A Commitment to Public Health — Dr. Barbara DeBuono

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Kim Ribbink

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By Kim Ribbink

Dr. Barbara DeBuono, as Senior Consultant to the WHO, was assigned to the organization’s SEARO, Southeast Asia Regional Office in New Delhi, India, to review public-health aspects of the tsunami relief and recovery operations. She worked with the WHO offices in India, Maldives, and Thailand and was on location from February through April 2005. Dr. DeBuono partnered with local governments, international agencies, and NGOs to assess the public-health aspects of the crisis, including the initial relief operations and the transition, plans, and policies leading to rehabilitation, recovery, and reconstruction.Barbara DeBuono, M.D., MPH, has been at the center of innovative and important changes critical to public-health issues throughout her career. Whether serving in the public sector or in private industry, Dr. DeBuono has been helping to galvanize activities to improve the treatments of different patient populations. As a trained healthcare provider, Dr. DeBuono is naturally drawn to situations and opportunities to advance the way medicine is practiced. She was at the forefront of significant initiatives to improve breast-cancer screening and found innovative ways to tackle the spread of infectious and communicable diseases. She spurred advancements in New York state’s healthcare system. And, more recently at Pfizer, she is leading the way on vital health issues, such as improving health literacy and helping to create crucial partnerships with a wide spectrum of health groups — nonprofit, public-health associations, and so on — in keeping with Pfizer’s goals of developing and deploying holistic health programs. “At Pfizer, I’ve had the privilege of being able to work in health literacy, policy, and public-health areas within the company and doing nonbranded, nonproduct activities and programs that add value to our organization because they address patient and population health beyond merely just the delivery of a therapeutic agent,” she says. Dr. DeBuono joined Pfizer in 2000, and since then her roles have been varied. She has served as an advisor on key public-health issues, been a pioneer in the area of health literacy for the company, and acted as an ambassador for Pfizer in important settings, such as the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO). It has been an exciting transition for Dr. DeBuono, and one that matches her extensive skills and knowledge. A firm believer in the importance of strong, dedicated teams — when discussing all aspects of her work at Pfizer, she uses the pronoun “we” not “I” — Dr. DeBuono maintains Pfizer’s greatest assets are its people. “The people within Pfizer are the value and currency of the organization; they make up what the organization is,” she says. Developing a Body of Work The desire to become a doctor came early to Dr. DeBuono. She remembers as a teenager, around the age of 14, deciding that she really liked biology and was inspired after reading a couple of books, one being Microbe Hunters, a science classic that details the chronicles and advances in infectious disease over the last several hundred years. “This was a sentinel moment for me,” she says. “I then quickly developed an interest in public health, primarily population and community health, which again stemmed from an interest in infectious diseases and the idea that by treating a person, then a family, then a community it would be possible to make a difference at a population level.” Knowing what she wanted to do, Dr. DeBuono then had to decide the best route to achieve her goal. She had a variety of options, including training through the CDC, gaining a master’s in public health, or pursuing a fellowship. Her decision ultimately was to pursue a fellowship in infectious disease. After finishing her fellowship at Brown University Medical School, Dr. DeBuono debated how to put her knowledge into practice. Her decision was to work in the trenches, as she describes it, in public health. She was recruited by the Rhode Island Health Department to create a breast-cancer screening program at a time when there was limited knowledge on the subject. It was around this time, the mid-1980s, that studies were beginning to emerge from Sweden and the United States indicating that low-dose, two views per breast mammography was an effective tool to identify early, very small cancer cells. Most importantly, early diagnosis could enable women to be treated quickly and, all things being equal, to return to normal health. With the support of two female radiologists who had a keen interest in the research, and a forward-thinking director of the health department, Dr. DeBuono and her colleagues initiated a mass-screening program for women in Rhode Island. The work attracted the attention of the Food and Drug Administration (FDA) and the CDC, which decided to take the program national. During her years at Rhode Island, Dr. DeBuono also worked on key initiatives in the areas of cervical cancer and HIV/AIDS, two issues that were regarded at the time as key public health threats facing the nation. “Based on my work as the state epidemiologist, the governor of Rhode Island appointed me as the director of health,” she says. “And it was the work I did in Rhode Island that was noticed by the then