Professor Kristie Ebi presented at the World Health Organization conference on health and climate in Geneva last week -- a "watershed moment in making health central in international and national actions to avoid, prepare for, and cope with the risks of current and future climate change," Ebi said. This was the first WHO conference on climate change and health and over 400 people attended. Ebi presented on strengthening health resilience to climate change, and working across sectors.
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The Human Animal Medicine Project is now officially the Center for One Health Research (COHR), residing in the Department of Environmental and Occupational Health Sciences in the School of Public Health at the University of Washington in Seattle, WA. The Center for One Health Research investigates the health linkages between humans, animals, and their shared environments; including zoonoses, comparative clinical medicine, animals as sentinels, animal worker health, nutrition and food safety, and the human-animal bond. Through transdisciplinary partnerships, COHR develops innovative strategies for healthy coexistence between humans and animals in sustainable local and global ecosystems. COHR is led by director Peter M. Rabinowitz, MD MPH, who is an Associate Professor in the Department of Global Health. For more info, visit their new website.
The Washington Global Health Alliance announced its Second Annual Pioneers in Global Health Awards, three prestigious awards selected by a panel of judges including last year’s Impact Award Winner, Department Chair Dr. King Holmes. Congratulations to Kenneth Stuart, Pathobiology faculty and founder of Seattle Biomed, for winning the Award for Impact!
From the WGHA website:
The second annual Award for Impact, previously awarded at WGHA's Party for the Health of It, recognizes a creative and inspirational leader dedicated to solving global health inequity with a commitment to building partnerships in Washington State as well as on the global stage. Dr. Ken Stuart is a true pioneer. He founded Seattle Biomedical Research Institute more than 35 years ago in Issaquah. Since that time under his leadership, the institute has grown to more than 300 employees and is a leading global health research institute.
“It has been a stimulating and gratifying experience to be a part of the global health research endeavor. When I came to Seattle, the strong research was centered at the University of Washington and Seattle had somewhat of a localized feel. However, Seattle has become an epicenter of global health research through the work of many and their willingness to cooperate on our common goal of eradicating the massive suffering and death that result from the diseases we are working to eliminate,” said Ken Stuart, PhD, founder of Seattle BioMed.
Each award winner was selected because of their demonstrated desire to nurture and grow Washington’s collaborative global health community. Winners will be honored at WGHA’s annual event, the Pioneers of Global Health Awards Dinner, October 9, 2014 at The Foundry.
For more information on the Washington Global Health Alliance’s Pioneers in Global Health Awards:
Director of Communications
Washington Global Health Alliance
Ukraine has one of the most serious HIV/AIDS epidemics in Eastern Europe and Central Asia and is experiencing one of the fastest-growing HIV epidemics in the world. The first case of HIV was identified in 1987; since that time 245,216 cases have been officially recorded, with 31,999 deaths. As of January 1, 2014, more than 134,000 HIV-positive patients were registered with and receiving care and treatment from the state health care facilities.
I-TECH began working in Ukraine in 2011 at the invitation of the U.S. Centers for Disease Control and Prevention (CDC) and the Ukrainian Ministry of Health. Read more about their work to stem the HIV epidemic in Ukraine.
Last month, a distinguished group from the University of Washington’s International Training and Education Center for Health (I-TECH) and Department of Global Health (DGH) visited Addis Ababa and Gondar, Ethiopia, for several days of discussion, workshops, events, and celebration — including the University of Gondar’s 60th anniversary Diamond Jubilee and the inauguration of the University of Gondar Comprehensive Outpatient Center.
I-TECH has had a presence in Ethiopia since 2003, and in that time, has become a guiding force in antiretroviral therapy service delivery and human resources for health, building the capacity of the Regional Health Bureaus (RHBs), universities, and health facilities; introducing innovative initiatives such as task sharing; activating effective monitoring and evaluation interventions; advocating for and implementing TB prevention programs, including MDR-TB; and building the capacity of health facilities and regional labs. The team acts in close partnership with the RHB offices of the Ministry of Health in Afar, Amhara, and Tigray and will be transitioning most of its programs to the RHBs in September 2014.
In advance of this transition, Dr. King Holmes, Chair of the Department, and Dr. Ann Downer, I-TECH Executive Director, met with staff in Addis Ababa during a July 4 coffee ceremony. The meeting was an opportunity to say farewell to some incredibly valuable members of the I-TECH Ethiopia team who are leaving as projects are transitioned to the RHBs and discuss highlights of more than a decade of outstanding work in Ethiopia. Both Department Chair King Holmes and I-TECH Executive Director Ann Downer visited the sites, including a namesake training hall at the University of Gondar: the King Holmes Continuing Professional Development Center. “What a wonderful and humbling experience,” Dr. Holmes said of the visit. “And what a great way to end the trip.” Read more and check out photos from the trip.
In the fall, Health Equity Circle (HEC) students are working directly with Sound Alliance under the supervision of Dr. Rick Arnold to offer UCONJ 624: Health Equity and Community Organizing in Autumn 2014. This course will equip students from the six health sciences schools to work together to develop community organizing skills focused on upstream action for health equity. Through HEC, students will have the opportunity to participate in a campaign with community members during the 2014-2015 academic year.
Students can email David Fernando directly for course access (firstname.lastname@example.org). We look forward to offering students novel and quality experiences to support health equity.
Health Equity Circle (HEC) is a SoM started interdisciplinary registered student organization. We are committed to student development through interdisciplinary advocacy and community organizing opportunities in the greater Seattle area.
A new Scientific American (SA) article special issue highlights the 12 recommendations of an Institute of Medicine (IOM) report, Promoting Cardiovascular Health in the Developing World: A Critical Challenge to Achieve Global Health, published in 2010. DCP3 series editor and Project Director and Clinical Associate Professor Dr. Rachel Nugent was a member of the committee that prepared the report and expounds on recommendation 9 in the special issue. She urges countries to define resource needs by using the most up-to-date data about in-country capacity.
