In honour of Valentine’s Day, we asked U of T couples to tell us the stories of how they met. Below is a selection.

Actor Turned Husband
I had been active in high school theatre, so in my first year at New College I signed up to be the assistant stage manager for The Brothers Karamazov.

Although I had a boyfriend, I became very good friends with Allan Price, a first-time actor who had landed the small role of Father Zosima. We started going to plays and spending time together in the New College music room listening to Beatles albums. We even selected our courses to avoid Wednesday afternoon lectures so we could go to the O’Keefe Centre and the Royal Alex at student matinee prices.

I eventually broke up with the boyfriend, and Allan and I were married six weeks after my graduation, in June 1968.

I am now an information technology consultant and no longer a stage manager, but Allan is still an actor. We have two children and celebrated our 40th wedding anniversary some time ago. Participation in activities outside of classes certainly worked out well for me!

Liz (Dolgy) Price
BA 1968
New College Toronto

His Pulse Quickened…
My husband Rick and I met in 1967 on our first day of classes at U of T, on the St. George Campus. I was in nursing. For frosh week we had to dress up in lab coats and nurse’s caps and solicit males from each faculty and then take and record their pulse.

I recognized Rick from a high-school dance where he had accompanied another friend of mine, so I approached him and asked him what faculty he was in (Phys Ed) and whether or not he would let me take his pulse. He agreed and his pulse rate was high at 100+ (he must have liked me).

We dated through our days at U of T and married in 1973. We have been married for 38 years, and have three children and four grandchildren. Thanks U of T!

Moya Johnson
BScN 1971
Georgetown, Ontario

Hockey with Dad
I met Rick in the fall of 1981. I first saw him at the Benson building where I was trying to find a place to store my batons so that I could practice [what?] in the gym. He was a Phys Ed student getting his locker. For several months after that, I tried to “bump into” him on campus – at the Ramsey Wright building where he had a class before me, at the New College deli, where I dragged my girlfriend so I could watch him eat lunch with his friends, and at the weekend pubs. When I found out that his name was Rick, I began to refer to him as “Rick with the beautiful smile.”

He finally noticed me and, on December 4, 1981, asked me to come watch him play inter-faculty hockey for the Phys Ed Team. I sat with his father of all people. Afterward we went to “Frank Vetere’s” for pizza. Six years later, on April 25, 1987, we were married at U of T at Knox College. We will celebrate our 25th anniversary by going on a cruise with our two kids this year.

Heather Hadden (nee Lawson)
BSc Phm 1984

Exercise in Love
I was in my first year of physiotherapy in 1983. In my kinesiology class, the professor’s assistant, Larry, had enlisted our class to be subjects in his study. So once a week we went into a room, sat on a Cybex machine and extended our knees to strengthen our quadriceps. Some of us had electrical stimulation; I, luckily, did not. However, the computer always seemed to crash when I was on the machine, requiring some extra help from Larry.

By the end of the school year, the study was nearly complete. I needed some extra help preparing for my kinesiology exam so asked Larry. We went on our first date after the exam that April, and were engaged the following February. We married in May 1986 after I finished my BSc in Physical Therapy. Twenty-five years and four children later, we have relocated to Kamloops, B.C. I treasure those years I spent in Toronto, though. I met the love of my life at U of T, and I was fortunate to get my degree at a fabulous place in a field that I still love working in.

Patricia Takeuchi
BSc PT 1986

Concrete Bonds
My husband, Duane McDonald, and I came to U of T and lived at the St. George Graduate Residence on Bloor St. in 1972. Duane came from Connecticut to study Victorian history. I came from France to be a teaching assistant in the French department. We met at the residence, and have remained in Toronto ever since. One year when the city repaved the sidewalks we engraved our names in the fresh cement. They remained there, on the south side Bloor, between the Royal Conservatory of Music and the residence, for years. Our friends used to get a real kick out of this. But the sidewalk may have been repaved by now.

