HMS Department of Preventive and Social Medicine
Dr. Leon Eisenberg
Dr. Arthur Kleinman
Dr. Byron Good
Department of Social Medicine
Department of Global Health and Social Medicine
Department of Social Medicine and Health Policy, 1980–1984 and earlier
Seeds of social medicine and global health: preventive medicine, community health
The roots of the department extend back to the inception of the Department of Hygiene in 1871. This would evolve into the Department of Preventive Medicine and Hygiene in 1908, the Department of Preventive Medicine in 1940, and the Department of Preventive and Social Medicine in 1971, reflecting shifting institutional, intellectual, and social contexts at each transformation. For the 1871-1980 history of the department, please see these presentations by Drs. Scott Podolsky and Emily Harrison from the September 2021 symposium celebrating 150 years of social medicine at Harvard. From such a background, the Department of Social Medicine and Health Policy was established in 1980 by Harvard Medical School’s then Dean, Dr. Daniel Tosteson, and the Dean for Academic Affairs, Dr. James Adelstein, who invited Dr. Leon Eisenberg to be its founding chair. The Department’s immediate organizational predecessors were the Department of Preventive and Social Medicine and the Center for Community Health. The former (as the Department of Preventive Medicine) 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 later led by Professors 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 the Department’s 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.
Leon Eisenberg builds an 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. Professor 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 the history of medicine, and in ethics and in health policy. In 1988, a separate Department of Health Care Policy was established at HMS, and the name of the department became the Department of Social Medicine (DSM).
Department of Social Medicine, 1988–2008
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; a National Institute of Mental Health 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 Department of Social Medicine 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. Ongoing 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 anthropologists, physicians, epidemiologists, and medical students. PIDSC has been linked since its inception to Partners In Health (PIH), a nonprofit 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 would during this period receive crucial 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. In 2000, PIH relocated its offices from Cambridge to the Department of Social Medicine, bringing the academic work of the DSM and the commitment to linking medical care to issues of social justice into a 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 the Division of Global Health Equity.) In the years since, all three entities have expanded tremendously in size, requiring each to have their own office spaces across the Longwood Medical Area and Boston.
Dr. Byron Good, and 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 Professor 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 Yong 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—among those included are current department faculty, Mercedes Becerra, Carole Mitnick, Salmaan Keshavjee, and Joia Mukherjee—agreed to build a treatment program for HIV/AIDS and TB in Rwanda, a commitment that would continue to expand and ultimately include the formation of the University of Global Health Equity (as detailed below).
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 in 2004 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 Professor 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, Professor 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.
Additional Highlights from 1999–2006
The Program in Urban Health. Founded in 1999, under the leadership of Patricia Case, the Program in Urban Health brought 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.
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.
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 the development of a new global health delivery program, building a new science of implementation in global health care aiming 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.
HMS curriculum requires study in social medicine and medical ethics
As a result of HMS medical education reform efforts that began in 2005 and took effect in the fall of 2007, first-year medical students were, for the first time, required to take courses in “Introduction to Social Medicine” and “Medical Ethics and Professionalism.” (Previously, they were expected to take an elective course in social medicine, medical ethics, health policy, or other social science, population health, or related topic.) Allan Brandt, Jim Yong Kim, Paul Farmer, and David Jones led the development and teaching of the introductory course in social medicine, and Mary-Jo Good, Byron Good, and Michael Fischer led the development of a course for the HMS-MIT Health Sciences and Technology 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. The direction of the HMS MD-PhD Program in the Social Sciences transferred from Professor Brandt to Associate Professor of Social Medicine Anne Becker.
Department of Global Health and Social Medicine, 2008-present
On July 1, 2008, the name of the department changed to the Department of Global Health and Social Medicine. The name change reflected 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 would have a global reach. It also aligned the Department with the interfaculty Harvard Initiative for Global Health, dedicated to increasing opportunities for educating the next generation of global health leaders. The Department would maintain 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 recognized 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.
