Medical researchers must work together across disciplines to provide better health care to those who need it most, according to panelists at Stanford Medicine’s Annual Population Health Sciences Colloquium.

The symposium, hosted by the Stanford Center for Population Health Sciences, brought together working groups from across the Stanford campus to showcase the latest findings in population health research.

“Population health science at Stanford is likely to make the most important contributions when we cross traditional intellectual expertise disciplines,” said Paul H. Wise, a core faculty member at the Center for Health Policy/Center for Primary Care and Outcomes Research (CHP/PCOR).

Many of the scholars at the daylong conference on Tuesday stressed that an interdisciplinary approach to health care is crucial to understanding and aiding underserved populations.

“To deal with life-course questions we need to create-life course observational windows,” said Mark Cullen, chief of the Division of General Medical Disciplines and director of the Stanford Center for Population Health Sciences.

Instead of trying to create an all-encompassing care plan for the human population as a whole, panelists demonstrated that studying the needs of particular groups, or smaller populations, can better serve individuals within populations that may not receive the best care.

Douglas K. Owens, director of CHP/PCOR, said the U.S.  Preventive Services Task Force, of which he is a member, has “often faced a real paucity of data trying to develop prediction guidelines for both the very young and the old.”

The Task Force, a panel of experts that makes recommendations for medical prevention services, is generally able to make guidelines for large populations like adults, but suggestions for specialized groups like children and the elderly are more challenging. Though Stanford researchers like Wise are working to improve care for particular sectors like children, more study is needed.

Several speakers at the conference said the underserved population of poor children could benefit from research targeted toward their population group.

“We don’t really understand the biology of the life-course, why things taking place in gestation and early life actually affect healthy aging and adult onset disease,” said Wise, adding, “We have a very poor understanding of how to translate this understanding into effective interventions for communities in need.”

Panelists agreed that big data can help them understand smaller, poorly served populations, such as young children in impoverished communities. By collecting large amounts of data from the general population, researchers will increase the amount of data available for more specific groups. This allows researchers to study these populations more closely and help create better outcomes.

Abby King, a professor of health research and policy and of medicine, and Jason Wang, director of the Center for Policy, Outcomes and Prevention (CPOP) and a CHP/PCOR core faculty member, believe life-course digital applications can provide individualized care while collecting data on a large-scale.

According to King, a life-course app, or a device to track health and provide care throughout one’s life, would grow with the user and help them through important developmental stages.

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Health-care techniques using mobile devices, known as mHealth, could be particularly useful in underserved populations. King notes that even low-income populations have cell phones, so using phones as health-care tools could help decrease the gap between higher- and lower-income populations.

“I think for us one of the major challenges of the century is to really close that health-disparities gap and mHealth can help.”

However, each app must be tailored to the user.

“There’s no reason to believe that an African-American 16-year-old is going to be motivated the same way as a 45-year-old white man,” said Wang. “You need to involve patients in the design of the app.” When the app fits the specific patient’s needs, they are more likely to use it regularly, and knowing the needs of their population helps determine their preferences.

As the world continues to become more connected, the panelists said that reaching across disciplines and incorporating technology may hold the key to effective health care in the 21^st century.

A podcast from the book event on Jan. 15 is available at the link above. An earlier interview with author Michael Armacost was first published in Oct. 2015 and is reposted below.

When it comes to elections, politics can supersede strategy. But what is often overlooked is the process through which the United States selects their commander in chief and its impact on policy – particularly, foreign policy.

What then shapes foreign policy during that time? “Events, my dear boy, events,” Harold Macmillan, a former British prime minister, famously replied when asked what could change a government's directions. To which Michael Armacost agrees and explores the interplay between campaign politics and foreign policy in his new book.

“Since World War II, the United States has consistently pursued a global role, but the tempo of its engagement with the world has been repeatedly adjusted to reflect circumstances and domestic moods,” Armacost wrote.

A veteran scholar, former ambassador and undersecretary of state for political affairs, Armacost is an expert on the U.S. government system and policy process. In the book, he examines ideology and the struggle for power in the six elections that have taken place since 1948, ending with Barack Obama’s re-election in 2012.

The book, which reads somewhat like a guide, largely began as a project for students, he said. 

