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The Mailman School of Public Health is today one of the most important components of the Columbia University Medical Center. Its faculty is world-renowned, its graduates highly sought after, and it receives major private and government grants and awards. But the public health school did not always enjoy such a lofty position.

Created in 1922 with a $3 million gift from the estate of Joseph DeLamar, a Dutch-born sea captain, the Joseph DeLamar Institute of Public Health began its existence as just another institute within the College of Physicians and Surgeons – and it was not considered one of the university's more valuable units.

"The school was founded in an atmosphere when there was little understanding of the significance of the study of public health," says Dr. Allan Rosenfield, the DeLamar Professor of Public Health, professor of obstetrics and gynecology and current dean of the Mailman School. "The university pretty much ignored the public health school for the first 50 years of its existence."

A historian who has studied the Mailman School extensively, Annette Ramirez de Arellano, says that in the early 20th century, public health was not recognized as a medical specialty in its own right, but rather a sub-discipline of medicine. "A lot of the people involved in public health were not faculty in the medical school," she says. "They were in the social sciences and engineering divisions, and many were at the downtown campus. As a result, their ideas were often not taken seriously uptown."

Dr. Haven Emerson, the first director of the institute, who was an 1899 P&S graduate, spent 17 years trying to build up the new program. Under his leadership, the institute moved in 1928 to the then-new Columbia-Presbyterian Medical Center campus. In 1939, the institute joined forces with the New York City Department of Health in a small shared facility on 168th Street and Broadway.

Dr. Emerson often met resistance from the university about implementing some of his ideas. "Dr. Emerson received a lot of kudos for his work elsewhere, but at Columbia, it was nothing but grief," says Ms. Ramirez de Arellano. "While his legacy to the school was extraordinary, by the time he stepped down in 1939 he was frustrated with the experience. It was a bad marriage that lasted too long."

Many of his attempts to expand the faculty and to increase its programs and activities were unsuccessful. His successor, Dr. Harry Mustard, who took the top position in 1940, brought about a change in name, with the institute evolving into a school in 1945 – an important step up the academic ladder. Thus, a new entity, the Columbia School of Public Health, was created. With the Columbia name now prominent, some increase in autonomy and respect in academia soon followed.

While this transformation was an important step forward, it was really only a half-step, because the school remained a department within P&S, and thus its access to its own funding remained limited. Two decades after the public health school's founding, the university continued to favor academic medicine and had yet to place great value on the discipline of public health.

That recognition finally came with the appointment of Dr. Ray Trussell, the school's director from 1955 to 1968. Dr. Trussell partnered with Dr. Jack Elinson, professor emeritus of sociomedical science and founder of the Department of Sociomedical Sciences at the Mailman School, on a seminal 1957 study of chronic health problems in rural America that would become one of the most important public health studies of the era. This study, which combined medicine and sociology, laid the foundation for the way modern public health research would be conducted – a mixture of social science methodology backed by hard medical evidence. After Drs. Trussell and Elinson released their findings, the National Health Service, which had been planning its own field study, insisted that physical examinations be a part of its project, as they had been in the innovative Elinson/Trussell work.

"It was very exciting to work with Dr. Trussell," Dr. Elinson says today. "He saw that social science could contribute to the understanding of public health problems."

In 1972 under the leadership of Dr. John Bryant, the school achieved formal status as a separate school of public health, and in 1983, during the tenure of Dr. Robert Weiss, its budget was separated from the Faculty of Medicine. For the first time in its history, the school of public health achieved financial autonomy.

This move set the stage for the most recent phase of the school's development. "Over the past 15 years, the school has grown dramatically. In fact, it has become one of the largest sources of federal and private grant income at Columbia, second only to P&S," Dr. Rosenfield says.

With the $33 million gift from the Mailman family to the school in 1998 – the largest single capital and endowment gift that had ever been given to any school of public health until that time – the school was renamed the Mailman School of Public Health. In 1999, the school received a $50 million, five-year grant from the Bill & Melinda Gates Foundation, the largest single foundation grant in Columbia's history. In addition, the increase in support from the NIH, the CDC, and a number of private foundations has been dramatic.

While those financial resources have been crucial to the school's growth and expansion, just as valuable was the decision made in 2000 to turn the school into a separate faculty – the faculty of public health, one of the faculties that now compose the Columbia University Medical Center. Now in the process of completing a move into its own campus building in the former New York State Psychiatric Institute, research is under way on a wide variety of projects both in the United States and internationally. They range from studying infectious diseases such as SARS to finding ways to decrease maternal deaths to investigating some of the world's most pressing environmental health challenges. Mailman is also leading a pioneering AIDS care and treatment program focused on women and their families in resource poor settings in Africa, Asia, and Latin America. With all of these ongoing projects, The Mailman School of Public Health is at the epicenter of cutting-edge public health activity.

"We've come a long way from the days when we were squeezed into tight quarters and had to fight for recognition both inside the university and in the rest of academia," says Dr. Rosenfield. "The contributions our institution makes to furthering the understanding of public health is now a given. Our mission now is to become a truly global school that seeks to understand and have an impact on many of the health care issues facing the world today and, at the same time, to increase the collaborative efforts of the four schools of CUMC."

—Will Wade