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. Allan Brandt receives the Bancroft Prize
The Department delighted in the 2008 awarding of the Bancroft Prize to Allan Brandt in recognition of his book, The Cigarette Century: The Rise, Fall, and Deadly Persistence of the Product that Defined America (Basic Books, 2007). This prize, awarded by Columbia University, is considered one of the most distinguished academic awards in the field of American history and among the most prestigious awards in American history writing. Dr. Brandt’s book was also a finalist for the Pulitzer Prize for General Non-fiction.
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, making him the 23rd of Harvard's 12,000 faculty members to hold a university professorship. Dr. Farmer would be 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 (2009-2016), 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
Haiti Earthquake January 2010
The 7.0 magnitude earthquake that struck Port-au-Prince, Haiti, on January 12, 2010, drew upon the expertise of the Global Health Delivery Partnership and led to new developments in global health delivery. Faculty members participated in the immediate care of patients and the organization of resources for health care and reconstruction. Dr. Louise Ivers was in Port-au-Prince at the time of the quake and led efforts to respond immediately to the disaster, managed one of the largest internally displaced persons camps, and worked to control the cholera outbreak that began that October and lasted for almost a decade. Paul Farmer and colleagues, notably Dr. David Walton of the BWH Division of Global Health Equity, guided a vision for constructing the University Hospital of Mirebalais, a world-class teaching hospital in Haiti’s central plateau, where HMS students and trainees now gain clinical experience and participate in research with significant contributions from Dr. Joia Mukherjee, who also serves as chief medical officer at Partners In Health. Experiences from the earthquake continue to inform approaches to global emergency response.
HMS Center for Primary Care
Given the demonstrated value and critical importance of primary care, the HMS Center for Primary Care was established in 2010 to elevate and build a primary care presence both on the HMS campus and among our local, national, and international communities. The HMS Center for Primary Care is strengthening health care through the transformation of systems, teams, and leaders. It intersects with the DGHSM through the Program in Global Primary Care and Social Change and through the shared belief that strengthening primary care is essential to enabling improved treatment of all diseases. The DGHSM manages academic appointments and visa sponsorship for CPC faculty and trainees.
A. Bernard Ackerman Professorship on the Culture of Medicine
In 2011, following an international search, Dr. David S. Jones was named as the first incumbent to the A. Bernard Ackerman Professorship of the Culture of Medicine. This interdisciplinary position was established to expand the University’s research and teaching in the cultural, historical, social, humanistic, and ethical aspects of medicine. This professorship helps to define an emerging field that draws on the medical humanities while also initiating fresh scholarly research directions by including approaches from medical anthropology, sociology, and history of medicine. Professor Jones was charged with encouraging existing multi-disciplinary interests and facilitating interactions between the study and practice of medicine and the humanities, as broadly understood. Appointed jointly in the Faculty of Arts and Sciences (History of Science) and the Faculty of Medicine (Global Health and Social Medicine), he teaches undergraduate, graduate, and medical students and he has important intellectual and administrative responsibilities in building programmatic initiatives that complement and expand upon existing strengths at Harvard. As part of this charge, Dr. Jones established the Harvard Medical School Arts and Humanities Initiative.
Dr. Jim Yong Kim moves to the World Bank
The Department was proud to see Jim Yong Kim named the 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.
Programs in Global Health and Social Change
Building on the model of the Program in Infectious Disease and Social Change, which integrates the pedagogy and research of the University with clinical service organizations, such as Partners In Health, the Department established the Programs in Global Health and Social Change as the vehicle to carry out the vision that Paul Farmer articulated in April 2010. Dr. Farmer remarked, “A department of global health must have global programs, and it is to the great benefit of our students, faculty and patients that our teaching hospitals’ catchment areas extend over several continents. The more closely research, teaching and delivery are connected in a feedback loop, each reinforcing the other—and the more faculty, trainees and students are able to participate fully in all three—the higher will be the quality of all our work, and the greater our ability to impact the field.” The Department established programs in non-communicable disease, mental health, surgery, public policy, medical education, and neonatal health that apply the knowledge-base and expertise generated at Harvard Medical School to transform health care delivery capacity for patients and communities in greatest need in Boston, the U.S., and around the world. Later, additional programs were established in health economics and family care for the elderly.
