When epidemics converge

Don Operario, the new chair of the Department of Behavioral, Social, and Health Education Sciences, studies how “syndemics” affect vulnerable populations.

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As a young man in California, Don Operario watched the tumult of the HIV/AIDS epidemic playing out in his back yard. As a postdoctoral student, he learned how community-based research could address this and other critical health issues, especially for populations on the front lines of risk. He brings that understanding—and two decades of research across disciplines, continents, and intertwined epidemics—to his new role at Rollins.

Ten years ago, while attending a public health conference in Atlanta, Don Operario took a break from meetings. Wandering through neighborhoods always has been one of his favorite pastimes, and the Emory campus was inviting. When he reached Rollins he suddenly had an epiphany. I’m quite happy at Brown’s School of Public Health, he thought, but if ever I decided to leave, this is where I would come.

In July 2022 he did just that, becoming Grace Crum Rollins Distinguished Professor and Chair of the Department of Behavioral, Social, and Health Education Sciences (BSHES). Rollins felt made for him, he said: its vision for transdisciplinary collaboration; its dedication to preparing the next generation of health equity champions; its setting in an exciting city filled with public health expertise; and its opportunities to engage with a broad and diverse community. He had been moving in this direction his entire adult life.

Serving overlooked populations

Operario was born in Los Angeles. His parents were recent arrivals from the Philippines, and like many in the immigrant first generation to go to college, he was encouraged to become a physician. After three years of pre-med, a mentor pointed out that the young man’s interests seemed to lie more in the social aspects of health. That certainly rang true. At the time, in the 1980s, the global HIV/AIDS epidemic was raging. Living in its epicenter, Operario considered it personal. He knew people who were dying, knew activists demanding solutions. How could he help? “Public health wasn’t the household word it is today,” recalls Operario, “but changing my focus to social psychology set me on that path.”

He completed a bachelor’s degree in psychology at UCLA, then a master’s and PhD in social psychology at the University of Massachusetts, where he and fellow graduate students primarily conducted classic social psychology research projects with undergraduates eager for extra credit. He learned how to do research, certainly, but only when he returned home for a postdoctoral fellowship in behavioral medicine at UCSF did he find his answer about how he could best help with the health and social problems he saw around him. From then on, he would use behavioral and community-based research to address critical community health problems, engaging marginalized, often overlooked populations.

After completing his studies, Operario worked as a research specialist at the UCSF Center for AIDS Prevention Studies; a lecturer on evidence-based social intervention at the University of Oxford; and—beginning in 2008—at Brown University, at first in the medical school’s department of community health. The Brown School of Public Health’s history resembles that of Rollins. Brown University began developing public health programs in 2002, offering an MPH, then created more academic lines with the goal of becoming an accredited school. It was successful. In 2013, Operario moved from the medical school to become a professor of behavioral and social sciences in the newly launched public health school.

As the school grew, Operario took on various administrative roles, including a stint as associate dean for academic affairs. In this role, he helped the school achieve full accreditation status, expanded the portfolio of graduate degree programs, and initiated a diversity and inclusion strategic action plan. At the same time, his research was expanding in both size and scope. Interests in racial and ethnic minorities broadened to include sexual and gender minority populations in the US and abroad.

His former chair, Christopher Kahler, says Operario was instrumental in helping Brown develop a critical mass of research involving these too-often neglected populations and in expanding and serving as a leader in the school’s global health research efforts. Operario also played a key role in conceptualizing a program focused on HIV and alcohol use in Brown’s well-known Center for Alcohol and Addiction Studies.

Studying syndemics

Today, Operario describes himself as “a community-oriented behavioral social scientist who engages in analysis and interventions related to the experience of syndemics.” It’s not as complicated as it sounds, he says.

Syndemics is the idea that epidemics don’t operate in silos. Multiple epidemics go on simultaneously, interacting with one another, each increasing the impact of the others. An example of syndemics in his own work is the relationship of the HIV/AIDS epidemic with the rising epidemics of violence and mental health problems such as depression and suicidality. He focuses on how these syndemics create health inequities, disproportionately affecting communities of color and marginalized, often-stigmatized communities, such as sexual and gender minorities.

