Inspired

By Sara Talpos.

For some SPH faculty and graduates, history is alive, well, and very much a factor in what they do today.

National Security

Lisa Gordon-Hagerty on the Radiation Health Program

"In the decades following World War II, SPH played a critical role in strengthening radiation protection across the country. The professional society to which I belong—the Health Physics Society—originated at U-M, where its first full meeting was held in the 1940s. In 1957, the Radiation Health Program was established at SPH to determine how to positively exploit the benefits of radiation and radioactivity while protecting humans and the environment.

Observers are illuminated by an 81-kiloton atomic bomb test at Enewetak Atoll, April 8, 1951.

"My career path led me into the fields of military application/nuclear weapons and counterterrorism. The tie to public health is inextricable. Whether working in national security, homeland security, or defense, you have to think about health care, protecting people, and protecting the environment. Currently, I run a company that focuses on counterterrorism and countering weapons of mass destruction. As a result of my education at U-M, I have a unique technical expertise in understanding the effects of nuclear, chemical, and biological weapons. That expertise affords me the remarkable opportunity to ensure the public health and safety of Americans and our allies against weapons of mass destruction.

"It's really quite amazing to be a Michigan alum and to run into people who also have SPH degrees. There's a string that ties us all together. I think it's because there is an identity to each of the students while they are at Michigan, and there is such an intimacy between the students and the faculty."

Lisa Gordon-Hagerty, BS '83, MPH '86, studied health physics at SPH before making her way to Washington, D.C., where she served from 1998 to 2003 on the White House National Security Council as director for combating terrorism. She is now president and CEO of LEG Inc., a consulting firm specializing in domestic and national security, global energy, crisis management, and related issues.

The U-M Health Physics Program existed as a formal track within SPH from 1957 to 2002. It now resides within the U-M College of Engineering as the Department of Nuclear Engineering and Radiological Sciences.


Equal Partnerships

Cleopatra Caldwell on Community-Based Participatory Research

"When the W.K. Kellogg Foundation first funded the school's community-based participatory research (CBPR) program in 1992, researchers had begun to recognize that some public health interventions were failing, in part, because they lacked input from the communities whom the interventions were meant to help. SPH Professor Barbara Israel, a pioneer in the field, advocated for equal partnerships between researchers and communities. Since then, CBPR has dramatically changed public health—and research more broadly. Now we want to engage the communities and people being impacted by our work, recognizing that they have a lot to contribute to framing the problems and the solutions. Their lives are being impacted.

SPH faculty and staff partner with residents of Flint, Michigan, on a community-improvement project in 2008."I was intrigued by the possibilities of CBPR when I came to SPH in 1996. My colleagues reached out to me, and I eventually became involved in Flint as principal investigator (PI) of the Fathers and Sons Project. Our Flint partners were initially a bit skeptical of the university and its interests. So often people come into their neighborhood, do research, and leave. But ultimately, our partners were willing to learn along with us as we figured out how to do research that would benefit their community.

"The community PI on our very first grant was a Flint resident named Mrs. E. Hill De Loney. Sixteen years later, she is still the community PI. Mrs. De Loney has traveled around the country with the Centers for Disease Control and Prevention to help other places implement CBPR. Recently, she came with me to a community breakfast in Chicago, where we're replicating the Fathers and Sons Project. After all these years, we're still together doing this work—and SPH is recognized as a global leader in the field."

Cleopatra Caldwell is a professor and incoming chair of the SPH Department of Health Behavior and Health Education and principal investigator for the Fathers and Sons Project, which aims to reduce youth substance abuse, violent behavior, and early sexual initiation by strengthening bonds between nonresident African-American fathers and their eight- to 12-year-old sons. Caldwell and her community partners recently received a grant from the National Institutes of Health to replicate the project in Chicago, including a focus on depression and substance use among fathers.

Barbara Israel is a professor of health behavior and health education at SPH, with more than 30 years' experience in community-based participatory research. She directs the Detroit Community-Academic Urban Research Center.


Research Study Design

Gonçalo Abecasis on Felix E. Moore

"My professorship is named after former SPH Professor Felix E. Moore, who helped design the famous Framingham Heart Study. Since 1948, the study has followed residents of Framingham, Massachusetts, tracking their health in order to identify risk factors for cardiovascular disease. Over the years, the study has grown to include children and even grandchildren of that original cohort.

