Although the theme of panels at both the medical school and the public health school reunions was the impact of disease and disaster on society, Donald O. Lyman, M.D. ’68, turned that topic on its head.

“It is not so much that infectious disease affects society,” he said, speaking at the medical school symposium, Infectious Disease and How It Impacts Society, Public Health and Safety. “It is that societal patterns influence the diseases we suffer.”

Past epidemics of infectious disease stemmed from unusual social patterns such as urban crowding. Long before antibiotics these diseases were successfully addressed by easing congestion and providing basic sanitation. That lesson—addressing societal problems to eliminate disease—is now being applied to lifestyle patterns such as smoking and nutrition.

Most deaths, illnesses and disabilities today stem from two sources, cardiovascular disease and cancer, Lyman said. And they, in turn, are largely the result of three things—smoking, poor nutrition and lack of exercise. In California, where he is chief of preventive medicine for the state’s Department of Health Services, Lyman has begun to address those matters. An anti-smoking campaign has reduced adult smoking by a third and consumption of tobacco products by two-thirds. Over the past decade the incidence of cancer in California has fallen by 10 percent, he said. The state has seen a similar reduction in cardiovascular disease. “Our next step will be nutrition and physical activity,” he said. 

Also on the panel was Frank J. Bia, M.D., M.P.H., FW ’79, professor of medicine and laboratory medicine, who outlined the early history of anti-microbial agents, including the first use of penicillin at Yale during World War II. Vincent J. Quagliarello, M.D., HS ’81, professor of medicine and clinical director of the section of infectious diseases, offered an update of the SARS epidemic around the world (See “SARS Remains a Moving Target,”). What is known about the emerging syndrome, he said, keeps changing as more is learned about it. Margaret K. Hostetter, M.D., chair and professor of pediatrics and professor of microbial pathogenesis, discussed diseases common to children adopted from other countries.

After the symposium, then-Dean David A. Kessler, M.D., spoke on the effects of HIV/AIDS on children. Calling the disease the “worst epidemic in world history,” Kessler said that by the end of the decade, 45 million people will be infected. Despite that dire figure, Kessler noted that the world is responding to the crisis with offers of aid. The Bill & Melinda Gates Foundation, he said, has pledged $15 million for projects to prevent mother-to-child transmission of HIV. An ongoing program at Yale sends first- and second-year medical students to South Africa to work on local HIV prevention projects.

“I think increasingly we are becoming a global medical school at a global university,” Kessler said.

At the annual meeting of the Association of Yale Alumni in Medicine (AYAM), three graduates received the Distinguished Alumni Service Award: Harold D. Bornstein Jr., M.D. ’53, HS ’56; Robert J. Donohue Jr., M.D. ’58, HS ’59; and Andrew J. McGowan Jr., M.D. ’58.

The AYAM’s executive committee elected new officers at the reunion. Donald E. Moore, M.D. ’81, M.P.H. ’81, is the new president. Francis M. Lobo, M.D. ’92, was elected vice president. Christine A. Walsh, M.D. ’73, is the secretary.

War and public health

In Vietnam the unintended consequences of war persisted after hostilities ended. Bomb craters filled with water and became breeding grounds for mosquitoes. The effects of Agent Orange continue to emerge generations later. In early June, despite the declaration of an official end to the second Persian Gulf War, unexploded ordnance continued to kill and maim Iraqis. And the disruption of the Iraqi infrastructure spread disease, as evidenced by cholera outbreaks.

At the public health reunion on June 6 at the New Haven Lawn Club, keynote speakers Barry S. Levy, M.D., M.P.H., and Victor W. Sidel, M.D., co-editors of War and Public Health and Terrorism and Public Health, cited these and other examples as they described the effects of war and terrorism on public health.

In the United States, the anthrax outbreaks that followed the September 11 attacks highlighted the importance of public health and led to increased funding to handle bioterrorism. But according to Sidel, the overall picture is less than rosy.

“What we have seen over the past year or so,” Sidel said, “is the diminution of public health resources. Very few bioterrorism funds can be put to dual use. They do not make up for huge losses that health departments have suffered because of economic downturns and sharp reductions in state and local government budgets.”

In the afternoon, the discussion focused on the consequences of war for public health. Gregory Hess, M.P.H. ’95, who designed and managed the Peace Through Health program for the World Health Organization, described how relief efforts offer a chance for peace-building. War, said Unni Karunakara, M.P.H. ’95, health advisor for Doctors Without Borders, disrupts many aspects of human security, including politics, the environment, the economy and food supplies. “All of those impact health,” he said. 

Other speakers included Bruce R. Grogan, M.P.H. ’76, principal in The Grogan Group, which advises both the private and public sectors on sustainable development and institutional capacity building, and Richard C. Poole, M.P.H. ’78, a Naval Reserve Medical Service Corps commander, who is organizing a conference on bioterrorism and emerging infectious disease in Latin America.

Karunakara and Andrew D. McBride, M.P.H. ’77, were inducted into the Alumni Public Service Honor Roll. Karunakara was honored for his international work and McBride, director of public health for Milford, Conn., was honored for his years of service, including a stint as commissioner of health for North Carolina. For his service to the School of Public Health, Eric Mood, M.P.H. ’43, became the first recipient of a new award, the eph Alumni Bulldog Award.

Joseph A. Zaccagnino, M.P.H. ’70, president and CEO of Yale-New Haven Hospital, received the 2003 Distinguished Alumni Award.

“Health care is an industry in transition,” Zaccagnino said after receiving the award. “It is an industry that leads and lags the rest of the world. We have access to the most advanced medical technology anywhere, but our population is not as healthy as those in many other industrialized nations, and we have 40 million citizens who are not protected by medical insurance.”