He uses multiple approaches to understand why such public health syndemics exist in the first place. Then, he develops and tests interventions to reduce or mitigate the prevalence of these syndemics and their impact on communities. For example, in a recent article on behavioral and social interventions to promote optimal HIV prevention and care, he calls on researchers to expand their focus from individuals to include the structural, environmental, and economic vulnerabilities that shape HIV inequities and to recognize interventions based within community-based organizations and local health care settings.

With research well-funded by the NIH and other sources, Operario has published more than 250 articles. He serves as editor or a member of the editorial board of half a dozen prestigious academic journals. He received the Dean’s Award for Excellence in Teaching in the Brown School of Public Health and the University of Oxford’s Excellence in Teaching Award.

In addition to working with colleagues and communities in the US, Operario has developed long, productive international collaborations, which he brings with him to Atlanta. Pre-COVID, he was on an airplane every month (even though he hates to fly). Those trips are starting up again.

Wherever his research takes him, he works in conjunction with community-based groups, including members of the populations who are living with or affected by troubling public health conditions. He tries to “recognize their experiences, allow their voices to be heard, reinforce their expertise, and champion their rights.”

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Power of collaboration

Operario believes public health is at an important crossroads—and a time of reckoning. He says COVID-19 opened a window to show the world how pronounced health inequities really are. It also highlighted the strong interconnections between various health issues—infectious disease, mental health, violence, and substance abuse—and social determinants of health—housing, employment, education, and access to health care.

As he moved through his career, he has learned that public health research is an enormously collaborative process. Everything that matters must be done across departments, schools, disciplines, methodologies, and communities. And that takes time, resources, a willingness to speak across jargons, the necessity to understand what sociologists are doing in one part of the university and what statisticians are doing in another part, and what virologists are doing in their laboratories. “We all need to speak together to address public health problems most powerfully.”

Such commitment to and practice of collaboration is a large part of what drew him to Rollins and Emory—and is also part of what makes him so excited about the possibilities going forward.

Taking the reins

Before coming to Rollins, Operario was well aware of the school’s deep expertise in many public health domains relevant to the world today, including substance abuse, different types of violence, sexual and reproductive health, HIV, obesity, and general wellness. That awareness only intensified during his first weeks as chair, as he met one-on-one with faculty and administrators in the department and across Rollins. In these meetings he found “high motivation, even hunger” to work together.

And therein lies his first priority as chair. He wants to build more bridges across these health domains, finding more ways for faculty to work synergistically to address critical problems and their interactions, especially concentrated in marginalized communities. “That’s something that Emory can do really well,” he says.

He also looks forward to working closely with students in the department’s master’s and doctoral programs, to learning from and with these students, and to drawing inspiration from their scholarship. “BSHES students have expressed deep commitment to equity, anti-racism, and justice as guiding principles of our science and praxis,” says Operario. “I hope we can further strengthen these themes throughout our educational portfolio.”

Operario sees another opportunity in what George Miller, former president of the American Psychology Association, once referred to as “giving psychology away.” Operario wants to do exactly that with the BSHES department: “to give away, to strategically translate and disseminate, the department’s many areas of expertise and abilities to the people, places, and organizations who could benefit from our knowledge.”

Kahler, Operario’s former chair and research colleague, says Rollins is fortunate to have him here—on so many counts. “At Brown, Don gracefully and effectively juggled an immense research portfolio and numerous administrative roles. But he also remained humble and approachable, a person of great wisdom and compassion, someone people trusted to go to discuss challenging issues.”

Jennifer Nazareno could not agree more. After completing her doctorate at UCSF—another first-generation success story—she began a postdoctoral fellowship at Brown where Operario was “the best mentor I ever had. He was selfless with his time and with sharing his work. He created opportunities, opened doors, and made me see and believe in what was possible.”

As Operario moved into his new post at Rollins, Cam Escoffery was able to transition out of her role as interim chair, which she had held since January 2022 following Colleen McBride. As chair for eight years, McBride had increased the department’s size, scope, and reputation—and changed its name to better reflect its many areas of expertise. Both Escoffery and McBride have returned to their positions as professors in the department.

“Don Operario is a leader in areas that will continue to advance the BSHES department’s mission to better the health of all people and prepare tomorrow’s leaders to change behavior and social conditions that influence health,” says Daniele Fallin, James W. Curran Dean of Public Health. “His experience, his domestic and international collaborations, and his commitment to give voice to all communities, especially those which are sometimes underrepresented, bring additional perspectives and increased energy to this dynamic, growing department.”

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