first-term New York Governor George Pataki.” In New York, Dr. DeBuono and her team worked to transform the Medicaid program to one that promoted managed care for Medicaid recipients, to deregulate New York’s hospital rate-setting system, and expand the state’s child health insurance program, called SCHIP. When the Clinton administration started the national childhood insurance program, New York was able to further expand its program. “At this point in New York there are very few uninsured children, because of some wonderful programs we were able to put in place,” she says. A couple of years before joining Pfizer, Dr. DeBuono spent some time in the hospital setting at the New York Presbyterian Healthcare Network. Again, she was in the driver’s seat to help the hospital tackle change, steering it through a difficult merger. But she quickly learned that she was still more interested in taking care of patients at a population level rather than the individual level, and she decided to pursue other opportunities. During her years working in public health, Dr. DeBuono had achieved a great deal of success in the areas of vaccines and immunizations, and this attracted the attention of several companies, including Pfizer, which she joined in August 2000 as senior medical advisor for U.S. Public Health and Policy. Push-Pull Communications The enormity of the issues Dr. DeBuono confronted during her public-health career taught her the importance of tenacity, persistence, and effective communications. “With the outbreak of an epidemic or the analysis of a cancer cluster, there are learnings that can have political as well as clinical implications,” she says. “I learned how to be tenacious in the analysis of the data and how to effectively communicate my findings through the media to families and to the communities.” Today, those lessons are put to valuable use at Pfizer where much of her work is focused on patient-physician communications, in particular in the area of health literacy. Dr. DeBuono’s involvement in health literacy was based on the company’s awareness of the need to think beyond the discovery and delivery of medicines to adherence and understanding how patients take their medications. “What quickly became apparent to me is that messages need to focus not just on the instructions about the medicine but on information about the disease condition,” she says. “There must be a sensitivity to, and knowledge about, the cultural and societal norms around the use of medicines and diseases. These learnings must be addressed to have a fully adherent patient population.” Thus, Dr. DeBuono explains, health literacy entails gaining awareness of, being sensitive to, and addressing issues, such as patient norms, cultural norms, and family structures. “We continue to drill into the hearts and minds of health professionals to think about the way patients hear what is being said,” she says. “It’s vital to listen to what patients care about and what they’re experiencing when they hear a complex diagnosis or a complex set of instructions.” The work Dr. DeBuono and her colleagues in public health and policy have done in the area of health literacy has transformed the way that Pfizer, health professionals, nonprofit organizations, and other companies develop patient-education materials. “There has been an internal transformation around the way our brand teams develop patient-education materials and materials for providers,” she says. “We’ve also had a profound impact on the medical community as well as on the nonprofit health advocacy community and even on the federal agencies, such as the Centers for Medicare and Medicaid Services (CMS) and the FDA in the way they think about how patients learn and how patients are impacted by the information they receive about health.” Dr. DeBuono says her dedication to improving patient communications is in some ways a continuation of the work she did as a public-health professional — improving the dissemination of important information — and an evolution in her appreciation of the importance of how messages are received. “I feel I’ve come full circle; I continue to work to get the public-health community to be engaged in improving health literacy,” she says. Dr. DeBuono does this through initiatives such as Partnership for Clear Health Communication, a nonprofit organization started by Pfizer to advance health literacy. The organization is now an independent entity. (For more information about this organization, reference A Market for Education in the October 2006 issue of PharmaVOICE.) A Global Ambassador In addition to her day-to-day responsibilities, Dr. DeBuono fulfills an ambassadorial role for Pfizer, ensuring that the company is recognized as having expertise and credibility in the policy, public-health, and health-information arenas. “I do a great deal of work with nonprofit organizations in health-related fields, and I like to keep current with what’s going on in the field of health policy,” she says. Dr. DeBuono sits on the board of the Partnership for Prevention, an organization devoted to building evidence of sound disease prevention and health promotion policies and practices, and advocating for their adoption by the public and private sectors, including large businesses, Congress, federal agencies, and states. She sits on the CDC corporate roundtable as a Pfizer representative, along with representatives from organizations such as