Heels

I’m so excited about how great the men’s and womens’ teams have done. And the Davidson basketball game was thrilling. March madness is magical when we’re in it.

Our millennial students

Last week, I mentioned that I had just read a book titled the Millennials Go to College (Howe and Strauss, LifeCourse Associates, 2007). It is a fascinating glimpse into today’s students who, the authors claim, are way different from boomers—including most faculty members. Millennials learn differently (with your laptops, cell phones, teams), allocate time in different ways (you multi-task amazingly well, according to the statistics), and the authors say you won’t put up with being bored the way many of us were in school. A really interesting YouTube video A Vision of Students Today brings this home. (It’s always dangerous to generalize about groups so I apologize for doing so.) According to Howe and Strauss, more than other generations, millennials will be attracted by personalized attention and recognition in the recruitment process. The question is: how are we in the SPH going to interact with today’s students? What should we do differently? We need students to work with us to turn our ways of teaching into your ways of learning. How’s that for a big challenge!

Black cloud over NIH funding

In a recent letter to the DTH, one of our students wondered why we need a gift of $50 million when we received about $54 million in NIH grants and contracts in 2006-2007. It’s a reasonable question. The answer is complicated.

For one thing, grants aren’t guaranteed. That $54 million we got last year isn’t a sure thing for this year or next year. It’s not even a strong likelihood. It depends on the annual vagaries of the federal budget, which change from year to year. With the war in Iraq and other priorities of this President, NIH and most other health agencies are suffering, with flat budgets or worse. Because of out-year commitments, a flat budget is a cut budget. As the NIH budget tightens, money is harder to get. Junior investigators are hit especially hard, but even established investigators are having a hard time. Tight budgets tend to make reviewers more conservative, making it more difficult to get resources to pursue ideas that may appear riskier but could have greater payoff.

Elite private institutions have large endowments that help them weather storms associated with budget downturns. UNC never has had endowments like Harvard, Yale and Penn or even UVA, Michigan and many other public universities. These endowments often provide resources to help faculty get pilot funding necessary to compete successfully for grant funding. Without pilot funding, most applications are dead on arrival.

“A Broken Pipeline,” a report released recently by a group of organizations, including Harvard, Duke and Ohio State, contains very sobering facts.

• 5 years of flat funding for NIH coupled with inflation have added up to a 13% drop in real purchasing power for research. What does this mean for us? Our faculty may have to submit their grants 2 or 3 times before they get funded. It’s a demoralizing process. Each cycle between submissions threatens their staffs and delays discoveries that may benefit people. Some investigators won’t get funded at all. We are trying to buffer the in-between time for faculty, but if the situation gets much worse, we won’t be able to help everyone.

• A cascading effect
  As the report said, the overall success rate for NIH research project grants dropped from 32% in 1999 to 24% in 2007; more than three of every four research proposals are not funded. This trend represents a clog in the system that is causing researchers to abandon promising work, downsize labs, and spend more time searching for other financial support.

How the Gillingses’ gift and other gifts help

The gift from Dennis and Joan Gillings gives us an endowment. Much of the gift will be invested so that it reaps benefits for years to come. An endowment is the best hedge against the future. This isn’t about getting bigger although it is about getting better and better. It also is about pure survival. The funds will support Gillings Innovation Laboratories (GILs) to solve big public health problems. Our researchers will be funded by an internal competitive process that, when we finish its beta test, will be significantly shorter than the NIH process. We will encourage rather than discourage innovative ideas. We also want applicants to provide support for students to work on projects. GILs will help SPH researchers obtain critical pilot data. There are other activities associated with the gift as well (http://www.sph.unc.edu/accelerate). The Gillingses’ gift represents the generosity of two people with deep connections to the SPH. We’re grateful that they and many other donors care about and support our mission. As the Federal health budget shrinks, these gifts become more important. These are private not corporate gifts.

