In Memory of Zena Stein, Public Health Pioneer, Advocate for Justice

Zena Stein, influential and beloved emerita professor of epidemiology at Columbia Mailman School, died on Sunday at age 99. Across decades and time zones, Stein advanced public health science while integrating social justice into every aspect of her work. Friends say she retained her passion for the world to the end. Even earlier this year, she spoke about her hopes for the future with a new president and the availability of the COVID-19 vaccines.

Stein and her late husband and longtime collaborator, Mervyn Susser, chair of epidemiology at Columbia Mailman School from 1966 to 1978, were seminal figures in the establishment of the discipline of epidemiology. Their creative and rigorous research brought new insights to understanding mental health, reproductive health, and the social determinants of health. Their groundbreaking work on starvation during pregnancy laid the foundations for the field that has come to be known as life-course epidemiology. As the HIV pandemic exploded in the 1980s, Stein was a powerful voice drawing attention to the needs of women. Her research and advocacy helped lead to the development of the female condom and microbicides to prevent the transmission of the virus.

Stein and Susser may be best known for launching a series of rigorous studies of the Dutch Famine, a nine-month period of malnutrition during the Second World War. In a 1972 paper that upset the prevailing orthodoxy, they found that babies exposed to famine prenatally were no more likely to have cognitive deficits. Subsequent research found that babies conceived during the famine’s peak had elevated rates of congenital nervous system anomalies, including neural tube defects. These results helped lead to clinical trials to investigate the role of folate in pregnancy, and eventually to a federal recommendation that all women who could become pregnant consume folic acid daily. Data from the Dutch Famine study continues to be analyzed by Columbia Mailman faculty members and public health researchers around the world; for example, Ezra Susser, son of Stein and Susser and chair of Epidemiology, 1999-2009, developed studies of schizophrenia built around the Dutch Famine Study.

With the arrival of the HIV/AIDS epidemic, Stein’s work focused on its impact on women, particularly those afflicted by social and economic disparities in Africa. She recognized the need for studying, not only the health of ciswomen, but also sex workers and to consider bisexual and heterosexual transmission. A founding leader of the effort to empower women in HIV prevention, she promoted work on women-initiated prophylactics in HIV prevention, including research on the “female condom,” or internal condom contraceptive—approved by the FDA for use in the U.S. in 1993. She was also a leading advocate for the development of microbicides to prevent the transmission of HIV—an achievement later realized by her Columbia colleagues Salim Abdool Karim and Quarraisha Abdool Karim, in 2010. 

Throughout their lives, Stein and Susser were active in political causes, notably the fight against Apartheid. They were allies and friends with Nelson Mandela and other leaders in the struggle. In their early career, they worked together with Black leaders to organize mass student protests against the medical school’s practices of discrimination against Black students. Later they made their home an asylum for émigrés, particularly those escaping Pinochet’s Chile. During the 1980s, as the Anti-Apartheid movement intensified in South Africa, they organized the Committee for Health in Southern Africa, to alert the public about the links between human rights violations and disease in that country. Stein was a relentless activist for social justice in the U.S. protesting injustice and working for change to address the deep fissures of inequality in U.S. society.

Zena Athene Stein was born on July 7, 1922 in Durban, South Africa. She attended the University of Cape Town and received her medical training at Witwatersrand University during which time she married Susser, a childhood friend and fellow medical student. After earning their degrees, Stein and Susser together with another couple established one of the first urban community health centers in Africa, in Alexandra Township, Johannesburg. They emphasized the prevention of disease as well as access and participation in care among the area’s poor Black residents. Active in the struggle against Apartheid, the couple eventually left South Africa for England and then the United States. In Manchester, they developed a prescient community mental health service and psychiatric registry, and Zena led work on social inequalities and intellectual disability, as well as on enuresis and other aspects of child development. In 1966, moving to the United States, they joined the faculty at Columbia University’s Public Health School. In 1968, Stein was also named director of the Epidemiology Research Unit in the New York State Psychiatric Institute, a position she held for 30 years.  A founding member of the Gertrude H. Sergievsky Center in the 1970s, she helped build its research into developmental disorders of the nervous system. Among her signal achievements in this period was the development of research and services for children with neuropsychiatric disabilities in poor countries across the globe and the Dutch Famine Study.

In 1987, she co-founded the HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, shifting her focus. It was the first Center to direct attention to women and HIV.  In the 1990s, working initially with medical allies of the African National Congress (ANC) that led the struggle against Apartheid, she became an expert and mentor in HIV epidemiology in South Africa, and at the same time, KwaZulu Natal South Africa emerged as the world epicenter of the HIV epidemic. After the end of Apartheid, Zena and Mervyn moved to a remote and at the time dangerous Hlabisa, KwaZulu Natal for six months to launch the Africa Centre for Health and Population Studies. In 1994, she launched Columbia’s AIDS International Training and Research Program in South Africa, a program that went on to train more than 800 fellows.

Stein was the author of more than 250 scientific papers and five books on many social and epidemiological themes. She has carried out several WHO consultancies and served on the editorial boards of professional journals in the fields of epidemiology, public health, genetic epidemiology, and teratology. She received the John Snow Award from the American Public Health Association, and honorary doctorates from Columbia University and Witwatersrand University. The Africa Center in Kwazulu, South Africa dedicated an auditorium to Susser and Stein in 2002. Each year, the Society for Epidemiologic Research gives a series of Susser-Stein Inclusion Awards in support of under-represented individuals in the field of epidemiology.

At Columbia Mailman, colleagues remember Stein for her warmth and collegiality, boundless intellectual curiosity, and steadfast commitment to racial and social justice, and the understanding that health inequalities over the life course are shaped by social injustice.

She is survived by her son, Ezra Susser, professor of epidemiology and psychiatry at Columbia Mailman School and New York State Psychiatric Institute; her daughter Ida Susser, Distinguished Professor at CUNY, whose work includes “AIDS, Culture, and Society in Southern Africa” and relates in more detail Zena’s experiences in this field; and her daughter Ruth King, whose dedication ensured that her last years were happy and peaceful; and by numerous grandchildren and great-grandchildren. Her three children write in remembrance: “She was a brilliant and extraordinary woman whose warmth, caring and insights illuminated the lives she touched at home and thousands across the world.”