2023 Lemuel Shattuck Award

Adrienne (Andy) Epstein, RN, MPH, is a member of the Advisory Council on Public Health for the Brookline Public Health Department. She has spent more than 45 years as a nurse and public health advocate in Massachusetts and Africa and has been a role model for how public servants and public resources can be deployed to tackle health problems and systems challenges grounded in social conditions that create health inequities.  

Andy’s clinical work has crossed settings, from home-visiting, to community health centers, to emergency room care in a developing health system in Mozambique. In each of these settings Andy not only brought clinical skills in diagnosis and treatment, but developed strategies for new models of care delivery that addressed social conditions and could therefore improve outcomes. 

In 1988 Andy helped develop an initiative with visiting nurses from home health agencies across Massachusetts to provide care for homebound and dying people with HIV. This was a time when HIV and AIDS were highly stigmatized and options for care statewide were severely limited. There was no treatment save for AZT which extended life for 4-6 months. There was no Ryan White Care Act, and therefore no federal funding for HIV and AIDS care and treatment programs. Andy rallied nurses to start HIV programs at agencies that rarely went outside their “lane.”  She then turned her attention to developing the framework for the creation of the ACT-Now program, which utilized state resources to incentivize the provision of HIV/AIDS treatment and support services by hospitals and health centers. This innovation formed the basis of integrating HIV/AIDS care into routine medical care, very different from the specialized and isolated AIDS clinics that formed in the rest of the country.  The impact of this work is that Massachusetts continues to have some of the highest rates of HIV viral suppression in the U.S. and concomitant sustained reductions in HIV incidence. 

Andy’s work at the state Department of Public Health and the Boston Public Health Commission brought her focus and skill to additional public health challenges. She helped inform the clinical and public health components of the Commonwealth’s pilot needle exchange program, oversaw its first program evaluation, and later directed the pilot use of nasal naloxone at a time when this life-saving medication was only available via injection by EMTs and emergency room clinicians, reversing thousands of overdoses and saving lives.  In the early 2010’s, Andy worked to overhaul Massachusetts Medical Orders for Life-Sustaining Treatment (MOLST). With her guidance, a landmark report was created on how to empower residents of Massachusetts to make informed and well-considered end-of-life decisions. 

When Medical Marijuana was approved by the voters, and even before, Andy, working behind the scenes as usual, helped create the structures to support a regulatory regime for medical marijuana dispensaries within DPH. In 2015, Andy began working as a nurse at one of the first medical marijuana dispensaries in MA. In that role, she helped many patients with a range of disorders who found that marijuana, used thoughtfully, could alleviate many painful and distressing symptoms.  

Throughout her career, Andy Epstein has worked to think creatively and push systems to respond to emerging health needs, keenly focusing on health inequities.