Federal Express, UPS, Johnson & Johnson, and Wal-Mart. “This is a group of business leaders who are advising the CDC on any number of issues — from preparedness to crisis management to health communications to employees,” she says. In addition, Dr. DeBuono has been a consultant to WHO, partnering with local governments, international agencies, and nongovernmental organizations (NGOs) associated with the United Nations to assess the public-health aspects of the 2004 tsunami, which claimed more the 275,000 lives and destroyed the livelihoods of countless communities. In so many of these issues, Pfizer seeks to be a leader, and Dr. DeBuono is committed to ensuring the pharmaceutical company’s place at the table of international and national health affairs. But equally, she wants to bring back information gleaned from outside sources to the company. “I want Pfizer to know what’s going on in the prevention research and advocacy arenas,” she says. “I view my work as having very much a bidirectional benefit.” For Dr. DeBuono, and also for Pfizer, the fit has been spot on. The company has been able to take advantage of her enormous public-health expertise and knowledge, and in turn Dr. DeBuono has been inspired by the ingenuity, entrepreneurship, and willingness to adapt to new environments and opportunities expressed by Pfizer’s leadership. For example, with its smoking-cessation product Chantix, now launched, the company has taken a lead on bringing in public-health groups, prevention research groups, and nonprofit organizations to work collaboratively in the antismoking arena. The leaders of the Chantix team approached Dr. DeBuono for advice before launching the product. “I was asked who our partners should be for this program, how to reach out to them, how we can educate them about the product, and how we can create a win-win situation and meet the needs of patients, physicians, and the smoking-cessation community as we advance this product,” she says. Enterprising Operations Dr. DeBuono says in the six years since joining the company, she has witnessed many changes both internally and externally. Pfizer has grown in size, having acquired first Warner-Lambert in 2000 and then Pharmacia in 2003, and it has been subject to greater constraints, as has the entire pharmaceutical industry, with regard to transparency, accountability, and implementing a broader framework of rules in which it must operate. Dr. DeBuono is inspired by the way the company has responded to those demands, while ensuring it maintains its entrepreneurial character. “I’ve been impressed by the way the leadership of the organization is beginning to articulate the lexicon of public health,” she says. “This is a strategy that has evolved over the last six years. I’d like to think I have had something to do with this, but I also think that the leadership is informed, intelligent, and open-minded, and is taking a world view and envisioning the big picture of healthcare, not merely medicines.” Pfizer’s and Dr. DeBuono’s endeavors on advancing public health resonate at all levels. For example, David Nabarro, who was the medical director for WHO during the tsunami aftermath, told Dr. DeBuono that her recommendations had helped to form the organization’s policies to address the clinical-health needs of the population in rural Thailand. “Many of WHO’s messages around sanitation and infection control weren’t reaching down into the community and clinic levels,” she says. “Dr. Nabarro said Pfizer’s input on how to translate those messages to the local level had a real impact, and that was very rewarding to hear.” Another example of Dr. DeBuono’s leadership in the arena was illustrated by the recent visit of former U.S. Surgeon General Richard Carmona, M.D., MPH, FACS, to Pfizer. Dr. Carmona was invited to speak to Pfizer’s Latino council as part of Spanish heritage month. His speech was a confirmation of the powerful message that Dr. DeBuono has been promoting since she began working for Pfizer. Early in her career at Pfizer, Dr. DeBuono met with Dr. Carmona, who had at the time just been named Surgeon General, to talk about health literacy. “As a Hispanic physician coming from and growing up in Spanish Harlem he related to the notion of a cultural divide in communication and health literacy,” she says. “Overcoming this gap became a goal during his four years as Surgeon General. During his recent address at Pfizer he recognized the work I have done in health literacy and Pfizer’s commitment to these initiatives, describing how transformative our programs have been to the health literacy field. It was rewarding to hear what a profound impact we had on his role as Surgeon General, and now he’s taking that information and that mission and weaving it into his new work in health and wellness.” Dr. DeBuono hopes to continue to make important contributions to Pfizer and the organizations to which she has served as an advisor. “I’m eager to play a more active advisory role, particularly in a global health context,” she says. “I’m interested in taking what I’ve learned in health literacy and applying that knowledge globally. Over the next decade or so, I’d like to address the best ways to bring basic health education to populations in developing countries.” PharmaVOICE welcomes comments about this article. E-mail us at feedback@pharmavoice.com. With a firm focus on public health, Barbara DeBuono, M.D., MPH, is constantly