Good vs. bad money

Most of us in the school of public health don’t think all dollars are alike. This is like sensitivity and specificity in epidemiology. You can set the cut-point at different places, and there are implications of where it is set. If we were to say we’d accept no corporate funding, then, we’d make no mistakes by choosing to partner with organizations that might some day disappoint us. But we’d also miss out on huge opportunities. If we took any corporate opportunity that came along, we’d risk tainting our good name and possibly tainting research results as well when we associate with questionable companies. A case in point was played out last week when it was reported in the New York Times that Claudia Henschke’s research on lung cancer screening, published in the highly esteemed New England Journal of Medicine, was funded by the cigarette industry. Now people wonder if that affected her results. Most of us agree that research funded by the cigarette industry is not research we want to do. Across the school, I have been impressed by how different one faculty member is from another, and how strongly each defends their right to pursue their own priorities. I don’t micromanage individuals’ decisions about what research to undertake or where to seek funding once we agree on certain foundational rules, e.g. we don’t take tobacco money. Some faculty members have worked effectively with a range of companies for many years; others are not comfortable doing so. One of the great things about academia is that there is freedom to pursue different strategies within ethical and legal boundaries.

SPRING:

Hope folks enjoyed the weekend. It was magnificent in Chapel Hill. I finally planted the daylilies I have been thinking about for a few weeks. I don’t know if it is an act of foolishness or optimism to plant so early. We used recycled water from our rain barrel to water the new plants. Shopping for plants now is like going to the grocery store and reading nutritional labels. Is it drought resistant? How much water will it need?

RACE:

One has to give Barack Obama credit for putting race on the table in his speech last week (especially since it has been there all along). Commentators, including NPR’s Daniel Schorr, admitted they may have been too quick to call this a “post-racial generation.” Obama’s speech gave us new ways to work through some old, but still aching, wounds. We are dealing with the remnants of some of those racial wounds here on the UNC campus now and throughout our larger community, in the wake of the horrific murders of UNC student body president Eve Carson and Duke graduate student Abhijit Mahato. Talking to people at the School of Public Health and around town, in the wake of Eve Carson’s horrific murder, it is clear that race is an even more urgent issue we must confront here on our home ground. The loss of these two promising students will be even greater if people feel less safe and if racial tensions are exacerbated. I am not sure what the School’s best role is in confronting these tensions. Naturally, we study, teach and conduct research on health disparities. But is there more we can or should do? I really want to encourage the Minority Student Caucus to help us think about this so we can do the right thing.

LISTENING:

Last week, I mentioned upcoming faculty/staff forums. We will post times and dates/locations in the next couple days. One of our student leaders wrote and asked if it perhaps an oversight that I hadn’t mentioned students. I’m thrilled to have such careful readers! Actually, Felicia Mebane, Dave Potenziani, Mae Beale and I have been trying to nail down a plan for monthly lunches with students. Here’s what we are going to do. Every month, we will host a pizza lunch for up to 20 students. Students can sign up for a preferred month on a first-come, first-served basis. It’ll be a chance to tell us what you’re thinking and feeling and what you want us to know about and do. Ask us questions. We’ll do our best to get the answers if we don’t have them. We want to listen to our students and get to know them better.

READING:

I just finished a really interesting book called The Millennials Go To College. I’ll tell you more about it next week.

Happy Monday. Go Heels!

Welcome back!

Hope those of you who went away for spring break had a great time.

Your feedback

Thanks to those of you who have sent comments on prior blogs. I appreciate all comments, positive and negative. In most cases, I’ll respond to your comments directly in the blog without mentioning names. I will respond privately when that seems indicated.

Exciting weekend games

Wow! That was quite a men’s basketball game Saturday. I suspect a lot of us were on the edge of our seats, but the men’s Tar Heels pulled it off Saturday and then again Sunday. Congratulations to Roy Williams, the other coaches and the Tar Heels for the ACC championship. What a fantastic team! And ditto for the women’s team, Sylvia Hatchell and the women’s coaches. I am always impressed by how good our folks sound when they are interviewed. And of course, there’s much more “March Madness” to come. Their efforts remind us of how much we can accomplish when we work together as a team, whether competing in sports or searching for solutions to public health problems.