Duane and I got married in 1973 (40th anniversary next year), first in Canada, then in France. We lived for quite a few years in U of T’s married student residences on Charles Street. Duane finished his master’s and went into the PhD program; I did my diploma in translation. We had a daughter (Alexandra) and a son (Eric). Both also graduated from U of T. And we hope our three grandsons will graduate from there as well! We have wonderful memory of our time at U of T and of all our wonderful friendships there.

Evelyne McDonald
Diploma in Translation 1976 Woodsworth
Toronto

Growing Stronger
My girlfriend, Clare Eno, and I first met in high school, but we only starting speaking to each other in Grade 12 (I was an awkward kid). By the end of the school year we both discovered that we had been accepted to Trinity College at U of T.

I had asked Clare to our high school prom, and we began dating over the summer before starting university. Clare was my first girlfriend, and I thought things were going well. Unfortunately they weren’t.

After the end of Frosh Week, she gently broke things off with me. While heartbroken, I was determined not to become the sad ex-boyfriend and to ensure that we would stay friends. After a couple months of university in which we saw each other a few times every week, she asked me out again, on Nov. 1, 2005.

We’ve now been together for more than six years, and despite the rocky periods and our different backgrounds (she’s from Barbados and I’m Armenian) we have emerged stronger – both as a couple and as individuals. She is my closest and best friend, and I’m thankful that we’re together every day.

Michael Keoshkerian
BA 2009 Trinity

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Aida da Silva (BSc 2004 VIC) was at the 2010 Luminato Festival when she took this photo. Created by Philip Beesley, Sargasso was a responsive art installation that transformed Brookfield Place. “Sensors activated balloons, which inflated and deflated depending on the spectators’ movement; it was quite impressive” says da Silva. The artwork is named after the Sargasso Sea in the North Atlantic Ocean, which now abounds with floating plastic junk. The photo’s bluish tint comes from an adjustment she made to the white balance setting.

Da Silva discovered her love of photography during a family trip to Portugal over 20 years ago. Since then, she’s climbed fences to access ancient ruins, toured former prisons, and gotten lost in a nature reserved blanketed with heavy fog – all in the name of photography. “I’ve even searched for clues to the whereabouts of the Holy Grail,” she adds. She prefers travel photography: “It justifies my exploration of the world.” Hoping to guarantee herself even more adventures, da Silva is currently pursuing a photography certification.

Visit Aida’s Flickr page

On the surface, Khadijah Goes to School: A Story about You is about a young girl who is nervous about starting at a new school, and meeting her new teacher and classmates. But at another level, the book is about the importance of reading and education, finding your true self and reaching your maximum potential.

It also champions diversity. On one two-page spread, Hussain (BSc 1999, HBSc 2005) has included the word “read,” and its equivalent in 220 languages, including sign language, braille and computer language. “The whole point is to instigate discussion about diversity and the concept of the self. What does it mean to be you?”

Unlike most English-language books, Khadijah Goes to School opens left to right, as books do in such languages as Arabic and Hebrew. Hussain says he hopes readers will recognize in this an alternate way of doing things.

The book contains a self-affirming message as well, delivered by Khadijah’s teacher, that everyone can make an important contribution to society. Although Hussain himself believes education is important, he has little time for university graduates who look down on those lacking formal education. He sees colleges and universities as offering “one way to be educated, but not the only way. Brilliance is not limited to one standard. A lot of kids wonder what education is for. Ultimately it’s about contributing to society and helping other people.”

A Pakistani-Canadian, Hussain grew up in Toronto and Mississauga, and studied computer science at U of T. After obtaining his degree, he worked for three years in the information technology industry, and then returned part-time for three more years in political science. He’s now an IT consultant, but says he’s always had a creative side that he’s recently exploring with writing and publishing. “When I become dedicated to something I really work for it.”

Khadijah Goes to School is available through http://khadijahgoestoschool.com and Amazon.com.

But until one attains these latter plateaus, the gripe of class sizes is often used, by undergraduates at least, as a common reason for poor grades. I disregard this reasoning. For one, this is university, not high school, and large classes are to be expected. Do we not forgo individual coddling when we walk underneath the Latin-inscribed arches of Victoria College, or through the hallowed halls of University College?

