Consuelo Beck-Sague, MD.

"There are multiple opportunities--both long and short term--in public health, laboratory science, and epidemiology at the Centers for Disease Control,"she says. "We are trying to make these programs as diverse as the people who actually have the diseases, which is vital."

Cuban-born Beck-Sague followed her own dream to Temple University's medical school. Then she received pediatric and public health training at the Martin Luther King Health Center in the South Bronx and went to Atlanta for a stint with the EIS program.

Now in her fourteenth year at the CDC, she has been involved with fighting the reemergence of infectious diseases. "Minority participation in this fight is crucial,"she says. "Minority communities have been severely affected by the emergence, in part because the public health programs for these diseases have been so successful that they were closed down. Now the country needs to rebuild its public health infrastructure in this area" Beck-Sague says.

"There is a crisis in reemerging infections and emerging infections that has hit hardest in the minority communities, communities with socioeconomic problems that affect access to care," she says. "It is vitally important that we get people who are involved in our community. These are the people who are going to be the pioneers of public health laboratory practice in the year 2000."

Laurie C. Elam-Evans, PhD, knew on the first day of class that this was what she was going to do. She was not interested in epidemiology before and probably would not have enrolled in the class if Spelman College in Atlanta did not require it for premed students.

"I managed to find something that combined my interest in biology and health with my interest in computers and statistics,"she says. She changed her major to natural science and developed a career plan. Her goal was to be an officer in the Epidemic Intelligence Service (EIS) in 10 years.

That was in 1984. She began her EIS training in July 1994, and she now will concentrate in infant health as a medical officer in the Public Health Service.

Leading her toward this goal was a summer in CDC's Project IMHOTEP, a training program for minority students interested in public health. Then she obtained a master's degree in public health from Emory University followed by her doctorate in epidemiology from the University of North Carolina at Chapel Hill.

And she still remembers the definition that her first professor, the CDC's Bill Jenkins, gave her on the first day of her first epidemiology class: Epidemiology is the study of the distribution and the determinants of disease or conditions in the human populations."

It's not just investigating outbreaks of viruses, says Elam-Evans, who has worked primarily in infant health. "It could be infant health, it could be injury or violence, it could be a chronic condition like cancer. Epidemiology is the methods used to come up with why certain people are sick. It's finding out who is sick and why and developing the right prevention and intervention strategies."

Helene P. Gayle, MD, MPH, is the director of the National Center for HIV, STD, TB Prevention. As head of the center, which has 1,000 employees and a $634 million budget, she is the CDC's highest ranking African-American woman.

That's not something she talks about, however. "One of the hallmarks of CDC is team work," she says. "I don't pretend to think that I am truly the sole decision-maker. I have an excellent team who bring many years of public health experience to bear, and I use that team as effectively as possible."

Nor will she take pride in the fact that the rate of increases of new AIDS cases has slowed to about 5% annually. "We still need to do more. It has not shown negative growth yet," Gayle says. It is spreading more rapidly in some minority populations, she says, and the center will need to step up its prevention efforts in those communities.

Under the CDC mission, the center leads the nation in preventing the disease, while the National Institutes of Health is charged with finding a cure for it. "Our society tends to have this sense that you don't worry about prevention, you just worry about cure," Gayle says. "By preventing something, you save all of the suffering, all the cost. This is what we stand for as an agency."

Gayle, a pediatrician who received her MD from the University of Pennsylvania and her MPH from Johns Hopkins University, remained with the CDC as a staff epidemiologist after finishing her Epidemic Intelligence Service training and her residency at the agency. She has worked extensively in Africa, evaluating and implementing child survival programs as well as AIDS research.

Her goals are focused on universal global health outcomes. "We hope to eliminate tuberculosis in this country by the year 2000," she says. And we're actively engaged in syphilis elimination. The south is the last remaining area, mostly among poor Black rural folks who don't get a lot of medical care."

As for her trail-blazing role as a leader in public health, Gayle says it's just a beginning: If I am here that means there will be many more after me. It's just a matter of time.

Carol L. Johnson, MPH, echoes the words of many medical students when she says: "I wanted to be a doctor ever since I could remember."

This dream was nearly shattered during her first year at Clark University, when allergies began flaring up every time she went into a chemistry lab. Her college advisor steered her into public health and the CDC's Project IMHOTEP, a training program in biostatistics and epidemiology.

While still an undergraduate, she spent a summer analyzing the smoking habits among white women in rural Kentucky for a cancer study. She learned computer programming and more about epidemiology and statistical analysis than her college courses could ever teach her.

After receiving her master's in public health at the University of Alabama-Birmingham, Johnson knew where she wanted to be, "CDC is the Mecca for public health," she says. "It occurred to me that I could work at a state health department, but my goal was to come back to CDC."

Johnson is now pursuing her predominant interest as an epidemiologist specializing in respiratory health. One of her first projects was to look at how fuel additives affect the people of Stanford, Connecticut, interviewing and collecting data on-site. "To me that's the fun part,"Johnson says. "You work on something that could have a major impact on the lives of other people."

