Dr. George Rosenkranz —a world-renowned scientist who devoted his life to improving global health and established a prize to foster innovative research among emerging Stanford scholars — leaves behind an extraordinary legacy of science and humanitarianism.

Rosenkranz was 102 when he died Sunday after a prolific scientific career, one that would forever change the course of women’s reproductive lives.

A Hungarian Jew who fled the Nazis during World War II and eventually emigrated to Mexico, Rosenkranz was one of three scientists who pioneered the chemical compounds that led to the birth control pill. He was also instrumental in developing medicines to fight venereal diseases.

His family established The Dr. George Rosenkranz Prize in 2010 at the Freeman Spogli Institute for International Studies; the prize is administered by Stanford Health Policy. The $100,000 award goes to researchers working to improve health care in the developing world.

The beloved figure often made it to the campus symposiums that honored the prize winners.

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The first Rosenkranz Prize was awarded in 2010 to SHP’s Eran Bendavid, an infectious disease physician and associate professor of medicine. He used his award to study whether U.S. money spent on malaria and HIV programs in sub-Saharan Africa translated into better health outcomes for women and their children.

“George has galvanized a community of global health researchers at Stanford,” said Bendavid. “We now have a community of scholars whose focus on critical issues in other countries has been powerfully enabled by George's legacy. He and his family have been an inspiration for us and, by extension, our students. The spirit of promoting promising young researchers is something we all benefit from. His is a wonderful name and a legacy to be attached to.”

Other Rosenkranz Prize winners honor his legacy with remembrances:

“There are very few people who have changed the world as much as Dr. Rosenkranz; his work in synthesizing and bringing oral contraception to market changed how people form families, and empowered women around the world.” — Mike Baiocchi, a Stanford statistician and the 2017 winner.

“The Rosenkranz Prize helped our young lab take risks where we might not have been able to; risks that have paid off intellectually,” said Baiocchi, whose team is conducting the largest-ever randomized trial to measure the impact of No Means No Worldwide project, which is training 300,000 boys and girls in Kenya and Malawi to prevent rape and teen pregnancy.

“The prize money allowed us to bring two of our statistics PhD students to Kenya to visit the communities they have been working with, to present their work to the stakeholders. This has built a passion for in these students, who have each launched their own Kenya-based study to examine means for reducing gender-based violence.”

“Dr. Rosenkranz's professional and personal legacy are closely intertwined. By his example, I and many other Rosenkranz scholars have been enabled to marry what sometimes feel like dueling passions: social justice and rigorous scholarship. I feel so fortunate to have met Dr. Rosenkranz and hope that many others will continue to be inspired by his message of equity, global fellowship, and excellence.” — Ami Bhatt, the 2016 winner who is building the first multi-country microbiome research project focused on noncommunicable disease risk in Africa.

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“As a Mexican awardee of the Rosenkranz prize it is a privilege to be part of the legacy of one of the most prominent Mexican scientists, whose generous support was a vital seed to create my research laboratory on Human Genomics in Mexico.” — Andrés Moreno Estrada, the 2012 winner who is analyzing the DNA of indigenous groups in Latin American, one of the most underrepresented populations in the field of genetics.

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“The prize was a huge boost to my career as an early stage researcher. It allowed me to do work in India on antimicrobial resistance (AMR) at a time when the topic was not a high priority for global funding agencies. The project led to a series of a collaborations with a large public hospital in India. There were several publications as a result of this partnership, and the studies we performed were innovative and informative on the prevalence on AMR in community-dwelling individuals.” — Marcella Alsan, one of two 2015 prize winners.

Asia Health Policy Program Director Karen Eggleston and colleagues examine China’s progress in enhancing financial protection under its social health insurance to achieve universal health coverage.

In 2009, China launched comprehensive health system reforms to address challenges such as increasing rates of non-communicable diseases and population aging, problems with health financing and healthcare delivery, and overall growing health expectations of its people. Promoting universal health coverage by building a social health insurance system was a central pillar of the reforms.