If adulthood is the final level of independence, then shouldn’t university act as the transition period? And if that is the case, then certainly large classes provide a means for students to prepare for life “on the outside”: one is anonymous in the lecture hall, but one still has access to tutorials where “academic service” is more personalized.

Optimism, dreams, hopes and aspirations aside, the stark reality of life after university is one of mostly anonymity. When starting a new job, one can’t expect to receive an incredible amount of attention. One could argue that entry-level, or middle positions in companies can be viewed as the 100- and 200-level courses of the business world. Students must be prepared for this, and large classes train them in the principles of independence. Success in these positions, much like success in those huge lectures at Con-Hall, allow a progression into 300- and 400-level courses, effectively the management positions of companies which then are more personal, and can focus on the individual name opposed to employee number. But this isn’t to say university prepares students to become only anonymous cogs in the workforce machine. But nonetheless, large classes teach one thing that is paramount to the growth of every young adult: independence, whether it be in the office or at home.

On top of this, one often hears the complaint, especially from the U of T Students’ Union, that tuition fees are too high. If they are already as astronomical as some profess, what would be the outcome of smaller classes at the first- and second-year levels? The university would have to hire more professors, and with more professors on the payroll, this would cause an increase in costs for the university.

My generation seems to like the idea that the universe revolves around them. Most of us subscribe to this notion – even I do sometimes – though I would never admit it in public. This feeling of entitlement is detrimental, and rather than be fostered, should be fought against. Large class sizes to do this: if students can work amongst the faceless hundreds, and do their work well, then they deserve to be taken care of more personally in future classes. In a sense, large lecture sizes act as a filter, or quality control. While the thought may sound callous to some, it’s not the university’s job to simply give students what they want; it’s to give them the means to get what they want. Post-secondary education is a game of give and take, and at an internationally ranked school such as U of T, it should come as no surprise that there may seem to be a bit more take than give during first and second year. This is done in order to teach students what cannot be learned from textbooks: how to be independent. If anything, students should applaud big classes. After all, they turn U of T from being a school that teaches a lot of theory, to a school that also teaches valuable, practical life lessons.

In the opera, Ford falls asleep at his desk, meets Atwood in a dream and mistakes her for God. He is also judged by Toronto librarians. But librettist Michael Patrick Albano says the work is “not a bombastic attack on Rob Ford” — which wouldn’t be theatrically interesting. “I’m a great fan of the theatre of the absurd. It releases you from the pressure of logic, and you can write extraordinary things,” he says. “But that does not mean it’s a free-for-all.”

Albano is the opera training program’s resident stage director at U of T’s Faculty of Music. He wrote Rob Ford, the Opera for the Student Composer Collective, now in its 15th year. The collective started as a workshop and became a graduate course, allowing students to gain experience in writing and staging a performance.

Master’s and PhD students contributed music to the opera. The goal is to experiment so that students learn to develop their own voice, Albano says. “Four composers are passing the reins to each other and it has an interesting musical continuity. The moods change when the scenes change.”

Originally, Albano was working on an adaptation of Sophocles’ Antigone. But while writing at Starbucks in the summer, he decided to change track. “Everyone around me was talking about Rob Ford,” he says. “And this is a course where we’re supposed to be pushing the boundaries, dragging the art form into the 21st century.”

He notes that classic operas often deal with then-contemporary and contentious issues. For example, Verdi’s works ran into trouble when they portrayed prostitutes or royalty. “Some opera premiers were delayed because of censorship from the state — Verdi had a dream where he moved to colonial America to get around the censors,” Albano says.

Toronto’s mayor may be a controversial figure, but he’s welcome at the show. Albano sent a handwritten note inviting Ford to attend Sunday’s performance. No response yet, but as Albano says, “The week is young.”

