Emory Report
August 29, 2005
Volume 58, Number 1


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August 29, 2005
A long road taken

BY eric rangus

To describe the home of the Task Force for Child Survival and Development as modest is to understate the situation. It’s not that it’s run down; many nonprofits would be perfectly content with a suite on the fourth floor of the Chamber of Commerce building in downtown Decatur.

That the brick building on Commerce Drive is about as nondescript as they come, actually plays into the task force’s advantage, according to its executive director, Mark Rosenberg.

“The task force focuses on putting large-scale, global health programs together and helping implement them,” said Rosenberg, an adjunct professor in the Rollins School of Public Health (RSPH) and the School of Medicine (SOM) (as well as the Morehouse School of Medicine). “So we’re very small, we’re non-bureaucratic, we’re flexible and agile, and we can do things that larger bureaucracies could never get done.”

An Emory affiliate since its founding in 1984, the task force’s mission is to help public and private organizations promote health and human development by building coalitions, forging consensus and leveraging scarce resources.

Its ties to Emory have been strong since the beginning. In addition to Rosenberg, task force staff teach in the RSPH, the SOM and the Nell Hodgson Woodruff School of Nursing; the task force has ties with Goizueta Business School; and task force staff (who number about 95) have mentored students from a variety of schools, served as dissertation advisers and employed students so they could gain real-world work experience. All of this is accomplished without a lot of flash.

“The way you can help people collaborate effectively is by giving credit to those organizations that you bring together and not taking the credit for yourself or trying to feather your own nest,” Rosenberg said.

That low-key approach is how an organiztion can remain relatively anonymous with a Board of Directors that includes former Emory President Jim Laney, former Surgeon General and Morehouse School of Medicine faculty member David Satcher, and Carter Center Executive Director John Hardman, and a partners list that includes national governments on several continents (Peru, Kenya, the United States), international pharmaceutical companies (GlaxoSmithKline and others), global nonprofit organizations (WHO, UNICEF), and multibillion-dollar foundations (Gates, Rockefeller).

Rosenberg came to the task force in 1999 after serving as assistant surgeon general under former President Bill Clinton. He previously had served 20 years with the CDC and was the first permanent director of the National Center for Injury Prevention and Control. The task force’s goals melded perfectly with Rosenberg’s background in infectious disease prevention, global health, child well-being and injury and violence prevention.

The task force’s eight active programs include efforts focused on polio eradication, fighting AIDS around the globe, and drug donations to battle river blindness. Rosenberg is in charge of three efforts: a collaboration in global health, tuberculosis control and global road safety. Perhaps surprisingly, it is that last program that could be the center’s most important.

According to World Health Organization (WHO) statistics, an estimated 1.2 million people—more than 200,000 of them children—are killed every year in road traffic crashes worldwide. About 96 percent of these deaths take place in developing countries. And those deaths are going up. Rosenberg said the trends mirror those from HIV/AIDS in the early 1980s—a pattern that was missed in the developed world, and the planet continues to pay for that error. Part of the reason global road safety has not raised any alarms in the United States is that roads in this country are remarkably safe.

“If you look at the United States, for every 10,000 car crashes, very few people are killed,” Rosenberg said. The numbers are 66 deaths per 10,000 crashes. Statistics are frighteningly different in the developing world, he said. In Kenya, 1,786 deaths occur for every 10,000 crashes. In Vietnam, it’s 3,181 per 10,000—in other words, if you are involved in a car crash in Vietnam, there is a 30 percent chance you will die. If those numbers appeared in the United States, the problem would move up the list quite quickly.

“There are the dots, but no one is connecting them,” Rosenberg said. “People still think of these things as ‘accidents.’ ‘They happen one at a time; they are unpreventable. If you can’t predict it, you can’t prevent it.’ People have this sense of fatalism that this is a cost of development. What the task force is trying to do is change that notion and generate the political will to treat this as the serious problem it is.”

Some very important people are taking notice. In 2004 the task force, led by Rosenberg, made a presentation to the United Nations General Assembly about road safety. Secretary General Kofi Annan’s response appears on the cover of all the task force’s materials related to the project: “We need to do more,” he said.

The traffic problem in the developing world is a perfect storm of bad cars, bad roads and bad drivers. Roads in Cairo look just like those in Atlanta, Rosenberg said, but drivers in the Egyptian capital have no problem driving onto the sidewalk to pass. Pedestrians walk down the middle of the street in the developing world. Until they learn how to protect themselves, they will continue to become statistics.

“There are lots of ways to improve the situation,” Rosenberg said. “Create an agency in charge of road safety that coordinates health, law enforcement, transportation and education; enforce the laws you have; and collect data on what is happening to people.

“There are five other simple steps,” he continued, counting them off on his fingers. “Pay attention to safe roadway design, wear seatbelts, wear helmets, control speed, and control drunk and impaired driving.” The next step is getting governmental buy-in, which is what he is working on now.

Rosenberg augments his medical work in interesting and thought-provoking ways. For instance, he is an avid and gifted photographer. An author of many scientific books and articles, he cites one of his most memorable works as Patients: The Experience of Illness. In the book, Rosenberg uses photographs to tell the story of several medical patients as they go through treatment for a variety of illnesses including cancer and open-heart surgery.

The stark, black-and-white photos are jarring in their rawness. A medically inclined reader might not be phased seeing the torso of middle-aged man sewn up navel to neck following open-heart surgery, but such a photo—common in the book—would give many a lay person pause.

The captions describe the patients’ health, often following them from procedure to procedure and continuing on into their recovery. The stories are all the more poignant because not all of them have a happy ending—not every patient is a survivor.

Rosenberg’s more recent photography work rings the floor of his office. Taken on a trip to South America where he was working with the center’s Partnership Against Resistant Tuberculosis program, the
half-dozen color photos chronicle one family’s struggle against the disease. Some members died from it (their pictures are displayed by a relative in one Rosenberg photo), but others have defeated it—and the smiling children in one photograph are proof.

The first photo in the set is a contrast. It shows two women, one named Patricia, in her mid-20s—she appears at least 10 years older—but a close study of her pensive face (she is not looking at the photographer) shows that she retains some of her youth. The second woman, in the background, is her mother.

Rosenberg’s text, which is printed below the photo, reads:

Patricia was 26 years old and had MDR-TB [multidrug-resistant tuberculosis]. She had been sick with cough and fever for several years. When she finally started on treatment for MDR-TB, she was so wasted that her arms were like sticks, her eyes deeply sunken and her face ghostlike. The original name for TB was phthisis or “consumption” from the Greek word for “wasting.” Her lungs had been so damaged by the TB that she was extremely short of breath, even just sitting absolutely still. She died several months after this picture was taken.

It’s an immediacy that brings Rosenberg’s work home, and—as is clearly his intent—it is not easily forgotten.