Department of Social Medicine and Health Policy, 1980–1984 and earlier
Seeds of social medicine and global health: preventive medicine, community health
The Department of Social Medicine and Health Policy was established in 1980 by Harvard Medical School’s then Dean, Dr. Daniel Tosteson, and his Dean for Academic Affairs, Dr. James Adelstein, who invited Dr. Leon Eisenberg to be its founding chair. The Department’s organizational predecessors were the Department of Preventive Medicine and the Center for Community Health. The former had been headed for many years by David Rutstein. He was followed by Julius Richmond and by Dieter Koch-Weser as Acting Chairman during the years that Dr. Richmond served in President Carter’s administration. The latter had been headed from its inception in 1968 by Paul Densen. Under the Center for Community Health, Professor Rashi Fein, a member of the Department and of the Center, participated in a postdoctoral fellowship program in Health Policy, Economics and Political Science for MDs and PhDs. This program, begun in the late 1960s, funded by the Rockefeller Foundation, benefited over 25 fellows, many of whom became influential in academic health policy. The Center represented a tradition of social action, real-world research, and cross-departmental activities, such as the fellows’ project on a model for prepaid clinical practice initiated at the Massachusetts General Hospital. The Center also administered the medical student clerkships in the Southwest, serving American Indian communities.
Culture, medicine, psychiatry
A seminar on "Culture, Medicine and Psychiatry," organized at Harvard in 1975–1976, funded by the Robert Wood Johnson Foundation, and led by Professor Arthur Kleinman, Leon Eisenberg, and Byron Good, formed another intellectual seed for the future Department of Social Medicine. This seminar generated interdisciplinary excitement, attracting faculty as well as graduate students from anthropology, sociology, political science, and the history of medicine. Presentations from seminar meetings led to the initial volume of Culture, Medicine and Psychiatry: An International Journal of Comparative Cross-Cultural Research.
Dr. Julius Richmond
Dr. Julius Richmond, pediatrician, and Dr. David Hamburg, psychiatrist, were also influential in DSM history. Dr. Richmond chaired the HMS Department of Preventive and Social Medicine from 1971–1977, before joining the Carter Administration as Assistant Secretary of Health and Surgeon General from 1977–1981. Dr. Hamburg served as John D. MacArthur Professor of Health Policy, a cross-faculty appointment at HMS and the Kennedy School, from 1980 to 1982 before assuming the presidency of the Carnegie Corporation in 1983. When Dr. Richmond returned to Harvard from government service in 1983, he was appointed the John D. MacArthur Professor of Health Policy and launched various University-wide initiatives, including one on child health and one on Medicare reform.
Interdisciplinary faculty—social sciences and humanities applied to medicine
While leading the Department, Leon Eisenberg built and established an interdisciplinary social science faculty in medical anthropology and history of medicine. In 1982, he recruited Arthur Kleinman, with a mandate to develop new bridges to the social sciences in the Faculty of Arts and Sciences. Prof. Kleinman recruited Byron Good and Mary-Jo Good to join him in building medical anthropology as a new discipline in the medical school and the Department of Anthropology. During Dr. Eisenberg’s tenure as Chairman, Allan Brandt and Harry Marks were appointed to teach and carry out research in the history of medicine. Dr. Lynn Peterson, a surgeon and ethicist, joined the department to lead a new Division of Medical Ethics in 1989. All faculty taught courses for medical students and advised students in research, in international health and medical anthropology, in history of medicine, in ethics and in health policy. In 1984, a separate Department of Health Care Policy was established at HMS, and the name of the department became Department of Social Medicine (DSM).