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Despite what it may appear to be, this is not a single photograph of a car. Alumnus Albert Tan (BSc 2011 Vic) actually shot 109 pictures of his sister-in-law’s BMW and stitched them together to create a final image with a resolution of 94 megapixels. “I just wanted to try something different for once,” says Tan. “I had never photographed vehicles before and had to make do with no lighting equipment and a rather boring location, so I had to exercise creativity in the shooting method instead.” This method of stitching many long focal-length shots together to produce a much larger image with a wide angle of view and a thin depth of field is known as the Brenizer method, says Tan. “The resulting effect is one that could never be captured with a single shot – at least not on any camera being manufactured today.”

Tan is no stranger to artistic pursuits. He plays the guitar, drums and ukulele, and he sings. He has also moonlighted as a professional graphic designer and designs T-shirts for deviantART’s clothing line. Tan originally wanted to attend design school after high school, but he ended up studying biochemistry and human biology. He credits his parents, and his own trepidation for the switch to sciences. He will be attending dental school next year and hopes to become an oral and maxillofacial surgeon.

Visit Albert’s Flickr page

Beginning in December 1937, during a six-week period, the Japanese army killed an estimated 300,000 Chinese people, and raped tens of thousands of girls and women. Known as the Nanking Massacre, these atrocities took place during the capture of Nanking, China’s then-capital city, during the second Sino-Japanese War. When Tso saw a documentary about the horrific events in 1997, she felt compelled to write about what she’d seen, to make more people aware of what she calls a “forgotten holocaust.” “It’s still not widely spoken about,” she says. There is an underlying culture of dissension between the Japanese and Chinese, but Tso felt that her generation was mostly unaware of how deep the pain ran.

What continues to astonish Tso is the lack of awareness that still exists. Survivors of the massacre are often unwilling to talk about the traumatic events they saw or experienced, and many history books worldwide are incomplete or don’t mention the massacre at all, she says. In the interest of telling the story of her ancestors, Tso decided to use the medium she knew best. “The stage is my public arena to voice stories and truths, and hopefully change or inspire,” she says. After spending years working on her story, Tso is excited for the debut of her play.

Red Snow is the story of a Chinese-Canadian woman who has recurring nightmares about her grandparents. The dreams are always in the form of a Chinese opera, but strangely, there is no singing. The character, Isabel, knows that her grandmother died during the war, but her grandfather refuses to talk about what happened. “She gets to the point where she can’t live like this – she has to know the truth,” Tso says. Isabel travels to Nanjing to discover their stories, and on her journey she falls in love with a Japanese-Canadian man whose past is intertwined with her own. “It’s through their love that they struggle and they find a way to reconcile the past with the present,” Tso says.

The events of the Nanking Massacre are still incredibly controversial and divisive. Historians throughout the world disagree about the number of victims and the degree of brutality, and some deny that it happened at all. But Tso does not see it as her role to resolve the issue for her audience. “As an artist, I’m not here as a history teacher,” she says. “This is something that should touch everyone’s heart; it’s about racism, prejudice, war and how we overcome.” Tso believes that in war there is no black-and-white; and she isn’t interested in demonizing anyone. “It’s about dialoguing, and working brick by brick to take down the walls and build bridges.”

Tso went back to Nanjing (as the city is now widely known) in 2008 and spoke with survivors. One man told how his mother was stabbed in the chest by a soldier. She lay bleeding to death, but asked her son to go find his baby brother so she could breastfeed him. He found the baby crying, and crawling back and forth on snow stained with blood, which gave Tso the title of her play.

Regardless of the darkness we may unearth, Tso insists that we can never talk too much about the past. “We have to learn from the past and be inspired by the past,” she says. After all, “who are we without our stories?”

Red Snow opens January 14th at Theatre Passe Muraille.

Delving into decades of competing land use plans, the 29-year-old Eidelman (who will defend his thesis this year) concluded that the deeply fractured ownership structure of Toronto’s post-industrial waterfront has militated against the implementation of a cohesive development plan. In his research, he also demonstrated how this flaw set Toronto apart from comparable waterfront cities, especially Chicago. “The ownership [in Chicago] was settled in 1910 through various lawsuits,” he explains. The result: the windy city emerged with a consolidated land holding and could enact certain development policies, such as the ban on tall buildings at the water’s edge.

