Zena Stein, 99, Dies; Researcher Championed Women’s Health

She studied the impact of AIDS on women and explored the effects of famine and poverty on health with an “unwavering commitment to social justice.”,

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Dr. Zena Stein, a South African-born epidemiologist whose influential work encompassed the effects of famine on children, the health of entire communities afflicted by poverty and the impact of the AIDS crisis on women in Africa, died on Nov. 7 at her home in Coatesville, Pa. She was 99.

Her daughter Ida Susser confirmed her death.

Dr. Stein came of age in South Africa during World War II and started her career in the early years of institutionalized apartheid. Those backdrops shaped her approach to epidemiology: She aimed to identify the social, economic and political conditions that can affect the health of a population as well as individuals, an approach known as social medicine or community-based medicine.

Dr. Stein’s research focused closely on women’s health at a time when the bulk of scientific study spotlighted men. She was also well known for her research on child development and on mental illness.

She and her husband, Dr. Mervyn Susser, worked as a team and conducted hundreds of studies, many of which shaped the field of epidemiology and community health care. Dr. Stein is listed as the author or co-author of 270 academic articles and several books, including “Eras in Epidemiology: The Evolution of Ideas” (2009), which she wrote with Dr. Susser.

Early in their careers, the couple ran a clinic in the South African township of Alexandra, near Johannesburg, with another husband-and-wife medical team. In one of their first articles, written with collaborators and appearing in the scientific journal The Lancet, they demonstrated that melding medical care and social support made people healthier. The clinic taught patients and family members, for example, how to care for illnesses at home and pregnant women how to improve nutrition. Varieties of the treatment plans Dr. Stein helped develop are still in use today.

In a tribute to her and Dr. Susser in the journal Pediatric and Perinatal Epidemiology, the researchers Richard Neugebauer and Nigel Paneth wrote that the Lancet article “presages enduring themes” in the couple’s work.

“On the scientific level, it reflects their commitment to an analysis of human health centered both on the immediate environment and larger society,” they wrote, adding, “On a deeper level of conscience and morality, it signals their unwavering commitment to social justice.”

Dr. Stein often spoke of her most treasured accomplishment: a seminal study in 1972 on a nine-month stretch of famine in the Netherlands during World War II. The study was based on government data assembled and examined by Dr. Stein and Dr. Susser. In a finding that countered the accepted wisdom, they showed that babies born during a famine were no more likely to experience cognitive deficiencies than babies raised with plentiful food. (Later research, however, showed possible links between prenatal famine exposure and congenital nervous system problems.)

The Dutch famine data had implications for research on prenatal nutrition. Further studies by other scientists using the data pointed to folate, or the various forms of vitamin B9, as a key nutrient during pregnancy, and led the U.S. government to recommend daily folic acid supplements during gestation.

The large data set is still in use today, including by Dr. Stein’s son, Dr. Ezra Susser, a former chairman of Columbia University’s epidemiology department.

Dr. Stein later turned her attention to the effects of the H.I.V./AIDS crisis on women, who made up a minority of patients and were often overlooked. She was a proponent of a female condom for AIDS prevention, particularly in South Africa, where treatment options were more limited. Securing institutional funding for her work, her daughter Ms. Susser said, presented a perennial challenge: Medical authorities did not place great value on AIDS research focused on women. But Dr. Stein was not cowed and found ways to publish nonetheless.

As she told The New York Times in 1990, “If we’re serious about preventing H.I.V. infection in women, then we’re going to have to empower women.”

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Dr. Stein was a proponent of the female condom as a way to protect women from H.I.V. infection. Columbia University has materials on the subject from her papers.Credit…Columbia University Libraries

Zena Athene Stein was born on July 7, 1922, in Durban, South Africa, to a family of Lithuanian Jewish immigrants. Her mother, Lily (Rolnick) Stein, was a homemaker. Her father, Philip Stein, was a mathematics professor at Natal Technical College, which became the Durban University of Technology.

She attended the University of Cape Town for her bachelor’s and master’s degrees in history, and earned her medical degree in 1950 from the University of Witwatersrand. Dr. Susser also studied medicine there, and the two married in 1949. While in medical school, they organized a protest over the treatment of Black students, who were barred from observing autopsies of white cadavers.

The couple, part of a leftist social set in Johannesburg, started their work at the clinic in Alexandra Township in 1952. They worked there for three years, until, in 1955, the clinic’s board threatened to fire Dr. Susser if he went ahead with a scheduled appearance on a panel sponsored by the anti-apartheid African National Congress. He and Dr. Stein, staunch supporters of the A.N.C., resigned in protest.

The couple had helped write guidelines for health care in South Africa’s Freedom Charter, the 1955 statement of principles by the A.N.C. and its allied parties.

Dr. Stein and Dr. Susser, along with their three children, emigrated to Britain in 1958. They initially lived in boardinghouses and worried about money; Dr. Stein worked nights in a mental hospital. After a year, Dr. Susser found work at the University of Manchester, and Dr. Stein followed suit; she was a researcher there from 1959 to 1965.

The family went to the United States in 1965, and Dr. Susser shortly received a job offer from Columbia University. Dr. Stein began teaching there as well, first as an associate professor of epidemiology, then earning a full professorship and assuming administrative positions in what is now the Mailman School of Public Health. Her work included research on developmental disorders in children.

She and Dr. Susser were founding members of Columbia’s Gertrude H. Sergievsky Center, which originally studied disorders of the nervous system.

In 1987, she founded the H.I.V. Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University. The center embarked on the first major effort to draw attention to women living with AIDS. It is now one of the largest centers of its kind in the world, employing about 100 investigators and staff members in the study H.I.V. using different disciplines, including psychology, psychiatry, public health, anthropology, sociology and social work.

Dr. Stein retained her South African roots, corresponding with Nelson Mandela, returning to her home country for conferences and speaking out for racial equity in the post-apartheid era.

After retiring from full-time work in 2003, she continued to write articles with her husband, her daughter and other researchers. Dr. Susser died in 2014. In addition to their daughter and son, Dr. Stein is survived by another daughter, Ruth King; her brother, Wilfred Stein; eight grandchildren; and six great-grandchildren.

In a remembrance on the Sergievsky Center’s website, a former student of Dr. Stein’s, the Columbia professor Dr. Louise Kuhn, wrote of her teacher’s relentless pursuit of knowledge.

“She always wanted me to go further and deeper into understanding issues,” Dr. Kuhn wrote. “Is that all you can conclude?” she quoted Dr. Stein as saying. “Where does that take us? Can’t you do more?”

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