Nadia Arang (BS, Microbiology, Minor, Global Health 2014) began full-time work at Seattle BioMed just a week after graduating from the UW. She researches how malaria parasites get inside the human liver, where they grow and multiply. "The research has a very clear and direct impact on human life," Arang says. "It's very easy to stay engaged."
Congrats to Jillian Pintye, MPH '14 (Epi, Global Health), who won a prestigious Young Investigator Award at the 20th International AIDS Conference (AIDS 2014) in Melbourne, Australia, July 20-25.
The US$2,000 Young Investigator Award is jointly funded by the International AIDS Society and the French National Agency for Research on AIDS and Viral Hepatitis to support young researchers who demonstrate innovation, originality, rationale and quality in the field of HIV research. One prize is awarded in each of the five conference tracks to the highest scoring abstract of young investigators less than 35 years of age.
Pintye received the award for the track on Epidemiology and Prevention Sciences. Her abstract was titled, "Male circumcision and the incidence of syphilis acquisition among male and female partners of HIV-1 serodiscordant heterosexual African couples: a prospective study." Pintye worked on her abstract with Renee Heffron, assistant professor of global health, Jared Baeten, professor of global health and Lisa Manhart, associate professor of epidemiology. Her research found that male circumcision was associated with decreased incidence of syphilis in women and HIV-infected men.
Pintye is now a PhD student in nursing at the University of Washington and works as a research assistant in the Department of Global Health.
The Department sent another large cohort into the world June 11, 2014 -- our eighth since we formed in 2007. We graduated 32 MPH students, nine pathobiology PhDs, and 18 certificate students. Additionally, 27 doctors were trained through the Global Health Pathway, and three post-graduate fellows and 13 post-bachelor fellows completed their fellowship at the Institute for Health Metrics and Evaluation (IHME). And we had more than 100 global health minor undergraduates. These graduates join a network of over 1,000 alumni who are working in all aspects of global health around the world.
Graduates are going on to exciting new jobs such as biodefense policy for the federal government, post-doctoral fellowships with the National Institutes of Health, improving health workforce development in Sierra Leone, and targeting malaria at Seattle Biomed.
Please join us in congratulating our 2014 graduates, and check out these moments of jubilation as captured by Amanda Koster:
MPH and PhD grads celebrate.
First year MPH student Anthony Natif captures a photo during the program.
PhD graduate Sara Murray is hooded by her mentor Dr. Nick Crispe.
Girl power: PhD in Pathobiology graduates pose with their new hoods.
Prof. Emmanuela Gakidou checks in with daughter Natasha. She is the Director of Education and Training at the Institute for Health Metrics and Evaluation (IHME), and leads the Institute's research activities in the area of evaluations.
Graduates of the Global Health Pathway for medical students show big smiles with Global Health faculty and staff including Department Chair King Holmes, Vice-Chair Judy Wasserheit, faculty members Susan Graham and Scott McClelland, and staff Jennifer Lucero-Earle.
“Real education should consist of drawing the goodness and the best out of our own students. What better books can there be than the book of humanity?” –Cesar Chavez
In May 2014, the Department of Global Health awarded fellowships to 19 outstanding students and medical residents. With support from one of these five programs they will travel to 10 countries to work on wide variety of projects addressing issues such as childhood cancer, TB, and mental health. The 2014-2015 fellowship recipients are listed below.
Pulitzer International Reporting Fellowship | Stergachis Endowed Fellowship for International Exchange | George Povey Social Justice and Activism | Thomas Francis Jr. Global Health Fellowship |
Global Opportunties (GO) Health Fellowship
For more information on the fellowships, visit the Global Health Resource Center's Funding and Fieldwork page.
Paul Nevin, MPHc – Global Health, School of Public Health
Paul’s diverse experience ranges from researching urogenital schistosomiasis in rural Ghana to leading multiday vacations for adults with developmental disabilities. He has also worked in project management for various nongovernmental organizations in Ethiopia, Ecuador, and Costa Rica. Paul is interested in social, cultural, and environmental determinants of health and looks forward to exploring the underlying structural causes of health inequity in Kenya in partnership with a Communications Department student.
Suzanne McGoldrick, MD, MPHc – Global Health, School of Public Health
While born in Ireland, the majority of Suzanne's childhood was spent in Germany, where she completed her Medical School training at the Albert Ludwig University, Freiburg. Her interest in Pediatric Cancers led her to do her pediatric residency at Duke University in North Carolina and her Pediatric Oncology Fellowship at the University of Washington and Seattle Children’s Hospital. With the generous Stergachis Fellowship award she plans to travel to Kampala, Uganda, and spend a months learning more about the problems faced by pathologist and clinicians involved in the care of children with cancer. Specifically my project will focus on the diagnostic issues surrounding Burkitt Lymphoma, the most common childhood cancer in many countries in Africa.
Jessica Dyer, MPHc – Global Health, School of Public Health
Spending time in the field is important to Jessica and over the past seven years, her work has taken her to Uganda (2007-2009) where I served as a community health and education volunteer in the United States Peace Corps. She has also worked extensively in Sierra Leone and Vietnam, where she worked in collaboration with public sector health systems to design and implement nationwide public health interventions preventing disability. With this award, she will be working with women in Timor-Leste to conduct qualitative research exploring and understanding their experiences using Liga Inan. Liga Inan is a mobile health (mHealth) technology providing pregnant women with regular text messages to promote healthy behaviors during their pregnancy, delivery, and postpartum periods, and is the first of its kind in Timor-Leste.
Adrian Hughes, PharmDc – School of Pharmacy
After starting her career in HIV vaccine research, Adrian pursued pharmacy as a unique opportunity to merge her love of biochemistry and molecular biology with direct patient care. A traveler since her first passport landed in her hands, she attended an exploration seminar in India through the School of Nursing and found herself at home, overwhelmed by a passion for global health. Her project seeks to determine the feasibility of establishing a pregnancy-exposure registry for women on anti-retroviral therapy in Namibia, a critical way to gather data on the safety of these important and effective medications in a vulnerable population. She seeks to develop her skills in qualitative research through this fellowship, with the ultimate goal of working globally to promote the unique skills contained in the profession of pharmacy to improve the safe and effective use of medications worldwide.
