started working at SPH, and with each move, a poster titled “Pathways to a Healthy Life” has traveled with me. The poster depicts three generations of Native American women. At first glance, the poster suggests that healthy mothers produce healthy children. Recently, I have begun to interpret the poster in another manner.

As my grandmother, Nana, ages, she has become more of a storyteller, sharing stories from her youth that neither my mother nor I have heard. While listening to the stories, I began to wonder, why is she revealing her history now? The stories that Nana tells are the harsh, brutal stories of African-American women growing up in the Deep South from 1920 to 1950, and then the struggle of integration in Detroit in the 1960s and 1970s. I finally realized that she can tell these stories now because she no longer needs to protect us from them. She did not tell these stories before because of the potential impact they could have on who we became. She wanted us to be free of some of the burdens and misery she faced. In turn, she helped to create a pathway to a healthy life—mine.

Dana Thomas
MPH ’05; Internship Coordinator, UM SPH Office of Public Health Practice

As a geneticist, the “ah-ha” moment I keep having over and over is the realization that we are all related to each other. In my work, this means that our DNA, although unique, is really a mosaic of the DNA of our relatives. If we compare our DNA sequence to that of our close relatives—say parents, siblings, or even cousins—the mosaic pieces are rather large. If we compare our DNA sequence to much more distant relatives—like the proverbial man on the street—the pieces are much smaller.

When I started in genetics, we had very incomplete measurements that could only pick up the larger mosaic pieces, so we were limited to studying rare families with many affected individuals. Although we can’t yet measure the full sequence of every individual we study, we can now measure each individual in enough detail to identify critical pieces that are associated with disease.

In a recent study, we searched the entire genome to identify a small piece of chromosome 17 that increases the risk of asthma in children by about 60 percent. At first, it wasn’t obvious how it did this, since this particular DNA piece didn’t seem to affect any of the proteins commonly involved in immune and allergic responses. Eventually, we were able to show that it regulates expression of the gene ORMDL3, and our results were reported in the July issue of Nature.

We are now trying to figure out what ORMDL3 does—and that will probably be my next “ah-ha” moment!

Goncalo Abecasis
Associate Professor, Department of Biostatistics

Send correspondence about this or any Findings article to the editor at sph.findings@umich.edu. You will be contacted if your letter is considered for publication.

 Web Exclusive Ah-Ha Moments!

As a public health student at Michigan, I signed up for a course in injury control. The instructor, Pat Waller, then director of the UM Transportation Research Institute, introduced us to the idea that “accidents” were not random events, as the name implies, but predictable occurrences. Furthermore, many injuries could be prevented or minimized by simple alterations to the physical or social environment. Professor Waller showed us how these principles had been applied to motor vehicles, with the result that deaths from car crashes had consistently diminished, even as the number of cars and miles driven had increased.
Even more exciting for me was the fact that these same principles could be applied to intentional injuries such as violence—a very new idea at the time. My experience managing a child-abuse and neglect-prevention program had led me to public health, and this course illuminated the connections between the science of injury control and my commitment to violence prevention.
Today at SPH, we are applying injury-control theory in the Youth Empowerment Solutions project in Flint. The project connects middle-school students with neighborhood organizations to create community change. The youth and adults are transforming neglected properties into community assets, replacing dangerous environments with settings for social interaction and recreation. We are studying whether these environmental improvements will lead to changes in residents’ perceptions of neighborhood safety and to reductions in violence.

Susan Morrel-Samuels
MPH ’93; Managing Director, Prevention Research Center of Michigan, UM SPH

When I graduated from college, my education in the Spanish language stopped. I had taken Spanish courses while in high school and college, but I had convinced myself that because I was fluent in English and Thai, becoming fluent in a third language would be too difficult and unnecessary.
My view quickly changed when I visited my friend Christian in his hometown of Cologne, Germany. While showing me around, he introduced me to his friends that he’d met while studying abroad in Spain. In an effort to include me in the group conversations, Christian would translate their Spanish conversation into English for me. I was touched by his effort to include me and amazed at his ability to move quickly between two languages, especially when neither of them was German, his native tongue.
The experience reminded me that learning a language is more than simply acquiring a new skill—it is also a way of showing respect to those with different cultures or backgrounds. My trip to Germany surprisingly renewed my interest in learning Spanish, and I plan on pursuing it after graduation.

Pat Vijitakula
M.P.H. Candidate ’07; Co-Chair, SPH Public Health Student Association, 2006–2007

As a postdoc in the Department of Social Medicine at Harvard Medical School in the early nineties, I was interested in studying violence, so I got permission to observe the emergency room activity at Boston City Hospital. One of my hypotheses was that the underlying attitude of the people taking care of patients in the ER would be, “Oh, these were the perpetrators,” even though by definition when you come into an emergency room you’re a victim.
The hypothesis was true, but in ways that I didn’t imagine. It turns out that even though they were victims, sometimes as many as half of the ones that came in did perpetrate the event that they got injured in, because most of these situations were in revenge for one of their homies that had gotten injured or killed. I realized that many of these boys were actually working themselves through something self-destructive. I talked to this one kid, and he realized he could have died, and he articulated that he wanted to die, because they’d killed his best friend, they’d killed his bro.
For me, the big “ah-ha” moment, the one I wanted to follow up on research-wise, was, oh my goodness, there’s all of this grief, all of this depression, and that’s what drove them to do this event. But they would come into the emergency room, and nobody would even say, “Hey, how are you doing? … You know, you might have bad dreams about this. … You might not be able to sleep for weeks. … You might have flashbacks.” That part of their humanity wasn’t touched. They got excellent care, excellent surgical care—the emergency room saved lives. The one thing that was absolutely missing was the idea that these young men had a pyschological life.
When I fed that back to some of the community leaders, they realized they really needed to reach out and touch these kids. The black clergy, mainly, reached out to the mostly black and some Hispanic gangs in Boston and worked with them to satisfy some of their needs, and the violence went down.

Don Vereen
Director, Community-Based Public Health, SPH Office of Public Health Practice; Former Deputy Director, Office of National Drug Control Policy, The White House (1998–2001)