looking for ways to improve the health of the general population, be that through health-literacy initiatives focused on patients and providers or as a consultant to national and international health organizations. Her commitment to the field has made her a leading light in the area of public health. Thinking Global In an exclusive interview with PharmaVOICE, Barbara DeBuono, M.D., MPH, talks about the challenges ahead for global health and the many complexities involved in addressing these problems. As a professional who has devoted her career to the public-health sector, it is not surprising that the challenges in global health are a high priority for Barbara DeBuono, M.D., MPH. But as Dr. DeBuono notes, the issues extend far beyond medical and clinical matters and encompass controversial topics, such as cultural and economic issues. If these problems are to be addressed, it will take the commitment of people from many different disciplines working together in a comprehensive, integrated way to scale up any solutions or strategies. “When we think about AIDS in Africa, for example, there are broad and profound issues that need to be addressed to comprehensively tackle the crisis; it’s so much more than just getting a series of drugs to people or conducting testing,” she says. Rather than having grandiose notions of stamping out AIDS, Dr. DeBuono says the public health, medical, and business communities need to take an iterative approach. “To affect change, it will be vital to address poverty, education, and cultural norms and barriers,” she says. “It means we have to be willing to move the needle in a small way to ultimately affect change in a big way.” Another example is a pandemic crisis, which extends beyond medical issues. In the recent outbreak of avian flu, hundreds of families killed off flocks of chickens to prevent the spread of the disease, leaving them without a livelihood. “This now becomes an economic issue as much as a medical one,” Dr. DeBuono says. “Who is going to replace the chickens? Who is going to replace the income lost? The challenges in global health are so complicated and daunting that I’m humbled by them.” These issues are likely to resonate more in the industrialized world in coming years, as the notion of connectivity across the world becomes more apparent. “This is no better illustrated than in the way in which an infectious agent, such as a pandemic flu or SARS, can spread and travel around the globe,” she says. “These incidents make one realize that the world is flat, to draw from Tom Friedman’s notion.” And that connectivity travels both ways. For example, Dr. DeBuono says while working with the World Health Organization in Thailand on issues concerning the tsunami she met with the country’s leaders in the ministry of health to better understand what they considered to be key public-health issues. “I was amazed when one of the deputy health ministers that I met in Bangkok said one of the biggest concerns is the increase in obesity among young children in Thailand,” she says. “I told him that childhood obesity is one of the big challenges that we are grappling with in the United States. And he attributed the causes to some of the same factors we have: children are much more sedentary, the increased use of video games, and the widespread Westernization of the way food is delivered to children through a variety of fast food places. It was so interesting to hear his observations, and it’s so important in public health to view the world beyond the microcosm in which we live and work.” A Path of Greatest Assistance Aug. 2000 — Present. Senior Medical Advisor, U.S. Public Health and Policy, Pfizer Global Pharmaceuticals, Pfizer Inc., New York Nov. 1998 — Jan. 2000. Chief Executive, New York Presbyterian Healthcare Network; Executive VP, New York Presbyterian Healthcare System, New York Jan. 1995 — Nov. 1998. Commissioner of Health, New York State Department of Health, New York June 1991 — Feb. 1995. Director of Health, Rhode Island Department of Health, State of Rhode Island and Providence Plantations, Providence, R.I. Oct. 1986 — June 1991. State Epidemiologist and Medical Director, Division of Disease Control, Rhode Island Department of Health, Providence, R.I. July 1986 — Sept. 1986. Medical Epidemiologist, Rhode Island Department of Health, Providence, R.I. 1976. College Traveler, Academic Press Inc., New York Academic Appointments June 1996 — Present. Adjunct Professor of Medicine, University of Rochester Medical Center, School of Medicine and Dentistry, Rochester, N.Y. Spring 2000. Clinical Professor of Medicine, Department of Medicine, Columbia College of Physicians and Surgeons, Columbia University, New York Sept. 1995 — Aug. 1998. Professor, Department of Health Policy, School of Public Health, University at Albany, State University of New York, Albany, N.Y. July 1994 — July 1999. Clinical Associate Professor of Medicine, Department of Medicine, Division of Infectious Diseases, Brown University Medical School, Providence, R.I. July 1990 — June 1994. Clinical Assistant Professor of Medicine, Department of Medicine, Division of Infectious Diseases, Brown University Medical School, Providence, R.I. June 1987 — June 1990. Clinical Instructor in Medicine, Department of Medicine, Division of Infectious Diseases, Brown University Medical School, Providence, R.I. Education 1984. M.P.H. Harvard University School of Public Health, Boston 