Stephanie Kovacs, MPH, PhDc – Epidemiology, School of Public Health
Stephanie worked for two years as a research fellow with the Centers for Disease Control and Prevention in Tanzania focusing primarily on prevention of mother to child transmission of HIV and maternal and child health. Her research interests focus on infectious disease and phamacovigillance surveillance specifically in low and middle income countries. Her dissertation combines these interests to study the safety of antimalarial drugs in pregnancy. Stephanie will be traveling to Liverpool, United Kingdom to collaborate with the Liverpool School of Tropical Medicine and the Malaria in Pregnancy Consortium (MiPc). During her stay in Liverpool, she will be working intensely with the data management team of the MiPc to combine data from eight randomized clinical trials and a multi-site cohort study in order to assess the safety of antimalarial drugs.
Diana Marangu, MPHc – Global Health, School of Public Health
Diana is a pediatrician and tutorial fellow in the Department of Pediatrics and Child Health at the University of Nairobi. Her passion lies in preventive respiratory health, an area in which she hopes to be a global leader in the future. The fellowship will facilitate her proposed research on exploring the barriers, facilitators and potential solutions to TB contact investigation in Nairobi County in Kenya. The findings in this formative research will inform the development of implementation tools used to optimize TB contact investigation in this context and in areas with similar opportunities and challenges.
Manuela Raunig-Berhó, MPHc – Global Health, School of Public Health
Manuela earned her Bachelor’s degree in Psychology and prior to coming to UW worked as a Behavioral Health Care Coordinator with Sea Mar Community Health Center. The research project funded by the Thomas Francis, Jr. Fellowship will provide her with experience in conducting a baseline assessment regarding mental health needs, and will further provide experience in key research methodologies needed to study the ways in which sociocultural contexts impact perceptions of mental health care. This work will be valuable in relation to her long-term goal of improving access to mental health treatment in global settings.
Andrew Secor, MPHc – Global Health, School of Public Health
Andrew earned his Bachelor’s degree in International Development from Brown University. Most recently, he served in the U.S. Peace Corps as a Program Development Officer for a community-based organization in the Limpopo district of South Africa. He has also worked in Uganda, Rwanda, and Nepal. His areas of interest include: access to care, infectious diseases, and marginalized populations. The Thomas Francis, Jr. Global Health Fellowship will enable him to travel to Mtwapa, Kenya to assist in the implementation of an intervention to increase ART adherence among men who have sex with men (MSM) in the area. He will also be able to develop his thesis – a study of the associations between HIV status and psychosocial markers in Kenyan MSM.
Yu Yu, MPHc – Global Health, School of Public Health
During the past 7 years, Yu Yu has been actively engaged in promoting mental health as a public health student in Central South university of China. With 7 years of higher learning and quality hands-on experience in Public Health in China, she is now ready to expand her research interest to other parts of the world. Her main work for this project includes investigating the risk factors and outcomes of non-communicable diseases (NCDs) especially mental illness in rural South Asian populations and their responses to illness and health care decision-making for the Household Chronic Disease Risk Factor (CDRF) study, and working with the China India Mental Health Alliance on a paper--- “Rethinking suicide: lessons from China and India”.
Sara Diedrich, MPHc – Nutritional Sciences, School of Public Health
While earning a BA in Biology at St. Olaf College Sara had the opportunity to study and volunteer in Europe, Northern Africa, Asia and Central America. She has been interested in Nutritional Sciences for many years, but became especially interested in Global Health Nutrition after traveling to Nicaragua with a team of researchers from the University of Minnesota to assist with a community health assessment and cervical cancer screening project. She is grateful for this GO Health Fellowship, which will give her the opportunity to combine her interests in community nutrition and education as she carries out a health literacy and nutritional assessment of school aged children in the Peruvian district of Puente Piedra. With the help of Dr. Joseph Zunt at UW and his team at the San Marcos University in Lima, she hopes to use the results of this research to develop an education program to improve the nutritional health of children in Puente Piedra.
Chris Hearne, DNPc (Nursing) – School of Nursing
Chris' professional background is as a registered nurse working in mental health. He is currently in his first year of the doctoral adult-gerontology nurse practitioner program at the University of Washington School of Nursing. He has experience working in healthcare in developing countries, including projects in Tanzania and China. Chris' GO Health Fellowship will be in Kenya in summer 2014. His project will be focused on developing capacity in a small rural health clinic in a Maasai community. The end goal is for this clinic to have the certification to distribute ART and TB medications, so that the local population has access to treatment and prevention for these illnesses. His personal goals for the fellowship are to contribute meaningfully to the goals of the clinic and to develop my professional knowledge and skills surrounding public health capacity building, HIV/TB prevention and treatment, as well as cultural competency.
Rebekah Heckmann, MD, 3rd Year Medical Resident – Div. of Emergency Medicine, School of Medicine
Rebekah has worked in the field of international public health for over ten years and have been the primary investigator for research projects conducted in the Republic of Korea and Ecuador. Completion of this project would serve as the capstone research project of her residency, will allow her to refine her research interests prior to making final global health fellowship decisions, and would provide for the development of a valuable network of collaborators with whom she can continue to work during her fellowship years. Most importantly, this study will improve patient care by characterizing the case mix of patient presentations in a major Kenyan ED. Additionally, this project will introduce simulation education into the Kenyan health care system based upon local health needs and will provide useful information when determining whether this type of education is applicable to other EDs in the region.
