Caring For the Global Village

By Kristin Livingston and Mark Sullivan

Margie Skeer never intended to go into public health. She had planned on a business career, until an internship at a drug and alcohol rehabilitation center in New Jersey changed her path. She listened to heart-wrenching stories of lost childhoods and broken lives. “They were so young when they started using drugs,” she says. Sometimes, she would shut her door and sob.

Today Skeer is one of many at Tufts School of Medicine who have devoted themselves to the greater good. An associate professor of public health and community medicine, she works to prevent substance abuse and risky sexual behavior in adolescents. Sometimes the solution to these kinds of big issues can be elegantly simple, family mealtimes, for example.

Various studies have determined that eating meals together as a family can reduce the probability that adolescents will smoke, drink and use drugs, as well as lower the incidence of risky sexual behaviors,” Skeer says. “It is generally thought that what happens at family meals, rather than the meals themselves, fosters this protective effect. If family meals are frequent and consistent—five or more dinners together each week—mealtime can serve as a conduit for open, ongoing communication, a time when family members talk about their days.

This focus on the well-being of whole populations has been embedded in the DNA of Tufts University School of Medicine since its early days—from Joslin Diabetes Center co-founder Priscilla White, M23, a faculty member whose work led to a doubling of the survival rate of infants born to diabetic mothers, to Jack Geiger and Count D. Gibson, the faculty members who founded the nation’s first community health centers in the 1960s, one in rural Mississippi and the other in a Boston housing project, to those like Skeer who are working on the frontlines of public health today.

Lately, the medical school is seeking to build philanthropic support for its programs in public health and community medicine and draw greater attention to its scholarship and research in the field. A gift pledged by Harris Berman, dean of the School of Medicine, and his wife, Ruth Nemzoff, has given a significant boost to that goal.

“Community health and medicine are an important part of the solution to making health-care reform work, yet they tend to be grossly underfunded by federal and state governments and universities,” says Berman, who became interested in population medicine as a young Peace Corps doctor in India.

“We want public health to be integral to the teaching of medicine,” Berman says. “How do we keep people healthy beyond the individual patient who walks into our office? How do we take care of populations?”

Public health at Tufts encompasses more than 250 medical students who also train in public health, health communication and pain research, education and policy, said Aviva Must, N87, N92, the Morton A. Madoff, M.D., M.P.H., Chair of Public Health and Community Medicine and dean of public health and professional degree programs.

M.P.H. concentrations are offered in epidemiology and biostatistics, health management and policy, health communication, nutrition and global health. “Our tagline, ‘Working Across Disciplines and Global Boundaries,’ is realized through these dual-degree programs, as well as our research and focus on applied training for master’s students in global health,” says Must, whose own research explores the epidemiology of obesity.

Tufts Public Health sends 10 to 15 students each year to the Christian Medical College in Vellore, India, which serves more than 300,000 people in the region. “Our students learn how to take care of villages,” Berman says. “We send students abroad not just to see tropical diseases they won’t see at home, but to learn what it’s like to take care of a population.”

Personal Missions

Alejandro Alvarez, who earned a Tufts M.P.H. last year, learned this lesson as a young boy. The son of a physician and a nurse, Alvarez spent the first 15 years of his life in Peru, watching his parents treat the poor in underserved communities and advocate for their civil rights. This year, Alvarez is headed back to Peru to pick up where his parents left off.

Working with the Pan-American Health Organization, he will investigate the rates of malnutrition in Peruvian children. While the overall prevalence of chronic malnutrition has dropped by 12 percent in the past decade, there is great disparity among children, depending on the region in which they live. Alvarez will tap into 40 years of Peruvian health survey data to determine if government socioeconomic reform has affected the nutritional status of children under age 5.

Nani Loui Morgan, who received her M.D. and M.P.H. degrees last year, also wants to help folks back home—in her case, Hawaii. She was aware of the high rate of diabetes among Native Hawaiians and Pacific Islanders but was stunned by the results of a health needs assessment she conducted as part of her public health capstone project. “Native Hawaiians and Pacific Islanders are three times more likely to be diagnosed with diabetes than whites in Hawaii,” says Morgan, who is part Native Hawaiian.

Morgan, who’s currently doing research in rheumatology and cardiology at Tufts Medical Center, plans on returning to Hawaii next year to practice internal medicine. She says her experience in public health will be an asset. The combined-degree program in medicine and public health, she says, “has broadened my appreciation for the many determinants of health extending beyond the individual.”

This article first appeared in the Fall 2012 Tufts Medicine magazine.

Kristin Livingston can be reached at kristin.livingtston@tufts.edu. Mark Sullivan is a freelance writer.