"In 1961, the Framingham Heart Study helped establish the link between blood cholesterol levels and heart attack risk. This discovery led to the development of statins, which lower cholesterol levels and reduce the frequency of heart attacks. The study has also become a treasure trove for the field of genetics—in fact, I've worked on it.

Participants in the Framingham Heart Study, 1952.Using the DNA of Framingham study participants, we can explore the genetic causes of familial risk for heart disease. Specifically, my research group and I have been working to identify genes that modify cholesterol levels and then checking to see if these genes affect the risk of heart disease. Thanks to the study, we've identified a couple of dozen different genes. Each one of them is a potential target for medicine in the future.

"By observing people in detail over a long period of time, the Framingham Study established an effective model for identifying health outcomes and risk factors. We've adapted this model for a number of our own studies, including one in Sardinia, where we've enrolled 60 percent of the adult population in four neighboring villages. Every three years, we measure participants' health in terms of bone density, immune function, etc., and combine that with genetic information to learn about the causes of disease and the causes of variation among people."

Gonçalo Abecasis is the Felix E. Moore Collegiate Professor of Biostatistics and chair of the SPH Department of Biostatistics. His research team in the U-M Center for Statistical Genetics develops statistical tools to analyze the genetics of human disease.

Felix E. Moore (1912-1993) was an SPH faculty member from 1957 to 1979, during which time he devoted 14 years to chairing the Department of Biostatistics. In addition to his work with the Framingham Heart Study, Moore played a key role in designing U-M's pioneering Tecumseh Community Health Study.


The Classroom

Kenneth Warner on SPH Students

"I'm inspired by our graduates and what they've accomplished. Jonas Salk is the most obvious example. As a postdoctoral fellow, Salk studied virology at SPH with Thomas Francis Jr. He then went on to create the polio vaccine, which has saved over a million lives and prevented countless debilitating illnesses.

SPH students in class"Sometimes when I'm in a classroom I wonder what this current crop of students is going to contribute to their world. The students undoubtedly have similar questions as well, although their attention likely focuses on more prosaic matters such as, "Where am I going to find a job?" One of the more effective things I did as a teacher occurred years ago in a departmental course with all of the first-year master's students. Each week or two, I'd bring in a highly accomplished alum who had sat in those same seats 20 years earlier. Transfixed, the students would listen to each alum describe his or her professional career. You could almost see the students' brains churning with excitement at the idea that they might be looking at themselves a couple of decades hence. The experience enhanced their sense of purpose and their optimism concerning where this otherwise sometimes abstract education might take them.

"It's been fun watching our alums' careers flourish. I had the privilege of teaching Larry Brilliant and Marianne Udow, among others, and frequently crossing paths with Julio Frenk. Each has become a close friend, in addition to being a highly valued colleague. They—and all of our graduates—are part of our history and a defining variable of who we are today."

A member of the SPH faculty since 1972, Kenneth E. Warner is the Avedis Donabedian Distinguished University Professor of Public Health and a professor in the Department of Health Management and Policy. He served as dean of the school from 2005 to 2010. In this Findings Web Extra, watch Warner's keynote address from the SPH 75th Anniversary Symposium.

Larry Brilliant, MD, MPH '77, participated in the World Health Organization smallpox eradication program. In 1978, he co-founded the Seva Foundation, whose programs and grantees have returned sight to more than 3.5 million people worldwide. Brilliant is a past director of Google's philanthropic arm, Google.org, and the current chair of the Skoll Global Threats Fund.

As Minister of Health of Mexico, Julio Frenk, MD, MPH '81, PhD '83, launched the country's first comprehensive universal health insurance. Now president of the University of Miami, he founded the National Institute of Public Health of Mexico in 1987. Subsequently he served as second-in-command of WHO and, later, as dean of the Harvard T.H. Chan School of Public Health.

Marianne Udow-Phillips, MHSA '78, directs the Center for Healthcare Research & Transformation, a nonprofit partnership between U-M and Blue Cross Blue Shield of Michigan. She is a past director of the Michigan Department of Human Services and former senior vice president of Blue Cross Blue Shield of Michigan.