After a decade of system reforms, has the Chinese government made good on its commitment to bolster universal health coverage? In a new article published in a BMJ collection, a team of four co-authors including Karen Eggleston, APARC’s deputy director and director of the Asia Health Policy Program, evaluates China’s progress towards enhancing financial protection of social health insurance and identifies the main gaps that need to be filled to achieve universal health coverage. Their article is part of a special BMJ collection with Peking University that marks the tenth anniversary of China’s health system reforms by analyzing their accomplishments and challenges ahead.

The 2009 reforms aimed to cover the entire Chinese population with one of three (since 2012 one of two) basic social health schemes. To provide added financial protection to patients with critical illnesses, catastrophic medical insurance was initially launched in 2012 and implemented nationally in 2015. Eggleston and her co-authors determine that the expansion of health insurance has had several major successes. First, it improved access to and use of healthcare. In 2011, China achieved near-universal health insurance coverage, with more than 95% of the Chinese population covered by health insurance. Moreover, the annual inpatient hospital admission rate increased from 3.6% in 2003 to 17.6% in 2017, and admission rates for outpatient services were much higher than the global average.

Second, the expansion of health insurance coverage reduced the share of out-of-pocket heath expenses in total health expenditure, thus raising the level of financial protection. Third, catastrophic medical insurance was also effective in supplementing the basic social health insurance schemes and provided extra financial protection to a range of vulnerable groups. By 2017, more than a billion people in China were covered by such insurance.

However, much remains to be done. Out-of-pocket health expenditures remain fairly high and are one of the main reasons for catastrophic health expenses and low financial protection in China, which disproportionately affect deprived populations. Catastrophic medical insurance currently does not target underprivileged people, while medical aid is relatively small in scale and covers only a minority of patients with catastrophic health expenses.

Eggleston and her colleagues conclude that the Chinese government should focus on underprivileged populations within the current insurance system and enhance their financial protection as an important element of targeted poverty alleviation. Such targeting, the researchers emphasize, requires a clear and integrated policy encompassing the basic social health insurance schemes, catastrophic medical insurance, medical aid, and improved healthcare efficiency.

Mariam Noorulhuda has seen health disparities up close in the developing world, particularly in Afghanistan, where she interned at a hospital in Kabul last summer.

“There was a shortage of trained health-care professionals, especially women, poor facility conditions, and insecurity,” she said. “Our hospital was minutes away from multiple bombings.”

Noorulhuda is a rising senior and one of six Stanford undergraduates chosen for the inaugural class of Stanford Health Policy Undergraduate Research Fellows. From a variety of disciplines, they will spend this summer partnered with SHP faculty to work on research projects. The students were chosen for their desire to blend health policy with their own undergraduate studies.

Noorulhuda’s Story

Mariam Noorulhuda

That is when she lost another brother, as health-care infrastructure was demolished after much of the capital was destroyed in bombings. When the Taliban targeted her father for his resistance efforts, they fled again and were granted asylum in the United States in 1997. Though raised in the Bay Area, many family members remain in Afghanistan.

“Much of my family has been affected by the brutal impact that war has on health — not entirely through bombs and bullets per say — but through indirect effects like displacement and virtually nonexistent health systems,” said Noorulhuda, a history major with a minor in human rights.

She will work with SHP’s Eran Bendavid, an infectious diseases physician and associate professor of medicine who focuses on the impact of health policies and outcomes in developing countries. He is the fellowship coordinator for this inaugural summer program.

Impact of Health Policy

"There is a growing recognition that health policy impacts just about every facet of human experience and well-being, and we see students picking up on that earlier and earlier,” said Bendavid. “The scholarship at SHP — from the effects of gun ownership or armed conflict to quality of care and guideline development — is an exceptional environment for gaining experience and a deep-dive into health policy research."

