Inauguration Day

Early on January 20^th, it started snowing, and the snow kept up until early afternoon. It was a beautiful snow, and it could not have come on a better day—many people were able to stay home and watch the inauguration with their friends and families. Our School of Public Health family enjoyed watching in our living room , the Michael Hooker Research Center atrium. (Pictures below by Linda Kastleman.) I enjoyed experiencing the event with the community of our School. It felt somehow intimate and connected in a very authentic way. I appreciated the efforts of IIS and our Communications folks to make this work.

I reread President Obama’s speech several times. I liked his honesty about the bad situation we’re in and the call to action that we all must work together to pull ourselves out of the mess. Obama’s observation that, 60 years ago, his Kenyan father might not have been served in a restaurant in the same city in which his son was taking the sacred oath for the Presidency was both chilling and uplifting. It feels like our country has come a long way, although there is still a long way to go.

North Carolina State Health Director’s Conference

January 24^th, I addressed the state health directors, a truly dedicated, energized and impressive group of people. It was a conference I wish I could have attended throughout. I’d especially have wanted to hear Howard Frumkin, PhD, MD, MPH, from Centers for Disease Control and Prevention (CDC), talk about the environment. There was a special recognition of Leah Devlin, DDS, MPH, State Health Director and Director, Division of Public Health and a member of our School’s Public Health Foundation Board. I am really going to miss working with Leah in her current role. Over the number of years we have known each other, we have become not just colleagues but also friends. It’s really helped our organizations stay connected. It was clear from the many heartfelt messages that we all agreed Leah is not just a remarkable leader who can see the big picture and the details, a visionary who can get things done and a master of working with the legislature. She also is a gracious, warm, funny, totally human leader who is adored. There are not many people who inspire the kind of true affection that Leah does.

By the way, IIS videotapes the annual conference as part of the support our NCIPH provides. We will add a link to the talks as soon as available.

Health Care Reform

Discussions about health care reform are heating up. Jonathan Oberlander, PhD, Associate Professor Health Policy and Management and Social Medicine, School of Medicine, had a good perspectives piece in the New England Journal of Medicine last week about forces that could facilitate and those that could inhibit passage of health reform legislation. Jon observed that while reform is improbable, it is not impossible. His article provides a good overview of the issues. This is a time when all of us in public health should be aware of the debates and try to influence reform, however we define it. Another UNC professor, Norton Hadler, MD, has weighed in, arguing that any approach that does not put major emphasis on evidence as a driver of payment is doomed to fail. As a member of CDC’s Task Force on Community Preventive Services, I agree. And, of course, any meaningful reform package must emphasize and incentivize evidence-based prevention and wellness interventions. See recent Senate hearings for discussions about this. Reform must work this time, because we won’t have another chance for a long time, I’d expect. Lives depend on it.

The Health Care Blog‘s Sarah Arnquist has an interesting piece on legislative language setting aside more than a billion dollars for comparative effectiveness research, which, she says, may be portrayed by some as a prelude to rationing. Undoubtedly “rationing” will be only one of several specters that will be seen lurking in the shadows of reform. I hope that we in the School can have great debates about the issues without petty partisan politics getting in the way.

Kay Yow Remembered

I was so sorry to read that Kay Yow, women’s basketball coach at North Carolina State University, died of breast cancer Saturday after a more than 20 years battling the disease. I first met Kay Yow soon after she had been diagnosed, when she agreed to address a summit on breast cancer, and several of us went to visit with her at NC State. She was a remarkable coach and human being who coached winning teams while fighting metastatic cancer. There’s a lot to learn from feisty people who keep on going even when the going is very tough.

Happy Monday.

Barbara

Martin Luther King remembered

The juxtaposition of Martin Luther King Day and the inauguration of Barack Obama as President is striking. I am old enough to remember King’s speeches as a charismatic minister who exhorted the country to dream of a better time, old enough to remember the horror I and the people around me felt when he was killed, living close enough to downtown Detroit that summer to see the flames as buildings burned in anger and fear after his murder, and young enough once to have struck against my University, with hundreds of other students and faculty and hundreds more workers from the University of Michigan, seeking to increase the proportion of Black students on campus. Although we won that battle, we also learned that changing the complexion of the student body would take far more than goals alone. Martin Luther King did not die in vain. We’re still working to increase the diversity of our University and this School and to end health disparities. Toward that end, check out the agenda for the upcoming Minority Student Caucus’s next conference, titled “Our World, Our Community: Building Bridges for Health Equality.”