1980. M.D. University of Rochester School of Medicine, Rochester, N.Y. 1976. B.A. University of Rochester, Rochester, N.Y. Residency and Fellowships 1994. John F. Kennedy School of Government Fellowship, Program for Senior Executives in State and Local Government, Harvard University, Cambridge, Mass. 1984 — 1986. Fellow, Infectious Diseases, Brown University Medical School, Affiliated Hospitals Program, Providence, R.I. 1980 — 1983. Internal Medicine Residency- New England Deaconess Hospital, Boston Special Public Health Assignments 2006 — 2007. Mentor for the Association of State and Territorial Health Officials’ State Health Leadership Initiative Mentoring Program 2005. Advisor to U.S. Surgeon General for Call to Action, U.S. Public Health in the Context of Global Health 2005. Senior Consultant to World Health Organization 2004 — 2005. Regional Judge, Robert Wood Johnson Foundation: YES (Young Epidemiology Scholar) Competition 2004. Advisor to U.S. Surgeon General for Call to Action for Health Literacy Barbara DeBuono — Resume Promoting the Public Path For Barbara DeBuono, M.D., MPH, public health is not only the career path she chose but also a field that she is passionate about. With that in mind, Dr. DeBuono strives to find ways to encourage young people to join the public-health workforce, both through initiatives at Pfizer and through mentoring students and young professionals. As part of that goal, she and her colleagues at Pfizer have been collaborating with various associations and community health officials, including the Association of the Schools of Public Health, to uncover ways to attract young people to the field of public health. In addition, Pfizer has created public-health fellowships for young people who have finished their doctorate in public health and are interested in jump-starting their academic careers. “We have a fellowship program that allows students to engage in what I call translational public-health research — bench to bedside research — into solutions and tools that can advance public health at the local community level,” she says. “We also have an applied epidemiology fellowship with the Centers for Disease Control that encourages medical students to think about medical epidemiology, about the science of epidemiology, and about population health.” Dr. DeBuono says the epidemiology fellowship is in its fourth year. Every year, through the CDC, Pfizer supports eight medical students who are schooled and trained to think about populations, health outcomes, and whether individual treatment when applied to a population can advance the health of the population in a scientific way. Dr. DeBuono also has committed much time in recent years to developing three books on public health: Advancing Healthy Population: A Pfizer Guide to Careers in Public Health, Faces of Public Health, and Milestones in Public Health. The books are published by Pfizer and distributed to schools of public health as well as available online, free of charge. “Each book focuses on different aspects of the field,” she says. “The first one is about careers in public health. It looks at the different careers that are available, for example, as a researcher in infectious disease, as a legislator, or as a public health lawyer. The second book celebrates heroes in public health around the country. We asked health officers and deans to identify the people in the trenches who are doing real public-health work; that book has been extremely inspirational for young people. The third book is a history of public health. It talks about the 10 major milestones in public health over the last 100 years and then talks about the field and the future.” Dr. DeBuono’s role with these books has been extensive. She has acted as a writer, has been editor in chief, has designed the covers, and has approved photography. She has done this in collaboration with a team of writers and experts. “These books have been labors of love; they’re my babies,” she says. In addition, Dr. DeBuono guest lectures at schools of medicine and public health about public health issues and health literacy. “We’re developing a curriculum to accompany the Milestones in Public Health book, and one of the things I hope to do in the future is to teach that course,” she says. “A couple of schools are interested in having me teach their class on the History of Public Health using the Milestones books. I like the notion of giving back and mentorship.” In particular, Dr. DeBuono gets a great deal of satisfaction by motivating young people to consider a career in the sector. “For example, my 23-year-old son has a friend who is applying to medical school, five years ago he was determined to be an orthopedic surgeon; now, he’s going to become a public-health physician and I know it’s because of the experiences in public health that I have helped expose him to,” she says. “I’m completely devoted to finding people who have an interest in medicine and turning them on to public health.” In addition to the young people she comes into contact with through her two sons and her lecturing, Dr. DeBuono mentors people she works with at Pfizer. “I enjoy discussing larger public-health issues and opening up to young people the world to new possibilities,” she says. I feel I’ve come full circle; I continue to work to get the public-health community to be engaged in improving health literacy.

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