sph this year 2017 in a perplexing world. in aperplexing THOUGHT “ Our core purpose commits us to redouble our eort to ensure that we narrow these divides to produce the science and scholarship that contributes to a better, healthier world for all.” DEAR COLLEAGUES: WELCOME TO SPH THIS YEAR, our School’s us to always ask what the role of public health is in annual report. these changing times. To that end, while in this issue Our School’s core purpose is “Think. Teach. Do. of SPH This Year we feature the work of the School, For the health of all.” This aims to describe and we also feature 23 deans and program directors of animate what we do: we generate ideas through our other schools and programs talking about the role scholarship and research, think; we transmit this of public health in these times—their comments knowledge to the next generation, teach; and we work are captured on pages 46 to 49 of this issue and on to communicate these ideas and be a part of the the web at bu.edu/sph/thisyear17—who create a action that contributes to a healthier world, do. This compelling portrait of the central role that academic issue of SPH This Year focuses on our scholarship at public health stands to play in the years ahead. Thank a time when thought and science have become more you to all of our colleagues who participated in these important than ever. interviews; we learned from all your comments and Over the past year, we have seen the country— are excited to work together in the coming years. and to some extent, the world—engage in debate and I hope that all readers of SPH This Year enjoy this discussion that challenge the foundations on which summary of our work. A hard-earned thank-you goes the health of the public is built. We have seen e­orts to the communications group responsible for pro- to push back on gains around global environmental ducing SPH This Year. As important, a thank-you to climate change, gender equity, and social and eco- all members of our community, including the faculty, nomic justice. This creates a dangerous world, one sta­, students, alumni, and friends of the School— that has experienced repeated natural disasters and some of whom are featured in this SPH This Year, but the US’s deadliest-ever mass shooting, and one that many more who are not—who make this a dynamic, threatens to erode hard-fought gains in the health forward-looking School, deeply committed to promot- of populations. These shifts are, indeed, in many ing the health of populations. ways perplexing. But they also speak to some of the fundamental divides that color our world. Our core Warm regards, purpose commits us to redouble our e­ort to ensure that we narrow these divides to produce the science and scholarship that contributes to a better, healthier Sandro Galea, MD, DrPH world for all. Dean, Robert A. Knox Professor The cover, a Rorschach blot comprised of hundreds Twitter: @sandrogalea of images reflecting some of the most important public health themes that rose to prominence over the past year, challenges us to ask what we see in these pictures, what we see overall, and where these narratives lead us. Most importantly, it challenges COVER ILLUSTRATION CHARIS TSEVIS, KHENG GUAN TOH/HEMERA/GETTY IMAGES; LEFT ERIC LEVIN IMAGES; TOH/HEMERA/GETTY KHENG GUAN CHARIS TSEVIS, ILLUSTRATION COVER contents FEATURES SPECIAL FEATURE THERE’S SOMETHING IN THE AIR: PCBs. New Bedford Harbor is polluting 12 the city’s air. WHY ARE OUR MOTHERS DYING? Maternal mortality 22 rates are up in the US. NO EASY Rx FOR POOR PHARMACEUTICAL ACCESS. Getting essential medicines to those who need them. HOW WE SEE IT. 30 Public health professionals from across the US discuss today’s challenges. UPENDING THE GUN DEBATE. YOUR MONEY OR YOUR LIFE. Shifting the gun Preventing a 21st-century health-poverty trap. debate from control 46 4 34 to safety. SMALL BLOOD FACULTY SPOTLIGHT DEAN’S NOTE SAMPLES YIELD BIG CLUES ON LONGEVITY. IS JUSTICE CRUCIAL Biomarkers predict TO HEALTH? aging and its related eff ects. Shared justice can improve 40 56 public health. WEIGHT HISTORY 18 SIGNATURE EVENTS CAN TIP SCALES OF HEALTH RISK. PROFESSOR RECEIVES Extra weight at PRESTIGIOUS BU TEACHING AWARD. 