Public Health --- The World's Welfare

Seven years ago the Harvard School of Public Health became an independent graduate school. For the first time in its 33 year history, it had its own Dean and separate facilities, appointed its own faculty, and handled its own budget. Today, after a vast program of expansion and improvement, the student body has tripled, the faculty has tripled, and the curriculum has doubled. The Harvard School of Public Health now leads the public health movement in the United States.

It is an educational paradox. Not only has it expanded more rapidly than any other graduate school of the University--it claims world recognition besides. Yet here at Harvard, it is virtually unknown. The services that the school performs for the local and international community affect the world's health as almost no other public health institution. Yet few realize the basic work it does training leaders in all branches of public health and providing them with the latest tools for their job.

Successful Experiment

Begun as an experiment, the school has become a necessity. Stamping out disease, improving industrial working conditions, and providing basic public health service, the school pioneered the first work of its kind in this country.

After forty years of development, it is in its best shape. The school looks optimistically ahead, hopes for greater financial stability, and considers itself well-equipped with an excellent faculty and expanding research.

It has taken its biggest strides during the last seven years. An ambitious reorganization program was launched just after World War II. Public Health officials at Harvard were then awake to the pressing manpower problems that plagued this country during the war. They saw a world in poor health and thought they could take positive steps to improve it.

Because of the difference between teaching curative and preventive medicine the University felt that the two schools--Medical and Public Health--could do their jobs most effectively by splitting their joint departments. The aim of Public Health instruction was to teach preventive medicine, while the aim of the Medical School was to teach curative medicine. With individual departments, the two schools would be able to carry out their own projects more easily. Public Health separated from the Medical School in the summer of 1946 and immediately began its program of expansion.

Its History

The history of public health at Harvard goes back to 1913 when the school originated as an experiment called The School of Public Health Officers of Harvard University and the Massachusetts Institute of Technology. President Lowell of Harvard had long nurtured an interest in preventive medicine. When the time was ripe, he gave the go-ahead to a group of Harvard and M.I.T. doctors to form the school. Taking the Department of Preventive Medicine and Hygiene in the Medical School as a nucleus, they began operating in the fall of 1913. Seven students formally registered in this--the first school of public health in the United States.

It flourished so well for eight years that by 1920 the Administrative Board reported that it was "in its eighth year of successful operation and . . . no longer an experiment." They felt a real need had successfully been met and suggested extension of the work.

Two years later a drastic change took place. Handicapped by having to issue joint degrees, and by an unusual organization, the school had attracted little of the independent financial aid which it needed desperately. To meet this budget crisis, plans were drawn up under the direction of Dr. Roger Lee which recommended setting up a separate Harvard School of Public Health. They were accepted by the Corporation, and thanks to a generous grant from the Rockefeller Foundation, the new school began in the fall of 1922, with Dr. Lee as acting Dean.

World-Wide Projects

For twenty-four growing years, it trained leaders in public health from around the world. Expeditions studied disease in the four corners of the globe, returning with information for further research. Dr. Richard Strong lead a series of trips through the Belgian Congo and Liberia during the middle thirties, while Dr. George Shattuck investigated the health problems of Guatemala. These were but a few of many varied trips sponsored by the school in cooperation with foreign health organizations.

In its second decade about thirty-five public officers graduated annually. This was considered an adequate contribution for Harvard to the country's demand for workers and as a result few attempts were made to enlarge the school. The several departments that did join during this period worked closely with the Medical School. Difficulties arose from this arrangement, however, because of unnecessary duplication. Professors with joint appointments to both schools found it difficult to teach post-graduate and undergraduate health and medical students.

Research Mushrooms

But little was done to change the relationship. Research in the Health School continued to mushroom rapidly. With the arrival of World War II, a heavy burden fell on the school. Any reorganization had to be shelved in the face of increased research for the war effort. Under the auspices of the Army public health program, the school played a major role investigating new health problems. With the end of hostilities, Harvard saw a pressing need for specialists and adapted itself to cope with a world torn by destruction. Reorganization plans were taken down, dusted off, and put to use. The break with the Medical School was completed and the revitalized School of Public Health began.