A new era begins

Tuesday, in the same orderly way Presidential transitions occur, President Bush left office, and President Obama will begin a new day in American history. While I respect the people who might wish John McCain were being administered the oath Tuesday, I look forward to Tuesday with real hope and optimism for the future. And I am so grateful that in my lifetime, we have come to this point that irrespective of race, Americans voted for the person they thought could best lead them into the future, our future.

Reading now

I am in the middle of Daschle’s book Critical about challenges in health care and the necessary elements of an effective health care system. It’s a very thoughtful, well-researched book. One of our alumni, Jeanne Lambrew, PhD, MSPH, who is leading the White House organization for Tom Daschle, is a co-author.

A real privilege!

Friday night, I was coming back to the School as one of our faculty members, Anita Farel, DrPH, MSW, was leaving. We talked a little about our respective activities and about the challenges of decision season, when students are sent letters informing them about the results of their applications, and they and their advocates sometimes call to talk about the outcomes. Some of the saddest calls I have are with applicants who really wanted to be accepted or with someone who really wanted an applicant to be admitted, but their efforts were unsuccessful. I thanked Anita for her efforts in so many domains, including talking with applicants. Her answer was so wonderful that I wanted to share it. (Anita, usually I ask permission first, but in this case, I hope you are fine with my sharing.) She said, “It’s a privilege.” I thought that summed up so well what it is that makes Anita and so many of our faculty and staff so fabulous. They see what they do as a privilege, and that recognition shapes their behavior. We are privileged to work at the School, for this fine University, with our fabulous students, in this great state. In the day to day business of life, it’s easy to forget, and I am so grateful to people like Anita who remind me, “It’s a privilege.”

Happy Monday!

Looking at our own behavior

Early Saturday morning as I was reading the New York Times, before going to the gym, I became absorbed in an article by Sam Freedman, called When Serving the Lord, Ministers Often Neglect Themselves. It was about a discovery made at the Duke Divinity School that many Methodist ministers are so focused on their parishioners’ needs that they neglect their own health. It made me think about people in public health, our School, and our own behavior. Could the same be true of us?

The story caused me to reflect, as I have before, about one of the paradoxes of being public health professionals. We teach (and sometimes preach) about good health practices that data show extend the quantity and quality of our years, like eating 5-9 fruits and vegetables each day, exercising briskly several times a week, getting enough sleep, nurturing one’s social network, managing chronic diseases and getting screened for cancer.

But we are human beings. As such, there often are inconsistencies between what we know and what we do. (As Goethe said, “Knowing is not enough. We must do.“) Oprah Winfrey publicly told her very painful saga of having lost a lot of weight and then regaining nearly all of it over the last couple years. This is the time of year when we try to realign the inconsistencies by making resolutions to do better. I’d like us to think about how we can make the School an environment more nurturing of good health practices. In our midst, there are people who have lost 100 or more pounds and kept it off for years as well as people who have lost smaller amounts of weight successfully and perhaps an even greater number of us who are always struggling.

Among us are amazing role models for fitness—from people who ride their bikes to School several times a week to marathon runners and devoted swimmers to regular walkers and committed participants in aerobic exercise classes. There are ways we can make their expertise and that of the successful weight losers/maintainers available to people who are trying to figure out how to put an eating and exercise program together. Our Nutrition department has done a great job of providing tips about healthy eating. Maybe Amanda Holliday, Clinical Assistant Professor of Nutrition, would do some healthy cooking demonstrations in the teaching kitchen for our faculty, staff and students.

Here are a few things I’ve done or am trying to do in our office.

• Our advisory boards and Dean’s Council meetings generally don’t start before 8:30 AM to allow people time to exercise first. Except for a few events a year, we try to end at a reasonable hour so people can get enough sleep.

• We rarely schedule formal weekend meetings that involve multiple people to maximize the opportunities people have for family and friends—and maybe some reflection as well. (Of course, it doesn’t mean we don’t work.)