Health Care Administration

Gail Warden on Walter McNerney

"When I was applying to graduate schools in hospital administration, Walter McNerney told me if I didn't come to Michigan I'd be making a big mistake. He was right—and he continued to be right as he mentored me throughout my career.

"McNerney was unique in his ability to influence the field of health care administration. He was a teacher and an accomplished executive, one of the first with experience running health care organizations and an insurance company, Blue Cross Blue Shield. McNerney influenced young people entering the field, physicians, health care executives, even government officials who wanted to know what he thought about the changes taking place in health care.

Walter McNerney, far right, vice-chair of the President’s Committee on Health Education, with President Nixon and committee chair R. Heath Larry in 1973."Throughout my early career, McNerney helped steer me toward key jobs. He helped me understand that the country was moving toward pre-paid health care—what would become HMOs. McNerney always told me to consider where the future was going to be in health care. It's like when you're playing hockey: you skate to where the puck is headed.

"McNerney believed that pre-paid health care could reduce medical costs and encourage insurance companies to take responsibility for a given population. His efforts stimulated some of the early attempts at capitation, where experts identify what it will cost to provide care to a given population. These plans incentivize preventive health care.

"He was an amazing person. I was lucky to have him as a mentor. Because of that relationship, I learned how important it is to mentor others."

Gail Warden, MHA '62, is a professor of health management and policy at SPH and president-emeritus of the Detroit-based Henry Ford Health System, where he served as president and CEO from 1988 to 2003. A chairman emeritus of the National Quality Forum, the National Committee for Quality Assurance, and the National Center for Healthcare Leadership, and a past chair of the American Hospital Association, Warden helps direct the Gail L. Warden Leadership Fellowship at U-M.

Walter McNerney (1925-2005) founded U-M's Program in Hospital Administration in 1955. Its curriculum remains the core of Michigan's graduate degree program in health management and policy, which U.S. News & World Report has ranked #1 in the nation every year since 1993. McNerney left U-M in 1961 to become president of the Blue Cross Association. He helped create the Medicare and Medicaid programs in the 1960s and oversaw the merger of Blue Cross and Blue Shield in the late 1970s.


Health Care Disparities

Bill Manns on "Doc" Lichtenstein

"I had the privilege of meeting Rich Lichtenstein, or Doc, as I call him, when I applied to the inaugural class of the U-M Summer Enrichment Program (SEP) in 1986, when I was 21 years old. He was fascinating. I thought, here's this white guy from New York, accent and all, who is taking an interest in health care disparities. As a young African-American man, I remember wondering, why does he care? Doc had compassion and integrity. He wanted to do the right thing for the sake of doing the right thing.

Rich Lichtenstein works with a student"Through SEP, I worked at Henry Ford Hospital in inner-city Detroit and saw firsthand the disparities that Doc talked about in lectures. As a person of color, you see and experience things that you probably wouldn't otherwise, and so you're sensitized to certain aspects of the health care system, especially as they relate to the care that you or a loved one might receive. With that perspective, there's almost an obligation to change the system—be it through trying to eliminate bias in hiring practices, or through the actual delivery of health care, where you try to ensure that the policies you implement are fair and just, regardless of color.

"The quote that I use to describe Doc comes from the late U-M Professor Avedis Donabedian, who reminded us that "systems awareness and systems design are important for health professionals, but they are not enough. It is the ethical dimensions of individuals that are essential to a system's success. Ultimately, the secret of quality is love." Doc gave us an opportunity to help shape the health care system by working to end health care disparities. To me, that's an aspect of love, of something coming from the heart that you don't see every day."

Bill Manns, MHSA '91, is president of Mercy Health Saint Mary's in Grand Rapids, Michigan.

Founded in 1986, the U-M Summer Enrichment Program in Health Management and Policy educates future leaders who are committed to eliminating racial, ethnic, and socioeconomic health inequalities. More than 90 percent of its graduates have completed graduate study in public health, medicine, health sciences, and business. Richard Lichtenstein, the S.J. Axelrod Collegiate Professor of Health Management and Policy, retired earlier this year as the program director.