School as a role model

Those of you at the school hopefully have seen the excellent diet and eating tips in the atrium provided by the Nutrition department. Nutrition faculty members are doing some very cool things around campus. Just last week, Amanda Holliday and her “Healthy Heels” club put on a cooking demonstration during lunch in Lenoir Hall to show students how to cook healthy meals and snacks in their dorm rooms with ingredients available on campus. I’d like to see the school be a role model for healthy behaviors. We are going to sponsor some road races and help with the annual Heart Walk to show our support for local activities and as a way to align what we preach and practice. The first event is the Franklin 5000 April 26, 2008. Stay tuned for announcements: we will give away some race entries.

Op Ed

Julie Macmillan and I have received a lot of comments on the Op Ed piece from Friday’s News and Observer. The previous week Steve Wing and Cat Warren had a column in the same newspaper. Debates about academic issues and extending those to our school are healthy. Good people may differ on how they feel about issues like corporate partnerships, naming the school and the like. As I mentioned last Monday, we are scheduling some forums so faculty and staff can raise issues or make comments about anything related to the SPH.

Eve Carson memorial

Tuesday at 4pm, there will be a memorial for Eve Carson in the Dean Smith Center. Classes in our school will be cancelled from 4pm-6pm so people can attend. Many in our School, especially our undergrads, knew Eve and have taken this tragedy really hard. I was so moved by the words of her father, Bob Carson, on the UNC website. It is nearly unfathomable how this man who was in the throes of the greatest tragedy that can befall a parent was able to transcend his own family’s terrible loss and speak with optimism to her generation (http://universityrelations.unc.edu/alert/carson/bobcarsonremarks.html). This must be what Albert Camus was thinking when he wrote, “In the depth of winter I learned that there was in me an invincible summer.”

Have a good week. Barbara

Last week

Last week was a very sad one for Carolina, particularly for friends and family of Eve Carson, the Carolina Student Body President who was brutally murdered in Chapel Hill. Our minds and hearts cannot comprehend that kind of senseless violence. Yet, here it was in Chapel Hill, robbing her family and this campus of a wonderful young woman who made the world a better place and who had so much promise ahead of her. Violence is a public health issue, and it is important that a number of our faculty, staff and students are working in the area of violence prevention.

Responding to comments

In the past few weeks and months, some people have raised issues about one thing or another in the School. I want to respond. For that reason, this blog will be longer than most. Also, because a blog reaches some people but provides limited options for dialogue, Dave Potenziani and I will schedule some open forums where people can come and talk about what’s on their minds. If anyone has concerns or issues about where the School is headed, I welcome the opportunity to talk with you face-to-face. I have been gratified at the wide support for the gift from Dennis and Joan Gillings but understand that some people may be skeptical or even negative about it. Our options to start new activities and even to expand what we do would be severely curtailed without philanthropy and corporate partnerships. I believe that these relationships can be managed ethically and responsibly.

For the rest of the blog, I will list some of the comments I have heard, usually from only a few people, and then respond.

We are state-supported. Why do we need this gift?
The gift brings an endowment that will generate funds for years to come, and resources to enable this School to do what we do best, solve big public health problems. While North Carolina is generous to its universities, the state budget covers only about 18.3% of our expenditures, and federal funds are falling precipitously. Without successful fund raising from private citizens, foundations and corporations, we could lose our competitive edge. However, we must develop these relationships in an ethical manner with a clear understanding of what the School needs, what we are willing to offer and with which individuals and organizations we want to partner. Last fall, we developed a statement about the latter issue.

Have you “sold” the School for $50M?
Dennis and Joan Gillings made a pledge of $50M to the School of Public Health. It is customary at Carolina and other schools to provide naming opportunities for very substantial gifts. Even before I became dean, the former dean and UNC officials sought a donor who would make a gift large enough to name the school. A gift that is large, even as large as $50M, doesn’t equate to selling the School or to a corporate takeover. Multiple UNC officials, including Chancellor Moeser, reviewed the agreement, and the final agreement was approved by the UNC Board of Trustees. This is a personal gift from Dennis and Joan Gillings. It is not a corporate gift. In September 2008, the School will be named the Gillings School of Global Public Health to recognize their generous gift.

Do you have the right to rename the School?
UNC has well-developed procedures that must be followed when naming is an option for a gift, and we followed the rules. Kenan-Flagler was renamed some years ago; naming negotiations are underway at several other UNC Chapel Hill schools. About 20 percent of all schools of public health (public and private) carry donors’ names. Many others seek such gifts to provide for the financial health of their schools.

