In Memoriam

An inspiring leader. A modest man of oversized accomplishments. A visionary with the passion, intellect, and character to move conversation into action. Those are among the encomiums voiced by the colleagues and friends of Harrison Spencer upon his untimely death last August at the age of 71, as they recalled an exceptional life of dedication and a career that stretched from Atlanta to Africa, Geneva to London, San Salvador to New Orleans, and ultimately to Washington, DC.

“Harrison is best described as a problem solver,” said Georges Benjamin, MD, executive director of the American Public Health Association. “Fifteen minutes with him on a curbside was in many ways worth hours of discussion with other people.”

Stellar educational credentials helped shape Spencer’s thinking: undergraduate work at Haverford College; a medical degree from the Johns Hopkins University School of Medicine; a master’s degree in public health from the University of California, Berkeley, School of Public Health; and a diploma in tropical medicine and health from the London School of Hygiene & Tropical Medicine. Two years of training at the Epidemic Intelligence Service of the Centers for Disease Control and Prevention (CDC) reinforced his lifelong commitment to building a healthier planet.

The depth of Spencer’s talent was further honed in leadership positions of increasing responsibility. He held impressive titles at some of the world’s finest institutions, served on numerous committees and boards, and earned membership in many prestigious professional societies.

But ultimately, it was his personal style that gave him so much influence. He knew that to build an organization or transform a field, he had to bring the right people along. “It was never about Harrison. It was always about what he was doing in collaboration with others,” said William Roper, MD, MPH, dean of the School of Medicine and vice chancellor for medical affairs at the University of North Carolina at Chapel Hill. “He was the model of a servant leader, dedicated to making things better but not trying to put himself out in front.”

During many decades, team after team of dedicated professionals came together under Spencer’s guidance to tackle some of public health’s great challenges: reducing the threat of malaria in Kenya and parasitic diseases in the United States, breaking down the wall between practice and academia, and seeking ways to connect public health faculty to educators in other health professions.

In Kenya, where he was a senior physician and malaria coordinator at the Kenya Medical Research Institute, Spencer is remembered as the man who laid the groundwork for advances against malaria. “We would not be where we are today if it were not for the early contacts that Harrison established,” said Kevin DeCock, MD, who now directs CDC’s country mission in Kenya. Spencer built that mission from scratch in the early 1980s, establishing field operations and directing research on malaria immunology, treatment resistance, and community-based control. During subsequent years, that fledgling enterprise blossomed into what is now a 170-person operation with an extensive research portfolio that also emphasizes human immunodeficiency virus (HIV) infection.

From Kenya, it was on to Geneva for a 3-year stint as senior medical officer at the World Health Organization in the mid-1980s and then back to the United States to close out the decade as chief of CDC’s parasitic diseases branch. In 1991, academia beckoned, and he became dean of the Tulane University School of Public Health and Tropical Medicine, one of the nation’s oldest schools of public health and one of very few in the United States specializing in tropical medicine.

Although Spencer had by then authored dozens of articles, he was less interested in doing his own laboratory work than in cultivating the next generation of researchers. “Harrison had a keen interest in the development of people,” said Donald Krogstad, MD, a colleague at the Epidemic Intelligence Service, whom Spencer later recruited to serve as a department chair at Tulane University. “One of the discussions we had was that it would be no tragedy if neither he nor I never wrote another paper on which our name appeared first but that it would be a tragedy if we never developed a paper that had a trainee’s name first.”

Along with cultivating junior faculty at Tulane University, Spencer quickly gained a reputation for diffusing the tensions that sometimes characterize a university setting. When someone brought forward an idea that did not resonate with him, he managed to change the direction of the conversation with such subtlety that he never gave offense. As he listened, Spencer would smile that characteristic smile of his, tilt his head down, look over the top of his glasses, and from time to time toss his pen in the air. Mostly, he managed to catch the pen, although it would occasionally clatter to the floor. Something about his mild response and his look, at once bemused and gentle, removed any possibility of confrontation. “It was a marvelous strategy to watch,” Krogstad said. “The challenge was to support the person but to somehow make it clear that he was not going to be able to say yes.”