Like many another graduate schools Public Health soon found that finances were headaches which threatened to curb ambitious plans. An initial grant of $1,000,000 from the Rockefeller Foundation and special funds from the Corporation gave it an initial send-off. (The Rockefeller money runs out in 1956.) But they were only temporary boosts, incapable of sustaining research and planning for years ahead.

Long-Range Expansion

Under Dean James Simmons, appointed in 1946 after serving as Chief of Preventive Medicine for the Army during World War II, the school planned long-range expansion. Departments were to be enlarged, faculty increased, and more students admitted. But only with more money could such schemes go into effect.

A momentary answer was found in temporary, short-term grants for special research from private foundations, industry, and the government. Professors continued working on many projects begun during the war, while several special jobs designed specifically for industry got under way.

With the jump in lab work, the school expanded its facilities, acquiring the old Huntington Avenue Cancer Hospital which it turned over to the Departments of Nutrition, Microbiology, and Epidemiology. But this expansion did not adequately meet pressing demands for more space. The demands have not yet been met. No one is more aware of their cramped quarters than the professors themselves. But they only smile when someone suggests enlarging them. "What for?" they ask. "We would only fill up that space too."

Grants Run Low

Grants are constantly running out. To provide for what may be a serious financial situation, the Dean, with former Massachusetts Governor Bradford, has launched a stabilization and consolidation program. They are aiming for $12,000,000. If plans run according to schedule, they will use this money to construct a seven story annex to the school's main building. Part of it will go towards establishing a more permanent endowment fund. And the rest, with other ten-year grants, will build on the school's program to assure life tenure for senior faculty members.

But most of the school's finances still rests on short-term grants. Seventy-one percent of last year's budget came this way. Government money helps more than the Dean likes to admit. "If it were not for government aid," he says, "this school and many like it would have folded long ago."

The budget difficulties affect the faculty where it hurts--in the pocket book. Young professors come with no assurance that they will be carried from one June to the next. Assistant Professors are not granted life tenures because the salary money does not exist. Actually the school cannot guarantee positions for more than five or ten years in the future. They plan for the future, hope for the future, but can do nothing definite until their budget is on a more stable footing. It is like a runner who hurdles a wide hole confident that he will land on the other side. Public Health today vaguely hopes the other side is there.

Instability

Many instructors arrive with the understanding that they must support themselves and their departments by securing grants from outside sources. Worry over how their work is going to be done, and whether industries will be in a generous mood to assist them next year haunts these professors. It cuts into experiment time and curbs the school's effectiveness. Lack of endowment has given Public Health an unhealthy sense of instability. Even small grants must be turned down because of limited time and space.

Yet the mystery of Public Health is its vitality. The school hums with activity. The answer may be that men who might normally relax, secure that they have a job for life, are out hustling to get funds to carry on their research.

Proof of the pudding is in the eating. And the proof that Harvard has not yet been seriously hurt by budget troubles is the number of qualified students and professors who flock to the school every year. They come with new ideas for experiments--kept current to meet the demands of new public health problems. Many of the younger men at one time or another have been offered jobs outside the school with a hike in salary, yet they have refused to leave Harvard. Most are confident that the school will soon solve its financial worries.

High Overhead

A second serious handicap to research has been high overhead. Almost one third of all money spent on projects pays for indirect costs and eats into precious funds necessary for experiments. Regrettably, the majority of grants stipulate only a ten to twenty-five percent cut for meeting such costs. The difference must be made up by the school. Experts feel this overhead difficulty will only be cured when the faculty accepts grants which pay for "total cost"--both indirect and direct.

Actual research covers myriad fields. It ranges from work on air filtration sponsored by the Atomic Energy Commission, to highway safety studies and improved methods of transportation, and back to research in the calcium requirements of Americans. Causes of overweight are being investigated side-by-side with dangers from alcohol.