Armacost initially came to Stanford in 1994, and in 2002, returned as a distinguished fellow at the Walter H. Shorenstein Asia-Pacific Research Center. He co-teaches a graduate course on U.S. policy in Northeast Asia.

“When I left government, I found a lot of literature on how foreign policy affects elections but little in the reverse,” Armacost said. “So my aim behind the research was to not only satisfy my own curiosity but to offer a comprehensive and accessible analysis for students.”

Armacost’s career in government began in 1983 when an advisor encouraged him to apply for a White House fellowship. His fellowship in the deputy secretary of state’s office – which was only set to be a single year in Washington – led to 24 years of public service.

He went on to serve as the U.S. ambassador to Japan from 1989 to 1993 and the Philippines from 1982 to 1984, and was a member of the National Security Council.

Armacost said he remains positive about the electoral system, while also suggesting a few reforms. The system ensures a cyclical chance to step back and assess where America stands in the world, he said.

“Our system provides regular opportunities to put the spotlight on troubling foreign policy problems,” he wrote. “And supplies an incentive to consider course corrections for costly, inconclusive foreign as well as domestic policies, or offers a chance to select new management to fix them.”

Shorenstein APARC asked him a few questions about his research in the context of the 2016 election cycle. His answers are posted below.

Will Obama attempt a “sprint to the finish line” on foreign policy?

He is well embarked on that sprint. In the fourth quarter of his presidency, he is eager to burnish his foreign policy legacy. President Obama’s agenda is clear. It includes the normalization of relations with Cuba, implementation of the Iran nuclear agreement, ratification of the Trans-Pacific Partnership free trade agreement, and promotion of further international cooperation on climate change. He will also seek to avoid losing ground in geopolitical competition with ISIS in Iraq and Syria, the Russians in the Ukraine and elsewhere, and China in the South China Sea.

A president’s power to effectively undertake controversial initiatives at home and abroad tends to ebb as his tenure runs out. Those requiring Congressional support are particularly problematic. And events will play a large role in determining the problems and opportunities that come his way before Jan. 20, 2017.

Does the Trans-Pacific Partnership (TPP) stand a chance of getting ratified?

It stands a chance, but it will not be easy. Fortunately, Trade Promotion Authority has been secured from the Congress. Hence, it will be limited to an up or down vote without amendments.

Opposition from labor unions and environmental groups assures that there will be very limited Democratic support for the TPP, and Hillary Clinton, Bernie Sanders and Martin O’Malley have publicly expressed their opposition. There has also been some erosion of support for free trade among the Republicans, whose leaders have mostly expressed misgivings about some of the TPP’s provisions.

I believe the TPP will advance U.S. economic and strategic interests, but whether its ratification will be achieved before or after the 2016 election is at this point uncertain.

How do the politics of the TPP differ from that of George H.W. Bush’s pursuit of the NAFTA agreement in 1992?

In 1992 President Bush didn’t hesitate to push hard for NAFTA throughout his campaign. And the Mexican and Canadian governments also regarded the U.S. election day as a convenient deadline for getting the agreement finished. The president’s GOP Party believed in free trade, and considered the push for an embryonic hemispheric market a worthy and historic objective. A NAFTA accord could be portrayed as extending a helping hand to a friendly neighbor. The Party’s business constituency was supportive; the bulwark of opposition to the deal were labor and environmental groups, which were unlikely to vote for Bush anyway.

Promoting NAFTA also offered the president a chance to put the Democratic candidate, Bill Clinton, who had made public remarks supporting such an agreement, on the spot. If he reversed his position and opposed the accord, he could be accused of “waffling;” if he didn’t, he would risk alienating his labor and environmental constituencies. Bush nearly got the deal finished, but side letters on labor and environmental issues remained to be completed after Clinton won the election.

This year, a Democratic president is confronting major opposition from his own party, and widespread support from Congressional Republicans is therefore indispensable to his chances of ratifying the agreement. A number of Republican leaders who are generally supportive of free trade, however, contend that President Obama was so eager to wrap up the deal on his own watch, that he missed a chance to drive a harder bargain. Others are reluctant to hand the president a foreign policy victory during a presidential campaign.

And as November 2016 nears, the Democratic candidate is likely to be reluctant to buck unions and environmental groups who not only provide much needed financial support, but supply the volunteers who perform crucial “get out the vote” duties on election day.