• I review menus for our events to be sure there are healthy choices and to remove most unhealthy options. That includes, selfishly, making sure there’s a healthy, low carb vegetarian option, not a plate of dense, soggy pasta. We’ve stopped serving sugary sodas at meetings in the School for which we provide food and have been selecting vendors that provide healthy Mediterranean options rather than oversized sandwiches with huge cookies when we order food. We are trying to figure out how to handle bottled water from an environmental perspective. Folks in ESE have made some good suggestions.

• We are trying to avoid food with trans-fats.

• For a lot of reasons, including the local economy, we have asked our caterers to try, if at all possible, to buy locally.

Several of us have a vision of a Public Health Commons that circles the School. It would include attractive water features, maybe a meditation garden, and a walking trail with art and signage with health tips. The School covers a fair amount of land, and we could use it to greater advantage to promote health—our own and others’. Hopefully, one of these days, a donor will help.

Mahatma Gandhi said, “Be the change you want to see in the world.” Without being moralistic or intolerant, it seems that schools of public health should be model environments for health behaviors. Certainly, we should do our best to practice what we teach. If anyone has suggestions about how we can do a better job, please let me know. I’d welcome other suggestions about how to make our own environment healthier.

And On a Totally Different Topic—the Presidential Inauguration

I asked our information technology folks to make it possible to view coverage of inauguration day activities several places in the School on January 20^th, besides desktop computers. A couple people asked why and said this wasn’t done last time there was an inauguration. Well, first, I wasn’t dean then. Second and most important, this is a very significant event, one I believe we will look back on and see as a moment that signaled huge change in America. Some people want to experience that as a private event, but some people want to come together as a community. Experience it as you wish; there will be choices. Also, not everyone in this School has a computer at his/her desktop. We have people in the Café, mail, maintenance and other domains who would have no access. I want them to have a place also. We need to get past the election; the election is over. In less than two weeks, Barack Obama will become our President, the President for all of us. It no longer matters who I supported or who you supported. To get out of the mess we now are in, the new President will need our help and support. He’s got mine!

Happy Monday. Barbara

Another year gone

To paraphrase Dickens, it was a great year. It was a terrible year. And it’s over.

It’s true that as one gets older, the years go faster – anyway, that’s my perception. This year raced by. On balance, it was a wonderful year for our School. It was an exciting year for the country as we experienced an election season like no other, and we prepare to inaugurate the first Black president, a first of which we can all be proud. Yet, it also was one of the worst economic years in our history, one whose terrible consequences reverberate around the world and will haunt us for years to come. Our campus reeled from the murder of student body president Eve Marie Carson. Her death touched us all.

As we approach 2009, we do so with cautious optimism, realizing that we face additional budget cuts within the University, economic pain in North Carolina and across the U.S., and instability of many kinds around the world. Yet, this School is a rock; it is a Carolina institution that has experienced tough times and will recover – thanks to our outstanding faculty, staff, students, donors, advisers and our many other friends. Wednesday, as economic indicators continued to send ominous signals, I was delighted to receive several generous checks for the School and gracious letters from new and continuing donors. We are grateful that even in these times, we have generous friends who understand the importance of public health and our school of public health.

Too much happens in a year to review it all, but here are some highlights of the good and the bad. This is longer than my usual posts, but here goes.

First, the bad stuff….

The Bad Stuff

I may as well begin this list by acknowledging that both our men’s and women’s basketball teams lost in the Final Four. Other losses were both more personal and more permanent.

A number of faculty and staff retired, including Ramona Womble, director, Human Resources; Kathy Cheek, business manager in Health Policy and Management; and Fred Pfaender, PhD, professor Environmental Sciences and Engineering. We also bid farewell, sadly, to professors Doug Crawford-Brown, PhD, Milton Heath, LLB, and Stephen M. Rappaport, PhD, as well as Donna Simmons, staff member in environmental sciences and engineering. Longtime statistician Sandy Irving retired, leaving a large hole. By the way, these retirements are losses for the School but important, happy transitions for the people involved.