The fellowships were made possible with generous support from Stanford political scientist Scott Sagan, and his wife Sujitpan Bao Lamsam, vice chairman of Kasikornbank in Thailand. Sagan is a senior fellow at the Center for International Security and Cooperation who focuses on nuclear strategy, the ethics of war and the safety of hazardous technology.

“One of the great strengths of Stanford is the opportunity for undergraduates to get deeply involved in faculty research projects,” said Sagan, whose daughter Charlotte Sagan (BA, `15) was a research assistant in health policy while at Stanford. “We wanted to help create such opportunities for future students.”

Tiffany Liu

Tiffany Liu just finished her freshman year and has yet to declare her major, though she’s thinking symbolic systems, the study of human-computer interaction.

“Both fields incorporate so many diverging perspectives and methods in order to solve salient issues,” said Liu, who will work with Jason Wang, an associate professor of pediatrics who looks at the use of innovative technology to improve quality of care and health outcomes.

“I’m eager to engage in health policy research through a mix of technical and non-technical methods — we can process and analyze data in so many more interesting ways using computers, and yet we can’t ever lose the humanistic aspect of health initiatives,” Liu said.

Nikhil Shankar, also a rising senior, is an economics major. He jumped at the health policy fellowships because he believes applied economics can have “real-world impact.”

He will be working with SHP’s Grant Miller, a senior fellow at the Freeman Spogli Institute for International Studies and director of the Stanford King Center on Global Development. They will examine the impact of population policy on child health outcomes by gender in China.

Nikhil Shankar

Health-care inequality driven by factors beyond the control of individuals is something that troubles Andrea Banuet, a human biology major and another a rising senior.

“Factors such as socioeconomic status, age, ethnic and racial backgrounds should not determine the type of care an individual can attain — but the really sad reality is that in many parts of our country, it does.”

She believes that policy informed by research has the power to combat institutional biases and promote change in health-care accessibility. She will be working Kathryn M. McDonald, executive director of CHP/PCOR, an expert on health-care quality and patient safety.

Conrad Milhaupt is another rising senior with a double major in economics and public policy.

“I have a passion for the intersection of economics, politics and policy, with a particular focus on health and environmental policy,” said Milhaupt, who will work with SHP’s Jay Bhattacharya, a professor of medicine and economics.

Milhaupt took Bhattacharya’s health economics class in his sophomore year and became intrigued by the discrepancies in costs for health services with only marginal differences in outcomes. He is particularly interested in health care in rural America and ways that changes to our public-private insurance mix may improve access to care and help manage costs.

“Ultimately, I am driven to study this topic by my belief that health care is a human right and that health is an integral aspect of every individual’s life,” he said.

Conrad Milhaupt

Calvin Tolbert, with funding from the Office of the Vice Provost for Teaching and Learning, will work with Eric Sun, an economist and assistant professor of anesthesiology who researches consolidation in physician markets and the economics of pain treatments.

Tolbert is a rising junior majoring in economics and classics, with a minor in mathematics.

“The thing that initially drew me to economics was the fact that it was both math-intensive and pertinent to public policy, which is a keen interest of mine,” he said.

He will be working on a project that looks at physician compensation across countries and the wide gap in costs and access to medical care and drugs.

“This is an area that first caught my eye, when I read accounts of medical tourism in the news, including both people from developing countries who come to America for serious procedures and Americans who visit other countries to receive treatment due to the expense of medical care in this country.”

The United States has more people with new HIV diagnoses each year than any high-income nation. There is this widespread misconception out there that we’ve got it under control; that the drug cocktails are so effective that HIV is no longer a leading threat.

“Unfortunately, HIV remains a major public health problem in the U.S.,” said Stanford Health Policy’s Douglas K. Owens. He is chair of the U.S. Preventive Services Task Force, which issued two influential recommendations Tuesday for the prevention and treatment of HIV.

“Each year, almost 40,000 people acquire HIV, he said. “It’s not acceptable and requires our urgent attention.”

