Howard H. Hiatt, a physician, scientist and academic who reshaped the field of public health, moving it away from the narrow study of infectious diseases toward larger questions of fiscal and social responsibility in medicine, died Saturday at his home in Cambridge. , Mass. He was 98 years old.
His son Jonathan Hiatt said the cause was pulmonary hypertension.
Harvard Public Health, a journal published by the Harvard School of Public Health, where Dr. Hiatt was dean for 12 years, writing in 2013 that Dr Hiatt “made public health the conscience of medicine”.
Early in his seven-decade career, Dr. Hiatt worked in Paris with future Nobel Prize winners on the discovery of messenger RNA, a key element of cell biology. He later visited the White House to urge President Ronald Reagan to end the nuclear weapons buildup of the era, which Dr. Hiatt called “the final epidemic.”
A Harvard-educated physician who has held leadership positions at some of the nation’s most prestigious hospitals, Dr. Hiatt has been an outspoken critic of inequities in American health care. He accused American medicine of being biased toward expensive, high-tech treatments while excluding millions of people from basic care.
In a 1987 book, America’s Health in the Balance: Choice or Opportunity?, he argued for universal government-run health insurance, modeled on aspects of the systems in Britain, Canada and China. “I’m especially eager to reach out to those who are hard-hearted enough to accept the prospect of two-class medicine in America,” he told The Toronto Star.
At the Harvard School of Public Health (now the Harvard TH Chan School of Public Health), where Dr. Hiatt was dean from 1972 to 1984, he brought together experts in various disciplines, including biostatistics and health management, to focus on the economic, political and social causes of ill health, not just biological factors.
“He transformed education at the Harvard School of Public Health and the very definition of what the field of public health means,” Dr. Harvey V. Fineberg, colleague of Dr. Hiatt, who in 2002 became president of the Institute of Medicine (now the National Academy of Medicine), said in an interview.
Looking beyond US shores, Dr. Hiatt later founded the Department of Global Health Equity at Brigham and Women’s Hospital in Boston, an unusual commitment by a teaching hospital to expand its resources to care for the sick and poor abroad.
The program was a starting point for Partners in Health, a recognized nonprofit organization providing health care to impoverished communities in Haiti, Africa and elsewhere, founded in 1987. The organization’s founders included two Harvard medical students, Dr. Paul Farmer and Jim Yong Kim, who considered Dr. Hiatt a father figure.
“He took it upon himself to mentor literally hundreds of young people who came through Harvard Medical School and Brigham and Women’s Hospital who wanted to make a difference in the world,” Dr. Kim said in an interview.
When Dr. Kim and Dr. Farmers discovered a drug-resistant tuberculosis outbreak in Peru in 1995, running up a $100,000 bill to Brigham Hospital’s pharmacy for specialty drugs. Soon the hospital president was on the phone with Dr. Hiatt complaining about the debt. Dr. Hiatt found a donor to cover the costs and later helped Partners in Health secure a $45 million grant from the Gates Foundation.
Dr. Farmer, the subject of a 2003 book by Tracy Kinder, Mountains Beyond Mountains: The Search for Dr. Paul Farmer, a man who would heal the world,” died in 2022. Dr. Kim became president of Dartmouth College and the World Bank.
When Dr. Kim learned in 2011 that Dr. Hiatt had not actually graduated from Harvard College—he had skipped medical school—he wrote a “diploma” on a napkin from the Hanover Inn awarding Dr. Hiatt degree Dartmouth BA Dr. Hiatt framed it and hung it in his home.
Howard Haym Hiatt was born on July 22, 1925, in Patchogue, New York, on Long Island, to Alexander and Dorothy (Askinas) Hiatt. His father had immigrated alone from Lithuania at 15. The family, with its name changed from Chaitowicz to Hiatt, moved to Worcester, Massachusetts, where Alexander Hiatt ran a small shoe company.
Howard was his high school teacher, but he was initially denied admission to Harvard. There was, he recalled later in life, a quota on the number of Jews who could be admitted at the time. After his high school principal protested to the dean of admissions, he was allowed to enroll in 1944. He entered Harvard Medical School two years later.
While there, he met Doris Bieringer, a student at Wellesley College. the couple married in 1948, the year Dr. Hiatt received his Ph.D. Mrs Hiatt studied librarianship and was the founder of a book review magazine for school libraries. He died in 2007.
In the mid-1950s, Dr. Hiatt was a researcher at the National Institutes of Health. This work led to a one-year laboratory position in 1960 at the Institut Pasteur in Paris, then the center of the exciting new field of molecular biology.
In Paris, he worked under Jacques Monod and François Jacob, the future Nobel Prize winners who first named and described messenger RNA, a molecule that carries genetic codes for protein production. Messenger RNA was the foundation of the first Covid-19 vaccines approved for use in the US 60 years later.
Back in Boston, Dr. Hiatt in 1963 became professor of medicine at Harvard Medical School and chief physician at Beth Israel Deaconess Medical Center. His research focused on the application of molecular biology to medical problems, particularly cancer. He was one of the first to demonstrate messenger RNA in mammalian cells.
As he raised research and clinical standards at the hospital, he became a magnet for medical school graduates seeking licensure. Medical schools tried to recruit Dr. Hiatt to be their dean. He turned down Columbia and Yale before accepting the headship of the Harvard School of Public Health.
“Historically, the faculty has been very strong in tropical medicine, sanitary engineering, and other specialties that in recent years have seemed to have little relevance to the public health issues facing this country,” wrote The Boston Globe when Dr. Hiatt 1972.
But the rapid changes he introduced made him an enemy, and in 1978 a group of tenured teachers signed a petition calling for his dismissal, complaining of his “administrative incompetence”.
Derek Bock, president of Harvard, who had recruited Dr. Hiatt, rejected the effort to remove him.
In December 1981, Dr. Hiatt joined a delegation sent by Pope John Paul II to explain to President Reagan the medical consequences of a nuclear exchange. “The president was not very comfortable with our visit,” recalled Dr. Hiatt in 2006 for Web of Stories, an archive of oral histories by scientists and others.
In addition to his son Jonathan, a labor attorney, Dr. Hiatt is survived by a daughter, Deborah Hiatt, an artist. a brother, Arnold Hiatt; eight grandchildren; four great-grandchildren; and his longtime partner, Penny Janeway. His son Fred Hiatt, the longtime Washington Post editorial page editor, died in 2021.
In 2004, Dr. Hiatt and his wife established a residency at Brigham and Women’s Hospital that trains physicians in internal medicine and global public health. Many of the 70 or so doctors who have since gone through the program have gone on to work in Haiti, Lesotho and other poor countries where Partners in Health operates.
Dr. Hiatt visited many of the international clinics, which provided him with inspiration and purpose in his later years, Jonathan Hiatt said.
“That basically added 15 years to my father’s career,” he added.
