The seminar will examine critically the current state of the art in global health crisis management with particular reference to HIV/AIDS, SARS, and Avian Influenza. Speakers include internationally recognized experts from various disciplines including public health and the social sciences.
Philippines Conference Room
Shorenstein APARC
Stanford University
Encina Hall, Room E301
Stanford, CA 94305-6055
Stella Quah, (PhD, University of Singapore; M.Sc [sociology], Florida State University) is professor of sociology at the National University of Singapore. She was a Fulbright Hays scholar from 1969 to 1971. Since 1986 she has spent academic sabbaticals as research associate and visiting scholar at the Institute of Governmental Studies, University of California Berkeley; the Center for International Studies at the Massachusetts Institute of Technology; the Department of Sociology at Harvard University; the Harvard-Yenching Institute, Harvard University; the Stanford Program in International Legal Studies, Stanford University; and the National Centre for Development Studies, Australian National University.
Professor Quah was elected vice president for research of the International Sociological Association (ISA); chairperson of the ISA Research Council for the session 1994-98; and served as associate editor of International Sociology (1998-2004).
Among her professional activities, Professor Quah serves on two institutional review boards; is member of the Society for Comparative Research; member of the International Advisory Board of the British Journal of Sociology; member of the Editorial Advisory Board of Health Sociology Review, the journal of the health section of the Australian Sociological Association; member of the editorial board of Marriage & Family Review; member of the International Advisory Board of Asian Population Studies; editor of the Sociology in Asia Series; and editor of the Health Systems Section, Encyclopedia of Public Health (Elsevier Inc).
Professor Quah's main areas of research are medical sociology, social policy, and family sociology. The complete list of her publications is at http://profile.nus.edu.sg/fass/socquahs.
473 Via Ortega, Y2E2, Room 255
Stanford, CA 94305-4020
Jennifer (“Jenna”) Davis is a Professor in the Department of Civil and Environmental Engineering and the Higgins-Magid Senior Fellow at the Woods Institute for the Environment, both of Stanford University. She also heads the Stanford Program on Water, Health & Development. Professor Davis’ research and teaching is focused at the interface of engineered water supply and sanitation systems and their users, particularly in developing countries. She has conducted field research in more than 20 countries, including most recently Zambia, Bangladesh, and Uganda.
Past research has identified social and environmental causes and correlates of behaviors thought to be associated with obesity and weight gain among children and adolescents. Much less research has documented the efficacy of interventions designed to manipulate those presumed causes and correlates. These latter efforts have been inhibited by the predominant biomedical and social science problem-oriented research paradigm, emphasizing reductionist approaches to understanding etiologic mechanisms of diseases and risk factors. The implications of this problem-oriented approach are responsible for leaving many of the most important applied research questions unanswered, and for slowing efforts to prevent obesity and improve individual and population health. An alternative, and complementary, solution-oriented research paradigm is proposed, emphasizing experimental research to identify the causes of improved health. This subtle conceptual shift has significant implications for phrasing research questions, generating hypotheses, designing research studies, and making research results more relevant to policy and practice. The solution-oriented research paradigm encourages research with more immediate relevance to human health and a shortened cycle of discovery from the laboratory to the patient and population. Finally, a "litmus test" for evaluating research studies is proposed, to maximize the efficiency of the research enterprise and contributions to the promotion of health and the prevention and treatment of disease. A research study should only be performed if (1) you know what you will conclude from each possible result (whether positive, negative, or null); and (2) the result may change how you would intervene to address a clinical, policy, or public health problem.
Drs. Bundorf and Bhattacharya received an RO1 grant (RO1-AG028236) from the National Institute on Health (NIH) to extend their work to look at the external costs of obesity through large public health insurance programs, including Medicare and Medicaid. Results from the seed have been presented at four national meetings. A paper entitled, “The Incidence of the Health Care Costs of Obesity,” was published in Journal of Health Economics.
