University Times

Statistics from the National Institutes of Health (NIH) reveal that in the last two years Pitt’s Graduate School of Public Health (GSPH) has more than tripled its rate of increase (40.9 percent) in NIH funding over the other top public health schools. For FY2002, NIH research grant funding totaled $44 million, as compared to $38.32 million in FY2001 and $31.2 million in FY2000. The total NIH funding, which includes research grants, training awards, fellowships and R&D contracts for GSPH, is $47 million.

Under the leadership of Dean Bernard Goldstein, who took over the reins of the school two year ago, GSPH has risen to 4th nationally among the 31 accredited U.S. public health schools in NIH funding.

Goldstein discussed GSPH’s status, success and goals recently with University Times staff writer Peter Hart.

UNIVERSITY TIMES: The school’s NIH funding has been rising dramatically since you became dean. Why? And what does it mean for your school?

GOLDSTEIN: NIH funding is considered a superb metric of the competitiveness of your faculty for basic biomedical research. While we’re very proud of this, we recognize that it is not the only metric of our success.

Perhaps I would even downplay it a little bit: It is a much better metric for a medical school than for a school of public health. About half the external funding for public health schools comes from the NIH, while it’s closer to 80 percent for medical schools.

We’re particularly interested in other metrics and we think we’ve done very well in those as well. For instance, we have two major competitive CDC [Centers for Disease Control] grants in the past two years, one funding a Center for Healthy Aging, the other the Center for Public Health Preparedness. They’re in the range of $700,000 to $1 million a year, so they’re substantial grants but neither gets into the NIH statistics.

Also, we have people who are doing superb work on health care organization, health care administration, community health, public health policy and management — these and others are competitively funded from other governmental organizations and from foundations.

So as dean, I need to strike a balance between touting our NIH total and our other important work.

The good news is that the NIH is becoming in some ways a better metric for us than it was before, because the NIH is widening its horizons. I’m going to get on my soap-box here. I’ve said this in the past: The National Institutes of Health sometimes acts like a national institutes of disease. The NIH has traditionally been focused on biomedical research aimed at the understanding of disease leading to cures.

The classic definition of health by the World Health Organization and the U.S. government is that health is not merely the absence of disease, but includes the social, physical and mental well-being of the individual. And the NIH is broadening its mandate by focusing more on community-based approaches to health.

UNIVERSITY TIMES: Can you give an example?

For instance, one of our most recent grants is a $6.2 million NIH grant called “Export Health” for the Center for Minority Health, which uses a community-based approach to dealing with health disparities.

A public health approach says that the best we can do really is defined by the healthiest segment of our population, which tends to be relatively affluent, white individuals. So, based on the resources that are available now, and based upon human biology, we’re saying that any group that isn’t doing as well on the average basically could do as well.

One thing we’re learned from the human genome project is that genetic difference is trivial. Now, for those people who have a genetically determined disease, obviously it’s overwhelming; but on the whole, there is very little difference between different races, different groups, so that what we’re talking about are disparities that are determined by something other than biology, such as access to medical care.

But to the extent we need to change our understanding, our social systems, our life styles and those kinds of things — that’s where the National Institutes of Health in the past played very little role but is now increasing their role.

If we can a make a difference in these disparities using a population approach — Wow, the number of lives saved and the years of healthy living added to lives would be enormous!

UNIVERSITY TIMES: Why is NIH changing its approach?

I think there’s a lot of public pressure and public frustration. People are saying, ‘Gee, we’ve invested all this money in NIH research, what difference is it making in our lives?’ The jargon phrase these days is ‘translational research,’ which, frankly, is translated in different ways by different people, but the bottom line is how we take what we find at the bench and bring it to make a difference to people, and to do that you need epidemiology and you need biostatistics, which, not incidentally, are two of the departments here.

A key strength of the school is the Epidemiology Data Center. We have evolved through the years because of outstanding key faculty. [GSPH epidemiologists] Lew Kuller and Katherine Detre would be on top of that list.

A central aspect to epidemiology is what’s called power: Do you have the power to ask the questions? Do you have enough patients, enough individuals in the population, so that what you get has some statistical likelihood or meaning?

