Emory University Woodruff Health Sciences Public Health

Photo by Mark Rosenberg

THE THREAT OF AN AVIAN FLU PANDEMIC has set public health professionals scrambling to prepare for what could be a worst-case scenario, illustrating the complexity and magnitude of today’s global health challenges. These challenges require collaboration and expertise not only in understanding the epidemiology of disease but also in guiding prevention, health education, and sound health policy—and all this in the context of organisms that move around the globe with far greater ease than ever before. And infectious organisms are only part of a global health equation that touches on every aspect of daily living, ranging from drinking water and adequate nutrition to political, environmental, and cultural issues that impact individuals as well as populations as a whole.
In a strategic plan unveiled last fall, Emory University committed to taking on some of these challenges, an action that represents no small ambition. Finding solutions to health problems of global magnitude will require not just resources and expertise but also creativity, innovation, and courage.
The Rollins School of Public Health (RSPH) is playing a key role in helping the University realize its vision, and vital to this effort is the Hubert Department of Global Health. Following are highlights of the ways this department is leading the way in this arena and training a whole generation of others to do so as well.

Gender issues in cultural contexts

Last March, Kathryn Yount found herself at the center of two highly publicized court cases in Atlanta that involved female genital cutting. This practice, which occurs in approximately 2 million girls each year, ranges from the removal of the skin around the clitoris to infibulation, where the clitoris and vaginal lips are removed and the external genitalia are stitched together. The trials drew attention to the presence of this controversial practice close to home, in the immigrant communities in Georgia.
For her testimony as an expert witness, Yount drew on evidence from her research in Egypt and from other national studies. In her study population in Egypt, less severe versions of this practice have had negligible effects on reproductive health, but severe practices elsewhere have increased rates of infertility and stillbirths. Yount’s research has helped policy makers think about potential health messages for populations steeped in the ritual and how immigrant practices fit into U.S. and state health policies. In March 2005, the Georgia legislature passed House Bill 10, creating a specific criminal statute against female genital cutting of minors.
Yount also has worked on several longitudinal studies in Egypt that look at the causes of disparities in men’s and women’s health throughout their lifetimes. In Egypt, being a man has some important advantages, she says. Her research has shown a higher risk of mortality among girls, parental discrimination against daughters in the allocation of food and health care, and biased care by providers who treat children for diarrheal disease. Her study demonstrated for the first time potential gender inequalities in provider care in Egypt. Through new research on older women and men in Egypt, she now is studying how early-life disparities in care affect the health and well-being of men and women into adulthood.

Food for thought

Hubert faculty members recently completed research for the most comprehensive assessment ever of the importance of nutrition for economic productivity. The findings point to the role of malnutrition on intellectual performance and physical growth and the resulting impact on an adult’s economic potential.
     After following a study population in Guatemala for more than three decades, a research team led by Rey Martorell has shown that improving nutrition in preschool children not only improves their physical and intellectual development but also affects their ability to earn a living over the course of their lifetimes. Research from a follow-up study from 2002 to 2004 carried out by Martorell, Ari Stein, Rafael Flores, Usha Ramakrishnan, and others will be published this year, but already a supplement to Food and Nutrition Bulletin outlines the findings: strong effects on body size, educational improvements in reading tests from 10% to 15%, and an 18% increase in lifetime income—all resulting from a simple nutritional supplement provided to children.
     “This study brings more argument for why governments should invest in children,” says Martorell.
     The research in Guatemala is just one area where the RSPH is making an impact in global nutrition. Glen Maberly, founder and director of the Program Against Micronutrient Malnutrition, has been a key leader in an effort to eliminate iodine deficiency in children in China.


	Training the next generation
	The Hubert Department attracts 40% of the applicants to the RSPH, in part because of the array of choices it offers—joint programs in environmental health, epidemiology, international nursing, and global nutrition, to name a few. Mid-level career professionals can compete for slots in the Hubert H. Humphrey and Edmund Muskie fellowship programs as well as the William H. Foege Fellowships in Global Health. (For the Humphrey fellows, the RSPH offers the only U.S. campus with an AIDS concentration in the country.) The Peace Corps master’s program at the RSPH is the second largest in the United States, allowing students to combine graduate studies with Peace Corps service to earn a degree. The Center for Health, Culture, and Society allows students from public health and arts and sciences to explore the interplay among these disciplines. And the Fogarty Fellowship Program provides opportunity for public health and medical professionals from developing countries to do interdisciplinary research in HIV prevention and care.

Safer water = saved lives

In an arid eastern Africa district near Kitui, Kenya, a woman might walk for hours to get to the river bed. When she arrives there, the river is dry so she digs down until she finds enough water to fill her pails with what she can carry. Then she starts the journey home.
     In Nyanza province, there is a different problem. Here water is plentiful, but it is contaminated by animals, people, and pollution. Drinking this water contributes to the highest diarrheal rates in Kenya, accounting for some 20% of deaths in children under 5.
      The Atlanta Rotary Club finds both of these scenarios troubling. Teaming up with the Center for Global Safe Water at the RSPH, CDC, and the Rotary Club of Kenya, the Atlanta club is funding two programs to bring safer water to Kitui and Nyanza. The first is a project to drill 100 new wells in eastern Kenya. Although the wells are spread out, still requiring a walk to reach them, Kenyans at least will have the guarantee of water rather than a dry river bed when they arrive. The second program is distribution of a water purifier, WaterGuard, through microbusinesses run by local community women in Nyanza province. The goal is to have 1,000 women selling WaterGuard in two years.
     Trish Anderson, MPH04, is the project coordinator for both efforts. When Anderson entered graduate school, her timing was perfect to join the first group of students to study global environmental health at the RSPH. Most of her time now is spent in western Kenya, where she helps women get started in their own businesses to sell WaterGuard. She also holds training for a safe water system developed by CDC that involves a purifying method, storage in safe containers, and hygiene education.
     “We are trying to teach rural women new skills within confines of the culture where one-size-fits-all business models don’t work,” Anderson says. “These women are motivated by their role as caretaker as much as if not more than their need to make a living. Creating profitable and sustainable businesses with that in mind takes time and patience.”
     The partnership with Atlanta Rotary is just one of the collaborations of the Center for Global Safe Water. Center director James Hughes and faculty Rick Rheingans and Christine Moe spearhead a variety of water and sanitation initiatives from training the next generation of water experts to supplying technical assistance and scientific advice for the Community Watershed Partnerships, a national initiative by Coca-Cola for improving water access and quality abroad. The center is working with CDC to take its safe water system to new locations in the developing world, through sanitation research with the El Salvador Ministry of Health, and with CARE, CDC, and the Coca-Cola Company to expand water education in 500 schools in Kenya.