Connected
Aruna Chandran, An academic researcher and in-the-trenches epidemiologist, bridges two worlds.
For seven years, Aruna Chandran, MD, MPH ’04, was every bit the globetrotting public health professional. A junior faculty member in International Health and an Iowa native, she had a dog-eared passport and a public health career measured in published academic papers as well as frequent flyer miles.
In Mexico and Brazil, she examined interventions designed to reduce high rates of traffic injuries and deaths. She studied bacterial meningitis in children in southern India, and in Pakistan she assessed childhood nutrition issues and strategies for mitigating household injuries. Her interest in childhood respiratory disease among Native Americans led her to Navajo and Apache reservations in the Southwest.
Then everything changed. In January 2012, her focus shifted from global to local. Instead of addressing needs around the planet, she chose to confine herself to a mere 92 square miles of it—Baltimore City. That month, she became chief of Epidemiological Services for the Baltimore City Department of Health.
“One thing I missed [while travelling] was living in or near the community I was working for,” Chandran says, explaining her reasons for making the change. “This idea of doing something for my immediate surroundings and local population was appealing.”
Two more compelling reasons to stay put (for now) are due to be born this spring: Chandran is expecting twins, a boy and girl.
A Career Times Two
The city health department resides in a low-slung brick building on East Fayette Street in the Jonestown neighborhood. To the west is a phalanx of downtown office towers and the city hall dome. Looking eastward presents the cluster of Johns Hopkins buildings on the hilltop East Baltimore campus, site of the Bloomberg School and Hopkins Hospital. This location is symbolic for Chandran because, though she has traded red-eye flights for rush-hour traffic, she has not severed ties to Johns Hopkins. Instead, she transferred to the Department of Epidemiology where she continues to teach as an associate scientist.
Now she divides her time between the two symbolic domes in a hybrid public health position.
“I think it’s working out fantastically,” said former Baltimore City Health Commissioner Oxiris Barbot, MD, who recently took over as New York City’s first deputy commissioner of health. “The city [of Baltimore] benefits from a top-notch epidemiologist who is very comfortable both in academia and working in an environment where the demands are coming from all over the place—from constituents and elected officials.”
Chandran isn’t the first epidemiologist to divide her time between the city and the Bloomberg School. Her position, vacant for three years, had earlier been held by research scientist Caroline Fichtenberg, PhD ’07, in a joint arrangement. Johns Hopkins pays Chandran’s salary and the city reimburses the school for time she spends in the Health Department.
Chandran’s office at the Health Department is windowless, so see can’t see the Baltimore skyline or either dome from her desk. It really doesn’t matter since she spends her days looking at Baltimore through the prism of data—the numbers, stats and figures that provide a picture of this city’s overall health. Her job is to “collect, compile and analyze” such data, she says, be it the density of liquor stores, the rate of new HIV infections or the percentage of Baltimoreans lacking health insurance.
“It’s a lot of crunching numbers and interpreting those numbers and attending meetings where I share those numbers,” Chandran explains. “If you look at my life here versus the life of an academic epidemiologist it probably doesn’t look all that different except that now, I have to be ready to answer quickly and be willing to accept some uncertainty and incomplete knowledge because the city doesn’t wait for you to have perfect numbers.”
From Classroom to Office
The seat-of-the-pants reality of serving as head epidemiologist in a big city health department is something Chandran strives to share with students through the pair of classes she teaches at the Bloomberg School: Public Health Practice, and Public Health Surveillance.
“We really have them work on problems of Baltimore City as if they were a health officer at the Health Department,” she says. “It’s a practical and applied approach versus a theoretical and research approach.”
Standing in a fourth-floor classroom before 20 Public Health Practice students who peer at her over their laptop computers and tablets, she launches into a lesson: “The Baltimore Health Department was actually founded in 1793, so it is the longest continuously running health department in the United States,” Chandran tells the future public health professionals. But she quickly leaves 18th-century Baltimore behind to engage the class in the realities of life here in the 21st century.