UNIVERSITY TIMES: So does Pittsburgh’s dwindling population put the school at a disadvantage?

What we’ve pioneered here — some of it by Bernie Fisher in the NSABP [National Surgical Adjuvant Breast and Bowel Project] — are major studies where Pittsburgh has been the home for beginning the studies. If you have 10 people with Hepatitis C in a hundred different locations, you have 1,000 people, enough to make a meaningful study even when we simply could not reach that critical mass of people here locally.

But you need to be sure that the data are handled very carefully, that protocols are being strictly followed. Katherine Detre is a master at this. Pittsburgh is the data-management center for many major NIH grants. Being able to do that is something that puts us well in the lead of other schools.

We have other advantages here: for instance, the stability of our population. We’re the second oldest population in the country, second to Dade County (Fla.). The difference is that most of our people retire here, while a large number of Dade County residents go there to retire.

If you want to do a 30-year study you really can’t do that in Dade County, because people aren’t there for 30 years and you can’t do it elsewhere because by the time you’re ready to measure outcomes, the population has moved to Dade County.

UNIVERSITY TIMES: Are there other advantages GSPH enjoys?

We have a wonderful symbiotic relationship with the medical school. Really, it’s perfect. Because our epidemiology and biostatistics are so strong here, we can participate with the clinicians and the laboratory people there in putting together some top-notch grants that get well-funded by the NIH. We couldn’t do that without all the great things they’re doing there with patients and patient care and research, so that were we to move this school away from the medical school we’d be in great trouble, and the medical school would lose some of the leadership it enjoys in NIH funding were it not for the fact that this school of public health is right here.

There is roughly about one school of public health for every four medical schools in this country, but if you look at the top 20 NIH-funded medical schools, about one-half have public health schools on the same campus.

Actually, our public health school ranks higher in NIH research funding than three of the six Pennsylvania medical schools — last year we jumped ahead of Penn State.

Another advantage here: Except for arts and sciences, I’ve got the broadest range of disciplines. I’ve got laboratory people; epidemiologists; social science experts; health education practitioners; economists; data specialists.

Our belief is that there are no major public health problems that you can’t solve better with interdisciplinary work. And while there’s no reason that the French department and chemistry department need to be next to each other, for us, there are no departments we have that do not benefit from having the other departments close by. So a lot of my challenge as dean is to get different folks together from different disciplines, and focus on problems.

And what we’re seeing the NIH doing is moving its funding strategies to much more openness to research that has a broad range of disciplines involved.

UNIVERSITY TIMES: Is it an issue that GSPH mainly is housed in one of the older campus buildings?

Yes, it’s one of the older buildings and we’re proud of how we’ve been able to do as much as we have in one of the older buildings. Also, we’re fortunate that we can lease a lot of good space in Oakland to support our faculty. We would love a new building, but we recognize the University is committed to the 10-year [facilities] plan [which does not include a new building for GSPH]. When discussion for the next plan comes around, we’ll be in there pitching. We might get some space in the BST3 [Biomedical Science Tower 3] but the medical school issues are still the key ones, because by comparison we’re still relatively small potatoes.

UNIVERSITY TIMES: Are there other items on your wish list for the school?

We’re certainly excited about the field of human population genetics. In fact, we’re the only public health school that has a full department; at most universities, if there is a department of human genetics it’s in the medical school. We would like to expand our programs there.

Genetics for most of us loads the gun and the environment pulls the trigger, which is a very good way of looking at this. Our genetic potentials are going to be manifested depending upon our environment interaction, and by environment I mean in the broadest sense: what we eat, our sexual habits, as well as the pollutants that are out there.

To work that interaction out, the ideal place is where there are particularly isolated human populations, very little intermarriage, in rather distinctly different environments. The United States is the worst place in the world for that.

Add to that the fact that some of the more powerful approaches to genetics involve working with siblings, and in large families that works best — we don’t have many large families either.

