The Researcher's Perspective
Podcast Interview with Ken Olden

Views and opinions expressed in these podcasts are those of the interview
subjects and do not necessarily reflect the views, opinions, or policies
of EHP or of the National Institute of Environmental Health Sciences.

Narrator: EHP presents The Researcher's Perspective.

Ernie Hood: Hello again.  I'm your host, science writer Ernie Hood.  On this 
episode of The Researcher's Perspective, we welcome Dr. Kenneth Olden.  Dr. 
Olden was Director of the NIEHS and the National Toxicology Program from 
1991 to 2005.  He served as NIEHS Director Emeritus and continued his 
research activities at the institute until 2008, when he left to help establish a new 
school of public health at the Hunter College campus of the City University of 
New York.  The new school is scheduled to open in 2010.  Dr. Olden, welcome to 
The Researcher's Perspective.  

Dr. Olden: Thank you very much.  I'm very pleased to be part of it.

Ernie Hood: What do you see as the major public health challenges we face in 
the 21st century?  

Dr. Olden: I think there are four challenges, and one of those is urbanization.  
People are migrating from the rural areas into cities in large numbers, and this is 
a global phenomenon.  It's happening all over, in China, Japan, Africa, and the 
U.S.  So it's a major challenge that we face as a world.  The young people are 
moving into cities looking for better opportunities, because farming is not, you 
can't make much of a living in farming in almost any country today, and so 
they're looking to cities for better opportunities to earn a decent income and have 
a good quality of life.  But as people migrate into these cities, they are 
overwhelming the public health infrastructure.  Cities were not made for these 
large populations, so there are issues related to pollution, disposal of waste, and 
not to mention the stress associated with noise and having lots and lots of people 
around you all the time.  So these are major problems that we're going to have to 
deal with, and I think an international city like New York, New York would be a 
good place to investigate some things that could be done to improve the quality 
of life of people in urban settings. So urbanization is one of them.  

Aging of the population is another.  This is the demographic shift that's occurring 
all over the world as well.  People are living longer, we're having fewer children, 
and so there's a demographic shift to older people.  As the people age, then, 
we'll have increased prevalence of chronic diseases as people reach 65 and 
older.  So aging of the population is just one of the issues, so what we have to do 
is promote healthy aging, so that people can live to be 80 or 90 or more, longer, 
but be healthy and independent and not dependent on the health care system or 
our social systems.  

So healthy aging is an issue and aging is a challenge, but increasing prevalence 
of chronic diseases, that we are now facing epidemics of, not infectious diseases 
but chronic diseases, and again, this is a global phenomenon.  A few years ago, 
actually when I was director of the NIEHS/NTP, the World Health Organization, 
the Fogarty International Center and the World Bank sponsored a conference at 
the NIH where they asked that question, what are the major burdens of disease, 
and concluded that now worldwide, and I think by the year 2020, chronic disease 
is supposed to be the major cause of morbidity and mortality worldwide.  So 
we've got to make sure that we do the work that really impacts things like cancer, 
Alzheimers, Parkinson's, diabetes, obesity, hypertension.  These are the major 
killers.  They are here in New York, and they are all over the world. 

And finally, the fourth issue is disparities in health.  We've known for a large 
number of years that poor people and racial and ethnic minorities, because 
they're disproportionately poor, have worse outcomes than others.  But the gap 
between the poor and those of us who are better off is growing.  So it's going to 
be a major problem, and particularly in cities, because the people now who live in 
cities, in large measure, are the two extremes Ð the very rich and the very poor.  
So the gap is growing and we have to figure out what we need to do to prevent 
and promote healthy lifestyles among the poor.

So I think these are the 21st century public health challenges, and I think most 
agencies and schools of public health are still focusing on the challenges of the 
20th century.  Not that we've solved all of the challenges of infectious diseases, 
we clearly have not.  But going forward, I think the major costs, costs in terms of 
money, and in terms of quality of life, morbidity and mortality, will be associated 
with chronic diseases. 

So those are the four in my estimation.  

Ernie Hood:  Dr. Olden, each of those challenges you described involves 
interaction with the environment.  How do you see the environmental health 
sciences and public health working together to meet those challenges?

Dr. Olden: I think the environment is a major contributor here, because it's clear 
you cannot explain disparities in health, the epidemic of chronic diseases among 
aging people, due to genetics, because the changes have been too rapid.  So it 
is environmental, and the environment is in the domain of public health, because 
that's prevention.  And the fact that there are disparities, which means that some 
people have a good life free of certain diseases while others are not, at least that 
indicates that at least these diseases and morbidity and mortality associated with 
environmental exposures are preventable.  So I think the major contributor here 
is environmental exposures interacting with a constant genetic substrate.  So I 
think when we actually address and acknowledge the fact that this is the 
caseÉin other words, we are not going to solve the problem, the riddle of 
complex diseases until we understand how genes and environment interact with 
behavior to cause these dysfunctions and diseases and illness.  So the 
environment is the major player, and I think environmental efforts have been 
under-appreciated.  But clearly there is a greater appreciation for the contribution 
of the environment in many circles now, in clinical settings, and I think with time it 
will be on par, and public health will be on par, with basic fundamental research 
and clinical research.  So it's a three-legged stool, and what we have now are 
two strong legs and one very weak one, and the weak one is public health and 
the environment.  So that, I think, is the contribution that we can make here as a 
school of public health, is to make sure that there is integration of public health 
approaches and understanding and integration of the environmental sciences 
and behavior into looking at the pathogenesis of diseases. 

