The Harvard T.H. Chan School of Public Health is the public health school of Harvard University, located in the Longwood Medical Area of Boston, Massachusetts. The school grew out of the Harvard-MIT School for Health Officers, the nation's first graduate training program in population health, which was founded in 1913 and then became the Harvard School of Public Health in 1922. Michelle Ann Williams became the school's dean in 2016 following the departure of former dean Julio Frenk. She is the first African American to head a Harvard faculty.Considered a preeminent school of public health in the United States, Chan is ranked as the 2nd best public health school in the nation by U.S. News & World Report.
In sub-Saharan Africa, population growth coupled with weak or missing markets for clean energy means that the absolute number of people relying on woodfuels for cooking is growing. Charcoal, which has distinctly different environmental and economic implications from firewood, has become one of the most consumed fuels in the region. However, among rural populations, the drivers and consequences of charcoal use remain under-studied. We examine rural woodfuel dynamics in Malawi, a majority rural country with high poverty, rapid population growth, lagging economic development, and abundant but rapidly declining forest resources. We examine how household energy transitions are influenced by concurrent demographic, economic, and land use changes. Using four waves of national household surveys and satellite-derived forest cover datasets, we investigate trends in household energy consumption, identify factors driving rural household fuel choices, and characterize geographic patterns of forest cover loss during 2004–2020. During this time, the share of rural households using charcoal grew from 3.9% to 13.4%. Rural households that are smaller, headed by younger individuals, and are asset-rich but land-poor had greater odds of using charcoal compared to firewood, indicating that rural livelihood dynamics have important consequences for household energy transitions. Several protected areas have experienced > 20% forest cover loss since 2001, characterized by geographic patterns consistent with unsanctioned woodfuel extraction. These findings emphasize a renewed need for integrated natural resources, energy, and livelihoods management strategies. Our insights provide information for policy makers to better predict and understand the continued growth of charcoal’s popularity in Malawi and similar contexts.
Health equity depends not only on insurance eligibility, but also on access to the administrative system that enables coverage. Using Medicaid administrative offices in the United States as a case, we assess accessibility from over 80,000 census tracts to the nearest Medicaid office across driving, public transit, bicycling, and walking using distances and travel times. We identify a proximity–access paradox: while geographic distances to offices are broadly similar across modes, functional accessibility diverges sharply once translated into time and transportation feasibility. Driving times are generally short and consistently feasible, whereas walking and transit often require substantially longer times, and public transit is infeasible for over 40% of tracts. Multilevel analyses further show that accessibility varies systematically with neighborhood income, racial composition, age structure, disability prevalence, and state context. These findings highlight transportation barriers as an important structural determinant of administrative access to health insurance coverage and suggest that improving health equity requires policy attention not only to eligibility and coverage expansion but also to the transportation systems that enable people to reach the administrative institutions of health systems.
Antimicrobial compounds are pervasive consumer product additives that have been linked to allergic disease outcomes. Human-affiliated microbiomes may induce susceptibility or confer resilience to antimicrobials, or may be a mechanistic link between antimicrobials and allergy. In this review we summarize what is known about the connections between antimicrobials, microbiomes, and allergic disease states in children. Our review highlights studies on triclosan, a legacy antimicrobial, while pointing to the need for more research on parabens and quaternary ammonium compounds (QACs), which have continued widespread use in the United States. We found evidence that childhood triclosan exposure is linked to eczema, allergic rhinitis, and asthma, and the few studies of parabens and QACs also found associations with allergy outcomes. Microbiomes in the gut and airways, on skin, and potentially in human milk are also linked to allergic outcomes. Together these findings provide evidence that antimicrobials and microbes may interact in their associations with allergy, but most studies have not looked at microbes as mediators or modifiers of these associations. While the existing evidence of associations among antimicrobials, microbiomes, and allergic disease is compelling, additional epidemiologic and mechanistic studies are needed to elucidate the nature and directionality of these associations.
The purpose of this review is to synthesize literature investigating the relationship between type 2 diabetes (T2D) and obstructive airway diseases and to identify implications for clinical care. Type 2 diabetes is a common and challenging comorbidity in patients with asthma and chronic obstructive pulmonary disease (COPD). Basic, translational and clinical studies support a bidirectional association between T2D and the lung. In animal models and human studies, insulin resistance and hyperglycemia are associated with pulmonary inflammation, respiratory exacerbation risk and disease severity. Corticosteroids are a mainstay for respiratory disease control and exacerbation treatment but promote ongoing metabolic dysregulation. Randomized, placebo-controlled trials of glucose-lowering medications for asthma are actively ongoing. Additional studies addressing clinical pathways to co-manage respiratory and metabolic risk are needed. Patients with comorbid T2D and asthma or COPD are at risk for worse outcomes. There are opportunities to improve cross-disciplinary care, potentially reducing risk and multimorbidity associated with both conditions.
The aims of this study are to examine the associations between discrimination experienced by children’s caregivers, socioeconomic factors (household income, caregiver education, and Child Opportunity Index [COI]), and child IQ. We also examined whether these associations differ for Black children’s caregivers and White children’s caregivers. Using Environmental influences on Child Health Outcomes (ECHO) program data, we analyzed the Everyday Discrimination Scale (EDS; range 4–24, higher score means more discrimination) scores of caregivers of children from 3 to 8 years and the full-scale IQ (FSIQ; range 40 to 160) scores of the children. Median EDS scores were compared by education and income category. FSIQ scores were compared separately for Black (n = 259) and White (n = 820) children across categories of household income, parental education, and COI (very low/low opportunity and moderate/high/very high opportunity). Multivariable generalized linear regressions were used to assess the characteristics associated with EDS scores and examine the impact of everyday discrimination on FSIQ when adjusting for these characteristics. EDS scores were not associated with FSIQ for either group (Black, β = 0.21 [95
