Health and Medicine

FSI’s researchers assess health and medicine through the lenses of economics, nutrition and politics. They’re studying and influencing public health policies of local and national governments and the roles that corporations and nongovernmental organizations play in providing health care around the world. Scholars look at how governance affects citizens’ health, how children’s health care access affects the aging process and how to improve children’s health in Guatemala and rural China. They want to know what it will take for people to cook more safely and breathe more easily in developing countries.

FSI professors investigate how lifestyles affect health. What good does gardening do for older Americans? What are the benefits of eating organic food or growing genetically modified rice in China? They study cost-effectiveness by examining programs like those aimed at preventing the spread of tuberculosis in Russian prisons. Policies that impact obesity and undernutrition are examined; as are the public health implications of limiting salt in processed foods and the role of smoking among men who work in Chinese factories. FSI health research looks at sweeping domestic policies like the Affordable Care Act and the role of foreign aid in affecting the price of HIV drugs in Africa.

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China has recently reformed its health care system with the intent of providing universal coverage for basic health care to every Chinese citizen. Three separate health insurance plans have recently been launched to achieve this objective: the rural newly cooperative medical scheme, urban resident health insurance, and urban employee-based health insurance. Each plan differs substantially in terms of insurers, insured population, premiums, and benefits packages. Using data from the 2009 China Health and Nutrition Survey, Hai Fang will discuss a study that investigates whether and to what extend different health insurance plans have created disparities in health care utilization and expenditure.

Hai Fang is an assistant professor in the Department of Health Systems, Management, and Policy at the University of Colorado Denver, and a research associate in the Kennedy School of Government at Harvard University. He earned his doctorate in economics and master of public health from the State University of New York at Stony Brook in 2006. Before joining the University of Colorado Denver, he taught at the University of California, Davis, and the University of Miami. His research interests include health economics, labor economics, and public health.

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Hai Fang Associate Professor, Department of Health Systems, Management, and Policy Speaker University of Colorado Denver
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This seminar explores whether and to what extent the relative circumstances of men and women following marital dissolution affect sex selection behavior within marriages. China's new divorce law, which was enacted in 2001, reduced divorce costs, especially for women, by granting the right to divorce and claim damages in the case of domestic violence and extra-marital relationships and by securing women's property rights upon divorce. Ang Sun has modeled the legal change as a decrease in women's divorce costs in a household in which all the marital surplus accrues to the husband. Sun shows: (1) that the new divorce law predicts an increase in divorce rates after the birth of a daughter; (2) that the new law results in fewer sex-selective abortions for the second birth if the first birth produced a daughter; and (3) that the effect of the new law on the sex ratio should have diminishing returns to divorce cost reduction for women. All the predictions are supported by the empirical evidence. Most importantly, she finds that most of the decline occurred in historically high divorce-cost regions, which is consistent with the predictions of the model and helps rule out concomitant changes in household income and relative returns to male and female children.

Ang Sun received her PhD from Brown University’s Department of Economics. Sun’s research interests encompass development economics, labor and demographic economics, and health economics. She focuses on intra-household allocations, gender differences, and household formation. In particular, she studies how a combination of different forces in China—including traditional values, rapid growth, and the population structure—is affecting Chinese families.

Philippines Conference Room

Walter H. Shorenstein
Asia-Pacific Research Center
616 Serra St C335
Stanford University
Stanford, CA 94305-6055

(650) 724-5668 (650) 723-6530
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2011-12 Asia Health Policy Fellow
SunAng_Profile.jpg MA, PhD

Ang Sun joins the Walter H. Shorenstein Asia-Pacific Research Center (Shorenstein APARC) from Brown University’s department of economics where she recently received her PhD.

Sun’s research interests encompass development economics, labor and demographic economics, and health economics. She focuses on intra-household allocations, gender differences, and household formation. In particular, she studies how a combination of different forces in China—including traditional values, rapid growth, and the population structure—is affecting Chinese families. During her time at Shorenstein APARC, Sun will participate in an interdisciplinary study of the impact of the aging process in Asia on economic growth.

Sun holds a PhD and an MA in economics from Brown University, and an MA from the China Center of Economic Research. She also received a BA in economics and a BS in information and computer science from Beijing University.

