Geeta Rao Gupta, Ph.D., president of the International Center for Research on Women, summed up the sentiments of many at a Washington, D.C., tribute to Dr. Rosenfield in May 2006: “A man who stands for women’s rights and reminds the world that a woman must not be taken for granted is definitely a hero to be worshipped. Millions of women worldwide should know that they’re better off today because of your efforts.”
BY PETER WORTSMAN
WHEN ALLAN ROSENFIELD'59, A LEGEND IN THE FIELD OF PUBLIC health and the longest serving dean of any school of public health in the nation, announced plans to step down as dean after 20 years, you could almost hear a gasp extending from Bangkok to Broadway. The gasp was promptly followed by a global outpouring of love not likely to abate any time soon.
In Washington Heights he is best known for building what is now the Mailman School of Public Health from a small department within the medical school into one of the country’s most prominent schools of public health and a major institutional player in the age of AIDS and the post-9/11 era. But to the international public health community, he is first and foremost the man who put the neglected M back into MCH for maternal and child health and reminded the world of the forgotten M in MTCT mother-to-child-transmission of HIV. For more than half a century he has promoted the cause of reproductive health and empowerment of women to control their own bodies and destinies.
To others, like actor Richard Gere, founder of the Gere Foundation and Healing the Divide and an activist in AIDS and other humanitarian work, Allan Rosenfield’s name is quite simply the gold standard in public health. “Wow! Wow! Wow!” the celebrated screen star said before adding a fourth “Wow!” when he reflected the emotion directed toward Dr. Rosenfield at a June 2006 Columbia University World Leaders Forum, “Taking a Stand: Challenges and Controversies in Reproductive Health, Maternal Mortality and HIV/AIDS.” Hosted by President Lee Bollinger, the two-day event honoring Dr. Rosenfield’s leadership included a dinner held under two large tents set up on Columbia’s Morningside campus. Distinguished speakers for the two-day event included then UN Secretary-
General Kofi Annan, Sen. Hillary Clinton, former President Bill Clinton, former President of Ireland Mary Robinson, and Stephen Lewis, UN envoy for AIDS in Africa.
“In addition to his passion,” President Clinton said of Allan Rosenfield, “he has something I find quite useful in the nongovernmental world. He actually knows how to get things done.”
Dr. Rosenfield’s astounding efficacy in making good things happen is founded upon his extensive medical knowledge and experience, a profound belief in access to health care as a universal right, a rare ability to think outside the box, seemingly limitless stamina, and, not least of all, great personal charm. Diagnosed with amyotrophic lateral sclerosis, a debilitating and often deadly degenerative disease, he has resolved to wrestle with destiny. Although stepping down as dean when a successor is identified, he will retain his academic titles and continue to be active in causes dear to him as long as his health permits.
Secret Weapon: The Rosenfield Smile
The Rosenfield smile, a joyous affirmation of life that emanates straight from the heart and immediately establishes a common bond of shared humanity, neutralizes all resistance. Nobody can say no to Allan Rosenfield.
Not Clare Stein Rosenfield, his wife of more than 40 years, who, weeks after meeting him, accepted his proposal of
marriage and his proposition to join him on a “working honeymoon” in Lagos, Nigeria, where he had been hired to teach ob/gyn at the University of Lagos Medical School.
|Allan Rosenfield with former President Bill Clinton, left, and Columbia President Lee Bollinger, right
Not Phyllis Mailman, president of the Joseph L. Mailman Foundation, whose family foundation made history with the largest naming gift ever at that time for a school of public health, resulting in the Mailman School of Public Health. “The man is a skilled sorcerer,” she declared at the June forum. “He managed almost single-handedly to bedazzle and bum-foozle three reasonably intelligent human beings my daughter, Jodi, my son, Josh, and me, who, incidentally had absolutely no connection to Columbia or to public health. He then proceeded to separate us from a significant chunk of our foundation resources. Allan does not practice slight-of-hand; he practices slight-of-mind, and we are eternally grateful that he is such a master at it.”
A longtime colleague and friend, Dr. Georgiana Jagiello, the V.G. Damon Professor Emeritus of Ob/Gyn at P&S, vividly recalls their first encounter in the office of the late Dr. Raymond Vandewiele, then chairman of ob/gyn. Both she and Dr. Rosenfield had been recruited to collaborate in a new departmental venture, the International Institute for the Study of Human Reproduction, she to run the basic science component, the Center for Reproductive Sciences, and he to direct its public outreach arm, which he named the Center for Population and Family Health. “We were talking one afternoon, Raymond and I,” Dr. Jagiello remembers, “and the door bursts open and in comes this dynamo of a man in dirty loafers, with a slightly harried look, having just flown in from Thailand. He shook hands and said, ‘May I use the phone?’” Dr. Jagiello imitates his frenzied dialing. “‘Hello,’ he says. ‘Is Danny Kaye there?’ Pause. ‘Hey, Danny, what about that money you said you’d donate to my center?’ After a while he hung up and smiled, ‘I got it!’ That was my first encounter with Allan Rosenfield.”