Nicole Ide, MPHc – , Global Health, School of Public Health
Prior to her graduate studies, Nicole received a BA in Political Science/International Affairs from Seattle Pacific University. With the assistance of the GO Health Fellowship, Nicole will travel to Nepal to implement a validation study of the SmartVA verbal autopsy tool developed by the Institute for Health Metrics and Evaluation. She will work alongside the Dhulikhel Heart Study, which is currently seeking out a method to measure and track mortality. Additionally, she will train local health workers at Dhulikhel Hospital and coordinators/interviewers for the Dhulikhel Heart Study to use the tool in their health surveillance systems. Partnering with the Dhulikhel Heart Study will provide Nicole with a deeper insight into her primary interest within global health, that is, measuring and responding to the non-communicable disease burden in a low resource setting.
Darya Kizub, MD, – 1st Year Medical Resident, School of Medicine
Darya first became interested in global health while studying public health and medicine at the Johns Hopkins University. After participating in research related to HIV and tuberculosis in Russia and Morocco, she has continued to learn about the intersection of medicine and culture/tradition by providing care to patients at the International Medicine Clinic at Harborview Hospital. The GO Health Fellowship will give her the opportunity to travel to Kisumu, Kenya to work with Dr. Susan Graham at UW and the Nyanza Reproductive Health Society (NRHS) on a project that will provide antiretroviral treatment to 250 HIV-positive men who have sex with men (MSM) in an attempt to prevent HIV transmission to their partners. The program will also aim to reach and retain 750 HIV-negative MSM in a year-long HIV prevention program. If successful, the program could be expanded to other locations in Kenya and Africa. I hope to use my experience as a clinician and public health researcher to help the NRHS with program implementation and evaluation.
Abigail Korn, MPHc – Global Health, School of Public Health
Abi holds a BA in Latin American Studies from Washington University in St. Louis, and her research has focused on sexual and reproductive health as well as indigenous people’s access to health care. This summer, Abi is looking forward to working in Guatemala with PRONTO International, an organization committed to reducing maternal and neonatal mortality. She will be conducting birth observations to collect baseline data on teamwork and clinical practice in northwestern Guatemala, an impoverished, largely rural, and indigenous area known as “the corridor of death” for their extremely high maternal mortality ratios.
Daisy Krakowiak, PhDc – Epidemiology, School of Public Health
Daisy Krakowiak earned her MPH and a graduate certificate in Global Health from the University of Utah in 2010. She is working with her mentor, Dr. Carey Farquhar, on a randomized clinical trial of home-based education and HIV testing of partners of pregnant women in Western Kenya (The HOPE Study). In this trial, community health workers perform home visits with pregnant couples and cover educational topics such as HIV prevention and treatment, the importance of facility delivery, exclusive breastfeeding, and postpartum family planning, as well as conduct couple HIV counseling and testing. Daisy is developing a qualitative interview to learn what aspects of the home-based health education and HIV testing intervention were effective from a user perspective. This information will help in improving the intervention for potential nationwide roll-out if the intervention is found to be acceptable, effective and cost-effective. She is excited and thankful for this hands-on opportunity to further her passion and research experience in global health.
David Phillips, PhDc – Global Health, School of Public Health
David Phillips is a native Seattleite. He holds a research position at the Institute for Health Metrics and Evaluation. With experience in data analysis, and education in statistics and study design, David hopes to use his quantitative disposition to improve public health policies and interventions with a focus on population-level health and equity, particularly child health. David’s recent research has focused on enhancing the utility of data on causes of death, measuring smoking cessation at a country level and producing novel models for the Global Burden of Disease Study using advanced statistical techniques, machine learning and mathematical optimization. David loves international travel, seafood and camping trips with his fiancé and dog.
Aradhana Thapa, MPHc – Global Health, School of Public Health
Before this, Aradhana worked with communities in Nepal for improving health care system and rehabilitation of children with disabilities. She is deeply grateful for the financial support of Global Opportunities (GO) Health Fellowship program. This will assist her in completion of her research work in Nepal that will explore the health worker’s perspective on provision of family planning counselling among post-abortion clients. She is working under supervision and support of faculty at the UW, Annette Fitzpatrick, and with the Program Director at the Family Planning Association of Nepal. This project will help the organization to improve the delivery of family planning contraception among post abortion clients and will help Aradhana develop research skills. As a female with cultural roots in Nepal, her cultural knowledge, experience, public health skills and zeal to contribute in efforts to improve the health in her country will be beneficial to the organization.
Bradley Wagenaar, PhDc – Epidemiology, School of Public Health
Bradley came to UW after finishing Master’s level training at Emory, with a focus on the epidemiology of depression and suicide in rural Haiti. He is a returned Peace Corps Volunteer from Northern Cameroon. He is currently working with Health Alliance International to support strengthening integrated primary health care in Mozambique. He will use the GO fellowship to support dissertation activities to assess the availability of psychotropic medications, to conduct chart reviews to determine current diagnosis and treatment patterns for mental disorders, and to survey health-facility staff around perceptions, knowledge, and current practices for common mental disorders in Sofala Province, Mozambique.
How can smart phones prevent mother-to-child HIV transmission? Three approaches are gaining attention for their innovative use of technology to improve access to safe breast milk, patient education and HIV testing at home. Read more about how technology is being used by Global Health faculty Carey Farquar, MD, MPH and partners UW Computer Science and Engineering (CSE) and PATH, in the June 2014 edition of Columns, the UW alumni magazine.
For article, click here.
Washington Global Health Alliance Discovery Series Lecture 'The Gun Violence Morass: Science Can Get Us Out of It' - with Mark Rosenberg (May 5, 2014)
An expert in medicine and public health, ranging from infectious diseases, to injuries, and mental health, Dr. Mark Rosenberg served 20 years with the Centers for Disease Control and Prevention (CDC), including early work in smallpox eradication, enteric diseases, and HIV/AIDS. He was instrumental in establishing CDC’s National Center for Injury Prevention and Control and became the first permanent director in 1994, serving as director and Assistant Surgeon General until 1999. He has worked with President Oscar Arias of Costa Rica to organize a coalition to address road traffic injuries throughout Latin America and the Caribbean. He is the CEO of the The Task Force for Global Health.
