Public Health’s Past and Future

Michelle A. WilliamsPhotograph by Ben Gebo/Courtesy of the Harvard T.H. Chan School of Public Health

Michelle A. Williams attracted a great deal of attention last year when she was appointed dean of the Harvard T.H. Chan School of Public Health (HSPH)—less for her career as a distinguished epidemiologist than because she is the first African American to lead a Harvard school. In person, her soft-spoken disposition doesn’t appear to invite public attention. Was the symbolism of her appointment personally important to her? “It was my first exposure to a massive amount of public attention,” she recalled at a recent interview in her Kresge Building office. “And it did set me back a little bit. So much focus on my race, my gender, and the fact that I’m foreign born” (her family emigrated from Jamaica to New York when she was a child). “I’m proud of all of those. If I can be a positive symbol, that it’s possible to overcome minority status and that there are no limits to the capacity to excel and achieve leadership roles at the highest institutions, then it’s important to me.”

Williams, who earned her Sc.D. in epidemiology from HSPH in 1991 and whose research has focused on maternal and infant health, assumed office last July, succeeding Gregory professor in cancer prevention emeritus David Hunter, who had temporarily taken up the post following the departure of Julio Frenk (now president of the University of Miami). HSPH had exceeded its capital campaign goal of $450 million, thanks to an unrestricted $350-million gift that transformed its financial structure—the largest-ever donation to a public-health school. Williams says the central goal of her tenure has been to use the gift to “position the school to soar to even greater heights,” particularly as federal funding as a share of the school’s research funding has decreased. “It’s an urgent area of concern,” she said. “After the 2008 crisis, it became very evident that we as an institution had to work diligently to diversify our funding streams. Seventy-five percent of our funding comes from sponsored research; 85 percent of that comes from the federal government. We are the most dependent of the Harvard schools on federal funding.”

HSPH’s campaign aimed to position the school as a premier center of research into the determinants of human health in the twenty-first century: old and new global pandemics; harmful physical and social environments (including industrial pollution and gun violence); poverty and humanitarian crises; and failing global-health systems. Williams’s expertise at the intersection of epidemiology and biology, as well as her sensitivity to the social context of health, position her well to lead across those domains. The campaign also aimed to raise funding for new professorships, student financial aid, and renewal of the school’s infrastructure. The latter, according to Williams, might sound boring, but remains essential to promoting interdisciplinary work: “We’re spread out across 25 physical addresses, which means we don’t benefit from having the enormous talent represented in the school collocated in a way that fosters collaboration.”

To those ends, the naming Chan gift, along with new partnerships with the for-profit sector and foundations (what she called “non-traditional collaborators”), have augmented HSPH’s resources as public funding has attenuated; in May, for example, the school was awarded $4.9 million from the Massachusetts Life Sciences Center, a private investment agency, to fund an initiative to study the microbiome. Philanthropy has also helped fund a new professorship in humanitarian studies; a Center for Health and Happiness; and a global cancer-prevention initiative; and has helped fund the school’s transition from an Sc.D. program to a fully funded Ph.D., to attract and support the field’s strongest students. Students still in the Sc.D. program typically don’t receive living stipends or the same benefits as Ph.D. students: “The irony is that the transition highlighted very obvious inequities,” Williams explained. With the Chan gift, “We did manage to close the gap—it’s not completely closed, but we’ve worked with the Sc.D. students to provide tuition support and help cover the gap.”

At last year’s Commencement, Williams spoke about the philosophy of public health as a field that for the first time linked the categories of health and human rights. But in the twentieth century, Williams stressed, the field experienced transformational shifts in its philosophy and practice: “There are some not very appealing episodes in the history of public health in this country. There have been episodes of coercion used against minority populations: outside of reproductive health, we’ve had ugly episodes like the Tuskegee trials. Those are horrible cases whose ramifications are still felt in communities of color.” And “in light of public health’s especially troubling history concerning reproductive health,” she added, it is “critically important…to recognize where the field stands today: for reproductive justice, which means every woman should have a right to the full array of reproductive health services, including birth control, screening for reproductive disorders, and abortion rights.

“There has to be recognition, when community outreach is being done,” she said, “that the history [of the field] is not ignored. Because of that history, public health needs be to attentive to the diversity of its workforce, needs to be attentive to the fact that the philosophy of public health is that it’s a social movement that is designed to optimize maximum human potential at a population scale, that it is about honoring individual human rights.”

Read more articles by Marina N. Bolotnikova

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