Avedis Donabedian (1919-2000) was the Nathan Sinai Distinguished Professor of Public Health at SPH, where he worked for 28 years until his retirement. He is world-renowned for his work in the area of quality assessment and monitoring of health service.


Health Behaviors

Vic Strecher on Marshall Becker

"Marshall Becker is the only professor who made me fall out of my chair laughing. Buried in his humor, however, was a scorn for the intellectually mediocre, shallow, and lazy. Not afraid to challenge the hype of 1980s-era health promotion, Marshall Becker deftly excoriated "researchers" who pushed a vast array of behavior changes with flimsy evidence.

Marshall Becker at U-M SPH, ca. 1990."Eating Chinese food at his favorite lunch place, Marshall would point the newspaper at me. "First, cholesterol is supposed to be bad for you. But look at this headline: 'Impulsive Homicidal Behavior Can Be Connected with Low Cholesterol Levels.' Does adhering to a low-cholesterol diet make one wish to commit murder? Tell you what, Vic. Next time someone is chasing me down the street with a knife, I'm leading him here for General Tso's Chicken!" While noted for his development of the Health Belief Model, Marshall saw the behavior of individuals within a broader context. And with the advent of the AIDS epidemic in the 1980s, the world needed this perspective. He was asked to join the effort and contributed immensely to our understanding of risk-reduction behaviors of different populations in different environments. In his early fifties, Marshall fell ill to a cancer that swept through his body. Despite this devastating blow, Marshall remained funny, positive, and insightful. And poignant. In an address he gave in 1992, shortly before the end of his life, Marshall said: "The purpose of life is not only to be happy; it is to matter—to be productive, to be dedicated to goals higher than one's own self-indulgence; in other words, to have it make some difference to the world that you have lived at all.

"These words have stared at me in my office for the past 20 years and continue to resonate with me both personally and professionally."

SPH alumnus Vic Strecher, MPH '80, PhD '83, is a professor of health behavior and health education at SPH and director for Innovation and Social Entrepreneurship. He is the founder of Health Media, which pioneered web-based health coaching, and the founder and CEO of JOOL Health, a digital company integrating the science of purpose, advanced mobile technology, and big data analytics to help improve health and overall well-being through sustainable behavior change.

Marshall Becker (1940–1993) was professor of health behavior and health education from 1977 until his death in 1993. He was internationally known for his elaboration of the Health Belief Model and pioneering work on patient compliance with medical regimens.


Data Collection

Sharon Kardia on Victor Hawthorne

"I met Victor Hawthorne when I was a junior faculty member, in 1998. By that time, he was one of the grandfathers of epidemiology. He was quite the storyteller, with his wonderful Scottish accent. He told stories of the real championship efforts that individuals make when they believe in something. He talked about how he had to work his way up the channels. We often forget how important a story is to capture the imagination, to inspire. I miss that.

"One of Victor's biggest contributions was his work helping public health departments conceptualize their role in tracking the major health outcomes in their states. Victor was one of the early advocates for departments of health to start regular surveillance of their populations for the major chronic diseases, as well as infectious diseases.

Health surveillance work in Central America, 2013."Thanks in large part to Victor's work, now when people are concerned that something systematic is making people sick within a community, often there will be data on the disease trends in a given locale. Consider cancer, for example: we can pull the data to see if there really is an excess of cases in a location. It shortens the investigation time considerably between the first signs of community concern and an evidence-based assessment of the community.

"I was really inspired by Victor's relational ethic. He was tremendously kindhearted. I remember a conversation when he was extolling how we should be collecting good data regularly to help people and communities and institutions identify culprits and act quickly. He was always talking about how it was both a privilege and responsibility to be a faculty member, to be working in public health. He was a longstanding member of the Michigan Governor's Advisory Committee, including the years when the state's Public Health Code was being created. He had a deep concern for people and felt that faculty should be standing up for the people who cannot, in order to make sure that their places of work and play are safe for them."

Sharon Kardia is an SPH alumna (PhD '91), senior associate dean for administration, and professor of epidemiology.

Victor Hawthorne (1921-2014) came to U-M in 1978, serving as chair of the Department of Epidemiology until 1986. He was named professor emeritus in 1991, but remained active in research and practice until shortly before his death in 2015.