Barbara Olshansky is Director Counsel of the Global Justice Initiative and Deputy Legal Director of the Center for Constitutional Rights. Barbara's current docket at the Center for Constitutional Rights includes class action lawsuits concerning international human rights; immigrants' rights; race discrimination in employment, education, the environment, and public health; and prisoners' rights. Barbara recently co-authored two books: the most recent, entitled America's Disappeared, discusses the plight of America's "war on terror" detainees; and the second, entitled Against War With Iraq, analyzes the international law ramifications of the U.S. decision to pursue a military campaign in Iraq.
Barbara has also written two other books: Democracy Detained, discussing America's secret practices used in the "war on terror," and Secret Trials and Executions, assessing the military commissions scheduled for Guantánamo detainees. Stanford Law School recently named her 2005 Public Interest Lawyer of the Year.
Stanford Law School, Room 190
The USSR's anti-plague system had four main responsibilities: monitor natural foci of endemic dread diseases such as plague, tularemia, anthrax, and Crimean-Congo hemorrhagic fever; protect the nation from imported exotic diseases (e.g., cholera and smallpox); protect the nation from biological warfare; and perform tasks for the Soviet offensive biological weapons program. Although the anti-plague system appears to have had successes in public health, its work undoubtedly was compromised by excessive secrecy, which led to anti-plague scientists having to overcome substantial barriers before being able to communicate with colleagues in other Soviet public health agencies, publish the results of their work, and undertake travel to non-socialist countries. This system disintegrated after December 1991, but was resurrected as elements of the newly independent states' health systems.
Reporting on the findings of a recently concluded project carried out by the Center for Nonproliferation Studies (CNS), I will discuss: (1) the threats that the anti-plague systems' human resources, pathogen culture collections, and equipment pose to international security; (2) the promises these systems hold, should they regain their former level of scientific/technical capability, for enhancing international public health; and (3) current activities by U.S. government agencies to lessen the security and safety threats of these systems and, simultaneously, increase their public health capabilities. As appropriate, I will illustrate the presentation with photos taken by CNS personnel in the course of having visited more than 40 anti-plague institutes and stations.
Dr. Raymond Zilinskas worked as a clinical microbiologist for 16 years, after graduating from California State University at Northridge with a BA in Biology, and from University of Stockholm with a Filosofie Kandidat in Organic Chemistry. He then commenced graduate studies at the University of Southern California. His dissertation addressed policy issues generated by recombinant DNA research, including the applicability of genetic engineering techniques for military and terrorist purposes. After earning a PhD, Dr. Zilinskas worked at the U.S. Office of Technology Assessment (1981-1982), United Nations Industrial Development Organization (1982-1986), and University of Maryland Biotechnology Institute (UMBI) (1987-1998). In addition, he was an Adjunct Associate Professor at the Department of International Health, School of Hygiene and Public Health, Johns Hopkins University, until 1999.
In 1993, Dr. Zilinskas was appointed William Foster Fellow at the U.S. Arms Control and Disarmament Agency (ACDA), where he worked on biological and toxin warfare issues. In 1994, ACDA seconded Dr. Zilinskas to the United Nations Special Commission (UNSCOM), where he worked as a biological analyst for seven months. He participated in two biological warfare-related inspections in Iraq (June and October 1994) encompassing 61 biological research and production facilities. He set up a database containing data about key dual-use biological equipment in Iraq and developed a protocol for UNSCOM's on-going monitoring and verification program in the biological field.
After the fellowship, Dr. Zilinskas returned to the UMBI and Johns Hopkins University. In addition, he continued to serve as a long-term consultant to ACDA (now part of the U.S. Department of State), for which he carried out studies on Cuban allegations of U.S. biological attacks against its people, animals, and plants and investigations carried out by the United Nations of chemical warfare in Southeast Asia and the Arabian Gulf region. Dr. Zilinskas also is a consultant to the U.S. Department of Defense.