Rwanda Human Resources for Health Program
The Human Resources for Health Program was a Rwanda-led initiative that sought to strengthen the health education system and expand the number, scope of specialization, and skill level of health professionals in Rwanda. It was operated by the Rwanda Ministry of Health and a consortium of American medical schools. The Department of Global Health and Social Medicine contributed educational expertise and administrative support in the first years of this program, which ran from 2011 to 2019.
Expanding faculty expertise to include quantitative fields
The Department, since the 1980s, has historically focused on applying social science approaches to understanding disease and its remedies. Faculty members represent a depth of expertise in qualitative research informed by the fields of anthropology, sociology, history, and philosophy. As the vision for global health equity grew and the Programs in Global Health and Social Change launched, a need to strengthen capacity for quantitative and mixed methods studies in biosocial research emerged. Epidemiological and biostatistical methods are particularly critical to global health research, in evaluating and refining health interventions as well as in understanding their social, economic, and health impacts. The Department gained long-term support for its epidemiologists and was able to appoint a leading tuberculosis researcher, Dr. Megan Murray. It was also able to hire additional epidemiologists and a biostatistician. Many of these faculty members serve in the Global Health Research Core, supporting colleagues on project design and analyses. These faculty are essential to the work of collaborating with local scientists in building research capacity within the host countries where our work is conducted. They also mentor students, trainees, and colleagues in epidemiologic and biostatistical methods.
Master of Medical Sciences in Global Health Delivery
In 2012, under the leadership of Dr. Joia Mukherjee—Associate Professor of Medicine and of Global Health and Social Medicine, and Chief Medical Officer for PIH—HMS and the DGHSM launched the Master of Medical Sciences in Global Health Delivery program to provide training in research, program design, and management to support the work of social and delivery science and policy research in resource-limited settings. A field-based mentored research project is at the core of the program and serves as the basis for a master’s thesis. In its first 10 years, this program enrolled 113 students from 38 countries. Many students and alumni come from and serve in countries of the Global South.
In 2013-2016, a devastating Ebola outbreak swept through West Africa, and many DGHSM faculty were actively involved in the response. Paul Farmer and Jim Yong Kim (serving in his capacity as President of the World Bank) provided high-level expertise to inform the national and international coordination of a global epidemic response. Partners In Health, internationally recognized as an emergency response organization, was invited by the ministries of health in Liberia and Sierra Leone, alongside nonprofit organizations, Last Mile Health (in Liberia) and Wellbody Alliance (in Sierra Leone, and founded by MMSc-GHD alum, Dr. Bailor Barrie) to respond to Ebola in the most hard-hit regions of West Africa. During the height of the epidemic, Partners In Health delivered on-the-ground patient care, built up existing treatment centers, and developed protocols that forever changed the standard of care in these settings. These clinical sites also provided a platform for DGHSM faculty to conduct research and significantly contribute to the quickly growing scientific literature on Ebola. Also, during this time, Dr. Eugene Richardson, now an assistant professor in the DGHSM, was serving as a volunteer clinician for Médecins Sans Frontières and then Partners In Health. A medical anthropologist by training, Dr. Richardson’s area of research added value to the DGHSM and he joined the faculty soon after the emergency response was over.
Working alongside local clinicians and staff to collect on-the-ground data during the response, DGHSM faculty were also actively engaged in Ebola research. Dr. Megan Murray pursued questions to understand whether Ebola carriers could be symptom-free, the time between showing symptoms and being infectious, and long-term effects of the disease. The hope was that such questions would inform treatment and containment practices and improve outcomes. Dr. Murray’s team also examined the accuracy of point-of-care diagnostic tests. Another study looked at experiences of Ebola survivors, including immune response, health problems, and social integration following treatment.
Dr. Murray, Dr. Paul Farmer, Dr. Joia Mukherjee, Dr. Gene Richardson, and several others co-authored a paper in the Journal of Infectious Disease on lessons learned while responding to the epidemic in Sierra Leone on how to strengthen health systems while responding to a health crisis. (This paper was one of many that emerged from DGHSM faculty activities and research in responding to Ebola.) In a Harvard Medicine interview, Dr. Murray remarked, “’Ebola is a microcosm of what we do in other settings, but faster and more intense…. The logistics we’ve learned dealing with Ebola will apply to everything we do.’”
