To others they may just look like three black letters after my name on my business card:  MPH.  Many people don’t even know what MPH stands for.  However, my family and my dearest friends (among others) are impressed to know that they stand for Master of Public Health.

To me these three little letters glow because they not only stand for the final accomplishment of my five year part-time education, but for all of the various experiences and events that have taken place in those five years.  There was the evening of my first class in the fall of 2005, Healthcare in the United States, after which I slipped in a quick trip to Prague before the second class the following Monday night.  There was the last class I took this past December, a stimulating course in Healthcare Ethics.  And there were all the classes in between:  the Tuesdays of falling leaves in Adolescent Health, the snowy Thursdays melting to spring buds in Public Health Program Planning and Evaluation or Biostatistics, the steamy summer nights in International Public Health, Epidemiology, and Environmental Health.  Five years of “to everything there is a season” and a time for every exam and research paper and group project, text books, notebooks, highlighters, Pathologies of Power, Complications, and How to Change the World.  And how I myself was changed doing algebra equations I thought I had forgotten 40 years ago, grasping the legal implications of patients without DNRs, struggling with the rights of adolescents, the rights of parents, the rights of the deceased, the rights of the unborn.

And while I was changing and learning from my instructors, my professors, and my classmates, I was changing personally as well.  I was changing though my personal journeys to Rio de Janeiro, where I worked with the innovative children’s health program, Saude Crianza Renascer, to Hong Kong, Swansea, Wales, and San Diego to present on the Moving Mountains Project I developed to address abuse of children with disabilities, to eight women’s hospitals nationally to study their different models of women’s health, to Nevada to serve on an expert child death review panel, to Bogota, Colombia to keep a friend company during the drawn out adoption process for her son, to a vacation in Paris, and to Saratoga (the track, SPAC, and kayaking) after a summer Healthcare Marketing class.  During those five years I got divorced, bought a house, moved, went to my middle daughter’s wedding, my eldest daughter’s home in Texas and my youngest daughter’s college graduation, and I ecstatically welcomed two beautiful grandchildren. Yes, the times they were a changin’.

How appropriate for the process of obtaining a degree in public health since in fact change is what public health is all about.  Changing health status, changing disease rates, changing mortality and morbidity by increasing access to health care, reducing risk factors, raising awareness through education, decreasing non-compliance, changing systems, methodologies, outreach strategies, group practices, individual behaviors.  And of course measuring those changes with well-designed studies:  observational, experimental, the ecologic studies, cross sectional studies, case-control studies and cohorts -- the more robust, the better. 

My own experience of writing my thesis on global maternal mortality had been a challenge as I was told by some experts in the field that the public health preventive approach had failed and only medical treatments could reduce the deaths of women in childbirth.  An article in The Lancet on April 12, 2010, documented a new study that indicated that indeed prevention, women’s empowerment and attendance at birth by skilled attendants, but not necessarily physicians, had been reducing maternal mortality over the past 20 years. The Lancet, Editor Richard Horton noted in an editorial, had been “invited” by some organizations to delay or suppress the new research and the article.  This change was very controversial as change usually is.  How daring, I thought. The history of public health, however, is full of challenges:  John Snow identifying the cause of cholera as microorganisms in a water well debunked the miasma theory of illness. Ignatz Semmelweis in the mid-1800s recommended hand-washing to reduce deaths in childbirth -- to us now a no-brainer, but at the time he was so ridiculed by his peers that he died in an institution at the age of 47 after a nervous breakdown.  Initiating change can be dangerous, risky.

As I sat in my black gown and mortar board awaiting my diploma, surrounded by my classmates, I couldn’t help but wonder what public health changes lay ahead that would be the result of this class of graduates.  I wondered about the risks we might take to publish research that would change accepted health practices, the challenges we might face in the process of supporting system changes, altering governmental policies, taking on big business, personal risks of going into areas of political unrest to reach vulnerable populations.

There in the decorum of a traditional graduate and medical school graduation I couldn’t help but think of the words of a leader far outside the health care sector, Niccolo Machiavelli, who wrote in The Prince:

There is nothing more difficult to take in hand, more perilous to conduct, or more uncertain in its success, than to take the lead in the introduction of a new order of things.

And I could see not only my MPH glowing, but all the many around me burning with a passion to change the world.

Karel Rose Amaranth, MPH, MA, is a member of the MCH Section.