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Department of Social Medicine, 1984–2008
Training global leaders in medical anthropology—U.S., Kenya, and Tanzania
During the first decade of the DSM, several fellowship programs were instrumental in shaping the intellectual direction of the department. These included the MacArthur Foundation grant to support HMS medical students to pursue PhD work in the Faculty of Arts and Sciences, particularly in anthropology and history of medicine; an NIMH pre- and post-doctoral training program in "clinically relevant medical anthropology," focused on culture and mental health services; and a program in history of medicine. The DSM thus began to play a critical role in bridging the medical school and the Faculty of Arts and Sciences, as faculty and students developed affiliations with the FAS through appointments, educational programs, teaching and research. The Carnegie Fellowship program in Health and Behavior in East Africa (1989–1999) increased the number of international postdoctoral fellows and visiting scholars who joined the department each year to further their work in medical anthropology, history of medicine and the social sciences. In the ensuing years, 37 post-doctoral fellows and 29 PhD students in medical anthropology were supported by the NIMH training grant, and 32 physicians and social scientists from Kenya and Tanzania were supported by the Carnegie program.
The Division of Medical Ethics
The Division of Medical Ethics, directed by Professor Allan Brandt from 1997–2003, expanded during the DSM’s second decade as well, developing a rich network of medical ethicists in the HMS teaching hospitals and public programs designed to stimulate consideration of some of the most pressing ethical issues associated with developments in contemporary biomedicine. Academic programs for medical students, clinical faculty, and postgraduate fellows in medical ethics were developed as new faculty and staff joined this increasingly influential set of programs.
Dr. Arthur Kleinman, World Mental Health, and expansion of training and research to China, Indonesia, Haiti, and Peru
Professor Arthur Kleinman was appointed chair of the DSM in 1991 and led the DSM into its second decade, continuing and strengthening academic programs in medical anthropology, the history of medicine, social and health policy, the humanities, and medical ethics. Under his leadership, many DSM faculty and fellows contributed to the world mental health report (World Mental Health: Problems and Priorities in Low Income Countries), which has been influential in placing mental health on the international public health agenda. Other research programs, including those supported by the Center for the Study of Culture and Medicine, conducted studies of ethnicity and psychiatry, Harvard’s medical education reform, biomedicine, biotechnology, and oncology, as well as suicide and mental illness in China. The Department continued its commitment to postdoctoral training programs. The Freeman Foundation Fellowship for China and Southeast Asia was established in 1996, and, until 2004, brought physicians and social scientists from China, Hong Kong, Indonesia and Thailand as postdoctoral fellows. On-going collaborative research and educational activities were established and have continued to the present, with faculty exchanges and collaborative research in China, Indonesia, Peru, Haiti, Kenya and Tanzania. Medical students, undergraduate and graduate students, and NIMH fellows have benefited from exchanging views with visiting scholars from around the world.
Program in Infectious Disease and Social Change; collaboration with Partners In Health and Brigham and Women's Hospital
The second decade also witnessed the establishment and growth of the Program in Infectious Disease and Social Change (PIDSC), headed by Paul Farmer, Jim Yong Kim, and their team of socially active anthropologists, physicians, epidemiologists and medical students. PIDSC has been linked since its inception to Partners In Health (PIH), a not-for-profit nongovernmental organization committed to social justice and to providing health care in a partnership with the poor in Boston, Haiti, Peru, and other low-income societies. PIDSC and PIH have received support from the Open Society Institute and the Bill & Melinda Gates Foundation to develop innovative programs to treat multi-drug resistant TB and HIV, radically transforming global health policies and leading a global campaign to bring quality medical care to persons living in poverty, particularly in Haiti, Peru and Russia. PIH relocated its offices from Cambridge to the Department of Social Medicine in 2000, bringing the academic work of the DSM and the commitment to linking medical care to issues of social justice into closer relationship with one another. In 2001, the Department of Medicine in the Brigham and Women’s Hospital initiated a Division of Social Medicine and Health Inequalities, with strong links to the DSM. (The name of this division has since changed to Division of Global Health Equity.)
The Program in Urban Health
The Program in Urban Health was founded in 1999, under the leadership of Patricia Case, to bring special attention to problems of health in urban communities in the US. The Program conducted research on drug use and infectious diseases in Boston and New York City. It ended in 2005.
