January 19, 2010

Dean Michael Klag of The Johns Hopkins Bloomberg School of Public Health

The Gazette launches a yearlong series of talks with Johns Hopkins' leaders

At the start of a new decade, The Gazette launches a yearlong series of talks with the leaders of Johns Hopkins’ nine academic divisions and the Applied Physics Laboratory.

Michael J. Klag, a physician and internationally known expert on the epidemiology and prevention of heart and kidney disease, took the helm of the Johns Hopkins Bloomberg School of Public Health in 2005.

Klag had big shoes to fill. He replaced the charismatic Al Sommer, who had been dean since 1990 and had led a 12-year construction and renovation project that modernized and nearly doubled the size of the school’s presence on the university’s East Baltimore campus.

A School of Public Health graduate who had served on the Johns Hopkins School of Medicine faculty since 1987—and a very bright-minded optimist—Klag is an enthusiastic champion of the field of public health who wants to further extend the Bloomberg School’s reach.

Established in 1916, the Johns Hopkins School of Public Health was the first of its kind and remains a leading international resource for global health. It’s consistently ranked as No. 1 in its field by U.S. News & World Report.

The school’s faculty and students conduct research in the United States and in more than 90 other countries. The largest school of its kind in the world, it currently operates more than 50 centers and institutes, has 2,056 students from 78 nations and receives 20 percent of all federal research funds awarded to the 43 accredited U.S. schools of public health.

Dean Klag recently sat down with The Gazette to discuss both local and global public health issues, the past and future of the school, the popularity of public health studies and other topics. We learned not only that Klag has an infectious optimism but—as evidenced by the spectacular travel photos of his that line his office walls—a keen eye for detail and beauty, even in the harshest of locales.

Q: Certainly a public health issue that has been on everyone’s mind this past year is the swine flu [H1N1] pandemic. How would you grade our response?

A: One of the very good things that President Bush did was to cause the development of a national flu plan. It was in reaction to concerns over H5N1, the avian flu, which leads to very high mortality and presented a very worrisome scenario. Because of this concern, Bush mobilized the CDC, NIH and other arms of the government to develop a flu plan. So, we were planning ahead. We had an infrastructure in place and had monies available.

I think we were very fortunate that we did not have an H5NI pandemic. Rather, it was an H1N1 pandemic. We knew we were going to have a pandemic of some sort. We have one about every 30 years and we were overdue, but if it had been H5N1, it would have meant many millions of deaths.

Overall, I’d give government a B+. I think we handled it well. There were issues with the vaccines, availability issues, but it was developed very rapidly. When you look historically at how fast this vaccine was developed and manufactured, it’s remarkable.

Q: What about JHU’s response?

A: I think we did a pretty good job. We had CEPAR [Johns Hopkins’ Office of Critical Event Preparedness and Response], which was originally focused on the clinical side. Again, when we became concerned about a pandemic, CEPAR broadened its mission and turned to issues related to the university and students, not just the clinical setting. Jonathan Links [deputy director of CEPAR and professor and deputy chair of Environmental Health Sciences at the School of Public Health] worked with CEPAR director Gabe Kelen. They had a very good plan, and it was instituted well. A lot of work went into our response, and we were very fortunate that it was not a high-case mortality influenza.

Q: What public health issues should people be talking about more?

A: If you look at big issues facing the world, clearly global warming and its effects on health. We are transforming our world. We are seeing changes in the biology of invertebrates, other animals and ecosystems. How that affects health is something we need to study and make plans for.

Availability of water is another major issue. There are a billion people in the world without access to safe water, and when you look at the United States and other developed countries, there are emerging contaminants in water—new organic chemicals that our regulations don’t deal with at all. We have incredibly safe water in the United States, but we need to look at new and emerging contaminants and assess their presence and their health risks.

I think that emerging diseases—diseases that pass from animals to humans, such as avian flu and swine flu—is something else to look at closely. These are infections that can jump species and cause new diseases.

Underlying a lot of these issues is a fundamental problem that nobody is talking about, population growth. If you look at global warming, emerging diseases, availability of water, death from disasters, food security and other issues, population growth is behind many. That really did fall off the agenda.

Q: Why?

A: Several reasons. In some cases, ideological decisions were made by the federal government to not fund solutions to population growth, such as family planning. There has been unbridled growth of population in many countries, which has led to many health issues such as poor health of children. Population growth is something we need to examine and refocus on.

Q: Public health has been a top major at Johns Hopkins, and at other schools, for a number of years now. What is fueling this interest in public health studies?

A: I think one reason is that the world is a smaller place, and people now are exposed to conditions outside the United States, through the media and travel, in ways that they simply weren’t before. They are aware of the great disparities that exist in this world between countries like ours and countries that are underdeveloped. They recognize the problems, and they want to do something about it.

And I think there is an encouraging spirit of altruism in the young population. I interact with our students, and when I do, I feel good about the future of the human race.

There is also a sense of entrepreneurism that is out there. There was a time when people would be confronted with very big problems and be overwhelmed by them. I think that is less so now. We know we can make change. We have philanthropists like Mike Bloomberg and Bill Gates who provide role models at very high levels, and who are passionate about saving lives around the world.

Q: How has this growth of interest directly impacted the Bloomberg School?

A: The history of public health in the United States, and in the world, has been that it’s been a graduate degree. People got an undergraduate degree or a professional degree, such as an MD or nursing, and then later would get public health training. So undergraduate education in public health is a new paradigm. We have an incredible need for people to work in public health agencies and NGOs [nongovernmental organizations]. So the need is nowhere near being fulfilled.