Ang Sun 2011-12 Asia Health Policy Fellow Speaker Stanford University
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Recent events in the U.S. have raised concerns about the safety and security of research with hazardous microbial agents, particularly with regard to the insider threat. The anthrax letters of 2001 and several technical surprises in legitimate infectious disease research, led to a series of high-level committee recommendations on safety and security of the ongoing work. When a scientist from a U.S. military high-containment laboratory was implicated in the anthrax letters case, the president and congress called for more regulation. Subsequently, a series of steps to reduce the risk have been proposed: from armed guards, pathogen accountability and medical and psychological exams for scientists to training, ethical frameworks, codes of conduct and standards of quality research. Franz will discuss the implications of these events on both security and productive research in support of public health and the life-sciences enterprise, and the important role of leadership and culture in enhancing both safety and security.


About the speaker: Dave Franz is a Vice President and Chief Biological Scientist at MRIGlobal. He served in the U.S. Army Medical Research and Materiel Command for 23 of 27 years on active duty and retired as Colonel. He served as Commander of the U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID) and as Deputy Commander of the Medical Research and Materiel Command. Prior to joining the Command, he served as Group Veterinarian for the 10th Special Forces Group (Airborne). Dr. Franz was Technical Editor for the Textbook of Military Medicine on Medical Aspects of Chemical and Biological Warfare released in 1997. He serves on numerous national committees and boards. Dr. Franz holds an adjunct appointment as Professor for the Department of Diagnostic Medicine and Pathobiology at the College of Veterinary Medicine, Kansas State University. The current focus of his activities relates to the role of international engagement in the life sciences as a component of national security policy.

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Dave Franz Vice President and Chief Biological Scientist Speaker MRIGlobal
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Abstract:

There is a wide diversity in the provision of public services in India. In some states one can go for miles without seeing a functional school or public health centre, where roads are poorly maintained, and electricity has not yet been introduced. In other places, governments tend to function remarkably in extending basic public services to all, with tremendous consequences to human lives. In this talk, Vivek Srinivasen will explore why some parts of India have developed an impressive social commitment to such services unlike others. In this context, he will also discuss the remarkable changes in Bihar and other parts of North India in the recent years.

 Speaker Bio: 

Vivek Srinivasen joined the Liberation Technology Program as the manager in February 2011 after completing his Ph.D. in Social Sciences from the Maxwell School of Syracuse University. Prior to this, Srinivasen worked with campaigns on various socio-economic rights in India, including the right to food, education and the right to information. Based on these experiences he has written (and co-authored) extensively on issues surrounding the right to food, including Notes from the right to food campaign: people's movement for the right to food (2003), Rights based approach and human development: An introduction (2008), Gender and the right to food: A critical re-examination (2006), Food Policy and Social Movements: Reflections on the Right to Food Campaign in India (2007).

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Vivek Srinivasen Program Manager Speaker Program on Liberation Technology, Stanford University
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The November 17 Liberation Technology Seminar was co-hosted by the Stanford Institute for Economic Policy Research (SIEPR), a nonpartisan economic policy research organization that unites remarkable economic talent from all parts of Stanford University. This seminar featured four student-led design projects that were created in the Designing Liberation Technologies course taught each spring at Stanford's Hasso Plattner Institute of Design (d.school) by professors' Josh Cohen and Terry Winograd. The class works in partnership with the University of Nairobi's School of Computing and Informatics to develop user-based designs that address outstanding challenges in the slums of Nairobi, Kenya. 

Josh Cohen described the three main elements of the design school class:

(1) There is a focus on user/human-centered design. Projects are designed based on a close engagement with end users: the people who will be using the solutions. (2) Courses are inter-disciplinary. The idea is to take people who are deeply embedded in a certain discipline and put them together with people from other disciplines. In order to come up with a solution to a real problem, team collaboration is necessary and (3) The approach to problem solving is about practice, not about theory. It is necessary to fail early and fail often in the process of creating workable solutions.

The panelists consisted of students who were working with partners in Kenya on how mobile technology could be used to address various social issues. A multidisciplinary team of students work in close collaboration with partners in Kenya, and some of these ideas are now being tested on the ground.