Eidelman’s research, though historical, is nothing if not timely. Last fall, Councillor Doug Ford, Mayor Rob Ford’s elder brother, stepped forward with a blue-sky scheme to build a large-format mall, a ferris wheel and a monorail on the city’s 700-acre Port Lands district – an area that’s already been the subject of intensive planning and official plan policies. To Eidelman, the gambit seemed like history repeating itself. “This happens time and time again,” he says, referring to 1960s controversies involving the competing development aspirations of certain waterfront agencies.

In this case, however, the existing development strategy, which has been created and promoted by Waterfront Toronto over several years, survived to see another day, although council has ordered the agency to accelerate its plans. Eidelman cautions that it is too early to tell whether that plan – which calls for a mixed-use community arrayed along a naturalized estuary at the mouth of the Don River – will endure. (City officials insist the funds for the infrastructure don’t exist.) And he warns that the city still hasn’t confronted the ghost in this machine, which is title. “If I were to fix the problem, I would find a way to consolidate land ownership.”

Eidelman presented a summary of his analysis last April. It is available here.

According to the study, people who feel pressured into changing prejudiced views will actually become more prejudiced. On the other hand, methods that persuade people that giving up prejudice is good for its own sake are more effective.

Lisa Legault, Jennifer N. Gutsell and Michael Inzlicht of UTSC came to those conclusions in an upcoming paper in Psychological Science.

They were interested the effectiveness of campaigns such as the government of Canada’s “Racism. Stop It!” campaign – with its talk of “stamping out” prejudice. Across North America billions of dollars are spent every year on prejudice intervention, many with a similar design.

Previous research has shown that people who are driven by their own judgments that prejudice is wrong are the most effective at changing prejudiced attitudes. But people who are pressured into changing their attitudes – because they are threatened with social disapproval, for instance – don’t change as much.

Researchers say that the first group is autonomously motivated, while the second group experience controlled motivation – that is, they feel controlled by outside pressure.

Previous studies looked at people’s existing attitudes. The UTSC researchers were interested in interventions. What happens when you try to change people’s attitudes using persuasion vs. pressure? To find out they tried two experiments.

In the first, the team took 103 non-black undergraduates and divided them into three groups. The first received an “autonomy brochure” that emphasized choice and explained why prejudice reduction was worthwhile. The second “controlling brochure” urged people to combat prejudice and comply with social norms. The third group received no brochure, but merely read definitions of prejudice.

The three groups were then given a test that measured their levels of prejudice (for instance, asking if they agreed that blacks simply need to work harder). The people who received the autonomy brochure ranked lowest in prejudice. The people who received no brochure were in the middle. And the people who received the controlling brochure were the most prejudiced. In other words, the controlling brochure actually made attitudes worse than no brochure at all.

The second experiment was similar, but sought to “prime” subjects by having them read statements that would affect their attitudes. Autonomy-primed students read statements like, “I enjoy relating to people of different groups,” and “It’s fun to meet people from other cultures.” The controlling primed subjects read things like “It is socially unacceptable to discriminate based on cultural background,” and “Prejudiced people are not well liked.”

Once again, the autonomous group scored lowest in prejudice, the group which received no priming scored in the middle, and the controlled group was most prejudiced.

According to the researchers, people who feel they are being controlled sense a threat to their autonomy and rebel, reacting by adopting even more prejudiced attitudes.

The researchers suggest that anti-prejudice campaigns should focus on discussing the importance and enjoyment of non-prejudice, and should reframe campaigns that pressure people and could backfire.

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Third-year student Yi Zhao was walking on King Street in October when he came across the Occupy Toronto protest. To Zhao, the woman in the photo (whose name he never learned) seemed to embody the words of the political poem by Percy Blythe Shelley that she had quoted: “Stand ye calm and resolute, like a forest, close and mute…” Zhao noted that while everyone around the woman was shouting, she seemed quiet and at peace. “She used her own special way to protest,” say Zhao, who took the photo in color and then converted it to black and white.