We were saddened by the deaths of a number of alumni. (I regret not being able to list them all here.) I especially want to note the deaths of Laura Elizabeth Zaks, MPH (Nutrition) and Patricia Trimmer, MPH (HBHE), women who’d been all over the world and had great impact in their public health careers; their time was far too brief. We also mourn the loss of Patricia Meador, JD, MPH, an outstanding HPM alumna who made many contributions to health care, including here in North Carolina. Daniel Horvitz, former RTI International executive vice-president and a pioneer in statistical theory and survey research, passed away June 2008. Jimmie L. Rhyne, MD, MPH, died in October 2008. He had a distinguished career in public health as a clinician, administrator and advocate. We were very sad to lose Michelle Mayer, PhD, a former HPM faculty member, whose journal and newspaper articles and blog spoke so compellingly about her multi-year battle with scleroderma. She taught us about courage, advocacy and loss. We also were saddened to learn about the death of former MCH student services manager, Linda Southern, on Christmas eve. Carol Williams led the calling room for the Survey Research Unit within Biostatistics from 1991-2005. Sadly, she passed away in May 2008.

Some of our faculty, staff and friends face life-threatening illnesses, and we wish them strength and good health in 2009. Spouses, partners, parents, children and friends have lost jobs or fear losing them. And those of us fortunate enough to have retirement accounts sometimes stare at the declining balances in disbelief. Last week, I spoke with a friend who told of two friends who’d lost everything they owned to Bernard Madoff’s schemes. It is inconceivable to think of being retired and waking up one morning to find that everything one thought one had is gone, irretrievably lost because of human greed. Here, we are coping with budget cuts and hoping that the next wave will be less than we fear. It has been a year to forget, filled with lessons to remember.

We pick ourselves up and move on.

Now, the good stuff…

In spite of illness and loss and bad economic indicators, a lot of good things happened. First, we were ecstatic that professor Kurt Ribisl, PhD, made a miraculous recovery from a brief but serious illness.

Renaming Celebration

On September 26, 2008, we celebrated as we added the words Gillings and Global to our name. It was a wonderful day, as hundreds from across the School, campus, North Carolina and as far as Japan gathered to celebrate. While, in large part, we were celebrating the magnificent gift from Dennis and Joan Gillings who had made it all possible, we also were celebrating who we are and always have been – Carolina’s School of Public Health. We were thrilled that our speakers that day included President Bowles, Chancellor Thorp, PhD, Board of Trustees Chair Roger Perry, State Health Director and Director, Division of Public Health, N.C. DHHS, Leah Devlin, DDS, MPH, and Student Government Co-President Lauren Thie. Each speaker offered a unique and insightful perspective on public health and on our school. See pictures of the renaming. As we expand the already strong global presence the School has had since its earliest days, we are more committed than ever to North Carolina. We are deeply embedded in North Carolina through our teaching, research and service. And just as we have from the earliest days of the School, also are working all over the world. Local and global, teaching, research and service – UNC Gillings School of Global Public Health. As the new signs went up, the bar was raised on the impact we are expected to deliver – both for North Carolina and the world – and we are ready. I recognize that not everyone was happy with the changes, but hope that over time, they will be reassured.

Around the School

A former faculty member who attended our renaming celebration and who hadn’t been back in a while, commented how great the School looked. Our outstanding facilities staff – director Rob Kark, MBA and Brent Wishart – indeed wrought remarkable changes. Finally, the first floor of Rosenau Hall is light-filled, thanks to glass doors at either end of the hall. It’s amazing what happens when we let light in!

We asked faculty, staff and students to send us photos. Thanks to all those who contributed and to Linda Kastleman, who organized it all and had the photos framed and hung. The photos tell a compelling story about all the places you’ve been and the important work you do. There are some amazing photographers in our midst. We’ll put them up on the web soon. Keep your photos coming.

Right now, a lovely AIDS kite is hanging in the atrium.   Next, we need to tackle McGavran-Greenberg Hall, if only we can get sufficient funds.

Our Research

In spite of a declining economy, our faculty members were awarded many impressive grants in the last year to conduct research that has potential for real impact. Awards to our School faculty totaled about $103 million for 2007-2008. We celebrate all grants, no matter their size. However, every now and then, the size of a grant is particularly noteworthy. Maternal and Child Health’s Sian Curtis, PhD, research associate professor, was awarded (through Carolina Population Center) the largest grant given to a UNC faculty member – up to $181 million to continue the USAID-funded MEASURE evaluation projects. Sian and her team are assessing the impact of many programs funded through USAID, a number of them related to AIDS. And speaking of USAID, Mark Sobsey, PhD, Kenan Distinguished University professor in environmental sciences and engineering; Tom Outlaw, EMBA; and colleagues received a large grant to expand their research on ceramic water filters. This project has the potential to bring a dramatic increase in the scale of their work. Sobsey also was awarded the International Water Association’s 2008 Project Innovation Award for the research endeavor.