Owens, the Henry J. Kaiser, Jr., professor at Stanford Medicine, said an estimated 1.1 million people are currently living with HIV in this country — and more than 700,000 people have died of AIDS since the first cases were reported in 1981. Of the 38,281 new diagnoses of HIV reported in 2017, 81% were among men and 19% among women.

“There are highly effective preventive interventions that can help us toward the goal of ending the HIV epidemic in the U.S.,” said Owens, who is also an investigator at VA Palo Alto Health Care System “However, we know not enough people receive these interventions.”

The task force recommends clinicians screen everyone aged 15 to 65 and all pregnant women for HIV and offer pre-exposure prophylaxis (PrEP) — a pill that helps prevent HIV — to people at high risk of contracting the potentially fatal infection.

It released its recommendations with a series of articles and editorials in the Journal of the American Medical Association (JAMA), calling for dramatic action to end the AIDS epidemic in the United States once and for all. 

The task force is an independent, volunteer panel of national experts in prevention and evidence-based medicine who work to improve the health of all Americans by making recommendations. They typically give letter grades to its recommendations, and this time issued its highest grade, an A.

The draft recommendations were made last year and then put out for review and public comment. The recommendations made Tuesday are final.

The benefit of this endorsement could be substantial, according to one of the accompanying editorials in JAMA, because under the Affordable Care Act, Grade A and B recommendations made by the USPSTF should be covered by private insurance without patient cost-sharing.

“How this recommendation will be implemented is of critical importance because cost is a major barrier for people both to start and to stay on PrEP,” wrote Diane V. Havlir, MD, and Susan P. Buchbinder, MD, in their editorial. At present, they wrote, the average monthly retail cost for PrEP without insurance is nearly $2,000.

The task force members concluded “with high certainty” that while there are some small harms associated with PreP, the magnitude of benefit with oral tenofovir disoproxil fumarate-based therapy to reduce the risk of HIV infection in people at high risk is substantial.

“Clinicians can make a real difference toward reducing the burden of HIV in the United States, Owens said in the task force statement. “HIV screening and HIV prevention work to reduce new HIV infections and ultimately save lives.”

Fewer than half of all adults have ever been tested for HIV in the U.S. and many of those requiring more frequent testing are not receiving it. The task force emphasized that clinicians should make testing routine and ensure patients are given an environment that is free of judgment during discussions of sexual health.

Screening is the only way to know if a person has been infected with HIV because, after initial flu-like symptoms, HIV does not cause any signs of symptoms for several years. So the task force recommends HIV screening for everyone between of 15 and 65 and for pregnant women.

In addition to screening, people need to prevent getting HIV by using condoms during sex, the task force said, for those who inject drugs, using clean needles and syringes.

People at high risk for HIV have an additional strategy for prevention in taking PrEP, the task force said in its statement. “For people at high risk of getting HIV, the benefits of PrEP far outweigh the harms, which can include kidney problems and nausea.”

Read the full task force statement and accompanying articles and editorials in JAMA.  

A new study by Stanford economists shows that giving fathers flexibility to take time off work in the months after their children are born improves the postpartum health and mental well-being of mothers.

In the study, slated for release by the National Bureau of Economic Research on June 3, Petra Persson and Maya Rossin-Slater examined the effects of a reform in Sweden that introduced more flexibility into the parental leave system. The 2012 law removed a prior restriction preventing a child’s mother and father from taking paid leave at the same time. And it allowed fathers to use up to 30 days of paid leave on an intermittent basis within a year of their child’s birth while the mothers were still on leave.

The policy change resulted in some clear benefits toward the mother’s health, including reductions in childbirth-related complications and postpartum anxiety, according to their empirical analysis.

“A lot of the discussion around how to support mothers is about mothers being able to take leave, but we often don’t think about the other part of the equation — fathers,” says Rossin-Slater, an assistant professor of health research and policy.