The first project that was described was M-maji (mmaji.wordpress.com). Sangick Jeon described how water in Kibera is scarce, costly and contaminated. Their aim is to use the nearly ubiquitous mobile technology to improve access to water. Vendors are able to advertise their water and then buyers can ask questions and provide feedback. This saves the time and resources that it takes to find clean water.

Nishuari, the second project, addresses the problem of inaccurate advice and rumors which lead to risky sexual behavior and often HIV and AIDS. They provide a mobile counseling service whereby individuals can submit health questions and receive responses from trained counselors using text messages. This helps to break down logistical and social barriers.

The third, Makmende considered the issue of serious crime in Kibera. Their aim is to look at how individuals can get safely from Point A to Point B. They set up walking groups so that people would not have to walk alone. Over 90% of people had a mobile phone and this was seen to be an effective way of building timely communication, so that groups of people can coordinate to walk more safely to reach their destinations.

The final project was Take Taka, which was the one project that was not focused on using computer technology. The team took up sanitation as the project and decided early on that the use of mobile phones adds no value to the issue. The focused instead of designing a special sanitary bucket that could be used instead of a toilet inside the home, and on developing a system of transmitting the deposits to a biogas unit. This project however has not been carried forward.

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Infectious diseases, especially those transmitted from person to person through the respiratory route, continue to pose a threat to the global community. Public health surveillance systems and the International Health Regulations are intended to facilitate the recognition of and rapid response to infectious diseases that pose the risk of developing into a pandemic, but the response to the 2009 H1N1 influenza pandemic illustrates the continuing challenges to implementing appropriate prevention and control measures. The response to the 2009 H1N1 influenza pandemic will be discussed and its implications examined.


Speaker biography:

Arthur Reingold, MD is Professor and Head of the Division of Epidemiology and Associate Dean for Research in the School of Public Health (SPH) at the University of California, Berkeley (UCB). He holds concurrent appointments in Medicine and in Epidemiology and Biostatistics at the University of California, San Francisco (UCSF). He completed his BA and MD degrees at the University of Chicago and then completed a residency in internal medicine at Mt. Auburn Hospital in Cambridge, Massachusetts. He is board certified in internal medicine and holds a current medical license in California, but has devoted the last 25 years to the study and prevention of infectious diseases in the U.S and in developing countries throughout the world.

He began his career as an infectious disease epidemiologist at the U.S. Centers for Disease Control and Prevention (CDC), working there for eight years. While at CDC, he worked domestically on Toxic Shock Syndrome, Legionnaires’ disease, bacterial meningitis, fungal infections, and non-tuberculous mycobacterial infections and internationally on epidemic meningitis in West Africa and Nepal.

Since joining the faculty at UCB in 1987, he has worked on a variety of emerging and re-emerging infections in the U.S.; on acute rheumatic fever in New Zealand; and on AIDS, tuberculosis, malaria, and acute respiraatory infections in Brazil, Uganda, Ivory Coast, Zimbabwe, India and Indonesia. He has directed the National Institutes of Health (NIH) Fogarty AIDS International Training and Research Program at UCB/UCSF since its inception in 1988; co-directed (with Dr. Duc Vugia of the California Department of Health Services), the CDC-funded California Emerging Infections Program since its inception in 1994; and served as the Principal Investigator of the UCB Center for Infectious Disease Preparedness (CIDP) since its inception in 2002.

He also has ongoing research projects concerning malaria in Uganda; HIV/AIDS and related conditions in Brazil; and tuberculosis in India.  He regularly teaches courses on epidemiologic methods, outbreak investigation, and the application of epidemiologic methods in developing countries, among others. He also teaches annual short courses on similar topics in Hong Kong, Brazil, Switzerland, and other countries.

He has been elected to membership in the American Epidemiological Society; fellowship in the American Association for the Advancement of Science and the Infectious Diseases Society of America; and membership in the Institute of Medicine of the National Academy of Sciences. In Hong Kong, He has a close working relationship with Chinese University, particularly with its School of Public Health and its Centre for Emerging Infectious Diseases. Dr. Reingold gives short courses at the School of Public Health each year and he serves on the Advisory Board of the Centre for Emerging Infectious diseases.

