Championing the Public Good Across Two Great Pandemics
The world has changed in profound ways since 1922, the year that the Columbia Mailman School of Public Health was founded. But the School’s core mission has stayed the same: to deliver solutions to protect and improve the health of people everywhere.
Among their many achievements, Columbia Mailman’s scientists, educators, practitioners, and advocates are responsible for launching the first multi-country HIV care and treatment program, identifying hundreds of emerging pathogens, improving maternal and child survival, and developing data models to predict the spread of COVID-19.
Columbia News sat down with the dean, Dr. Linda P. Fried, as Columbia Mailman’s centennial celebrations were getting underway. A pioneer in the science of aging, Fried teaches a course called “(Y)our Longer Life” that’s part of a public health concentration she designed for Barnard and Columbia undergraduates. Fried is the DeLamar Professor of Public Health at Columbia Mailman, a professor of medicine at Columbia's Vagelos College of Physicians and Surgeons; and senior vice president of Columbia University Irving Medical Center.
Q: The Columbia Mailman School of Public Health was founded on the heels of the 1918 flu pandemic, the last great pandemic before this one. How has the discipline of public health changed?
Linda P. Fried: The principles for public health that were first articulated a hundred years ago still pertain. We’re responsible for the science and solutions to prevent disease, disability, and injury, and to elevate the health of everyone with science-based solutions and by working in partnership with all sectors of society to translate knowledge into collective action. In the last century, we’ve greatly expanded our knowledge, but society hasn’t fully invested in using it. If we respect what the science tells us, we will all be the beneficiaries.
Q: What's the most important COVID takeaway?
Fried: Our ability to deliver what the public needs is deeply threatened by polarization and a lack of shared responsibility for the greater good. We can only create safe water, food, and air for everyone through shared public investment, regulations, and action. We can only increase childhood survival through programs that help everybody, at scale. We have somehow been sold a bill of goods that individual independence absolves one of collective responsibility. That is really harming us in this pandemic, because we can only solve a pandemic by together preventing the spread of the infection.
Q: What did we get right?
Fried: Two things. Public health knows how to lead the containment of the spread of infectious diseases, and where this knowledge has been used, it’s worked. We have non-pharmacologic interventions: the incredible effectiveness of masking, handwashing, physical distancing, having the right ventilation, and contact tracing. Those are simple, low-cost, high-yield approaches that you can readily scale. Then, there’s the miracle of scientific discovery. Over the last few decades, scientists have been building the knowledge around mRNA that enabled them to create a vaccine in a year’s time. It was the outcome of decades of investment to understand and neutralize viruses.
Q: What do you see as the greatest public health achievement in the last century?
Fried: There are so many. Reproductive health advances, understanding the role of the environment in creating health, the science that’s shown us how to prevent chronic diseases. What these accomplishments add up to is something that we’ve never seen before in history. We’ve added 30 years to human life expectancy around the globe. That’s never been done, and 25 of those 30 years are attributable to public health. We’ve added a whole new stage to human life. And there’s no single thing that did it. It’s all of those things.
Q: Where has Columbia Mailman made its biggest contribution?
Fried: The School has worked on all the issues to great effect, and many don’t have easy outcome measures. The closest is infectious diseases because they happen at a moment in time and outcomes can be counted in short order. Dr. W. Ian Lipkin, the director of the Center for Infection and Immunity, has been honored by China for having saved the country from SARS. ICAP, led by Dr. Wafaa El-Sadr, has been honored for having saved 20 million people from HIV by strengthening health systems, and delivering the ability to both treat and prevent HIV. Those outcomes are easier to count, and they matter, obviously! But even in infectious diseases, we have a gazillion other accomplishments that don’t have numbers attached to them. Our faculty helped manage the Ebola response in West Africa for the World Health Organization and the U.S. Centers for Disease Control. They have defined the concept of emerging infections; we are seeing novel infectious agents now that we never saw before at an escalated scale.
A core area of concern that unifies the faculty is how to solve health disparities across people, populations, and ZIP codes. Why are some people deprived of the opportunity for health, whether because of structural racism and discrimination, or because of cumulative disadvantage across their lifetime? How do we solve that? Throughout the School’s history, everyone has been dedicated to solving health disparities around the corner, and around the world.
