The second James Dalen Distinguished Visiting Lecture in Public Health Care Policy was delivered on April 3, 2009, by William H. Foege, MD, MPH, above, in University Medical Center's DuVal Auditorium. The title of his lecture was "Building Legacies: Everything Affects Everything," which was received by a very appreciative audience. This article is a summary of this lecture and his major points. View the lecture in iTunes.
Iman Hakim, MD, PhD, MPH, Dean of the Mel and Enid Zuckerman College of Public Health (MEZCOPH), introduced Dr. Foege.
Dr. William Foege and Dr. James Dalen went to medical school together and have been friends for a long time, so he opened his lecture with an amusing story about their college years. Dr. Foege said that while all the other guys were focusing on their golf games, or what type of car they someday wanted, or other typical college student plans, James Dalen always said that he just wanted to be a dean! “How many guys grow up wanting to be a dean?” Dr. Foege joked.
On the serious side, Dr. Foege stated that he came to the University of Arizona to "celebrate and honor Jim Dalen’s legacy," and all of the beneficial things that Dr. Dalen has done for the medical center, the University, and the Mel and Enid Zuckerman College of Public Health, and the state of Arizona.
“What is a legacy? What does it take to build one?,” Dr. Foege asked. The dictionary defines a legacy as “Something handed down from an ancestor or a predecessor or from the past.” A legacy can be the good we have done in our lives which benefits those around us and those who come after us, or a legacy can be something that is destructive. “Global warming is as much of a public health problem as hypertension,” said Dr. Foege. And he pointed out that people would think and act differently every day if they considered global climate change and the havoc it will wreak in the future as part of our legacy to coming generations, along with eradication of diseases and other good that we strive to do.
Leaving a positive legacy to the future, such as the one James Dalen has carefully constructed, requires thought and care, Dr. Foege said, and gave the following advice for building a positive legacy to everyone involved in public health, including students and professionals:
You’re in school to change the world, whether you’re currently in a college of public health, medical school, or later the school of life. Dr. Foege said that at least 30% of people in most cultures are fatalistic, or feel that they can’t change the future. This number can go up to 90% in some countries. He told the audience that they do have the power to change the world, particularly in public health. Fatalism inhibits growth and building a positive legacy.
Use science for the benefit of everyone. Science has no moral compass, some say. This is true in some ways, but not all, said Dr. Foege. “Science seeks truth,” he said. “The greatest challenge is to use science for the benefit of everyone!” He quoted Richard Feynmann, the late, renowned physicist and educator, who said, “Certainty is the Achilles Heel of Science.” We think we know things, but in truth we can only know them to a certain margin of error.
As an example of using science to benefit everyone, he used the eradication of smallpox. The deadly disease could be controlled with vaccinations, but the vaccine was usually in very short supply especially in developing countries. Vaccinations for smallpox are vital – even today there is no treatment for those afflicted with the disease, and at least 33% die who are infected. Administering with traditional needles used more of the precious vaccine than was needed.
Then on April 12, 1953, the bifurcated needle was invented by microbiologist Benjamin Rubin. At the time Rubin was born in 1917, over 2 million people died per year of smallpox. The forked shape of his new needle allowed for vaccinations to be given using much less of the vaccine, so many more people would be protected. In 1980, the World Health Organization declared the smallpox was eradicated, due in part to Rubin’s invention. (And also in large part to Dr. Foege's efforts!) Those are good legacies: a new needle to protect more people, eradication of a disease from the planet, both an improvement on past science.
Know Who Your Bosses Are. A three-year old asked, “Do doctors have bosses?” The medical saying is that good doctors have bosses — their patients. But Dr. Foege said that a better answer is: “All the people who will be born in the future are our bosses.” He pointed out that Abraham Lincoln left no descendants, but left “social DNA,” his mark on our world and society, a legacy. The public health practices used today will affect many generations to come. The polluting and wrecking of our planet that we are doing now will certainly have devastating effects on future generations of humans as well as other species and the environment as a whole.
Think and Act Globally and Locally. The original environmental saying is “Think Globally, Act Locally,” but Dr. Foege has rewritten it for public health and medical advances. He pointed out that we need to think AND act in both the global and local arenas. The United States is losing its lead in science due to a lack of thinking and acting globally. He said this is due to 1) restrictions on students, 2) the fact that India and China are graduating 10 times more biologists than the United States, and 3) Stem cell policy was set behind by the previous administration. “We are still more national than global in our thinking,” he said.
Keep your balance. In your own life, in your work, and all you do, your life has to be balanced and at peace before you can give your best efforts to others. You must attempt to be special. It doesn’t happen automatically! Doing remarkable things in your life requires work, and risk, and striving to be better.
Do no harm. Dr. Foege said he was struck by how empty that phrase has become when a medical supervisor said in front of him, “You’ll never forget those you kill!” In fact, he said, we do harm and kill more by what we don’t do, such as not ensuring that all children have vaccines to protect them from preventable, deadly childhood diseases; not taking care of refugees in desperate situations; and by not caring for orphans from AIDS and other calamities in other countries.
Doctors don’t get paid for prevention. In this busy world where doctors are given five minutes per patient, it’s easy to skip finding out what a patient is eating or doing that is making him or her sicker. Take the time to advocate prevention and a healthy lifestyle.
Tenacity – use it in your endeavors. Dr. Foege told the story of an Olympic marathoner who finished two hours after everyone else. “Aren’t you embarrassed?” asked the news reporter. “No,” he said, “My country sent me 7,000 miles to finish the race.” He could not give up and disappoint those back home even if it was painful to him personally; that's tenacity.
The measure of civilization is how people treat each other. Health workers have their own language, which can often alienate them from the public. Treat others with respect and speak to them in a way that they can understand. Translate public health and medical information so that it can be used by the general public.
Be optimistic.
Close the gap. Everyone has a personal story, and it’s a surprise all the students are here. Ghandi said “People become who they believe themselves to be.”
“Improve the world for your future bosses,” he told the audience, as he summed up his lecture, “even though they won’t be born for hundreds of years!”
Thank You, Dr. Foege!
Thank you for this inspiring lecture, Dr. Foege! Audience members asked multiple questions after the lecture was completed, also.
A reception in the Arizona Cancer Center's Kiewit Auditorium followed Dr. Foege's lecture. More photos of the lecture and reception will be posted soon.
For visitors from the 2009 Public Health Week Web Site:
Go back to the 2009 Public Health Week Web Site
Links:
- Read about the Global Health Program at the Bill & Melinda Gates Foundation: " We target diseases and health conditions that cause the greatest illness and death in developing countries, yet receive little attention and resources. Our mission is to help ensure that advances in health are created and shared with those who need them most."
- Visit the Carter Center at Emory University on the web. Dr. Foege was executive director of the Center from 1986 to 1992. The Carter Center’s motto is “Waging Peace, fighting disease, building hope.”
Please send comments, questions, or errors in this article to
the author of this article, Loretta McKibben, at mckibben@email.arizona.edu.
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