When Engineering Met Public Health

To most, the word 'engineering' brings thoughts of 'high tech': robotics, satellites, iPhones, and computers. For the medically inclined, one might think of biomedical technology like new drugs and medical implants.
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Click here to read an original op-ed from the TED speaker who inspired this post and watch the TEDTalk below.

Having studied engineering in college, I'm often asked what led me to a career in public health or, more pointedly, how public health and engineering might even be related. To most, the word 'engineering' brings thoughts of 'high tech' futures: robotics, satellites, iPhones, and computers. For the medically inclined, one might think of biomedical technology like new drugs and medical implants.

In response, I usually note that the history of public health is in fact rooted in engineering. One key historical figure of epidemiology and public health was John Snow, a physician whose sleuthing in London in 1854 identified the source of a cholera outbreak in a public water pump, a technology that I'm sure was 'high tech' for the 19th century.

And in the United States, the first training institution in public health was the Harvard-MIT School of Health Officers, founded in 1913 (with the school separating from MIT not long after). Back then it was touted as the first such institution in the world to meet "the growing demand for health officers throughout the country" (Boston Globe Archives, June 26, 1913, p 10). Not to mention, one of MIT's oldest departments is Civil Engineering, which was once called Civil and Sanitary Engineering. Without a doubt, this little-known discipline of sanitary engineering played a critical role in the precipitous decline of mortality in the United States, particularly from 1920 to 1950 (see figure).


Source: U.S. Centers for Disease Control and Prevention and National Center for Health Statistics from Cutler, Deaton, and Lleras-Muney, 2006

Indeed, professors David Cutler and Grant Miller at Harvard and Stanford, respectively, found that clean water in the US was responsible for nearly half of the total mortality reduction and three-quarters of the infant mortality reduction in major cities -- a public health 'home run' of scale uncommonly seen today. (And yes, it is the health economists like Cutler and Miller who informed us, half a century later, of the impacts of clean water in saving millions of lives.)

It was at MIT where as an undergraduate I took a class taught by Amy Smith called D-Lab and learned, to my shock, that a leading cause of child death in the world was diarrhea (far higher than malaria), a preventable and curable disease virtually eliminated in the West. Because of D-Lab, I ended up majoring in engineering and dabbled in making water filters among other things, eventually leading me to pursue a graduate degree in public health to try to figure out how and why technologies get taken up and used.

As a one-time engineer watching Nathan Myhrvold's TED Talk, I am reminded of the creative juices of my MIT classmates trying out all kinds of ideas. Engineering is an iterative, playful, and experimental process - where ideas outside the box are encouraged. Without that creative energy, the world would be without many a technology, be they laser zappers, water pumps, or sanitation facilities (toilets). Even Bill Gates has called for engineers to reinvent the toilet and the condom, two simple technologies which could be made adapted in order to reach many more people. We need this kind of energy.

But as a public health professional, I have my doubts (if not very large doubts) that the laser zapper will be useful in poor countries that face major energy and infrastructural challenges that may render this technology just a creative and fun idea. And, as impressive as Myhrvold's laser-zapping of mosquitos is (especially in slow motion), such technologies tend to reinforce a stereotype of engineering for public health as being 'high tech'.

The reality is that the world is winning the war against malaria with a package of technologies that are simple, low-cost, and accessible in low-income settings. Increased access to four core technologies - insecticide-treated bed nets, insecticide residual spraying, preventive therapy for pregnant women, and artemisinin-based combination therapy - has contributed to unprecedented progress against malaria. When deployed appropriately, these simple technologies have saved countless lives. And if donors like the Global Fund to Fight AIDS, Tuberculosis, and Malaria and the US President's Malaria Initiative continue their commitments to these technologies, the war against malaria can be won. With financial support to expand coverage of what we already know works, it is possible to eradicate malaria, as impossible as it may sound. The world cannot afford to give up now, lest we give way to malaria resurgence and lose previous gains seen. We know what works; we just need to do it.

Actually, what I was more excited about in Myhrvold's TED Talk was his long-lasting refrigerator for vaccines, admittedly less thrilling than a laser-zapping mosquito gun. A recent study found that only a third of hospitals in 11 African countries have reliable electricity, without which a vaccine is just a dud. An energy-conserving refrigerator for vaccines may not be as futuristic as a laser, but it would help ensure the appropriate use of one of the most cost-effective interventions in health today. Maybe GAVI Alliance, the world's funder for vaccines in developing countries, will take note.

Dr Victoria Fan is a research fellow and health economist at the Center for Global Development (CGD). Prior to joining CGD, she consulted for various organizations including SEWA, BRAC, WHO and the World Bank. She holds an SB from MIT and an ScD from Harvard School of Public Health. You can follow her on Twitter at @FanVictoria.

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