Are you using $50M to globalize the School of Public Health?
Funds from the Gillings’ gift will support many initiatives, including but not limited to global health. As we’ve said repeatedly, we are more committed to North Carolina than ever before. In fact, already the gift is paying dividends for North Carolina. For example, we supported a strategic planning process initiated by the Department of Health, under Dr. Leah Devlin’s able leadership. The process will lead to better coordination between hospitals and health departments to improve the health of North Carolinians. Many of the Gillings Innovation Laboratory applications received to date focus on N.C. problems.

Why all this emphasis on global health?
As Leah Devlin has said so well, “We are all global citizens.” Families USA defines global health as “health problems that transcend national borders.” This includes health problems like AIDS, malaria, TB and obesity that have global, political and economic impact. We must pay attention to these global health problems for a variety of reasons that range from the humanitarian to their direct and indirect impact on us. Recently, the Institute of Medicine said that “the failure to engage in the fight to anticipate, prevent and ameliorate global health problems would diminish America’s stature in the realm of health and jeopardize our own health, economy and national security.” (IOM, America’s Vital Interest in Global Health). For more on this topic, see www.familiesusa.org/issues/global-health/matters/.

Paying attention to the world’s health does not make us one bit less committed to North Carolina. Lessons we learn here can be applied elsewhere and vice versa. We expect that a substantial part of our investments from the Gillingses’ gift will be used to solve problems in North Carolina. We are proud to be the top public school of public health. We live here. We have a great responsibility to this state and its citizens.

Have faculty, staff and students been involved?
Faculty and staff were part of developing the plan we proposed to Dennis and Joan Gillings. Faculty members comprise the planning group to operationalize financial literacy by determining core competencies and how they can be met. Faculty members and leaders are a fundamental part of the review process for Gillings Innovation Laboratories and other activities funded by the gift. Several School alumni are members of the Acceleration Advisory Committee. We welcome even more input.

Are corporate interests in the School too strong?
The SPH has a long tradition of our faculty working with different companies. For example, some biostatisticians consult with industry on pharmaceutical trials. They bring their expertise to assure that the best methods are used to analyze trial data. Meanwhile, students often have experiences working on real world problems that really matter. Faculty members in environmental sciences have collaborated with waste management companies and those interested in developing safer water treatment methods. Nutrition faculty members long have worked with various food companies.

I strongly believe that we should avoid dichotomous thinking that corporations are bad, and public health is good. Some corporations are ones with which we would not want to be associated. And while ultimately, publicly traded companies are accountable to stock holders for the bottom line, it often is in their interests to partner with us to achieve shared goals. While public health may not be their raison d’etre, it may be well within their missions to advance the public’s health. Public companies are under more scrutiny than ever before, and doing good can bring multiple benefits. In the New York Times Magazine 3/9/2008, Larry Brilliant, physician epidemiologist and head of philanthropy for Google, made a good observation. “What I did not understand when I was young was that corporations have personalities just like humans do. It is possible for companies to be virtuous.” I agree.

It is easy to say we will not work with tobacco companies. Except for some medicinal purposes, tobacco is a product that when used as intended, kills. But few other products are so clearly evil. People have to eat. By partnering with food companies, we can help to develop safer, healthier products, influence industry to reduce trans fats and make other changes conducive to health. We could create the best water filter in the world. But unless there is a company or organization willing to manufacture it, our impact will be modest at best. A large amount of literature shows that far too many of our innovations sit on shelves, because they lack capacity to scale. Prudent, ethical partnerships can permit us to achieve greater public health impact. I welcome your suggestions about additional ethical sources of support for the School.

One more thing, most partnerships between faculty members and companies are not approved by me. Our faculty members have tremendous freedom to initiate these relationships. Some of you, me included, may not be thrilled about some of these partnerships, but that is part of academic freedom also.