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Arthur Reingold Professor of Epidemiology and Associate Dean of Research Speaker UC Berkeley School of Public Health
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Two Stanford graduates with close ties to FSI’s centers have been named 2012 Rhodes Scholars. A third was selected as a Mitchell Scholar.

Anand Habib was a graduate of the 2011 CISAC honors program in international security studies and a 2010 Dachs undergraduate intern. Habib and Katherine Niehaus – who is now a research assistant for a CHP/PCOR project evaluating whether HIV medication increases the risk of cardiovascular disease – will study at the University of Oxford in England under the Rhodes program. 

Philippe de Koning, who will study in Ireland as a Mitchell fellow, wrote a manuscript about Japan’s defense and financial crisis with Shorenstein APARC faculty member Phillip Lipscy. Lipscy, a political scientist, was de Koning’s advisor through his undergraduate career and also advised him on his senior thesis. De Koning was also a 2010 CISAC honors student.

More about the scholars:

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Anand R. Habib, 22, of Houston, Texas, is a 2011 graduate of Stanford, where he earned a bachelor's degree in biology, with honors in international security studies. He plans to pursue a master's degree in public policy and in medical anthropology at Oxford.

Habib is working on community health programs at St. Joseph's Clinic in Thomassique, Haiti, under a one-year global health fellowship awarded by Medical Missionaries. The nonprofit organization is a volunteer group of more than 200 doctors, nurses, dentists, and others who work to improve the health of the poor in the United States and throughout the world.

In 2011, he won a Deans' Award for Academic Accomplishment, which honors extraordinary undergraduate students for "exceptional, tangible" intellectual achievements. One of the professors who nominated him for the award described him as a "superb critical thinker" whose work is characterized by "creative genius" and "mature insights," adding that he "exemplifies exactly the kind of deeply informed, pragmatic and caring leadership that the world needs and Stanford enables."

As a Stanford student, Habib worked on behalf of politically and medically disenfranchised people in India, Mexico and Guatemala. His field research internship in Guatemala’s indigenous region during summer 2010 was carried out under the supervision of Paul Wise, professor of pediatrics and FSI senior fellow, as part of FSI’s Dachs mentored undergraduate research program.  On campus, he turned the Stanford tradition of the annual Dance Marathon into a vehicle dedicated to addressing the HIV/AIDS pandemic by engaging not only Stanford students but also local communities and corporations, raising more than $100,000. His exceptional work was recognized by his participation in the Clinton Global Initiative University Conference in April, 2011.

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Katherine "Kate" Niehaus, 23, of Columbia, S.C., earned a bachelor's degree in biomechanical engineering in 2010 and a master's degree in bioengineering in 2011 – both at  Stanford. Her class and research work focused on biomechanics and her interests lie in its applications to high technology entrepreneurship.

She plans to pursue a doctorate of philosophy in systems approaches to biomedical science at Oxford.

At Stanford, Niehaus captained Stanford's varsity track and cross country teams, won the Pac-10 5,000 meters, and won Academic-All American status. She also served as a mentor and tutor for students in low-income families.

Working with faculty in the Center for Health Policy, Kate led a project to evaluate how well newer HIV antiretroviral drugs work compared with older drugs.  Her work was among the first to evaluate comprehensively all of the trials of new drugs in treatment of experienced patients, and showed that these drugs have substantial benefits.

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Philippe de Koning, 22, of Paris, France, earned a bachelor's degree in international relations at Stanford in 2010. He plans to pursue a master's degree in international security and conflict resolution at Dublin City University.

He is a Herbert Scoville Jr. Peace Fellow at the Nuclear Threat Initiative in Washington, D.C. The nongovernmental organization works to prevent nuclear, chemical, and biological threats from materializing. De Koning is researching nuclear materials security and the U.S.-China dialogue on nuclear issues.

De Koning, who earlier was awarded a Fulbright Scholarship, spent the 2010-2011 academic year at Hiroshima University in Japan. He examined various components of Japanese security policy, with emphasis on current evolution of Japanese Self-Defense Forces, policies on nuclear issues and approaches toward peacekeeping.

