Picture of health


DR. ALFRED SOMMER is stepping down after 15 years as dean of the Johns Hopkins Bloomberg School of Public Health. In September, he will rejoin the school's faculty. Dr. Michael J. Klag will succeed him as dean.

Sommer reflected on his time as dean in a phone interview from Monterey, Calif., where he was attending his last annual meeting of the country's public health deans - a gathering he started not long after taking the helm at Hopkins.

What are the most important developments in public health today?

There are really two different strains that are terribly critical. The first, and most immediate and acutely deadly, is the emergence of new infectious diseases, one so horrendous - HIV/AIDS - that it is almost difficult to imagine how much damage it is wreaking.

Like most things that are chronic and ongoing, it has become so pervasive, and we have read so much about it, that people in the United States have become quite passive about it. At the beginning of this horrendous epidemic, when we did not know what caused it, people were scared stiff, afraid to touch other people. That has morphed into too many people referring to it as just another chronic disease like diabetes. That drives me up a wall because it is not like any other chronic disease. HIV/AIDS is a disease that is entirely preventable.

So there is this major thread, that long after we thought infectious diseases were conquered by vaccines and antibiotics, there has been the emergence of these new and potentially dramatically deadly diseases - not only HIV/AIDS but also SARS [severe acute respiratory syndrome], and now, of course, avian flu or some other form of flu that could replicate the pandemic of 1918 when some 20 million people died.

The background noise to that is that public health has been immensely successful. Ninety percent of the increase in life expectancy has to do with public health improvements - basic nutrition, sanitation, better living conditions. Only 5 to 10 percent is due to so-called modern medical methods. But when public health is successful, nothing happens, so people don't recognize how important it is to continue to invest in it.

The other important thread is the emergence of the export from the United States of chronic diseases, largely because of changes in lifestyle. Increasingly, we see the same things that have happened in the United States happening to the middle class and upper classes in developing countries, such as obesity, which leads to diabetes with all its costs and complications, chronic heart disease, cancer. One of the biggest things that is spreading in the developing world is a huge epidemic of lung cancer because of the export and marketing of tobacco products.

Is public health getting more respect than it did when you became dean 15 years ago?

Unquestionably. People are now much more sensitive to the implications of public health. You don't see that in investments by the government. The federal government for the most part is not into preventive services - either domestically or overseas - to the degree that they are warranted. But on the individual level, you see an enormous respect and concern for academic public health.

One of the first jolts to the average American was the anthrax letters sent out after 9/11. There weren't many of them, they killed very few people, but what concerned people was this totally unknown, nonpredictable deadly event. Because of bioterrorist concerns, there followed a major political discussion of what might be the appropriate strategy to protect the U.S. population from smallpox. The public debated immunizations and its complications. That was immediately followed by the SARS outbreak. These were the kinds of things that truly sensitized people to the importance of public health. It was as if they were marketing tools that I invented.

Not as dramatic, but things like the movie Supersize Me, the book Fast Food Nation, made people better understand the growing obesity problem, the impact that's going to have on diabetes and other chronic diseases. Maybe you are keeping yourself healthy, but you are paying the bills for those who are not, which leads to enormous strains on our health resources.

Another thing that is half done is a very successful war on tobacco use. We have seen places like the city of New York and the state of California on the vanguard, using essentially every major device available to the political establishment - regulation, education, taxation and legislation.

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