Spencer is widely said to have rejuvenated Tulane’s School of Public Health during his 5-year tenure. Always with his eyes on the prize, he brushed aside nuisance details, avoiding the minutiae that can swallow up an administrator’s time, while recruiting top faculty, attracting new financial resources, and building up activities that had direct practice implications.

It was little wonder that the London School of Hygiene & Tropical Medicine soon came calling. In 1996, Spencer became the first dean who did not hail from the United Kingdom. For another 5 years, he built new partnerships, broke down interdisciplinary barriers, and attracted a $40 million award from the Bill & Melinda Gates Foundation to advance the campaign against malaria. He also created a distance-learning training program that has since provided graduate and postgraduate training to more than 8000 health professionals from 130 countries.

The school invited Spencer to renew his contract for 5 more years, but he and his wife, Christine, decided that it was time for the family to head home. Around that time, at a gathering in Madrid with other deans of European schools of public health, he encountered Alfred Sommer, MD, MHS, dean of the Johns Hopkins Bloomberg School of Public Health. Spencer and Sommer, who traced their ties back to CDC, started talking about the Association of Schools of Public Health (ASPH), as it was then known, a small organization of 29 deans. Sommer was serving as president at the time, a position that rotated among the deans. ASPH members were beginning to discuss a wholesale reorganization, recognizing that they would have to bring in new staff leadership with academic public health experience to do it.

Without consulting Spencer, Sommer floated his name to the other deans, to unanimous enthusiasm. A national search committee agreed that no one was more qualified, and in 2000, Spencer accepted the position as president and chief executive officer of ASPH. “That led to an extraordinary transformation within the association,” said Sommer. “Not only was he a well-respected leader, but he had exactly the right personality. He was supportive, not threatening. He was collegial, and he had a wonderful way of disarming people.” Finally, a man who sometimes seemed to be in perpetual motion would stay put, shaping and growing academic public health until his death 16 years later.

One of Spencer’s boldest proposals was to expand the association’s membership to include not only schools of public health accredited by the Council on Education for Public Health (CEPH) but also CEPH-accredited programs. With his deft hand and collegial approach, he steered the proposal through to its adoption by members. Even so, everyone expected some bumps during the expansion, which was completed in 2013. Would the programs be viewed as second-class citizens to the schools? How would the differing resources and unique challenges of programs and schools be addressed? Spencer’s emphasis on inclusiveness helped answer those questions to everyone’s satisfaction.

“He walked the talk on respecting both the schools and programs,” said Allison Foster, MBA, acting president and chief executive officer of what became the Association of Schools and Programs of Public Health (ASPPH). Program representatives were quickly invited onto the board, and the phrase “equal representation, equal dues” became the mantra. At least once per year, leaders at every member school and program would get a personal check-in call from Spencer asking, “How can we do better? What challenges are you facing? What can we do to help you?” Today, 107 schools and programs claim membership in ASPPH, including 3 outside the United States.

Spencer had a knack for sensing the future and a striking willingness to embrace change. “He would see where we were going as a field and an organization long before anyone else did,” said Donna Petersen, ScD, MHS, CPH, dean of the University of South Florida College of Public Health. “Sometimes he would float an idea and it would immediately be shot down. And he’d say, ‘Okay, I was just trying to see what you were thinking.’ And then he’d wait for everyone else to catch up. Inevitably, the idea would surface again, and when it did, he’d say quietly, ‘Well, that is a good idea.’” Getting credit never mattered to him. Advancing the cause of public health always did.