“Our study underscores that the father’s presence in the household shortly after childbirth can have important consequences for the new mother's physical and mental health,” says Persson, an assistant professor of economics.

Rossin-Slater and Persson are both faculty fellows at the Stanford Institute for Economic Policy Research.

Among their main findings of effects following the reform: Mothers are 14 percent less likely to need a specialist or be admitted to a hospital for childbirth-related complications — such as mastitis or other infections — within the first six months of childbirth. And they are 11 percent less likely to get an antibiotic prescription within that first half-year of their baby’s life.

There is also an overall 26 percent drop in the likelihood of any anti-anxiety prescriptions during that six-month postpartum period — with reductions in prescriptions being most pronounced during the first three months after childbirth.

What’s more, the study found that the average new father used paid leave for only a few days following the reform — far less than the maximum 30 days allowed — indicating how strong of a difference a couple of days of extra support for the mother could make.

“The key here is that families are granted the flexibility to decide, on a day-to-day basis, exactly when to have the dad stay home,” said Persson. “If, for example, the mom gets early symptoms of mastitis while breastfeeding, the dad can take one or two days off from work so that the mom can rest, which may avoid complications from the infection or the need for antibiotics.”

These indirect benefits from giving fathers workplace flexibility are not trivial matters when you consider the health issues mothers often face after childbirth and after they get home from the hospital, says Rossin-Slater, who is also a faculty member of Stanford Health Policy.

Infections and childbirth complications lead to one out of 100 women getting readmitted to the hospital within 30 days in the United States, according to the study.

Meanwhile, postpartum depression occurs for about one out of nine women, and maternal mortality has also been a rising trend over the past 25 years in the U.S.

The study comes as a growing number of lawmakers in the United States vocalize support for paid family leave but have failed to pass federal legislation.

Washington, D.C., and six states have adopted various paid family leave laws, but the U.S. remains the only industrialized nation in the world that does not have a national mandate guaranteeing a certain amount of paid parental leave.

Some federal lawmakers are working on family leave measures and have proposed such legislation over the past few years — including The Family Act, The New Parents Act — but none of them have ever gained enough traction to proceed in Congress.

This new study can help broaden the policy discussions, the researchers say.

The larger context around paid family leave policies is often framed today as a way to help narrow the gender wage gap by giving women more workplace flexibility and fewer career setbacks.

This study, however, shines a light on maternal health costs and how a policy on paid family leave — that includes workplace flexibility for the father — offers more benefits than previously thought, Rossin-Slater says.

“It's important to think not only about giving families access to some leave, but also about letting them have agency over how they use it,” she says.

And when it comes to concerns that fathers might use paid parental leave to goof off instead of spending the time as intended, the researchers say their study should assuage those worries.

“It's not like fathers are going to end up using a whole month to just stay home and watch TV. We don't find any evidence of that,” Rossin-Slater says. “Instead they only use a limited number of days precisely when the timing for that seems most beneficial for the family.”

“For all these reasons,” Persson says, “giving households flexibility in how to use paternity leave makes a lot of sense.”

People today can generally expect to live longer and, in some parts of the world, healthier lives. The substantial increases in life expectancy underlying these global demographic shifts represent a human triumph over disease, hunger, and deprivation, but also pose difficult challenges across multiple sectors. Population aging will have dramatic effects on labor supply, patterns of work and retirement, family and social structures, healthcare services, savings, and, of course, pension systems and other social support programs used by older adults. Individuals, communities, and nations around the world must adapt quickly to the demographic reality facing us and design new approaches to financing the many needs that come with longer lives.