Peggy Leatt, PhD, associate dean for academic affairs and professor and chair, Health Policy and Management, was awarded a training grant from the National Cancer Institute, National Institutes of Health to train people in issues related to quality of cancer care, a pressing national issue.

Andy Olshan, PhD, professor and chair, Epidemiology, won a successful recompetition for his neuroblastoma research grant.

We began a remarkable collaboration with the The Environment Agency–Abu Dhabi (EAD) and were deeply honored to be awarded a contract to conduct a comprehensive environmental risk assessment and develop an environmental plan for the United Arab Emirates (UAE). Led by ESE assistant professor Jackie MacDonald, PhD, and co-led by Ivan Rusyn, PhD, MD, ESE associate professor and Andy Olshan, PhD, MS, professor and chair, Epidemiology, the collaboration involves UNC-Chapel Hill, RAND Corporation, EAD, United Arab Emirates University (UAEU), Resources for the Future (RFF) and the Norwegian Institute for Air Research (NILU). The team is making good progress and soon will begin conducting 600 household interviews. It was gratifying to join our successful team in two trips to Abu Dhabi, first as we presented the proposal and then to sign the contract and begin the project. It is a truly fascinating place, and we have the opportunity to make groundbreaking contributions through this project. It is especially inspiring that people from across the School and University are collaborating and working with partners around the world. As I wrote earlier in December, we were pleased to host the team from Abu Dhabi, along with all our partners, at UNC in December. I am proud that the team is making great progress.

Especially during a time when research dollars have declined nationally, we are fortunate that two large investments were made in UNC and our School, by the state legislature for the University Cancer Research Fund (UCRF) and by Dennis and Joan Gillings. UCRF funds already have supported the launch of a new cancer survivors’ research project, led by Marci Campbell, PhD, professor, Nutrition, and Marilie Gammon, PhD, professor, Epidemiology. UCRF funds also support the Jeanne Lucas Breast Cancer Study, led by Barbara Sorenson Hulka, professor, Epidemiology Bob Millikan, DVM, PhD. This study continues the groundbreaking research that led to new understanding about why Black women may be more likely to die of breast cancer than white women. The funds also have supported a faculty recruitment, with more underway. All of this is aimed at improving cancer outcomes in North Carolina.

Over the last year, we funded 10 Gillings Innovation Laboratories (GILs) on a variety of topics ranging from an examination of the economic, health and environmental consequences of local foods to a new paradigm for infant vaccines to an attempt to develop a rational strategy for mental health system changes in North Carolina. I am so excited about these projects. At a time when NIH and CDC funding have shrunk dramatically, these funds help us invest in innovative solutions to some of public health’s greatest challenges. They allow our faculty to be innovators and problem solvers. Project PIs come from many different departments and are people of all ranks. Seventeen students now are supported on these projects. The Gillings Visiting Professor (GVP) program is in full swing, with three GVPs – Sheila Leatherman, MSW, Tom Ricketts, PhD, and Jim Merchant, MD, PhD. Rohit Ramaswamy, PhD, soon will begin a GVP. (See Carolina Public Health Solutions’ web page for more information about GILs and GVPs.) I am so grateful to Julie MacMillan, MPH, and her team for having established fair, efficient and accessible practices to govern these competitions. A lot of people contributed time to reviewing, and a group of chairs and other key School leaders have worked collaboratively to make decisions about funding priorities. I am excited that we are solving problems in North Carolina and around the world. The acronym “GIL” has become part of the School’s vocabulary.

The North Carolina Institute for Public Health received several important grants, including one from CDC for a new preparedness center (led by Pia MacDonald, PhD, MPH, research assistant professor, EPI) and one from the Robert Wood Johnson Foundation. In the latter, Sarah Strunk, MHA, director, Active Living by Design and her team are coordinating new Healthy Kids, Healthy Communities awards across the U.S.

There’s so much more research going on across the School from our undergraduates to our postdoctoral fellows and across all departments. Check out our Office of Research’s Web page to learn more.