Here is a transcript from his lecture at UW May 5, 2014:
For several reasons it is a special honor and pleasure to be able to speak to you here today. First, I am delighted to be speaking to the Washington Global Health Alliance because you are a model for what we hope to do in Atlanta, pulling together the Atlanta Global Health community to make a whole that is larger than its parts, get a little closer to global health equity together than we might do alone. Second, one of your distinguished residents, Chris Murray, has observed that “Injuries, which account for 10% of global mortality, are often ignored as a major cause of death.” So it is nice to be able to put violence on a global health agenda that is usually dominated by a focus on diseases. And finally, because we are in the Foege Auditorium. Bill Foege was my teacher when I was a preventive medicine resident at CDC in 1975. He later became my boss, then my mentor, and then a very special friend. The wonderful American author Philip Roth, writing a eulogy for his mentor who died at the age of 103 told how his relationship with his mentor had developed. “To cut to the chase,” he wrote, “Bob and I fell in love.” That is the ultimate payoff of having a wonderful mentor. I have been so lucky and that’s why I am so moved to be speaking here in the Foege auditorium.
I want to talk to you about violence prevention, with a special focus on gun violence. And I want to make three points.
1. The prevention of violence must be based on science. Science is every bit as important here as it is in the development of pharmaceuticals and new medical devices, and it will be every bit as effective as it has been in the fight against heart disease, cancer, and road traffic injuries. We have every reason to be optimistic about the ability of scientific research to deliver us to safety.
2. But keeping science in the forefront won’t be a slam dunk because there are challenges— including political forces and strongly held social and cultural beliefs—that may stand in our way. We need to keep politics from stopping or interfering with our research. Public health is inherently political, and the issue of firearm injuries is more contentious than many public health fields and therefore subject to more political intrusions. But we must support our scientists so that they can collect and examine the evidence and then reach decisions based on it. We cannot afford to let scientific research be contaminated, manipulated, or stopped by organizations or individuals driven by their own economic gain or their own personal agendas. We need to be wary of arguments driven by ideology rather than evidence.
3. The field of violence prevention must be collaborative to succeed. Collaboration in the service of violence prevention is not just the nice, polite, or politically correct thing to do, but it is a matter of life and death. And it is hard work that does not come naturally.
Vi Harwell: An Example of Science in Real Life
I want to share with you a very personal story about someone else who taught me a tremendous amount, someone who was steadfast in her pursuit of the truth.
I first met Vi Harwell, when she was in an intensive care unit and not talking or interacting with her caretakers or the people around her. I had trained as a psychiatrist so her doctors thought I would be able to get her to communicate. I introduced myself and sat with her, and sat and sat and sat. And then came back and sat. And finally she started to open up.
Vi Harwell grew up in a family and in a place where violence was common. When she was a child, her brother, Bobby, had intervened in an argument that a young, intoxicated man was having with a woman. The young man thought Vi’s brother had embarrassed him and disrespected him and several days later he sought revenge by shooting and killing Vi’s brother.
Vi went on to marry Alex, the first black State trooper in Tennessee And Vi herself became the first black woman elected to the school board in Pulaski, TN. She even had her own radio show. They had an 8-year-old son, little Alex.
But her husband felt that Vi was neglecting him, that she was too busy with her work. She was becoming better known than he was. For him, this was unacceptable because it wasn’t consistent with the image he thought the man of the household should have. The tension grew between them, and Alex started to drink more and threaten her more. Things got so bad that Vi finally asked her husband to move out of the house. Her husband was furious and drank even more. He waited one night for Vi’s friend to leave their house, and then went up behind Vi, put his 357 magnum to the base of her skull and fired the gun at point blank range.
Vi survived, but she was totally paralyzed from the neck down, dependent on a ventilator. She could swallow and she could speak, but only if she timed it with the exhalation of the ventilator.
That’s when I met Vi at the Shepherd Center in Atlanta. Over a period of 4 years, we got to know each other very well, talking by phone almost every week. She was one of the most amazing people I have ever met. Vi lived in fear that her respirator might become disconnected and that she would be powerless to call anyone or do anything.
And one night, in March 1994, that happened.
Vi had started going out with her husband in about 1983, and if only we knew then—and applied--what we know now about violence prevention things might have been so very different.
In Vi’s community young black men were killing other young black men so frequently that there was a sense that violence was inevitable, senseless, and not preventable. Young black men like Vi’s brother Bobby were dying in large number.
When we compiled the homicide rates for the U.S. and compared them to rates for other comparably developed countries, the U.S. stood out.
When we compared the rates for young black men in the U.S. –third line from top--with the rates from other countries, we saw that the rates went on and on…
But we have learned that violence is preventable. Criminal justice, in large part, had focused on intervention after the fact, using both specific deterrence and incarceration. Public health does not just try to rescue drowning swimmers from the river, but it goes upstream “to see who is throwing them into the river.”
Using Science to Prevent Violence
We have developed a scientific framework that helps us understand homicides—based on science: What’s the problem? What are the causes? What works?
How do you do it, how do you implement the programs and policies that work?
The same questions can be asked about what happened to Vi, intimate partner violence or gender-based violence: What’s the problem? What are the causes?
What works? How do you do it?
The impact on Vi’s son, little Alex, was great and very long lasting. He used to wake up with nightmares.
LeNita, Vi’s sister explained, “Alex, Vi’s son, had some bad dreams and woke and came to my bedroom. He had a nightmare saying that his dad was chasing him with a butcher knife. We calmed him down and assured him that he loved him. We told him that his mom loved him too, and that he didn’t ever have to worry about his dad chasing him with a butcher knife because his dad loves him. I just let him get in bed with us, and he went to sleep.