But just as there has been an explosion on the undergraduate level of interest and training, there has also been an explosion on the graduate level. Now there are some 43 schools of public health in the country, a number that will only increase.

Q: When President Daniels made his first public visit to the School of Public Health, he trumpeted the divisional collaborations and multidisciplinary initiatives being led by the school. Can you comment on some of the current such work going on here?

A: For one, our faculty teach undergraduate public health at the Homewood campus, and then those students, when they complete their core courses, come here and take more courses. Overall, there are many students in the Krieger School of Arts and Sciences who come here to take courses in their later undergraduate years.

We have a combined MPH/MBA degree with the Carey Business School. We have two combined master’s degrees with SAIS. A big collaboration with the School of Medicine is the Graduate Training Program in Clinical Investigation. Many trainees in the School of Medicine come to our school to learn about epidemiology, biostatistics and health services research. They take those techniques and apply them to clinical problems.

If you think in terms of research, we are partnering with folks up at the School of Engineering in the Institute for NanoBioTechnology. Our faculty play a big role in that, especially in terms of toxicology of nanoparticles. There’s also JHU’s Global Water Program, which partners our Center for Water and Health, DoGEE at the School of Engineering and SAIS.

We will also offer courses as part of the new major in [global environmental change and] sustainability offered through [Arts and Sciences’ Department of] Earth and Planetary Sciences.

Our faculty are involved in lots of collaborations with other divisions. Public health by its nature attacks big problems, and you can only do that through collaborations. It’s the nature of how we work.

Q: We are entering a new decade. How much has changed in the field in the past 10 years? Were we even talking much about things like studies in bioterrorism back in 2000?

A: Certainly not much. D.A. Henderson, a dean emeritus here, was a voice in the wilderness talking about bacterial warfare. It really was 9/11 that catapulted such thoughts into our world.

I would say emergency response wasn’t a field that received much academic study. It was a field that was incredibly underfunded that has now been greatly expanded due to interest from the federal government. I think health informatics has also exploded.

Q: What about changes in terms of how the school educates its students?

A: I would say there has been a great expansion in our distance learning. Now we have more than twice as many online MPH students as face-to-face traditional MPH students. And they come from all over the world.

If you want predictions, I think that increasingly we will be using the technologies and techniques that we’ve learned through distance education and use them to support classroom learning. Students now are much more oriented to using the Web to get information. We are thinking of how to use these technologies to increase our efficiency of teaching in the classroom and make it a richer experience.

Q: Can you talk about the school’s international expansion and programs?

A: One of the things that was a legacy of 9/11 is that it became much harder for students from some countries to come to learn in our country. We had this golden age of American universities after WWII, when there were more universities here than anywhere else in the world. What we are seeing now is an expansion of universities outside the United States, which is a good thing. [Students] have opportunities to learn in their own country and, as their home country economies have improved, they have jobs. But now it costs them more to come here. There are barriers.

I think we need to bring our education to people, using a combination of Internet techniques and repeated faculty face-to-face time. When I became dean, I thought we needed to expand our educational footprint around the world, not just in Baltimore. For example, in Barcelona, with our partners there, we have a fall symposium. We recently hosted a summer institute in Asia where we taught courses. We are in the United Arab Emirates to help train leaders in public health management, the next generation of health leaders to address the health problems over there.

Q: What about the past year in terms of accomplishments?

A: It might sound a bit crass, and I don’t want us to come off sounding rich, because we are not, but last year we raised $163 million in our development campaign. That is a phenomenal achievement, especially in this economy. Much of that was due to the hard work of our faculty in obtaining foundation grants and support. It was also the generosity of donors who recognized the power of public health and the ability of interventions that are applied across populations that can save millions of lives at a time.

Importantly, we also returned our school to financial health. We are in the black and can move close to controlling our own destiny. That was a huge management accomplishment.

If you look at science, our faculty have had an incredible impact. Take the circumcision study. This is the trial in Africa that showed that you could reduce the risk of getting HIV as a man by getting circumcised. If we had a vaccine like that, or any other intervention, we would be doing handstands. That is something I’m very proud of.

The trouble is, when you list one thing, you run the risk of offending 500 faculty [laughs]. We’ve had discoveries and breakthroughs related to injury prevention and control. We are working on improving the health of adolescents in Baltimore. Our faculty are engaged in so many areas.

Q: What about the school’s physical growth in Baltimore?

A: I think we went through an unbelievable period of expansion during Al Sommer’s leadership, but we really had to pull in our horns over the last several years because there were severe financial challenges for the school. We have met those challenges and have overcome them. And now I think in the next 10 years we will need to build. We need to upgrade Hampton House, and it needs more space. The School of Nursing has just completed negotiations with the Johns Hopkins Hospital endowment to purchase land behind the school. We are going to share that lot with them, and we’re developing plans to build there. But that is going to be expensive. We need to raise money. But it’s clear we need to continue to grow.

We are also in the process of obtaining a significant multimillion dollar capital project grant from NIH. One of the things that people from outside our school don’t always realize is that a third of our school is basic science research: biochemistry, immunology, molecular biology. We do research that goes from nucleotides to cells, to organs, to people, to communities, to global. So one of the things that this grant will do is to help give our scientists first-class lab facilities and expand the footprint of basic sciences at the school.

Q: Anything else you want to add?

A: Yes, we continue to attract great students. One challenge is financial aid; it’s our greatest need. So before I think about building, I want to address financial aid.

Q: Totally off topic: What are you reading right now?

A: I’m reading Dan Brown’s Digital Fortress. It’s a real potboiler.