Defending the public good through two major pandemics
Colombia News sat down with Dean Dr. Linda P. Fried as Columbia Mailman’s centennial celebrations began. A pioneer in the science of aging, Fried teaches a course called “(Your) Longer Life” which is part of a public health concentration she designed for undergraduates at Barnard and Columbia. Fried is DeLamar Professor of Public Health at Columbia Mailman; Professor of Medicine at Vagelos College of Physicians and Surgeons at Columbia; and Senior Vice President of Columbia University Irving Medical Center.
Question: The Columbia Mailman School of Public Health was founded in the wake of the 1918 influenza pandemic, the last major pandemic before it. How has the discipline of public health changed?
Linda P. Fried: The principles of public health that were first formulated a hundred years ago are still relevant today. We are responsible for the science and solutions to prevent disease, disability and injury, and to improve the health of all through scientific solutions and by working in partnership with all sectors of society to translate knowledge into action collective. In the last century, we have greatly expanded our knowledge, but society has not fully invested in its use. If we respect what science tells us, we will all benefit.
Question: What’s the most important COVID takeaway?
Fried: Our ability to meet the needs of the public is deeply threatened by polarization and the lack of shared responsibility for the common good. We can only create safe water, food and air for all through public investments, regulations and shared actions. We can only increase child survival through programs that help everyone, on a large scale. We have been sort of sold a bill that individual independence absolves collective responsibility. It really hurts us in this pandemic because we can only solve a pandemic together by preventing the spread of infection.
Question: What did we understand correctly?
Fried: Two things. Public health knows how to contain the spread of infectious disease, and where that knowledge has been used, it has worked. We have non-pharmacological interventions: the incredible effectiveness of masking, hand washing, physical distancing, good ventilation, and contact tracing. These are simple, inexpensive, and high-yielding approaches that you can easily scale up. Then there is the miracle of scientific discovery. Over the past decades, scientists have developed the knowledge around mRNA that has enabled them to create a vaccine within a year. It was the result of decades of investment in understanding and neutralizing viruses.
Question: What do you think is the greatest public health achievement of the last century?
Fried: There are so many. Reproductive health advances, understanding the role of the environment in creating health, the science that has shown us how to prevent chronic disease. What these accomplishments add to is something we have never seen before in history. We have added 30 years to human life expectancy around the world. It has never been done, and 25 of those 30 years have been attributed to public health. We have added a whole new stage to human life. And there isn’t a single thing that has done it. It’s all of those things.
Question: Where has Columbia Mailman made its greatest contribution?
Fried: The School has worked on all the questions to good effect, and many do not have easy outcome measures. The closest infectious diseases are infectious diseases, as they occur at a certain time and the results can be counted in a short period of time. Dr W. Ian Lipkin, director of the Center for Infection and Immunity, has been honored by China for saving the country from SARS. ICAP, led by Dr Wafaa El-Sadr, was honored for saving 20 million people from HIV by strengthening health systems and providing the capacity to treat and prevent HIV. These results are easier to count, and they do, of course! But even in the area of ââinfectious diseases, we have a billion other achievements to which no numbers are attached. Our faculty helped manage the Ebola response in West Africa for the World Health Organization and the United States Centers for Disease Control. They defined the concept of emerging infections; we are now seeing new infectious agents that we have never seen before on an increased scale.
A central area of ââconcern that unifies the faculty is how to resolve health disparities between people, populations, and zip codes. Why are some people denied the opportunity to be healthy, whether because of structural racism and discrimination, or because of cumulative disadvantage throughout their lives? How do we solve this? Throughout the history of the School, everyone has been dedicated to solving health disparities around the corner and around the world.
Question: You led the charge to create a core curriculum that is now the standard for schools of public health nationwide. Why?
Fried: When I became dean, we conducted a strategic planning process with the faculty to identify the issues that a large school of public health has the responsibility and the capacity to address. We have compiled a list of non-trivial issues: the impacts of climate change on health; global health and globalization, food systems, pandemics, health equity and how to make sure people spend those extra 30 years of healthy life. The 21st century is a very different game from the 20e, in terms of the problems, our scientific capacities and the lifespan of our students. They will be in the lead in 2020â¦ and 2060! The same people!
Our faculty envisioned a radically different curriculum to achieve these goals, which took two years to design, and when that was done, we had to spend a third year training ourselves to teach a new interdisciplinary curriculum, heavily based on case that gives students the big picture. Regardless of their career development, they have the context to understand how their work fits. .
Question: What keeps you from sleeping at night?
Fried: There are three public health threats that keep me awake at night, all caused by humans. The first is health equity. The health status of the United States has plummeted over the past 30 years, to the lowest of 36 developed countries. What is driving this is a disinvestment in public health nationwide.
The second is the impact of climate change on health. We have to solve them because they are close to an existential threat. Based on our strategic planning process 12 years ago, we launched the country’s first public health program on the impacts of climate change on health. At the time, most people thought it was science fiction.
A third challenge is to extend our âhealthy periodâ so that those extra 30 years of life that I mentioned earlier are healthy years. We need everyone to recognize that the most powerful public health solutions with the highest return will come from using science and implementing it at scale, for everyone. It’s the public health mantra, I guess, to create the conditions that make healthy options easier.
Question: What role does research play in policy development? Recent successes?
Fried: The way public health and medical science work is to start with the problems that affect people, recognize their importance, identify their cause, and find solutions. Our Center for Children’s Environmental Health began partnering 20 years ago with a nonprofit, WE ACT for Environmental Justice, to try to understand why asthma rates – the leading cause of absenteeism school for children – were so brought up in Harlem. They conducted community, demographic, and laboratory studies and found that the fumes from idling New York buses parked in Harlem were the cause of the asthma epidemic. The problem was magnified by the pesticides the city used to spray cockroaches in homes. Armed with evidence, the Center and WE ACT proposed to the mayor and city council that the city switch from diesel buses to electric hybrid buses. They did, and more recently the city has switched to all-electric buses.
In a second example, Virginia Rauh and her colleagues showed that the pesticide chlorpyrifos, a pesticide commonly used in agriculture, is a potent neurotoxin. In fact, it harms the development of children’s brains. With their evidence, based on population science, the US Environmental Protection Agency was set to ban chlorpyrifos early in the Trump administration. The administration blocked the ban, but our scientists stayed there! In 2018, Ginny testified before the Governor and State of Hawaii, who established the first statewide ban on chlorpyrifos. It is fabulous because it protects the development of children but also of agricultural workers whose brains are affected by this toxin.
Question: And at the national level?
Fried: After decades of research and advocacy, the Biden administration announced last August a ban on the use of chlorpyrifos on food crops.
Question: You have been dean for 13 years. What are you most proud of having accomplished during this time?
Fried: We have done a lot. It is difficult for me to choose an achievement. But overall, we have built a school that will lead the 21st century on the challenges of our collective future. I am inspired every day walking here. I have the privilege of working with people who create knowledge for the world and craft the solutions to make it happen. They are great at what they do.
It is our centenary time, and in our experience of the epidemic, to make people understand that public health is the foundation of a healthy society. Public health science, knowledge and solutions create 70 percent of the health of any population. People don’t know it. It is really important! The consequences of a sick population are devastating for the well-being of society. If some people have the opportunity to be healthy, and many others do not, it is also hurting the future of this society.