'Going Upstream to the Problem'
By blending epidemiology and engineering, Tufts' David Gute is working to solve public health problems at home and around the world.
David Gute has long seen improving people's quality of life as one of his primary goals. But it wasn't until 1973, when he enrolled in an epidemiology course after being fascinated by his wife's graduate school coursework in public health, that Gute discovered how he would do it.
"'My God!'" Gute recalled realizing."' You can actually prevent illness as a result of mastering chemistry and mathematics and biology!'"
From that point on, Gute—an associate professor of civil and environmental engineering, who also holds joint appointments at Tufts School of Medicine and the Friedman School of Nutrition Science and Policy—set up shop at the intersection of engineering and public health, devoting himself to preventing illness and exploring and promoting public health in open-minded but practical ways.
As an epidemiologist for the state of Rhode Island in the early 1980s, he was involved in one of the first attempts to use death records in a surveillance capacity to look at occupational illness.
"We uncovered a raised rate of stomach cancer among female jewelry workers in Rhode Island," recalls Gute, citing their heavy reliance on potentially toxic solvents, paints and enamels in producing costume jewelry. "[The jewelry] would be made in very small enterprises, around tabletops, sometimes literally in the kitchen," Gute adds. "So kids could be exposed, the women themselves could be exposed."
The project—like much of Gute's work—would go on to have national as well as local impact. "The data results were compelling enough for the National Institute for Occupational Safety and Health [NIOSH] to institute a whole program of training funeral directors in how to conduct an interview about the death certificate, and also reaching out to the attending physicians," he says.
From that experience, Gute learned that when you connect research to improving the way things work, it can yield better information. "[It] also taught me that if you have a finding at the local level that can then be put into a larger system, you're going to have even more impact," he explains.
Gute's latest project brings him full-circle from his Rhode Island experience. The School of Engineering recently received a four-year grant of $899,644 from NIOSH to study occupational health risks among immigrant workers in Somerville. Gute, as principal investigator, will work with Tufts colleagues at the School of Engineering and Friedman School of Nutrition Science and Policy, community organizations and state agencies to address the health concerns facing this vulnerable population.
"The ability to do multidisciplinary work that's engaged in solving real problems is something that's been a great gift to me," he says, calling the breadth of impact made possible through public health the "true beauty" of the field.
"Suppose you're a cardiologist," he posits. "You're fixing one heart at a time; you're doing retail,” In contrast, Gute explains that “public health is wholesale. An epidemiologist is focused on the population from which the individuals come. We're going upstream to the problem."
Tufts students Greg Bonci and Amy Lynch working in Kwabeng.
Sometimes literally. While directing the Massachusetts Center for Health Promotion and Environmental Disease Prevention in the mid-1980s, he oversaw the state's public health activities in Woburn when a cluster of childhood leukemia cases emerged around the city's Aberjona River. The events were chronicled in both a book and movie of the same name, A Civil Action.
Water's connection to public health continues to shape Gute's work at Tufts, where he has taught since 1988. He had a key role in the development of the interdisciplinary Water: Systems, Science and Society graduate certificate program, which launched in 2004.
In January, he and a group including two WSSS colleagues (Associate Professor of Civil and Environmental Engineering John Durant and Associate Professor of Public Health and Family Medicine Jeffrey Griffiths), seven undergraduates and three graduate students brought their engineering expertise to Kwabeng, Ghana, in the battle against schistosomiasis, a parasitic disease that affects a third of Kwabeng's youth.
Gute's multifaceted and multidisciplinary role at Tufts—he developed the first environmental health course in the Tufts School of Medicine's MPH/MD program, and for the past several years, he has served as the academic director of the Tufts in Talloires program—reflects his belief that engineering and public health must be more closely integrated.
"Tufts' School of Engineering is one of the few places nationally where you have a public health focus within the engineering school," says Gute, citing Professor Emeritus N. Bruce Hanes and Professor Linfield Brown as early and key supporters of "health as a content area within the Department of Civil and Environmental Engineering."
"Engineers design products, road systems, buildings—things that have all sorts of potential to protect people, but, if ill-designed, to harm people," adds Gute, a member of the committee that developed Tufts' Masters in Public Health program. "So the wonderful thing about teaching undergraduate engineers as an epidemiologist is that you're teaching them about the importance of primary prevention."
Another advantage of looking at engineering from an epidemiological standpoint? One of the biggest stumbling blocks in environmental epidemiology is retrospective exposure assessment (that is, quantitatively determining when and for how long an individual was exposed to a specific environmental factor).
"Engineers have a great facility and interest in measuring things [like this]," says Gute.
It's Gute's goal to make use of the engineering know-how behind such techniques to more comprehensively understand the complexities of the relationship between water and health. "My vision is to do a longitudinal study of water and health that would set the mark for such studies," he says. "I think we're building a critical mass at Tufts such that we could really shine a light on understanding the role of water in general in health," he says.
It's just one more step toward Gute's goal of achieving "closer coordination between public health and engineering on the policy level."
"I think that is starting to happen," he says. "I think people are starting to recognize the wisdom of that, and I would like to be able to contribute to it."
Profile written by Patrice Taddonio, Class of 2006
Patrice Taddonio, a native of Holland, Pennsylvania, is an English major and a communications and media studies minor. Currently editor-in-chief of the Tufts Daily, she interned with the Improper Bostonian magazine during her sophomore year and worked as a temporary text editor with the Associated Press at the July 2004 Democratic National Convention. A songwriter, Taddonio has also performed on guitar and vocals at on-campus venues and at Boston-area benefits.
Additional reporting by Georgiana Cohen
Photo of Gute by Melody Ko, University Photographer. Ghana photos courtesy of the Kwabeng Project.
This story originally ran on Mar. 27, 2006.