“Little Alex had been a wonderful student before he moved here to Chicago with us. But during the winter he started having a lot of problems. His teachers let us know that he was not doing his schoolwork or turning in his homework. And worse than that, he was lying about it. When we found out, I started going with him to a child therapist. That worked great. It really turned him around and he went from being a real problem to where he was selected as the star student of the week. They invited me to come to his class on the day he was supposed to get the award. It was a surprise. I was delighted and he was surprised and very happy.
After he got the award, he introduced me to his class. He said, 'This is my mother, LeNita.'” Better, yes; healed, no. He got better for a while, but had a very hard time focusing his life, completing school.
Research Has Taught Us A lot
We used to think that the cost of violence was primarily the sum of the costs of taking care of the acute injuries that resulted from that violence. But we have had to make a huge paradigm shift because of what the science has shown us.
There are several notable findings:
The game-changing studies on adverse childhood events by Felitti and Anda and many others demonstrated empirical associations between early exposure to violence and subsequent major causes of mortality in adulthood, such as the non-communicable diseases or NCDs. Early exposure to violence, neglect, and abuse leads to children who grow up hyper-vigilant, and unable to calm themselves or tamp down strong hormone- driven feelings to fight or take flight. As they grow up and across their life span they are at higher risk for hypertension, heart disease, asthma, substance abuse, high risk sexual activity and sexually transmitted diseases, suicide, and violence.
And now we are starting to understand the biological underpinnings for these associations. Traumatic stress such as that associated with violence impairs brain architecture (both structure and function), and can confer lasting damage at the most basic levels of the nervous, endocrine, and immune systems. These exposures can even influence genetic alteration of DNA (Danese and McEwen 2009; Anda and others 2010). Nurture affects nature.
Violence extends across the whole life-span from child abuse and neglect to elder abuse, including suicide and self-directed violence. And each type of violence can be understood with the same scientific approach, asking the same 4 questions.
Keeping Politics Out of Research
The second big point I want to make is that we need to keep politics out of our research, and make sure that our science is driven by evidence and not ideology. Because politics interfered with research at CDC, we don’t understand what we need to know about how to prevent firearm injuries. Those we are trying to serve are paying the price, with lives lost, families shattered, and children and communities terrorized.
In 1983, the same year that Vi’s son Alex was born, Bill Foege convinced me to come back to Atlanta and my family moved down from Boston. I returned to the Centers for Disease Control (CDC) to help start a program looking at violence as a public health problem. We started to put together a science base for the prevention of firearm injuries. In the 1990s, the National Rifle Association and the forces of politics killed that program.
Since the Newtown massacre, the national statistics on gun violence have been widely reported. Firearms deaths number more than 30,000 each year, and ⅔ of these deaths are suicides. Tens of thousands more people are seriously injured by guns. Those injuries impose significant and frequently life-long burdens for care and rehabilitation on families, communities and the health care system. But we have known little about these deaths other than how many occur each year.
We faced a similar challenge 50 years ago when we realized that cars were killing too many of our citizens. In the mid-1960’s the federal government invested hundreds of millions of dollars in research that helped us reduce risks related to motor vehicle crashes. We discovered ways to make cars safer by adding front and side impact protection, seat belts, air bags, anti-lock brakes, and elevated rear stop lights. We learned how to improve roadway design to make roads safer, and we understood how to make drivers safer by passing stricter laws that could get the majority of drunk and impaired drivers off the road. As a result of this research, we saved more than 325,000 lives between 1960 and 2002.
At the National Center for Injury Prevention, we set out to do similar research on firearm injuries, a problem that accounted for about the same number of deaths as motor vehicle crashes. We wanted to answer the same four questions that we use to understand other specific forms of violence.
What is the problem? We wanted to know how many firearm-related injuries occur; where, when and how they occur; the characteristics of the shooters and victims and the relationship between them; and the circumstances of death and the weapons used.
What are the causes? What are the factors that increase or reduce risk? We found, for example, that the presence of a firearm in the home, rather than being protective, is associated with a 300% increased risk of homicide and a 500% greater risk of suicide.
What works? What practices or policies prevent firearms deaths and injuries? Some simple interventions have proven effective (childproof locks, storing firearms locked and unloaded), but we have not yet adequately studied the impact of most public policies such as gun-owner licensing, firearm registration, background checks for criminal histories or mental illness, or barring access to certain types of weapons or ammunition. We don’t know, for example, how death and injury rates are affected by prohibiting gun ownership by felons or the adjudicated seriously mentally ill. We just don’t have the evidence.
How do you do it? How do you implement effective practices and take them to scale? This is similar to the challenge of disseminating best practices in medicine: we would like to generate and deliver evidence-based practices that could be widely adopted.
In the area of “firearm injuries”, we know a fair amount about the first two steps, but woefully little about “what works” and “how do you implement and scale up the things that work.”
So, at CDC we set out to answer these questions by collecting surveillance data on firearm injuries and supporting investigator-initiated peer- reviewed research. Had we done so then, we might have saved many of the more than half-million lives lost to firearms injuries in the last 17 years.
But the NRA leadership stopped us by misrepresenting our research. They told their members that our research would result in all firearms being confiscated. And the pro-gun constituents launched relentless attacks on our science, calling the injury center the “cesspool of junk science.” Six senators wrote to the secretary of HHS requesting that I should be fired and the injury center shut down.
In 1996, they persuaded a number of congressmen and senators to eliminate firearm injury research at CDC. Led by Congressman Jay Dickey, a republican from Arkansas, the House removed $2.6 million from the CDC budget, an amount designated to support a firearm injury surveillance system. Although the Senate restored the money to the budget for other purposes, Congress added language to CDC’s appropriations bill that said no funds could be used “to advocate or promote gun control.”
We were in the business of research, not advocacy, but this ambiguous language was a threatening shot across the bow that effectively undermined firearms research. Federal bureaucrats grew wary of conducting research about which the NRA could harass them mercilessly. David Satcher, then director of CDC, asked for a review of CDC’s firearm research by a panel of highly respected scientists and this review concluded that the research was extremely well-done, important and that there should be more of it.