Ernie Hood: So do you think we need to change the educational infrastructure to 
prepare future researchers to address these major challenges you've described?

Dr. Olden: Yes I do.  I think we tend to train people along disciplinary lines, and 
people are trained as biostatisticians, or basic scientists, epidemiologists, or 
clinicians, and we're not trained in an interdisciplinary kind of way.  So we don't 
appreciate the skills, the knowledge, the perspectives of our colleagues in 
different areas.  But it just turns out that the problems we have to solve today, 
issues like diabetes, is a very complex disorder, alzheimers, Parkinson's, 
asthma, and you can't solve complex problems like these diseases with one 
discipline.  Basic sciences can't solve it, clinical medicine can't solve it, 
epidemiology.  What you need is a team approach.  You need to bring several 
individuals in a room, with different expertise, and present them with a problem, 
and say, how do we solve this problem?  And we will discover that we need the 
expertise of all of these people to solve those problems.  So I think the way we 
make that happen is to train people in an interdisciplinary fashion.  Team teach 
courses, and teach courses from a perspective of problem-solving.  In other 
words, this is the problem, how do we solve it?  And we will discover that we will 
need all of the expertise in the room to solve those problems.  If you look an 
infectious agentÉan infectious agent, you don't need all of the expertise in a 
room, because you're looking at one agent, one micro-organism or virus that 
caused these diseases, so they can be solved by one specialty, one special 
group.  But you cannot solve the complex problems.  For example, if we're 
talking about outcomes research, let's say two persons with the same disease 
phenotype, let's say sickle cell disease.  Both people have sickle cell disease, the 
same genetic mutation, but the outcome for those two people can be very 
different, depending on their social, economic, and physical environment.  So 
context means a lot.  The context in which the person lives means a lot.  So one 
discipline, a physician, for example, who knows how to treat sickle cell disease, 
but yet cannot prevent different outcomes among different patients living in 
different communities.  So you do need lots and lots of people.  We need to 
break down the silos; that's what we need to do.  And we need to train people the 
way that we expect and would like to see them work in the field, and that is as 
teams.  And that's been the big problem of gettingÉI think that's the reason the 
NIH researchÉand I think the NIH was right in starting the roadmap, because the 
main objective of the roadmap was to try to figure out, how do we translate all of 
these discoveries into practice?  And the way to do that, of course, is to promote 
team research, and to bring behavioral scientists together with basic scientists, 
with clinicians, with environmental health scientists, because all of these factors 
are involved.  

Ernie Hood: Dr. Olden, I know you're planning to institute an innovative structure 
at the CUNY School of Public Health.  How do you see that contributing to 
improving translation of research into practice?

Dr. Olden: We're going to train a cohort of students, people who are going to go 
out into the work force who are accustomed to working together in teams, and 
people who can appreciate the knowledge, the expertise, and the value system 
and perspectives of people working in different fields.  I think that is what in fact 
is needed.  For example, if we use the community as a classroom to train 
students, we need all of the professions involved Ð the public health practitioners, 
nurses, physicians.  Because if you go into a community setting, the issues that 
people face are very difficult, are very complex, and you can't just solve one of 
their problems, because there are a number of factors, a number of issues that 
need to be addressed to promote healthy living and healthy aging and good 
health.  So it's not just good nutrition, it's exercise, it's anti-smoking, it's 
compliance with medicationÉSo it's a number of issues that have to be 
addressed.  And I think if you try to do that with the way that we train people now, 
in other words, physicians and nurses and public health practitioners rarely work 
together in community settings, and I think here in Harlem and Spanish Harlem, 
in these communities usually the public health agencies have one or two of the 
disciplines that are needed, but not all of them.  The public health people are 
rarely at the table, or the nurses.  So we need people to be trained differently, 
because it's the mindset that's going to make a difference, it's the attitude.  It's 
the respect for other disciplines that's going to be important.  And I think that 
you've learned that early on in your career, and you begin to appreciate and 
recognize the necessity and the need to have nurses as part of the team and to 
respect their opinions, or a public health practitioner, or a physician.  And so 
rarely are all of these expertise part of a team in a setting where that's exactly 
what you need.  So I think if we train people right, then the respect will be there 
and appreciation will be there, and we will discover that we will get better results, 
and that's I think what public health is about. 

Dr. Ken Olden, thank you so much for joining us, and best of luck in your new 
endeavor.

Dr. Olden: Thank you very much. 

Ernie Hood: And thank you for listening to The Researchers Perspective.