The Division of Medical Ethics becomes the HMS Center for Bioethics
In May 2014, HMS Dean Jeffrey Flier announced the transformation of the Division of Medical Ethics into the independent HMS Center for Bioethics and named Dr. Robert Truog—the Frances Glessner Lee Professor of Medical Ethics, Anaesthesiology & Pediatrics—as the first center director. Dean Flier remarked: “The HMS community is home to world-class thinkers about the ethical dimension of new discoveries and new ways of delivering care. In this time of extraordinary change, with rapid advancements in biomedical science, the Center for Bioethics will provide a crucial focal point for these discussions.” The Center would continue to offer HMS courses on medical ethics and professionalism and a year-long fellowship in bioethics. In addition, it launched a Master of Bioethics degree program in 2015, which as of June 2022 has graduated 211 students. In 2022, the Center is expanding its research faculty.
HMS Center for Global Health Delivery – Dubai
HMS established the Center for Global Health Delivery – Dubai in 2014 under the leadership of Dr. Salmaan Keshavjee. The Center expanded Harvard’s health care delivery research and training footprint in the Middle East and North Africa as well as nearby parts of Asia, Africa, and Eastern Europe. The Center focused on four areas: diabetes and obesity; surgical care; infectious disease; and mental illness. Projects focusing on the health of women and children were prioritized. The Center approached the improvement of global health delivery through a four-phase cycle: (1) It provided training to build capacity for better health care delivery research and implementation; (2) It paired regional investigators with Harvard faculty to carry out delivery research; (3) It offered workshops to enable exchanges of expertise, connect people, and disseminate blueprints for progress; and (4) It drafted policy to inform local and national government actions. Between 2014 and 2019, the Center funded 110 scholars to attend Harvard courses and training programs, hosted more than seven interns, sponsored 24 student research projects, sponsored 32 cooperative faculty research projects in 13 countries, and hosted 61 workshops, symposia, and courses. It published 25 proceedings and two policy briefs. In 2019, the Center headquarters moved from Dubai to Boston and several new regional hubs are operating.
Continuing efforts to improve TB treatment and stop its spread
In 2022, after SARS-CoV2, tuberculosis (TB) is the world’s leading cause of death from an infectious agent. There are approximately 10.4 million new cases and 1.8 million deaths from TB each year. One-third of these new cases remains unknown to the health system, and many are not receiving proper treatment. With the advent of Covid-19, estimated TB mortality rates rose for the first time in a decade, a rise which is attributed to a reduction in access to diagnosis and care during the pandemic.
Since the start of our work on MDRTB at the turn of the century, we have continued to focus on improving TB outcomes through multi-disciplinary research. We develop new diagnostics for TB in children and for drug resistant disease and strategies for early detection, scale-up preventive therapy, and identify risk factors for infection, disease progression and drug resistance. We work closely with partners in Peru where we have conducted large cohort studies in addition to collaborating with teams in India, Indonesia, Russia, and South Africa. Toward optimizing--shortening the duration and decreasing the toxicity of--treatment, we also conduct clinical trials of TB drugs; this work includes a 17-country clinical trial of oral treatment regimens. A wide range of collaborative projects continue to advance this work. Some examples include the Sentinel Project on Pediatric Drug Resistant Tuberculosis, the Zero TB Initiative, endTB, and other projects described on the Global Health Research Core site.
Social medicine education is part of new Essentials of Medicine course
The 2015 curriculum reform of the MD program at Harvard Medical School included the creation of a new required course, Essentials of Medicine. This is a two-month full-time course: Students complete the first month in January of their first year, and then the second month after completing their core clinical rotations. The existing courses on social medicine and medical ethics were integrated into this course, along with health policy, clinical epidemiology, and public health.