32 SPH BY THE NUMBERS any time in life increases risk. Sophie Godley honored for 60 FACULTY PUBLICATIONS 52 inspiring students. COVER ILLUSTRATION CHARIS TSEVIS, KHENG GUAN TOH/HEMERA/GETTY IMAGES; LEFT AP IMAGES; RIGHT TOP TO BOTTOM CARL PEER; JOSE LUIS LUIS PEER; JOSE CARL BOTTOM TO RIGHT TOP LEFT AP IMAGES; IMAGES; TOH/HEMERA/GETTY KHENG GUAN CHARIS TSEVIS, ILLUSTRATION COVER IMAGES EMESILVA/GETTY IMAGES; ROMANELLI/GETTY MARC REX/SHUTTERSTOCK; IMAGES; NURPHOTO/GETTY IMAGES; PELAEZ INC/GETTY NEWS IMAGES SPENCER PLATT/GETTY SCOTT; RIGHT CYDNEY LEFT TO BOTTOM IMAGES; TOH/HEMERA/GETTY KHENG GUAN CHARIS TSEVIS, TOP 50 feature BROAD INITIATIVES ARE NEEDED TO ADDRESS GROWING INEQUITIES AND PREVENT A 21ST-CENTURY YOUR HEALTH-POVERTY TRAP. MONEY OR YOUR THE SURVIVAL GAP between the richest and poor- est Americans is widening, with the richest 1 per- cent living 10 to 15 years longer than the poorest 1 percent, feeding the country’s growing health inequities, according to School of Public Health LIFEresearchers writing in a special series in. The Lancet. AP IMAGES feature BOSTON UNIVERSITY SCHOOL OF PUBLIC HEALTH | SPH THIS YEAR 2017 | 7 THE LITERATURE POINTS OVER “WHELMINGLY TO THE FACT THAT SOCIOECONOMIC Based on current trends, the gap in life expectancy between the poorest 20 percent and wealthiest 20 percent of Americans is projected to increase by nearly a decade in a single HEALTH generation—rising from 77 versus 82 years for Americans born in 1930, to 76 versus 89 years for those born in 1960. GAPS “We are witnessing a slow-moving disaster unfolding for the health of lower-income Americans ARE WIDENING who entered the labor force after the postwar boom and have spent their working lives in a period IN THE UNITED of rising income inequalities,” Bor said. “Rising economic insecurity among poor and middle-class STATES. THIS CONSENSUS Americans has led to the persistence of smoking and the rise of obesity and opioid epidemics, IS NOTABLE with adverse consequences for health and life expectancy. At the same time, paying for healthcare GIVEN CURRENT in the USA today can bankrupt households and impoverish families.” EFFORTS TO SPH researchers say that behind changes in individual risk factors, such as smoking, obesity, CUT SAFETY NET and substance use, lie “distal factors” fueling the growth of survival inequities, such as unequal PROGRAMS access to technological innovations, increased geographic segregation by income, reduced eco- THAT PROTECT nomic mobility, and increased exposure to the high costs of medical care. THE HEALTH OF They recommend further research into socioeconomic inequalities in illness, rather than THE POOR.” JACOB BOR, just mortality: “Without interventions to decouple income and health or to reduce inequalities in ASSISTANT PROFESSOR OF GLOBAL HEALTH income, we might see the emergence of a 21st-century health-poverty trap and the further widen- ing and hardening of socioeconomic inequalities in health.” “The rise in income inequality in the USA in 1980–2015 has coincided with widening THE RICHEST 1% LIVE inequalities in health and longevity. Not only do the poor have lower incomes, they increasingly live shorter lives than do higher-income Americans,” writes Jacob Bor, assistant professor of global health; Sandro Galea, dean and Robert A. Knox Professor; and Gregory Cohen, statistical analyst in epidemiology. The five-paper Lancet series highlights the need for broad initiatives to address struc- tural racism and inequality and health reform that moves toward a single-payer system 10–15 to address growing health inequities and prevent a 21st-century health-poverty trap. The SPH team reviewed studies assessing changes in survival gaps between Ameri- cans of di­erent socioeconomic strata since 1980. “The literature points overwhelmingly to the fact that socioeconomic health gaps YEARS are widening in the United States,” Bor said. “This consensus is notable given current e­orts to cut safety net programs that protect the health of the poor.” LONGER THAN THE The researchers noted that, since 2001, the poorest 5 percent of Americans have POOREST 1% experienced no gains in survival, while middle- and high-income Americans have seen their life expectancy increase by two years. The researchers identified two distinct trends from 2001 to 2014: poverty deepened, and poverty became an increasingly important risk factor for poor health. PETER ESSICK/ GETTY IMAGES PETER ESSICK/ research BOSTON UNIVERSITY SCHOOL OF PUBLIC HEALTH | SPH THIS YEAR 2017 | 9 % Police-Led Addiction 95 Program in Gloucester OF THOSE OFFERED Shows First-Year PLACEMENTS ENTERED THEIR ASSIGNED Success PROGRAM. ACCORDING TO A REPORT by SPH researchers published in the New England Journal of Medicine, during the first year of a widely publicized initiative aimed at combatting the opioid epidemic, about 95 percent of individuals with substance-use disorders who came to the Gloucester Police Department for help accessing addiction treatment were placed in detoxifica- tion or substance-use treatment programs. The authors cred- ited a number of factors for the program’s success, including participants motivated to enter treatment, police working to find placements and establish a relationship with a local treatment center, and state-mandated insurance covering drug detoxification. In June 2015, the Gloucester Police Department began the initiative—dubbed the Angel Program—that encourages those with opioid use disorders to come to the department and ask for treatment help, with no threat of arrest.