Petersen chaired ASPPH’s Framing the Future Task Force, a 3-year comprehensive review of public health education timed to coincide with the 100-year anniversary of the seminal Welch-Rose report of 1915. As the task force’s work evolved, the need to engage other partners became more apparent, and Spencer advised slowing everything down so that all stakeholders could be heard. The resulting listening sessions helped make it “an open, transparent, and fair process,” to use one of his favorite phrases. Spencer sat on the task force but never pulled rank. “He would give me his fiery, honest, straightforward opinion,” said Petersen. “But if we disagreed, he would always say, ‘You are the chair.’” Task force recommendations ultimately led to new accreditation criteria for schools and programs of public health, and they continue to provide signposts for the way forward.

Interprofessional education—which provides learning opportunities for students from 2 or more professions to enhance collaboration and improve health outcomes—was another area in which Spencer’s brand of leadership changed norms. “People had talked about the need to build interprofessional education and practice literally for decades,” said Darrell Kirch, MD, president and chief executive officer of the Association of American Medical Colleges. Seemingly trivial issues, such as differing accreditation requirements and academic calendars, had always been thrown up as barriers.

When he helped launch the Interprofessional Education Collaborative in 2009—initially with representation from allopathic and osteopathic medicine, dentistry, nursing, pharmacy, and public health—Spencer simply refused to accept those barriers. Instead, said Kirch, “when people needed urging, he gave it. When the situation required creativity, he offered it. And most importantly, when people lapsed into a protective kind of guild-oriented stance, he reminded us of our greater obligation to the health of the public.” By 2016, 9 additional health professional organizations had signed on as collaborative members, all of them committed to pedagogy designed to enhance team-based approaches to health and health care.

Spencer was also an important advocate for undergraduate education in public health, and he actively promoted development of the Certified in Public Health credential, which is now a benchmark for professionals. Some common threads tied all of these efforts together. “He built consensus, he listened and acted based on what he heard, and he took a strong stand when core values were at stake,” said Anthony Mazzaschi, senior director for policy and research at ASPPH.

Spencer’s characteristic approach to a meeting was to sit a few feet back from the conference table, deferring to committee chairs, board members, or senior staff members. He raised his hand if he had something to add, but his was rarely the first one up. “His style was to sit back and watch the conversation and then bring the broader perspective,” said Petersen. “We tend to see the world from our own narrow view, but he saw all of it.”

Soft-spoken but sometimes blunt, Spencer was a fierce champion for ASPPH and believed that all of its members deserved recognition and respect. He was comfortable with ambiguity but never compromised on issues of principle. At ASPPH, he wandered so often into nearby offices to talk something through, and he sent out so many emails, often before dawn, and made so many phone calls asking “What do you think?” that his colleagues there still half-expect those encounters, months after his passing.

Harrison Spencer was a towering figure—and not only because of his 6′ 4′′ height—and his loss is immeasurable. It is not easy to speak of the way in which he died—at the hands of an adored son with severe neuropsychiatric illnesses. But if any good can come from the public heartbreak of a private family and everyone who knew him, it is a reminder of how society fails so many who suffer from chronic mental illness.

“Harrison and I had opportunities to talk about the tragedy of people who suffer from a brain disease in which their ability to seek help and stay with treatment is impaired,” said Kirch. “He had an extraordinary amount of empathy for any patient but especially for what his son was facing. I greatly admired the way he balanced his love and respect for his son with his hope and desire that he could get through his illness to a better place.”

But when treatment is elusive or becomes ineffective, a family’s unbounded compassion, love, and determined efforts are sometimes not enough. Despite Spencer’s lifelong commitment to making the world a better place for those who suffer and a remarkable track record of success, he could not find the tools to solve the most profound problem that he had ever faced—the illness of his son—because there were none that worked for him.

“The 3 things that mattered most to Harrison were his faith in God, the love of his family, and service to others in public health,” said longtime friend James Curran, MD, MPH, dean of the Rollins School of Public Health at Emory University in his memorial eulogy. Anyone who knew Harrison Spencer knew that his eyes lit up when he spoke of his wife and their 2 sons. A renewed societal commitment to direct more attention to chronic mental illness would be a great gift to them and to all those who loved him.