Zhao is studying physics at Innis College, but would like to switch to architecture — an influence of his father, who is an architect and professional photographer. Zhao prefers documentary photography, and believes that photos are an important way of telling the story of the present for future generations.

View Yi’s Flickr stream

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In their quest to track health patterns across populations, epidemiologists often call themselves “disease detectives.” Not Dr. Prabhat Jha. He uses a somewhat more radical term to describe the work that he and his team are doing. “I like to think of ourselves as epidemiological terrorists,” he says jovially. “We blow up assumptions.”

Here’s one example. It concerns malaria, a disease that the West doesn’t pay much attention to. The World Health Organization (WHO) had long been reporting that in India, malaria claims 15,000 lives a year – a significant but not overwhelming loss in a nation of more than a billion people. But Jha learned that the WHO figure was based solely on patients who receive proper diagnoses from clinics or hospitals. Jha, who was born in India, was well aware that such a statistic would exclude many rural and poor Indians with no access to formal medical care. So, more than a decade ago, he set out to design a different system for gathering data. The Million Death Study, which Jha launched in 2002, began sending trained teams to homes across the country to conduct door-to-door surveys about recent deaths.

This method has produced startling new findings. A paper Jha published in fall 2010, for example, indicates that the death toll from malaria is an astonishing 200,000, or 13 times the WHO estimate, most of them adult deaths. And that’s just India. Jha believes that many other countries, especially in Asia and Africa, may similarly be basing their public health policies on incorrect statistics. “Deaths from malaria in our view have been vastly underestimated worldwide,” Jha says, suggesting a total death toll of close to 1.3 million – 50 per cent higher than the WHO’s estimate. Jha believes that at least 200,000 malaria deaths among adults in Africa currently go unreported.

Here’s another widely held assumption that Jha is challenging: the United Nations had been reporting in the mid-2000s that 400,000 people in India die of HIV-AIDS every year – more than any other country. The numbers had been based on clinical testing for HIV in young pregnant women. But Jha’s team found that the figure is likely far lower, probably closer to 100,000. That’s good news, especially as Jha has published widely on HIV-AIDS prevention. But if malaria kills twice as many people as HIV-AIDS, why does malaria receive only a fraction of the attention? Jha is determined to redress that inequity. “HIV-AIDS is something we treat, but malaria is something we cure,” he says, citing the now-standard combination drug therapy that can cure malaria if given promptly. The drugs are free in Indian public clinics and affordable in private ones. “Those malaria deaths should not occur. That’s why these findings are exceedingly important. What gets measured is what gets done.”

The findings on malaria and HIV-AIDS are only part of Jha’s Million Death Study, one of the largest studies of mortality ever undertaken anywhere in the world. Jha, the founding director of the U of T–affiliated Centre for Global Health Research, created and designed the study to focus on India – a country that doesn’t require death registration and where most deaths occur at home without medical attention. Jha believed that visiting individual households and talking directly with family members was the only way to acquire the necessary information about how loved ones died. Not that he’s obsessed with death, he points out, so much as with death numbers. “People say to me, ‘Don’t you do depressing work, just concerned about deaths?’ Actually, no. By studying the dead you can get a real sense of the opportunities of life. The best investment for the health of the living is to count the dead.” Indeed, it was the data on lung cancer deaths in the West in the 1930s and ’40s that led to the link with smoking, and it was the statistics on unusual diseases killing young men in California and New York in the early 1980s that led to the identification of HIV. Public health measures ensued, preventing millions more deaths.

Jha, the Canada Research Chair in Health and Development at U of T’s Dalla Lana School of Public Health and the university’s Inaugural Endowed Professor in Disease Control, has long been fascinated by the power of mortality statistics to drive global health initiatives. Born in the industrial city of Ranchi in central-east India, he immigrated at age six with his family to Winnipeg, where his father worked as a civil engineer (and is now an NDP member of the legislative assembly) and his mother raised Jha and his older brother and younger sister. Jha, with twin interests in medicine and economics, received his medical degree from the University of Manitoba, then a doctorate in epidemiology and public health from the University of Oxford in England, where he studied as a Rhodes Scholar. It was during his time at Oxford that he became aware of the extent of the miseries of the global poor, when world-renowned epidemiologist Sir Richard Peto, Jha’s professor and mentor, spoke passionately about the huge burden of disease in developing countries from completely preventable factors, such as tobacco. It motivated Jha to want to research the issues further, and then turn that research into action.