Q: You led the charge to create a core curriculum that’s now the standard for public health schools nationwide. Why?
Fried: When I first became dean, we did a strategic planning process with the faculty to identify the issues that a great school of public health has a responsibility and the capabilities to solve. We came up with a list of non-trivial issues: the health impacts of climate change; global health and globalization, food systems, pandemics, health equity, and how to make sure that people spend that extra 30 years of lifespan in good health. The 21st century is a very different game from the 20th, in terms of problems, our scientific capabilities, and the lifespan of our students. They will be leading in 2020 … and 2060! The same people!
Our faculty envisioned a dramatically different curriculum to meet these goals, which took two years to design, and when it was done, we had to spend a third year training ourselves to teach a new interdisciplinary, heavily case-based curriculum that gives students the big picture. No matter how their careers evolve, they have the context to understand how their work fits in. The lovely thing is that the faculty built the curriculum for their students, but an unexpected benefit is that it became the accreditation criteria for all public health schools nationally.
Q: What keeps you up at night?
Fried: There are three public health threats that keep me up at night, all caused by humans. The first is health equity. The U.S. health status has plummeted in the last 30 years, to the flat-out bottom of 36 developed nations. What’s driving that is a disinvestment in public health nationally.
The second is the health impacts of climate change. We have to solve for them because they are close to an existential threat. Based on our strategic planning process 12 years ago, we started the nation’s first public health program on the health impacts of climate change. At the time, most people thought it was science fiction.
A third challenge is extending our "health span" so that those extra 30 years of life I mentioned earlier are healthy years. We need everybody to recognize that the most powerful public health solutions with the highest return will come from using the science, and delivering it at scale, for everybody. This is public health’s mantra, I guess, of building the conditions that make healthy options the easy ones.
Q: What role does research play in policymaking? Any recent success stories?
Fried: The way public health and medical science works is to start with problems that are affecting people, recognize their significance, identify their cause, and build solutions. Our Center for Children’s Environmental Health started partnering 20 years ago with a nonprofit, WE ACT for Environmental Justice, to try and figure out why rates of asthma—the number one cause of absenteeism from school for children—were so high in Harlem. They did community, population, and laboratory-based studies and realized that fumes from New York City buses idling and parked in Harlem were driving the asthma epidemic. The problem was amplified by pesticides the city used to spray for cockroaches in people’s homes. Armed with evidence, the Center and WE ACT proposed to the mayor and City Council that the city shift from diesel to hybrid-electric buses. They did and, most recently, the city shifted to all-electric buses.
In a second example, Virginia Rauh and her colleagues have shown that the pesticide chlorpyrifos, a commonly used pesticide in agriculture, is a powerful neurotoxin. It actually harms the brain development of children. With their evidence, based on population science, the U.S. Environmental Protection Agency was on the verge of banning chlorpyrifos at the beginning of the Trump administration. The administration blocked the ban, but our scientists stayed at it! In 2018, Ginny testified before the governor and state legislature of Hawaii, which established the first statewide ban on chlorpyrifos. It’s fabulous because it protects children’s development but also the agricultural workers whose brains are affected by this toxin.
Q: What about nationally?
Fried: After decades of research and advocacy, the Biden administration this past August announced a ban on the use of chlorpyrifos on food crops.
Q: You’ve been dean for 13 years. What do you feel most proud of accomplishing in that time?
Fried: We’ve done a lot. It’s hard for me to pick one accomplishment. But in the aggregate, we have built a school that will lead the 21st century on the issues of our collective future. I’m inspired every day walking in here. I have the privilege of working with people who create knowledge for the world and build the solutions to get there. They’re great at what they do.
This is the moment of our centennial, and in our experience of the epidemic, to have people understand that public health is the foundation for a healthy society. Public health science, knowledge, and solutions create 70 percent of any population’s health. People don’t know that. That’s really important! The consequences of a sick population are devastating to the wellbeing of society. If some people have the opportunity for health, and many others do not, it hurts that society’s future, too.
Celebrate the Mailman School's Centennial
A century ago, Columbia University made a bold commitment to help shape the study and practice of public health. Join the celebration.