This imperative is the focus of a newly published special issue of The Journal of the Economics of Ageing, entitled Financing Longevity: The Economics of Pensions, Health and Long-term Care. The special issue collects articles originally written for and discussed at a conference that was dedicated to the same topic and held at Stanford in April 2017 to mark the tenth anniversary of APARC’s Asia Health Policy Program (AHPP). The conference convened top experts in health economics and policy to examine empirical and theoretical research on a range of problems pertinent to the economics of aging from the perspective of sustainable financing for long lives. The economics of the demographic transition is one of the research areas that Karen Eggleston, APARC’s deputy director and AHPP director, studies. She co-edited the special issue with Anita Mukherjee, a Stanford graduate now assistant professor in the Department of Risk and Insurance at the Wisconsin School of Business, University of Wisconsin-Madison.

The Financing Longevity conference was organized by The Next World Program, a Consortium composed of partners from Harvard University, Fudan University, Stanford University, and the World Demographic and Aging Forum, and was cosponsored by AHPP, the Stanford Institute for Economic Policy Research, and the Stanford Center on the Demography and Economics of Aging.

The contributions that originated from the conference and are collected in the Journal’s special issue cover comparative research on more than 30 European countries and 17 Latin American countries, as well as studies on Australia, the United States, India, China, and Japan. They analyze a variety of questions pertinent to financing longevity, including how pension structures may exacerbate existing social inequalities; how formal and informal insurance interact in securing long-term care needs; the ways in which the elderly cope with caregiving and cognitive decline; and what new approaches might help extend old-age financial security to those working outside the formal sector, which is a major concern in low-income countries.

Another challenge of utmost importance is the global pension crisis, caused due to committed payments that far exceed the saved resources. It is a problem that Eggleston and Mukherjee highlight in their introduction to the special issue. By 2050, they note, the pension gap facing the world’s eight largest pension systems is expected to reach nearly US $400 trillion. The problem cannot be ignored, as “the financial security of people leading longer lives is in serious jeopardy.” Indeed four of the eight research papers in the special issue shed light on pensions and inequality in income support for older adults. The other four research papers focus on health and its interaction with labor force participation, savings, and long-term care.

The issue also features two special contributions. The first is an interview with Olivia S. Mitchell, a professor at the University of Pennsylvania’s Wharton School and worldwide expert on pensions and ageing. Mitchell explains the areas offering the most promise and excitement in her field; discusses ways to encourage delayed retirement and spur more saving; and suggests several priority areas for future research. The latter include applying behavioral insights to questions about retirement planning, improving financial literacy, and advancing innovations to help people imagine themselves at older ages and save more for their future selves.

The second unique contribution is a perspective on the challenges of financing longevity in Japan, based on the keynote address delivered at the 2017 Stanford conference by Mr. Hirotaka Unami, then senior Director for policy planning and research of the Minister’s secretariat of the Japan Ministry of Finance and currently deputy director general with the Ministry’s Budget Bureau.

In Japan, decades of improving life expectancy and falling birth rates have produced a rapidly aging and now shrinking population. Data released by Japan’s Statistics Bureau ahead of Children's Day on May 5, 2019 reveal that Japan’s child population (those younger than 15) ranks lowest among countries with a total population exceeding 40 million. In his piece, Unami focuses on the difficult tradeoffs Japan faces in responding to the increase in oldest-old population (people aged 75 and over) and the overall population decline. Japan aspires to do so through policies that are designed to restore financial sustainability for the country’s social security system, including the medical care and long-term care insurance systems.

Unami argues that Japan must simultaneously pursue a combination of increased tax revenues, reduced benefit growth, and accelerated economic growth. He notes that these three-pronged efforts require action in five areas: review Japan’s pension policies; reduce the scope of insurance coverage in low-risk areas; increase the effectiveness of health service providers; increase a beneficiary’s burden according to their means; and enhance policies for preventive health care for the elderly.

The aging of our world’s population is a defining issue of our time and there is pressing need for research to inform policies intended to improve the financial well-being of present and future generations. The articles collected in the Financing Longevity special issue and the ongoing work by APARC’s Asia Health Policy Program point to multiple areas ripe for such future research.

View the complete special issue >>

Learn more about Dr. Karen Eggleston’s work in the area of innovation for healthy aging >>