One of her first duties as chief epidemiologist was to create an interim update to Healthy Baltimore 2015, the city’s 50-page health policy agenda released in 2011. It outlined targeted health improvements sought by 2015 in 10 different priority areas, including better access to health care, reducing the spread of HIV and redesigning communities to prevent obesity.
These Health Department priorities are now the students’ priorities as well. Each will select one to be the focus of assignments for the rest of the class. While this is a practicum course, today is one long lecture as Chandran expounds on each priority area. For instance, when discussing the city’s obesity problem she brings up the concept of “food deserts”—areas in the city without ready access to supermarkets or other sources of healthy food. Residents within them often rely on mom-and-pop places that focus on selling candy and snack food. An extensive analysis by multiple city agencies and the Johns Hopkins Center for a Livable Future determined that 1 in 5 Baltimoreans live in these deserts.
“[Researchers] actually physically walked into every corner store and marked off if they have fresh food, do they have produce, and does it look edible,” Chandran tells the class.
Chandran adroitly moves back and forth between being public health professor and in-the-trenches epidemiologist. Days later she is in her Health Department office holding a meeting on the topic of food deserts.
Joining her are Bloomberg School student intern Janani Veluchamy and health department co-worker Laura Flamm, MHS ’11, who coordinates a unique response to this issue: The Baltimarket Virtual Supermarket Program. The innovative online grocery ordering/delivery system is one strategy for reaching a 15-percent reduction in the obesity rate by 2015.
Is the program influencing eating habits and having an impact on the obesity epidemic? Finding evidence-based answers to these complex questions is one of Chandran’s jobs.
The other is to engage students in the issues.
Reality Check
David Celentano, ScD ’77, MHS ’75, chair of the Bloomberg School’s Department of Epidemiology, says Chandran’s dual role brings a new richness to the classroom. “One of the things I’ve been trying to do over the last five years is get much closer to the practice of public health and move our department away from strictly an epidemiological research focus,” he says. “It turns out that over half of our graduates do not go into academia so we really need to be training half of them for life in a health department or an applied epidemiologic setting.”
Chandran prepares her students for real-world topics in the under-the-gun atmosphere that exists outside academia. She assigns her students to write policy briefs, a standard public health document she often is called on to create.
“It’s a document that they have written for other classes before, but instead of them getting two weeks to do it, we give them only 24 hours,” Chandran says. “That is the reality of how the Health Department works, where you have to turn things over very quickly.”
Chandran has been a conduit for many Hopkins students to work for and with the Health Department through research projects and internships—from PhD students to undergraduate Public Health Studies majors. “I try to find ways to make the students really feel like they have their finger on the pulse of the Health Department,” Chandran says.
Daily, Chandran faces the health realities of Baltimore City where nearly one in four in citizens lives in poverty.
Updating the Healthy Baltimore report was a “crash course” in the dynamics of this city’s health, she says. Among its dozens of goals: a 10 percent decrease in the rates of premature death from cardiovascular disease; reducing rates of gonorrhea and chlamydia in adolescents by a quarter; cutting the rate of alcohol- and drug-related hospital admissions by 10 percent; and a 15 percent increase in colon cancer screenings by adults 50 and older.
The report demonstrates that Baltimore is a city of haves and have-nots when it comes to health issues. For instance, those with personal incomes of less than $15,000 a year are more than twice as likely to be obese as city residents making $75,000. African-Americans in Baltimore are nearly three times as likely to suffer from type 2 diabetes than whites, and twice as likely to suffer from hypertension. People with college diplomas, are much more likely to get certain cancer screenings.
“Health is not strictly defined by disease condition,” Chandran says. “You can’t be thinking about health without the perspective of poverty and race and ethnicity and gender and all of these things. Academic centers now are finally teaching it that way, getting students to think about a broader perspective of health and public health work.”
Chandran’s dual role affords her a balanced view of the big picture, she says. That’s exactly what she hopes to convey to Bloomberg School students as she engages them in assessing and addressing the health issues of this city, and beyond.
“There are lot of positive things happening,” she says. “Maybe the Health Department needs to do a better job of promoting the good things that are happening.”