A Boston Obstetrician’s Son Takes His M.D on the Road
Born in the Boston suburb of Brookline and educated at Harvard College, Allan Rosenfield entered P&S intending to follow in the footsteps of his father, Dr. Harold Rosenfield, a respected Boston obstetrician/gynecologist, and eventually inherit his father’s practice.
After two years of residency training in surgery and before entering his ob/gyn residency, young Dr. Rosenfield was drafted and served for one year at a U.S. Air Force hospital in Osan, Korea, several years after the end of the Korean war. Volunteering after hours
at a local civilian hospital, he got his first taste of medicine in the developing world. While the medical resources were sparse, the doctors few, and the conditions grim, he was impressed by what could be done and gripped by a desire to pitch in.
|“In addition to his passion,”
Bill Clinton said of Allan Rosenfield,
“he has something I find quite
useful in the nongovernmental world.
He actually knows how to get things
He returned to the States to complete his ob/gyn residency at the Boston Hospital for Women, a Harvard affiliate, then decided to postpone his practice when he accepted the University of Lagos Medical School offer. Accustomed to the care available in major medical centers in urban America, he was struck in Nigeria by the limited access, particularly in rural areas, to health care generally and specifically to maternity care and family planning services and the staggering number of deaths of women in childbirth that resulted.
To his father’s initial surprise, Dr. Rosenfield took another “temporary” position to work with the Population Council in Thailand as an adviser to the Thai Ministry of Public Health. A one-year position turned into a six-year commitment. Dr. Rosenfield helped the ministry develop a national family planning program. Assessing the scarcity of physicians outside the cities and the under-utilization of auxiliary midwives, he recommended that the ministry undertake a study to train auxiliary midwives, using a simple checklist, to prescribe oral contraceptives. The study was successful and more than 3,000 auxiliary midwives were approved to provide oral contraceptives. This dramatically changed the National Family Planning Program in Thailand and, later, family planning programs in many other countries.
The Thai experience also had a profound personal effect. Realizing that he could have a greater impact on the health of individuals by addressing the health needs of populations, his perspective shifted from his plans to establish a private ob/gyn practice in Boston to a broader public health focus on health care, particularly the reproductive health needs of women both in the United States and globally.
Public Health Back Home on the Heights
“Where is the M in MCH?”
In 1975 he returned to Columbia to accept a joint appointment as professor of ob/gyn and professor of public health and to found the Center for Population and Family Health within the School of Public Health. Considering the health problems in the medical center’s own backyard, particularly in the largely low-income Dominican immigrant population in Washington Heights, he decided that “teenage issues were of key importance.”
In 1976 he and a new recruit, Judith Jones, established the Young Adult Clinic, the neighborhood’s first after-hours family planning and reproductive health clinic for adolescent girls. Another clinic for teenage boys and innovative school-based clinics in middle schools and high schools followed. These programs still thrive today and have served as local and national models. Dr. Rosenfield helped revitalize the health of the neighborhood, raising funds to build an ambulatory care facility for both adult and adolescent family planning and reproductive health care to help make the program more responsive to community needs.
In 1985, when Columbia’s School of Public Health sought a new dean, Dr. Rosenfield topped the list of candidates. He took office the following year and, building on the efforts of his two immediate predecessors, Robert J. Weiss’51 and Jack Bryant’53, he proceeded over the course of two decades to revolutionize the school’s administrative structure and institutional mission.
Another eminent Columbian, William Henry Welch, an 1875 P&S graduate and the acknowledged father of academic public health in this country, had taken his talents to Johns Hopkins in Baltimore, where he served as dean of the medical faculty and the first director of the School of Hygiene and Public Health, an independently governed body within Johns Hopkins University.
Holding up the successful Hopkins model as an example, Dr. Rosenfield convinced the trustees of Columbia University to confer independent faculty status on the School of Public Health, then a part of P&S. Many academic initiatives were launched under his watch, with a particular focus on strengthening the school’s six departments, recruiting dynamic new faculty members, and creating many new programs, such as the executive master of public health in health services management.
For Dr. Rosenfield, innovative administration and independent thinking have always gone hand in hand. In 1985, he and a colleague, epidemiologist Dr. Deborah Maine, challenged the public health establishment with a seminal paper they co-
authored and published in The Lancet, “Where is the M in MCH (Maternal and Child Health)?”
|Galvanizing global attention and using private foundation support, Dr. Rosenfield and colleagues launched the MTCT-Plus Initiative to extend AIDS treatment to mothers, their children, and families.
“Although in recent years much attention has been given to ‘maternal and child health’ (MCH),” wrote Drs. Rosenfield and Maine, “scrutiny of MCH programmes shows that most of them will do little to reduce maternal mortality. ... The world’s obstetricians are particularly neglectful of their duty in this regard.”
Subsequent meetings with The World Bank were followed by the first meeting on maternal mortality, held in Nairobi, Kenya, where the Safe Motherhood Initiative was born. Ever sensitive to social inequities, he argued for a focus on women in general, not just mothers, “because not all women necessarily want to be mothers. They are often at the mercy of a lot of sexually active men .”