But it wasn’t only the NRA and their allies that undermined our effort.
Even scientists we had funded turned against us. I don’t think it would come as a surprise to hear that scientific research is an intensely competitive enterprise. Nor should it come as a surprise that a research area that has many committed scientists competing for very limited resources, tends to have its share of disgruntled scientists and opportunistic administrators who are not only willing to sacrifice a field like gun violence research but will actively participate in the attack when it suits their own personal self-interest. They turned on scientists who were and still are seeking truth based in science. We desperately need more leaders like David Satcher who not only allow scientists to pursue questions when the questions and answers they generate may not be politically popular but they will actively defend them when they come under attack.
The money that CDC spent on firearm injury research fell drastically, by more than 95%. And at CDC today, there remains a small group of extraordinarily dedicated and able researchers, but “guns” is a four letter word that makes researchers cringe because it’s a red-flag that makes it very difficult to get a paper cleared or research approved.
Beyond the U.S.
We still face significant challenges in bringing the benefits of violence prevention to low- and middle-income countries, where men, women, and children bear 90% of the global burden of violence, an enormous burden that hits the world’s poorest people in the world’s poorest places and helps to perpetuate extreme poverty. The biggest obstacle is that we lack proof of effectiveness for many interventions in low- and middle-income countries and without the proof of effectiveness neither country governments nor donors want to invest in preventive interventions. Without their wanting to invest, we can't demonstrate effectiveness. In addition, most low- and middle-income countries don’t have the capacity to collect the data needed to measure cost-effectiveness, and rigorously evaluate the outcomes.
Collaboration in Violence Prevention
My third and last major point is that if we are to be successful going forward, we will have to do a better job of respecting, understanding, and working with each other. In the area of firearm injuries, collaboration has a very special meaning: our research must simultaneously meet two objectives. The first is to reduce firearm deaths and injuries; the second is to be mindful of the legitimate concerns of responsible, law-abiding gun-owners.
This task is similar to finding a cancer chemotherapy that will both stop tumor growth and preserve that patient’s overall wellbeing. There are plenty of drugs that will stop tumors and shrink them away. If this were our only concern, we would not need research to find new drugs. The problem is that these drugs are toxic and, while stopping the tumor, they also severely damage the kidneys, liver, and heart. If we were not concerned with the tumor’s growth and concerned only with protecting the patient’s kidneys, liver, or heart, we might not need research to find new treatments. When we want to both stop the cancer and preserve the patient’s vital organs, the challenge is much greater and we need good scientific research to find the solutions.
So it is with preventing firearm injuries and protecting gun rights. Ignoring either objective might make research unnecessary. We could disregard the risks of death and injury, and — as the NRA suggests — do nothing to limit access to firearms, the types, number, or way they are sold. Or, we could set aside gun rights and prohibit civilian ownership of firearms. Either of those paths makes easy work for the policy makers.
But, the constitution — and our duty to protect the lives of family and community members — require us to pursue both objectives and make informed choices. We need research to find out what works to reach both objectives, to find the best way forward.
Collaboration, especially across types of violence, across sectors, and across stakeholders among whom there is so much distrust—is challenging to be sure. Even when the science is easy, people are hard, and institutions are impossible. There is competition for credit, power, and funding. Obstacles (and opportunities) occur every day at every level: global, multinational agencies, regions, countries, communities. Stakeholders speak different languages, have different cultures and every organization wants things its own way.
Collaboration, like democracy, is not perfect, but it offers a better chance than any other option we have.
Vi Harwell lived the last four years of her life as a quadriplegic and ultimately lost her life because of a firearm injury. That was almost 20 years ago, and between then and now more than 600,000 people lost their lives to firearm injuries in this country alone. This does not have to continue. Science has dismantled the superstitions of ignorance, one after the other. During our own lifetimes we have seen extraordinary progress made in protecting us from cancer, heart disease, mental illness, and death on the highway. So too, science will dismantle peoples' belief that violence is an inevitable part of being a human being.
We can’t let the science in a vital life and death area like this one, get side-tracked or derailed. But while it is just what we need for stayin’ alive, it won’t be easy. When Vi’s husband went on trial for shooting Vi, the jury was not allowed to hear the truth. They were not allowed to hear about domestic violence. Truth was remarkable for its absence. Vi’s husband testified that he had his 357 Magnum out for target practice even though it was pitch black outside; and he said that the gun went off “accidently” while he was standing in front of Vi. The medical examiner testified that Vi was shot at point blank range from behind her, and that a 357 Magnum required too much pressure on the trigger to go off accidently. In a gross miscarriage of justice, her husband was acquitted. We can’t allow a gross miscarriage of science. There is too much riding on this.
Jay Dickey, my arch-enemy when David Satcher and I testified before the House appropriations committee in 1966, was so angry that my CDC handlers had told me “Don’t you ever speak with him. It will be like throwing a match on gasoline. But one day his staffer called me to his office to see if I could explain some things to him. I did go and we spoke and as I was leaving he said, “The Congressman is here and would like to say hello to you.” What was I to do? I didn’t want to be fired but I didn’t want to be completely impolite so I went in.
Jay is a born-again Christian, Southern conservative Republican working for the NRA. And I was a young, Jewish liberal from the northeast. But over time we became good friends and came to know and trust each other. That trust is critical. We have come to agree that we must do more research to learn how to prevent firearm violence.
Writing about the situation in Egypt in the New Yorker last year, George Parker said something that could equally well apply to the stalemate between the sides that oppose each other on the gun issue:
“The core political problem …is … a culture of suspicion and confrontation, a mentality of winner-take-all…we have two groups that regard one another as obstacles to power, not as legitimate players in a complex game that requires inclusion and consensus.”
The prize—safety for our children, our families, our communities, and our country—and beyond—is too big a prize for us to lose. In the short-, medium-, and long-run, the cost of proceeding with our eyes closed to the truth will be much more than we as a civilized and caring society can afford.