Advocating and investigating to support global scaling-up of HIV and multidrug-resistant TB treatment
As the DSM entered its third decade, HMS Dean Joseph Martin named Professor Byron Good Acting Chair in 2000 and Chair in 2002. Under Prof. Good’s leadership, the Department expanded rapidly, increasing levels of funded research, building on the strengths of its academic programs, negotiating new ties with clinical programs in the hospitals, and making new and strategic commitments to respond to several of the greatest global health problems — MDRTB, HIV/AIDS, and mental health problems. A major grant from the Bill & Melinda Gates Foundation supported the efforts of PIDSC and PIH to scale up the treatment of MDR-TB in Peru and Russia, demonstrating the feasibility of lowering drug prices and treating a condition long assumed to be too expensive to treat in poor countries. The model of treating MDR-TB served as a worldwide impetus to establish treatment of HIV/AIDS in the poorest societies. From 2003 through 2006, Jim Kim moved to Geneva to build a new global commitment to treating HIV/AIDS. The “3 by 5 Program” committed WHO and global collaborators to enroll 3 million HIV/AIDS patients in treatment by 2005. The new WHO activities were closely linked to new commitments in the DSM. Partners In Health, members of the Department, and faculty and fellows from the Brigham’s Division of Global Health Equity agreed to build a treatment program for HIV/AIDS and TB in Rwanda, a commitment which continues to expand into the present as Rwanda scales up its HIV and public health programs.
Expanded mental health research and training in Indonesia, China, and the U.S.
Professors Byron and Mary-Jo Good worked closely with the International Organization for Migration in Indonesia to help build clinical services in the province of Aceh, ravaged by a massive tsunami and a violent conflict that traumatized civilian communities for nearly 20 years. In China, Arthur Kleinman continued efforts to place suicide and major mental illness squarely on the national health agenda. This work was supported by the establishment of a new Fogarty International Training program in international mental health in the Department, directed by Prof. Byron Good, that brought fellows from Hong Kong, Shanghai, and Beijing to the DSM to build research capacity and new collaborations in mental health services, with special interests in early psychosis, dementia and care for China’s aging population, and the establishment of new models of mental health services. The NIMH training program continued, and with support from the Russell Sage Foundation, Prof. Mary-Jo Good launched a study of how ‘culture’ is represented and responded to in Boston mental health clinics, serving diverse communities and the city’s new immigrants.
Highlights of 2001–2006
Focus on youth. In 2001 Professor Felton Earls joined the Department. He completed his research on human development in Chicago neighborhoods, studying violence in communities, families and schools, and started the Child Health and Social Ecology project with children affected by AIDS in Tanzania.
Vietnam-CDC-HMS AIDS Partnership. Between 2002 and 2006 Eric Krakauer founded and directed the Vietnam-CDC-HMS AIDS Partnership, training Vietnamese doctors and other healthcare practitioners in prevention and treatment of HIV/AIDS as well as encouraging voluntary screening for HIV.
HMS MD-PhD Program in the Social Sciences. Dean Joseph Martin appointed Professor Allan Brandt to reinvigorate the MD-PhD Program in the Social Sciences. Medical Anthropology, Health Policy, and History of Science, as well as other disciplines all continued to attract strong candidates.
Program in Ethics and Health. In 2004, Professor Dan Brock was recruited to be the first Professor of Medical Ethics at Harvard Medical School and to direct the Division of Medical Ethics. Professor Brock established the Division as a major center for training and research, built new links across the hospitals, initiated a new course required of medical students, and established a University-wide Program in Health and Ethics.
Harvard Medical School curriculum revision. DSM faculty participated actively in Dean Martin’s reform of the medical curriculum, taking on new responsibilities for the education of physicians in the social sciences and humanities, as well as in community and global health care. Byron and Mary-Jo Good piloted a specialized concentration in global health, and ran the Department’s first global health seminar for medical students. And members of the Department launched new activities in the medical humanities, linking faculty and programs in the Medical School with those in the Faculty of Arts and Sciences.