In September 1998, Dr. Zilinskas was appointed Senior Scientist at the Center for Nonproliferation Studies (CNS), Monterey Institute of International Studies. On September 1, 2002, he was promoted to the Director of the Chemical and Biological Weapons Nonproliferation Program at the CNS. His research focuses on achieving effective biological arms control, assessing the proliferation potential of the former Soviet Union's biological warfare program, and meeting the threat of bioterrorism. Dr. Zilinskas' book Biological Warfare: Modern Offense and Defense, a definitive account on how modern biotechnology has qualitatively changed developments related to biological weapons and defense, was published in 1999. In 2005, the important reference work Encyclopedia of Bioterrorism Defense, which is co-edited by Richard Pilch and Dr. Zilinskas, was published by Wiley. He currently is writing a book on the former Soviet Union's biological warfare program, including its history, organization, accomplishments, and proliferation potential, which will be published in 2006.
Reuben W. Hills Conference Room, East 207, Encina Hall
Shorenstein APARC
Stanford University
Encina Hall, Room E301
Stanford, CA 94305-6055
Stella Quah, (PhD, University of Singapore; M.Sc [sociology], Florida State University) is professor of sociology at the National University of Singapore. She was a Fulbright Hays scholar from 1969 to 1971. Since 1986 she has spent academic sabbaticals as research associate and visiting scholar at the Institute of Governmental Studies, University of California Berkeley; the Center for International Studies at the Massachusetts Institute of Technology; the Department of Sociology at Harvard University; the Harvard-Yenching Institute, Harvard University; the Stanford Program in International Legal Studies, Stanford University; and the National Centre for Development Studies, Australian National University.
Professor Quah was elected vice president for research of the International Sociological Association (ISA); chairperson of the ISA Research Council for the session 1994-98; and served as associate editor of International Sociology (1998-2004).
Among her professional activities, Professor Quah serves on two institutional review boards; is member of the Society for Comparative Research; member of the International Advisory Board of the British Journal of Sociology; member of the Editorial Advisory Board of Health Sociology Review, the journal of the health section of the Australian Sociological Association; member of the editorial board of Marriage & Family Review; member of the International Advisory Board of Asian Population Studies; editor of the Sociology in Asia Series; and editor of the Health Systems Section, Encyclopedia of Public Health (Elsevier Inc).
Professor Quah's main areas of research are medical sociology, social policy, and family sociology. The complete list of her publications is at http://profile.nus.edu.sg/fass/socquahs.
Encina Commons Room 101,
615 Crothers Way,
Stanford, CA 94305-6006
As a health and development economist based at the Stanford School of Medicine, Dr. Miller's overarching focus is research and teaching aimed at developing more effective health improvement strategies for developing countries.
His agenda addresses three major interrelated themes: First, what are the major causes of population health improvement around the world and over time? His projects addressing this question are retrospective observational studies that focus both on historical health improvement and the determinants of population health in developing countries today. Second, what are the behavioral underpinnings of the major determinants of population health improvement? Policy relevance and generalizability require knowing not only which factors have contributed most to population health gains, but also why. Third, how can programs and policies use these behavioral insights to improve population health more effectively? The ultimate test of policy relevance is the ability to help formulate new strategies using these insights that are effective.
If rational individuals pay the full costs of their decisions about food intake and exercise, economists, policy makers, and public health officials should treat the obesity epidemic as a matter of indifference. In this paper, we show that, as long as insurance premiums are not risk rated for obesity, health insurance coverage systematically shields those covered from the full costs of physical inactivity and overeating. Since the obese consume significantly more medical resources than the non-obese, but pay the same health insurance premiums, they impose a negative externality on normal weight individuals in their insurance pool.
To estimate the size of this externality, we develop a model of weight loss and health insurance under two regimes——(1) underwriting on weight is allowed, and (2) underwriting on weight is not allowed. We show that under regime (1), there is no obesity externality. Under regime (2), where there is an obesity externality, all plan participants face inefficient incentives to undertake unpleasant dieting and exercise. These reduced incentives lead to inefficient increases in body weight, and reduced social welfare.
Using data on medical expenditures and body weight from the National Health and Interview Survey and the Medical Expenditure Panel Survey, we estimate that, in a health plan with a coinsurance rate of 17.5%, the obesity externality imposes a welfare cost of about $150 per capita. Our results also indicate that the welfare loss can be reduced by technological change that lowers the pecuniary and non-pecuniary costs of losing weight, and also by increasing the coinsurance rate.
