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Q & A: Harvard Official Discusses Center on Human Rights, Health

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The Harvard School of Public Health, which like most institutions of its kind has focused on the health-care system, recently received a $20 million gift from the Francois-Xavier Bagnoud Foundation to expand its mission. With the grant, the school has established a center to explore the linkages between illness and human-rights issues, including access to education.

Dr. Harvey Fineberg, the dean of the school, spoke about the new center's mission with Staff Writer Jessica Portner.

Q. What is the purpose of examining the link between illnesses and the social forces that impact on them?

A. The purpose is to create a scholarly and action-oriented enterprise, a deeper understanding of the interactions between illness and disease and violations of human rights.

We hope that in establishing the center, training students here, and trying to bring forward the best thinking about health and human rights, we can help to shape and define the field as it unfolds.

Q. Is this what you mean by "the new public health''?

A. Yes, I see the new public health as emphasizing social as well as biological forces that create the conditions for good health or for illness. If you take AIDS, for example, it is an illness which is devastating to the body, but also has extremely serious consequences emotionally and in a social dimension.

So the violations or risks to individual rights, the tradeoffs as they may occur between different strategies for public health and the cost of protecting individuals as well as the public, all of these issues are part of what we expect will be the mission of this new center.

Q. How do you go about examining and analyzing the social and physical impact of discrimination against people with AIDS?

A. You attempt to compare groups within the population who've been exposed to a potential cause to those who have not been exposed, and then you look at the differences in illness in those subgroups with and without the exposure.

Q. But how do you isolate them from other factors, especially when you are talking about social factors, which can be very complicated?

A. Its a very complex challenge. And in technical jargon, it's the problem of "confounding,'' as it is called, in which you have multiple associated events or pressures, and teasing apart where one is incidental and another is in fact a cause, is a big challenge.

The way scientifically or methodologically one approaches the problem is by attempting to define experiments or quasi-experiments, or observational studies, which are sufficiently rich in their data that you can separate out the instances of these different potential causes.

Q. How do you hope that the data that you come up with might be used?

A. Improvements or expansions of our way of thinking about health and concrete specific strategies to improve health, I believe, can come out of this kind of study. I think it is very important for our political and other leadership to be aware of the sources of ill health and [to] implement ways we can actually improve life chances. And those range from the biological level of introducing vaccines to more socially based changes and educational changes, like what we teach our children [and] what goes on in the schools.

Q. How will the center focus on children's health problems, in particular?

A. The problems of infant mortality and childbirth, refugees from war, famine, from natural disaster--there are many projects ranging from healthy beginnings, school health education, adolescent choices in terms of health behaviors. ...

If you are concerned about infant mortality, the well-being of the newborn, one of the strongest predictors of improvements in infant mortality is literacy of women. So there's a direct linkage between access to education and the health of children.

Children tend to be without political voice, without the capacity to express their own needs and command resources and attention to their problems. And children in many parts of the world are horribly exploited, ranging from child prostitution to all forms of abuse and child labor. You cannot have a healthy population if you do not begin with healthy children, so there will be special attention in the work of the center to the rights of children.

Q. How can schools be involved in implementing this knowledge?

A. There is a very substantial opportunity for school-based educational programs to promote healthful living and understanding about individual rights and respect for one another and tolerance. There are many ways in which the public-health community might be motivated more effectively to support the efforts in schools to educate youngsters in the facts and the choices that young people have.

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