Where does foreign policy fit into the 2016 campaign? 

Foreign policy is likely to feature very prominently in the coming election, particularly if the economy continues its steady, if modest, rate of growth. The reason is simple. The United States faces serious challenges in the Middle East, the Ukraine, South Asia and the South China Sea. And many voters who favored retrenchment in 2008, now fear it is now perceived increasingly by friends and adversaries as weakness and/or retreat.

One should not, however, expect the presidential campaign to illumine the strategic choices we face abroad. Presidential contenders typically articulate a wide range of aspirational foreign policy goals. But they rarely outline priorities among these declared aims, let alone their potential costs and risks, or the trade-offs among them. To address these core elements of strategy might offend one or another potential voting bloc. Candidates, therefore, tend to focus upon the appeal of their foreign policy objectives at home, rather than their efficacy abroad.

A wide field of candidates has emerged early on. What foreign policy issues are not being addressed that should figure in the debates?

It’s a bit early to say. The first primaries are still three months away. Few debates have yet been held. The election is likely in any event to be in part a referendum on President Obama’s record. But Hillary Clinton, who served for four years as the Secretary of State, is differentiating her position from that of Obama’s on a number of foreign policy matters. And as I noted above, the focus in most campaigns is on laudable goals rather than the key elements of strategy, i.e. the operational tests of foreign policy for anyone who occupies the Oval Office.

What will happen to the U.S. “pivot back to Asia” strategy?

President Obama performed a useful service in underlining America’s growing stake in Asia. I would expect the candidates of both major parties to affirm their intent to devote more time, attention and resources to the Asia-Pacific region. The problems the current administration has experienced in Asia are a by-product of the policy’s implementation. Many Asian leaders wonder whether the policy has been forgotten or overtaken by events. Adjustments in our regional security policy have been essentially symbolic.

With China, we are still looking for a sustainable balance between constructive engagement and prudent hedging. The diplomatic opening to Myanmar was timely, but progress has been complicated by ethnic struggles in that country. American leaders visit Asia periodically, but the United States is still perceived as primarily preoccupied with problems in the Middle East. Conclusion of the TPP will lend credibility to the policy, but only if the agreement is ratified. So it will be up to the next president to put some meat on the bones of this strategic initiative.

How do election cycles in the United States and South Korea mesh, and what might the coming cycle mean for U.S.-Korean relations?

America has a four-year election cycle for the presidency. The Republic of Korea elects its presidents for a five-year term. We have experienced several occasions when our cycles appeared out of sync, i.e. when the United States elected more conservative candidates to the White House as the Koreans chose more liberal contenders for the Blue House. George W. Bush, a conservative, served during a period when the South Korean presidents – Kim Dae Jung and Roh Moo-Hyun – were both liberals or progressives. American and South Korean perspectives on policy toward North Korea diverged sharply. Nonetheless, they joined hands in launching the U.S.-Korea Free Trade Agreement, and formulated plans for a major redeployment of U.S. military forces away from the Seoul metropolis to bases further south. And President Obama, a liberal, fashioned a close relationship with Presidents Lee Myung-bak and Park Geun-hye, both conservatives.

Thus, shared national interests have a way of tempering the ideological predilections of our respective leaders, enabling them to collaborate when dangers loom or when opportunities beckon.

South Korea now trades twice as much with China as it does with the United States and Japan combined. So its economy is tied more closely to China now, though it still looks to Washington for protection. Seoul will not want to choose between its economic interests and its strategic concerns. The United States has no reason to force such a choice on its ally, but it is clear that Beijing hopes to use its economic leverage to influence the Republic of Korea’s strategic decisions, for example, its readiness to deploy a THAAD, high altitude ballistic missile defense system. This is the kind of issue that could feed back into our election-year politics.

Related links

WNYC Brian Lehrer Show (Audio): How Elections Derail Foreign Policy (Aug. 4, 2015)

Forty-eight national security and foreign policy leaders urged U.S. government and businesses to take action to fight climate change in a statement released by the Partnership for a Secure America. Thomas Fingar, a distinguished fellow in the Freeman Spogli Institute for International Studies, is a signatory. The statement can be accessed by clicking here.