President Conant has pointed out that the job of preventive medicine is to prevent medicine. The health schools of the nation struggle to wipe out disease and illness so that the doctor will become a relic of by-gone days. One Boston physician was so perturbed by this possibility that he devoted much of his life to campaigning against public health schools, fearing all the while he would be out of work if they were successful. Only through such a varied and complex list of projects does the school expect to lick the causes of disease and end it before it starts.

Ten Pillars

The ten pillars of Public Health at Harvard are its ten departments, each with its own staff of teachers and researchers. Once watertight compartments, under the reorganization program they have loosened up and are now working more effectively together. Lectures are no longer duplicated and courses are more closely coordinated. For example, the Nutrition Department is working hand in hand with the Department of Maternal and Child Health, swapping the latest information on diets.

Mainstay of the new cooperation are the Dean's Faculty Research Conference and Curriculum Committees which coordinate some of the school's scattered research programs. Each department still runs itself and must hustle to get its own money, but more and more, individual problems have become school problems. Though inde dependently-minded and involved with his own experiments, the department man takes a world view of public health. He catches the spirit of the Dean who says that Harvard is a "mecca for world health."

This world view carries over to the student body. With more than 1300 alumni scattered in 78 countries and territories, the school is acutely aware of international health problems. An average class of 115 students has 40 foreigners. Many come for a year with the express purpose of picking up additional training to enable them to take charge of public health projects in their home counties. Dr. John Gordon reported visiting with top health men in Iraq, Iran, and Lebanon all graduates of the Harvard school. The Iranian Minister of Health and Child Welfare is an alumnus. With some pride the school quietly reminds itself that it has sent graduates to head five of the ten American schools of Public Health.

Foreign Interest

Despite over-growing foreign interest in the health field, the school feels that few American are aware of the tremendous job public health officials have done in this country. With an ever-increasing demand for health personnel, the supply of eligible American leaders remains the same, and has even dropped slightly. This bothers men at Harvard. Some consider it one of the most serious problems the school must face. Unfortunately, low salaries and little public recognition offer little inducement and not much is being done to attract new men into the field.

Meanwhile, Harvard does well by its students. Many come to the School having already earned a degree in some field of medicine and with experience in one of the medical sciences. They are a mature group, anxious to work long, hard hours.

Their time is divided between laboratory, lecture hall, and field trip. The school stresses these frequent outside expeditions to neighboring hospitals since it is situated in the heart of Boston's Medical District. The Peter Bent Brigham Hospital is across the street, while the Children's Medical Center, "Boston Lying-In" and Beth Israel Hospital are near-by.

Public Health officials are warmly invited to lecture on current health problems and to demonstrate their work. These local experts are often invited into classroom discussion.

Service

Service is the last important phase of Public Health at Harvard. Through directorships, appointments, and work with health committees the school's faculty keeps in close touch with the profession, in addition to offering its advice. The Department of Maternal and Child Care is typical of nearly every department in the School. Here every teaching member serves on some board or commission of a federal, state or local health agency. Six of the school's faculty are special advisors to committees of the World Health Organization.

Aside from direct community, the school annually sponsors conferences on health problems. Last year the Industrial Tropical Health Conference attracted medical directors and management officials from twenty-three major industries. The Institute on Child Health and Development drew thirty-four Public Health social workers from twenty states, Alaska and Hawaii, while the school's conference on Health and Safety in Aviation brought together top air officials.

Internationally, the stream of professors comes and goes from 55 Shattuck Street to all corners Professor Stare of the Department of Nutrition has just left for Indonesia, while Dr. Gordon is now in India with the World Health Organization. The most immediate recognition of such international work came from the Belgian government. It presented the school with $20,000 toward the school's newest professorship estab-6Laboratory research makes up a third of the training of a public health student. Here a group are experimenting and checking facts they learned in a discussion group earlier in the day. The third part of a student's training goes into research in the field, where they visit local hospitals to see public health actually at work.