In 2009, he was a member of the Stanford delegation to the United Nations Climate Change Conference in Copenhagen.

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This colloquium will discuss the state of evidence, challenges, and research agenda regarding the growth of private hospitals and public-private hospital partnerships in developing Asia.

Dominic Montagu is an assistant professor of epidemiology and biostatistics and lead of the Health Systems Initiative at the Global Health Group of the University of California, San Francisco (UCSF). His work is focused on private delivery of health services in developing countries and on market function for health services and health commodities. He has active field research projects ongoing in Nigeria and Myanmar. Montagu holds masters degrees in business administration and public health, as well as a doctorate in public health, from the University of California, Berkeley (UC Berkeley). He has worked extensively in Africa and Asia, and teaches on the private sector in developing countries, and on the regulation of private hospitals and public-private-partnerships at UCSF, UC Berkeley, and on behalf of the World Bank Institute.

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Dominic Montagu Speaker University of California, San Francisco
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As markets around the world slump, sputter and slump again, China maintains the fastest-growing economy. But despite the country’s boom, it has fallen behind in making sure its children will be healthy, strong and smart enough to cash in on it.

About 30 percent of children living in China’s rural areas are anemic – sick with an iron deficiency that Stanford researcher Scott Rozelle and his colleagues with the Rural Education Action Project have proven leads to bad school performance. And a poor education coupled with anemia’s physical blow puts those kids at risk for lives of poverty and missed opportunities.

But things are changing. Influenced in part by the research Rozelle has conducted and presented to Chinese officials, the government recently launched a policy to improve school lunches for about 20 million children across the country.

The plan invests $2.5 billion a year during the next nine years to ensure the meals are more nutritious for elementary and middle school students. That doubles the amount spent on lunches for China’s neediest children.

“For 5,000 years it was OK to be anemic if you're never going to leave the farm," said Rozelle, an economist and senior fellow at Stanford’s Freeman Spogli Institute for International Studies who is still experimenting with ways to improve children's health in rural China and get the government to adopt the most effective methods.

"But we're looking 20 years into the future where there are much fewer farms and you need at least a high school education to make a living in the city,” Rozelle said. “If you are sick with anemia, it is going to affect your cognitive ability, educational performance and ultimately your chances of going on in school."

Rozelle began studying anemia and its links to school performance in 2008.

After conducting an initial study of about 4,000 primary school students in Shaanxi province, he found that nearly 40 percent of the children were anemic – the result of diets that consisted mostly of rice and noodles in regions where meat, fruit and fresh vegetables are expensive and often hard to come by.

Those survey results were presented to the government in a 2009 policy brief written by Rozelle and his collaborators. Officials adopted the brief, making rural primary school nutrition part of China’s official policy discussion.

A second study conducted between 2008 and 2009 found that anemia rates dropped when schoolchildren were given vitamins fortified with iron. And as their iron levels rose, so did their test scores.

An experiment followed to back up those findings, while another set of large-scale surveys across four provinces reinforced that childhood anemia was indeed a widespread problem.

The findings from those surveys and tests were packaged in another policy brief that was accepted by the government earlier this year, prompting a government directive urging more concrete action in the area of student nutrition.

Those documents, along with several presentations Rozelle has made to government officials and commissions, have culminated in a move to pour $22.5 billion into more nutritious school lunches between now and 2020. It will likely be up to local government and school officials to decide exactly what those meals will include, but Rozelle is hopeful they’ll lead to diets with more meat, vegetables and iron supplements.

“Research-based results are an important avenue for affecting policy in China,” said Chen Zhili, vice chair of the Standing Committee of the National People’s Congress and a former minister of education. “The new programs for child nutrition were only made possible by the work of groups (like the Rural Education Action Project).”

And a national policy aimed at improving nutrition and curbing anemia helps ensure that China maintains its foothold in the world’s economy and grow in a more stable, equitable way, Rozelle said.

“The social return is huge,” Rozelle said. “These kids will be able to do better in school, work harder and sustain China’s growth.”