The Kletjian Chair
In 2015, Dr. John G. Meara was named as the first Steven C. and Carmella R. Kletjian Professor of Global Health and Social Medicine in the Field of Global Surgery. The Kletjian Foundation endowed this chair with the vision of appointing an academic who is a practicing surgeon with significant expertise in research, training, and care delivery in settings marked by poverty and health disparities. A track record of developing novel training programs for young surgeons and anesthesiologists and allied professionals within academic medicine, and a history of achievement in a domain of research relevant to surgical care, especially among patients poorly served by existing health-care systems, were important qualifications. The Kletjian chair requires capacity to work with multidisciplinary and trans-regional (usually multinational) teams with a stated commitment to health equity. The professorship was awarded to Dr. Meara as a practitioner-scholar with proven leadership in academic global surgery, including administrative experience within a hospital and university setting, as well as participation in international academically affiliated institutions engaged in setting the course for global surgery as a field of inquiry and practice in academic medicine. Dr. Meara, who long directed the Program in Global Surgery and Social Change, would lead a program that trains visiting medical students and postdoctorates in surgery, anesthesia, and related fields in global surgery research and advocacy methods and provides opportunity for conducting scholarly research with colleagues in low- and middle-income countries. In 2022-23, Dr. Meara stepped down from the Kletjian Chair when he was named the Boston Children’s Hospital Professor of Surgery in the Field of Pediatric Plastic Surgery. He also passed the directorship of the Program in Global Surgery and Social Change to Dr. Robert Riviello, Associate Professor of Surgery and of Global Health and Social Medicine.
The Pershing Square Chair in Global Health
In 2017, following an international search, Dr. Vikram Patel became the first incumbent of The Pershing Square Chair. This position was established to shape the then emerging academic discipline of global health delivery science through teaching and research. Candidates were sought who had expertise and direct experience in developing, implementing, and evaluating health delivery programs in resource-poor settings (in the U.S. or other countries); demonstrated excellence in leadership, in the engagement of local knowledge, and in building and sustaining collaborations among diverse actors and constituents in the communities and health systems served; and significant scholarly contributions to the scientific literature on global health. The appointee was expected to advance Harvard’s commitment to global health research and clinical capacity-building across a wide variety of settings, including in the classroom and through field-based mentorship.
Dr. Patel was already a leading, internationally renowned researcher and innovator in global mental health. He is a psychiatrist and epidemiologist committed to improving access and delivery of care globally and to promoting the human rights of people with mental disorders. Dr. Patel has done trailblazing work in documenting the burdens of mental illness in developing countries and creating interventions to alleviate these burdens. He has implemented interventions to integrate service and increase access to care among resource poor populations, particularly in Goa, India, through Sangath, the nongovernmental organization he co-founded. While pioneering these delivery platforms, he also has investigated the social and cultural determinants, epidemiology, and treatment of mental disorders in community and primary health care settings in India and other low- and middle-income countries and elucidated the strong associations between mental disorders and poverty and the association between depression and other illnesses. Dr. Patel co-founded the Movement for Global Mental Health, the Centre for Global Health at the London School of Hygiene & Tropical Medicine, and the Mental Health Innovations Network. At Harvard, he is continuing this work and expanding it to U.S. communities and within the University. He co-leads the Mental Health for All lab in the DGHSM and GlobalMentalHealth@Harvard, a university-wide initiative.
The Ronda Stryker and William Johnston Professorship in Global Health
In 2016, Dr. Megan Murray was named the first Ronda Stryker and William Johnston Professor of Global Health. This endowed professorship was established to catalyze and accelerate the Department’s work in building capacity for research in global health, training and educating future leaders in this field, and advancing the vision of integrating research and teaching with global health delivery. Dr. Murray is a physician, epidemiologist, and internationally respected educator and scholar of tuberculosis who is making important contributions to the understanding of epidemics and infectious disease transmission. She directs the Global Health Research Core and, through mentorship and co-authorship of scientific publications, fosters the next generation of global health leaders. She and her team collaborate with field-based clinicians in Peru, Haiti, Rwanda, and other countries to enhance their capacity for conducting research and evaluation of health care interventions. Their work to develop infrastructure in these challenging resource-poor settings creates a foundation for producing knowledge to improve health care delivery and opportunities for interrupting the cycle of poverty and disease.