While working in the mid-1990s at The World Bank, whose mission is to provide loans and resources to improve lives of people in developing countries, Jha chose India to study the link between smoking habits and smoking-related illnesses and deaths. Not only did he have a cultural connection, but he was interested in the impact of smoking in a country that was undergoing a massive transformation, with rapid development, increasing urbanization and a growing middle class. Jha discovered that Indian smokers tend to pick up the habit at a later age than smokers in the West. They tend to smoke less, and often still smoke locally manufactured cigarettes called bidis that contain only one-quarter of the tobacco of western commercial brands. Were Indian smokers therefore causing less damage to themselves than smokers in the West? While smoking mortality studies had been done in developed countries, no one knew the health impact of smoking in India.

Jha met with India’s registrar general, whose government department oversees that country’s census, to suggest a simple proposition: include a mention on an individual’s death certificate of whether the deceased was a smoker or a non-smoker. But with only about 20 per cent of India’s estimated 10 million annual deaths reliably registered, millions of people would still be missed. How, then, to reach those next-of-kin to ask about their deceased loved ones? “That’s when we came up with the idea to apply verbal autopsy,” Jha says.

Verbal autopsy involves asking family members about the events that preceded the death. Countries have long relied on information gathered through in-person household surveys. Such a method in India could go far beyond asking about smoking habits, Jha realized, and inquire about a range of signs and symptoms involving every deceased below age 70. (The cause of death among older people is more complex to ascertain, as there are often multiple symptoms.) This method had never been used on the scale Jha envisaged. Death is such a formidable event, he says, that it stays imprinted in people’s memories. “Just think back on your own family experience of death, and you’ll find you remember the details even years later,” he says. When he asked his own grandmother, who lived in a rural village in India, about how his grandfather had died 20 years earlier, she recalled the details so vividly that Jha immediately identified the classic symptoms of a stroke.

India already had a “sample registration system,” in which government-paid census takers would make monthly visits to each of about 200 homes in their district to ask about births, deaths and other changes in the household. Every six months an independent surveyor would repeat that work, to confirm the accuracy. Piggybacking on that system, Jha designed the Million Death Study to use those twice-yearly surveyors and train 800 of them to do verbal autopsies in 7,000 districts across the country. Their completed questionnaires would then be sent to two of 130 physicians to establish a probable cause of death. In case of disagreement, a senior physician would be the final arbiter.

Jha says the study, which coded 300,000 deaths in its first five years, has exceeded his expectations. The participation rate of the communities is close to 100 per cent – at least as high as Canada’s response rate of 98 per cent in the 2011 census. Jha, who speaks Hindi and who has accompanied field staff on home visits, says communities have been quick to recognize the legitimacy of the study. While residents may be leery of a drug company rep, they trust the government field staff who tell them upfront that while the study probably won’t be of direct help to the respondent, it may help identify health priorities that will benefit the community and may improve their children’s or grandchildren’s lives. Households become willing participants, offering warm hospitality and cups of chai. Jha says that in a sub-study of selected households on blood pressure, the participation rate was 105 per cent. “The neighbours showed up, clamouring over each other to say, ‘Why aren’t you including us?’ So we just included them all.” He adds that Indians also respond well to the study’s connection with the University of Toronto, an institution they respect that’s situated in a city where everyone, even those in the smallest Indian towns, seems to have a cousin.

