Health in America has improved significantly in the last century, with progress seen in a number of areas, such as life expectancy. In 1900, the average American could expect to live to about age 47. That number has since risen to nearly 79. This progress reflects generations of public health improvements, better living standards, nutrition, and sanitation. But this progress is not the whole story. Health gaps remain, notably between racial groups. The percentage of US adults 18 or older with diabetes, for example, is 15.1 percent for American Indian/Alaska Natives, 12.7 percent for Hispanics, 12.1 percent for black non-Hispanics, 8 percent for Asians, and 7.4 percent for white non-Hispanics (Figure 1). Black mothers are over three times likelier to die in childbirth than white mothers (Figure 2). And young African Americans are likelier than whites to die from a range of conditions that are typically more common at older ages, such as high blood pressure and stroke (Figure 3). While there has been progress towards closing some racial health gaps, they remain a persistent challenge for public health.

I WAS working as a young doctor for Médecins sans Frontières in Somalia in the late 1990s when I realised for the first time how helpless I was in improving the health of my patients.

I was the only doctor for about 350 000 people. Every day, they’d come through the door, most of them with malaria or another preventable injury or disease, their lives literally in my hands.

The end of summer can be a melancholy time, but in academia it is an occasion for joy. Welcoming first-year students and faculty, along with returning members of our community, makes for a kind of second spring, as our school renews itself. It is a time to look to the future, but also to mark where we have been. SPH has undergone many changes over the last few years, building on the work our community has done over four decades to deliver a world-class public health education to our students. I would like to use this Dean’s Note to reflect on our evolution as a school, while anticipating, with excitement, the future. This is a time when the work of public health is more important than ever. It strikes me as fitting that, at the start of the academic year, we reaffirm why we do what we do, touching on the core values that animate our school, as we come together once more to build a healthier world.

Like many Americans, I have found it hard to stop thinking about the heartbreaking photo of the bodies of Óscar Alberto Martínez Ramírez and his daughter, Angie Valeria, migrants from El Salvador who drowned while attempting to cross the Rio Grande to seek asylum in the US. I think about the hopes and fears that might have caused them to make such a dangerous journey—hopes for a better life in America, fears of having to return to face gang violence and economic hardship in El Salvador. I have especially been thinking about Óscar and Valeria this Fourth of July week, a time to celebrate the country’s founding, and the ideals of freedom and opportunity that characterize this nation at its best. These ideals are important to all Americans, but, I would argue, they are particularly important to immigrants. Indeed, they are the reason many immigrants come to this country, often in the face of difficult circumstances.

It's Pride Month, a time for celebrating the LGBT (lesbian, gay, bisexual, and transgender) community. LGBT individuals have made significant strides toward greater equality, notably with the 2015 passage of marriage equality in the U.S. Yet this population continues to face a range of mental health challenges, many of which are linked to conditions of marginalization.

Harvard University’s recent announcement that law professor Ronald S. Sullivan Jr would no longer remain faculty dean of one of its undergraduate houses raises profound questions for all university senior leaders.

The reasons for Harvard’s decision are complex, involving long-standing complaints about Sullivan’s administration of the house. But the recent focus on his leadership was precipitated by an outcry over his time on the legal defence team of Hollywood producer Harvey Weinstein. Some members of the Harvard community felt that Sullivan’s willingness to defend Weinstein, who has been accused of multiple sexual crimes, compromised his ability to provide a safe, supportive environment for students. Sullivan’s advocates, on the other hand, have said that although Sullivan no longer represents Weinstein, his willingness to do so is testament to the fact that even people accused of heinous offences still have the right to the best legal defence they can access. Some have even cited John Adams, a Harvard alum, who, in 1770, defended the British soldiers accused of carrying out the Boston Massacre, despite his personal sympathies for American independence.

The Sullivan controversy highlights the challenge leaders of schools and universities face as they navigate the conversation around difficult issues. As the dean of a school of public health, I have long pondered when and how academic leaders should take public positions on issues they feel are important. To my thinking, they must do so. But Sullivan’s case raises the fraught question of what happens when that position runs counter to the views held by many in the institution (since choosing to represent Weinstein has been perceived, rightly or wrongly, to amount to taking a position).

Access to legal abortion is under threat in the US as never before in the post-Roe era. Anti-abortion laws passed in states like Alabama and Missouri have all but ended legal abortion access in these areas. If legal challenges to these laws reach the Supreme Court, the Court’s new conservative majority raises the possibility that the precedent set by Roe v. Wade in 1973 will not be upheld, clearing the way for conservative states effectively ending access to abortion for millions of women.