Why are business people members of the Acceleration Advisory Committee?
The AAC is providing advice to Carolina Public Health Solutions. Its members include academics, people from local and state governments and foundations, alumni, and business. (See Acceleration Advisory Committee roster for members.) They are not a policy group as stated in a recent Op Ed article. The School has one policy board – the Public Health Foundation Board. Already, the AAC has given us good ideas about where faculty members might look for additional funding and other useful suggestions. They are not making final decisions about Gillings Innovation Laboratories although some members are providing feedback about certain elements of GIL proposals, e.g. feasibility and potential for scale. Funding decisions will be the result of a robust process that includes input from Chairs and other School leaders, ratings from an outstanding group of reviewers from around the U.S. and discussions between me and Julie MacMillan, Managing Director, Carolina Public Health Solutions. One of the lessons I learned while at the NIH is the value of bringing into organizations people with vastly different knowledge and perspectives. We won’t change the world if we talk only to people like ourselves. I’m committed to keeping this school a vibrant place where many voices are heard. We have a lot to learn from corporate leaders with an interest in public health, and they can learn from us.

That’s all for now, but let’s keep talking

I am very optimistic about the future of this School. Thanks to the gift from Dennis and Joan Gillings, we have an infusion of resources to enable us to tackle big problems and to achieve greater public health impact. In a period of abrupt decline in federal funding which is likely to be a part of life for many years to come, we now have other alternatives for support. How we manage and develop the gift is a work in progress. We will continue to seek input from many people about priorities and progress. To learn more, go to http://www.sph.unc.edu/accelerate/.

Next week, I will mention some of the plans for September when we will unveil the new name for the School.

Thanks to those of you who have made public and private comments.

If you are on spring break, have a good one.

Happy Monday. Best, Barbara

Our amazing students

This past Friday, Feb. 29, I welcomed participants, guests and speakers to the 29th Annual Minority Health Conference. This year’s conference may have been the best yet, with more than 620 participants, dozens of terrific posters and exhibitors and a fascinating line-up of speakers and sessions. The planning committee did a fabulous job! I am not aware of any other student-run conference that attracts this level of participation and attention. I’ve been to a lot of professionally-run conferences, and this is as well-done as the best of them but with a great deal more enthusiasm and passion. It was awesome to walk into the Friday Center, teaming with people of all ages and colors, vibrant in energy and excitement. We are so grateful to Bodil and George Gellman for their financial support of the event. It was great to catch up with folks like Professors Small and Browne.

• Details on the conference
• Archive of the webcast

The conference highlighted what we in public health now recognize—that health cannot be separated from our environments, economies, policies and the very fabric of our lives. Nor can we ignore the growing disparities in this country. It was really important, though, that the conference organizers focused not just on deficits associated with the lives of minorities but also their assets and strengths.

Unfortunately, as Dean, I often have to leave conferences after giving a welcome, because I have to get to another meeting or event. But I always try to stay for the keynote lecture for the Minority Health Conference, because I learn so much. This year was no exception.

Dr. Nancy Krieger, Professor of Society and Human Development at Harvard School of Public Health, gave a wonderful talk on the science of racism. It is not an oxymoron to talk about science and racism. As Dr. Krieger’s talk elucidated, we still need good data to show the consequences of racism on people’s health status. Data often are the first step to more just policies. Dr. Krieger applied rigorous epidemiologic methods, some quite innovative, to understand factors that explain deepening disparities in the U.S. As she said, “death is inevitable, but premature mortality is not.” She is a great role model of someone who is an impeccable scientist but also a powerful, effective advocate for social change.

Public health and our school especially have a fundamental role to play in understanding and overcoming health disparities. Bringing science to bear is only part of our job. To paraphrase Goethe, “knowing is not enough. We also must apply.”

As I looked out at the nearly full auditorium, mostly with students and young people, I was encouraged that our future is in their hands.

Bringing it home

The conference and recent experiences led me to issue this strong statement. Our school has zero tolerance for racism. If any of our staff, students or faculty experience racism or other discrimination in the school, please report it to your chair or unit head. If you are not comfortable with that, see me.

Paula’s wisdom

Regular readers know that I am a spinning regular, and that I resonate with Paula’s aphorisms as she does a superb job leading classes. Today, she said. “You only have one body so take care of it.” That’s especially good advice during this nasty flu season. (And now, unfortunately, I speak with authority!)

Happy Monday and take care!
Barbara