Editor's Note:The following is excerpted from remarks given by Dr. Frederick Rivara in accepting the School’s Distinguished Alumni Award at the 2009 Awards Ceremony and Graduation Celebration.

My Path to Public Health and What I Learned Along the Way

Frederick Rivara

I am a pediatrician and had been trained to think that what doctors did was interact and treat patients individually, in an exam room, or at the bedside, in an emergency room or hospital. This changed for me when I volunteered for the National Health Service Corps in 1976 in a place called Hazard, Ky. Hazard is a town of 6,000 people in the middle of the Appalachian coal fields. It’s famous in bluegrass songs, in the history of the struggle for unionization of the coal miners, and for the poverty that has long existed in its hollows. Lyndon Johnson sat on the porches of houses in these hollows and talked about his dream for a Great Society.

In Hazard, I began to understand what public health was all about and its critical importance, by learning to pay attention to the health of the public, the well-being of the entire population, not just those who came into the clinic or the hospital. My mentor showed me that the clinic was mostly a Band-Aid for the health problems in the community and by itself could not make people healthier. If we really wanted to care for the health of the population of Hazard, we needed to become public health practitioners—preventing disease and injury through organized efforts in the community.  This meant an infant home visiting program, with public health nurses traveling up and down the hollows in four-wheel drive vehicles to follow infants in their homes. It meant starting up Women, Infant, and Children nutrition programs in church basements and community centers to prevent iron deficiency and replacing the modern east Kentucky breakfast of an RC cola and a moon pie with something a bit more nutritious. It meant getting fluoride in the water to prevent the problem of rotten teeth.

It was in Hazard that I really first came face to face with the problem of injury. Two children stand out in my mind. One was an eight-year old child who received a deep third-degree burn on his leg when the mini-bike he was riding fell on top of him, pinning his leg against the hot tail pipe. The other was a 12-year old boy who was struck by a coal truck while walking home from school. Coal trucks would come barreling along the roads, going as fast as they could on the mountain roads because the drivers were paid by the load not by the hour. This child sustained a femoral fracture and a traumatic brain injury. While both of these children survived, their injuries were not accidents—they were preventable.

These experiences and many others, combined with education I received from faculty in this School, led me to become involved in injury control. I realized that while trauma centers like Harborview do a great job, if I really wanted to make a difference in the public’s health, I had to think more on a population level. I had to think about what kind of changes in policy, in the things we use every day, and in the environment could be more effective at decreasing the morbidity and mortality from trauma.

So what have I learned in the last 30 years of working in public health?  Here are some of my personal lessons that I hope might be of some use to the new graduates here today.
First, base your work on your passions and your personal experiences. As a public health professional, you will put a great deal of time, effort, and yourself into your work. This will be so much easier if it is something that you can get excited about. These passions usually arise from your own personal experiences—the patients you see, the people you care for, the tragedies you experience.

Second, make the most of opportunities that come your way. Nearly every experience you have can be turned to good, into a learning experience for you, into something that motivates your career. At the least, you can learn something from it. At the best, it can be a defining experience and help to determine your niche in public health.

Third, there are many routes to making a contribution to the health of the public. Much of my own way has been through research, trying to show what works and what doesn’t, what saves lives and what wastes resources. That is just one path; there are many others, whether it’s working in a health department at the state or local level, working in an NGO abroad or here in the US, or working in the hills of Appalachia or inner-city Detroit.

Fourth, sometimes you can tell you are on the right track by how many people get upset by your work. We have seen this many times among the graduates and faculty at this school. Bruce Psaty and Rick Deyo were attacked by the pharmaceutical industry when they published a paper on the adverse effects of calcium channel blockers for the treatment of hypertension. Arthur Kellermann and I were attacked by the NRA for our work demonstrating the strong association between home ownership of guns and risk of violent death in the home. The NRA even tried to remove our funding. In cases like these, it is important to use the training you received here to make sure you have the science right and then to stand by it in the face of attacks.

Finally, collaboration is much more productive and much more fun than working alone. The collective knowledge, experience, and creativity of a group is always much greater than that of any one individual in the group. I urge you to work in an interdisciplinary fashion in which each discipline interacts and develops ideas with others. This is in contrast to multidisciplinary work, which is sort of like kids in kindergarten playing in parallel in the sandbox rather than playing together. I’ve always appreciated the openness in Seattle to reach across organizational and disciplinary boundaries to collaborate with others.  
           
Public health is especially important now, at this time in 2009, when we are faced with a very serious economic crisis and what looks like potentially substantial changes in our health system. We need to be leaders in thinking about and promoting the public’s health, and we need to figure out how to do it in the best possible way, with the most effective methods—but with an eye to the cost. If we don’t, then who will?