Investigations
Practical public health
A self-described short, nerdy guy, Harold Pollack
wears oversize glasses, sports floppy, graying brown hair, and looks
at home in the groves of academe. He’s mild mannered, and
at a Friday afternoon appointment he speaks so softly that it’s
difficult to hear him over the Law School cafeteria’s end-of-week
hilarity. But the School of Social Service Administration (SSA)
associate professor doesn’t confine his research to academic
debates. His interests rest instead with the practical interface
between public health and poverty—his curriculum vitae cites
HIV and hepatitis prevention for intravenous drug users, drug abuse
among welfare recipients and pregnant women, and infant mortality
prevention as recent research topics.
Pollack, whose forthcoming articles explore issues
such as methadone treatment and AIDS reduction, wasn’t always
aiming to bring ivory-tower expertise to bear on urban poverty.
After completing his bachelor’s in electrical engineering
and computer science at Princeton, he worked in a lab while volunteering
nights at a homeless shelter. “It was a mixture of realizing
what I most enjoy and pure happenstance,” he explains. While
earning a master’s and doctorate in public policy from Harvard’s
Kennedy School of Government, he met a girlfriend (now his wife,
Veronica) who later went on to study at Yale. Eager to be with her,
when Yale advertised a post-doc position in health policy, “Of
course I decided health policy was really important.”
Since joining the SSA from the University of
Michigan early this year, Pollack has focused in large part on harm
reduction—improving the well-being and social performance
of drug users. But for many policy makers, he says, the “notions
of harm reduction are politically radioactive.” As an example
he often returns to needle exchange, a service providing sterile
hypodermic needles to drug users, helping to prevent the transmission
of blood-borne infections. Some elected officials and their constituents
oppose needle-exchange programs, arguing that they send the wrong
message and don’t produce tangible results, such as reducing
crime.
According to Pollack, this concern represents
a failure on the part of the public-health community. The objection
to certain interventions would make sense, he says, if substance-abuse
policy researchers only faced right-wing critics like retired North
Carolina senator Jesse Helms. But when strong opposition also comes
from the urban political left, Pollack asks, “Have we really
communicated effectively what we’re trying to do? And why
can’t we build political constituencies to try to do this
better?” He jokes, “We shouldn’t call needle exchange
‘needle exchange.’ Maybe we should call it ‘sunshine
health services’.”
More seriously, Pollack finds value in “constructive
ambivalence”—admitting the troubling aspects of some
interventions, such as providing clean needles to a pregnant drug
user, while recognizing the positive results, such as reduced HIV
infection rates and ultimately lower crime and drug use. With the
well-publicized horrors of HIV and an exploding prison population
of drug dealers and abusers, the public seems more receptive to
such an approach than five or ten years ago. However, he cautions,
“one has to recognize that it takes a long time to influence
public policy, and that process is indirect.”
Pollack’s part in that process is creating
a better fit between effective interventions and public values.
Practical policies are developed with an understanding of how a
community works, and Pollack approaches hard-hit areas, such as
Flint, Michigan, or Chicago’s South Side, from multiple perspectives.
Teaching economics in the SSA, he often turns to statistics. “If
you really ask the question the right way,” he explains, “and
you have the right data, then you see the answer on a graph…and
the paper writes itself.” But numbers provide only part of
the picture, so he’s hoping to do additional one-on-one interviews
with the individuals whose behavior he wants to change.
“It’s important to ask people some
basic questions,” he says. “Why are you selling sex
for drugs when you know as much as I do about AIDS? Why are you
sharing dirty needles? I don’t think that talking to drug
users is the only way to get answers, and those answers are not
necessarily completely true or truly complete, but I think you have
to ask.”
In his lesson plans on substance abuse, Pollack
addresses such motivating factors as pleasure, social structures,
stress, price, and convenience. “All these factors are very
important in understanding why people are using crack, why people
are using heroin,” he says—but they have broader implications.
“Not too many of my students are using crack or heroin. Most
of them are going to the vending machine more than they’d
like to.”
Hot-button issues, like increased obesity among
children and the dangers of secondhand smoke, have inspired some
of Pollack’s recent papers. In an Archives of Pediatric and
Adolescent Medicine study, he found that all overweight children
suffer social consequences, but those penalties differed by race
and gender: African American girls were the most accepting of different
body types, non-Hispanic white girls the least. It’s also
true that problems of obesity are more severe among black women
while anorexia is more prevalent among white women. The challenge,
says Pollack, is to reduce obesity while promoting positive social
attitudes. “We have to be very careful not to perpetuate the
stigma,” he explains. “We tried to reduce youth tobacco
use by stigmatizing smoking—we would tell kids, ‘The
boys aren’t going to want to kiss you if you’re smoking.’
And that would be a terrible approach to take to issues of overweight.”
Systematic stigmatizing may help to reduce some
unhealthy behaviors, suggests another of Pollack’s studies.
His results, published in the American Journal of Public Health,
show that while the number of adult smokers fell modestly between
1992 and 2000, levels of exposure to secondhand smoke in the home
dropped dramatically. The reduction could be related to increased
restrictions on public smoking. “This shift in social norms
also may have translated into changes in behavior,” Pollack
told the University of Chicago Chronicle, though more investigation
needs to be done.
His favorite research, he says, is simple and
addresses practical issues. “One of the nice things about
public health is it’s not an esoteric enterprise. In many
parts of the University one gets the feeling that if you found the
cure for cancer people would say, ‘Well, that’s really
interesting, but what’s the methodological contribution?’
And I don’t feel that way when I come into the office.”—A.L.M.
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