Dr. Jim Yong Kim and Global Health Delivery
In 2006, Professor Jim Yong Kim was brought back from the WHO and named Chair of the Department of Social Medicine. He also became head of the Harvard University Francois-Xavier Bagnoud Center for Health and Human Rights at the Harvard School of Public Health and chief of the Brigham and Women’s Hospital Division of Social Medicine and Health Inequalities. Dr. Kim led development of a new global health delivery program, building a new science of implementation in global health care that aims to more effectively transfer the great array of services, knowledge, and other resources for prevention and treatment of disease to the many in need of this help. The program focuses primarily on improving the care of people who live with infectious disease in resource-poor settings, but has wide ranging implications for responding to the gap between what the medical sciences are able to treat and what is actually treated in most parts of the world. The program also responds to the treatment gap in the United States and in Boston, drawing lessons from what is being learned from global health activities and developing new approaches to address the failures of American medicine to provide quality medical services.
HMS curriculum requires study in social medicine and medical ethics
During this period, Harvard Medical School began implementing a reform of the medical education curriculum. As a result of the reform, first-year medical students were required to take new courses, including “Introduction to Social Medicine” and “Medical Ethics and Professionalism.” Allan Brandt, Jim Yong Kim, Paul Farmer, and David Jones led development and teaching of the introductory course in social medicine, and Mary-Jo Good, Byron Good, and Michael Fischer led development of a course for HST students, introducing social medicine via global health. Dan Brock, Bob Truog, and four of their colleagues designed and taught the medical ethics course. In January 2008, Allan Brandt was named Dean of the Harvard Graduate School of Arts and Sciences. He continues to teach in the introductory social medicine course as well as serve as the Amalie Moses Kass Professor of the History of Medicine in the Department. Direction of the HMS MD-PhD Program in the Social Sciences transferred from Professor Brandt to Associate Professor of Social Medicine Anne Becker.
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Department of Global Health and Social Medicine, 2008
On July 1, 2008, the name of the department changed to the Department of Global Health and Social Medicine. The name change reflects the increasing importance of the Department’s international orientation, the growth of interest in global health among students and faculty, and Harvard Medical School’s commitment to ensuring that its impact on health and medicine will have a global reach. It also aligns the Department with the interfaculty Harvard Initiative for Global Health, which is dedicated to increasing opportunities for educating the next generation of global health leaders.
Social medicine at the heart of global health; developing the science of implementation for global health delivery
The Department maintains its basic commitments to building academic excellence and wide-ranging teaching programs, to linking the social sciences and humanities around the University, and to advocacy work rooted in values of social justice. The change in the department’s name recognizes the increased globalization of these commitments, demanding new interdisciplinary sciences bridging the social sciences basic to medicine, clinical science, and global health delivery, and the development of new specialties and specialists to provide leadership in a changing era of social medicine.
Dr. Paul Farmer and Dr. Anne Becker
In the spring of 2009, Jim Yong Kim was named president of Dartmouth College. Paul Farmer, Maude and Lillian Presley Professor of Social Medicine, was named chair of the Department of Global Health and Social Medicine effective July 1, 2009. On December 16, 2010, Harvard announced the awarding of the Kolokotrones University Professorship to Paul Farmer, adding him to the 23 of Harvard's 12,000 faculty members who hold university professorships. Dr. Farmer is the first incumbent of this seat, which was established through a gift from Wendy and Theo Kolokotrones, MBA ’70. On May 31, 2011, Anne Becker, Vice Chair of the Department, was named the Maude and Lillian Presley Professor of Global Health and Social Medicine. In addition to Paul Farmer, Leon Eisenberg, and Arthur Kleinman each bore the Presley name during their careers in this department.
Dr. Jim Yong Kim moves to the World Bank
The Department was proud to see Jim Yong Kim named president of the World Bank in 2012. (See the stories in the Washington Post. He took office on July 1, 2012.
The Global Health Delivery Partnership
The Department and collaborators, Partners In Health and Brigham and Women's Hospital, formalized the Global Health Delivery Partnership to translate knowledge, generated in academic medical centers and in settings of poverty, and transfer skills and resources in order to improve delivery of effective, equitably distributed health care. The Partnership is committed to improving health throughout the world, and particularly for the poor and marginalized. Its work focuses on four essential elements of global health delivery: (1) delivering high quality health care; (2) building local capacity and strengthening health systems; (3) transforming medical education; and (4) documenting our work and diffusing lessons learned.