Joseph Gone brings leadership in American Indian and other Indigenous mental health research
Professor Joseph P. Gone joined the DGHSM in 2018 as a clinical-community psychologist whose interdisciplinary scholarship examines cultural influences on mental health status as well as the intersection of evidence-based practice and cultural competence in mental health services. A citizen of the Aaniiih-Gros Ventre Tribal Nation of Montana, he investigates these issues through collaborative research partnerships in both reservation and urban American Indian communities. In 2019, Professor Gone, who is jointly appointed in the Department of Anthropology, was named faculty director of the Harvard University Native American Program. He has enlivened the Global Health and Social Medicine community through hosting a colloquium series on Indigenous Health and Well-Being.
University of Global Health Equity, Butaro, Rwanda
The University of Global Health Equity (UGHE) was built with the leadership and support of Dr. Paul Farmer and many other HMS faculty, alumni, trainees, and students from Harvard and Harvard-affiliated hospitals. An initiative of Partners In Health, UGHE is a health sciences university and medical school located in rural Rwanda and directly linked to Butaro District Hospital, requiring all its medical, dental, and nursing students to earn joint degrees in global health delivery. This approach is one way that the UGHE supports the integration of clinical training with research to fight against poverty and the human suffering caused by disease. The global health delivery curriculum is modeled on the HMS Master of Medical Sciences in Global Health Delivery program. Led by Dr. Agnes Binagwaho, Senior Lecturer on Global Health and Social Medicine and former Minister of Health of Rwanda, UGHE aims to help fill shortages of health care providers and researchers in low-resourced settings. Such shortages are critical drivers of health inequity worldwide. Several DGHSM faculty work closely with UGHE faculty and staff on curriculum development, teaching, and clinical rotations at UGHE. Among other HMS representatives, Harvard Faculty of Medicine Dean George Daley participated in the ceremonies celebrating the opening of the UGHE.
The Professorship in Global Health and Social Medicine in the Field of Medical Anthropology
In 2021, Dr. Salmaan Keshavjee was named the first incumbent of the Professorship in Global Health and Social Medicine in the Field of Medical Anthropology. This position establishes the legacy of medical anthropology as an essential field of scholarship for the advancement of global health equity. It will increase the Department’s work in building capacity for research in global health, training and educating future leaders in this field, and improving the lives and conditions of people and communities living in poverty around the world. Dr. Keshavjee is a physician, medical anthropologist, and public health expert, who applies biosocial approaches to eliminating tuberculosis (TB), leading a multipronged effort to combat TB worldwide and to ensure that all patients receive optimal treatment. He is chair of the Zero TB Initiative steering committee and director of the HMS Center for Global Health Delivery. He has contributed significantly to the development of TB treatment guidelines for both U.S. and international bodies. He is among the faculty who taught the first required social medicine courses at HMS and who teaches a popular global health course at Harvard College. His book, Blind Spot: How Neoliberalism Infiltrated Global Health, is required reading for anthropology and social medicine courses taught at Harvard and other universities.
The Jeffrey Cheah Professorship in Global Health and Social Medicine
In 2021, Dr. Mercedes Becerra was named the first incumbent of the Jeffrey Cheah Professorship in Global Health and Social Medicine. This chair was established to focus on transforming global health delivery through vital scholarship and training activities addressing diseases that are of greatest burden to those living in poverty. Incumbents commit to ensuring the relationship of innovative, cutting-edge research to delivery of care and treatment. Dr. Becerra is an epidemiologist who has devoted her career to countering misguided policies on treatment of multidrug-resistant tuberculosis and seeking improved outcomes among TB patients. Among her contributions, Dr. Becerra co-built a platform for conducting TB research in an impoverished community of Peru. Core partners in building this platform are the local colleagues whom she trained to conduct first-quality research. Her trainees not only participated in the research projects but some also became independent researchers and teachers who are strengthening Peru’s capacity for research. Dr. Becerra’s work in Peru has influenced improvements in TB treatments and policy globally and in specific countries, such as Russia and South Africa. She founded the Sentinel Project on Pediatric Drug-Resistant Tuberculosis and co-founded the Zero TB Initiative.