I am deeply indebted to work done by so many advocates and researchers, bureaucrats and leaders, friends and mentors who have helped to totally transform this field and helped me understand so much more than I did when I first started working on violence prevention 30 years ago. In particular, for help with this presentation I want to thank Don Berwick, Alex Butchart, Jay Dickey, Bill Foege, Fran Henry, Howard Hiatt, Jim Mercy, and Jill Rosenberg.
Students from the University of Washington are helping to improve the health of women and children across the world through Global Center for Integrated Health of Women, Adolescents, and Children (Global WACh), a growing research and education center on the UW Campus. This year, Global WACh students completed projects in Nepal, Uganda, Ethiopia, and Seattle, focused on topics like nutrition, family planning, preventing mother-to-child HIV and adolescent health. On Wednesday June 4, the center will celebrate the work of these students at “The Next Big Thing.” The event will include scholar and poster presentations, and will allow attendees to learn more about the great work of this center.
Global WACh is unique in its approach to maternal and child health – students are selected from a variety of areas including nursing, public health, public affairs, and medicine.
Across their diverse disciplines, these students share many qualities, but among them are a passion for giving back and hope for a brighter future. We caught up with some of the recent scholars to learn more about their projects and why they chose global health.
Maura Carroll, 2nd year Doctor of Nursing Practice-Family Nurse Practitioner (FNP-DNP) student
School of Nursing 2nd year Doctor of Nursing Practice Student Maura Carroll was interested in gaining a global perspective from early on in her education. A Peace Corps volunteer in Nicaragua, Maura returned to the US and knew that nursing and global health were in her future. After entering an accelerated bachelors of nursing program at Johns Hopkins, her work in an HIV inpatient unit sparked a passion for service to those suffering from HIV.
“Nurses are amazing,” she said. “The scope of practice in the US is somewhat limited compared to globally. Nurses do all kinds of care in some countries where there are few doctors or very limited access.”
After another international trip to Mozambique, Maura entered UW’s Nurse Practitioner program and found a niche with Global WACh. She assisted on a pilot project with Food for the Hungry Uganda, a faith-based NGO that works to prevent mother-to-child HIV transmission using community health workers. Maura was deeply involved in helping develop the final program evaluation and providing trainings on PMTCT best practices and clinical guidelines, and believes strongly that her nursing background set her up for success.
“Nursing has a stronger understanding of the big picture,” she said. “Nurses have the skills to go into settings like these and manage tough situations with limited resources.”
Although Maura only was on site in Kitgum, Uganda for two weeks, the interventions made a major difference to the community. All of the children who were at risk for HIV at birth remain HIV free, thanks to the work of the program.
Christopher Kemp, Master in Public Health Student
For most of us, returning home from a two-year stint in the Peace Corps in South Africa would call for some rest and relaxation. For Christopher Kemp, a MPH student at the Department of Global Health, it calls for travel to Nepal to work on improving child nutrition. Soon after returning home, Kemp was selected to work with the UNICEF Office in Nepal to support the monitoring and evaluation of the Maternal and Young Child Nutrition Security Initiative in Asia (MYCNSIA) Program.
Nepal is the first country to implement a multi-sector approach to improving child nutrition by engaging six different ministries - including education, agriculture and water - in planning, implementation and evaluation of activities to improve child nutrition. Kemp worked closely with colleagues at the UNICEF office and the district and national health offices over four months.
His advice for other up-and-coming global health practitioners? Approach communities with humbleness. Rather than assume your education provides you with legitimacy, listen and learn from the community from the beginning, said Kemp.
And perhaps we should head Kemp’s advice because all six of his metrics and evaluation frameworks were endorsed by all the sectors, meeting every initial goal set forth by the project.
Emily Robinson, 2nd year Doctor of Nursing Practice-Family Nurse Practitioner (FNP-DNP) student
Emily knew she wanted to be a nurse from the age of 12, and continues to be immensely passionate about nursing as she pursues her graduate education at the UW. After three years of work as a nurse in Cairo, Egypt during the revolution of 2011, Emily moved to Seattle to join the UW FNP program and continued to share her passion for global health.
“Nursing has a unique perspective,” she said. “In many areas of global health, the nurse can be the bridge between the patient and provider when the patient is uncomfortable communicating with their provider directly due to cultural differences.”
In a few weeks, Emily will head to Ethiopia for three months to work with UW’s Strengthening Care Opportunities through Partnership in Ethiopia (SCOPE) program in an effort to reduce rates of mother-to-child transmission of HIV. Following in the footsteps of MPH student Kristen Savage, who assisted in program development and evaluation last year, Emily will be working closely with populations in the community to educate and inform women about the necessity of pre-natal care.
Emily looks forward to her experience in Ethiopia and is excited to see the role nursing will take on in this context thanks to Global WACh.
Learn more: Join us on June 4th
Global WACh “The Next Big Thing” will be held on June 4 at the Foege Building on UW Campus. Seed grant awardees and scholar presentations will occur in the Foege Auditorium from 5:00 p.m. - 6:00 p.m., followed by a reception with graduate certificate program poster presentations from 6:00 p.m. - 8:00 p.m. at the Vista café.
With a new report highlighting that one-third of the world’s population is overweight or obese, the Institute for Health Metrics and Evaluation’s latest analysis is garnering major news coverage from outlets including the Wall Street Journal, BBC News, and GlobalPost, and in India, South Africa, Brazil, Australia, and New Zealand, and the UK. The report release, like any big IHME report, features infographics and data visualizations showing growing obesity in the Middle East and developing world. Authors include UW faculty, staff and fellows: Marie Ng, Christopher J L Murray, Emmanuela Gakidou, lan D Lopez, Tom Achok, Ali Mokdad, Tom Fleming, Margaret Robinson, Blake Thomson, Nicholas Graetz, Christopher Margono, Erin C Mullany, Stan Biryukov. Read the study for a full list of authors.
UW students help kids with the polio eradication game at the Seattle Center