We’re aiming our genetics approach at trying to understand why people are susceptible to disease and what are the characteristics that we could all change that would affect that susceptibility, so it’s a preventive, population-based public health approach.

Again, the bulk of the NIH research in genetics up to this point has been to cure genetically determined diseases, but that’s changing.

And the other way we’re interested in expanding is in global health.

We’ve always had a significant amount of global health programs, but we would like to give consideration to whether it will be a department, maybe in 3-5 years. A lot of our students are from overseas; part of it is they get the training for when they return to their countries. Part of it is that American students need to learn about international public health issues, for instance, the population basis of genetics, the ability to study the ideas behind gene/environment interaction.

We’re not in a world where we can say, ‘We’re from America, now let us study you.’ We have to do this by working cooperatively, and so we’re proud of the different cooperative international programs we have developed, including several of them that are competitively funded by the NIH.

UNIVERSITY TIMES: What do you see as the local role of GSPH?

Public health itself is very much a local issue. One of our departments is infectious diseases and microbiology. It’s the oldest kind of public health; that’s where public health schools came from. Now with SARS, bioterrorism, HIV/AIDS, we’re into that again: We’ve got to get people working on this, and in fact we do, we’ve had many meetings on these issues. The issue of SARS, on the one hand, and bioterrorism demonstrate further that there is a need for public health infrastructure in this country.

One of the stories about the response to bioterrorism that isn’t really as recognized as much as it should be, is what did the public health workforce not get done? Because you just can’t be passive. We have a very thin workforce. In fact, Pennsylvania ranks last in the country in public health workforce per capita.

We have the Center for Public Health Practice that deals with public health practitioners, funded by federal agencies to help train folks here in Pennsylvania.

And we have a good working relationship with the Allegheny County Health Department, something that’s been very important to me, and we’re working with the state health department as well. Part of our job is to make sure that we’re training future leaders of health departments, and the best way to do that is to have a good association with the departments to begin with.

We also have the support of Mayor [Tom] Murphy and County Executive [Jim] Roddey. They and others turn to us with these issues and ask us to help with the interface. But by the same token, we recognize we’re offering advice based on the best scientific evidence available, and we’re constantly looking for that, but we’re not the health department.

To use SARS as an example, what you do is ask not if but when. We need to assume that SARS will get to Pittsburgh, to ask what will we do, and there are so many uncertainties.

I believe we will be very well prepared. Our infectious disease folks who run laboratories also help run a medical school clinical lab, which has the assays to test whether or not someone has SARS; and they’re working on finding out which assays work best.

I’m happy to see the mayor and county executive support our efforts on this; they’ve asked the school of public health to be part of the city’s committee concerned with public health issues.

UNIVERSITY TIMES: What about more preventive public health issues?

I’d like to see more emphasis on a planned environment. For instance, whether you and I walk, how much weight we put on and the rise in obesity is to some extent due to the condition of the sidewalks.

So from an environmental health point of view, in the development of the suburbs, the roads, where we put houses and fences, has long-range effects. We’re designing neighborhoods where kids can’t walk 100 yards to see a friend because there’s no way to get there. Once you get into suburbia, you have to drive the kid everywhere, and you wonder why we have childhood obesity.

The NIH is now thinking about these issues. I just came from an NIH planning meeting in North Carolina, a retreat focused on how to get the NIH involved in issues like diabetes — not just how to detect and treat it — but what are better ways to prevent it, how is it related to obesity, and child obesity.

The question we were asking is, is that an NIH issue? The question is not if it’s a public health issue. It’s clearly a public health issue. But to solve it, we’ve got to get the policy people and the environmental health people together; we’ve got to get the planning people on board, too. And we’re not that good yet at getting the planning people involved, but we’re getting better.

My job as dean is to serve on these NIH and other national committees and convince the NIH in general we want to go there.

The more they’re convinced, the better off we are here.

We really think we contribute something to the city, and it’s not just the fact that we bring in a substantial amount of federal funding that translates into jobs and taxes and so forth, but also gives recognition to Pittsburgh as a leader.

Again, we’re proud of the fact that we’re high in NIH funding, but there’s a whole lot more going on here.