Since 2005, the Million Death Study has produced 15 publications in major medical journals such as the Lancet, the New England Journal of Medicine and the British Medical Journal, as well as four major reports in both India and Canada. The publication of each new finding has resulted in a hail of publicity, with crowded media conferences, TV reports and front-page headlines in India and beyond. Smoking was named a much bigger risk than previously thought: Jha combined his own findings with government statistics to report that 70 per cent of smoking-related deaths occur in middle-aged people aged 30 to 69; even a few bidis or cigarettes a day may be lethal; smoking is a leading cause of tuberculosis; and oral cancer, highly related to smoking and chewing tobacco, is higher in women than men. Citing these results in Parliament, the country’s health minister successfully introduced warning labels on cigarette packages, soon followed by higher tobacco taxes.

Jha and his researchers also found that while selective abortion of females following prenatal sex determination is growing in this country that favours boys, families generally don’t act on it with the first pregnancy. If that child is a boy, families will often happily accept a second child of either sex. But if that first child is a girl, a significant minority, especially among educated wealthy families, will opt for selective abortion with the second pregnancy in their quest for at least one boy. The study, to which media outlets attached the headline “Ten Million Missing Girls” (now up to an estimated 12 million over the past 30 years), has caused an ongoing heated debate in India that has reached into popular culture, Jha says. “The Indian soap operas have started covering this issue, with the strong-willed pregnant daughter-in-law resisting pressure from her equally strong-willed mother-in-law and the husband in between.” He adds that evidence is emerging, partly as a response to the debate, that the practice has begun to slow in the northern states.

Among the most recent findings from the Million Death Study: the number of suicide deaths in India has been underestimated, especially among the 15–29 age group; unintentional injuries such as drowning kill more than 82,000 children under five every year, which is up to three times more than previously thought; and simple, affordable prenatal care could prevent one million newborn deaths caused by prematurity, infections and birth trauma.

The study has raised not only awareness but also controversy, particularly with regard to the malaria findings. The World Health Organization, whose malaria numbers looked like an embarrassingly low underestimate, came out with a statement asserting that while verbal autopsy may be efficient for some causes of death, it’s poor at differentiating malaria from other fever diseases, such as septicemia, encephalitis or pneumonia. Nata Menabde, the WHO’s representative in India, told reporters, “The new study uses the verbal autopsy method, which is suitable only for diseases with distinctive symptoms and not for malaria.”

But other specialists have hurried to the study’s defence. Dr. N.K. Ganguly, the former director of the Indian Council of Medical Research, says that while some may question the reliability of verbal autopsies, there’s no denying that the results correlate with local doctors’ reports as well as with the seasonal variability of mosquitoes. And Dr. Roger Glass of the U.S. National Institutes of Health says, “It’s important that we not underestimate malaria deaths, particularly among adults living in rural areas.” He adds that the study indicates that population-based disease surveys are valuable. Jha, who in the early 1990s served as senior scientist at WHO, says that the Indian government has now set up an independent task force to verify malaria deaths. He adds, “I think they’ll come up with something much closer to our estimate than the WHO estimate, and that in turn will get the government to say, ‘We should do something about it.’”

The Million Death Study is scheduled to continue until 2014, but Jha predicts that because the data-gathering system is solidly in place, data collection will continue well beyond that year, eventually coding many more than one million deaths. He expects future findings may cover health data that have previously gone unnoticed or under-reported. For instance, although coronary heart disease is considered to be the leading killer in wealthy, developed countries, it’s also proving to be the number 1 cause of death among poor, rural Indian men aged 30 to 69. Another area of interest is the role that alcohol may play in causing disease or accidental deaths. Alcohol consumption has been difficult to track in India because home production for self-use remains common. The study is also finding that snakebite deaths could be up to three times higher than current estimates, as many victims never make it to a clinic.

Currently logging four or five annual trips to India, Jha, a married father of two school-age daughters, plans to cut those visits back – especially as the Million Death Study becomes more automated and self-sustaining. He plans to turn his sights toward rolling out the program to other countries. The government of South Africa has expressed a keen interest, and several other African countries as well as China are lacking accurate death statistics.

“My dream project would be not the Million Death Study,” Jha says, “but the Ten Million Death Study.”

Marcia Kaye (marciakaye.com) is an award-winning journalist specializing in health issues.

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Watch a video of Prabhat Jha talking about his research: