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FOOD FRIGHT Targeting Sugar & Salt

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FOOD FRIGHT Targeting Sugar & Salt Harvard Public Health Review Fall 2009 FOOD FRIGHT Targeting Sugar & Salt ALSO INSIDE John Briscoe’s “waterspace” Health inequality on the Internet Social and environmental pollution: a toxic mix Tracking urban air pollution Tapping into stimulus funds Cancer looms in the developing world HARVA RD School of Pu blic Health DEAN OF THE FACULTY Alumni Councilors VISITING COMMITTEE Julio Frenk 2006-2009 Jeffrey P. Koplan Anthony Dias, MPH ’04 Chair ALUMNI COUNCIL Harvard Ramona Lunt, MPH ’74 Ruth L. Berkelman The Harvard Public Health Review Biba Nijjar, MPH ’06** Nils Daulaire Officers is published three times a year for Nicholas N. Eberstadt Mark S. Clanton, MPH ’90 2007-2010 supporters and alumni of the Harvard Roderick King, MPH ’98 Tore Godal President School of Public Health. Its readers share Monisha Machado, SM ’07** Jo Handelsman a commitment to the School’s mission: Royce Moser, Jr., MPH ’65 Gloria Rudisch, MPH ‘70 Risa Lavizzo-Mourey President-Elect advancing the public’s health through 2008-2011 Bancroft Littlefield learning, discovery, and communication. Elsbeth Kalenderian, MPH ’89 G. Rita Dudley-Grant, Nancy T. Lukitsh Vickie M. Mays Secretary MPH ‘84 Harvard Public Health Review J. Jacques Carter, MPH ’83* Sean Dunbar, SM ‘08** Michael H. Merson Harvard School of Public Health Immediate Past President Maxine Whittaker, MPH ‘86 Anne Mills Office for External Relations Kenneth Olden Third Floor, East Atrium Regional Representative John W. Rowe 401 Park Drive Myron Allukian, Jr., MPH ’67* Bernard Salick Boston, Massachusetts 02215 Burton Singer (617) 384-8991 **Class Representative * Harvard Alumni Please visit www.hsph.harvard.edu/review Association-appointed and email comments and suggestions to director [email protected]. Dean of the Faculty Julio Frenk T & G Angelopoulos Professor of Public Health and International Development Vice Dean for External Relations The Association of Schools of Public Health recently embarked on a campaign entitled Ellie Starr “This Is Public Health,” because many people outside the profession don’t understand Sr. Director of Development Marketing what public health is and how it affects their daily lives. In this issue of the Review, we and Planning use the campaign logo and accompanying text so readers can easily share with friends Julie Fitzpatrick Rafferty what public health’s mission is and how HSPH contributes to the field. To learn more Guest Editor about the “This Is Public Health” campaign, go to www.thisispublichealth.org/. Madeline Drexler Associate Editor Larry Hand For information about making a gift to the Harvard School of Public Health, Art Director please contact: Anne Hubbard Ellie Starr Development Communications Vice Dean for External Relations Coordinator Office for External Relations Amy Roeder Harvard School of Public Health Third Floor, East Atrium Principal Photographer 401 Park Drive Kent Dayton Boston, Massachusetts 02215 Cover: Kent Dayton/HSPH (617) 384-8970 or [email protected] For information regarding alumni relations and programs, please contact, at the © 2009 President and Fellows of above address: Harvard College James Smith, Assistant Dean for Alumni Affairs (617) 998-8813 or [email protected] www.hsph.harvard.edu/give Public Health Review Fall 2009 14 Food Fright 8 Mr. Water in His Element Public health takes aim at sugar and salt. John Briscoe offers bold, unorthodox ideas for managing scarce water in the developing world. 4 The Shadow Epidemic Also in this Issue 24 Cancer is on the rise in developing nations. 38 In Memoriam 21 Navigating Health on the 40 Alumni News Information Superhighway Researcher removes roadblocks HSPH in Brief for people with limited income and literacy. 42 Research 24 The Wrights’ Stuff 44 Philanthropic Impact Couple’s combined expertise forges new directions for treating 46 New Initiatives asthma and lead poisoning. 47 Faculty News 28 Stimulating Ideas 48 Bookshelf Researchers tap into a new 32 source of government dollars. 49 Continuing Professional 30 Catching the Flu Before It Education Calendar Catches the World 52 HSPH Commencement 2009 HSPH investigators help lead H1N1 research and response. 32 Clearing the Air Students target air pollution, from Boston to Sub-Saharan Africa. 34 2009 Alumni Award Winners Are Scientific Pioneers, Inspirational Teachers Image credits: top left, Sean McCabe; top right, Tony Rinaldo; all others, Kent Dayton/HSPH Cancer Prevention Malignancies are on the rise in developing nations. by Julio Frenk, MD, MPH, PhD Dean, Harvard School of Public Health hile it’s well known that cancer According to the most recent In low- and middle-income Wis a leading cause of death World Health Organization (WHO) countries, the high incidence of and disability worldwide, what is less estimates, in 2004 there were malignant tumors related to commu- recognized and understood is the 7.4 million cancer deaths worldwide, nicable diseases, such as the human significant growth of cancer in the representing around 13 percent of papilloma virus (HPV), reflects a developing world. Only two decades total deaths. More than 70 percent dearth of reliable systems for disease ago, the percentage of new cases was of those deaths occurred in low- and control and screening services. By similar for developed and developing middle-income countries. contrast, the increasing incidence of regions. Today, 55 percent of new lung, breast, and colorectal cancer is cases arise in developing nations—a PUBLIC HEALTH SUCCESSES SET STAGE largely the result of demographic and figure that could reach 60 percent by Why is cancer increasing in the devel- lifestyle changes, including longer life 2020 and 70 percent by 2050. oping world? expectancy and accelerated urbaniza- Unless a shift in mindset Ironically, successes in other tion, which in turn leads to repro- occurs—with those committed to realms of public health are partly ductive patterns (pregnancy at older global health investing more in cancer behind this shift. Gains made against ages, low prevalence of breastfeeding) information, prevention, screening, infectious diseases and increases in and lifestyles (tobacco consumption, and treatment—the number of new child survival beyond age 5 now make high calorie intake, alcohol abuse) cancer cases worldwide will grow from it possible for people in developing associated with several forms of around 12 million today to 15 million countries to live long enough to suffer cancer. in 2020, with much of that growth the noncommunicable diseases associ- occurring in developing nations. ated with age. Yet infectious diseases remain serious threats, creating a double burden of ill health. 4 Harvard Public Health Review A COMPREHENSIVE VIEW OF by agents such as HIV, HPV, hepatitis Hemisphere outside of sub-Saharan GLOBAL HEALTH B virus, and Helicobacter pylori. Africa are more alike than different,” says The global health agenda remains In addition, noncommunicable Barry R. Bloom, former Harvard School focused primarily on communicable diseases and injuries are increasingly of Public Health dean. diseases and the traditional identifi- prevalent in the developing world. cation of international health with Problems only of the poor—such FALSE DILEMMA CREATES BARRIERS infectious disease control. We need, as common infections, undernutri- Today’s alarming cancer statistics stand however, to adopt a more comprehen- tion, and maternal deaths—are no in stark contrast to an equally alarming sive view. First, the separation between longer the only problems of the poor. lack of awareness, both locally and glob- communicable and noncommunicable Impoverished groups also suffer the ally. Sadly, a false dilemma has created diseases is not as clear-cut as it was highest rates of many chronic ailments, barriers to action. Screening procedures once thought. According to WHO, such as cardiovascular diseases, cancer, for cancer are considered too difficult one-fifth of all cancers worldwide are and mental disorders. “Healthwise, the and costly to implement. Some experts caused by chronic infections produced Northern Hemisphere and the Southern continued STATISTICS PAINT A CHANGING CANCER PICTURE Women Men • Breast, cervical, stomach, lung, and colorectal • Lung, stomach, liver, esophageal, and colorectal cancers are the most common cancers among cancers are the most common cancers in men in women in developing nations. developing nations. • Breast cancer now surpasses cervical cancer as • While rich countries are witnessing a decline the number one cause of cancer-related deaths in new cases of lung cancer (a result of broad in all but the poorest nations of the world. antismoking campaigns), low- and middle- Developing countries account for 45 percent income nations—the focus of billion-dollar of the 1 million new cases of breast cancer tobacco industry publicity campaigns—are diagnosed each year, and 55 percent of deaths. experiencing the opposite trend. • In Latin America, two countries, Uruguay (83 • Developing countries’ share of new lung cancer per 100,000 women) and Argentina (75 per cases increased from around 30 percent in 1980 100,000 women), have already reached breast to more than 50 percent in 2007. cancer incidence rates similar to those of Canada (96 per 100,000 women), which are among the • In China alone, smoking prevalence in the highest in the world. general population is 31 percent. In adult Chinese men, smoking prevalence may be • Cervical cancer, now a rare disease in rich reaching 70 percent. nations, causes more than 200,000
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