Academics

Our departments are strong, with outstanding leadership across the board. Two departments, Biostatistics and Epidemiology, had Graduate School Reviews in the last year and came through with flying colors. Our Executive DrPH program, which started several years ago, graduated its first students last May and has seen huge increases in applicants. We continue to get applications from some of the best students anywhere. I am so impressed not only by their intelligence but their passionate sense of mission.

Recognition of our faculty, staff and students

Our faculty, staff and students received awards and recognition for their many outstanding contributions. Just a couple highlights: We are proud that an ESE undergraduate student, Aisha Ihab Saad, was awarded a Rhodes Scholarship, one of the most competitive scholarships anywhere, to focus on global environmental policy. As I have said before, we are very pleased that so many of our students receive the Graduate School’s Impact Awards.

Peggye Dilworth-Anderson, PhD, professor Health Policy and Management, and associate director of Aging and Diversity, Institute on Aging, was elected President of the Gerontological Society of America, the largest organization devoted to research on aging.

Ramona DuBose, director, Communications, received the UNC Encouragement of Learning Award.

Bert Peterson, MD, FACOG, professor and chair, Maternal and Child Health, became head of a new WHO Collaborating Centre in global reproductive health.

Eugenia Eng, PhD, professor, Health Behavior and Health Education, received the Thomas Bruce Award from APHA for contributions to community-based public health.

Steve Zeisel, MD, PhD, professor, Nutrition and director, Nutrition Research Institute (NRI), received the American Society for Nutrition Osborne and Mendel Award for basic science research.

Two of our alumnae received high-level appointments recently – Jeanne Lambrew, PhD, and Deborah Winn, PhD. Dr. Lambrew was appointed deputy director of the newly formed White House Office for Health Reform. Dr. Winn was named deputy director, Division of Cancer Control and Population Sciences, National Cancer Institute. And their success is just the tip of the iceberg!

There’s far too many to highlight here, because our faculty, staff and students are simply amazing.

A new Chancellor

It was a momentous year for UNC-Chapel Hill as we welcomed a new Chancellor, Holden Thorp, PhD, and then had the opportunity to interact with him.

In October, we celebrated Chancellor Thorp’s installation. It was a wonderful, Carolina blue fall day, and we noted that he mentioned public health several times in his fine address. Chancellor Thorp has been extremely supportive of the School, as was Chancellor Moeser. He talks about public health issues comfortably when he speaks about the big issues the University must solve. He spoke at our renaming celebration, and a few weeks later, traveled with us to Kannapolis to celebrate the opening of the NRI. We are grateful for Chancellor Thorp’s support and for that of Provost Bernadette-Gray Little, PhD, President Bowles and others.

That same day, Leah Devlin, DDS, MPH, our alumna and State Health Director and Director, Division of Public Health for North Carolina, received the University’s Distinguished Alumna Award. Yeah, Leah!

In the News

Our faculty, staff and students were frequently in the news, but Barry Popkin, PhD, Carla Smith Chamblee Distinguished Professor of Nutrition and Director of the Interdisciplinary Obesity Center, probably was more than anyone (The New York Times, Reuters UK, The Washington Post, USA Today, Elle). Barry recently published a book called The World is Fat, and he is being quoted everywhere from The New York Times to Elle to newspapers around the world.

Nutrition Research Institute

In November, we celebrated the opening of the NRI in Kannapolis, led by Steve Zeisel, MD, PhD, professor, Nutrition and director, NRI. It is an awesome place with some of the best laboratory facilities in the world. Steve is doing a great job recruiting excellent faculty, but the state budget cuts will pose real challenges for us all.

Bring on 2009!

It’s been quite a year, and like most of you, I am quite ready for 2009. I cannot wait to watch Barack Obama become president of this country. If conservative columnist William Kristol can take pleasure in contemplating that fact (as he did in a The New York Times column this week), then we all can rejoice! And the Final Four isn’t that far away! Surely this is our year! It has been a difficult time, and for far too many people, it’s been a truly terrible time. But never has public health been more needed, more important, or more prepared. And that’s what we are all about. I am grateful not only to have a job but this job. Thanks to all our students, staff, faculty and friends who make the UNC Gillings School of Global Public Health the place to be. Thanks to the leaders of this School and the staff in our immediate office. Thanks to our many advisers and generous donors. We are so grateful to you all! Have a happy, healthy and productive new year.

Warmly, Barbara