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Congratulations to Anand Habib, selected this weekend for a Rhodes Scholarship. Habib, 22, of Houston, Texas, is a 2011 graduate of Stanford, where he earned a bachelor's degree in biology, with honors in international security studies. He plans to pursue a master's degree in public policy and in medical anthropology at Oxford.

Habib is currently working on community health programs at St. Joseph's Clinic in Thomassique, Haiti, under a one-year global health fellowship awarded by Medical Missionaries. The nonprofit organization is a volunteer group of more than 200 doctors, nurses, dentists, and others who work to improve the health of the poorest of the poor in the United States and throughout the world.

In 2011, he won a Deans' Award for Academic Accomplishment which honors extraordinary undergraduate students for "exceptional, tangible" intellectual achievements. One of the professors who nominated him for the award described him as a "superb critical thinker" whose work is characterized by "creative genius" and "mature insights," adding that he "exemplifies exactly the kind of deeply informed, pragmatic and caring leadership that the world needs and Stanford enables."

As a Stanford student, Habib worked on behalf of politically and medically disenfranchised people in India, Mexico and Guatemala. On campus, he turned the Stanford tradition of the annual Dance Marathon into a vehicle dedicated to addressing the HIV/AIDS pandemic by engaging not only Stanford students but also local communities and corporations, raising more than $100,000. His exceptional work was recognized by his participation in the Clinton Global Initiative University Conference in April, 2011.

From Haiti, Habib discussed his current position, his plans in Oxford, and how his CISAC thesis relates to his work. 

What are you currently working on? 

I am currently working on a global health fellowship with an NGO that operates a clinic in Haiti's Central Plateau. As part of the fellowship I am helping to manage a number of community and public health projects including fortified salt (to counter iodine deficiency and filariasis), a point-of-use potable water system, a malnutrition intervention program, and a small system of community health committees and community health workers. For the past two months, I've taken on a number of administrative functions along with my co-fellow, who is also a recent college graduate. I started the fellowship shortly after graduation at the end of June 2011 and I am slated to be in Haiti until the end of June 2012.

What will you do at Oxford?

I proposed two one-year Masters programs: a masters in public policy from Oxford's new Blavatnik School of Government, and an M.Sc. in medical anthropology. As of now, I'm thinking of sticking with my proposed programs -- probably pursuing the medical anthropology degree first as it is a bit more theoretical. I think it would be better to have the more "academic" experience first before gaining the practical tools that an MPP will hopefully afford me. After a short send-off in Washington, D.C., at the end of September 2012, I will fly with the other American Rhodes Scholars-elect to Oxford the first week of October with term beginning shortly thereafter.

How does your work in the CISAC Honors program relate to what you are currently doing, your plans for Oxford, or what you'll be doing afterward? 

My honors thesis has allowed me to contextualize my experiences in Haiti in some fairly amazing ways. Two very persistent issues in Haiti are that of poor governance -- e.g. lack of strong regulatory structures, lack of government effectiveness, etc. -- and ineffective aid modalities, or the ways in which aid is delivered. My thesis was situated exactly at this nexus: how to deliver aid more effectively in order to improve governance. Ninety-nine percent of relief aid after the 2010 earthquake in Haiti was funneled to non-state organizations and only 12 percent of recovery aid went toward supporting government activities. In Haiti, I've witnessed how detrimental a patchwork system of NGO activity can be with little coordination between NGOs and little harmonization of NGO activities with government objectives. It becomes very frustrating at times, because, if my thesis is any indication, things need not be this way if both NGOs and states were engaged in collaborative partnerships -- along the lines of what Dr. Paul Farmer, deputy U.N. special envoy to Haiti, calls "accompaniment."

My initial interest in the topic of global health financing was spurred by work out of Oxford's Global Economic Governance Project. The director of the project, Dr. Ngaire Woods, was actually named the Dean of the Blavatnik School of Government through which the MPP is offered. I'd love to continue exploring the issues broached in my thesis at Oxford -- especially issues of aid effectiveness and sustainable systems of delivering development aid for health. In the future, I hope to become a physician-policymaker, helping to not only deliver care to individuals in difficult conditions around the world, but also in fostering more robust global health governance.

- Interview by Michael Freedman

 

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