One hundred and fifty years of social medicine at Harvard University
In 2021-2022, the DGHSM celebrated 150 years of social medicine at Harvard University. On this occasion, several faculty members wrote reflections on the meanings and history of social medicine and the pursuit of global health equity. These reflections are available here.
The Passing of Dr. Farmer
On February 21, 2022, Paul Farmer died suddenly in his sleep of an acute cardiac event. He had been teaching at the University of Global Health Equity in Butaro, Rwanda. He will long be remembered for achieving things previously assumed to be impossible. He and colleagues at Partners In Health showed that it was possible to deliver complex, comprehensive care for people with HIV or multidrug-resistant TB in extremely low-resourced settings. Dr. Farmer was a renowned humanitarian who worked hand in hand with local governments and organizations around the world, including those in many rural and underserved communities, to establish partnerships to build hospitals, train medical workers, and establish community clinics in remote, impoverished areas where residents would otherwise have had little hope of receiving needed health care. He had a vision of the university that integrated research and education with service to communities, with insights from clinicians and others in the field informing research and education in a continuous feedback loop. The Department carries out this vision via the Programs in Global Health and Social Change, expanding the work Dr. Farmer led in infectious diseases by applying the research-education-service model in areas of mental health, surgery, non-communicable diseases, primary care, neonatal care, public policy, economics, elder care, and medical education.
Dr. Farmer’s successes in health care delivery innovation, buttressed by rigorous scientific studies and amplified by how nations and communities have been able to grow local capacity to deliver care, have been an inspiration to generations of caregivers, researchers, and educators. His approach demonstrated social medicine as the core of excellence in health care delivery. His colleague Dr. Joseph Rhatigan remarked, “Paul was never content with just treating the illness; he wanted people to thrive.” Similarly, Dean George Daley commented, “His example will always be a reminder that a doctor’s truest calling is to care for the sick and ailing. This is the reason that, for me, Paul represented the heart and soul of Harvard Medical School.”
Farmer is best remembered by his mentor, Dr. Arthur Kleinman, who wrote: “Paul was the epitome of decency and kindness. He was a thoroughly good, beautiful man. Yet, his deepest and most abiding commitment to social justice and health equity was like steel: unfathomably strong, unbending, an always-present inner core beneath the outer presence of warmth, humor, and love. That ever-giving presence brought others together to accompany the poor, give what they had and keep going against the odds. But it was the steel in his mind and heart that made for victories, small and large, that overcame, that triumphed even over the limits of his own body. That was the quiet passion, the true compass, that kept him on a moral journey so extraordinarily resonant and attractive to the best in us—that beyond the lightness of his warm touch and the sparkle in his eyes we knew he embodied values that should matter most for us. He was a world-historical moral figure who held no high position in global governance; led no army; headed no government agency; but more than these he created a moral praxis that survives beyond him and bends the arc of history.”
Allan Brandt is named Interim Chair (March 2022)
Professor Allan Brandt, Amalie Moses Kass Professor of the History of Medicine in the Faculty of Medicine and Professor of the History of Science in the Faculty of Arts and Sciences, was named Interim Chair.
Master of Science in Media, Medicine and Health
In September 2022, HMS and the DGHSM welcomed 18 students in its first cohort in the Master of Science in Media, Medicine and Health program. This is the only master’s degree program in the United States to offer evidence-based, multidisciplinary storytelling and an arts-driven curriculum focusing on health interventions. Students work with expert mentors to use the storytelling medium of their choice (for example, film, creative nonfiction, podcasting, or graphic design) to craft a novel public health intervention. The program is led by faculty directors Dr. Neal Baer, MD (writer and producer of ER, Law & Order SVU, and Designated Survivor, and executive producer of Peabody Award-winning Welcome to Chechnya) and Dr. Jason Silverstein, PhD (science journalist and writer-in-residence in the Department of Global Health and Social Medicine at Harvard Medical School).
Vikram Patel is named Chair (September 2023)
Dr. Vikram Patel, the Paul Farmer Professor, was named Chair of the Department of Global Health and Social Medicine.