A recent asthma study has brought Johnson national attention. When her research on asthma deaths was published in the CDC's Morbidity and Mortality Weekly Report, the Associated Press picked it up.

"I got a lot of calls from private citizens who were sharing their experiences with me," she says. "It showed how research can be exciting and meaningful."

Arthur P. Liang, MD, MPH, did not have public health on the top of the list of career choices when he was a medical student at the University of Maryland. "In the traditional medical educational environment, it's not a well-developed career path," Liang says. "Most of the people around you, your role models, are clinicians. You know there's a public health department, but it's not part of your daily life."

After medical school, Liang worked in the Kaiser Permanente clinics in Hawaii and began work on a master's in public health. While doing field work during an outbreak of Hepatitis B in Taiwan, he met an epidemiologist who became a role model and who steered him toward the training available through the CDC.

The young physician was not convinced that a public health career path was the right direction for him. An internal medicine specialty was still on his mind when he was accepted into the CDC's Epidemic Intelligence Service (EIS). By the time he finished his two years, Liang was committed. "EIS turned my career solidly into a public health career," Liang says.

After his two-year training, Liang was back in Hawaii with the state health department, where he worked with a leprosy program. "A large proportion of the patients were native Hawaiians. They were isolated and had not developed a resistance," Liang says. "When it hit first, it them the hardest."

After five years as a commissioned public health officer in the state health department, he was in Atlanta at the CDC headquarters. He now heads the CDC's Preventive Medicine Residency Program, additional hands-on training that can follow the EIS program. Liang's office also helps to coordinate four-to-six week senior medical student rotations at the CDC.

Each of these training programs is tailor-made for the individuals. "The model for the training here is a little bit of classroom work and lot of guided experience," Liang says. "Your office is your classroom."

James Marks, MD, MPH, might not be director of National Center for Chronic Disease Prevention and Health Promotion today if he had not had to changes planes in Atlanta years ago. As a young pediatrician, Marks was going to North Carolina to see about a fellowship program. Since he had to change planes anyway, he stopped to visit a friend in the CDC's Epidemic Intelligence Service program.

He heard enough about the program to convince him to forego the fellowship for EIS. "It sounded like good fun. It sounded valuable," he says. "I thought I could do that for a couple of years."

He had already developed an interest in public health during a residency in San Francisco, where he worked with a program for the infants of teenage mothers. He saw that the young mothers and their babies needed more than what a pediatrician could provide.

The move from pediatrics to public health was part serendipity and part planning. Marks says it is not as important to plan every step of a career as it is to have a clear idea of what it is you are trying to contribute. "There has to be a mix of what you enjoy and what you are committed to" Marks says.

After the EIS program, he did a residency in a state health department. Then he worked in a neighborhood health center while at the Yale University's public health program. That was where he became hooked on public health. "It allowed me to assess whether I was really committed to a public health career or wanted to go back to seeing patients," he says.

He came back to the CDC as a birth-defects researcher and later concentrated in nutrition and in maternal and infant health. An officer in the public health corps, he's now at the equivalent rank of an Army Major General and has been a center director since May 1995.

The diseases his center concentrates on--cancer, heart disease, diabetes---are the most deadly. Their prevalence in minority communities means the prevention activities in these communities need to be more effective, he says.

"We need to work harder on the prevention side of it. The importance of minorities, minority physicians, working in their communities is critical," Marks says. "We need more education in all of these areas, lifestyle areas, that affect us daily. It's every meal we eat, where we go shopping. We're not going to be as successful as we need to be until we take this on."

Louis Salinas, MPA, is like most of the CDC's public health professionals; he was attracted to the field because he wanted to help people. Unlike most, he came from a public administration rather than a medical background.

Salinas was working for the Texas health department when he came across people in the U.S. Public Health Service who were operating clinics. They convinced him to attend a public health seminar.

"I thought I would skip the session on epidemiology," Salinas says. He didn't. Attending that session, in fact, inspired him to the CDC for training.

His first assignment was as a public health advisor in San Antonio, specializing in programs combating tuberculosis and sexually transmitted diseases. For the next decade, Salinas worked as a CDC public health advisor in his home state.

Part of his time was spent recruiting for the CDC. "As a recruiter, I focused on everyone who could make the grade," he says. "When I came across minority students I really made a pitch for them because I thought they could make a good contribution, that they would be valuable to us and to the population they are serving."

Salinas has recently been named chief of the program coordination unit of the prevention support office for his center, taking over a new project, coordinating state activities dealing with TB, STD, and AIDS/HIV. "This is a challenging opportunity," he says..

James D. Seligman is the Chief Information Officer (CIO) for the agency. Seligman comes to information technology (IT) from a science and program management background. "I was on an educational track as a research scientist when I first started working at CDC in a public health program. The lure of making a difference in the lives of people through public health programs changed my career direction.

The application of IT to serve public health was a natural convergence for me of my education, experience, and interests. High quality and timely public health information is CDC's premier product. IT is used throughout CDC to collect and analyze health-related data and deliver public health information to health practitioners, policy makers, and the public. IT has and will continue to make dramatic strides in how public health is accomplished and the how the agency operates. IT professionals are critical to that process in providing leadership in the research and application of technology."