Meanwhile, back at Columbia, with seed support from Carnegie Corporation of New York, Drs. Rosenfield and Maine established the Prevention of Maternal Mortality Program, an international interdisciplinary effort to promote greater access by women to emergency obstetric care. And when Carnegie funds ran out, Dr. Rosenfield, never hesitant to promote a worthy cause, brought maternal health to the attention of the then fledgling Bill & Melinda Gates Foundation, which approved a $50 million grant in 1999, at the time the largest grant in Columbia University history, to create and support the Averting Maternal Death and Disability Program. The program has brought emergency obstetric care to women in more than 50 countries in sub-Saharan Africa, Asia, and Latin America.
“Where is the M in pMTCT (Prevention of Mother-to-Child Transmission)?”
The devastating scourge of AIDS made women once again forgotten victims in the medical shuffle. In a landmark presentation, “Where is the M in pMTCT (Prevention of Mother-to-Child Transmission)?” delivered at the XIII International Conference on AIDS, in Durban, South Africa, in 2000 and later published in the American Journal of Public Health with Emily Figdor, a graduate student, as co-author, Dr. Rosenfield pointed out the flaw in treatment regimens geared to prevent mother-to-child transmission in the unborn child: The regimens administered through the mother used her as a conduit but then left her to die, in large part because pMTCT programs first developed in the late 1990s included no funds for antiretroviral therapy in poor countries.
|Allan Rosenfield on a trip to India
Galvanizing global attention and using private foundation support, Dr. Rosenfield and colleagues launched the MTCT-Plus Initiative to extend AIDS treatment to mothers, their children, and families. Then United Nations Secretary- General Kofi Annan summed up its effectiveness: “Among all the initiatives that have been taken in the struggle against HIV/AIDS, none has done more than MTCT-Plus to focus attention on the situation faced by women in the pandemic.” Thanks later to a $125 million grant from the President’s Emergency Plan for AIDS Relief, the largest federal grant ever awarded to Columbia, Dr. Rosenfield oversaw the creation of the International Center for AIDS Care and Treatment Programs, under the direction of Dr. Wafaa El-Sadr, an infectious disease and HIV/AIDS expert. More than 100,000 individuals in sub-Saharan Africa have benefited from treatment.
A School (and a Building) Named
The figures speak for themselves in the Mailman School’s astounding administrative success story under Dr. Rosenfield’s watch. He expanded the school’s budget from $12 million in 1985 to the current level of $161 million and bolstered its endowment from $2 million to $86 million. Sponsored research has grown to $136 million, student applications have more than doubled, and enrollment has grown to more than 900 during his tenure. Dean Rosenfield made Columbia the hot place to study public health.
Success proved infectious.
One day in casual conversation with the lawyer of a small family foundation looking to support a health-related program in New York City, Dr. Rosenfield said, “You know, if you really want to name something in honor of the late Joseph Mailman, why don’t you think about naming the school?” And $33 million later, the Mailman School of Public Health was named in memory of philanthropist Joseph L. Mailman. His widow, Phyllis Mailman, called the move “the inspiration of a lifetime.”
“The combination of the Mailman gift and the Gates grant gave us a lot of visibility we didn’t have before,” Dr. Rosenfield says. “More philanthropists are beginning to understand the important role of public health in society.”
With its facilities, faculty, and staff scattered in various buildings on the medical center campus, Dr. Rosenfield pushed to realize his long-held dream of bringing as much of the school as possible under a single roof. When construction of the new building for the New York State Psychiatric Institute was completed, the dean found a home for his school in PI’s old digs, the 19-story Beaux Arts building at the west end of 168th Street.
In June 2006, Columbia University’s trustees voted to name the building to honor Allan Rosenfield. A Tribute Fund established in his honor will pay for further building renovations.
There are few national and international public health organizations in which Dr. Rosenfield has not played a pivotal role. He is former chair of the Association of Schools of Public Health, the Executive Board of the American Public Health Association, the Scientific and Technical Advisory Committee of WHO’s Human Reproductive Programme, the boards of Planned Parenthood Federation of America, EngenderHealth, the Guttmacher Institute, the New York State Department of Health AIDS Advisory Council, and amfAR’s program board. He also is on the boards of many other nonprofit organizations, including the David and Lucile Packard Foundation and the Henry J. Kaiser Family Foundation.
He has received awards from the Government of Thailand, the International Federation of Obstetricians and Gynecologists, the American College of Obstetricians and Gynecologists, the Jacobs Institute of Women’s Health, and the American Public Health Association. He also received a Special Recognition Award from the P&S Alumni Association. More recently he was honored with the New York Academy of Medicine’s Stephen Smith Award for Lifetime Achievement in Public Health, the Doctors of the World (USA) Health and Human Rights Leadership Award, and Planned Parenthood Federation of America’s Margaret Sanger Award. The list goes on and on.
In a televised interview in July 2006 with Charlie Rose on PBS, Dr. Rosenfield came pretty close to summing up his public health credo: “If you empower women so that they’re equal,” he said, “it changes society, it changes their role, it changes the future.” Thanks to Allan Rosenfield, that future looks brighter for women and the global family.